These are mad times we live in. I volunteered for secondment to NHS Nightingale at the ExCel centre but still no news of a start date. It was pleasing to learn that the number of patient admissions has been lower than expected which may mean my services as a dietitian in that sense are currently not required. I thought in that case, I would start offering my new found knowledge via a different channel so here I am!
Many of us are now working from home, myself included and this can present some challenges in a nutritional sense. It has never been more important to have a daily routine with our activities and meals; it is all too tempting to frequently walk over to the fridge, particularly when feeling down or bored. Keeping our minds healthy is key and I have posted some fantastic links and apps to help achieve this down below. This could be a great time to establish healthy habits to continue after lockdown.
I have been keeping busy by offering telephone consultations to my patients and by watching hundreds of webinars on nutrition and COVID 19. I have been impressed by how organisations have stepped up, offering these webinars freely and opening up their libraries of information for healthcare professionals to use. This is particularly important as many NHS staff are being asked to work outside their usual area of practice. This creates a fair amount of worry during an already worrying time so any support we can get is much appreciated.
I have been reflecting on what I have learnt from these webinars over the past 5 weeks and would like to summarise the main points in this article. Some of these issues are present in the community both pre and post admission to hospital and others are very much specific to intensive care. I will focus on nutrition in the community as this is relevant to all of us, whether or not we have been unfortunate to contract COVID 19 or simply just want to keep well-nourished and healthy during this time. This information may be useful to an older relative or friend that you know so please have those conversations and promote awareness. Remember, food is medicine!
Firstly, we are all very aware of the issues around food provision and stockpiling. This was particularly rife during the first few weeks but seems everyone is starting to calm down a bit now. We have to bear in mind that people may already be malnourished prior to becoming ill due to a range of issues which may include pre-existing conditions but also the inability to purchase food, prepare food and eat said food. Things some of us may take for granted. Poor appetite, dental problems and difficulty swallowing are a few examples of some of the daily challenges some individuals, particularly in later life, have to battle with.
GETTING THE RIGHT BALANCE
It is important we receive a diet adequate in energy, protein, vitamins and minerals (micronutrients). The amount of energy (or calories) needed can vary greatly depending on the current circumstances and the particular individual. 20 calories for each kilogram of bodyweight is seen as a starting point for healthy individuals, not accounting for additional needs due to physical activity or for weight gain. Elderly individuals (usually above 65 years old) could require on average 30 calories per kilogram or even more particularly if they have been unwell, have chronic conditions and are at risk of malnutrition. I appreciate this information may be confusing and difficult to translate into day-to-day living so it is best to seek the support of a registered dietitian. There will also be some practical food tips in the links posted below.
Protein has been found to be pivotal in the recovery from many illnesses and infections and the same stands in COVID19. Adults should aim for at least 1 – 1.5g protein per kg but this can be up to 2g protein per kg in older adults with severe illness or marked malnutrition. Be mindful that even overweight individuals can suffer with muscle loss and actually be malnourished due to poor diet quality or inability to utilise nutrients due to illness. Recovery from illness can be slow so we must ensure to consistently eat well for a long period afterwards.
3) Quality of diet
A high quality diet is important which includes eating nourishing foods and not relying too much on foods mostly high in fat and sugar. Plenty of fruit and vegetables (at least 5 portions per day) should be included on a daily basis. Foods such as cheese, nuts, greek yoghurt, soya yoghurt, skimmed milk powder, nut butters and protein powders provide energy, protein as well as important vitamins and minerals. Sweets, cakes and sugary drinks can be handy when we are really struggling to eat anything at all. Sometimes little and often of what you fancy can be a good way to go. However, long-term, our focus should be on including nourishing foods such as those listed above. See the BDA information on malnutrition below.
I am sure you all know the importance of drinking plenty of fluid. Good hydration is vital for our bodies to function effectively. Dehydration can cause poor concentration, headaches, tiredness and dizziness. If you have a fever, you need even more fluid! Keep water with you and sip regularly, simple as that.
SUPPLEMENTS – YAY OR NAY?
There is a lot of conflicting information on nutritional supplements floating about at the moment, particularly on social media. Unfortunately there is no magic supplement or remedy which can prevent or cure someone from COVID 19. However we know that a healthy diet and optimising your nutrition contributes to a healthy immune system. There is evidence for taking a daily vitamin D supplement of 10 micrograms per day, particularly in older individuals or those at risk of deficiency e.g. limited sun exposure. This could be included as part of a daily multivitamin and mineral.
HMB is a substance that has been mentioned in a few webinars, HMB stands β-Hydroxy β-Methylbutyrate (had to Google that one). It is linked with maintaining muscle mass, something people can struggle with following illness, and it does this without an increase to fat mass. This is handy for those who may be overweight but still at risk of muscle loss, weakness and poor recovery. The evidence is however inconclusive and does not consistently show to improve functional measures such as muscle strength. It cannot be broadly recommended on this basis but is certainly worth noting, particularly if paired with an exercise intervention.
KEEP MOVING AND KEEP STRONG
Loss of muscle mass is linked with poor mobility, risk of falls, frailty and overall reduction in quality of life. We should all keep active, aiming to do at least 30 minutes of moderate physical activity per day e.g. a brisk walk. As long as you can feel your heart working that little bit harder then it counts! Aim to avoid long periods of sitting down and instead stand up regularly as well as undertaking resistance exercise at least 2 times per week. There is information below on simple chair-based and resistance type exercise to go alongside the diet advice.
HOW HAVE DIFFERENT COMMUNITIES BEEN AFFECTED?
Unfortunately it seems a disproportionate amount of individuals from Black and Minority Ethnic (BAME) backgrounds have been hit by COVID 19 and have suffered complications as a result such as ICU admission and mechanical ventilation. The exact reasons for this are unclear but could be due to social reasons, higher levels of deprivation among some of these communities or due to the higher prevalence of medical conditions which makes them more vulnerable.
GOOD WISHES DURING RAMADAN
For all those observing Ramadan at this time, I do hope that this current crisis does not hinder your ability to engage in spiritual reflection and prayer. Please keep an eye out for those remote Iftar events and look out for each other. This could be a particularly worrying time for health professionals who are fasting while working long shifts in uncomfortable environments. Make sure you seek the support you require from your employer.
Please see below information to support this article. Do not hesitate to drop me a note via my website nkcnutrition.co.uk. I offer personal consultations over video call or telephone to help you create healthier habits, which can include the advice summarised above if relevant.
All the best,
Private and Freelance Registered Dietitian – NKCNutrition.co.uk