A significant number of people experience symptoms for many months after COVID-19 infection. These symptoms can be disabling and often include chronic fatigue and shortness of breath. Long covid clinics established in our public hospitals have been overwhelmed by demand. There has been a lot written about the need for long covid treatment and it’s good to see the establishment of multidisciplinary teams and criteria for diagnosing and monitoring the condition. However, treatment options are quite limited – psychotherapy and exercise therapy, both of which are important lifestyle domains – but we would like to offer an additional powerful therapy, whole foods, plant-based nutrition. A caveat for those planning to take this approach is the possibility that other medical conditions cause or contribute to symptoms so a medical assessment and pathology testing is essential.

Possible mechanisms of long covid include damage to small blood vessels, persistent inflammation and dysregulation of immune cells. Nutrition regulates all of these. Whole plant foods promote endothelial health, and most are low in the artery-damaging components of animal products and processed foods, saturated fats, trans fats, TMAO etc. Many plants have anti-angiogenic qualities, inhibiting the formation of abnormal capillaries without impairing normal capillary growth.

Many people are in a state of chronic low-grade inflammation even before they become infected with COVID-19. The combination of animal products and processed foods fuels inflammation through saturated fat and other inflammatory components of animal products (TMAO, haeme iron etc), oxidative stress, and secondary effects of insulin resistance and obesity. A whole foods, plant-based diet reduces inflammation across the board, with many plants (eg. Turmeric) having a direct anti-inflammatory action. The dietary fibre from minimally processed plants (esp. legumes and whole grains) provides fuel for the microbiome and has powerful immune regulating and anti-inflammatory effects through the production of SFAs (short-chain fatty acids such as butyrate) by gut microbes.

We would like to have clinical trials to support our assertion that a whole foods, plant-based diet may be an effective lifestyle intervention for long covid. However, we don’t, and it’s most likely that future trials will focus on pharmaceuticals rather than lifestyle and that a whole food, plant-only diet may be considered too radical for a lifestyle medicine trial. There is circumstantial evidence supporting our approach. A study found health care workers reporting a vegan diet were less likely to get severe COVID infection. Epidemiology observations show that people with diabetes, obesity and hypertension, conditions that respond to a WFPB diet,  were more likely to be hospitalised of die of COVID. A drug trial found that metformin taken during COVID infection reduced the frequency and duration of long covid – if reducing insulin resistance was the mechanism then WFPB should work even better. We have had a couple of clinical cases of rapid improvement in long covid symptoms following high adherence to a WFPB diet.

There is nothing to lose from WFPB for long covid treatment – the side effects are all good, reduced cardiovascular risk factors, better blood glucose regulation, healthy weight without portion control and better health in general. So if you or someone close to you is suffering from long covid, we encourage them to give it a try, focus on the basics, get some help and turn your health around.