Digestive issues after COVID: an RD answers

Digestive issues after COVID
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Digestive issues after COVID (and during!) are real. These symptoms can be just as upsetting and exhausting as many other symptoms of COVID. Here’s what you need to know.

Why do some people with COVID get digestive symptoms? 

COVID is a respiratory virus. But it’s not uncommon for COVID and other respiratory viruses to also cause gastrointestinal symptoms. Surveys from New York hospitals a few months into the pandemic showed that more than 30% of patients who were diagnosed with COVID also had at least one digestive issue.

But why can a respiratory illness upset your GI tract? In the last few years, there’s been a lot of research done on the connection between the gut and the brain–and also some studies on the gut-lung axis (the communication between these two parts of your body) in respiratory illness. After respiratory viruses and with chronic lung conditions, studies have shown that your gut microbiome can change. Changes in your gut environment can cause a wide range of digestive symptoms.  

Why autoimmune disorders and steroid use can create more GI upset 

If you have irritable-bowel syndrome (IBS) or any type of immunodeficiency, you’re probably more likely to experience GI distress. Some other things that can have a higher risk of contracting COVID and predispose you to more GI issues during a COVID infection are autoimmune disorders, like Crohn’s and ulcerative colitis. In these conditions, you have a level of immunity against your digestive tract and may be given steroids or other immunosuppressants to dampen that autoimmunity. Steroids can suppress your immune system and make you more vulnerable to viruses. They also inhibit prostaglandins in the gut. Prostaglandins help protect the lining of your stomach. If they can’t do their job, you might have gut issues with or without a COVID infection.

What does it mean if I have digestive issues after COVID?

In some cases, a COVID-19 infection leaves lasting symptoms. We’re still learning about ongoing issues with digestive issues after COVID. But anytime your gut microbiome goes through changes, it can take targeted work and some time for your GI tract to recover. 

After COVID, some people might experience or continue to experience intestinal dysmotility. Your gastric motility might be slower or faster than normal. Some interesting research is also coming out about the role micronutrients play in the course of COVID infections. Micronutrients are so important to your body’s overall functioning and immune response, and they also help coordinate your body’s response to a virus. If you are low in certain micronutrients (from diet, lifestyle, a virus, or poor absorption from existing GI disorders), your body might not be able to recover as well from any type of infection or function optimally. If you suspect a micronutrient deficiency in your GI issues, testing can be done to find specific opportunities to improve your nutrition.

Can I take something over-the-counter for diarrhea if I have COVID?

With COVID, don’t automatically reach for an over-the-counter antidiarrheal medicine without running it by your physician first. Some of these medicines work by slowing down intestinal motility (how fast things move through your gut). Yes, they are effective at calming diarrhea. But there’s a downside, too. Your body is working hard to get rid of the virus and is shedding viral particles. One of the ways it does that is by sending it out through bowel movements. If you slow down how fast things are moving through your digestive tract, your body might not be as effective at getting rid of the virus.

If you’re concerned about fluid loss from diarrhea, call your physician. They know your history and can assess the situation. There are medicines that can help with diarrhea that don’t slow down motility, and those might be better options in some cases.

How can I improve my gut health and digestive issues after COVID?

Improving digestive issues after COVID can take some time and patience. Nothing helps gut health right away. But there are a lot of little steps you can take that make a big difference in how you feel. Recently, gut health has been co-opted by our society’s diet-driven culture. We see probiotics everywhere and feel this is the new “thing” we should be worried about with our health. Influencers on social media are sharing results from their GI testing, food sensitivities, and what probiotics they’re taking to try to fix it. Restrictive diets are a blanket recommendation from practitioners. All of this leads to so much frustration and overwhelm for people, especially when trying to recover and improve digestive issues after COVID. Remember that what’s right for someone else isn’t always what’s right for you, and stressing your body out more after COVID will not help you feel better. 

Don’t rush to eliminate certain foods and honor your body instead

For someone with gut dysbiosis, I might approach that issue with a healing protocol–not elemental diets or elimination diets that can further disrupt your body’s balance. I use a therapeutic protocol to help you tune in to the wisdom of your body by learning to eat more intuitively. Eating intuitively works because you’re listening to the intuition of your body and what your body is telling you. You might have cravings because you’re not getting enough fats, carbs, or certain micronutrients. Or, if you eat something, you might notice that it doesn’t agree with you at that moment. 

Many people do not realize how great intuitive eating can be for gut health because it focuses on principles like “honoring our hunger” and adding more variety back into our diet. One of the principles is how to respect your fullness and eat mindfully, which is wonderful for digestion because it causes us to slow down and really pay attention to what is happening in our body. Learning to trust your body and stop listening to the voice up in your head (which I call “diet brain”) is the key to building better gut health. Your body needs a variety of foods to function, and we need to allow ourselves to eat.

Chew your food slowly and completely

Taking time to chew your food thoroughly is good for your gut health. It lets your body know to start the digestive process, from saliva to letting your stomach tell your brain that it’s full. Chewing also helps reduce overgrowth of some bacteria and helps indigestion and reflux.

Explore probiotics but not without prebiotics

Probiotics absolutely are good for our gut health because they help keep harmful microorganisms and pathogens in check. They help us digest food, absorb nutrients from those foods, and boost our immunity. I encourage people to add probiotics to their diet to increase the variety that they get. But I recommend you do it from food over randomly selecting a supplement. Some great food choices are sauerkraut, kimchi, yogurt, kefir, miso, and tempeh. If you feel like you need a supplement, I would encourage you to reach out to a practitioner that specializes in gut health to recommend one that would be a good fit. 

I would be remiss if I didn’t mention prebiotics. Prebiotics are like food for probiotics and help them to survive and thrive in our gut, which helps with digestive issues after COVID or otherwise. Prebiotics work alongside probiotics to optimize our gut health and boost immunity. Some examples of prebiotic foods are garlic, onion, leeks, banana, and sweet potatoes.

When should I see my physician?

The best person to answer this question is you. You know your body and when something’s off or you don’t feel quite right. But if you have digestive issues after COVID, some basic signs you definitely need to contact your physician are:

  • weight loss
  • signs of dehydration, like not going to the bathroom much, fatigue, dizziness, and excessive thirst
  • vomiting or unusual diarrhea, abdominal pain, cramping
  • inability to keep food or liquids down or eat

I heard gut health is important for my immune system. What should I do to keep it healthy?

Finding ways to reduce stress is important. Stress impacts your nutrient absorption and weakens your intestinal environment. Increasing fiber intake can also help you keep your gut healthy. Some bacteria in your gut need fiber to thrive. It’s recommended that women get 25 grams of fiber per day. You can increase fiber by adding in more food variety, such as fruits and vegetables. Whole grains, nuts, seeds, and beans are also good ways to add to your fiber intake. Some research says that most Americans are only getting about half the recommended amount of fiber daily.

One of the most important and often overlooked steps in gut health is water. It is simple and free, but so many people struggle to get it in, including myself. Being hydrated helps our stomach lining and our system eliminate waste and keep us regular. It even helps with the good bacteria in your gut. Sometimes clients I see will experience constipation, and when we add more water and some movement, they see a lot of relief with their symptoms. 

Wendie Taylor, RDN, LD, MBA
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