Tips for managing gastric symptoms of Long Covid

Photo by Frank Flores on Unsplash

Many of us with Long Covid struggle with gastric and bowel issues, so I thought I’d offer some tips from my own experience of Gastroparesis, Leaky Gut Syndrome, and Irritable Bowel Syndrome (IBS). Over the 14 years since my symptoms began, I have tried everything to alleviate my symptoms which include: slow gastric emptying, bloating, indigestion, vomiting, heartburn, stomach pain, and bowel spasms. 

I believe my symptoms were caused by pain medication, which was prescribed in abundance for years, without any warning of the permanent damage it could cause to my gastric tract. I have had a myriad of tests, met dieticians and consultants, and tried many medications, but my symptoms continue to impact my life. I eventually found a way of eating which helped me manage my symptoms better, along with supplements which alleviated some of my discomfort. In fact, in the last few months of 2020, I suddenly noticed a dramatic improvement and, that Christmas, I enjoyed Christmas cake and Baileys for the first time in years, with no after-effects! I started to think that I was finally turning the corner but then… 

Two weeks into 2021, I caught Covid. I lost two stone in weight, and completely lost my appetite and sense of taste. Unfortunately, as my appetite slowly improved, I noticed my gastroparesis and IBS return with renewed energy. I was unable to digest any food that strayed from my very limited FODMAP diet (more on this below), so I would have to throw up any undigested meals.

My symptoms persist but, with the help of the following tips, my attacks are now shorter and less often. I stress that I'm not medically-qualified so cannot recommend medication or specific supplements, and the advice I give here is based purely on my own experience. Your first port of call should always be your GP. 

Obviously, this is a huge subject which can’t be covered in one article, but hopefully the concluding references will encourage further research. There is lots of advice online, but it is vital to use reliable sources. I often find that medical research papers provide the most accurate information: they are dense, but you can skip to the conclusion or summary to glean the necessary information. There are academic studies available on various digestive conditions, on potential medications, and treatments such as Cognitive Behavioural Therapy (1).

Symptoms and advice

There are many conditions that can cause digestive problems, and it is often difficult to get a firm diagnosis. IBS is literally a syndrome of symptoms with no definite cause: and Gastroparesis is actually a symptom, meaning partial paralysis of the gastric tract. Your GP can refer you to a gastroenterologist, who may use a process of elimination to seek a diagnosis: this process may involve Gastroscopy, Colonoscopy, gastric emptying tests, and scans. A good dietician can help, if they understand conditions such as gastroparesis – but, in my experience, many don't. However, in recent years, there has been far more information online and even some books, including FODMAP recipe books.

Whether you receive a final diagnosis or not, your symptoms are real, exhausting, often embarrassing, and can impact sleep, appetite, mood, and family life. Whether medical intervention is offered or not, how can we help ourselves? My first advice is to cut out the following recognised triggers for gastric symptoms: alcohol, caffeine, spices, cigarettes, chewing gum, and fizzy drinks. 

Posture is important to gastric issues, especially slow gastric emptying or bloating: sitting upright when eating, and staying in that position, perhaps with a heatpad on your chest, for at least an hour after each meal, can aid digestion. If your symptoms, like mine, worsen at night, sleeping at a slightly upright angle, with your back supported by extra pillows, can reduce acid reflux. Posture is also helpful when performing stretches to help release trapped wind: there is an excellent resource for stretches in the references below (2).

Although gastric emptying slows during sleep, it is faster during REM sleep (3), so do seek help if your sleep is poor. This indicates how important a holistic, whole body, approach is to improving gastric symptoms. 

It’s best to not drink with your meal, as drinking and eating at the same time can cause trapped wind. It is also wise to eat food of the same temperature at the same meal, rather than mixing hot and cold: so avoid a hot dinner then ice cream immediately after. In fact, staying away from ice cold drinks altogether is a tip I found especially helpful! Eat slowly and consciously, cutting your food up small, and chewing each mouthful thoroughly - your food should be liquid so that it is easier to digest. Try not to talk whilst eating as that can increase the intake of air. It’s also best to prevent your tummy becoming empty, as hunger seems to cause more gas build-up when we do eat. So, at the first sign of hunger, I’ll have a little something, even if just a chocolate mousse. Online support groups provide lots of useful tips, including recommendations for foods that can soothe the gut but are still tasty and nutritious. 

Try to ensure you eat enough during the day so that you won’t need a large meal late at night: as night draws in, gastric emptying slows down (3). So, as the day progresses, my food intake becomes more liquid (and more boring!) If I do risk a slice of pizza or a bar of chocolate, it will be at lunchtime, to give my body the best chance to digest it before evening. A milky pudding as the last meal of the day, ideally a good two hours before bed – a bowl of custard, maybe – is far easier for the body to digest when lying down than a slice of pizza.

What is the FODMAP diet?

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols: these are short-chain carbohydrates (sugars) which the small intestine absorbs poorly. The FODMAP diet is aimed at avoiding these carbohydrates, and therefore reducing symptoms for people who suffer with gastroparesis, Small Intestinal Bacterial Overgrowth (SIBO), Irritable Bowel Syndrome, and reflux (4). The diet is too complicated to discuss in full here, but it’s definitely worth trialling to see if it helps you. See the references below for further info – the Monash University website (5) is a good place to start gaining a better understanding of the diet. The BBC also has excellent resources on its Good Food website (6). 

Whilst the FODMAP diet has its uses (7), everyone has individual triggers, and it’s important to find yours. The best way to do this is with an elimination diet, where you cut out all potential triggers and eat only safe, bland (and yes, very boring!) food, such as milky puddings, mashed potato, maybe flavoured with cheese spread. A good safe food for me is ready-meal macaroni cheese – I don’t like it, but my gut does! My vegan organic healthy diet of beans and veg is a fond but distant memory as I now know that, for me, processed food is less likely than fresh to trigger a gastroparesis attack. Liquidised food is not much fun but it can be useful for calming the gut. 

Yes, the elimination diet is boring, antisocial, and frustrating, but it can be incredibly helpful to nail down specific triggers. For example, it was only through an elimination diet that I realised that I didn’t need to eliminate orange squash – I just needed to eliminate aspartame as, it exacerbates my bowel pain. Unfortunately, if, like many of us, you have both IBS and gastric issues, it can be a struggle to find foods that both upper and lower tracts can tolerate, but the elimination diet can help you narrow down those ‘safe foods’. 

Whilst following an elimination diet, I note down everything - the time I ate, what I drank, exactly what food items - every veg, spice, etc. This helps me to spot definite triggers, and what times of day to avoid heavy meals. Everyone is different but common triggers are tomatoes, raisins, fresh fruit or veg, especially skins and seeds, any acidic foods, and dense difficult to digest foods such as pizza. 

If you do have a severe attack of gastroparesis or IBS, which can last days or even weeks, a good first tip is to let your tummy rest for a few days. As with the first stage of an elimination diet, it helps to focus on milky puds like rice pudding, custard, semolina, or tapioca (if you can get over the fact that it looks like frogspawn!) You can add jam for taste, but only if the jam has no skins or seeds.

Protein shakes are helpful as they provide much-needed electrolytes but are entirely liquid so gentle on the digestive system. If I feel faint because I’ve been unable to take in enough nutrition, I sometimes add a little salt into my diet. Salt is essential to the body and a deficiency can cause lightheadedness. I found a very interesting article on salt intake on Forces.net (8), but obviously do always take your GP’s advice on this. I can’t eat solid food at all in an attack, so I’ll put salt on a piece of melted cheese and let it melt in my mouth. An alternative is to take liquid electrolytes like Dioralyte. 

Once your gut has rested, hopefully symptoms should reduce, then you can slowly and gently try re-introducing more substantial foods. Try soups: tinned are often best, I find, as they are so heavily processed – you can strain any lumps out if necessary. Some of those with gastroparesis resort to baby food, but keep in mind that food intended for nine months onwards does have lumps in it, so you might be better off looking for early-stage weaning foods for three-six month olds. 

You then slowly re-introduce potential triggers, one at a time, ideally giving each food item a thorough test before returning to the bland diet for a day or two. Once any symptoms have settled again, try another trigger. A tip that many people recommend is to switch to white bread for a few days as it is more easily digestible and seems to give the gut ‘a rest’. With bowel symptoms particularly, I often find that eliminating fibre completely can soothe spasms and ease pain. Recent medical research conflicts with earlier claims that IBS could be cured simply by increasing fibre in the diet. It is also important to understand the differences between soluble and insoluble fibre – more information can be found on this by following the link in reference (9).

After a sudden and extreme attack of gastroparesis in 2018, I lost two stone in 12 days. I was faint, weak, and unable to consume anything other than protein shakes. In desperation, I saw a private doctor who specialised in holistic treatment. Dr P was far more understanding and empathic than any consultant I’ve ever met. He introduced me to various supplements and, after lot of trial and error, I found the combination that helped me start digesting food again. I still have attacks, but I get breaks in between where I can eat some normal foods without issue. I can even eat chocolate on a good day! 

For me, sadly, the damage to my gastric tract is permanent so I may never be able to eat my previously healthy diet again. But on good days I can now enjoy chocolate, cake, potatoes, or a cheese sarnie, which I couldn't before. When I'm in an attack, as I am now, I find I can't eat any fibre at all and nothing solid, so it’s back to custard and processed macaroni cheese until my symptoms ease! 

It isn’t easy. It’s disheartening that a restaurant meal involves a lot of planning - and discreetly asking the waiter if they can make you something special. Thankfully most restaurants serve chips or mashed potato and chefs will often help by adding cheese, or creating a special version of a dish. At home, sometimes adjusting how we enjoy our favourite foods helps: for example, I can’t eat broccoli stalks, but I can now eat the leaves, finely chopped, and they make a yummy addition to macaroni cheese. Bars of chocolate (sorry!) can definitely be a trigger but chocolate mousses satisfy that sweet craving. 

I take a cocktail of supplements daily, and it isn’t cheap, BUT I’m no longer losing weight and I can at least eat some normal foods now, albeit not all of the time. I found the easiest way to research supplements was to look at reputable suppliers and check their recommendations for digestive issues: I then do my own research on each supplement, looking for benefits, contra-indications, and side-effects. I shop around for the best prices, as they can often differ widely. To ensure the best value, don’t just look at the price, but at the amount of mg in each capsule and how many capsules in each pot. Yes, maths is a pain, but it’s worth the investment of time to save money long-term. Every time I run out of a supplement, I do a quick check again to ensure I’m still getting the highest quality product at the best price.

I desperately miss my yummy fibre-packed vegan casseroles, but I appreciate good food so much more now - and when I do occasionally enjoy an amazing meal without it making me ill, I treasure that experience so much more! I hope my suggestions have helped you, and encourage you to do further research. If you have any tips of your own, please do share!

References 

Long Covid

Published 06 September 2022

Sally Anne Goffin-Adams

Content Writer for Covid Aid

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