Thank you to everyone who tuned into my live video with Dysautonomia Dietitian! Here’s the full video and a summary of our conversation about nutrition, diet, and its role in chronic disease like long COVID.
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Nutrition and Long COVID: What Actually Matters
When people develop a chronic illness like long COVID, food suddenly feels much more complicated.
What once felt intuitive—eat when hungry, cook what sounds good—can become stressful and confusing. Many people begin searching for the “perfect diet” that will relieve their symptoms.
But according to registered dietitian Taylor Mallory, the science simply doesn’t support a single universal diet. Taylor is The Dysautonomia Dietitian here on Substack and she’s also experienced long COVID herself.
Taylor says the most effective nutritional strategies tend to focus on foundations that support the body’s core systems.
Below are the most important insights from our conversation.
1. There Is No “Long COVID Diet”
One of the biggest misconceptions is that there is a specific diet that treats long COVID.
The reality is much more complex.
Long COVID involves over 200 documented symptoms and affects multiple biological systems—from the nervous system to the cardiovascular system to the gut. Because of this variability, nutrition strategies must be individualized.
Instead of searching for a single protocol, Taylor recommends thinking about nutrition in terms of supporting biological systems, such as:
Inflammation regulation
Immune function
Mitochondrial energy production
Gut health
Blood sugar regulation
Nutrition provides the raw materials the body needs for these processes. Without those basic building blocks, more targeted interventions rarely work well.
2. Start With the Foundations
Before experimenting with elimination diets or supplements, the most important step is ensuring the basics are in place.
Taylor emphasizes foundational habits such as:
Stable blood sugar
Adequate caloric intake
Balanced meals
Nutrient diversity
These fundamentals benefit both healthy individuals and those with chronic illness.
For many patients, simply strengthening these foundations can make a meaningful difference.
3. Blood Sugar Stability Matters More Than Most People Realize
One of the most consistent strategies Taylor uses with patients is blood sugar stabilization.
Carbohydrates naturally raise blood glucose levels. But when carbs are eaten alone, they can produce rapid spikes followed by crashes.
The solution isn’t eliminating carbohydrates—it’s pairing them properly.
A helpful guideline:
Combine carbohydrates with protein, fat, and fiber.
This slows digestion and produces a more gradual rise and fall in blood sugar.
Instead of a sharp spike and crash (“a mountain peak”), the goal is a gentler bell-shaped curve, which supports energy levels and reduces physiological stress.
4. Chronic Illness Often Increases Energy Needs
A counterintuitive reality of chronic illness is that the body may require more energy even when activity levels drop.
Many long COVID patients experience:
tachycardia
breathlessness
autonomic dysfunction
systemic inflammation
All of these processes increase metabolic demand.
If calorie intake drops while energy needs increase, fatigue can worsen.
This means fatigue may sometimes reflect under-fueling, not just disease severity.
Ensuring adequate calories is therefore a critical (and often overlooked) part of recovery.
5. Small, Frequent Meals Can Help
Many people with long COVID struggle with appetite changes, nausea, or early fullness.
Taylor found that smaller meals spaced throughout the day were easier to tolerate than large meals.
Helpful strategies include:
Eating 4–5 smaller meals per day
Using liquid nutrition (like protein shakes) when appetite is low
Adding calorie-dense foods in manageable portions
For some people, gentle movement can also stimulate appetite—though this must be approached carefully in those with severe fatigue or PEM.
6. Nutrition Needs to Be Simplified
One of the most important themes in the discussion was reducing cognitive burden.
Long COVID often brings brain fog and fatigue, making complicated meal planning unrealistic.
Taylor recommends simplifying meals into four components:
A balanced plate includes:
Protein
Carbohydrate
Fat
Color (fruits or vegetables)
If a meal contains these elements, it is likely nutritionally adequate.
Importantly, meals do not need to be home-cooked or elaborate.
Convenience foods can absolutely be part of a healthy strategy.
Helpful shortcuts include:
Frozen vegetables
Frozen fruits
Canned foods
Pre-prepared meals
Frozen produce is often harvested and frozen at peak ripeness, meaning its nutritional value can actually be excellent.
As Taylor puts it:
“Nutrition that happens imperfectly is better than nutrition that doesn’t happen at all.”
7. Restrictive Diets Can Create More Harm Than Benefit
Many patients experiment with restrictive diets—especially keto, elimination diets, or extremely low-carb approaches.
While some of these diets have medical uses (for example, keto in epilepsy), the evidence supporting them in long COVID is limited.
Restricting entire nutrient groups can also create risks, including:
Nutrient deficiencies
Insufficient caloric intake
increased stress around eating
Carbohydrates, for example, are not only energy sources—they also provide important micronutrients like B vitamins, which support cellular energy production.
For most people, severe dietary restriction is unlikely to be helpful and may worsen fatigue.
8. A Better Mindset: Focus on What to Add
A helpful psychological shift is moving from restriction to addition.
Instead of asking:
“What foods should I eliminate?”
Taylor suggests asking:
“What nutrients can I add to support my body?”
Many problems with the standard American diet stem not from eating the “wrong” foods—but from missing important nutrients.
Adding nourishing foods can often produce greater benefits than removing foods.
9. Working With a Registered Dietitian
Nutritionists are not the same as dietitians. Registered dietitians (RDs) are medical nutrition professionals who receive extensive training, including:
A master’s degree
Supervised clinical practice
Certification through a national credentialing body
They provide medical nutrition therapy, which includes individualized dietary strategies for conditions such as:
diabetes
high cholesterol
PCOS
metabolic disease
chronic illness
A good dietitian also focuses heavily on education and behavior change, helping patients understand the why behind recommendations so they can build sustainable habits. Most are covered by health insurance.
Working with an RD has been an important and very valuable part of my own recovery. I’ve been able to identify what my new appetite cues are, learn where to invest my limited energy when it comes to diet, and learn what food stressors I could let go.
Final Takeaway
For people living with long COVID, nutrition often becomes a source of anxiety and decision fatigue.
But the most powerful strategies are often the simplest:
Eat enough
Stabilize blood sugar
Build balanced meals
Avoid extreme restriction
Use convenient foods when needed
Most importantly, nutrition should support recovery—not create additional stress.
Healing from chronic illness is difficult enough. Food should help nourish the process.
Thank you, Taylor, for joining me on a Substack Live. Consider subscribing to Dysautonomia Dietitian for more science-based nutrition guidance.
How has your relationship to food been impacted by your health? Let me know in the comments below.
-Dr Khan
