Post Covid-19 syndrome or long Covid are persistent symptoms that may remain for few weeks to months after recovery from Covid-19. (1,2) As with most infections, your body takes time to heal and recover. This is due to inflammation that may still persist in your body.

Possible symptoms after Covid-19

The Covid-19 virus affects different parts of the body during infection and causes different symptoms that may take a longer time to recover. Some of the most common symptoms may include (1-3):

• Fatigue
• Headache
• Cough
• Shortness of breath
• Chest pain
• Difficulty in concentrating
• Gastrointestinal/digestive issues

Post Covid-19 gastrointestinal symptoms

One of the most common symptoms that may persist after Covid-19 are gastrointestinal symptoms or symptoms related to the digestive system. Some of these symptoms may include (1-3):

• Diarrhoea
• Gastric pain
• Constipation and bloating
• Nausea and vomiting
• Loss of appetite

Gastrointestinal symptoms such as diarrhoea, gastric pain, and constipation may persist as a result of prolonged inflammation in the gut. (4) It is prevalent in other types of viral and bacterial infections as well. (4,5) Nausea and vomiting may be related to the effects on the nervous system and other gastrointestinal symptoms. (4) On the other hand, loss of appetite may occur as a result of the aforementioned gastrointestinal symptoms and / or it might be due to pain, fatigue, shortness of breath and other symptoms that may affect one’s appetite. (4)

How to eat after recovering from Covid-19

• Maintain a healthy diet

Adequate nutrition is essential to help the body to repair, recover, and to build up your immune system. Eat a healthy diet and vary your food choices in your meals for adequate calorie, protein, vitamins and minerals intake.

• Drink plenty of water every day

Drink 6 to 8 glasses of water daily. Staying hydrated is important for your immune system as water helps in transporting nutrients.

Source: Kementerian Kesihatan Malaysia (6)

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If you’re having digestive issues:

• Eat small frequent meals. Avoid eating large amounts of food at one go.
• Avoid spicy, oily food or any food that may trigger your symptoms.
• Avoid drinking water with meals.
• Eat plenty of fruits and vegetables to ensure adequate fibre intake.

References

1. Peghin M, Palese A, Venturini M, De Martino M, Gerussi V, Graziano E et al. Post-COVID-19 symptoms 6 months after acute infection among hospitalized and non-hospitalized patients. Clinical Microbiology and Infection. 2021;27(10):1507-1513.
2. Anaya J, Rojas M, Salinas M, Rodríguez Y, Roa G, Lozano M et al. Post-COVID syndrome. A case series and comprehensive review. Autoimmunity Reviews. 2021;:102947.
3. Blackett J, Li J, Jodorkovsky D, Freedberg D. Prevalence and risk factors for gastrointestinal symptoms after recovery from COVID‐19. Neurogastroenterology & Motility. 2021;.
4. Perisetti A, Goyal H, Gajendran M, Boregowda U, Mann R, Sharma N. Prevalence, Mechanisms, and Implications of Gastrointestinal Symptoms in COVID-19. Frontiers in Medicine. 2020;7.
5. Card T, Enck P, Barbara G, Boeckxstaens G, Santos J, Azpiroz F et al. Post‐infectious IBS: Defining its clinical features and prognosis using an internet‐based survey. United European Gastroenterology Journal. 2018;6(8):1245-1253.
6.    Malaysian Dietary Guidelines 2020. Kuala Lumpur: Kementerian Kesihatan Malaysia; 2021.

Vitamin C, also known as ascorbic acid is a water-soluble vitamin essential to the body. (1) It is an antioxidant commonly known to strengthen the immune system and may reduce the risk of infections. (2,3) Besides that, vitamin C also helps in collagen formation, wound healing, and improves iron absorption. (1)

Vitamin C and immune health

Vitamin C plays an important role in promoting a healthy immune system through supporting the production of white blood cells and antibodies. (4) Low levels of vitamin C can increase your risk of catching colds and you may take a longer time to recover as well.

Studies have shown that daily vitamin C supplementation is associated with a decrease of common cold incidences (3) and reduction of duration and severity of common cold symptoms. (5)

What affects vitamin C levels in the body

Smokers tend to have lower vitamin C levels as the chemicals in the cigarette take up vitamin C in the body. (6) This is because vitamin C is an antioxidant which reduces inflammation by protecting the body against damage from the chemicals of the cigarette. Besides smoking, drinking alcohol also depletes vitamin C in the body. (7)

Individuals with certain health and medical conditions such as diabetes (6), heart disease (6), stroke (6), and chronic kidney disease (8) also tend to have lower vitamin C status. Vitamin C levels also decrease during infections such as Covid-19 virus infection. (9) These conditions cause inflammation in the body and thus, depletes vitamin C levels in the body.

How to choose the best vitamin C supplement

When it comes to choosing the best vitamin C supplements, it is better to select those with the following features:

• Vitamin C from natural sources instead of synthetic
• Comes with bioflavonoids and other antioxidants or nutrients
• Vitamin C that is slowly delivered and sustainable for longer periods as the body cannot absorbed high doses at one go.
• From reputable companies emphasizing on evidenced-based, clinically proven formulas, and uses safe ingredients from trusted suppliers

Why Super C?

• Evidenced-based formulation.
• Clinically proven to more sustainable, faster absorption, and higher retention rate.
• Natural vitamin C from corn, comes with citrus bioflavonoids and fatty acids for maximum absorption and higher bioavailability.
• Comes with zinc and vitamin E for enhanced immune protection
• Non – acidic and gentle on the gut
• Convenient with a once-a-day dosage
• Easy to swallow, in powder form

References

1. Recommended Nutrient Intakes Malaysia 2017.Putrajaya: National Coordinating Committee on Food and Nutrition, Ministry of Health Malaysia; 2017.
2. Zhang J, Rao X, Li Y, Zhu Y, Liu F, Guo G et al. Pilot trial of high-dose vitamin C in critically ill COVID-19 patients. Annals of Intensive Care. 2021;11(1).
3. Sasazuki S, Sasaki S, Tsubono Y, Okubo S, Hayashi M, Tsugane S. Effect of vitamin C on common cold: randomized controlled trial. European Journal of Clinical Nutrition. 2005;60(1):9-17.
4. Carr A, Maggini S. Vitamin C and Immune Function. Nutrients. 2017;9(11):1211.
5. Hemilä H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane Database of Systematic Reviews. 2013;2013(5).
6. Carr A, Rowe S. Factors Affecting Vitamin C Status and Prevalence of Deficiency: A Global Health Perspective. Nutrients. 2020;12(7):1963.
7. Marik P, Liggett A. Adding an orange to the banana bag: vitamin C deficiency is common in alcohol use disorders. Critical Care. 2019;23(1).
8. Deicher R, Hörl W. Vitamin C in Chronic Kidney Disease and Hemodialysis Patients. Kidney and Blood Pressure Research. 2003;26(2):100-106.
9. Carr A, Spencer E, Dixon L, Chambers S. Patients with Community Acquired Pneumonia Exhibit Depleted Vitamin C Status and Elevated Oxidative Stress. Nutrients. 2020;12(5):1318.

Vitamin C, also known as ascorbic acid is a water soluble vitamin essential to the body. (1) It is an antioxidant commonly used to strengthen the immune system and to reduce the risk of infections. (2,3) Besides that, vitamin C also helps in collagen formation, wound healing, and improves iron absorption. Vitamin C can be naturally found in various types of fruits and vegetables, such as guava, kiwi, and capsicum. (1)

10 vitamin C rich foods other than oranges

1. Guava

Guavas are very rich in vitamin C. One serving of guava, which is around half of a small guava, contains up to 242 mg of vitamin C. Guavas deliver more vitamin C than oranges; it has 152mg of vitamin C per 100 g, which is approximately 3 times more than oranges (53 mg of vitamin C per 100g).

Besides vitamin C, guavas are also rich in fibre and minerals such as potassium and calcium. (4,5)

2. Kiwi

Kiwi fruits are also packed with vitamin C. One whole medium fruit has up to 135 mg of vitamin C. Comparing with oranges, it has 87 mg per 100 g, which is almost twice the amount of vitamin C oranges have (53 mg of vitamin C per 100g). Kiwi fruits are also rich in fibre and potassium. (4,5)

3. Papaya

Papayas are one of the most commonly eaten fruits in Malaysia. A slice of papaya has up to 113 mg of vitamin C. Papayas have 72 mg of vitamin C per 100g, which is around 1.5 times more than oranges (53 mg of vitamin C per 100g). Besides that, papayas are also rich in vitamin A and phytonutrients such as lycopene and beta-carotene. (4,5)

4. Strawberries

One serving of strawberries (around five whole strawberries) contain around 24.4 mg of vitamin C. The vitamin C content per 100 g of strawberries is approximately 52mg / 100g, which is similar to oranges (53 mg of vitamin C per 100g). (4,5) Strawberries are also rich in bioflavonoids, which have antioxidant properties. Antioxidants reduce inflammation by protecting the body against damage by free radicals, which is known to increase the risk of chronic diseases such as diabetes and heart disease. (6)

5. Grape fruit

Grape fruits contain 34.4 mg of vitamin C per 100g. One serving of grapefruit, which is around half of a fruit has up to 88 mg of vitamin C. (5)

6. Capsicum

Capsicums or bell peppers are the most vitamin C rich vegetable sources. Each capsicum contains around 180mg to 240mg of vitamin C depending on the type of capsicum. Red and yellow capsicums (150mg vitamin C / 100g) tend to have a higher vitamin C content as compared to the green capsicum (112mg vitamin C/ 100g). Nevertheless, all types of capsicums have 2 to 3 times more vitamin C as compared to oranges. (4,5)

7. Bitter gourd

Bitter gourds contain a variety of vitamins and minerals such as vitamin C, vitamin A, potassium, and iron. It has around 53 mg of vitamin C per 100 g, which is similar to oranges. (4,5)

8. Green leafy vegetables

Kale contains up to 107 mg of vitamin C per 100 g while choy sum or mustard leaves contain around 89mg of vitamin C per 100g. Both vegetables have a higher vitamin C content as compared to of oranges. (4,5)

9. Broccoli

Broccoli is also packed with vitamin C and other vitamins and minerals. One cup of broccoli delivers up to 80 mg of vitamin C. Similarly to choy sum, a 100g of broccoli contains around 85 mg of vitamin C per 100 g which is approximately 1.5 times more than of oranges. (4,5)

10. Cauliflower

One cup of cauliflower contains up to 53 mg of vitamin C, which is lower as compared to one cup of broccoli. However, it is also one of the vitamin C rich vegetable sources. (4,5)

How to include them into your daily diet

• Make a healthy breakfast with a variety of fruits. You can add them into your oats, yoghurt or blend them into a smoothie bowl.
• Add more vegetables into your meals. Fill in half of your plate with a variety of vegetables. Always follow the Malaysian Healthy Plate Method or SukuSukuSeparuh
• Include a variety of vegetables when cooking. For example, instead of just stir-fry spinach, add in some carrots for variety
• When eating out, opt for economy rice or mixed rice as it’s easier to include more vegetables and healthier options into your meals
• Eat fruits as desserts instead of sweet foods.
• Eat fruits or vegetables such as carrot sticks as snacks.

Healthy recipes packed with Vitamin C

• Super C Fruity Salad

A salad bowl packed with antioxidants and delicious goodness!

• Malaysian Stir-fry Mixed Vegetables

Easy stir-fry recipe packed with vitamins and minerals

References

1. Recommended Nutrient Intakes Malaysia 2017.Putrajaya: National Coordinating Committee on Food and Nutrition, Ministry of Health Malaysia; 2017.
2. Zhang J, Rao X, Li Y, Zhu Y, Liu F, Guo G et al. Pilot trial of high-dose vitamin C in critically ill COVID-19 patients. Annals of Intensive Care. 2021;11(1).
3. Sasazuki S, Sasaki S, Tsubono Y, Okubo S, Hayashi M, Tsugane S. Effect of vitamin C on common cold: randomized controlled trial. European Journal of Clinical Nutrition. 2005;60(1):9-17.
4. Malaysian Food Composition Database [Internet]. Malaysian Food Composition Database. [cited 27 September 2021]. Available from: http://myfcd.moh.gov.my/
5. Energy & Nutrient Composition of Food [Internet]. Food Composition System Singapore. [cited 27 September 2021]. Available from: https://focos.hpb.gov.sg/eservices/ENCF/
6. Giampieri F, Tulipani S, Alvarez-Suarez J, Quiles J, Mezzetti B, Battino M. The strawberry: Composition, nutritional quality, and impact on human health. Nutrition. 2012;28(1):9-19.
7. Super-C Salad [Internet]. Skinny Ms. 2015 [cited 27 September 2021]. Available from: https://skinnyms.com/super-c-salad-recipe/

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