South Africa currently has over 566,000 confirmed Covid-19 cases and there have been over 10,000 deaths. The rate of infections (and fatalities) continues to climb but it’s no secret that those with underlying medical conditions are at a greater risk. Comorbidities, including diabetes, hypertension, obesity, lung cancer, and kidney diseases are the most common conditions in patients who have died of the virus. So, what can we do aside from staying inside, social distancing, wearing masks, and washing our hands? Terry Harris, head dietician at Discovery Vitality, joins Alec Hogg to discuss the healthy foods we should eat and the choices that will give us the best chance against the virus. – Claire Badenhorst
Terry Harris is the head dietitian at Discovery Vitality. She joins us now at a very difficult time, I guess, for South Africans to try and protect themselves as much as possible against Covid-19. I was reading something over the weekend where a critic said, part of the reason why people do get very sick from Covid-19 is actually self-inflicted. In other words, their diets are exposing them to the worst of this virus. Is there any truth in that?
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Ja, it’s a really interesting point because we immediately want to say it’s somebody’s fault. It’s my fault that I am in the state that I’m in. I’m referring specifically to one’s weight. So, a lot of attention has come out recently, mainly from the UK with the prime minister there, including ways to tackle obesity as one of their key strategies to prevent the complications of Covid. So, you know, when you’re looking at weight, somebody immediately wants to say, well, it’s that individual’s fault.
Surely it was just their fault that they were consuming too much, but it’s really not as almost simple and as direct as that. It’s the environment in which we find ourselves in which contributes hugely. It’s the portion sizes and the advertising. There’s actually so much that contributes to one being overweight or obese. But we know now that those are critically, almost dangerous elements to have if you do contract Covid.
What is healthy eating?
Where do you start in getting that sorted out – getting the right habits?
If we hear now that being a healthy weight is important, we’re tempted to start crash diets. ‘How can we get a healthy weight now quickly?’ But you’re right, it’s a longer journey. It’s where do we even start? We start with the basic principles about ‘what is healthy eating’ because it will help us on our journey. Not just related to when you develop Covid and you’re trying to avoid complications. It also helps with leading up to being exposed to the virus because nutrition plays a huge role in supporting our immune system. It also plays a massive role in your mental health.
Now we know mental health has taken massive strain. All of us have really taken a knock through this pandemic. So, nutrition there can play a role in dealing with the softer aspects about your risk of developing Covid, and then when you have Covid, how do you prevent those complications? And, you know, I think the huge hopeful message is it’s not new eating. It’s not this new way of extreme eating. It’s very much the same mantra we’ve had for ages about what is healthy eating.
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The healthy foods you should be eating
OK, so help us out here. Someone you know is obese and they are worried that they’re going to get Covid at some point. What do they start doing now to protect themselves?
The most important food group is fruit and vegetables. There’s no doubt. It’s a long, well-known message and there, the aspect to look out for is the variety. So, the more colourful, the better. We tend to have our favourites. We tend to like, for example, Granny Smith apples, so we eat an apple. But the variety is critically important because each aspect or each type of fruit or vegetable provides different nutrients. Winter’s a tricky time. Thank goodness we’re heading into the warmer season, but it’s hard to eat vegetables, salads, and fruit in winter. We always tend to want to eat more of the comfort foods, but veggies and fruits – hands down, the most important food group.
So, just with the seasonal challenges, think of warmer aspects like including vegetables in your soups and your stews. Having a salad, but then almost adding some roast butternut or some exciting aspects like that. So first up, fruit and vegetables.
The second is a food group which we tend to not experiment with or enjoy often is our beans, lentils, chickpeas. They fall into the category called legumes. They are so critically important because they contain fibre and that fibre supports the bacteria in your immune system. All these foods you’ll see we’re talking about; they all support your gut microbiome – those bacteria that reside in your intestine which are responsible for your immune system, which help with your mental health.
So, second up is your beans, lentils, chickpeas – whether it’s in the traditional dried form, you know, we see those dried packets on the shelves and you need to prepare like a day in advance. Somebody like me, not a chance, so I rely on the tinned versions. So, I have tinned chickpeas, tinned lentils, beans – I just tip them into a colander and I just drain off all that salty water – and add in handfuls wherever you can. If you’re making a bolognese, throw in a handful of that soup mix or some split lentils. Chickpeas in a salad. They really are so critically important.
Another food group is obviously your whole grains. So, rice – the best choices to go for are brown instead of white rice. If you’re having pasta, rather go for the wholewheat pastas. Your darker, heavy grain breads, because again, those whole grains have a lot of fibre which support the bacteria in your immune system. And then dairy products – milk and yoghurt – are also incredibly healthy.
That’s interesting. Dairy actually is good for you.
It is. You just need to be smart with the choices you make, because, especially yoghurt – it’s a fermented food. Fermented means it’s got some bacteria in it already. It’s got those starter cultures which actually cause that texture and it gives it that taste, and those bacteria are also hugely beneficial for your body. So, as long as you choosing the wiser dairy choices – so low fat milk, low fat plain yoghurt. The sugary ones are delicious, but they’re basically a dessert. So, rather go for the plain options and sweeten with some fresh fruit.
We always have this eternal debate: would you choose cheese or chocolate if you had to have your one treat forever, because really we do classify cheese in the same light as chocolate. Even though it does have calcium in it, it’s got protein, it’s got a huge amount of fat and a huge amount of salt. So, not a great source of dairy, so stick to more of your yoghurt and your milk.
Better food choices will help fight the virus
Much of what you’ve spoken about now is in boosting the immune system. Is that really your best defence against the virus?
It’s certainly not from the point that we’re not going to be saying, eating a healthy diet is more or as important as washing hands, social distancing – absolutely not. Those are still critically important. Those are the most responsible avenues to take. It’s just that eating a healthy diet doesn’t take any more effort, yet it has so many benefits.
The most important aspects are social distancing, handwashing, wear a cloth mask, stay home as much as you can, be very responsible when you are out… but then make those food choices when you’re home because they cannot only help your immune system, they just help you with depression, anxiety, and they can also help if you do develop the virus. If you’re a healthy weight to start, you have a much higher chance of not having the complications.
We hear a lot about comorbidities and how that has caused people to die from Covid-19. Is that also diet-related or people with the comorbidities like diabetics? There’s not a heck of a lot, it seems, that one can do once you are, are there?
It’s a really good question and it is a good point that you’ve just made. It’s what we call a non-modifiable risk factor. So non-modifiable means there’s not much you can do to change it – your age or gender, and then those comorbidities. So, we’re not saying you’re absolutely doomed because we know that a good diet can prevent you from developing those conditions. But if you have already developed high blood pressure or diabetes, a good diet can really avoid those complications that those conditions themselves can cause.
Covid aside, we know a poorly controlled diabetic – the complications are severe and really, really unpleasant. The same as hypertension. And those comorbidities layered on top of each other also affect your risk of Covid complications, so you also want to avoid developing any more. Just because you have one, it doesn’t mean you’re doomed. It’s just that you want to prevent diabetes, as well as hypertension, and heart disease.
What should you eat if you have Covid?
What about the people now who are Covid-19 positive? Is there anything they can do on their diet, or adjust their diet to help them to overcome it quicker?
Again, it’s just trying to support your body and there you’ll be dealing with quite acute symptoms like high temperatures, a lack of appetite, etc. A big complaint that people have with having Covid is a lack of taste. So, it’s difficult to enjoy food if you can’t taste anything and you can’t smell anything, and that actually lingers for quite a few weeks. Then you’re tempted to almost throw more salt on your food because you’re thinking, this tastes bland. Your body is still reacting to salt. Your body will still react to all those really salty, high flavour foods. So, we’re not saying your food needs to be bland.
It’s just that when you do have Covid, drink loads of fluids, and again, the fluid that’s the healthiest is water. If you’re battling with normal water, try some plain Rooibos or herbal tea. Fluids are critically important, but not the sugar-laden ones because that will just open a whole new element of health issues. So, lots of fluids, healthy vegetables and fruits, and just regular meals because it could also affect your appetite. Regular meals and snacks help to keep your energy up, and rest, rest, rest. Just almost accept that your food will taste bland for quite some time. Don’t resort to loading loads of flavourants to it.
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Terry, just as a checklist for us now, if during this period we want to reduce our chances of getting really ill from Covid-19, how can we adjust our diets now? What for breakfast, what for lunch, and what for supper?
So firstly, what you’ve said is important – breakfast, lunch and dinner. We found that a lot of that has just gone out the window with working from home and the chaos that we find ourselves in. We’ve looked at the global research. We don’t have such level of detail for South Africa, but globally, you ask people, have they continued eating in the same regular routine that they were of meals, and they said no. So, where they were possibly eating two, three times a day before, people are now eating up to six times a day because we’re working and living close to our fridge. It’s really hard to avoid that call of the kitchen and the fridge. So, the first aspect is really, set a routine, set regular meals – breakfast, lunch and dinner. That’s going to be critically important.
Then, in between that, loads of water. Even as a dietitian, I find that by the end of the day I have a headache and I’m not sure what I feel like eating. I have hardly drunk water the whole day because really, whether we distracted with housework, kids, work – something is always distracting us. So, water is critically important. Just drink throughout the day, water, or as we said, plain Rooibos or herbal teas.
So, let’s look at meal types. So breakfast – it is great to have as much fibre in your breakfast as possible because it’s a good start to the day. If you want something warmer, go for a nice porridge like an oats porridge, cooked in some milk, will keep you sustained because if you tend to have just oats with water, there’s no protein, there’s no substance there to keep you going. So, stir in some peanut butter, some of the good healthy fats. If you prefer something more savoury – avo, some eggs on toast, or else you could have some baked beans. Absolutely wonderful. So, a good breakfast. And then just snack on, if you do feel like things in between, a fresh fruit. Naartjies are absolutely delicious at the moment. So really some nice, great seasonal fruits in between.
Lunch is tricky because we tend to think, I’ll have time, I’m home all day – surely I’ll have time to have lunch. Oh my gosh. We are jam-packed between Zoom calls, meetings, and kids at home. It’s difficult to have a healthy lunch so prepare the night before. If you are making dinner, just make a little bit extra. Almost serve up that plate of food so it’s ready and waiting in the fridge for you to have for lunch, or make things that are easy to grab, like a soup. Make sure it’s nice and balanced with loads of beans and vegetables. Add in some chicken or some meat, just to make it nice and heavy, which keeps you feeling full for longer.
If you are really at a loss and you just need to grab something quickly, again, some rye toast or wholewheat bread with avo, some cheese, or even eggs. Eggs are a great lunch, so a nice protein to have is to boil a few eggs, and keep them in the fridge because it’s a quick go-to protein. A tin of fish is absolutely wonderful, whether it’s tuna, or if you’re into sardines and pilchards. They’re not everyone’s favourite but they are so nutritious. Those Omega-3s are critically important. That’s another quick option. Roast a chicken and keep it in the fridge, or even just slice little bits so it’s easy to add to a salad, or to some bread if you want to make an open sandwich.
Avoid unhealthy snacking between meals
The snacking tends to start in the afternoons or the evenings. While we are cooking supper, we actually start to realise, oh my word, I haven’t eaten much today. I haven’t drunk much water. Try to resist that snacking and grabbing little bites to eat while you’re cooking dinner because you often find by the time you sit down, you’re not even that hungry anymore, but you’ve consumed huge amounts of calories. So, try to avoid the snacking. If you do need something to munch on while you’re making dinner, have some carrots. It sounds like such a diet cliche, but carrots are amazing because you actually have to chew them and that’s so satisfying. Or, just cut up some cucumber or have some tomatoes. Just snack on veggies if you are really hungry while you’re making dinner and then with dinner, plan the veggies first.
We tend to put vegetables last in that meal. We call it the side order quite often. Bring them way to the front of your plate. You know, we’ve looked at what actually members have purchased during lockdown (of our vitality members), and cabbage and spinach have been on the increase, interestingly. So, those were great because they green, leafy veg, and they’re healthy for you, so make those a salad like a nice carrot salad, cabbage salad, loads of vegetables, broccoli – any of your favourites. Stir fries… just bring them to the front and the main part of your plate.
As I mentioned earlier, it’s more your brown rice instead of your white, more of your wholewheat pasta – but smaller portions because it’s tricky to control the portions if you put them onto your plate first. If you’re dishing up, say, spaghetti bolognese and that plate is empty, you’re going to fill it with spaghetti and bolognese. Rather put the salad or the vegetables on the plate first, followed with a fistful of starch and then a fist or a palmful of protein, whether it’s a piece of fish, some chicken, or some meat.
Then, the healthy fats that would go with that is, either if you’ve used some olive or canola oil and you’re cooking, or some avo. They’re in season at the moment and they’re absolutely amazing. So, ripen them, keep them in your fridge and have, say, a quarter half an avo with your dinner. Just mixed in with the salad can make it so creamy, delicious and a nice alternative to normal dressing.
Then the evenings, if you are still peckish in the evenings, you know, our working hours are completely upside down. If you have young kids like myself, I find my best times to work are in the evenings or early morning and you become a bit peckish. Make some nice hot chocolate, but I’m talking like the dietitian version of hot chocolate where you mix some water with milk, and you add some cocoa. Just a little bit. Less Milo, less of the hot chocolate powder. A nice yoghurt. Something warm in the evenings often helps the most.
Get into a routine
I think the key message is routine because there is no routine at the moment. So, bring that routine in through your eating, bring it in breakfast, lunch, and dinner. And just a point to make: there are some wonderful benefits that have come out of Covid. It’s the fact that we are home together. We’re cooking more, which is something we’ve always wanted to get people to do, and the fact that our lockdown has just caused that is a huge, huge benefit. People are cooking more. We’re eating more as a family.
So, really keep those devices off and have at least one meal a day as a family when you’re catching up. We tend to think, oh but I’ve seen that person the whole day. They’ve been in my house with me the whole day. But really talking to people – we need to actually still make effort. So, a dinner time is a wonderful time to actually talk and just connect with people.
