Dr. Megan Rossi: How to treat gut problems caused by Covid

Most infections like the common cold can leave us feeling very miserable for several days, but then we tend to recover slowly and get back to normal again within a week or so.

Sometimes, though, the infection can have a nasty sting in its tail, with long-term effects that may seem unrelated to the original symptoms. I am specifically talking about Irritable Bowel Syndrome (IBS) caused by Covid infection.

I’ve noticed this a lot in my clinic, where asymptomatic clients complain of problems like bloating, abdominal pain, and altered bowel habits within weeks of recovering from Covid.

You may be wondering how a respiratory infection like Covid can leave you with chronic bowel issues like IBS.

In fact, gut symptoms are a very common sign of Covid infection itself. Although I was able to avoid them, many of my clients were not so lucky, and nearly 20 percent of the general population experienced problems such as nausea, vomiting, diarrhea, and a lack of appetite.

Most infections like the common cold can leave us feeling very miserable for several days, but then we tend to recover slowly and get back to normal again within a week or so.

Studies have also shown that the virus is present in the stools of about 50 percent of people with COVID-19. During the height of the epidemic, it was actually considered a source of its spread.

This isn’t surprising given that the virus that causes COVID-19 (SARS-CoV-2) attaches to ACE2 receptors in your body — as well as in your lungs, these receptors are in the gut, allowing the virus to affect the gut lining directly.

Interestingly, several studies have also shown that people with poor gut health are more likely to develop Covid disease.

IBS caused by the Covid virus is slightly different – something basically messed up the gut: it looks good but it doesn’t work as it should, which is what we call a functional disorder. And research shows that gut infections and stress in general (such as when you’re sick) can increase your risk of IBS many times over.

So, too, the balance of your gut microbiome can change — inflammation from any gut infection can upset that balance, increasing your risk of IBS by threefold. So if you’ve had gut symptoms after Covid, it’s possible you’ve developed IBS. But before self-diagnosing, visit your doctor for an examination; There is also a Long Covid NHS service, visit yourcovidrecovery.nhs.uk.

If you’re still leaning toward IBS, keep in mind that there are official diagnostic criteria.

What many people don’t realize is that IBS isn’t ‘only’ about diarrhea or constipation: the main symptom is recurrent abdominal pain – according to official criteria, for a diagnosis of IBS, this pain must occur on average once At least 1 day a week (with symptoms appearing for six months), and it must be associated with two or more of the following:

  • The pain improves or gets worse when you have a bowel movement.
  • Pain is more common when more or less stools are passed than usual.
  • The pain coincides with your stools being softer or firmer than usual.

If this describes your symptoms, the first line of treatment is to look at your diet. This means giving up alcohol and avoiding spicy foods, caffeine, fried foods, and fatty meats, all of which stimulate a bowel movement that can worsen symptoms.

Artificial sweeteners are another thing to watch out for (especially those ending in -ol, like sorbitol and xylitol, as they can be poorly digested, causing gas and pain).

drink plenty of water, but reduce the intake of fruit juice and juices – you should aim for two pieces of fruit; Five servings of vegetables. Three servings of whole grains and two servings of nuts/seeds/legumes each day.

Irritable Bowel Syndrome caused by the Covid virus is slightly different - something basically messed up the gut: it looks good but doesn't work as it should, which is what we call a functional disorder

Irritable Bowel Syndrome caused by the Covid virus is slightly different – something basically messed up the gut: it looks good but doesn’t work as it should, which is what we call a functional disorder

Chronic gut symptoms are not just related to Covid infection. Gut bugs can also have a long-term effect that appears unrelated to the insect itself; For example, it causes temporary lactose intolerance.

Lactose is the sugar in dairy products, and temporary lactose intolerance is something I see all the time in the clinic. After a gut infection, people often find that they cannot eat as many dairy products they previously enjoyed because it causes symptoms such as cramping pain, bloating, and loose stools.

What happens is that the gut infection and the inflammation it causes damages the cells of the intestine that produce lactase, the enzyme that digests lactose. As a result, the lactose is not broken down properly and ends up in the large intestine, where it is fermented by the lactose-naive bacteria that live there, producing gas and causing gastrointestinal symptoms such as loose stools.

Fortunately, most other digestive enzymes are produced outside the small intestine, specifically in the pancreas, so gut infections do not tend to affect its ability to digest other components of our food. Most people affected by this can still handle small amounts of lactose – 50ml of milk (what you would take in a cup of tea) per session and up to 150ml over the course of the day – without any problems.

The difficulty is that there is a lot of “hidden” lactose in our food – it’s used as a sweetener in food processing, like cereal and crackers, for example – so you might not realize that your gut symptoms are actually caused by the lactose in that cracker and slice of cake and not IBS. for example.

But what may seem surprising is that while milk can cause problems, hard cheese is OK: This is because a lot of lactose is drained out during the production process, so it’s very low in lactose.

Likewise with live yogurt, a large amount of lactose was eaten by bacteria during the fermentation step to produce yogurt.

Many people who are lactose intolerant think they need to stop eating dairy products for good, but this is not the case. It is worth including small amounts that you can manage in your diet, as fermented dairy products in particular are associated with a range of health benefits such as reduced risk of heart disease and a healthy body weight, as well as being a major source of calcium, important for bone strength and nerve function.

Within two to three months, lactase production should return to normal as your gut has healed from the infection – and you can return to enjoying lactose-containing dairy products.

For those with genetic lactose intolerance — which can affect up to 95 percent of people of African American and Asian descent — it’s still beneficial to include a small amount of lactose in your diet. This in turn supports the growth of lactose-digesting bacteria in your gut, which over time enhances your gut’s ability to process lactose, resulting in greater tolerance and fewer symptoms.

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Ask Megan

My daughter (eight years old) often has flatulence and a hard stomach after eating – and has a lot of gas. How can we reduce this? The doctor’s tests revealed a slight lactose intolerance. We have greatly reduced our lactose intake and generally eat healthily.

Name and address provided.

It’s important to overcome gut symptoms when kids are young, but it’s also important not to over-focus and make them feel self-conscious, which can exacerbate gut issues in adulthood.

Talking openly with your daughter about her bowel habits will provide some valuable information to help you and your doctor determine whether diarrhea or constipation can lead to an upset stomach — two common causes of excess gas and bloating. I will consider the frequency of bowel movements, as well as consistency.

This information will also help detail any dietary recommendations. In general, your daughter’s diet appears to have a good amount of fibre. Fluid is also important, as it enables the fiber to work its magic in terms of slack, so I will make sure she also gets enough fluids (about 1,300ml per day for eight-year-olds).

If she doesn’t like water, add fresh mint and frozen berries to make it more appealing. Whole fruit is great for children, but, as with adults, overdoing it in one sitting can cause it to bloat a bit, so keep in mind that fruits are spaced no more than 80g per session, with up to three sessions over the course of today.

Try this: Zucchini and Hazelnut Salad

When you and your microbes are craving something light that doesn’t fall short on the flavor front, look no further. This light bite will hit the spot, giving you 7g of fiber and eight veggie points closer to your weekly goal.

serves 2

2 zucchini / 40g mixed salad leaves (such as spinach, arugula, watercress) / 60g crumbled feta (substitute 30g for Parmesan if you are lactose intolerant) 30g toasted hazelnuts, chopped 20g mixed seeds


  • 1 tablespoon of extra virgin olive oil. l juice of half an orange (about 40 ml); For 2 teaspoons vinegar juice. 1 teaspoon honey


  • 2 teaspoons mint leaves, finely chopped.
  • 40 grams of pomegranate seeds

Mix the sauce ingredients. Season and adjust flavors to taste. In a small bowl, peel the zucchini into strips, then pour the sauce over them.

Leave to soak for a few minutes before tossing the salad leaves.

Divide the zucchini mixture into two serving bowls, then add the feta cheese, hazelnuts, and seeds to each.

Pour over any remaining dressing, before scattering mint leaves and pomegranate seeds over it.

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