Neurologists always encourage their patients to try their best to stay as healthy as possible. In the midst of the COVID-19 outbreak, what was once encouraged is now a call to action. The healthier patients are, the less likely they'll be to experience flare-ups or breakthrough symptoms that may require office visits or hospitalizations. They also may be better able to fight infection if they become exposed to the coronavirus.

Eating well is a key component of good health. "Diet makes a huge difference in how we respond to infectious and inflammatory diseases," says Diane Stadler, PhD, RD, associate professor of medicine at Oregon Health & Science University (OHSU) in Portland. "Consuming a balanced diet with adequate amounts of vitamins and minerals, especially antioxidants, helps our immune response and allows us to maintain a healthy defense system," she says, citing a 2018 study in Nutrients and other studies that show that when individuals who are even marginally deficient in A, D, E, C, or B vitamins or in minerals like zinc and selenium are exposed to viruses, they are more likely to become infected, be sicker, and take longer to recover.

For people with multiple sclerosis (MS), a healthy diet also may help ease fatigue, says Vijayshree Yadav, MD, FAAN, associate professor of neurology at OHSU, who has studied the effects of a low-fat diet in patients with MS. A 2016 study she co-authored that was published in Multiple Sclerosis and Related Disorders showed that a low-fat, plant-based diet rich in fruits, vegetables, antioxidants, and whole grains helped MS patients maintain their health and energy levels. For everybody, a low-sodium diet full of vegetables, fruits, whole grains, lean proteins, low-fat dairy, and foods with omega-3 fatty acids can help control high blood pressure, a risk factor for stroke. "For any type of health condition, you want to put your best defense forward," says Dr. Stadler. "That means eating a well-balanced diet with adequate nutrients."

The challenges to eating healthfully during the COVID-19 crisis are manifold. If you have a neurologic disorder, you want to avoid the grocery store altogether or strictly limit your visits. If you're ordering groceries through delivery services like Instacart, Peapod, FreshDirect, or others, you'll have to account for delays and take what's available. When in-demand items are in short supply, you have to be careful not to default to junk or high-fat and sugary comfort food. But you can address these challenges with planning and flexibility.

If you're avoiding grocery stores altogether and don't want to rely on delivery services, pick a designated shopper in your household or reach out to local services for volunteer shoppers. To make the whole process more efficient and less stressful, think about your family meals over a two-week period and write down menus for each day and the foods you'll need, says Lindsay Bailey, MS, a dietitian at Akron Children's Hospital. "Stress can tear down your immunity, so it is important to avoid or reduce it." If preparing multiple meals every day causes stress, cook in large batches and freeze portions that can be defrosted and reheated for a quick, easy meal. Soups, quiches, muffins, stews, and chili would all work well; grains and beans also can be cooked in large quantities and frozen.

Shopping List Tips

Before you (or your designated shopper) go to the grocery store or before you order from a delivery service, create a nutritious shopping list. Look for recipes that feature a variety of fresh produce, protein, and whole grains, and put their ingredients on the list. "Foods that contain antioxidants—specifically, fresh fruits and vegetables, nuts, seeds, and beans—help protect the body against cell damage caused by free radicals," says Bailey. Consider healthier snacks like carrots, apples, hummus, or hard-boiled eggs. Dr. Stadler advises buying snacks like chips and pretzels in smaller quantities or not at all, though she notes that in moderation all foods can be part of a healthy, well-balanced diet.

As you compose your list, think about "eating the rainbow": Write down fruits and vegetables of different colors, such as kale, bell peppers, carrots, beets, apples, blueberries, and oranges. To meet your fiber quota, include whole wheat bread, brown rice, quinoa, and other whole grains on your list. Get protein from tofu, tempeh, or lean poultry and fish.

List foods that have a longer shelf life—grains, beans, lentils, nuts, and seeds—and that can be bought in bulk. Consider ingredients that can be used in multiple recipes or stored or frozen for later use, such as berries, cabbage, dark orange squash, root vegetables, sweet potatoes, and onions. Load up on frozen fruits and vegetables. Ask your shopper to buy whole chickens, large fish fillets, and family-size packages of ground turkey that can be divided into portions to be frozen.

If canned fruit is on your list, it should be packed in 100 percent fruit juice without added sugars. Canned beans should be low-sodium, and canned fish, like tuna, should be packed in water rather than oil and without added salt.

If someone in your household has dietary restrictions, plan accordingly. For example, a person with swallowing difficulty (dysphagia) may be limited to foods with certain textures. "Speech therapists recommend different types of modification—from thickened liquids to foods that are pureed or minced and moist or soft and bite-sized—based on the severity of dysphagia," says Karlie Diamond, a clinical registered dietitian at Shirley Ryan AbilityLab in Chicago. Examples include yogurt, smoothies, pureed soup, tender meats and fish, and soft-cooked chopped vegetables.

If you cook for somebody who has contracted COVID-19 and has difficulty tasting and smelling food as a result, Dr. Stadler recommends focusing on the temperature and texture of food so he or she can enjoy it through other senses. (For more about coronavirus-related loss of smell and taste, see Ask Your Neurologist.)

Even designated shoppers should minimize time spent in the store, so organize your list by category—produce, canned, frozen, beverages, dairy—so they can grab and go.

Food-Storage Secrets

While healthy shopping means you're getting vegetables like green beans, asparagus, broccoli, and leafy greens, these foods don't keep for long. But you can chop them into small pieces, blanch them in boiling water for 30 seconds, and freeze them for later. Spinach, kale, Swiss chard, or arugula that is starting to droop can be pureed with a little water and frozen in ice cube trays or small containers to add to recipes later.

Prepping fruits and vegetables before freezing makes them easier to use later, says Dr. Stadler. "For instance, cut butternut squash into 2-inch squares, shred zucchini, cut the ends off green beans, peel and cut or grate carrots, tear kale and other greens into bite-sized pieces, and blanch and peel Roma tomatoes," she suggests. "Store everything in sealable bags or containers and mark the contents and date of storage."

To preserve fresh herbs, which can wilt or go bad quickly, freeze in olive oil or vegetable broth, or freeze with vegetable scraps such as onion ends, carrot tops or ends, and celery stems to make stock for soups, stews, or grains. Meat, chicken, and fish should be wrapped tightly in plastic or freezer paper, then sealed in aluminum foil or a freezer-safe bag. They can last at least three months that way. When you're planning to prepare the meat or fish, thaw it in the refrigerator overnight.

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