General Health, Immunological

Clinically Meaningful Improvements in Long COVID Symptoms Following Ketogenic Metabolic Therapy Combined with Lifestyle Interventions—A Clinical Case Report and Review of the Literature

This case report describes a 44-year-old woman with Long COVID complicated by postural orthostatic tachycardia syndrome (POTS), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and probable mast cell activation syndrome. Her symptoms included severe fatigue, orthostatic intolerance, migraines, cognitive dysfunction, flushing, and multi-system complaints. These persisted despite conventional and integrative interventions such as medications, supplements, IV therapies, pacing, and dietary modifications.

In February 2024, she began a 12-week virtual program of ketogenic metabolic therapy (KMT), incorporating a 70% fat, 25% protein, 5% carbohydrate diet alongside circadian rhythm support and mindfulness practices. The plan included minimal plant toxins, high-dose thiamine, electrolyte supplementation, time-restricted eating, morning light exposure, reduced evening blue light, and mindfulness techniques (breathing, body scans, reframing). She measured her blood ketones and blood glucose daily, and she  recorded her dietary intake with a tracking app.

Patient-reported outcomes and clinical metrics were collected at baseline and post-intervention, with clinically meaningful changes defined by minimal clinically important difference (MCID) thresholds.

Results:

• Dysautonomia: COMPASS-31 score improved from 31 to 19.
• Physical activity: DASI-METS increased from 3.13 to 5.62.
• Migraine disability: MIDAS score dropped from 60 (severe) to 12 (mild).
• Dyspnea: mMRC grade improved from 3 to 1.
• Fatigue: MFIS total score reduced from 57 to 30.
• Vital signs: BP rose from 95/56 mmHg to ~125/70 mmHg; resting HR decreased from 109 to 72 bpm.
• BMI: Decreased from 23.0 to ~20.2 kg/m², later stabilized at 21.0.
• Fasting ketones/glucose: Maintained ketones at 0.8–4.2 mmol/L and glucose at 70–100 mg/dL.
• Function: Regained independence in daily activities; was able to perform cognitive work for 1-3 hours every other day by 3 months and 5-6 hours every day by 7 months.
• Symptom improvements: Resolution of chronic hypotension, sound/light sensitivity, and abnormal uterine bleeding; reduced headache frequency and flushing; improved brain fog and reduced PEM severity.

The authors discuss possible mechanisms for the observed benefits of KMT, which may improve mitochondrial energy production, reduce inflammation, and address insulin resistance – factors implicated in Long COVID. Other elements of the program, including high-dose thiamine, electrolyte supplementation, circadian rhythm stabilization, and mindfulness practices, may have provided additional support for energy metabolism, autonomic function, and stress resilience.

As a single case report, the study cannot establish causation or isolate the most impactful components. However, the range of improvements contrasts with observational studies showing most Long COVID patients experience persistent symptoms beyond one year. These findings support further research into integrated nutritional and lifestyle approaches for Long COVID and related post-infectious syndromes.