Colgan et al. (2025)
- Authors: Dana Dharmakaya Colgan, Diane D. Stadler, Aluko A. Hope, Heather Zwickey, Todd E. Davenport, Thomas Weimbs.
- Institutes: Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA; Department of Neurology and Long Covid Clinic Program, Oregon Health & Science University, Portland, OR, USA; School of Medicine, Oregon Health & Science University, Portland, OR, USA; Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA; Department of Physical Therapy, School of Health Sciences, University of the Pacific, Stockton, CA, USA; Department of Molecular, Cellular, and Developmental Biology, University of California Santa Barbara, Santa Barbara, CA, USA; Santa Barbara Nutrients, Inc, Santa Barbara, CA, USA.
- Publisher: Case Reports in Clinical Medicine
- Link: DOI
Summary
This case report provides a detailed account of a remarkable recovery in a patient with severe Long COVID, ME/CFS, and POTS using a combined ketogenic diet and lifestyle intervention. The authors suggest that this approach may work by correcting underlying metabolic issues, such as mitochondrial dysfunction and insulin resistance, which are increasingly thought to be drivers of the illness. For patients familiar with the typical non-recovering trajectory of ME/CFS, this report is significant because it documents a return to a high level of function from a state of severe disability. While this is only a single case, it offers a strong, biologically-plausible rationale for larger clinical trials to investigate metabolic therapies as a potential treatment.
What was researched?
This paper presents a case report on a 44-year-old female with severe Long COVID, including diagnoses of ME/CFS and POTS. It documents her response to a 12-week, remotely-delivered program that combined a ketogenic metabolic therapy (KMT) with lifestyle interventions aimed at stabilizing circadian rhythms and incorporating mindfulness.
Why was it researched?
Long COVID is a widespread and complex chronic condition with no FDA-approved treatments. The authors propose that because it affects multiple body systems, a multi-component, “whole person” approach is likely required. This study was conducted to explore whether targeting proposed underlying mechanisms of Long COVID, such as mitochondrial dysfunction and inflammation, with a combined metabolic and lifestyle intervention could reduce symptoms and improve quality of life.
How was it researched?
This study is a clinical case report of one patient. Prior to the main intervention, the patient had tried numerous treatments; some provided limited relief, including low dose naltrexone đź’Š which decreased neuropathic pain, iron infusions đź’Š which resolved iron deficiency, and saline infusions đź’Š which temporarily reduced hypotension. In February 2024, she enrolled in a 12-week virtual program that included a specialized ketogenic diet, daily supplements including Benfotiamine đź’Š (a form of Vitamin B1), Magnesium đź’Š, and Potassium đź’Š, and health coaching on lifestyle changes like sleep routines and mindfulness. Her symptoms and functional capacity were tracked using standardized patient-reported outcome questionnaires before the intervention and at one, four, and seven months after it began.
What has been found?
The patient experienced significant and clinically meaningful improvements across multiple domains. Within the first two weeks of the intervention, her chronic hypotension resolved, and she discontinued IV saline therapy. Over the course of the program and the following months, she reported resolution of light and sound sensitivity, normalization of her menstrual cycle, a drastic reduction in headaches, and improvement in brain fog. Most notably, her extreme fatigue episodes and post-exertional malaise (PEM) diminished, allowing her to resume daily activities, return to work full-time, and engage in light exercise without crashing.
Discussion
The authors acknowledge the primary limitation of a case report is that it cannot prove cause and effect; the patient’s improvement could be due to a placebo effect or natural disease progression. It is also impossible to determine which component of the multimodal intervention was most impactful. However, they contrast the patient’s dramatic recovery with recent studies showing that most Long COVID patients’ symptoms remain largely unchanged in the second year of illness, highlighting the potential significance of these findings.
Conclusion & Future Work
The authors conclude that the synergistic effects of combining ketogenic metabolic therapy with lifestyle interventions may target multiple underlying mechanisms of Long COVID, leading to reduced symptom burden and improved quality of life. They state that these clinical observations support the need for future, larger research trials to formally evaluate and optimize such multimodal nutritional and lifestyle programs for patients with Long COVID and related conditions.