Fully Remote, Telehealth-based Ketogenic Metabolic Therapy for Long COVID

National University of Natural Medicine11 enrolled

Overview

The goal of this clinical trial is to learn if a 12-week ketogenic diet program combined with lifestyle strategies (called KMT-LS) is practical and acceptable as a fully remote intervention for adults with Long COVID who also have Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. (ME/CFS) and dysautonomia (problems with heart rate, blood pressure, or other automatic body functions). The main questions it aims to answer are: Can a ketogenic diet program be successfully delivered entirely from home using online tools and virtual support? Do participants stay in the study, follow the diet, and find the program safe and satisfactory? Do participants experience improvements in fatigue, sleep, mood, daily functioning, and symptom flare-ups after exertion? Participants will: Follow a ketogenic diet for 12 weeks with weekly virtual nutrition support sessions Use at-home tools to track their ketone levels and confirm they are following the diet Complete online questionnaires about their symptoms, energy, sleep, mood, and daily functioning at the start of the study, after 12 weeks, and again 3 months later.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Long COVID Fatigue

Interventions

Keto-Life is a fully remote, community-based program for individuals with Long COVID, dysautonomia, and ME/CFS that combines a ketogenic diet with lifestyle strategies. Participants followed a ketogenic diet (low-carbohydrate, moderate-protein, high-fat) with a personalized intermittent eating schedule, no added sugar, and daily benfotiamine (vitamin B1) supplementation. Electrolyte support included magnesium, potassium, sodium bicarbonate, and sodium chloride. Nutrition calls were once a week via Telehealth platform, delivered by a medical nutritionist.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: Age 18 years or older English-speaking Suspected, probable, or confirmed SARS-CoV-2 infection as defined by the Pan American Health Organization Long COVID diagnosed via structured clinical interview, consistent with the World Health Organization clinical case definition and the National Academies of Sciences, Engineering, and Medicine (2024) definition Physician-confirmed diagnosis of post-infectious dysautonomia and ME/CFS; OR self-reported dysautonomia symptoms with a Malmö POTS Score Assessment (MAPS) score greater than 40 Met the National Academy of Medicine diagnostic criteria for ME/CFS Exclusion Criteria: * Known pregnancy or planning pregnancy during the study period Active cancer diagnosis Renal or liver failure Pancreatitis Atrial fibrillation or significant cardiac arrhythmia Significant atherosclerotic disease Uncontrolled hypertension or hypertriglyceridemia Active or recent thrombosis Use of antiepileptic medications Use of SGLT-2 inhibitors Substance use disorder Type I diabetes History of inborn errors of metabolism Previous completion of a nutritional and lifestyle program for this condition

Outcomes

Primary Outcomes

Acceptability

Acceptability data were measured via participants' perception of treatment suitability using a 5-point Likert scale (e.g., 1 = Not at all helpful; 5 = Extremely helpful). Participants were asked to rate their level of satisfaction with the program, the perceived helpfulness and relevance of the program, and the likelihood of recommending the program to others. Assessment burden was measured using a 5-point Likert scale (1 = Strongly Disagree, 2 = Disagree, 3 = Undecided, 4 = Agree, 5 = Strongly Agree). Participants were asked to rate the burden associated with sourcing food, cooking food, and completing assessment procedures. Further, acceptability was explored via questions pertaining to optimization of the study, including opinions on dosing and duration of the intervention.

Time frame: Acceptability data was collected at post-intervention (Week 13).

Feasibility

Feasibility of the research procedures and remote intervention was evaluated using metrics of enrollment (target sample size n = 10), attrition, population characteristics (e.g., percentage of participants identifying as non-white), completion of data-collection procedures within a 2-week window, amount of missing data, dietary adherence, and safety. The target sample size of 10 was selected to optimize group dynamics for the interactive, group-based components of the ketogenic metabolic therapy intervention, including weekly nutrition calls. Attendance at the weekly nutrition calls was recorded. We assessed adherence to dietary recommendations through participant self-report and objective metabolic data. Participants measured fasting capillary blood β-hydroxybutyrate (BHB) and fasting blood glucose using a commercially available, FDA-registered at-home device (Keto Mojo Meter, Keto Mojo, Inc.).

Time frame: Acceptability data was collected during at baseline, Weeks 1-12, and post-intervention (Week 13).

Secondary Outcomes

PROMIS-29

PROMIS-29 to assess self-reported levels of physical, social, and cognitive functioning, anxiety, depression, pain interference, and sleep disturbance. Each subscale is standardized to a T-score (Mean = 50, SD = 10), where higher scores represent more of the concept being measured (e.g., more anxiety or better physical function). A threshold of 3 T-score points is considered a minimal clinically important difference (MCID) for each subscale

Time frame: Baseline, Post-intervention (13 Week), and 3-month follow-up

Duke Activity Status Index

Measured functional capacity using a 12-item self-report questionnaire that assesses the ability to perform specific activities of daily living. Each item is weighted by its metabolic equivalent value, with total scores ranging from 0 to 58.2. Higher scores indicate greater functional capacity and serve as a validated surrogate marker for peak oxygen uptake .

Time frame: Baseline, Post-Intervention (13-Weeks), 3-Month Follow-up

Modified Medical Research Council Dyspnea Scale

Measures respiratory limitation, which categorizes breathlessness on a 5-point scale (Grade 0-4) based on the level of physical exertion required to elicit shortness of breath. A 1-point increase represents a significant decline in function and is recognized as the MCID.

Time frame: Baseline, Post-Intervention (13-Weeks), 3-Month Follow-up

Malmö POTS Symptom Score

MAPS is a self-rated, 12-item visual analogue instrument (0-10 per symptom, total 0-120) that measures orthostatic and autonomic burden. Each item scores current symptom burden; higher totals indicate greater symptom severity.

Time frame: Baseline, Post-intervention (13 Weeks), and 3-month follow-up

Good Day/Bad Day Questionnaire

The Bateman Horne Center Good Day/Bad Day Questionnaire is not scored as a symptom-severity index; its two anchors are Hours of Upright Activity (HUA) and the number/proportion of good days, both of which are functional-capacity metrics. More upright hours and a higher good:bad day ratio indicate greater functional capacity and less PEM burden; lower values indicate more severe illness.

Time frame: Baseline, Post-Intervention (13-Weeks), 3-Month Follow-up

Satisfaction with Life Scale

Evaluates global life satisfaction using a 5-item instrument that uses a 7-point Likert scale to assess an individual's conscious evaluative judgment of their life. Scores range from 5 (Extremely dissatisfied) to 35 (Extremely satisfied).

Time frame: Baseline, Post-intervention (13-Weeks), and 3-month follow-up

Fully Remote, Telehealth-based Ketogenic Metabolic Therapy for Long COVID

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes