From Fatigue to Focus: Keto’s Impact on Long-Haul Syndrome

A Lingering Mystery — and How a Ketogenic Diet Could Help

About seven percent of Americans—along with 400 million people worldwide—suffer from long-haul syndrome, a condition marked by crushing fatigue, brain fog, headaches, and lingering pain even after recovery from the virus that causes severe acute respiratory syndrome has cleared. Researchers are still unsure why the condition arises, but they suspect the hyper inflammatory response of the viral infection persists long after the illness has resolved. Treatment is generally non-existent beyond plenty of rest. However, scientists are exploring a promising option for this complex (and often baffling) condition: a ketogenic diet.

Long Haul Syndrome: A Case Study

Published last month in Case Reports in Clinical Medicine, a 44-year-old athletic woman with an unremarkable health history presented with long haul syndrome in late 2023.¹ She was experiencing extreme fatigue, chills, cold sweats, and significant cognitive dysfunction. Testing confirmed the presence of antibodies for a past viral infection of severe acute respiratory syndrome. After her first dose of the mRNA vaccine, her symptoms expanded to include severe joint pain and swelling; excruciating neuropathic pain in her hands and fingers; blisters below her fingernail beds; nausea, dizziness; and vertigo. She was subsequently diagnosed with multi system inflammatory syndrome by an infectious disease specialist. She then contracted the virus four more times, each episode worsening her post-exertional fatigue and leading to weight gain, light and sound sensitivity, irregular uterine bleeding, and low blood pressure.

She was also diagnosed with Postural Orthostatic Tachycardia Syndrome (POTS), ME/CFS, and neuroimmune disorder. Mast cell activation was also suspected, but was unconfirmed. Epstein-Barr reactivation, herpes, parvovirus viruses, systemic lupus, Sjogren’s syndrome, Graves’ Disease, celiac disease, and myasthenia gravis were ruled out. The team noted:

“The clinical progression included a documented vaccine injury, followed by multiple COVID-19 infections, and the eventual onset of clinical symptoms and diagnoses of LC and associated chronic illness, such as POTS and ME/CFS. While there is a clear need to distinguish between post-acute COVID-19 vaccination syndrome and LC, the lack of scientific and clinical data impeded the ability to discriminate between the diagnoses.”²

Nutritional and Lifestyle Protocol

After multiple pharmaceutical interventions without improvement of symptoms, the patient was then placed on a nutritional and lifestyle protocol that included:

• A ketogenic diet (60-80 grams of protein, 100 grams or more of fat (grass-fed organic ghee, beef tallow, or A2A2 butter (if tolerated), and 15-20 grams or fewer carbohydrates per day)
• Minimal plant toxins (lectins, oxalates, endocrine-disrupting glycoalkaloids, such as solanine and phytoestrogens)
• Elimination of sugar and starches
• Benfotiamine — a fat-soluble form of Vitamin B1 (starting with 250 mg/day and titrating up, as tolerated, to 2000 mg/day)
• B-vitamin complex, vitamin C, cod liver oil (2T/day)
• Magnesium citrate/malate (3000 mg/day)
• Daily electrolytes: Potassium citrate (3000 mg), Sodium bicarbonate (1200 mg), Sodium chloride (1000 mg)
• Four to six cups of homemade meat broth daily with cooked vegetables

Entraining the Circadian Rhythm:

• Exposure to bright morning light
• Reduced blue light from devices in the evening
• Intermittent fasting
• Time-restricted eating
• Stable routine of waking, eating, and sleeping every day

Mindfulness-Based Strategies:

• Breathing techniques
• Non-reactive awareness of negative thinking
• Reframing negative thoughts
• Body scans
• Mindful eating

The Results

After two weeks of following the specialized protocol, the patient reported a notable increase in energy (which coincided with the onset of ketosis), and her chronic hypotension resolved. By the second month: sensitivity to light and sound disappeared; irregular uterine bleeding ceased; headaches reduced from 4-5 times/week to one or two per month; and brain fog improved. Over twelve weeks she lost 15% of her body weight and was able to bathe, cook, shop, and walk.

The researchers found that the underlying driver of long-haul syndrome is hyperinflammation caused by mitochondrial dysregulation and impaired redox signaling.⁷ Because of this, a ketogenic diet may counteract mitochondrial dysfunction and inflammation by switching the primary mitochondrial fuel source from glucose to ketones.8 The diet also helps to reduce oxidative stress in the mitochondria and downregulate pro-inflammatory cytokines.^9,10 Along with key supplements and lifestyle support, the protocol alleviated many of the symptoms and helped the patient regain much-needed quality of life.

The team concluded:

“An all-unifying, pathophysiologic underlying mechanism does not yet exist for LC. Given the complexities of this disease, multiple treatment strands, positioned from a whole person health model, that provide multi-component approaches to care are likely ideal treatment.⁶ These clinical observations suggest that the synergistic effects of ketogenic metabolic therapy, combined with group health coaching sessions to entrain and stabilize circadian rhythm and teach mindfulness-based practices, may target multiple proposed mechanisms underlying LC, thus, reducing symptom burden and improving quality of life.”^3,4,5

The Ultimate Botanical Blend for Wellness

Herbal remedies are an outstanding complement to a ketogenic diet in cooling inflammation, improving mitochondrial function, boosting energy, banishing brain fog, and more. The following botanicals are included in our potent Eastern Blend formulation:

Chinese skullcap demonstrates antiviral activity against colds, flu, and severe respiratory illness — while also easing joint inflammation, calming anxiety, supporting sleep, and protecting brain function. Japanese honeysuckle adds further antiviral and antibacterial power, soothing upper respiratory tract infections and reducing inflammation. Japanese knotweed helps inhibit viral replication, strengthens cardiovascular health, supports cognition, improves metabolic function, and reduces neuroinflammation. Cordyceps medicinal mushroom stands out for its ability to combat influenza-related lung injury, inhibit viral entry, fight fatigue, ease chronic inflammation, and promote neuroprotection, memory, and learning.

OUTSTANDINGLY EFFECTIVE

“My family and I have used Nicole’s tinctures for quite some time with incredible results — and her Eastern Blend is no exception!

I have struggled health-wise for years due to Lyme disease, but when we experienced non-stop contagious illness in the winter, spring, and summer of 2021-2022, including contracting “you-know-what” an astounding three times in nine months, I knew we needed a different approach.

We started with the Bronchial Blend, which took care of our severe respiratory issues within a few days. For autumn and winter of 2022-2023, we began using Nicole’s Eastern Blend, Travel Pack, Mushroom FOURtress, and Balanced Gut.

Wow, what a difference from last year! We have not been sick one time, even though everyone else around us has been impacted by strep throat, influenza A, severe acute respiratory syndrome, and more. Plus, the inflammation, brain fog, and fatigue from the Lyme has disappeared. We are believers — these products work!

Thank you Nicole for your dedication to natural health and sharing it with the world!”

-C.Wright

Keto is powerful — but it’s even more effective with the herbal support of our Eastern Blend. Stop by the apothecary today and experience the benefits yourself!

Nicole Apelian

Nicole’s Apothecary Products in this Post

References

1. Dana Dharmakaya Colgan, Diane D. Stadler, Aluko A. Hope, Heather Zwickey, Todd E. Davenport, Thomas Weimbs Case Reports in Clinical Medicine Vol.14 No.8,  August 6, 2025. DOI: 10.4236/crcm.2025.148052  
2. Scholkmann, F. and May, C. (2023) COVID-19, Post-Acute COVID-19 Syndrome (PACS, “Long COVID”) and Post-Covid-19 Vaccination Syndrome (PCVS, “Post-Covidvac-Syndrome”): Similarities and Differences. Pathology—Research and Practice, 246, Article ID: 154497. https://doi.org/10.1016/j.prp.2023.154497
3. National Academies of Sciences, Engineering, and Medicine (2024) A Long COVID Definition: A Chronic, Systemic Disease State with Profound Consequences. https://nap.nationalacademies.org/catalog/27768/a-long-covid-definition-a-chronic-systemic-disease-state-wih
4. Al-Aly, Z., Davis, H., McCorkell, L., Soares, L., Wulf-Hanson, S., Iwasaki, A., et al. (2024) Long COVID Science, Research and Policy. Nature Medicine, 30, 2148-2164. https://doi.org/10.1038/s41591-024-03173-6
5. Davis, H.E., McCorkell, L., Vogel, J.M. and Topol, E.J. (2023) Long COVID: Major Findings, Mechanisms and Recommendations. Nature Reviews Microbiology, 21, 133-146. https://doi.org/10.1038/s41579-022-00846-2
6. Langevin, H.M. (2021) Moving the Complementary and Integrative Health Research Field toward Whole Person Health. The Journal of Alternative and Complementary Medicine, 27, 623-626. https://doi.org/10.1089/acm.2021.0255
7. Crook, H., Raza, S., Nowell, J., et al. (2021) Long COVID-Mechanisms and Management. BMJ, 374, n1648.
8. Santos, A.F., Póvoa, P., Paixão, P., Mendonça, A. and Taborda-Barata, L. (2021) Changes in Glycolytic Pathway in SARS-CoV2 Infection and Their Importance in Understanding the Severity of Covid-19. Frontiers in Chemistry, 9, Article 685196. https://doi.org/10.3389/fchem.2021.685196
9. Paoli, A., Gorini, S. and Caprio, M. (2020) The Dark Side of the Spoon—Glucose, Ketones and COVID-19: A Possible Role for Ketogenic Diet? Journal of Translational Medicine, 18, Article No. 441. https://doi.org/10.1186/s12967-020-02600-9
10. Stubbs, B.J., Koutnik, A.P., Goldberg, E.L., Upadhyay, V., Turnbaugh, P.J., Verdin, E., et al. (2020) Investigating Ketone Bodies as Immunometabolic Countermeasures against Respiratory Viral Infections. Med, 1, 43-65. https://doi.org/10.1016/j.medj.2020.06.008