Telehealth-Based Ketogenic Metabolic Therapy With Lifestyle Interventions for Post-viral Illness: [...] Patients’ Experiences, 2026, Colgan et al

[forestglip]

Telehealth-Based Ketogenic Metabolic Therapy With Lifestyle Interventions for Post-viral Illness: A Research Brief of Patients’ Experiences

Colgan, Dana Dharmakaya; Stadler, Diane D.; Grow, Tabitha; Ruddick, Mary; Weimbs, Thomas; Davenport, Todd E.; Zwickey, Heather

Background/Objectives
Infection-associated chronic illnesses are associated with substantial functional impairment that limits participation in traditional in-person research. A fully remote, multicomponent intervention that combines ketogenic metabolic therapy (KMT) with behavioral interventions targets several proposed biological mechanisms underlying these conditions. This study aimed to characterize patient-reported experiences with a fully remote intervention that integrated KMT and thiamine supplementation with behavioral strategies, including circadian entrainment and mindfulness-based resilience coaching.

Methods
In this cross-sectional study, quantitative data were collected via online REDCap surveys. Feasibility and acceptability benchmarks included perceived treatment suitability, relevance, safety, and reported treatment adherence. Optimization items evaluated preferred program duration, dosing, and structure, as well as components that respondents identified as most important for future refinement.

Results
Among an international sample ( n =41), all feasibility and acceptability benchmarks were met: 96% reported the intervention was helpful, 96% recommended it, and 75% felt “ a lot better ” after completion. Respondents provided patient-centered perspectives to optimize the intervention.

Conclusions
Incorporating patient perspectives is essential for guiding the development of safe, acceptable, and effective treatment strategies for infection-associated chronic illness, including Long COVID. Strong indicators of feasibility, acceptability, and perceived benefits support the rationale for larger controlled trials to investigate clinical efficacy and the underlying mechanistic pathways of multicomponent metabolic interventions.

Web | DOI | PMC | PDF | Journal of Patient Experience | Open Access

 

[forestglip]

Seventy-one percent reported dysautonomia with Postural Orthostatic Tachycardia Syndrome (POTS), nearly 60% reported ME/CFS, and 82% reported chronic pain. Approximately 83% reported a history of COVID-19 infection.

 

[forestglip]

Recruitment emails with survey links were sent to 194 adults who completed the 12-week KMT-LS program between June 2022 and June 2024. Respondents provided electronic informed consent and received a $50 gift card. Partially completed surveys were excluded. The response rate was calculated as the number of completed surveys divided by total emails sent.

Forty-five individuals responded, 44 consented, and 41 completed the survey (21% response rate).

Lots of room for selection bias since the survey was only sent to the participants who completed the program. The ones who didn't see improvement would likely drop out. Also, of the 194 participants who were sent the survey, only 21% completed the survey, probably further selecting for the participants who saw the most improvement.

This study was approved by the **’s Institutional Review Board and all respondents provided informed consent.

The what review board?

Parts of the "lifestyle" portion of the intervention:

Mindfulness-based practices included mindful eating, 60 minutes of daily meditation, and gratitude exercises.

60 minutes of daily meditation sounds very grueling to me.

Bolding added:

This cross-sectional study demonstrated that a fully remote, multicomponent program integrating ketogenic metabolic therapy, thiamine supplementation, circadian entrainment, and mindfulness-based resilience coaching is acceptable and feasible for individuals with infection-associated chronic illnesses, including post-viral dysautonomia, ME/CFS, and Long COVID.

No, it demonstrated that it's acceptable and feasible for 21% of the people who completed the program. We don't have data on the other 79% that completed the program. And it's unclear how many didn't complete the program. It may have been not acceptable or not feasible for the majority of people who tried the intervention.

Edit: clarified the sentence about what the 21% refers to.

 

[forestglip]

While the current feasibility study design does not permit an assessment of efficacy or causal effects, these respondent-reported observations align with prior clinical case evidence suggesting that KMT, when combined with lifestyle interventions, may be a viable management strategy for IACI.13

13 is a case report from this team about a person with long COVID completing this intervention: (links go to S4ME threads)

Clinically Meaningful Improvements in Long COVID Symptoms Following Ketogenic Metabolic Therapy Combined with Lifestyle Interventions—A Clinical Case Report and Review of the Literature (2025, Colgan et al., Case Reports in Clinical Medicine)

Another study from this team:

Designing Nutrition Studies for Long COVID and Related Infection-Associated Chronic Illness: Qualitative Insights From a Patient-Reported Evaluation of Ketogenic Metabolic Therapy (2026, Colgan et al., Journal of Patient Experience)

Andy pointed out that the paper says that one of the authors, Mary Ruddick, is the "owner" of the intervention being used, but did not consider it a conflict of interest:

Declaration of conflicting interests​

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Disclosures​

DDC: no disclosures; LB: no disclosures; DS: no disclosures; TG: no disclosures; MR: owner of Enable Your Healing, LLC and nutritionist who developed the Enable Your Healing program; HW: no disclosures; TD: no disclosures.

Personally I would have thought being the owner of the "healing" program that the particpants were recruited from and that this publication is a glorified advert for would be a confict of interest.

Mary Ruddick is also an author of the thread paper, but it doesn't include that she is the owner. With regard to the program, it just says she served as the nutritionist. This paper also says no potential conflicts of interest.

Enable Your Healing is a community-based educational program designed for individuals with post-viral dysautonomia, ME/CFS, and Long COVID that combined modified KMT and lifestyle strategies.

Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Author contributions [...] MR: Intervention, recruitment;

Disclosures [...[ MR: M. R. served as the nutritionist for the community-based program described in this study but had no role in study design, data collection, access to participant data or survey platforms, data analysis, data interpretation, or manuscript drafting. M. R.’s involvement was limited exclusively to providing nutritional guidance within the intervention, and did not extend to any aspect of the research process.

 

[forestglip]

The program being used in the study which combines a ketogenic diet, supplementation, meditation, bright light therapy, and various other things, is called Enable Your Healing.

There's a thread about this program on Reddit where someone says they were told the program could be up to $6000.

Hey so I just set up a phone call with one of her team members. Hoping it's not a scam. They quickly mentioned the program will be up to $6000.00!

That's the dollar amount stated by a couple other Reddit users about a program from Mary Ruddick [one, two]. The first link is someone who thinks the program was helpful.

 

[forestglip]

Todd Davenport, who is an author on many papers discussed on the forum, typically about things like PEM and 2-day CPET, is an author on all the above papers.

 

[forestglip]

The disclosure for Mary Ruddick says that she had virtually no role in the research for this paper:

MR: M. R. served as the nutritionist for the community-based program described in this study but had no role in study design, data collection, access to participant data or survey platforms, data analysis, data interpretation, or manuscript drafting. M. R.’s involvement was limited exclusively to providing nutritional guidance within the intervention, and did not extend to any aspect of the research process.

The journal policies say that to be listed as an author, one must have made significant or substantial contributions to the research:

Criteria for authorship
All listed authors must meet the following criteria:

• Made a significant contribution to the concept, design, acquisition, analysis or interpretation of data
• Drafted the article or revised it critically for important intellectual content
• Approved the final version of the article for publication
• Agreed to be accountable for all aspects of the work and resolved any issues related to its accuracy or integrity

Note: Requirements 2 and 3 should not disqualify those who have made substantial contributions to the research. Please refer to individual journal requirements for authorship by reviewing the submission guidelines. Some Sage journals use CRedIT taxonomy to provide greater transparency to individual contributions to the research.

It seems that she should not have been listed as an author.

 

[rvallee]

I have no idea what "mindful eating" is even supposed to mean, and they don't explain it. A ketogenic diet is very hard to adhere to, diets are notorious for being so, and this much "mindfulness" will quickly lead to giving up in most people. There aren't even any plausible benefits here. I generally want to throw people who pitch in anything about "gratefulness" into the deepest volcano in the solar system.

Given everything I have seen over the years, I am now convinced that all feasibility and acceptability trials are entirely useless, because obviously worthless things are routinely graded as acceptable. I frankly have a hard time imagining that a trial would be found unacceptable, given that everyone who has chosen to participate will obviously have found it acceptable enough to participate. Those grades are wildly inflated, so much that a 4/5 is probably equal to a normalized 2/5.

We deserve so much better than this. In fact, this is an unacceptable state of affairs.

 

[forestglip]

I have no idea what "mindful eating" is even supposed to mean, and they don't explain it.

I think mindful eating is basically a meditation technique to focus on the act of eating while eating.

- https://www.rochester.edu/mindful/mindful-eating/

Mindful eating is a holistic experience that engages our body, heart, and mind in the entire process of choosing, preparing, and consuming food. It involves deliberately immersing ourselves in the sensory details of eating, such as the colors, textures, scents, tastes, and sounds of our food and drinks (JC Bays, 2017). By being fully present and appreciating the food we consume, we shift our perspective to see food as a source of enjoyment rather than negativity or shame. 

 

[MrMagoo]

Mindful eating is an excellent way to find out whether you’d overcome an eating disorder, or not.