The impact of long COVID on socioeconomic status is therefore significant. In addition, women are disproportionately affected by these “long haul” symptoms, with a prevalence of 64% versus 35% in men ( 7). People affected with post COVID-19 sequalae are often more physically fit and younger at baseline. Because of the increasing number of cases of acute and long COVID worldwide, in October 2021 the World Health Organization clearly defined long COVID as a condition that “occurs in individuals with a history of probable or biologically confirmed SARS-COV-2 infection initially symptomatic at the acute phase, with numerous symptoms lasting for at least two months, usually three months, from the onset of COVID-19 that cannot be explained by an alternative diagnosis” ( 6). They include persistent exercise intolerance, breathlessness, cough, anxiety, palpitations, poor concentration, intense fatigue, mood swings, muscle/joint pains, headaches, attention disorder and memory loss or ‘brain fog’ ( 5). These post COVID-19 symptoms were first reported in the media ( 1, 2), and data now suggest one in three people are not fully recovered after several weeks ( 3), with as many as fifty symptoms being described ( 4).
Worldwide new variants keep emerging, and there is persistent infection and re-infection.įollowing apparent recovery from COVID-19 infection, several persistent post-COVID-19 symptoms have been documented in a cohort of patients. This likely underestimates the numbers as it does not capture cases from countries where diagnostic testing is not readily available, or untested cases with more mild disease. This hypothesis serves to encourage the development of clinical trials evaluating the impact of MCT supplementation on the duration and severity of post COVID-19 cognitive symptoms.Ĭurrent statistics 1 report that the SARS-CoV-2 pandemic (COVID-19) has exceeded 650 million cases worldwide, with over 6 million reported deaths. It is not associated with weight gain or adverse changes in lipid profiles. MCT is a component of enteral and parenteral nutrition supplements, including in pediatrics, so has a long record of safety in vulnerable populations. Research shows general tolerability with dose titration. MCT is readily available and, compared to pharmaceutical interventions, is cost-effective. If MCT supplementation is able to speed the cognitive recovery, this will impact importantly on quality of life. Although there is some suggestion that post COVID-19 cognitive symptoms may diminish over time, in many individuals this may take more than six months. We hypothesize that cerebral glucose hypometabolism associated with post COVID-19 infection can be mitigated with MCT supplementation, with the prediction that cognitive function would also improve. Research has supported their efficacy in managing intractable seizures, and cognitive impairment in MCI and AD. Medium chain triglyceride (MCT) is an exogenous route to nutritional ketosis. Long-term low carbohydrate intake or prolonged fasting is not usually feasible. They improve brain energy metabolism in the face of cerebral glucose hypometabolism in other conditions. Ketone bodies (B-hydroxybutyrate, acetoacetate and acetone) are produced endogenously with very low carbohydrate intake or fasting.
Similar FDG-PET changes have also been observed in post-COVID-19, raising the possibility of a similar etiology.
In other cognitive conditions such as Alzheimer’s disease (AD), typical patterns of cerebral glucose hypometabolism, frontal hypometabolism and cerebellar hypermetabolism are common. This cognitive dysfunction is associated with impaired cerebral glucose metabolism, assessed using 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET), showing brain regions that are abnormal compared to age and sex matched controls. Lack of ability to work, even for six months, has significant socio-economic consequences. Additionally, the predominant demographic affected by these symptoms is younger and still in the workforce. Over fifty post (long)-COVID symptoms are described, including cognitive dysfunction (“brain fog”) precluding return to pre-COVID level of function, with rates twice as high in females.
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