{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T03:26:52Z","timestamp":1776396412130,"version":"3.51.2"},"reference-count":138,"publisher":"Georg Thieme Verlag KG","issue":"03","funder":[{"name":"This study was supported by the Independent Medical\n                        Alliance."}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Horm Metab Res"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Metabolic alterations characterize a large subset of those with post-acute\n                    COVID-19 syndrome, and similar symptoms affect those with post-acute COVID-19\n                    vaccination syndrome. These symptoms are characterized by the triumvirate of\n                    post-acute COVID-19 (vaccination) syndrome symptoms: post-exertional malaise,\n                    fatigue, and cognitive impairment, commonly referred to as brain fog. These\n                    symptoms can be recreated through perturbations that disrupt mitochondria, and\n                    spike protein has been observed to disrupt mitochondria in vitro, providing\n                    mechanistic support for this relationship. Post-acute COVID-19 (vaccination)\n                    syndrome patients suffer from a severely decreased lactate threshold and can\n                    experience symptoms of overexertion even at low power output. Furthermore,\n                    biopsies have revealed disrupted mitochondria, and energetics and physiological\n                    studies have shown that lipid oxidation constitutes a significantly reduced\n                    fraction of total energy production\/consumption in post-acute COVID-19\n                    (vaccination) syndrome patients. This review explores the therapeutic axes of\n                    lactate, carbon dioxide, and fatty acid oxidation for resolving the energy\n                    production challenges in post-acute COVID-19 (vaccination) syndrome, suggesting\n                    interventions that increase the lactate threshold, increase tissue oxygenation\n                    (paradoxically through increasing partial pressure of CO2), and\n                    increase the rates at which lipids are oxidized relative to carbohydrates.\n                    Analogies from the world of exercise science are introduced, comparing\n                    post-acute COVID-19 (vaccination) syndrome to an overabundance of fast-twitch\n                    muscle fibers, with oxygenation similar to that experienced at high altitude,\n                    and presenting as an inverse 'fat adaptation' phenomenon, as observed\n                    in endurance athletes, especially those adopting low-carbohydrate diets.<\/jats:p>","DOI":"10.1055\/a-2794-9646","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:14:45Z","timestamp":1770855285000},"page":"90-102","source":"Crossref","is-referenced-by-count":1,"title":["Lactate, Capnia, and Fat Oxidation as Therapeutic Axes for SARS-CoV-2\n                    Spike Protein-Induced Sequelae"],"prefix":"10.1055","volume":"58","author":[{"given":"Carlos","family":"Gracidas","sequence":"additional","affiliation":[{"name":"Medicine, Dorrington Medical Associates, Houston, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rakeem","family":"Levy","sequence":"additional","affiliation":[{"name":"Medicine, Dorrington Medical Associates, Houston, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Varon","sequence":"additional","affiliation":[{"name":"Science, Independent Medical Alliance, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2487-0636","authenticated-orcid":false,"given":"Matthew","family":"Halma","sequence":"additional","affiliation":[{"name":"Science, Independent Medical Alliance, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"2220578","DOI":"10.1080\/22221751.2023.2220578","article-title":"A one-year follow-up study of systematic impact of Long COVID symptoms among\n                    patients post SARS-CoV-2 omicron variants infection in Shanghai, China","volume":"12","author":"J Cai","journal-title":"Emerging Microbes Infect"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"7892","DOI":"10.1038\/s41467-023-43661-w","article-title":"True prevalence of Long-COVID in a nationwide, population cohort 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