Gracidas, Carlos, Levy, Rakeem, Varon, Joseph et al. · Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme · 2026 · DOI
This review suggests that ME/CFS and long COVID symptoms—including exhaustion, brain fog, and crashing after activity—may be caused by problems with how the body's energy-producing structures (mitochondria) work. The authors propose that treatments targeting three areas could help: improving the body's ability to handle lactate (a byproduct of exertion), increasing oxygen delivery to tissues, and helping the body burn fat for energy more efficiently, similar to how endurance athletes train.
For ME/CFS and long COVID patients, this work provides a testable metabolic framework that explains why minimal exertion triggers disproportionate fatigue and symptom exacerbation. Understanding these three metabolic axes could lead to targeted interventions—dietary modifications, breathing techniques, or pharmacological agents—that address underlying energy production deficits rather than only managing symptoms.
This review does not establish that spike protein actually causes mitochondrial dysfunction in vivo or that lactate, CO₂, and lipid metabolism are the primary drivers of ME/CFS symptoms. The mechanistic connections are based on in vitro data and correlational clinical findings rather than randomized controlled trials demonstrating causation. The proposed therapeutic interventions remain theoretical and require clinical validation.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Gracidas, Carlos, Levy, Rakeem, Varon, Joseph, & Halma, Matthew (2026). Lactate, Capnia, and Fat Oxidation as Therapeutic Axes for SARS-CoV-2 Spike Protein-Induced Sequelae.. Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme. https://doi.org/10.1055/a-2794-9646
BibTeX
@article{mecfsatlas-gracidas-2026-lactate-capnia,
author = {Gracidas, Carlos and Levy, Rakeem and Varon, Joseph and Halma, Matthew},
title = {Lactate, Capnia, and Fat Oxidation as Therapeutic Axes for SARS-CoV-2 Spike Protein-Induced Sequelae.},
journal = {Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme},
year = {2026},
doi = {10.1055/a-2794-9646},
note = {PubMed: 41672424},
url = {https://www.mecfsatlas.com/evidence/gracidas-2026-lactate-capnia},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/gracidas-2026-lactate-capnia
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