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Common adverse effects may include hypoglycemia, dyslipidemia, gastrointestinal symptoms, carnitine deficiency, bone diseases such as osteopenia and osteoporosis, nephrolithiasis, and even growth failure, and a strict follow-up is then advisable, especially in pediatric patients [54,55,56,57,58,59,60,61]. Β-hydroxybutyrate, one of the principal ketones in humans, has been found to be a possible endogenous histone deacetylase inhibitor, with a subsequent protective role against oxidative stress . However, an interesting case report by Nebeling et al. described the Positron Emission Tomography findings of two girls with malignant astrocytoma following KD for eight weeks, which displayed a decrease of 21.8% in glucose intake at the tumor site . Finally, increased levels of ketone bodies could inhibit NLRP3 inflammasome, therefore limiting inflammation, which plays a pivotal role in cancer pathogenesis . 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