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This breakdown results in a pathological state marked by the aberrant upregulation of MHC class I and II molecules and the increased expression of NKG2D ligandsparticularly MICA and ULBPon the epithelial cells of the hair follicle

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therefore, to achieve health benefits, the patient's individual needs must be considered ( According to IKDSG guidelines, KD use is strictly contraindicated in patients with a deficiency of carnitine (primary), carnitine palmitoyltransferase (CPT) 1 or 2, carnitine translocase, pyruvate carboxylase, medium-chain acyl-coenzyme A (CoA) dehydrogenase (MCAD), long-chain acyl-CoA dehydrogenase (LCAD), short-chain acyl-CoA dehydrogenase (SCAD), and disorders of fatty acid -oxidation and porphyria