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A decrease in the fatty acid metabolite heptanoic acid was also observed, indicating an increased use of fatty acids as an alternative energy source, via -oxidation to acetyl-CoA and propionyl-CoA 85 .This use of fatty acids is further reinforced by elevated malonate levels in barren urchins, as malonate is converted to malonyl-CoA via the ATP-dependent enzyme acetyl-CoA carboxylase, the primary step in fatty acid synthesis 91

Classic ketogenic diet versus further antiseizure medicine in infants with drug-resistant epilepsy (KIWE): a UK, multicentre, open-label, randomised clinical trial