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Although exogenous ketones raise the blood concentration to the levels we wish to obtain in the initiation and maintenance of a KD, caution should be applied when comparing the two distinctly separate metabolic states of endogenous and exogenous ketosis (66). Additionally several case reports show spontaneous resolution following reintroduction of dietary carbohydrates and ketone level normalization (49). In another study monitoring the effects of differing levels of carbohydrate restriction, it was shown that participants on a diet constituting of 5 E% carbohydrate had close to double the level of βHB than those on a diet with 15 E% carbohydrate (5). Taken together, the authors conclude that monitoring liver function tests is crucial during the acute phase of ketogenic diet initiation (70). Further research is needed to determine if the abnormalities can resolve on their own while on the ketogenic diet, or if routine choline supplementation should be considered. 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