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The mechanisms of both subacute and idiosyncratic VHT remain incompletely understood, but it has been believed since the early 1980s based on limited experimental and clinical evidence [5356] that hypocarnitinaemia, subsequent imbalance between -oxidation and -oxidation, and accumulation of 4-en-VPA are involved
Adequate B12 status helps maintain energy levels even during caloric restriction
However, high doses ( 0.5 mg/kg/d) may activate the SREBP-1c pathway, increase liver fat synthesis, and lead to hypertriglyceridemia and fatty liver
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