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Fiber is a particular concern given that the keto diet restricts many fiber-rich foods such as whole grains, fruits, vegetables, and beans

It represents a meaningful and consistent protective effect

But compounded with dehydration from vomiting, reduced food intake from extreme appetite suppression, and interaction with other diabetes medications, blood sugar can drop to dangerous levels

Lateral neck x-rays, CT scans, or flexible laryngoscopy by an ENT specialist can visualize deep infections, abscesses, and structural causes when symptoms are severe or unusual

They typically improve as the body adjusts, and gradual titration keeps them manageable