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In the recent years, the interest regarding the benefits of ketogenic diets is growing up and expanding well beyond the seizure control. These studies demonstrated that plant-derived protein get better benefits on gut microbiome along with positive effects on the host metabolism. In our opinion since foods that have undergone deep fermentation seem to improve the gut microbiome diversity and gut health index adding small portions of fermented foods to the diet may be a useful prebiotic/probiotic supplementation as well as an effective aid to digestion. It has been reported [103,104] that foods enriched with these microorganisms are able to recovery and improve gut microbiota, reaching the state of eubiosis. Fermentation of prebiotics by gut microbiota produces SCFAs, which positively modulate the composition of microbiota (by increasing intestinal bifidobacteria and lactic acid bacteria), providing an energy source for colonocytes . More recently Qiao-Ping Wang investigated, through the use of NGS, the effects of non-nutritive sweeteners (NNSs) on the gut microbioma of mice at the organism level; the study reveals that artificial sweeteners has bacteriostatic effects and as well as change the composition of microbiota . Nettleton at al. found that low calorie sweeteners, such as acesulfame potassium (Ace-K) and sucralose, disrupted the structure and function of gut microbiota and gut mucosa . Authors suggested that in case of dysbiosis, it might be a good option the use of an extra-supplementation with pre or probiotics to maintain the “ecological balance” of gut microbiota . Patients with epilepsy demonstrated an imbalance of gut microbiota before starting the VLCKD. Recently, it has been explored the role of VLCKD on gut microbiota related to the anti-seizure effect on mice. VLCKD, by the drastic reduction of the carbohydrate intake, showed an impairment both on the diversity and richness of gut microbiota . It has been demonstrated the high fat–high sugar Western diet negatively impacts gut health and a high fat diet is closely related to inflammation , however, several studies [38,39,40] suggested the necessity to consider the structure and the function of different fatty acids. The fact that human microbial community is strictly influenced by diet, and, a good ecological community is connected with a better health, offers a range of opportunity for improving human’s health by changing the microbiota composition through different patterns of diet [32,33,34]. The variability among people and the adaptability of gut microbiota to substantial changes have permitted the manipulation of various external factors, restoring both the biological functions and richness of microbiota . The human gut microbiota, that means the types of organisms that are present in an environmental habitat, consisting of trillions of microbial cells and thousands of bacterial species . 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