Chapter 2:
History of the Ketogenic Diet
Before discussing the theory and metabolic effects of the ketogenic diet, it is useful to
briefly review the history of the ketogenic diet and how it has evolved. There are two primary
paths (and numerous sub-paths) that the ketogenic diet has followed since its inception:
treatment of epilepsy and the treatment of obesity.
Fasting
Without discussing the technical details here, it should be understood that fasting (the
complete abstinence of food) and ketogenic diets are metabolically very similar. The similarities
between the two metabolic states (sometimes referred to as ‘starvation ketosis’ and ‘dietary
ketosis’ respectively) have in part led to the development of the ketogenic diet over the years.
The ketogenic diet attempts to mimic the metabolic effects of fasting while food is being
consumed.
Epilepsy (compiled from references 1-5)
The ketogenic diet has been used to treat a variety of clinical conditions, the most well
known of which is childhood epilepsy. Writings as early as the middle ages discuss the use of
fasting as a treatment for seizures. The early 1900’s saw the use of total fasting as a treatment
for seizures in children. However, fasting cannot be sustained indefinitely and only controls
seizures as long as the fast is continued.
Due to the problems with extended fasting, early nutrition researchers looked for a way to
mimic starvation ketosis, while allowing food consumption. Research determined that a diet high
in fat, low in carbohydrate and providing the minimal protein needed to sustain growth could
maintain starvation ketosis for long periods of time. This led to development of the original
ketogenic diet for epilepsy in 1921 by Dr. Wilder. Dr. Wilder’s ketogenic diet controlled pediatric
epilepsy in many cases where drugs and other treatments had failed. The ketogenic diet as
developed by Dr. Wilder is essentially identical to the diet being used in 1998 to treat childhood
epilepsy.
The ketogenic diet fell into obscurity during the 30’s, 40’s and 50’s as new epilepsy drugs
were discovered. The difficulty in administering the diet, especially in the face of easily prescribed
drugs, caused it to all but disappear during this time. A few modified ketogenic diets, such as the
Medium Chain Triglyceride (MCT) diet, which provided greater food variability were tried but they
too fell into obscurity.
In 1994, the ketogenic diet as a treatment for epilepsy was essentially ‘rediscovered’ in the
story of Charlie, a 2-year-old with seizures that could not be controlled with medications or other
treatment, including brain surgery. Charlie’s father found reference to the ketogenic diet in the
literature and decided to seek more information, ending up at Johns Hopkins medical center.