History of the Ketogenic Diet
by Lyle McDonald

This is an excerpt from Lyle's book, The Ketogenic Diet: A Complete Guide for the Dieter and Practitioner.

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.

Charlie's seizures were completely controlled as long as he was on the diet. The amazing success of the ketogenic diet where other treatments had failed led Charlie's father to create the Charlie Foundation, which has produced several videos, published the book "The Epilepsy Diet Treatment: An introduction to the ketogenic diet", and has sponsored conferences to train physicians and dietitians to implement the diet. Although the exact mechanisms of how the ketogenic diet works to control epilepsy are still unknown , the diet continues to gain acceptance as an alternative to drug therapy.