Milly Gaines
The modern ketogenic diet, popularly known as 'keto', is a high-fat, low-carb method of eating that has captivated popular culture in recent years. While many people follow the diet today to lose weight or improve their health, it was originally developed as a treatment for epilepsy. The ketogenic diet was first introduced in the 1920s by Dr Russell Wilder at the Mayo Clinic, who observed that a diet rich in fat and low in carbohydrates could reduce the frequency and intensity of seizures in patients with epilepsy. Wilder's diet was designed to mimic the metabolism of fasting, which had been used as a treatment for epilepsy since at least 500 BC. The classic ketogenic diet, or 'classic keto', consists of a 4:1 ratio of fat to protein and carbs, with 90% of calories coming from fat, 6% from protein, and 4% from carbs.
| Characteristics | Values |
|---|---|
| Origin | The ketogenic diet was first introduced as a treatment for epilepsy. |
| Date | The first modern study of the diet was conducted in France around 1911. |
| Originator | The diet was first studied by an American osteopathic physician named Hugh Conklin. |
| Initial Results | Conklin reported a 50% success rate for adults and a 90% success rate for children. |
| Development | Dr. Wilder at the Mayo Clinic further developed the diet, observing that epilepsy patients had fewer seizures when consuming a high-fat, low-carb diet. |
| Standardization | Dr. Peterman of the Mayo Clinic standardized the diet into the "classic keto" approach, advocating a 4:1 ratio of fat to protein and carbs. |
| Initial Use | The ketogenic diet was widely used in the 1920s and 1930s as a treatment for epilepsy. |
| Decline | With the advent of antiepileptic drugs in the twentieth century, the use of the ketogenic diet declined. |
| Resurgence | In recent years, the diet has experienced a resurgence, particularly for weight loss and other health improvements. |
| Effectiveness | The diet has been shown to reduce seizure frequency by more than 50% in half of patients and by more than 90% in a third of patients. |
| Cost | The ketogenic diet can be less expensive than modern anticonvulsants. |
| Challenges | Cultural and religious factors, food preparation practices, and labelling issues can pose challenges to following the diet. |
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What You'll Learn
The ketogenic diet was first used to treat epilepsy
Around the same time, an American osteopathic physician named Hugh Conklin began to recommend fasting to his epileptic patients to help them control their seizures. Conklin's method involved fasting for 18-25 days at a time, and he reported a 50% success rate for adults and a 90% success rate for children.
In 1921, Dr. Wilder at the Mayo Clinic published two articles on the effects of ketonemia on epilepsy. Wilder first reported on the potential benefits of fasting for patients with epilepsy, suggesting that the reduction in seizures might be linked to ketonemia. He then hypothesized that similar results could be achieved with a diet that was very rich in fat and very low in carbohydrates, which would provoke ketogenesis. Wilder subsequently observed the effects of this diet on three patients for the first time, thus becoming the first author to report on the use of the ketogenic diet for epilepsy.
The ketogenic diet rapidly spread in the 1920s as a treatment for epilepsy, and it was widely used and studied for two decades. The diet proved to be very successful in children, with one study in 1925 reporting that 95% of 37 young patients had improved seizure control, and 60% became seizure-free. By 1930, the diet had also been studied in 100 teenagers and adults, with positive results. However, with the advent of modern antiepileptic drug treatments in the twentieth century, the use of the ketogenic diet declined dramatically.
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Fasting and dietary changes are influenced by cultural and religious factors
The impact of religious fasting on health has been studied in Buddhist, Christian, and Muslim populations. These studies indicate that religious fasting can positively affect body weight, glycemia, cardiometabolic risk markers, and oxidative stress parameters. For example, during Ramadan, a period of fasting observed by Muslims, individuals typically consume one substantial meal after sunset and a lighter meal before dawn, with an occasional additional meal before sleeping. Studies have shown that Ramadan fasting leads to weight loss, a reduction in systolic blood pressure, and positive effects on gut microbiota.
Cultural habits and local climate conditions also play a significant role in fasting practices. For instance, in a study of Iranian subjects during Ramadan, there was a higher consumption of vegetables and fruits, while the consumption of dairy products, meat, and cereals decreased. In Asian cultures, the traditional diet includes rice and noodles as the main source of energy, which can make their elimination challenging when adopting a ketogenic diet. Therefore, the MCT-oil form of the ketogenic diet, which allows for more carbohydrates, has proven to be a useful alternative.
When considering the implementation of fasting practices, such as the ketogenic diet, it is essential to acknowledge the influence of cultural and religious factors. In cultures where food is commonly prepared by grandparents or hired help, educating more people about the diet becomes necessary. Similarly, in families that share meals, separating the child's meal can be challenging. Additionally, in countries with non-mandatory food labelling, calculating macronutrients like fat, protein, and carbohydrates can be difficult.
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Early studies reported high success rates, especially in children
The modern ketogenic diet was discovered in the 1920s by Dr. Russell Wilder at the Mayo Clinic. The diet was developed as a treatment for epilepsy, based on the observation that a fast or starvation appeared to reduce seizures in patients. Wilder's ketogenic diet was a high-fat, low-carbohydrate approach designed to mimic the metabolic effects of fasting. Early studies reported high success rates, especially in children.
Indeed, the early success of the ketogenic diet in treating epilepsy, especially in children, was notable. One of the first studies to demonstrate this success was conducted by Dr. M. J. Peterson in 1925. This study followed
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The treatment protocol has changed over time
The type of patients treated with the ketogenic diet has also changed over time. Initially, the diet was not a treatment of last resort. In contrast, the children in modern studies have already tried and failed a number of anticonvulsant drugs and may be assumed to have more difficult-to-treat epilepsy.
The modern study design prefers a prospective cohort (the patients in the study are chosen before therapy begins), and the results are presented for all patients, regardless of whether they started or completed the treatment (known as intent-to-treat analysis). This is done to control for selection bias, as older trials excluded patients who were unable to start or maintain the diet, thereby selecting patients who would generate better results.
The ketogenic diet has also experienced a resurgence in recent years, particularly as a weight loss intervention, proving its efficacy in the short term.
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The diet was popularized in the 1970s
The modern ketogenic diet, commonly known as the keto diet, is a rebranded version of the Atkins diet, which was created by cardiologist Robert Atkins in the 1970s. The Atkins diet is a very low-carbohydrate, high-protein, and high-fat diet that was a commercial success and popularized low-carb diets to a new level. The keto diet gained popularity in the 1970s and 1990s, with many celebrities and social media fitness influencers endorsing it for its weight-loss benefits.
The keto diet is a mainstream medical dietary therapy that was originally developed in the 1920s to treat paediatric epilepsy. The classic therapeutic ketogenic diet was widely used in the 1920s and 1930s, but its popularity declined with the introduction of effective anticonvulsant medications. The diet was designed to provide sufficient calories and protein for body growth and repair in children with epilepsy. It achieved a 4:1 ketogenic ratio of fat to combined protein and carbohydrates. This was achieved by excluding high-carbohydrate foods such as starchy fruits, bread, pasta, grains, and sugar, while increasing the consumption of high-fat foods.
In the 1970s, the keto diet was studied for its potential as a long-term energy source. The diet induces a state of ketosis, where the body uses fat as its primary energy source in the form of ketones. The idea behind the keto diet is to manipulate the body's metabolic pathways by changing the distribution of macronutrients to promote weight loss. The standard ketogenic diet allows for only 10% of the diet to come from carbohydrates, which is a significant restriction compared to the typical American diet, which consists of 45-65% carbohydrates.
The popularity of the keto diet in the 1970s can be attributed to the creation and success of the Atkins diet, as well as the growing interest in low-carbohydrate diets for weight loss and the endorsement of celebrities and social media influencers. The diet has been studied for its potential health benefits and weight loss properties, contributing to its popularity and mainstream adoption.
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Frequently asked questions
The modern ketogenic diet is a high-fat, low-carbohydrate method of eating that aims to put the body in a ""fasted state".
The ketogenic diet was first introduced in the 1920s as a treatment for epilepsy. It was observed that patients who consumed low-calorie diets and fasted experienced fewer seizures.
Dr. Russell Wilder at the Mayo Clinic is credited with creating the ketogenic diet. He observed that epilepsy patients had fewer seizures when their blood sugar was lowered from eating a high-fat, low-carb diet.
Wilder first reported on the interest of fasting for patients with epilepsy and hypothesized that a diet very rich in fat and very low in carbohydrates would provoke ketogenesis and have a positive effect on seizures.
