History of the Ketogenic Diet

In 1911, the first modern use of starvation for the treatment of epilepsy was noted. Two physicians in Paris reported that seizures were less severe in period of starvation. While this was the origin for the ketogenic diet, it wasn’t until 1921 that any physician tried to generate ketosis. Dr. Rollin Woodyatt noted that under conditions of starvation, acetone, and beta-hydroxybutyric acid appear. Woodyatt also uncovered that acetone and beta-hydroxybutyric acid were observed if patients ate a low carbohydrate diet. Around the same time, Dr. Russell Wilder theorized that ketonemia could be produced for therapeutic benefit, but with a low carb diet rather than starvation. He developed the term “ketogenic diet.” The ketogenic diet become very popular in the treatment of childhood epilepsy. As better epilepsy medications were developed throughout the twentieth century, the ketogenic diet lost prominence as an epilepsy treatment.

In the 1970s, nutritional ketosis was introduced as an idea for weight loss by Dr. Robert Atkins. In his book published in 1972, he describes how reducing carbohydrates “creates a unique chemical situation in the body…ketones are excreted, and hunger disappears.” Although the Atkins diet was one of the first, many other low carb diets have been popularized since the 1970s, from the South Beach Diet to variations of the Paleo and Mediterranean diets. While the details of low-carbohydrate diets may have changed, they have remained a mainstream option for weight loss. Over the past few decades, many studies have sought to quantify the efficacy of low carb diets in terms of weight loss as well as evaluate the potential for amelioration of chronic disease. As research has investigated the mechanisms behind ketosis and weight loss, the ketogenic diet has become the de facto low carb diet of choice in the media and public dialogue.

What is the Ketogenic Diet?

The mainstay of the ketogenic diet is that dietary carbohydrates are kept very low, with varying levels of protein and fat. The classic ketogenic diet is defined as a diet with one gram protein per kilogram of body weight, 10–15g carbohydrates per day, and the remaining calories from fat. The goal of the diet is to induce ketosis. Ketosis is thought to alter metabolic pathways to induce weight loss and potentially improve other health outcomes, such as a reduction of hyperglycemia and improvement in lipid profiles.

What is Ketosis?

Under ordinary circumstances, the body primarily relies on carbohydrates for energy production. Insulin functions to extract and store energy derived from glucose. When the body has reduced carbohydrates available, insulin secretion is reduced. Initially, stored glucose in the form of glycogen is available for fuel, but after three to four days, this is depleted. Stored fat then becomes the most readily available fuel, and its breakdown into free fatty acids provides the raw materials for ketone production in the liver. Ketone production is primarily seen in times of starvation and prolonged exercise, but is also a function of adherence to a very-low carbohydrate diet. Importantly, in physiological ketosis, there is no change in blood pH versus pathological ketosis where there is a lowering of blood pH.