Fasting has one very important barrier to rampant clinical use: it’s not sustainable. You can’t starve for the rest of your life and expect it to last very long. In 1921, Drs. Stanley Cobb and W.G. Lennox became the first to observe that control of seizures by fasting occurs via a change in body metabolism that can be induced either by absence of food or by a very low carbohydrate intake. And this observation led to the birth of a form of nutritional starvation, the ketogenic diet, a term coined by Dr. Russell Wilder who developed the diet as an alternative to fasting and demonstrated its comparable effectiveness in epilepsy. Dr. Wilder observed that the diet produced high levels of ketone bodies in the blood and hypothesized that a high fat, low carbohydrate diet would mimic the anticonvulsant effects of fasting because limited glucose supply would force fat to be metabolized into ketones, which could then be used as an alternative fuel by the brain (this hypothesis took decades to prove, and the more detailed mechanisms remain largely a mystery). In 1925, Dr. Mynie Peterman, calculated the exact formula for nutritional ketosis, a daily diet comprised of: 10 – 15 grams of carbohydrate, 1 gram per kilogram of bodyweight of protein, and the rest fat (a macronutrient formula that is still within the narrow range used in various ketogenic diet variations today) . In the earliest epilepsy studies, calories were restricted to 75% of daily allowance, although the need for calorie-restriction concurrent with ketogenic diets for the treatment of epilepsy has since been disproved.
Research into ketogenic diets went through many ups and downs over the decades that followed. Every time a new anticonvulsant drug for epilepsy was developed, interest in ketogenic diets waned under the presumption that it’s easier, and more tolerable, to take a pill every day compared to a severely restrictive diet. However, interest was rekindled in the wake of professional and public recognition subsequent to: the popularity of the Atkins’ Diet Revolution; a Dateline report featuring a 2-year-old Charlie Abrahams whose intractable seizures are successfully stopped after he adopted a ketogenic diet; the creation of The Charlie Foundation which disseminates informational ketogenic diet videos to doctors and dieticians; and the movie Do No Harm. Since the late-1990s, research into ketogenic diets has expanded, including a series of long-term ketogenic diet studies for refractory epilepsy (epilepsy that did not respond to anticonvulsant drugs) and investigation of a variety of other applications such as weight loss, tumor shrinkage, and neurodegenerative diseases like Alzheimer’s.