The ketogenic diet may seem like a relatively recent approach to nutrition, but its origins date back more than a century. Developed in the 1920s as a treatment for epilepsy, the diet was designed to mimic some of the metabolic effects of fasting while eliminating the need for prolonged fasting.
Although keto continues to be used therapeutically for epilepsy and is being studied for other medical conditions, today many people follow a ketogenic lifestyle for weight loss, blood sugar management, and other health goals.
How did a diet developed for epilepsy become one of today’s most widely recognized approaches to low-carbohydrate eating? Let’s look at the history of the ketogenic diet and how its use has evolved over the past century.
Early Beginnings: Fasting
When you fast for an extended period, your body begins relying more heavily on stored fat for energy, and your liver produces ketones as an alternative fuel source. Although the metabolic processes involved weren’t understood at the time, fasting was used therapeutically as early as about 500 BC.
Here are a few historical examples of fasting being used as a medical treatment:
- Ancient Greek doctors used fasting to treat diseases.
- Hippocrates recorded fasting as the only treatment for epilepsy and managing epileptic seizures/seizure control.
- Benjamin Franklin said, “The best of all medicines is resting and fasting.”
- Mark Twain wrote, “A little starvation can really do more for the average sick man than can the best medicines and the best doctors. I do not mean a restricted diet; I mean total abstention from food for one or two days.”
- Before insulin was discovered, fasting was used for treating type 1 and type 2 diabetes.
- In 1922, an osteopath named Hugh Conklin fasted several children with epilepsy for up to 25 days, providing only limited liquids.
The Birth of Keto: An Alternative Treatment for Epilepsy
In the early 1920s, Dr. Russell Wilder of the Mayo Clinic began exploring whether a dietary approach could produce some of the beneficial effects of fasting without requiring people with epilepsy to go without food for extended periods. He developed a high-fat, very-low-carbohydrate diet that produced ketosis and coined the term “ketogenic diet” in 1921.
The ketogenic diet proved effective for many people with epilepsy and became an established treatment, particularly for children. However, after new antiseizure medications became available in the 1930s and 1940s, dietary therapy was used less frequently because medication was generally easier to prescribe and follow.
The Revival of the Ketogenic Diet
Although the ketogenic diet became less widely used for epilepsy after antiseizure medications were introduced, interest in carbohydrate restriction continued to grow for other purposes. Beginning in the 1970s, low-carb diets gained considerable attention for weight loss, while the ketogenic diet eventually experienced a revival as a treatment for epilepsy.
Here are some key developments that helped bring low-carb and ketogenic diets back into the spotlight:
- 1972: Cardiologist Dr. Robert Atkins publishes Dr. Atkins’ Diet Revolution, which popularizes a low-carbohydrate approach to weight loss. Although the Atkins diet isn’t the same as a therapeutic ketogenic diet, the book introduces millions of people to carbohydrate restriction.
- 1980s: Physician and researcher Dr. Stephen Phinney publishes studies examining very-low-carbohydrate ketogenic diets in people with obesity and endurance athletes. His research helps advance scientific understanding of how humans adapt to carbohydrate restriction and nutritional ketosis.
- 1993: NBC’s Dateline airs the story of Charlie Abrahams, a young boy whose severe epilepsy improved dramatically after he began a ketogenic diet at Johns Hopkins Hospital. His father, Hollywood producer Jim Abrahams, subsequently establishes The Charlie Foundation to increase awareness of ketogenic dietary therapy for epilepsy.
- 1997: Charlie Abrahams’ story inspires the television movie First Do No Harm, starring Meryl Streep. The film brings greater public attention to the ketogenic diet as a treatment for drug-resistant epilepsy.
- 1990s–2000s: Low-carbohydrate diets have become increasingly popular for weight loss, fueled in part by updated editions of Dr. Atkins’ books and growing public interest in alternatives to conventional low-fat diets. Researchers also begin conducting more clinical trials examining the effects of carbohydrate restriction on weight and metabolic health.
- 2010s: Scientific and public interest in ketogenic diets expands beyond epilepsy and weight loss. Researchers begin investigating their potential roles in type 2 diabetes, neurological disorders, cancer, and other conditions, while keto gains widespread attention through books, podcasts, social media, and online communities.
The Keto Diet Today
Today, ketogenic diets are used for weight loss, blood sugar management, and established therapeutic applications such as drug-resistant epilepsy, as well as emerging applications in neurodegenerative conditions, mental health disorders, and cancer, among other therapeutic areas.
At the same time, scientists continue to investigate who may benefit most from ketogenic diets, how different approaches affect long-term health, and where their limitations and potential risks lie.
More than a century after the ketogenic diet was developed, our understanding of its potential applications continues to evolve.
