The ketogenic diet is a high-fat, low-carbohydrate diet that is used to manage epilepsy in patients who do not respond to antiepileptic medications. It was designed to mimic the metabolic state of fasting, where the body burns body fat for fuel in the absence of its preferred energy source, carbohydrate. It has long been known that fasting can help reduce seizures for some people. In fact, fasting has been used to help manage seizures since at least 500 BC1. While fasting may help to control seizures, it cannot be used long term since the body will eventually run out of body fat stores, leading to starvation. (Note, fasting should never be used unless directed by a healthcare professional).
In 1921, Dr. R.M. Wilder, a physician from the Mayo Clinic in Minnesota, theorized that the metabolic state of fasting could be maintained long term with a "ketogenic diet" that mimicked starvation by limiting dietary carbohydrate and providing high amounts of dietary fat2. Instead of burning body fat for fuel, the body uses fat from the diet and remains in a state of "ketosis" as long as the diet is strictly maintained. In 1925, Dr. M.G. Peterman, also from the Mayo Clinic, published a study in the Journal of the American Medical Association showing significant seizure improvement in over 50% of patients following the ketogenic diet3. The ketogenic diet was widely used to manage epilepsy throughout the 1920's and 1930's. After the introduction of a new class of antiepileptic drugs in the late 1930's, the ketogenic diet began to fall out of favor and the focus of epilepsy research shifted to antiepileptic drug therapies.
The use of the ketogenic diet continued to decline until 1994, when an episode of Dateline NBC documented the story of Charlie Abrahams, the son of Jim Abrahams, a Hollywood film director. Charlie developed epilepsy that failed to respond to antiepileptic medications. Jim learned about the ketogenic diet, which was still offered at Johns Hopkins University, in Baltimore, Maryland. The Abrahams family traveled across the country for Charlie to initiate the diet at Johns Hopkins. Soon Charlie was seizure-free and his parents started the Charlie Foundation to raise awareness of the ketogenic diet as an option to manage intractable epilepsy. In 1997, Abrahams directed First Do No Harm, a movie starring Meryl Streep about a boy who develops intractable epilepsy that is successfully managed with the ketogenic diet.
Since the 1990's, public and clinical interest in the ketogenic diet has reemerged steadily. Today, research on the ketogenic diet is being published at a rate never seen before4. There is a significant amount of evidence, including both retrospective and randomized controlled studies, showing seizure improvement in approximately half of children on the ketogenic diet. The ketogenic diet is now offered at nearly all leading children's epilepsy centers in the United States and in medical centers worldwide. For the estimated 30% of epilepsy patients for whom antiepileptic drugs do not work, the ketogenic diet offers hope5.
1 Wheless JW. History of the ketogenic diet. Epilepsia. 2008 Nov;49 Suppl 8:3-5.
2 Turner Z & Kossoff EH. The Ketogenic and Atkins Diets: Recipes for Seizure Control. Practical Gastroenterology. 2006 Jun : 53-64.
3 Peterman MG. The ketogenic diet in epilepsy. JAMA 1925;84(26):1979-1983
4 Morandi G, et al. A bibliometric study of scientific literature on the dietary therapies for epilepsy in Scopus. Nutritional Neurosciences. 2014 Mar 17
5 Brodie MJ. Diagnosing and predicting refractory epilepsy. Acta Neurol Scand Suppl 2005;181:36-9.