THE AMAZING STORY OF THE KETOGENIC DIET

It was the pioneering experiments of two French “hygienist” doctors that led to the development of the ketogenic diet.

The ketogenic diet (also called Low Carb High Fat or LCHF in English), of which we published the first books in French, is a therapeutic diet that consists of consuming very few carbohydrates (sugars, fruits, potatoes, pasta, rice…) and a lot of fats. This diet was initially prescribed for epilepsy (since the 1920s) and is now proposed for type 2 diabetes and overweight. It is also used on an experimental basis in Alzheimer’s, Parkinson’s and certain cancers.

Here is its history and its origins.

FASTING AGAINST DIABETES

At the end of the nineteenth century, a French doctor, Dr. Guillaume Guelpa, began a series of experiments to treat various diseases by food restriction, i.e. fasting, first on himself, then on his patients. The idea was given to him by the work of another French doctor, Georges Saintfort Dujardin-Beaumetz, who found that in typhoid fever, it was the patients who lost weight the fastest who recovered the fastest.

Guelpa develops a diet that he will propose to his diabetic patients. Here it is:

• Drink every day a mineral water called purgative water, Janos water that was brought from Hungary
• To abstain from all food for 3 to 4 days;
• Drink as much as you like of cherry stem tea, linden tea, tea infusion, Evian water.
• This fast, which inspired the Newcastle University protocol for treating diabetes, gives spectacular results, since most of Dr. Guelpa’s patients are improved by the evening of the second day. The doctor also prescribed “purges”, meaning that the patient swallowed 40 grams of sulfate of soda per day (with water). Dr. Guelpa published a book in 1910, “The Cure for Diabetes,” which detailed the diet and its beneficial effects.

This diet evolved in the early twentieth century. It took the form of four days of fasting with a purgative, followed by four days of a vegetarian diet with a caloric intake reduced by half compared to normal.

He attracts the attention of another doctor, also a hygienist and philanthropist, the psychiatrist Auguste Marie, who treats many epileptics in Villejuif. This was the first time that Dr. Guelpa’s diet was tried for epilepsy. The results were less spectacular than for diabetes, but extremely encouraging, as they were much better than with the drug treatments of the time (potassium bromides), as long as this diet was continued (but Guelpa stated that the vegetarian diet “alone, without dietary restrictions, does not give encouraging results”).

FROM FASTING TO THE KETOGENIC DIET

Between 1910 and 1921, the therapeutic fasting of Dr. Guelpa and Dr. Marie was exported to many hospitals where epilepsy was treated, especially in the United States. Fasting was effective for patients, but as soon as they returned to their usual diet, the seizures returned. It is not possible to keep patients on a permanent fast.

In the meantime, the science of nutrition has evolved: it has been found that fasting puts the body in a state of ketosis, i.e. that compounds called ketone bodies appear in the tissues in quantity. The same ketone bodies, it was discovered, appear when we eat mainly fats.

Russell Wilder, an American physician at the Mayo Clinic (Rochester, Minnesota) was the first to formulate the hypothesis in 1921 that a fatty diet promoting ketonemia could mimic the beneficial effects of the diet of Dr. Guelpa and Dr. Marie in epilepsy.

Two other doctors from the Mayo Clinic, Henry Helmholz and Haddow Keith, were to experiment with this. Between 1921 and 1930, they administered this new ketogenic diet to dozens of epileptic children. In September 1930, they reported their results: 141 children followed the ketogenic diet, 43 were seizure-free for one to seven years and were considered cured; 32 were greatly improved (but were not, for the doctors, cured).

Very popular until the Second World War, the ketogenic diet fell into oblivion at the end of the conflict, with the appearance of effective and less restrictive drug treatments. However, it has been gaining interest again in the last ten years and its applications now extend to diabetes, but also (still in an experimental way) to certain cancers and neurodegenerative diseases.

Born in 1850, Dr. Guillaume Guelpa died in 1930. Dr Auguste Marie, born in 1865, died in 1934. Both were able to witness the emergence of the ketogenic diet of which they were the initiators.