Ketosis and Fasting
We’ve all heard about fasting, and we’ve all heard about the ketogenic diet. The ketogenic diet is so well known that we’ve shortened it to plain “keto”. But most of us don’t know the history of the ketogenic diet or its relationship to fasting. We don’t know the rocky course of the concept of diet as a medical treatment. We don’t know that the history of the ketogenic diet as a medical treatment will take us back more than two thousand years.
What most of us do know is that when we sleep, fast, or eat a low carbohydrate-high fat (ketogenic diet), our metabolism shifts into ketosis. Evidence shows that the state of ketosis is very efficient and helps us lose weight, and this state is healthy for both mind and body.
This understanding of the benefits of fasting and the ketogenic diet has not come easily. Some supporters of fasting called it miraculous. Others said fasting was medicinal (Arbesmann, 1951). Which is it, a miracle or a medicine? Let’s look at some amazing events in the roller coaster history of fasting and the ketogenic diet.
Fasting means different things to different people. We’ll use the term fasting in the historic sense, not eating for at least 24 to 48 hours.
History of Fasting and Spirituality
The histories of fasting and the ketogenic diet are intertwined with our understanding of epilepsy. In Western culture, the history of fasting to treat disease is ancient and universal. Peoples across the globe, from Asian to Native American, believed that fasting either improved health or developed spirituality (Arbesmann, 1951).
In ancient Greece, for example, people thought that foods held hidden dangers. Demonic forces might enter into foods and sneak into the body. Fasting was a type of prevention, reducing the risk of ingesting a demon hidden away in the food. Pythagoras, Abaris, and Epimenides praised the virtues of fasting for positive health. In biblical times, Moses, Elias, and John the Baptist recommended fasting (Kerndt et al., 1982).
In the next centuries, fasting was often thought of as an act of purification. Although Hippocrates believed that diet and fasting could control epilepsy and other diseases, this idea was lost. In Medieval times, scholars believed that demons caused seizures. The treatment recommendation was simple. Remove the demon, and stop the seizures.
See the medieval representation of a demon being removed. Usually, the treatment was successful because the demon was removed and the patient died. As you can see in the image, the treatment was truly worse than the disease. The image is from the Library of Congress. http://www.libraryofcongress.com
The Welsh Fasting Girl
People across the centuries eagerly followed the lives and claims of those who’d fasted for days, months, or years. Were these people closer to God? Did they possess special powers? How could they starve themselves when the rest of us couldn’t? Many stories grabbed public attention. Books were written. Articles appeared in local papers. Take, for example, Sarah Jacob.
The Girl Who Lived on Air Depiction of Sarah Jacob on the cover. From the Library of Congress. http://www.libraryofcongress.com
Sarah Jacob (1857-1869) hadn’t eaten any food since 10 years of age, or so she claimed. She became a celebrity, “The Welsh Fasting Girl”. Sarah convinced her family and many others that she was miraculous. Gifts and contributions poured in, but doctors weren’t persuaded. The doctors asked her parents to put her under medical supervision to verify her claim.
After two weeks, Sarah showed clear signs of starvation, and doctors told her parents that Sarah’s body was failing. Sarah’s parents insisted that she’d had episodes like this before, and she would soon recover. Sarah died. It came as no surprise that she’d secretly been consuming small amounts of food.
Sarah’s parents were convicted of manslaughter and sentenced to hard labor because they hadn’t allowed the medical staff to feed their daughter.
History of Fasting, a Ketogenic Diet, and Medicine
In Western culture, Greek physicians prescribed fasting as a medical treatment 2,5000 years ago. Hippocrates recommended fasting as a treatment for epilepsy in approximately 500 BC. Hippocrates, more than any other, was the father of the idea that fasting and the ketogenic diet could improve our health and even treat diseases such as epilepsy.
Hippocrates’ observation that fasting alleviated the symptoms of epilepsy persisted. In the fifth century A. D., physicians continued to treat epilepsy with fasting. Fasting as a medical treatment lost ground during the centuries which followed.
Fasting and the Ketogenic Diet Are Rediscovered
The next step in our historical journey into fasting and the ketogenic diet as medical treatments for epilepsy and other diseases takes us to Paris at the turn of the twentieth century when the link between fasting and reduction in seizures was rediscovered.
It is 1910. Two Parisian physicians, Guelpa and Marie, looked at the effect of intermittent fasting on seizure disorders (Hohn, Dozieres-Puyravel, & Auvin, 2019). Like today, Guelpa and Marie’s seizure patients didn’t follow the fasting protocol. For the six of the 21 patients who followed Guelpa and Marie’s dietary recommendation, four were improved and two had temporary improvements.
Geyelin continued Guelpa and Marie’s studies of the role which fasting plays in the treatment of seizure disorders (Geyelin, 1921). Geyelin suggested that intermittment fasting changed the body’s acid balance. Geyelin’s explanation of how fasting helped control seizures was wrong, but his research pointed the way for others.
There had to be an explanation! Geyelin presented an important paper to an American Medical Association meeting (Lefevre & Aronson, 2000). Geyelin described the dramatic reversal of a severe childhood seizure disorder with the use of a water diet or fasting.
The First Secretary of Health
About the same time in the United States, an ambitious osteopathic physician, Dr. H. W. Conklin wanted to be named as the first Secretary of Health in President Teddy Roosevelt’s cabinet. To make this happen, he hitched his star to a popular health guru, Bernarr MacFadden, who believed that fasting had major health benefits and that eating the wrong foods led to health problems.
Conklin tested MacFadden’s ideas about fasting. His research supported MacFadden’s contention that fasting could be used to treat seizures. Despite MacFadden’s popularity and Dr. Conklin’s research efforts, Dr. Conklin did not become the first Secretary of Health.
Bernarr MacFadden: Man with Many Hats
MacFadden argued that fasting for 3 days to 3 weeks would alleviate or cure any ailment (Wheless, 2008). MacFadden advocated vigorous physical exercise and believed that alcohol, drugs, gluttony, corsets, prudishness, tea, coffee, and white bread were dangerous. He advocated a diet consisting of carrots, beans, nuts, and raw eggs.
Without realizing the significance of his diet, MacFadden was following a ketogenic diet. One wonders how he knew white bread was dangerous.
MacFadden had other vigorous health practices. He slept on the floor and walked five miles to work each day carrying a 40-pound bag of sand.
Bernarr MacFadden had hundreds of thousands of followers, and his influence extended to Washington DC. This photo taken from the Library of Congress shows MacFadden instructing senators in the manly art of boxing.
MacFadden founded several early muscle magazines—Physical Development and Physical Culture (1898, 1899). He also published several pulp magazines such as the example below.
Cover from one of the magazines which made Bernarr MacFadden a millionaire and which offended the morality of the day! The image is from the Library of Congress. http://www.library of congress.com
A wealthy man’s son, HTH, had grand mal intractable seizures. He took his son to Dr. Conklin, and the boy was treated with a fasting diet called the “water diet” for 3 to 4 weeks. The boy’s seizures disappeared during the fasting period, but the seizures returned when the child began eating a normal diet.
HTH’s father, Charles Howland, worried about the long-term effects of fasting on his son. He consulted Dr. Stanley Cobb, a Harvard physician and professor of neuropathology. Howland offered grant money to find out how fasting helped reduce seizures. Cobb and his colleague, W. G. Lennox, found increased levels of ketone bodies in the blood and urine of subjects who had fasted.
Butanone Ketone Molecule. For the first time, a possible mechanism for the effect of fasting on seizures had been discovered. http://pixabay.com
When we fast, our bodies go into ketosis. It is the ketone bodies which act on the brain and reduce seizure occurrence.
From Fasting to the Ketogenic Diet
Long-term fasting wasn’t a useful treatment option. Developing children require a variety of nutrients. How to balance the child’s need for nutrients with a diet which would control seizures? This was the puzzle that faced pediatricians at John Hopkins Hospital and the Mayo Clinic.
Help came from Dr. R. T. Woodyatt, a diabetes researcher. He suggested that the ketone bodies which are found in the blood and urine after fasting could also be found when subjects ate a diet which was low in carbohydrates and high in fat.
Dr. R. M. Wilder of the Mayo Clinic tested the idea that the benefits of fasting on seizure severity and frequency could be produced by a diet which was rich in fat and low in carbohydrates (Wilder, 1921). He called this diet a “ketogenic diet“. The ketogenic diet could be followed over the long term, and eating a ketogenic diet didn’t pose any health risks.
Dr. Wilder reported the successful treatment of three patients using a ketogenic diet (Wilder, 1921).
As a result of the work at the Mayo Clinic and John Hopkins Hospital, putting children with seizure disorders on a ketogenic diet became the treatment of choice for epileptic children. The use of diet to control childhood seizures was included in all major texts on epilepsy until the 1960’s.
Ketogenic Diet and Fasting as Treatments for Seizure Disorders
The ketogenic diet and fasting were abandoned in the 1960’s for two reasons. First a ketogenic diet, low carbohydrate-high fat, is demanding to implement. It takes a trained doctor and a trained dietitian to design the diet. The diet has to fit the characteristics of the individual child. Each child’s diet must be carefully and regularly monitored by the doctor and the parents. Any parent can empathize with how difficult it must be to tell your child that he can’t eat what the other children are eating. No more candy bars!
Second, anticonvulsant medications were introduced. With the passage of time and the availability of anticonvulsant medications, doctors forgot the dietary approach to the treatment of seizure disorders. Pills were easier for parents and doctors. References to the ketogenic diet and fasting as treatments for seizure disorders disappeared from medical texts.
How One Family Made A Difference
Charlie’s story is really his family’s story. In 1973, Jim and Nancy Abraham’s lives became a living hell when their son, Charlie, then 2 years old, began having generalized seizures. Charlie had as many as 100 seizures per day. The best neurologists in Los Angeles treated Charlie with multiple medications. The first medication worked briefly, but the seizures returned. Neurologists had no answer.
In an interview, Jim Abraham recalled that he and his wife cried themselves to sleep every night. https://www.youtube.com/watch?v=5UTsvdvQyw8
Desperate to find help for their son, the Abrahams looked for alternative medicine treatments for Charlie. They found two treatments . . . a herbal treatment and old medical articles describing the ketogenic diet and fasting as treatments for seizure disorders. The Abrahams took Charlie to Houston to try the herbalist’s treatment. Charlie continued to have seizures. Next, Charlie was seen by Dr. Freeman and a dietitian at Johns Hopkins Hospital. Both providers were familiar with the ketogenic diet protocol. Charlie started a ketogenic diet, and he became seizure free in two days. He was off medication in two weeks.
Abraham Family Works to Help Other Families
Jim Abraham became an ambassador for the ketogenic diet as a treatment for epilepsy. A video describing his frustrating journey to find help for his son can be found on the Charlie Foundation website. He realized that other families needed help, so he started the Charlie Foundation. The foundation provides information and support to physicians and parents. http://charlie foundation.org
The foundation has funded publications describing the treatment as well as the first multicenter prospective study on the efficacy of a ketogenic diet. The foundation reports that since their beginnings twenty-five years ago four randomized controlled studies have shown that a ketogenic diet reduces seizures by at least 50% in half of the patients and 15 to 25% became seizure free. Their website has won humanitarian awards and deserves a look.
Charlie is an adult. He has used the ketogenic diet to control his seizure disorder since he was approximately two years old. The image from the Charlie Foundation website shows Charlie working with a group of children. A video shows Charlie giving an award to Meryl Streep for her help and support in a conference in 2012. https://www.youtube.com/watch?v=oef4-NCR9YU
For more information on epilepsy and a ketogenic diet, see this website. https://ketocertified.com/ketogenic-diet-for-epilepsy
The Work Goes On
Our understanding of the health benefits of following a ketogenic diet is literally exploding. There is a world wide revolution. Learn More (link to be added).
The health benefits of fasting are now resurfacing as well. Learn More (link to be added).
See statement of purpose for website, our credentials, and hazards of getting information from internet sites. https://carbohydrateconfessions.com/internet-information-jungle/
Arbesmann, R. (1951). Fasting and prophecy in pagan and Christian antiquity. Tradition, 7, 1-71.
Geyelin, H. R. (1921). Fasting as a method for treating epilepsy. Med. Rec., 99, 1037-1038.
Guelpa and Marie, cited by Keith, H. M. (1963). Convulsive Disorders in Children: With Reference to Treatment with Ketogenic Diet. : Little Brown.
Höhn, S., Dozières-Puyravel, B., & Auvin, S. (2019). History of dietary treatment: Guelpa & Marie first report of intermittent fasting for epilepsy in 1911. Epilepsy & Behavior, 94, 277-280. doi:https://doi.org/10.1016/j.yebeh.2019.03.018
Kerndt, P. R., Naughton, J. L., Driscoll, C. E., & Loxterkamp, D. A. (1982). Fasting: the history, pathophysiology and complications. The Western journal of medicine, 137(5), 379-399.
Lefevre, F., & Aronson, N. (2000). Ketogenic diet for the treatment of refractory epilepsy in children: A systematic review of efficacy. Pediatrics, 105(4), E46.
Wheless, J. W. (2008). History of the Ketogenic Diet. Epilepsia Open, 49 (Suppl. 8), 3-5.
Wilder, R. M. (1921). The effect of ketoemia on the course of epilepsy. Mayo Clin Bull, 2, 307.