Treatment of epilepsy: The ketogenic diet

Until the 20th century there were few effective treatments for epilepsy. Prayer and fasting had been advocated as therapy since at least biblical times. In the early 20th century attention turned to the fasting component and led to Wilder’s original publication in 1921 that outlined a ketogenic diet.1 On the basis of earlier studies of metabolism in diabetics, he recognized that fasting produced ketosis, which could be sustained by a diet that contained an excess of ketogenic foods (fats) rather than antiketogenic foods (proteins and carbohydrates). He and colleagues at the Mayo Clinic recommended an energyrestricted diet that provided approximately 1 g/kg per day of protein, a small amount of carbohydrates and more than 90 per cent of energy intake as fats.2.