How the Keto Diet Got Started: From Medical Treatment to Modern Trend

December 29, 2025 •

4 min read

The ketogenic diet, commonly known as 'keto,' was originally developed in the 1920s as a medical treatment for children with epilepsy, not as a weight-loss trend. Its modern popularity is the result of nearly a century of research, decline, and eventual revival for broader health and wellness applications.

Quick Summary

The ketogenic diet originated in the 1920s at the Mayo Clinic as a treatment for epilepsy, mimicking the effects of fasting. It later fell out of favor due to new medications but was revived for weight loss in the 1970s and became a mainstream trend in the 1990s.

Key Points

Ancient Practice: The use of fasting to treat epilepsy dates back to biblical times, influencing modern research.
Coined by a Doctor: Dr. Russell Wilder of the Mayo Clinic first coined the term “ketogenic diet” in 1921 to replicate fasting's effects.
Originally for Epilepsy: The diet was developed as a strict, medically monitored treatment for children with intractable seizures.
Faded with New Medications: The popularity of the diet declined significantly after effective anti-epileptic drugs became available in the late 1930s and 1970s.
Revived by a Parent: Hollywood producer Jim Abrahams' son was successfully treated with the diet in 1994, leading him to create a foundation and bring the diet back into the public eye.
Adapted for Weight Loss: In the 1970s, Robert Atkins popularized a low-carb version for weight loss, and modern keto has evolved from these iterations.
Mainstream Phenomenon: Thanks to media attention and social media, keto has become a major wellness trend, used for various health goals beyond its original medical purpose.

The Origins of a Therapeutic Diet

The story of how the keto diet got started begins not in a gym or on social media, but in a hospital, as a treatment for a debilitating medical condition: epilepsy. For centuries, physicians and healers noticed that periods of fasting could reduce or even stop seizures in some patients. This ancient observation laid the groundwork for modern research into the body's metabolic state of ketosis.

Fasting as a Foundation

Ancient Roots: The therapeutic power of fasting for epilepsy was documented as far back as ancient Greece and biblical times. Early medical texts from around 400 BC mention dietary therapies for controlling seizures.
Early 20th Century Research: In the early 1900s, this practice was revisited by osteopathic physician Hugh Conklin, who treated epileptic children with a long 'water diet' fast. While his claimed success rates were high, later analysis was more conservative, but his work drew attention from mainstream medicine.

The Birth of the Ketogenic Diet

At the Mayo Clinic, Dr. Russell Wilder and his colleagues were looking for a way to replicate the benefits of fasting for epilepsy patients without the need for prolonged starvation. Their work followed the observation by endocrinologist Rollin Woodyatt that fasting or a very low-carbohydrate, high-fat diet caused the liver to produce ketone bodies.

The 1921 Coining: In 1921, Dr. Wilder officially coined the term "ketogenic diet" to describe this specific dietary treatment.
The Original Formula: The classic ketogenic diet developed in the 1920s by Wilder's colleague, Dr. Mynie Peterman, was extremely strict, providing most calories from fat (often a 4:1 ratio of fat to protein and carbohydrates). This was a medically supervised regimen, not a lifestyle choice.
Success and Acceptance: For nearly two decades, the ketogenic diet was widely accepted and used to treat pediatric epilepsy, with reported high rates of seizure reduction.

Decline and a New Beginning

The Rise of Anticonvulsant Drugs

Starting in the late 1930s with the discovery of phenytoin (Dilantin) and continuing with the development of more effective antiepileptic drugs in the 1970s, the use of the restrictive ketogenic diet faded. Medications were easier for patients to follow, and the intense discipline required for the original keto diet became less practical for most.

The Atkins and MCT Variants

Despite its medical decline, the ketogenic concept reappeared in other forms. Cardiologist Robert Atkins popularized a low-carbohydrate, high-fat diet for weight loss in 1972. While not identical to the strict clinical ketogenic diet, the Atkins approach shared the principle of nutritional ketosis. In the 1970s, a variant using medium-chain triglycerides (MCTs) was also developed, allowing for a more liberal intake of protein and carbohydrates for easier adherence.

The Keto Revival and Modern-Day Context

The ketogenic diet experienced a major resurgence in the 1990s, catalyzed by an influential media moment.

The Charlie Foundation: After his young son's severe epilepsy was cured by the ketogenic diet in 1994, Hollywood producer Jim Abrahams created the Charlie Foundation to raise awareness. The foundation funded research and helped promote the diet as a viable therapy again.
Publicity from Pop Culture: A 1997 made-for-TV movie, ...First Do No Harm, starring Meryl Streep, dramatized Abrahams' story, thrusting the dietary therapy into the public spotlight.

From Epilepsy Treatment to Weight Loss Craze

With renewed interest, researchers and wellness advocates began to explore the ketogenic diet's potential for other conditions beyond epilepsy. Its ability to promote rapid weight loss, often due to initial water loss, made it a sensation among celebrities and social media influencers. This has driven a massive keto food industry, valued at billions of dollars.

The Evolution of the Keto Diet

The diet available today is a far cry from the original, medically supervised 4:1 ratio. Modern keto is often a more liberal version, with different approaches to achieve nutritional ketosis. However, the core principle remains the same: a very low-carbohydrate intake forces the body to burn fat for fuel, producing ketones.

Comparison of Classic Keto vs. Modern Keto


Feature	Classic Ketogenic Diet (1920s)	Modern Keto (21st Century)
Primary Purpose	Strict, medically supervised treatment for intractable epilepsy.	Primary use is for weight loss, but also for blood sugar management and other health goals.
Macro Ratio	Extremely high-fat, very low-carb (e.g., 90% fat) requiring precise measurements.	Typically aims for a lower carb count (20-50g net carbs) and less emphasis on exact ratios.
Adherence	Very restrictive and difficult to follow long-term outside of a clinical setting.	More flexible and adaptable to everyday life, though still restrictive compared to average diets.
Supervision	Required hospital admission for initiation and close monitoring by a medical team.	Usually self-managed, with consultation with a doctor or dietitian recommended.
Food Variety	Limited options due to strict ratios and precise measurements.	Wider variety of low-carb foods, with various recipes and products available.

The Journey Continues

The history of the ketogenic diet is a testament to the dynamic nature of medicine and nutrition. What began as a rigid, clinical intervention for a specific neurological disorder has morphed into a global wellness phenomenon. Its evolution has seen moments of obscurity and spectacular revival, driven by both scientific discovery and popular media. While today’s keto is more accessible and versatile, its foundations are rooted in a century-old quest to understand and harness the body’s metabolic power.

Reference: For more on the medical application of ketogenic diets, see the article published by the National Institutes of Health.

Conclusion

The keto diet's trajectory from a niche medical treatment for pediatric epilepsy in the 1920s to its widespread modern use for weight loss and general health is a remarkable story of evolution. Initially developed at the Mayo Clinic by Dr. Russell Wilder, the diet harnessed the power of ketosis to control seizures, reviving an ancient observation about the effects of fasting. Its medical prominence waned with the introduction of new drugs but was rekindled in the 1990s by public advocacy and media attention. Today, while the basic principle of low-carb, high-fat remains, the execution is far less restrictive and has been embraced by millions seeking its metabolic benefits.

Frequently Asked Questions

The historical keto diet was an extremely rigid, medically supervised treatment for epilepsy with a very specific, high-fat macronutrient ratio. The modern keto diet is a less restrictive, self-managed version primarily used for weight loss and wellness, with more flexible food options.

No, the keto diet was not initially created for weight loss. It was first developed in the 1920s as a treatment for pediatric epilepsy. The idea of using ketosis for weight loss was popularized later, most notably with the Atkins diet in the 1970s.

Doctors observed that fasting could reduce seizures in epileptic patients. Later, research by Dr. Russell Wilder and others confirmed that a low-carbohydrate, high-fat diet mimicked the metabolic state of fasting (ketosis) and had similar anti-seizure effects, making it a more sustainable option than prolonged starvation.

The keto diet fell out of favor primarily due to the introduction of more convenient and effective anti-epileptic drugs starting in the late 1930s. The diet was difficult to maintain and less practical than simply taking medication.

Jim Abrahams is a Hollywood producer whose young son's severe epilepsy was successfully treated by the ketogenic diet after other therapies failed. He founded the Charlie Foundation in 1994 to raise awareness, fund research, and promote the diet, leading to a resurgence of interest.

Ketosis is a metabolic state where the body, in the absence of sufficient carbohydrates, switches from using glucose for fuel to burning fat. The liver breaks down fat into compounds called ketone bodies, which are then used as an alternative energy source.

No, the ketogenic diet is not suitable for everyone and requires caution. It can have side effects and is contraindicated for people with certain medical conditions. It's always best to consult a healthcare professional before starting the diet.