In 1921, physician Russell Wilder at the Mayo Clinic proposed a high-fat, very-low-carbohydrate diet designed to reproduce some of the metabolic effects of fasting. That idea became the modern ketogenic diet for epilepsy.
From fasting to a repeatable treatment
Fasting had been used for centuries in attempts to reduce seizures, but it was not practical as a long-term treatment. Wilder linked the apparent antiseizure effect of fasting to ketone production and proposed that a diet producing sustained ketogenesis might achieve similar benefits without prolonged starvation.
What happened next
Wilder’s 1921 reports were followed by a rapid spread of ketogenic treatment during the 1920s. Historical review has identified nine published series from that decade involving more than 400 people with epilepsy.
Why it faded — and returned
As antiseizure medicines became more widely available, dietary therapy declined in many centres. Interest revived late in the twentieth century, and ketogenic dietary therapies are now established evidence-based options for selected epilepsies. Modern research also shows that ketosis alone does not fully explain how the treatment works.
Sources
History of dietary treatment from Wilder’s hypothesis to the first open studies in the 1920s
History of the ketogenic diet