Ketogenic diets have been used for weight loss for at least a century, making occasional appearances into the dieting mainstream. Complete starvation was studied frequently including the seminal research of Hill, who fasted a subject for 60 days to examine the effects, which was summarized by Cahill et. al. The effects of starvation made it initially attractive to treat morbid obesity as rapid weight/fat loss would occur. Other characteristics attributed to ketosis, such as appetite suppression and a sense of well being, made fasting even more attractive for weight loss. Extremely obese subjects have been fasted for periods up to one year given nothing more than water, vitamins and minerals.
The major problem with complete starvation is a large loss of body protein, primarily from muscle tissue. Although protein losses decrease rapidly as starvation continues, up to one half of the total weight lost during a complete fast is muscle and water, a ratio which is unacceptable.
In the early 70’s, an alternative approach to starvation was developed, termed the Protein Sparing Modified Fast (PSMF). The PSMF provided high quality protein at levels that would prevent most of the muscle loss without disrupting the purported ‘beneficial’ effects of starvation ketosis which included appetite suppression and an almost total reliance on body fat and ketones to fuel the body. It is still used to treat severe obesity but must be medically supervised.
At this time, other researchers were suggesting ‘low-carbohydrate’ diets as a treatment for obesity based on the simple fact that individuals tended to eat less calories (and hence lose weight/fat) when carbohydrates were restricted to 50 grams per day or less. There was much debate as to whether ketogenic diets caused weight loss through some peculiarity of metabolism, as suggested by early studies, or simply because people ate less.
The largest increase in public awareness of the ketogenic diet as a fat loss diet was due to “Dr. Atkins Diet Revolution” in the early 1970’s. With millions of copies sold, it generated extreme interest, both good and bad, in the ketogenic diet. Contrary to the semi-starvation and very low calorie ketogenic diets which had come before it, Dr. Atkins suggested a diet limited only in carbohydrates but with unlimited protein and fat. He promoted it as a lifetime diet which would provide weight loss quickly, easily and without hunger, all while allowing dieters to eat as much as they liked of protein and fat. He offered just enough research to make a convincing argument, but much of the research he cited suffered from methodological flaws.
For a variety of reasons, most likely related to the unsupported (and unsupportable) claims Atkins made, his diet was openly criticized by the American Medical Association and the ketogenic diet fell back into obscurity. Additionally, several deaths occurring in dieters following “The Last Chance Diet” – a 300 calorie-per-day liquid protein diet, which bears a superficial resemblance to the PSMF – caused more outcry against ketogenic diets.
From that time, the ketogenic diet (known by this time as the Atkins diet) all but disappeared from the mainstream of American dieting consciousness as a high carbohydrate, low fat diet became the norm for health, exercise performance and fat loss.
Recently there has been a resurgence in low carbohydrate diets including “Dr. Atkins New Diet Revolution” and “Protein Power” by the Eades but these diets are aimed primarily at the typical American dieter, not athletes.
1. Walters JK, et. al. The protein-sparing modified fast for obesity-related medical problems. Cleveland Clinical J Med (1997) 64: 242-243.
2. Yudkin J and Carey M. The treatment of obesity by a ‘high-fat’ diet – the inevitability of calories. Lancet (1960) 939-941.
3. Yudkin J. The low-carbohydrate diet in the treatment of obesity. Postgrad Med (1972) 51: 151-154.
4. “Dr. Atkins’ Diet Revolution” Robert Atkins, MD. New York: David McKay Inc. Publishers, 1972.
5. Council on Foods and Nutrition A critique of low-carbohydrate ketogenic weight reducing regimes. JAMA (1973) 224: 1415-1419.