History of the Ketogenic Diet
Before diving into the implications of a ketogenic diet, let’s discuss the different nutritional approaches that have been recommended over time for diabetes mellitus (DM) treatment.
Until 1921, the year insulin was discovered, the quality of life and survival of patients with diabetes was very short and traumatic.
Though not even 100 years have passed since this revolutionary discovery, it is impressive how the therapeutic resources have advanced from the comprehension and understanding of the pathophysiology of the disease.
Rollo’s Deptford Notes of a Diabetic Case
One of the first writings on diets for diabetes management dates back to 1779. John Rollo, a Scottish surgeon who worked for the Royal English Artillery, wrote a book called “Deptford Notes of a Diabetic Case” which accounted for the treatment he implemented in two soldiers with diabetes.
One of the cases was an obese army officer who began to lose weight at the beginning of the meat-based diet and went through a process of remission of his symptoms. The loss of sugar through the kidneys (glucosuria), thirst (polydipsia) and the constant need to urinate (polyuria) ceased.
After the presentation of the case, everything suggests that it was Type 2 diabetes (T2D) and surely the weight reduction and the low intake of carbohydrates contributed to the good results.
This would not have happened if it had been Type 1 diabetes (T1D) since this condition is characterized by total lack of insulin and although all the food sources of HC were reduced, the symptoms would have probably caused havoc due to the uncontrolled formation of glucose from the liver (gluconeogenesis). The lack of glucose into the cells added to the lipolysis (when the body burns its own body reserves of fat), proteolysis (destruction of muscle proteins) and the production of ketone bodies would have led to a body collapse.
The Allen Treatment
Years later, the writings and treatments from Dr. Frederick Madison Allen became very popular. Dr. Allen, who worked at the Rockefeller Institute in New York, published a book titled “The Allen (Starvation) Treatment of Diabetes: With a Series of Graduated Diets.”
The word “starvation” describes exactly what the diet was about. His motto was “less food, more life.“
The treatment began with therapeutic fasting that was sustained until the loss of glucose in urine disappeared. Then 10g of carbohydrates per day from vegetables were added until it was confirmed that glucose in the urine reappeared. At that point, the carbohydrate intake was reduced and proteins were added to cover the energy requirement. Then fats were incorporated.
The study counted approximately 8 percent of the total caloric intake in carbs, 18 to 20 percent of proteins, and up to 70 percent of fats.
Elliot Joslin’s Contribution
Elliot Joslin also used similar proportions in the distribution of nutrients, where only 10 percent of the calories ingested daily were from carbohydrates. This approach helped extend the life of people with Type 1 diabetes. Joslin also believed diabetes was merely an intolerance for carbs and his approach to reduce and eliminate carbs helped people with Type 2 diabetes, also at that time called the “fatty” diabetes.
Undoubtedly, the discovery of insulin was a milestone in the history of the condition that not only radically changed the course of the condition to turn it into a chronic condition but also allowed for greater food intake. Also for many years, diets that consisted of reduced carbohydrates continued to be recommended.