A year ago I was still a vegetarian. In fact, I had been a vegetarian for nigh on three decades. I was experiencing a whole range of problems and challenges, mostly health-related. This state of affairs convinced me of the need for change, I began researching various diets and came across several interesting YouTube channels and podcasts on keto. Gradually, over a period of weeks, I began to understand what the ketogenic diet might offer, the origins of keto, and the enthralling possibilities that come along with the lifestyle.
Making a Choice
Originally, my greatest concern was inflammation, I, therefore, searched for diets that were considered to be good anti-inflammatory ways of eating. Over time, it was becoming clearer and clearer to me, that so many of my problems, from my heart to my feet, from my forehead to my hands, were inflammatory in nature, so it seemed to me that this was a good place to start.
After a productive and informative hour or two, it was readily apparent that the Keto diet seemed to hit all the right buttons, although still considered very controversial by some. Despite the warnings of the naysayers, it was clear that this particular attitude to eating had a very long and very distinguished history.
Way, way back in History
Hippocrates, the father of medicine, was using fasting to treat epileptic patients several hundred years BCE on the island of Kos. He had little or no idea about the mechanism involved, but essentially his patients were entering ketosis because of caloric restriction. Other cultures from that time discovered very similar positive effects from fasting. It became a very fundamental health option in many philosophical and religious systems. In recent times the benefits of fasting have become readily apparent once again. This is particularly the case with autophagy, but that is the subject for another blog in the near future.
The Start of Modern Keto
Fasting, or variations on it, reappeared at various times down the centuries. Some individuals also discovered the mechanism more or less serendipitously. In 19th South Africa, an overweight undertaker by the name of William Banting decided to do something about his problem before he became a customer of his own company. He developed a form of eating that we would now recognise as ketogenic. This style of eating, high on fats and low on carbohydrates, is still referred to as ‘banting’ to this day in South Africa.
Early 20th Century Developments
In the early 20th century, two doctors from Paris, Monsieur Guelpa and Monsieur Marie, rediscovered the efficacy of fasting for treating epileptics. This created a wave of scientific interest and many attempts to try to get to the root of the matter.
An interesting observation was made by William Lennox of the Harvard Medical school. He noted that the changes in metabolism brought about by fasting usually occurred two to three days after the start of the fast. He postulated from this the notion that the body was actually swapping over to fat for its fuel rather than glucose.
In 1921, an endocrinologist called Robin Woodyatt found that acetone and hydroxybutyric acid, what we now know as ketone bodies, were present in people who had fasted for at least a couple of days.
Russell Wilder and Epilepsy
Following this and other research, Dr. Russell Wilder of the Mayo Clinic designed a ketogenic diet for his young epileptic patients in 1923. Essentially, the diet was low in carbohydrate, moderate to low in proteins, but very high in fats. Essentially, all modern ketogenic diets are variations on the theme of Wilder’s diet. This classic keto used a ratio of 4:1, which meant that there were four parts fat for every one part protein and carbohydrate.
A Dr. Peterman developed a standardised version of WIlder’s diet that allowed patients only between 10 and 15 grams of carbs per day. Interestingly, Peterman also noticed that this form of diet affected the brain’s performance quite profoundly, observing: “a marked change in character, concomitant with the ketosis, a decrease in irritability, and an increased interest and alertness.” We will, no doubt, be returning to these psychological effects of ketosis in subsequent blogs. Variations of the diet that Wilder and Peterman developed are being used by physicians for the treatment of epilepsy in the young to this day.
Late 20th Century and Robert Atkins
Over time, and throughout the twentieth century, doctors became gradually more and more aware that a diet low in carbohydrates and high in fat may have many benefits for their patients beyond merely its efficacy with epileptic patients. This early vanguard faced a lot of opposition from those who insisted that plant-based diets and the negation of fats were the only way to go, despite the mounting obesity crisis in the US and beyond.
Robert Atkins in particular, founder of the famous, some might even say infamous, Atkins Diet deserves an honourable mention for daring to go against the grain (pun fully intended) during those days when the conventional medical wisdom was so keen on the consumption of huge amounts of carbohydrate and barely any fats. Unfortunately, a little search through UK government websites or NHS recommendations will soon demonstrate that they still are. Fortunately, as more solid science begins to take over from the earlier and cruder epidemiological studies, we are now beginning to see quite a profound change of attitudes.
Keto’s Place in Anthropology
I sometimes read of people dismissing ketogenic dieting as a fad, especially those who advocate a high carb, or plant-based (as the modern vernacular would have it!) diet. In a sense, a keto diet of some sort or other has been the default through much of human existence. It seems clear though from the anthropological evidence, that humans have consumed meat, and particularly fatty meats, for many millennia. Isotope testing on ancient skeletons has confirmed this to be the case. So, in that sense, it becomes readily apparent that the ketogenic way of eating can hardly be called a fad!
Perhaps, we can go so far as to say that the boot may now be well and truly on the other foot. As study after study comes in, the argument for a plant-based, non-meat diet becomes thinner and thinner. Mankind has only been consuming grains as a staple of the diet for a few thousand years and has suffered many and varied ills because of it.
A Thought Experiment…
At this point, I believe a little thought experiment will illustrate clearly the problem for those who still wish to believe that humans could survive happily on a plant-based diet and that they would have done so in the past. As I record this blog on a cold November morning, I look out of the window and wonder how I would have survived four or five thousand years ago through a typically cool British winter.
According to a DNA test, the vast majority of my ancestry is from Celtic or Northern Europe. Is it likely, in November through December, January, and February, that I would find enough fruit, roots, and greenery to survive such an extended period facing the challenges of the British winter? Or is it far more obviously the case that I would have looked for creatures to hunt, trap and consume? The capturing of a single deer, eaten nose to tail, could feed a small family for a week. Just how much foraging would that same family have had to do in a chilly British November to supply their needs? It doesn’t bear thinking about! What a tough existence our ancestors had, yet somehow they thrived and passed on their genes, generation after generation, long before the joys of Tescos or Sainsburys!
So, you may well ask at this stage, what is the main idea behind the ketogenic diet?
Simplifying it terribly, and as Lennox postulated, the human body does indeed have two main sources of energy at its disposal. The first, and the one that most of us spend most of our lives utilising, especially if we consume a typical Western diet, is sugar. To be more precise, it is actually carbohydrates converted into sugars that are then spread into the bloodstream and circulated where needed. As the body can only store a few hours worth of this form of energy at a time, under this system it needs to be constantly resupplied with carbohydrates just to keep going. Just two hours of moderately intense exercise can more or less completely deplete the system.
The second system is ketosis, or keto for short. This relies on the production of ketone bodies, a process known as ketogenesis. Ketones are made from the body’s supply of fat, either fat that has been recently ingested or the fat stored on your stomach, hips, and thighs. Simply from the cosmetic point of view, burning this fat instead of storing more fat from the oversupply of carbs brings all sorts of benefits.
In normal circumstances, the body will burn its supply of glucose first. If it is insufficiently active, as so many of us are given the sedentary lifestyles we tend to lead, the surplus glucose will be converted to fat by the liver and added to its fat stores. Only once the glucose supply is exhausted will the body turn to its fat.
Hitting the Wall
Those of you who have run or marathon or are keen cyclists may have actually experienced this phenomenon. In running, when the body’s supply of glycogen runs out you are said to have ‘hit the wall’. This wall is normally hit at around the two to three-hour point into a marathon. The runner will suddenly feel drained of all energy, a horrible feeling that can last for fifteen to twenty minutes. At that stage, thankfully, ketosis will kick in and enable the runner to complete the race.
Suffering ‘the Bonk’
Much the same happens in cycling, particularly to those who cycle over longer distances. Many, many moons ago, in my slightly madder youth, I cycled a distance of 107 miles around the roads of Essex. Don’t ask me why, I think I may have been obsessed with the Tour de France at the time. The first ninety or so miles were quite pleasant and I felt that the century should be a breeze. Then I experienced what was then colloquially known in cycling circles as ‘the bonk’! For a time I could hardly push the pedals around at all and the slightest incline felt like an Alpine peak. Eventually, though, ketosis kicked in and by the completion of the ride, I felt as if I had so much energy that I could go around again!
In a Nutshell
So, to sum up, to get into ketosis we must first get through the body’s stores of glycogen, effectively sugars from carbohydrates. There are a couple of ways of doing this. The first is the rather arduous technique I just described. Exercising at a sufficiently high rate of intensity, and long enough, to completely deplete the stored up glycogen. The second, and far more comfortable way, is simply to avoid putting the carbohydrates into your body in the first place. This way of eating, the avoidance of carbs, or at least the reduction of carbs down to a very low level, is the very essence of the ketogenic diet but…
Enough for this week methinks!
We will get into greater detail about the diet itself in the next blog which, if all goes well, will be published in the coming week.