The ketogenic diet: Scientific principles underlying its use

The ketogenic diet (KD) is a high-fat, low-carbohydrate, low-protein diet that was initially formulated in the early 1920s as a treatment for intractable epilepsy (Wilder, 1921). Physicians in the 1920s and 1930s were well aware of the effectiveness of the diet; at that time, phenobarbital was the only other epilepsy treatment in widespread use. With the discovery of phenytoin in 1935, and other anticonvulsant medications over subsequent decades, the KD was used much less frequently; however, over the past 15 years, the KD has re-emerged as a viable alternative to standard anticonvulsants in the treatment of refractory epilepsy, especially in children (Freeman et al., 2007b; Kossoff et al., 2009). The history of the KD, including its origin and the reasons for the recent resurgence in its use, is reviewed elsewhere in detail (Freeman et al., 2007a, b; Swink et al., 1997; Wheless, 2004).