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A Quick History of Ketogenic Diets

“The Ketogenic Diet” is the latest buzzword in the nutrition world, but this is an approach to weight loss and dieting that has existed for over 150 years under different guises.

The diet world may appear complicated with new theories, but there are only two approaches under which almost every single diet can fall.

In every diet, weight loss is achieved through caloric restriction — no matter what the approach is: low fat, plant-based, low-carb, blood-type, etc. There is no exception to that.

How caloric restriction is achieved will vary on the method used.

So what are the two approaches to diet and nutrition? I have called them:

1) The medical model
2) The healthy model

The Medical Model

For almost 150 years, the medical model for dieting has been recommending a high-fat, low-carbohydrate diet. This diet is high in animal protein, although there are some rare vegan versions.

It started becoming famous in 1860 when Londoner William Banting lost 50 pounds on a high-protein diet that consisted of dry roasted lean meat, soft-boiled eggs, and vegetables. He wrote a book in 1864 called “Letters on Corpulence” that became an instant bestseller.

By 1880, “Banting” is America’s foremost weight-loss program. A little later, another doctor by the name of James Salisbury started promoting a diet consisting mainly of hot water and minced meat patties (the famous Salisbury steak) for health and weight loss.

When Dr. Atkins wrote his “Diet Revolution” in 1972, he didn’t invent anything new. He just kept on promoting the medical model for weight loss, which has always consisted of calorie-reduction in the context of a high-fat, usually high-protein diet.

Since then, most diets are just a variation on the same theme, with a different degree of restrictions. The Zone Diet, the South Beach Diet, and even the Blood Type diet were just “lighter” approaches on the medical model for dieting.

The Paleo diet is also a variation on the same theme.

Finally, the Ketogenic Diet is the technical term for this medical approach to dieting, with an emphasis on achieving a state of ketosis.

The different diets will vary in how much they restrict carbohydrates, and only a few of them will achieve a real state of ketosis when the body is starved of its glycogen and glucose reserves and must switch to ketone bodies for energy.

I call this the “medical model” because it’s what the medical community has endorsed for years, and because it has a sort of pharmaceutical mentality of obtaining quick results (losing weight), often at the expense of health (side effects).

The Healthy Model

The healthy model is different because it’s not so much concerned with weight loss but instead, views it as a positive side effect of eating the foods that are conducive to health in general.

Proponents of the healthy model to dieting are concerned with health primarily and will modify their diet to achieve more weight loss if necessary.

In this category we find, going back at least 200 years, but we could go all the way back to Pythagoras, roughly 2500 years ago in Greece.

If we start from more recent times, we have this timeline:

The vegetarian diet of Sylvester Graham (1794-1851)

He was one of the first public figures to advocate vegetarianism and what he called “temperance.” We may remember him as the inventor of the graham cracker, but his contribution was much more significant. His followers practiced the brushing of teeth, vegetarianism, sobriety, and eating whole foods (such as whole wheat bread instead of white flour), all practices that we take for granted today, but were very controversial at the time.

The fruit-based diet of Dr. Emmet Densmore (Main Work Published in 1890)

The concept of a “fruit-based diet” probably came from Dr. Emmet Densmore, an English doctor who published in 1890 a book called “The Natural Food of Man.” Densmore was a sick man, and could not find relief to his lingering lumbago problems in a purely vegetarian diet. So he adopted a diet of fruits, nuts, milk, eggs, and cheese.
His book mostly contains somewhat anecdotal evidence on the harm of grain products, and the benefits of a fruit-based, mainly raw diet.

The Natural Hygiene of Herbert Shelton (1895-1985)

Shelton became, in his youth, a passionate student of the writings of early health reformists, and proceeded to consolidate all their theories into a unified philosophy he called “Natural Hygiene.” In his thirties, he wrote his giant book “Human Life, Its Philosophy, and Laws.”

He then operated a health center in Texas where he practiced fasting and a clean, mostly raw food diet.

All of the modern Natural Hygiene movement stems from Shelton, although it gained even more popularity when T.C. Fry came along and later when the book “Fit For for Life” was released in the 1980s. All promoters of Natural Hygiene today are students of Shelton, who wrote more than 50 books.

Today we have more modern interpretations of this approach with:

  • The Heart-Disease Reversal Diet of Dr. Dean Ornish. Dr. Ornish was the first to prove through extensive research that coronary heart disease can be reversed, by making comprehensive changes in diet and lifestyle, including a low-fat vegetarian diet.
  • Dr. Esselstyn with his famous heart-disease reversal program.
  • Other proponents of the low-fat diet include Dr. McDougall, who has recommended a low-fat diet for decades and whose results are well documented. His main book is “The Starch Solution.
  • T. Colin Campbell who wrote The China Study. We also have most of the vegan and vegetarian doctors who wrote books and did their research, such as Dr. Klaper, Dr. Greger, Dr. Neal Barnard, Dr. Joel Fuhrman, and many others

Can the Two Approaches Work?

When we look at it like that, and if we go past the small differences regarding details, we can roughly see the following picture:

We have the medical model that’s promoted through many famous bloggers, best-selling books, newspapers, magazines, and fitness centers.

This model usually recommends a high-fat diet, with a lot of animal protein. It can also be ketogenic.

Then we have the “healthy” model, which is promoted by health-oriented doctors and researchers and is backed up by an extensive amount of data.

This model focuses on eating the foods that are genuinely conducive to excellent health:

  • Fruits
  • Vegetables
  • Nuts and Seeds
  • Beans (not recommended by Natural Hygiene)
  • Whole Grains (not recommended by Natural Hygiene).

There are some differences in the approaches here, and you’ll even find non-vegan options among the “healthy” approach. But animal products play only a small part in their program, and the focus is always plant foods.

Two Questions to Ask

Many people are thoroughly confused when they look at the two camps, and can’t seem to figure out who’s right and who’s wrong.

One of my most thoughtful readers asked me recently in an email:

(…) successful LCHF (Low Carb, High Fat) practitioners, proponents, and researchers claim to be able to feel great, eliminate
their health problems, and have greater mental energy and focus than ever before.
Furthermore, they would argue that all of the studies that claim to show adverse
effects from eating fat suffer from one or both of the above problems. They feel
that their diet is the best not only from a physical health standpoint but also from
the standpoint of brain health, intelligence, focus, and productivity. Their LCHF
approach seems to have gained a lot more traction than your LFHC (Low Fat, High Carb) approach in recent
years, especially in places like Silicon Valley where mental productivity is
paramount. What are your thoughts on this dietary approach? My suspicion is that
over the long term, it may be inferior to your LFHC approach, at least with respect
to physical health, but I’m not sure whether there is any evidence of that yet. The
LCHF proponents may be right about all the studies being done on people (or animals)
whose diets were not truly low-carb and/or whose sources of fat were unhealthy
and/or unbalanced.

Here we have some legitimate questions regarding the two approaches. Let me start with my two questions.

Which approach has been used successfully to help sick people overcome severe health problems such as heart disease and auto-immune diseases?

The winner here is the healthy approach.

There is no research showing that a Low-Carb, High-Fat diet can reverse heart disease. Although you’ll find some evidence that LCHF diets can help various health conditions, the weight of the evidence is on the side of the healthy approach.

As for mental productivity, I see it as nothing but another of those “stimulant traps.” Proponents of this diet, like Tim Ferriss and Dave Asprey, also happen to promote various kinds of prescription and legal drugs, including various concoctions of caffeine, modafinil (a powerful anti-narcolepsy drug used by Dave Asprey and his followers), and other schemes too numerous to mention. If you read Tim Ferriss’ Four-Hour Body book, you know that he’s pretty much experimented with every stimulant under the sun in his obsession to achieve states of peak-productivity. But in a recent interview, I heard him say that “There’s no free pass” and these drugs all have their side-effects.

Is it any surprise that the LCHF diet is more popular in Silicon Valley, where the philosophy is to favor productivity and material success at the expense of your health? Many silicon valley executives push their employees to work 70-90 hour workweeks, often to the point of total exhaustion. Their propensity to follow a LCHF diet is another of those ideas that favor quick results at the expense of long-term health.

What is the diet of long-lived cultures?

Proponents of the medical model often point out the rugged health of hunter-gathers. But their evidence that these people even ate a genuinely low-carb diet is weak. It’s also not a proof of longevity, as these groups do not live long lives.

Long-lived cultures that we have studied so far do not eat a low-carb diet.

When you look at epidemiological studies, you also find that high-carb, whole foods are not linked to disease, but increased longevity.

As I have pointed out before, societies today with the lowest BMI do not eat a low-carb diet. They either eat a high or average amount of carbohydrates.

Frederic Patenaude
Frederic Patenaude

Frederic Patenaude has been an important influence in the raw food and natural health movement since he started writing and publishing in 1998, first by being the editor of Just Eat an Apple magazine. He is the author of over 20 books, including The Raw Secrets, the Sunfood Cuisine and Raw Food Controversies. Since 2013 he’s been the Editor-in-Chief of Renegade Health.


Frederic loves to relentlessly debunk nutritional myths. He advocates a low-fat, plant-based diet and has had over 10 years of experience with raw vegan diets. He lives in Montreal, Canada.