As far back as 500 BC, it was understood that high levels of sugar in the body (and excreted in the urine) was part of the pathology of Diabetes. By the late 1700s, it had become clear that, once eaten, the starchy foods we consumed were converted to sugar internally, and that, not only the urine but indeed the blood of those afflicted with Diabetes had a high sugar content. By the mid to late 1800s, not only was it known that blood sugar levels increased after we consumed such foods, but that a more simple form of sugar termed “glucose” was being produced by the liver itself.
According to the prevailing wisdom of the time, excess glucose in the urine and blood were merely symptoms of Diabetes, however, a few pioneering doctors and scientists began to draw conclusions that perhaps we had it backwards, that Diabetes may be a “symptom” of excess and/or chronic sugar/refined carbohydrate consumption.
In 1797, Dr. John Rollo, leveraging the earlier work of an English physician by the name of Matthew Dobson (who identified sugar as a substance excessively excreted in the urine of Diabetic patients and present in unusual amounts in the blood), experimented with eliminating sugar and starch from the diet in an effort to not only stem the rise in blood glucose levels but cleanse it from the system completely.
“Rollo showed that a diet rich in protein and fat (largely from animal sources) and low in carbohydrates—together with the administration of several medications … resulted in a substantial weight loss, the elimination of Meredith’s (the patient’s) symptoms, and the reversal of both his glycosuria and hyperglycemia.”
READ: The Dartmouth Medicine magazine article “Diabetes Detectives“
As a better understanding of how the body dealt with different macronutrientss (carbohydrates, Protein and fat), a few visionary doctors began to prescribe and have tremendous success with a purely nutritional approach to the treatment of Diabetes, chief among them was Dr. F.William Pavy, one of the pre-eminent experts of the time. A Fellow with The Royal College of Physicians, Pavy, who was awarded the Prix Godard for his work on carbohydrate metabolism in diabetes wrote in his book “Researches on the nature and treatment of Diabetes” in 1862…
“…The exclusion of saccharine (sugary) and farinaceous (starchy) materials from the diet has now been generally acknowledged for some years past as forming one of the essential points, to be attended to in the treatment of diabetes.”
Below is Dr. Pavy’s exact diet for treating Diabetes…
And, as recommended by leading experts and medical professionals of the time, another dietary regime to treat Diabetes from the book “Diabetes Mellitus: Its History, Chemistry, Anatomy, Pathology, Physiology,” written in 1877, outlines a nutritional approach that eschews sugar and carbohydrates in all forms including grains, corn, pasta, rice, flour, potatoes, fruits, beer, sweet wines and cured meats.
While this zero/low carbohydrate approach was being prescribed to deal with the devastating effects of diabetes, doctors also took note of the diet’s dramatic effects on weight loss.
In 1856, leaning on the work of Dr. Claude Bernard (a renowned French scientist who discovered that the liver itself manufactures, stores and secretes a simple form of sugar called glucose (and in the presence of starch and saccharine matter will do so in large quantities), Dr. William Harvey, an English surgeon postulated that, given the excessive amount of glucose in the blood of diabetics, and given that many diabetic patients are also obese, and that a diet of grains, starches and sugar were also used to fatten animals for slaughter that…
“excessive obesity might be allied to diabetes as to its cause, although widely diverse in its development; and that if a purely animal diet were useful in the latter disease, a combination of animal food with such vegetable diet as contained neither sugar nor starch, might serve to arrest the undue formation of fat.”
Dr. Harvey proved his hypothesis in the famous case of William Banting…
“I soon afterwards had an opportunity of testing this idea. A patient who consulted me for deafness, and who was enormously corpulent, I found to have no distinguishable disease of the ear … I subjected him to a strict non-farinaceous and non-saccharine diet, and the volatile alkali alluded to hereafter. In about seven months he was reduced to almost normal proportions, his hearing restored, and his general health immensely improved. This case seemed to establish my conjectures, which further experience has confirmed.”
READ: On Corpulence in relation to disease: with some remarks on diet by William Harvey
Banting went from 202 pounds (at a height of 5’5) to 156 and reduced his waist size by over 12 inches in less than a year. He was so inspired by his success with Harvey’s diet that he made it his mission to promote it to the world and in 1864 wrote a book on his experience entitled “Letter on Corpulence.” The book went on to become a global phenomena, yet one that Banting refused to profit from, instead of cashing in on his fame, Banting donated the proceeds to hospitals and charities for the poor.
READ: “Letter on Corpulence” by William Banting
Banting asked for no recompense for his publications. Indeed, he saw it as a public duty to pass on the “cure” for obesity and gave all the profits from the many editions of Letter on Corpulence to hospital charities. The Letter sold 63,000 copies in Britain – a staggering number in an era when many were illiterate – was translated into French and German, and sold widely in Europe and the US.
READ: Mr Banting’s Old Diet Revolution
Looks a lot like the diet that Dr. Atkins became famous for in the 1990s, yet eliminating starch and sugar from the diet was being prescribed not just for Type 2 (non-insulin dependent) Diabetes and Epilepsy, but with astounding results for obesity over 150 years ago!
Tectonic Metabolic Shift
How many diseases are actually errors in metabolism, a malfunction in the body’s ability to process food and macronutrients nutrients effectively?
Although it was known even in the 1800s that carbohydrates had a direct effect on blood sugar, diabetes, and obesity, what was not understood was the metabolism’s relationship to these disorders, nor the metabolic shift that takes place in the absence of glucose as the body converts from burning sugar to fatty acids for fuel and its positive impact on on all manner of diseases related to a dysfunctional metabolism (which are in most cases an inability of the body to process glucose efficiently, and which in most non-inherited/genetic cases is inevitable when the body thrives on this toxic and debilitating junk fuel for too long).
Starving for Answers
In 1919, the race to unravel the metabolic factors at play began in earnest with Dr. John Howland, the head of pediatrics at John Hopkins, who, working to cure his nephew’s epilepsy, set out to decipher why prolonged fasting alleviated the dreaded seizures that racked his brother’s son.
“Having developed a deep interest in the treatment of epilepsy by the ketosis of starvation,” Howland recruited two doctors fascinated with uncovering what lie at the root of fasting as a successful treatment for epilepsy, Dr. Gamble and Dr. H. Rawle Geyelin, both studied the metabolic nature of starvation diets (as they were known) with epileptic patients, but even after a relentless search for answers, and extensive clinical data (Geyelin studied 36 patients), neither were able to identify the key to fasting’s success, all anyone knew for sure was that it worked!
Interestingly, Gamble stumbled upon the key to fasting’s success while reviewing the research on his epileptic patients, he found beta hydroxybutyrate and acetoacetate (two major ketones) in the blood of his test subjects, but dismissed these as little more than waste products of metabolism … unbeknownst to Gamble these oxidized fatty acids were, in fact, the missing piece to the metabolic puzzle!
READ: The Origin (and future) of the Ketogenic Diet by Robb Wolf
However in 1921, Dr. Rollin Woodyatt an endocrinologist, noticed exactly what Gamble had found in his studies with respect to the formation of certain ketone bodies, however Woodyatt realized the powerful significance of the presence of these ketones in the blood.
According to Woodyat…
“Acetone, acetic acid, and betahydroxybutyric acid appear … in a normal subject by starvation, or a diet containing too low a proportion of carbohydrate and too high a proportion of fat. It appears to be the immediate result of the oxidation of certain fatty acids in the absence of a sufficient proportion of ‘oxidizing’ glucose.”
READ: Epilepsy and the Ketogenic Diet
During this same period, Dr. Russel Wilder of the Mayo Clinic (and the first Director of the National Institute of Arthritis and Metabolic disorders) who had worked with Woodyatt at Presbyterian hospital of Chicago on the metabolism of ketosis, theorized that given ketones were being generated as the body metabolized its own fat stores during a prolonged fast, perhaps it was the ketones themselves now circulating in the bloodstream which played the key role in alleviating epilepsy’s dreaded convulsions.
And, as fasting is only a temporary treatment, if ketosis could somehow be induced without starvation, then this might present epileptics with a long-term solution. If you only consumed fat and moderate to minimal protein Dr. Wider wondered, then maybe you could prolong the effects of the fasted state indefinitely and control the seizures. Wilder named this approach the “Ketogenic Diet,” and was the first to test the nutritional plan’s efficacy in treating epilepsy.
READ: Bio of Russel Morse Wilder
“Dr. Wilder … proposed that the benefits of … fasting … could be obtained if ketonemia was produced by other means. The ketone bodies … are formed from fat and protein whenever a disproportion exists between the amount of fatty acid and the amount of sugar actually burning in the tissues. In any case, as has long been known, it is possible to provoke ketogenesis by feeding diets which are very rich in fat and low in carbohydrate. It is proposed therefore, to try the effects of such ketogenic diets on a series of epileptics”. Wilder suggested that a ketogenic diet should be as effective as fasting and could be maintained for a much longer period, compensating for the obvious disadvantages of a prolonged fast.
READ: History of the Ketogenic Diet by James W. Wheless
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