Diabetes: Pediatricians caution against low-carb diets for children

Evan Walker
Evan Walker TheMediTary.Com |
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  • A major pediatricians group cautions against low-carb diets for children with diabetes or prediabetes.
  • They say these diets could harm kids’ natural growth and development and should only be done under professional supervision.
  • Instead of low-carb diets, they recommend that children who need help managing weight or glucose levels limit carbohydrates from sugar, processed foods, and sugar-sweetened beverages.

Low-carbohydrate and ketogenic diets are popular among many people in the United States and in some instances can be helpful in managing type 2 diabetes or prediabetes among adults.

However, doctors and parents should avoid these diets for children with type 1 diabetes, type 2 diabetes, or prediabetes, states a new clinical report from the American Academy of Pediatrics (AAP).

The report states that children should typically receive 45% to 65% of their daily calories from carbohydrates, whereas low carbohydrate diets restrict that to less than 26% of total calories from carbohydrates. Very low carbohydrate diets and keto diets restrict that even further, with very low carb diets calling for 20 to 50 grams of carbs daily and keto calling for under 20 grams.

While these diets can benefit adults, in practical terms, there is little research to support the safety and efficacy of low-carb diets for children and, therefore no clinical guidelines on restricting dietary carbohydrate consumption, the AAP report reads.

“Despite the increasing popularity of low-carbohydrate and ketogenic diets for managing diabetes in adults, there are safety concerns to consider for youth with diabetes who are restricting carbohydrate intake to control weight and/or blood glucose,” the report’s authors write. “These include growth deceleration, nutritional deficiencies, poor bone health, nutritional ketosis that cannot be distinguished from ketosis resulting from insulin deficiency, and disordered eating behaviors.”

“Children should not be placed on low carbohydrate or ketogenic diets without proper monitoring or surveillance by healthcare professionals,” Tok-Hui Yeap, RD, a specialist in pediatric nutrition based in Oregon, told Medical News Today. “Having updated guidance on carbohydrate requirements for youth with type 1, type 2 diabetes, prediabetes and obesity will standardize practice recommendations from pediatricians and registered dietitians in guiding a treatment plan that is evidence-based.”

The report notes that there might be certain cases where a low-carb approach might be undertaken, but only under close diabetes care team supervision.

“This statement is not about restrictive diets – it is about providing evidence to clinicians so they can support parents and families in making informed decisions,” Dr. Tamara Hannon, FAAP, a professor of pediatrics at Indiana University and a co-author of the report, said in a press release. “Be sure to bring your questions to your pediatrician, who knows you best and can help provide guidance on a healthy dietary plan.”

Beyond the technical aspects of a low-carb diet, experts say that parents and doctors should be cautious about these eating plans because of how they could have long-term effects on how children feel about food.

“Balance, moderation, and variety are the keystones of good nutrition and overall health. One crucial drawback of a low-carb diet for children is the potential for kids to develop an unhealthy psychological relationship with food,” Dr. Christina Johns, a pediatric emergency doctor and senior medical advisor at PM Pediatric Care, told Medical News Today. “For example, a child experiencing strict limitation of one type of food might crave it more and try to consume it in secret, which could lead to overconsumption and feelings of guilt. Carbohydrates are not inherently ‘bad;’ in fact, they are an important part of a balanced diet and are critical for cellular metabolism.”

“I have encountered adolescents and children who’ve been on low-carb diets,” said Dani Lebovitz, MS, RDN, CDCES, a Tennessee-based food and nutrition education expert and founder of Kid Food Explorers.

“In many cases, these diets, though well-intentioned, led to more harm than good,” she told Medical News Today. “Many had issues with constipation, low energy, food fear, and shame. Following a restrictive diet also presented psychosocial concerns associated with stigma and peer pressure.”

Instead of low-carb diets, parents and educators should strive to take a more education-based approach, said Rachael Richardson, a registered dietitian and nutritionist and founder of Nutrolution.

“The main nutrition concept young, preschool-aged kids could and should be learning about is the distinction between ‘real’ and ‘fake’ foods, as well as being shown how food grows and being exposed to parents who model Healthy eating,” she told Medical News Today. “As they become school-aged, learning the fundamentals of growing food, cooking, and what is needed to constitute Health are all hugely important topics that all high school students should have the opportunity to master if we are to curb the prevalence of diabetes and other chronic diseases which weigh down our Health care system.”

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