Group of pediatricians warns against keto diet for children with diabetes

Amy Norton

MONDAY, Sept. 18, 2023 (HealthDay News) — Low-carb diets may be trendy, but they’re not for children with diabetes, according to the American Academy of Pediatrics (AAP).

In a new report, the AAP says low-carb diets cannot be recommended for children or adolescents with type 1 or type 2 diabetes. That’s because there is little evidence that they help. , but we are concerned about restricting children’s nutrition to this extent.

Instead, the AAP encourages families to focus on cutting out “bad” carbs: sugary drinks, candy bars, and other nutrient-poor processed foods. Just as important, children should eat enough healthy carbohydrates, including fiber-rich vegetables, beans, and grains.

The “keto” diet and similar diets popular among adults can place very strict limits on carbohydrates, with a ceiling as low as 20 grams per day, the equivalent of half a cup of white rice.

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A big concern is that low-carb diets deprive children of nutrients during critical periods of development, said Amy Reed, a pediatric dietitian at Cincinnati Children’s Hospital Medical Center.

Reed, who was not involved in the AAP report, said she agreed with its recommendations.

“The focus should be on healthy eating rather than restrictions,” said Reed, who is also a spokesperson for the Academy of Nutrition and Dietetics.

Diabetes exists in different forms: Type 1 diabetes results from an attack by the immune system against the pancreatic cells that produce insulin, a hormone that regulates blood sugar. In type 2 diabetes, often associated with obesity, the body loses its ability to use insulin properly.

As a result, blood sugar levels soar. Children with type 1 must receive daily insulin injections or wear an insulin pump. People with type 2 may need medication or help losing weight. In both cases, it is essential to pay attention to diet.

Some doctors recommend a low-carb diet for adults with diabetes, while many popular diets — and celebrities — tout cutting carbs for weight loss.

So some parents may be interested in adopting a low-carb diet to manage their children’s diabetes, said Dr. Tamara Hannon, one of the authors of the AAP report.

“But it doesn’t have to be extreme, it just has to be reasonable,” said Hannon, a pediatric endocrinologist at Riley Children’s Health in Indianapolis. “If possible, reduce sugary foods.”

Eliminating sugary drinks, including juice, is a great way to start, Hannon said.

“It can be difficult for families to eat well on a limited budget,” she noted. “But cutting out sugary drinks doesn’t cost anything.”

It also doesn’t carry the potential risks of low-carb diets for children. According to the AAP, these include nutritional deficiencies, delayed growth or bone development, and children’s immersion in “diet culture” that could lead to body dissatisfaction and eating disorders.

However, if parents are interested in trying a low-carb diet to manage their child’s diabetes, the AAP encourages them to work with their health care providers. The group recommends additional monitoring of children’s growth, bone health, nutritional status and more.

However, not all American families have access to such “gold standard” care, Hannon said, especially in areas of the country where specialists are scarce.

In general, the AAP recommends that children with diabetes or “prediabetes” (abnormal blood sugar levels that may precede type 2 diabetes) follow the same dietary guidelines in effect for all children ages 4 to 18 years :

  • About 10 to 30 percent of daily calories should come from protein.
  • Another 25 to 35 percent should come from fats, primarily unsaturated fats from sources such as vegetable oils and nuts.
  • The remaining 45 to 65 percent should come from carbohydrates, primarily fruits, vegetables, beans, dairy, and fiber-rich grains.

Reed pointed out that the typical American child doesn’t get enough fiber, and a low-carb diet would only make the situation worse.

Fiber, she says, can be helpful in managing blood sugar levels because it slows digestion.

For families on a budget, Reed noted that frozen or canned vegetables are not only good, but in some cases they can be even more nutrient-dense than their fresh counterparts. There are also kid-friendly ways to incorporate healthier carbs, she said, like making tacos with meat, beans and vegetables.

But feeding children isn’t just the parents’ responsibility, Hannon stressed. American society, she says, makes questionable nutritional choices easy and healthy choices harder, especially for low-income families.

According to the AAP, pediatricians can help by encouraging families eligible for federal nutrition assistance to sign up.

The report was published online September 18 in the AAP Journal. Pediatrics.

The American Diabetes Association provides advice on healthy eating.

SOURCES: Tamara Hannon, MD, pediatric endocrinologist, Riley Children’s Health, Indianapolis, professor of pediatrics, Indiana University School of Medicine, Indianapolis; Amy Reed, MS, RD, pediatric dietitian, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, spokesperson, Academy of Nutrition and Dietetics, Chicago; PediatricsSeptember 18, 2023, online

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