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• Posted September 18, 2023

Pediatricians' Group Warns Against Keto Diet for Kids With Diabetes

Low-carb diets may be all the rage, but they're not for kids with diabetes, according to the American Academy of Pediatrics (AAP).

In a new report, the AAP says that low-carbohydrate diets cannot be recommended for children or teenagers with either type 1 or type 2 diabetes. That's because there's little evidence they're helpful, but there are concerns about restricting kids' diets to that degree.

Instead, the AAP encourages families to focus on cutting out "bad" carbs: sugary drinks, sweets and other processed foods that are low in nutrients. Just as important, kids should get enough healthy carbs, including vegetables, beans and fiber-rich grains.

The "keto" diet and similar ones popular among adults can put very strict limits on carbs, with a ceiling as low as 20 grams per day -- equivalent to a half-cup of white rice.

A big concern is that low-carb diets will shortchange kids on nutrients during critical periods of development, said Amy Reed, a pediatric dietitian with Cincinnati Children's Hospital Medical Center.

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

"The focus should be on healthy eating, rather than restriction," said Reed, who is also a spokeswoman for the Academy of Nutrition and Dietetics.

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

As a result, blood sugar levels soar. Kids with type 1 need to take daily insulin injections or wear an insulin pump. Those with type 2 may need medication or help with weight loss. In either case, attention to diet is key.

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

So some parents may be interested in going low-carb to manage their kids' diabetes, said Dr. Tamara Hannon, one of the authors on 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. "Wherever you can, decrease sugary foods."

Eliminating sugar-sweetened drinks, including juices, is a great way to start, Hannon said.

"It can be hard for families to eat well on a budget," she noted. "But cutting out sugary drinks costs nothing."

Nor does it come with the potential risks of low-carb diets for kids. According to the AAP, those include nutrient deficiencies, stunted growth or bone development, and steeping kids in the "diet culture" that could lead to body dissatisfaction and eating disorders.

If parents do, however, want to try a low-carb diet for managing their child's diabetes, the AAP urges them to work with their health care providers. The group recommends extra monitoring of kids' growth, bone health, nutritional status and more.

Not all U.S. families, though, have access to such "gold standard" care, Hannon said, especially in parts of the country where specialists are in short supply.

In general, the AAP recommends that kids with diabetes or "prediabetes" -- abnormal blood sugar levels that may precede type 2 diabetes -- follow the same diet guidelines in place for all children aged 4 to 18:

• About 10% to 30% of daily calories should come from protein.
• Another 25% to 35% should come from fat -- mainly unsaturated fats from sources like plant oils and nuts.
• The remaining 45% to 65% should come from carbohydrates, mainly fruits, vegetables, beans, dairy products and high-fiber grains.

Reed pointed out that the typical American kid is not getting enough fiber, and that a low-carb diet would make that even worse.

Fiber, she said, can be helpful in managing blood sugar levels, as it slows digestion.

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

But kids' diets are not only the responsibility of parents, Hannon stressed. American society, she said, makes nutritionally dubious choices easy and healthy ones tougher -- especially for lower-income families.

One way pediatricians can help, the AAP says, is by encouraging families who qualify for federal nutrition assistance to enroll.

The report was published online Sept. 18 in the AAP's journal Pediatrics.

More information

The American Diabetes Association has advice on healthful eating.

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