Q&A: AAP recommends against low-carbohydrate diets for children with diabetes
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Key takeaways:
- A new AAP clinical report cites concerns about how overly restrictive dietary patterns may affect a child’s health.
- An expert recommended focusing on healthy carbohydrates.
In a new clinical report, the AAP recommended against low- and very low-carbohydrate diets for children and adolescents with type 1 diabetes, “except under close diabetes care team supervision utilizing safety guidelines.”
Low-carbohydrate diets restrict consumption to less than 26% of total daily calories from carbohydrates — 45% to 65% is the recommended diet — and very low-carbohydrate diets allow 20 to 50 g per day, whereas ketogenic diets generally allow less than 20 g of carbohydrate per day.
The new report, written by members of the AAP’s Committee on Nutrition, cites concerns that overly restrictive dietary patterns may affect a child’s health and suggests that kids focus on getting healthy carbohydrates in vegetables, fruits, whole grains and legumes.
We spoke with Tamara S. Hannon, MD, FAAP, director of the clinical pediatric diabetes program at Indiana University’s Riley Hospital for Children, about carbohydrate-restrictive diets.
Healio: What are the levels of carbohydrate-restrictive diets and how do they differ?
Hannon: The levels of carbohydrate restriction range from limits of carbs per meal to a certain gram value that is in the recommended range (dietary guidelines) to give approximately 50% of the calories needed from carb to no more than 20 g of carbohydrate per day to promote ketosis (ketogenic diet). Mealtime limits help to reduce blood sugar excursions post-meal but are not restricting to less than the recommended proportion of the diet from carbs. I strongly recommend limiting added sugars and focusing on carbohydrates from vegetables, fruits, and whole grains. This does not limit grams of carbs but limits the carbs in the diet that come from added sugar, which does not provide the best nutritional value.
Healio: Who are they recommended for?
Hannon: Carbohydrate-restricted diets may be recommended for adults trying to lose weight, adults with diabetes, or adults with prediabetes. Carbohydrate-restricted diets may also be recommended for children who have diabetes or who are at risk for developing diabetes, under the supervision of a medical team.
Healio: The review says evidence supporting the use of low-carbohydrate diets in children with obesity or diabetes is limited. What does the limited evidence say?
Hannon: The principal cause of health problems related to too much carbohydrate is from added sugars, such as in sugary sweets and processed foods.
The limited evidence says that diets that include a wide variety of foods (vegetables, fruits, whole grains) and limit added sugar promote better health outcomes than restrictive diet plans. However, there are no studies in children except for when we are using restrictive diets for seizure disorders (ketogenic diets) or when families choose to use a low-carb diet as part of the treatment plan for diabetes. Because there are few children who we have long-term outcomes for, it is difficult to know whether the potential benefits outweigh the potential risks.
Healio: Are there any misconceptions about these eating plans?
Hannon: There is a lot of popular press and social medial promotion of restrictive diets for all kinds of things. Any restrictive eating plan, whether it is for diabetes treatment or weight loss, should be supervised by a pediatric care team.
Healio: How can pediatricians and primary care providers counsel parents and patients about these diets?
Hannon: Pediatricians can first recommend the elimination of sugary drinks/juices, which contribute significant amounts of sugar to the diet. Then the recommendation would be to concentrate on decreasing processed carbohydrates while continuing to include plenty of vegetables, some whole fruits and whole grains.
References:
Neyman A, et al. Pediatrics. 2023;doi:10.1542/peds.2023-063755.
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