Doctors Warn Against Low-Carb Diet in Children With Diabetes

Pediatricians say there is insufficient evidence that low-carb or ketogenic diets are safe and effective in managing type 1 and type 2 diabetes and prediabetes in children.

The American Academy of Pediatrics (AAP) recommends that children aged 4 to 18 get 45% to 65% of their total energy intake from carbohydrates.

In a low-carb diet, 26% of daily calories come from carbohydrates, while a very low-carb diet allows as little as 20–50 grams of carbohydrates per day. A ketogenic diet is limited to less than 20 g of carbohydrates daily.


Previous studies have associated these diets with significant weight loss, reduction in insulin levels or insulin requirements, and improvement in glucose control in adults.

However, a new clinical report from the American Academy of Pediatrics (AAP), a major group of pediatricians, emphasizes a lack of long-term safety and efficacy outcomes of these diets in youth.

“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. 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,” the report reads.

Concerns about body image

Ketogenic diets are used to treat drug-resistant epilepsy in youth. However, because these diets require a significant amount of dietary restriction, adhering to them long-term is difficult for many who are prescribed this approach rather than choosing it themselves.

Additionally, the main concern associated with “diet culture” is using restrictive diets and developing disordered eating, especially among children and adolescents with a negative body image.

“Body dissatisfaction associated with restrictive dieting practices places children and adolescents at risk for inadequate dietary intake, excessive weight gain resulting from binge-eating after restricting food intake, and use of harmful weight control strategies,” the report authors write.

What are the recommendations?

According to the report, low-carbohydrate and very low-carbohydrate diets are not recommended for children and adolescents with type 1 diabetes, except under close diabetes care team supervision utilizing safety guidelines.


Instead, nutrient-poor carbohydrate intake could be reduced by minimizing the consumption of processed foods with high amounts of refined grains and added sugars.

To prevent and treat prediabetes and type 2 diabetes, pediatricians recommend eliminating sugar-sweetened beverages. This can significantly improve blood glucose and weight management.

Those with type 1 diabetes, prediabetes, or type 2 diabetes may be recommended to follow a healthy dietary pattern strategy, such as the Mediterranean diet.

Additionally, 60 minutes per day of moderate to vigorous aerobic activity can help reduce obesity, improve diabetes-related health outcomes, and promote optimal glycemic and cardiometabolic outcomes.


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