Pediatric perspectives on low-carb diets for kids with or at risk of diabetes

In recent years, diets centered around the benefits of low-carbohydrate choices, like the ketogenic or “keto” diet, have experienced a surge in popularity among adults with type 2 diabetes or those trying to manage their weight. With obesity and related conditions like prediabetes and type 2 diabetes also increasing among children in the United States, parents and caretakers may wonder if a low-carb lifestyle may also benefit young populations. 

In a recently published Pediatrics clinical report, the American Academy of Pediatrics (AAP) represented by Indiana University School of Medicine professor of pediatrics Tamara Hannon, MD, examined the suitability of low-carb diets for children and adolescents with type 1 diabetes or those who are overweight and susceptible to type 2 diabetes.

“Carbohydrate-restricted diets may be recommended for children who have diabetes or are at risk for developing diabetes, but only under the supervision of a medical team,” Hannon said. “What is always recommended is a reduction of intake of carbs from ultra-processed food sources, while increasing consumption of vegetables and whole fruit.”

Despite the prevalence of restrictive diet recommendations for adults, Dr. Hannon and her colleagues encourage families to exercise caution with these approaches in children. Existing evidence suggests that diets incorporating a diverse range of foods while limiting added sugar tend to lead to better health outcomes compared to strict or restrictive diet plans. However, except in specific cases where restrictive diets are used for managing conditions like seizure disorders, there is a current lack of comprehensive studies specifically involving children or families who independently opt for low-carb diets as part of diabetes treatment.

Because there’s no one-size-fits-all option for kids with or at risk of obesity or diabetes, the AAP recommends a collaborative approach. Pediatricians and health care providers should partner with patients and their families to tailor dietary choices to their unique requirements and circumstances.

As parents and caregivers partner with primary care providers to implement dietary changes in children, Dr. Hannon emphasizes the severity of health issues linked to excess sugar, particularly in beverages and juices.

“I strongly recommend complete elimination of all sugary beverages,” Hannon said. “The principal cause of health problems related to too many carbohydrates is from added sugars. Concentrate on decreasing processed carbohydrates while continuing to include plenty of vegetables, some whole fruits and whole grains.”

Beyond promoting nutritious dietary choices and advocating for more active lifestyles, the AAP also acknowledges socioeconomic disadvantages play a role in how families can combat health concerns and the pressing need for broader systemic changes to address these issues. The clinical report states pediatricians can play a crucial role in advocating for policies aimed at bolstering federal, state and local nutrition programs. Furthermore, they can actively encourage eligible families to engage in these programs. Pediatricians can reference the Food & Research Action Center’s Screen and Intervene: A Toolkit for Pediatricians to Address Food Insecurity as a resource for additional guidance.

While restrictive diets have gained popularity among adults, their appropriateness for children with type 1 diabetes or those who are overweight and susceptible to type 2 diabetes remains a subject of ongoing research and medical supervision. Dr. Tamara Hannon's insights and the guidance provided by the American Academy of Pediatrics highlight the significance of individualized care in addressing these health concerns and the importance of families and health care teams working together to create healthier outcomes.

Results from the AAP's clinical report were featured in MedPage Today.