Recently, especially during the pandemic where the use of social media reached to a new height, we see increases in exaggerated advices regarding nutrition and conversion of certain approaches, which strain and harm the organism at various aspects and cause the risk of "eating disorder" such as ketogenic diet, into a trend.
In the last year, I personally witnessed that low carbohydrate diets were recommended to about 10 children with Type 1 diabetes by physicians, who are known for exaggerated medical applications, and dietitians who act with the motivation of “making a difference”. I observed that blood glucose levels of these children followed a normal course for a while, their insulin requirement dropped critically, but their growth rate significantly slowed down after a while and keton readings increased and finally, they became lifeless/joyless/weak. Similar findings were already reported in 6 case studies published by Carmel Smart et al (
https://pubmed.ncbi.nlm.nih.gov/28397413/).
None of us suggest that children, especially ones with diabetes, should be given a carbohydrate rich diet. However, it should be emphasized that daily carbohydrate intake of the children under 100 grams is harmful. High, moderate, low and critically low carbohydrate levels for children are demonstrated on the chart below (
https://pubmed.ncbi.nlm.nih.gov/30362180/).
| |
Carbohydrate (g/day) 1-6 years of age |
Carbohydrate (g/day) 6-10 years of age |
Carbohydrate (g/day) 11-16 years of age |
| High carbohydrate diets (>55% of total energy) |
>170 g |
>230 g |
>320 g |
| Moderate carbohydrate diets (>45% of total energy |
140 g |
200 g |
280 g |
| Low carbohydrate diets (<25% of total energy |
< 80 g |
< 100 g |
< 150 g |
| Critically low carbohydrate diets (<15% of total energy |
< 30 g |
< 40 g |
< 60 g |
Adverse effects of a low carbohydrate diet or driving to opposite direction in traffic
Families of the children with type 1 diabetes may tend to take short cuts due to advices of others, urban legends or fear of high glucose levels and decrease the carbohydrate intake of their children. During this process, a normal course in blood glucose levels in response to low amount of insulin makes them happy. They believe that they have taken the correct road and the results even motivate the families. I see this as similar to driving in opposite direction in the traffic. The road appears empty and critical risks that may occur after a while can be ignored. I use this metaphor also to describe using proteins and fats to produce glucose instead of the normal direction of organism's energy metabolism, which uses carbohydrates. Indeed, decreasing the carbohydrate intake of the child (exogenous hunger), who already experiences insufficiency of glucose intake in various tissues due to insulin deficiency (endogenous hunger), means keeping the child hungry for a second time, which leads to accumulation of keton and chronic biological stress after a certain period of time. Many people believe that proteins are more important for growth. However, it has been long known that sufficient carbohydrate intake is very critical for growth, starting at infancy. Moreover, when the importance of insulin in growth is considered, forcing the children with diabetes to endure both low insulin levels and insufficient carbohydrate intake slows down the growth significantly and rapidly. Recently, I observed that the growth rate of two children, who followed this kind of diet and whose growth has slowed down or almost stopped, increased by two folds within 3 months after sufficient amount of carbohydrate was added to their diets (a type of growth for caching up).
Austrian nutrition specialist Carmel Smart, who studied nutrition of children with Type 1 diabetes for years, emphasized that low carbohydrate diets not just lead to growth retardation and deficiency of certain micro-nutrients but also causes “eating disorder” for children with Type 1 diabetes (
https://pubmed.ncbi.nlm.nih.gov/33353393/).
The nutrients, especially carbohydrates, have a critical role in happiness of human. Low/critically low carbohydrate diets disrupt the relations between children/adolescents and nutrients, cause dysfunction of their appetite centers and pave the ground for “eating disorders” and Anorexia Nervosa, which is an advance form of these disorders. It is just like a bow losing its spring tension and function due to being drawn excessively. Some adolescents experience difficulty to correct their eating habits following a certain time in the road of low carbohydrate diet and they face painful problems such as severe depression. As a physician, who personally witnessed damages and hurtful results caused by this problem in two female adolescents with Type 1 diabetes within last 2 years, I would like to warn everyone once more.
Protect your children from unhealthy products and ketogenic diets!
I examined a 9 year old girl from Malatya in the previous weeks. The family presented to various facilities due to fasting blood glucose level persisting on 105 mg for the last year; the child was diagnosed with prediabetes by a family physician, who uses unreal titles other than his specialty, in Istanbul and the patient was unnecessarily prescribed very low carbohydrate diet. It may sound unreal, but the child did not have such a problem. The child basked in happiness after I stated that she would no longer require a diet. Please protect your children from individuals who examine patients outside their specialty, physicians who specialize in adults and individuals who use titles such as "functional medicine".
In conclusion, I would like to state that as much as you should protect your child from unhealthy products of food industry, the unrelenting commercial / influencing / addicting attacks (and yes I mean Attacks!) which see the pandemic period as an opportunity, you should also protect them from exaggerated medical applications, miracle diets and low carbohydrate nutrition advices.
Prof. Şükrü Hatun, M.D.
School of Medicine, Koç University
Pediatric Endocrinology and Diabetes Division