Pediatricians warn against keto diet for kids with diabetes.

Pediatricians warn against keto diet for kids with diabetes.

The Truth About Low-Carb Diets and Kids with Diabetes

When it comes to low-carb diets, they may be the current craze, but the American Academy of Pediatrics (AAP) wants to make it clear that they’re not suitable for kids with diabetes. In a recent report, the AAP states that low-carb diets should not be recommended for children or teenagers with either type 1 or type 2 diabetes. Not only is there little evidence to support their effectiveness, but there are also concerns about the potential risks of restricting kids’ diets to such extremes.

A Focus on Healthy Eating for Kids with Diabetes

Instead of embracing low-carb diets, the AAP suggests that families should prioritize cutting out “bad” carbs, such as sugary drinks, sweets, and processed foods that offer little nutritional value. Additionally, it is crucial for kids to consume enough healthy carbs, which can be found in vegetables, beans, and fiber-rich grains. Unlike the “keto” diet and similar approaches popular among adults, where carb intake can be as low as 20 grams per day (equivalent to half a cup of white rice), the emphasis should be on healthy, balanced eating for children.

According to Amy Reed, a pediatric dietitian at Cincinnati Children’s Hospital Medical Center, one of the main concerns is that low-carb diets may deprive children of essential nutrients during crucial stages of development. Reed not only supports the AAP’s recommendations but also encourages an approach that focuses on healthy eating rather than strict restriction. As a spokesperson for the Academy of Nutrition and Dietetics, she believes that this balanced approach can foster a positive relationship with food and prevent the development of harmful diet cultures and eating disorders.

It’s important to understand that diabetes can manifest in different forms. Type 1 diabetes occurs when the immune system attacks the pancreatic cells responsible for insulin production, while type 2 diabetes is often associated with obesity and a reduced ability to properly use insulin. In both cases, managing blood sugar levels through diet is crucial. While some doctors may recommend low-carb diets for adults with diabetes, and various popular diets and celebrities champion carb-cutting for weight loss, the AAP emphasizes that a reasonable and balanced approach is more appropriate for children.

The Risks of Low-Carb Diets for Kids

Dr. Tamara Hannon, one of the authors of the AAP report and a pediatric endocrinologist at Riley Children’s Health in Indianapolis, acknowledges that some parents may consider a low-carb diet for managing their child’s diabetes. However, she advises against extreme measures and instead encourages reducing the intake of sugary foods whenever possible. Hannon particularly emphasizes the importance of eliminating sugar-sweetened drinks and juices, as this simple change can significantly impact a child’s overall health.

One of the crucial points made by the AAP is that low-carb diets pose potential risks for children. These include nutrient deficiencies, stunted growth or bone development, and exposure to the “diet culture” that can contribute to body dissatisfaction and eating disorders. Should parents still decide to explore a low-carb diet for their child’s diabetes management, the AAP strongly recommends collaborating with healthcare providers. Extra monitoring of the child’s growth, bone health, nutritional status, and other relevant factors becomes necessary in such cases.

It’s worth noting that not all families in the United States have access to high-quality care, especially in areas where specialists are scarce, says Dr. Hannon. Recognizing this, the AAP suggests that pediatricians play a role in encouraging eligible families to enroll in federal nutrition assistance programs, thereby providing them with greater support and resources.

Healthy Eating Guidelines for Kids with Diabetes

Overall, the AAP recommends that children with diabetes or prediabetes (abnormal blood sugar levels that could precede type 2 diabetes) follow the same dietary guidelines as all children aged 4 to 18. These guidelines include:

  • Protein should account for about 10% to 30% of daily calories.
  • Fat, mainly unsaturated fats from sources like plant oils and nuts, should make up approximately 25% to 35% of daily calories.
  • The remaining 45% to 65% of daily calories should come from carbohydrates, primarily derived from fruits, vegetables, beans, dairy products, and high-fiber grains.

Adequate fiber intake is another vital aspect highlighted by Amy Reed. She points out that the typical American child already falls short on fiber consumption, and adopting a low-carb diet would exacerbate this deficiency. Fiber is beneficial for managing blood sugar levels as it contributes to slower digestion. Reed advises families on a budget that frozen or canned vegetables are perfectly acceptable and, in some cases, may even pack more nutrients than their fresh counterparts. Additionally, she suggests inventive ways to incorporate healthy carbs into a child’s diet, such as making tacos with meat, beans, and vegetables.

Dr. Hannon emphasizes that the responsibility for kids’ diets does not lie solely with parents. American society often presents easy, yet nutritionally questionable food choices, especially for lower-income families. To address this, pediatricians can help by encouraging eligible families to enroll in federal nutrition assistance programs.

The AAP’s report was published online on September 18, 2023, in the journal Pediatrics.

For more information on healthful eating, visit the American Diabetes Association’s website.


  • 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 for the Academy of Nutrition and Dietetics, Chicago.
  • Pediatrics, Sept. 18, 2023, online.