A recent article on the consequences of restricted carbohydrate diets for T1D children

[tim2000s]

This article is getting a lot of noise on Twitter. https://www.ncbi.nlm.nih.gov/pubmed/28397413. Sadly it's behind a paywall and costs $6 to read. I've paid for it and I think it's worthwhile.

It took case studies of six type 1 children and identified that there were growth and cardiovascular indicators that were considered abnormal after the children were fed low carb diets as part of a strategy to manage their T1. The interviews with the children also suggest dissatisfaction with what the were given to eat.

The common theme throughout is that the children affected were not eating their full, required amount of energy consistently, so could be considered to be be under-nourished. The side effects were noted to be similar to those noticed in children fed ketogenically to treat epilepsy (i.e. low growth rate and CV markers). The other point of note is that high fat diets have been shown to blunt pituitary growth hormone release, which could affect both IGF and HGH release. Much less of an issue in adults, but obviously quite a big one in children..

Make of it what you will. I think it's worth a read and quite an interesting counter to what is often discussed on the forum.

 

[Deleted Account]

Interesting.
However, I wonder if a sample size of six is statistically significant enough.

 

[tim2000s]

@helensaramay In no way is six a statistically significant sample. The paper doesn't try and present it that way, although, if you read into the detail, there are one or two key things to pull out.

In terms of child growth, (height for age and weight for age) it's possible to see in the graphs that nearly all of the kids were negatively affected by low carbing, in that their weights and heights deviated from the percentile that they were originally in.

The increase is CV risk markers is only interesting if we had a before and after value for those items - it seems that only an after is reported, not an increase or decrease.

The most important factors I take from the article are:

1. under-nourishment was an issue in all cases
2. in changing diet, the parents often didn't balance nutrients correctly to feed a growing child
3. The secondary effects of changing the diet in this way were additional psychological issues relating to food for the kids (an issue we already know about being exacerbated)

So while six is certainly not statistically significant of its own, there is likely to be enough common data amongst the six to indicate areas that anyone dealing with t1 kids should check, if nothing else.

 

[DCUKMod]

@tim2000s - Thanks for posting that.

I'd be so interested to hear the reaction of the Dieticians and other HCPs using a keto approach with paediatric patients, for diabetes and other conditions. I wonder if anyone will bring it up at the PHCUK Conference at the weekend. Sadly, I'm not going this year.

@bulkbiker - I understand you're going to the Conference this weekend. Could you keep your ears open for dialogue on this topic? I'b be very grateful.

 

[TheBigNewt]

It doesn't make any sense to me to feed a growing kid a super low carb diet, diabetic or not. It doesn't make a lot of sense for adults either for that matter. Sure choose the types and GI of the carbs wisely, but to feed a kid mostly fat and protein is pretty lame IMO. Just use common sense.

 

[Robinredbreast]

A varied diet brought me and my siblings up ( and my dear old dad is still alive at 93) but that was in the 1970's, when I was a teenager, I am not overweight ( never have been) and just unlucky to get type 1 diabetes.

 

[tim2000s]

So let's be clear here. This isn't about feeding kids and teenagers low carb in general. It's about feeding kids and teenagers with T1D low carb to reduce prandial-related glucose spiking and reduce insulin doses according to the law of small numbers. For many parents using MDI and pumps, managing glucose excursions like that makes a lot of sense, especially when you consider how many of them have to outsource care to others that don't have enough time or knowledge to monitor a T1 kid carefully and identify hypos or hypers.

 

[CathP]

Interesting, I might stump up the cash to read the whole article. I low carb my 6 year old t1, and much as I love the results on her glucose, I'm aware there might be negatives.

 

[TheBigNewt]

I'm not interested enough to read it, but how many grams of carbs/day does this diet call for?

 

[tim2000s]

Interesting, I might stump up the cash to read the whole article. I low carb my 6 year old t1, and much as I love the results on her glucose, I'm aware there might be negatives.

I've summarised it on my blog, with some commentary. http://www.diabettech.com/low-carb-...e-the-effects-reviewing-some-recent-research/

I chose not to make my daughter go low carb. More for her mental health rather than her physical. I'm sure when she's older and sees the benefit of a low carb diet she will change her mind but for now, I want her to enjoy her childhood as much as possible and eat what she wants. As long as she's taking her insulin correctly, I don't see an issue.

I think this is a key point to consider, and one that often gets forgotten in the panic of glucose excursions. Well done on that one.

I'm not interested enough to read it, but how many grams of carbs/day does this diet call for?

It's the same as any version of low carb. Anything from <20g per day, through the Bernsteinian 30g up to 50-60g.

 

[TheBigNewt]

I don't consider 50-60g/d of carbs to be super low. That's 240 calories a day, and a kid probably needs 1000-1500/day so 16% maybe more.

 

[bulkbiker]

@tim2000s - Thanks for posting that.

I'd be so interested to hear the reaction of the Dieticians and other HCPs using a keto approach with paediatric patients, for diabetes and other conditions. I wonder if anyone will bring it up at the PHCUK Conference at the weekend. Sadly, I'm not going this year.

@bulkbiker - I understand you're going to the Conference this weekend. Could you keep your ears open for dialogue on this topic? I'b be very grateful.

Happy to keep an ear open, however a study with such a huge confirmation bias at its very start with apparently no control group sounds pretty flaky to start with.. (at least that's the feeling I get when reading Tim's very useful review on his blog).

 

[ickihun]

Why is the huge emphasis on type1s going low carb? Has management no longer believed to be effective anymore or are parents looking for an easier way to manage their child's diabetes to fit in with modern fast lifestyles?

There must be other ways this can be achieved without nutients which are needed are interferred with, surely?
I never thought type1 was a dietary problem. Maybe some type2s but not all.

Maybe the benefits of carbs need injecting too to counter-act the problem?
Timing can be everything in digestion and metabolism!
Just a thought.

 

[librarising]

Why is the huge emphasis on type1s going low carb? Has management no longer believed to be effective anymore or are parents looking for an easier way to manage their child's diabetes to fit in with modern fast lifestyles?

As a LADA on what seems like industrial amounts of insulin (c.85 units per day) I have had no unexpected hypos in 14 months.
I did have ONE 3.8 when I took a higher morning bolus, as my DP seemed to be rising day after day. Lesson learned. DP is DP.
I honestly don't feel I could say that if I ate higher amounts of carbs, requiring higher amounts of insulin. That would introduce higher risk.
I see carbs a bit like speed. Some can drive faster, and stay safe. Some can't.
Since being on insulin 38 and then 35. Hence my tagline.
Geoff

 

[tigger]

What counts as low carb in this study? I think when i was a child i was on 60-70g a day, definitely under 100g until I was 8. I didn't have supper, just a light tea as that way i could manage with one injection per day. If hungry i snacked on cheese and veg. I'm not saying it was great and it definitely had psychological implications but growth wise and cardiac i'm fine.

 

[britishpub]

Shock horror.

Growing children require a lot of energy.

Does the author of this study have a specialist subject of "the bleeding obvious"

 

[TheBigNewt]

What counts as low carb in this study? I think when i was a child i was on 60-70g a day, definitely under 100g until I was 8. I didn't have supper, just a light tea as that way i could manage with one injection per day. If hungry i snacked on cheese and veg. I'm not saying it was great and it definitely had psychological implications but growth wise and cardiac i'm fine.

The guy who read it said they got 50-60g when I asked him. Which is on the low side but not drastic.

 

[Daibell]

I'm sure having reasonable amounts of carbs when on insulin is fine as long as the BMI remains in the right range. As we know, too many carbs when on insulin can cause weight as it would in a non-diabetic.

 

[ickihun]

I'm sure having reasonable amounts of carbs when on insulin is fine as long as the BMI remains in the right range. As we know, too many carbs when on insulin can cause weight as it would in a non-diabetic.

It seems I'm only losing weight and getting close to 40bmi rather than 50bmi when I take enough insulin to keep my bgs low. Medium or high bgs cause me hunger and more insulin resistance. Hence added weight. Carbs are irrespective for me it seems.

 

[gavin86]

Kind of hard to draw any conclusions..
Regarding whether it's worth doing.. I guess you could argue that either side has positives.

I find myself wondering if this has actually achieved anything..