This post was written by Katja Rowell MD and Natalia Stasenko RD
“Ali gets too hyper with sugar, so we’re trying to limit her carbs, but that cuts out like, most of her accepted foods.”
“My husband’s family is going Keto and he wants our family to do it too. Aside from all the work I predict this putting on me, is it safe for kids?”
Back when RFPro founders were growing up, fat was the dreaded macronutrient (macronutrients are the main sources of energy and include carbohydrates, fat, and protein in contrast to a micronutrient like Vitamin A). Fat, in the US, was avoided at all costs, replaced, ironically, mostly with sugar and carbs. In the last decade, carbohydrates have become the macronutrient scapegoat for all of our ills. Do sugar and carbs deserve this horrible reputation?
Sugar is a carbohydrate
Carbohydrates are an important source of energy for the body. Sugar is a carbohydrate that is readily used by the body. In fact, the brain runs only on glucose (unless the body is starving or in ketosis, more later…).
Children need more carbs than adults
Most children prefer sweet tastes, and there is research to suggest that this is a biological drive. Children have relatively higher energy needs and carbohydrates help them replenish their energy easily! Children generally need 45-65% of their energy intake from carbohydrates. The human brain uses up about 20% of our total energy intake. Children also are growing muscle, bone, organs, and well, everything! That needs a lot of fuel, too, and carbohydrates are the easiest to access. Children need this quick energy to play, learn and thrive.
It’s important to clear up common misperceptions about the nutritional value of carbohydrates. Even what some may call “empty carbs” can provide a lot of nutrition including easily accessible calories, fiber, and protein (a cup of cooked pasta = 2/3 of the daily protein requirement for toddlers). Besides, most “refined carbs” are fortified with important nutrients such as iron, zinc, and folate. Simply speaking, carbohydrates are far from “empty.”
Carbohydrates such as grains, fruit and vegetables are also the main sources of fiber in children’s diets. Without sufficient fiber, children are more likely to have constipation-related discomfort and health issues, which can also decrease appetite.
Keto and low carb isn’t good for kids
The ketogenic (creating ketones) diet was developed in the 1920’s for children with epilepsy. Without glucose to give energy, the body thinks it’s starving and breaks down fat into ketones, which the brain can use. Even while it reduced seizures, many of the children weren’t able to stick to the diet, and once medications were developed to control seizures, the diet largely disappeared. A keto diet is expensive, and hard to stick to. While the brain can use ketones for energy, there is anecdotal evidence that keto diets can lead to brain fog, difficulty concentrating, and even mood changes. (Of course, there is anecdotal evidence for the opposite.) There is no long-term data on the safety and implications for the rapidly developing brain in children on a keto diet (or low-carb for that matter).
Keto diets are low in fiber and can: increase constipation; lead to nausea, irritability, and fatigue. Research suggests that keto diets in children can lead to dehydration, kidney stones, impaired growth, high blood lipids, low blood sugar, and vitamin and mineral deficiencies.
And a keto diet is very, very hard to stick to. Even “modified” keto, allowing for some carbs is tough, and there is no indication it is better or safer for children or that it improves behavior or sensory challenges.
Restricting carbs (and sugar) can make avoidant eating worse
Children with feeding differences and challenges are already more likely to deal with anxiety and even fear of foods and eating. Avoiding and demonizing certain foods often increases the fear and makes avoidant eating worse. And when children already have a limited number of accepted or preferred foods, removing them can send children into a tailspin of eating less and even falling off growth curves or losing weight.
Restricting carbs and sweets can make children more focused on them
Research tells us that restricting sweets makes children more interested in the forbidden foods and more likely to eat that food in an out-of-control way when they have access. This can look like an addiction or obsession.
The fear of sugar can cause more problems than the sugar itself. Our bodies are capable of balance and self-regulation as this interesting article on sugar-sweetened drinks showed: it replicated findings of an earlier study on “normal” weight women where “overweight” women compensated intake for the “extra” energy (calories) of sugary drinks. The author writes, “These findings suggest that because it is widely believed that sugary drinks are bad and part of an unhealthy diet, people then go on to behave accordingly.”
Focusing on sugar means health-promoting opportunities are missed
From a public health and mass media perspective, it’s far easier and more satisfying to blame parents for serving apple juice than to mobilize the necessary support and resources so that young children aren’t witnessing domestic violence (which was a predictor of “obesity” in this study, while apple juice and french fries consumption were unreliable predictors). Addressing poverty, improving health care access, eradicating food insecurity, addressing lead exposure and air pollution, accessing safe and fun physical activity – all would improve health and wellbeing.
Children can safely (and without shame) enjoy sugar and carbs
As part of the structure and variety of offerings, children can enjoy refined sugar, honey (after one year of age), maple syrup, or foods sweetened with fruit juices, and even high-fructose corn syrup. A study supported by the National Honey Board showed that honey, agave nectar, table sugar, coconut sugar, brown sugar, and maple syrup, act pretty much the same in the body. And agave nectar has more fructose than high-fructose corn syrup. This may help folks relax about HFCS.
Many parents themselves struggle with their relationships with food. They may tell you they eat “keto” or low carb and they feel fine. Avoid arguing with parents about their eating if they express satisfaction. Be firm if you believe that a keto or low-carb diet is not appropriate for children. If parents pursue it, advise at minimum that they work with a registered dietitian.
Carbs (even refined) may be the “healthiest” option
Carbohydrates often taste good, fill bellies, and are satisfying. For children with small appetites, or who may need to maximize energy intake because of higher metabolic demands, concerns about growth, or who have sensory challenges and preferences, carbohydrates may literally be a life saver. For children learning to eat, expand variety, learning about new textures and flavors, wean off feeding tubes, or who need to prioritize fuel… refined carbs may be the “healthiest” option for that child and in that moment.
Hopefully, this quick discussion helps to address one of the more common nutrition worries that we see fuel restriction and non-responsive feeding practices.
BONUS: supporting variety if a child “only eats carbs”
And we acknowledge that variety is important. We believe the way to get there is with responsive feeding (and therapy if needed). By feeding from a place of connection, nurturing, and offering, by addressing challenges (medical, oral-motor, food insecurity, systemic poverty, weight bias) and helping children feel good about food and their bodies, better nutrition is likely to follow. But that’s a whole other series of posts! Here are a few quick tips:
- Add options, don’t avoid or ban foods, especially preferred foods
- Pair new foods with favored foods
- Enjoy the foods you hope children will learn to eat
- Offer them over and over again, without pressure
- Serve with accepted condiments, sauces, or dips
- Use their enjoyment of sweet flavors to boost variety. Add sprinkles to yogurt or applesauce, branch out first with new flavors of ice cream…
- Raatz SK, Johnson LK, Picklo MJ. Consumption of Honey, Sucrose, and High-Fructose Corn Syrup Produces Similar Metabolic Effects in Glucose-Tolerant and -Intolerant Individuals. J Nutr. 2015 Oct;145(10):2265-72.
- Duchowny M. S. (2005). Food for thought: the ketogenic diet and adverse effects in children. Epilepsy currents, 5(4), 152–154.
- Wojcicki JM, Young MB, Perham-Hester KA, de Schweinitz P, Gessner BD. Risk factors for obesity at age 3 in Alaskan children, including the role of beverage consumption: results from Alaska PRAMS 2005-2006 and its three-year follow-up survey, CUBS, 2008-2009. PLoS One. 2015 Mar