If you have a child with Type 1 or Type 2 diabetes and you’re considering starting a new diet, understanding how these diets can affect your child’s condition may help you make decisions about what’s right for the whole family.

Story by: Whitney Cessna, M.S., RDN, LDN, CDE, MLDE on January 21, 2020

At the start of the new year, getting healthy and losing weight are on the minds of many. There are a lot of diets out there to choose from –– and while many diets promote their benefits, they may not promote that they are a fad diet. If you have a child with Type 1 or Type 2 diabetes, and you’re considering starting a fad diet, understanding how these diets can affect your child’s condition may help you make decisions about what’s right for the whole family.

What is a fad diet?

Spotting a fad diet isn’t always as easy you think. Some diet names may give clues, like “cabbage soup diet” or “liquid amino acid diet,” but others may not. A surefire way to know if an eating style you’re considering is a fad diet, it is:

• Popular for a specific time
• Generally promoting rapid weight loss and other “health” advantages
• Characterized by highly restrictive or unusual food choices (rigid menus)
• Possibly requiring no exercise
• Promoting a “quick-fix”
• Based on recommendations from a single scientific study

These types of diets usually fall into certain groups, including:

• Food-specific diets
• Low-carbohydrate, also called low-carb
• High-fiber, low-calorie
• Liquid diets
• Fasting

Some of the most popular fad diets of the past 10 years or so have been South Beach, Paleolithic (paleo) or caveman diet, ketogenic (keto), Whole30 and HCG. Intermittent fasting is also quite popular, but it technically is not a diet, but an eating pattern.

The American Association of Diabetes Educators (AADE) states that having diabetes doesn’t mean you have to give up your favorite foods or eating in restaurants. However, what you eat affects your blood sugar (blood glucose) — so eating regular meals and making choices that can help control diabetes can prevent other health issues.

So what are the risks of certain fad diets for children with diabetes?

Is keto diet good for patients with diabetes?

The ketogenic, or keto, diet is a high-fat, moderate-protein and low-carb diet, often with less than 50 grams of carbohydrates a day. The diet originally was developed to treat epilepsy. After several days of carb intake being drastically reduced on the keto diet, the body relies on fat as an energy source for the central nervous system. This increases the production of ketones. People can experience weight loss because of the lower insulin levels and a decreased sense of hunger.

Risks for Type 1 diabetes include:

• The diet may be able to improve a child’s weight, but the risks of diabetic ketoacidosis become greater over time. This can lead to other serious conditions, such as liver, kidney and brain damage, or even lead to death.
• The diet may affect a child’s cholesterol levels.
• It may have an impact on the child’s growth.

Risks for children with Type 2 diabetes may include:

• Reducing carb intake may be a helpful, quick option, but requires a regular, periodic reassessment. Since a low-carb diet/keto diet results in ketosis, these nutrition plans are not suitable for some patients with Type 2 diabetes, including women who are pregnant or lactating, people with or at risk for eating disorders, or people with renal disease due to the increased risk of ketoacidosis.
• There is a relative lack of data about the long-term safety, adherence and efficacy of eating keto and low-carb diets.

Intermittent fasting and diabetes

Intermittent fasting is an eating pattern in which a person cycles through periods of fasting and eating. The goal of the pattern is to lose weight. Ketosis is not a goal, but can be achieved by certain fasting regimens.

Studies have shown intermittent fasting benefits for diabetes, including:

• Insulin resistance improvement by reducing calories (Insulin sensitivity rises, and insulin levels fall.)
• Improved fasting and after-eating glucose levels
• Potential to reduce insulin levels and possibly lower chance of heart issues
• Improved metabolic and inflammatory pathways
• Reduced amount of insulin needed

Intermittent fasting risks for children with diabetes include:

• Hypoglycemia, especially for those on basal insulin and sulfonylureas
• Protein malnutrition if the child doesn’t eat the right amounts on days not fasting
• Could lead to insufficient energy intake
• Dehydration

Before trying intermittent fasting, talk with your child’s diabetes educator, registered dietitian and endocrinologist. They can help you come up with a plan and adjust your child’s medicines as needed to set your child up for success.

Whole30 and diabetes

Whole30 puts a focus on whole foods while eliminating certain “trigger” foods which may cause issues for your body. It is essentially an elimination diet that can possibly show you whether certain foods affect digestion, mood and body weight as you reintroduce them after 30 days of being on the diet. Whole30 is extremely strict, limiting artificial sugar, alcohol, tobacco, grains of any kind (rice, wheat, oats), legumes, dairy, MSG, sulfites or carrageenan. While on Whole30, participants can eat meat, seafood, eggs, some vegetables, some fruit, good fats from oils/nuts/seeds and fruit juice as a sweetener. If you “cheat” on the diet, you have to start over for another 30 days.

Concerns for children with diabetes:

• It’s a huge change to eating habits. Going from 200 to 350 grams of carbohydrates to 75 grams is a big shock to the body.
• Blood sugar will need to be checked more regularly to monitor for hypoglycemia, especially if on a set insulin dose.
• You can add in extra exercise; just be sure to adjust the insulin doses.

If you’re considering the Whole30 diet because you think your child may have an issue with gluten or another type of food, talk with your child’s dietitian and primary care provider to help you consider any testing or dietary changes.

What healthy eating style is best for a patient with diabetes?

At the end of the day, there’s no definitive “right” diet. We all have our likes and dislikes with food, and often food is very closely tied to the culture we come from. Making a focus on healthy eating should include:

• Complex carbohydrates, such as whole grain bread, oatmeal, potatoes, brown or wild rice
• Fiber, which you can get from beans, whole grains, fruits and vegetables
• Protein, which you can get from fish, chicken, turkey, eggs and egg whites, and some select cuts of beef and plant-based protein sources such as beans, tofu and more
• Vegetables, and lots of them!
• Limited amounts of heart-healthy fats, such as olive, peanut or canola oil; walnuts, almonds and flaxseed

Committing to eat whole foods and managing your portion sizes are good first steps to conquering healthy eating!

Whitney Cessna, M.S., RDN, LDN, CDE, MLDE is a registered dietitian and certified diabetes educator with the Wendy Novak Diabetes Institute.