A recent critique authored by Dr. Tro Kalayjian, Dr. Laura Buchanan, and colleagues in the Journal of Metabolic Health take aim at the American Academy of Pediatrics‘ (AAP) approach to low-carbohydrate diets for children with or at risk for metabolic diseases. Expressing significant concerns, the authors highlight biases and missed opportunities in the AAP’s consensus statement on Therapeutic Carbohydrate Reduction (TCR), also known as low-carb diets.
Dr. Kalayjian remarked, “I find it odd that injection hormones, and bariatric surgery are loud and clear recommendations by the AAP yet removing sugar and processed carbs is controversial and supposedly requires aggressive supervision.”
The critique focuses on the AAP’s failure to acknowledge the unique benefits of Medical Nutrition Therapy (MNT), specifically TCR, in managing metabolic conditions in children. Instead, the AAP’s report tends to conflate the strict ketogenic diet used for epilepsy treatment with the more commonly used well-formulated TCR. This conflation, the authors argue, undermines the therapeutic potential of TCR and perpetuates biases against it.
Dr. Buchanan expressed disappointment, saying, “I was excited to see the American Academy of Pediatrics publish a clinical report on low-carbohydrate diets in children and adolescents living with or at risk for diabetes. I hoped the report would represent a significant step toward providing clinicians and families with a highly-effective tool to combat childhood metabolic disease.”
Buchanan’s disappointment stems from the report’s failure to distinguish between the 4:1 ketogenic diet and a well-formulated TCR plan, and its tendency to medicalize the latter, recommending numerous lab tests, including carnitine levels, which are primarily obtained from meat which are allowed ad-libitum on a low-carbohydrate diet for metabolic disease.
Overall, the critique aims to address these biases and calls for accurate depictions of TCR to be disseminated among healthcare professionals and the public. They emphasize the need for professional organizations to reevaluate their approach to dietary recommendations for children with metabolic conditions given the escalating statistics, with a 45.1% increase in pediatric T1D and a staggering 95.3% rise in pediatric T2DM from 2001 to 2017, alongside a current prevalence of pediatric obesity at 21.5% as of 2020. Immediate action is imperative to address these epidemics.
The publication serves as a call to action for further dialogue and research into the efficacy and safety of low-carbohydrate diets for children with or at risk for metabolic diseases, aiming to provide viable solutions to combat these alarming trends.
Those interested in delving into further details can access the published paper for a comprehensive understanding of the critique and its implications.
