When you’re on keto, is it a good idea for your family to eat the same way?
The popularity of the ketogenic diet is undeniable, and with that popularity comes Instagram accounts, blogs and recipes dedicated to the keto lifestyle, which is based on a very low- or no-carb food plan. When a keto kids cookbook recently landed in the HuffPost newsroom, it got us thinking ― is it a good idea for kids to be on this diet?
We consulted with several nutrition experts (registered dietitians, a Ph.D and a pediatrician) to find out three key things: 1) Is it safe to put kids on keto; 2) Is it a good idea for parents to put their kids on the same restricted diet they’re following; 3) What’s the best way for parents to talk to their kids about their restricted diet? Here’s what we learned.
Kids and keto: A diet combo that has been around for decades
“The ketogenic diet originated in the 1920s to treat a certain type of epilepsy (called refractory epilepsy) in children when medication was not effective,” said Alyssa Pike, registered dietitian and manager of nutrition communications at the International Food Information Council Foundation. “Other than that specific circumstance that would be advised by a medical doctor, children are not recommended to adopt the keto diet.”
Pike added that no population-wide dietary guidelines recommend ketogenic diets for children “or suggest that such a diet would be beneficial to a child’s health.” Citing the 2015-2020 Dietary Guidelines for Americans, a 144-page document that does not include the term keto or ketogenic, Pike pointed out that none of the three recommended eating patterns would put someone in ketosis, the process whereby your body burns fat for energy instead of carbohydrates.
Pike also cited the Nordic Nutrition Recommendations 2012, which “set their average requirements for glycaemic carbohydrates at a level that avoids ketosis among children and adults,” as well as the American Heart Association’s Dietary Recommendations for Healthy Children; guidelines which, if followed, wouldn’t put children in ketosis.
Keto doesn’t provide the macronutrients children need for a healthy diet.
When it comes to the keto diet versus a traditional diet, vast differences exist between the recommended allowances for macronutrients, aka carbs, fat and protein.
Additionally, the highly popularized keto diet that is all the rage today has key differences from the established intractable epilepsy treatment for children. Most importantly, the latter is “a prescribed diet with close medical supervision that is precisely calculated to induce ketosis while providing adequate nutrition to prevent malnutrition and promote normal growth and development in children,” said Carol Kirkpatrick, a Ph.D and volunteer science and nutrition expert for the American Heart Association.
“A ketogenic diet that is followed by adults ― most commonly for weight loss and more recently type 2 diabetes management, but also by some athletes as part of their training regimen ― is typically not as precisely calculated as a ketogenic diet prescribed for children with drug-resistant epilepsy,” Kirkpatrick said. “The primary emphasis [of the adult keto diet] is a reduction of carbohydrate intake to 20-50 grams per day and limiting protein intake to 1.0-1.5 grams per kilogram of body weight ―or an ideal body weight if overweight ― to induce ketosis.”
In terms of macronutrient composition for the contemporary keto diet, this breaks down to 70-80% of daily energy from fat, about 15% of daily energy from protein and 5% of daily energy from carbohydrates.
“This macronutrient breakdown does not reflect the recommended macronutrient composition for children between the ages of 4–18 from the 2015-2020 Dietary Guidelines for Americans: 25-35% of total daily calories from fat, 10-30% of total daily energy from protein and 45-65% of total daily energy from carbohydrates,” Kirkpatrick said.
The keto diet can lead to nutritional deficiencies and other health issues.
“Even when used with children with intractable epilepsy and close medical supervision, there are possible adverse effects of a ketogenic diet, including increased low-density lipoprotein (LDL) cholesterol and triglycerides and increased risk for kidney stones,” Kirkpatrick said. “There is also a risk for reduced bone mineral density if the ketogenic diet is followed for longer than two years.”
Jonathan Valdez, owner of Genki Nutrition and spokesperson for the New York State Academy of Nutrition and Dietetics, cited a 2013 study on the efficacy and safety of the ketogenic diet in Chinese children, which found frequent reports of gastrointestinal disturbance, food refusal and hypoproteinemia (low protein levels in the blood).
“It seems that unless completely necessary for seizure control, the keto diet isn’t necessarily the best diet for children,” Valdez said.
Kirkpatrick noted that severely restricting kids’ carbohydrate intake to 20-50 grams per day (compared to the recommended dietary allowance of 130 grams per day) “restricts the intake of foods that provide fuel for energy and cognitive function, as well as foods that are rich in vitamins and minerals required for growth and development.”
“Children should be offered nutrient-rich carbohydrate foods, including starchy and non-starchy vegetables, fruits, whole grains, legumes, beans and dairy products like milk to achieve their carbohydrate needs,” Kirkpatrick said. “Carbohydrate foods that have less nutritional value and should be included minimally include foods with added sugars, sugar-sweetened beverages and highly processed or refined carbohydrate foods.”
“The best dietary guidance advises that children eat a diverse diet that provides them with the right amount of all the nutrients ― macro and micro ― that their growing bodies need,” Pike said. “This includes a wide range of fruits, vegetables, grains ― half of which should be whole grains ― and dairy. Many of these are forbidden or severely restricted on the ketogenic diet.”
She cited a study that outlines health issues that have been observed in children following the keto diet for seizure control, including micro- and macronutrient deficiencies and side effects like constipation, vomiting and diarrhea.
Unless medically prescribed, it’s probably not a good idea to put your kid on a restricted diet.
If you’re following a specific diet like keto, paleo or vegan, while it can be convenient to prepare those same foods for the entire family ― including your children ― it’s important to tread carefully.
“Children can eat similar foods that the parents are eating if the parents are following a special diet,” Kirkpatrick said. “However, parents should offer an overall healthy dietary pattern that teaches balance and a healthy relationship with food. Parents should offer a variety of nutrient-dense foods that are rich in protein, healthy fats and carbohydrates that promote the healthy growth and development of their children.”
Dr. Christopher F. Bolling, chair of the American Academy of Pediatrics section on obesity, pointed out that there are major physiological differences between children and adolescents versus adults.
“Rapid growth, bone deposition, hormonal changes, metabolic rate and a host of other differences make kids react very differently to nutrition than adults,” Bolling said. “Despite being more resilient in many ways than adults, [kids] will often be the first to show the effects of exposures or deficiencies.”
Bolling added that there are also behavioral concerns when it comes to children adopting the same restricted diet as their parents.
“It’s one thing for an adult to choose to do an unproven diet,” Bolling said. “How much choice does a minor really have? They can be coerced or shamed into a variety of unhealthy choices not of their choosing. Additionally, teens are much more susceptible to mental health issues like anxiety, depression and, most saliently, eating disorders. Equipping them with ways to deal with food healthfully is important so as to avoid maladaptive behaviors like excessively restrictive dieting or excessive exercise.”
When talking to your kids about a restricted diet you’re following, keep the focus on the health benefits.
“It is important for a child, at any age, to realize that while some foods may have a higher nutrient density than others, this doesn’t mean we should create this culture of negative food talk,” Valdez said. “This can lead to disordered eating and other issues down the road.”
Pike recommends that parents consult a health care professional like a registered dietitian before talking to their kids about a restrictive diet they’re following, as these experts are trained to counsel on this sensitive subject.
“It’s important for parents to be aware that children observe and are influenced by their parents’ relationship with food, including the negative language that is sometimes used around certain foods,” Pike said. “The tone of these conversations may affect how children view that food. There’s a fine line between labeling a food as ‘good’ or ‘bad’ and subsequently labeling yourself for eating or not eating that food.”
For parents following a restricted diet to lose weight, Kirkpatrick encourages them to avoid negative language about food and their bodies in front of their children and instead keep the focus on an overall healthy lifestyle.
“Children are very impressionable and focusing too much on dietary restriction or eating habits in general can increase the risk of disordered eating and body dysmorphia, which can cause them to struggle with eating and body issues far into adulthood,” Kirkpatrick said.