Children with Type 1 diabetes who ate very few carbohydrates had better blood sugar control and needed less insulin than those on standard diets, according to a large registry analysis.
The findings were presented at the annual meeting of the European Association for the Study of Diabetes in Milan, Italy, by researchers in Germany and the United States.
The team analyzed 25 years of registry data on 45,569 children ages 1 to 17.
They included children whose carbohydrates had been recorded at least twice over a year or longer, and grouped them by what percentage of their estimated daily calories came from carbs:
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Very Low-Carbohydrate: less than 10 percent of all calories (219 children, average follow-up 2.18 years)
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Low-Carbohydrate: 10 percent to less than 26 percent (4,837 children, average follow-up 2.4 years)
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Standard-Carbohydrate: 26 percent or more (40,513 children, average follow-up 3.67 years)
What the Study Found
The analysis found that children in the very low- and low-carbohydrate groups had smaller increases in body mass index, which means they remained closer to a healthy weight than children in the standard carbohydrate group.
At the end of follow-up, researchers found the average blood sugar levels over the previous two to three months were lower in the very low- and low-carbohydrate groups and increased less over time compared to those eating the standard amount of carbohydrates.
They found the same result for basal insulin, the long-acting type of insulin that covers the body’s background needs between meals and one of two types of insulin typically prescribed for Type 1 diabetes.
A measure that combines blood sugar levels with the amount of insulin a person needs was also lower in those groups at the end of follow-up. The lower result indicates better blood sugar control without using as much insulin, the researchers said.
They also found no evidence that very low-carbohydrate diets were associated with severe low blood sugar (hypoglycemia) or diabetic ketoacidosis (DKA)—severe high blood sugar without enough insulin to manage it. Without enough insulin, the body cannot use sugar for fuel and breaks down fat, flooding the blood with acidic chemicals called ketones.
DKA should not be confused with ketosis, which is the normal, harmless-by-comparison state in which the body burns fat for fuel because carbs are scarce. Both involve ketones, but in ketosis there is still enough insulin to keep ketone levels in check.
Previous studies have found similar results in adults and children following a very-low-carb diet, but researchers wanted to know whether such a diet could cause other health complications in children, such as stunting growth.
The very low-carbohydrate diet only showed metabolic benefits, it didn’t affect the children’s growth or present a greater risk for nutritional deficiencies, high cholesterol, or low blood sugar, lead researcher Christian Denzer, of the Department of Pediatrics and Adolescent Medicine at the University Medical Center Ulm, in Germany, told The Epoch Times.
Although the results were adjusted for sex, age, migration background, and diabetes duration, they could not rule out the possibility that other factors, including self-reported diet, affected the findings.
The analysis was based on a database of diabetic children that relied on self-reported dietary data, so researchers weren’t able to monitor the participants’ actual eating patterns.
Are Very Low-Carb Diets Safe?
In practice, a very low-carb diet means sharply limiting high-carb foods such as bread, pasta, rice, cereal, fruit, baked goods and sweets, and relying more on protein, fats, and non-starchy vegetables, Denzer said.
Families following such an approach may substitute foods such as cereal, bread, waffles, or pizza with alternatives made from eggs, dairy, and coconut or nut flours, he added.
Families considering the diet should talk to a diabetes provider who knows the approach to ensure adequate nutrition, healthy growth, and safe insulin management, Denzer said.
“This is definitely not a diet to randomly try at home like any other new health hack,” Dr. Victoria Finn, a board-certified endocrinologist in New York and contributor to LabFinder.com who was not involved in the study, told The Epoch Times.
Cutting carbs would lead to a “significant” reduction in the insulin dose, so the child’s whole endocrinology team should be involved: the pediatric endocrinologist, a diabetes educator, and a nutritionist familiar with Type 1 diabetes, she said.
“It’s crucial to remember the importance of adjusting insulin doses, using continuous glucose monitoring, and following up with the medical team,” she said, adding that diabetic children on very low-carb diets should be seen more frequently, with regular checks of growth, weight, blood fats, and overall nutrition.
“If everything is done under close supervision, patients can expect real benefits safely,” she said.
A Long History, Renewed Interest
Carbohydrate restriction has been used to help people with diabetes since the 1700s, but fell out of favor after insulin became available.
However, current therapies do not achieve optimal results, and most people with diabetes remain at high risk for complications.
Low-carbohydrate diets have recently regained popularity, particularly for Type 2 diabetes, with early research suggesting possible benefits for weight, blood sugar control, and other health measures.
A 2015 critical review found that cutting back on carbohydrates may lower blood sugar after meals and reduce the amount of insulin needed more than other dietary changes for both Type 1 and Type 2 diabetes. It may also improve other factors linked to heart and metabolic health.
