Low-carbing is great, except when it’s not.
Hear me out.
There have been more and more articles, observations, and studies about low-carb and it’s impact on diabetes management filtering through my social media lately. They show the incredible advantages of going low carb (see here for an easy-to-read NY Times article, and here for a study from the American Academy of Pediatrics), and people are evangelically yelling about it, questioning why we’re not put onto a super-low carb diet from the start, and why more people aren’t talking about it.
They have a point – why was I told to eat carbohydrates at every meal when I don’t need to? Low carb meals keep my BGL steady, and are delicious! However, a lot of these studies are missing the big point, and what we’re talking about here is CHOICE. Specifically, the food choices of children and their right to bodily autonomy.
Going low-carb has multiple benefits for management, that is obvious. However, life with diabetes isn’t just about managing your blood glucose levels. Life with diabetes is messy, incredible, and unpredictable – just like life without it. Eat low-carb with your kids, sure! As long as you are enjoying what you’re eating and it works, all the more power to you! But the moment that the low-carb lifestyle starts interfering in life experiences, when they’re scared to eat fish and chips on the beach or revel in Grandma’s custard tart, it’s gone from lifestyle to problem. I worry that by forcing kids to eat exclusively low-carb (the key words here are force and exclusively), we are setting them up for a disordered relationship with food. If your kid goes to a birthday party and is not allowed to eat the cake, and eats a low-carb ‘energy ball’ instead, that isn’t ‘ideal control’, that’s disordered eating. I’m sorry to drop a truth bomb on you, but there’s no other way around it.
The possibility of disordered eating with a low carb diet is obviously not a rule – the child in the NY Times article above is happy and content with his diet, and all power to him. Yet he is choosing to eat like this, and there are many kids with diabetes that I have met through volunteering on camps that don’t have a choice, because their parents are so focused on ‘optimal’ diabetes management that they forget that their kid needs to live a little. Diabetes management isn’t just about numbers – it’s about your mental health as well! This lack of choice sends them one of two ways – either they are terrified of carbohydrates, or obsessed with them when they escape their parents’ watchful eye. I’m in the privileged position to have conversations with these kids that they may not have with their parents, and many of them lament their lack of freedom and choice in regards to food – “I wish I could just eat like I did before” and “I hate that they always know what I eat” is a common refrain. I understand why parents want to restrict certain types of food – the idea of your child getting complications must be terrifying, and you want them to be healthy! Unfortunately, we can’t stop our kids having diabetes, or counting their food – that is a necessary evil that has to stay with us! We can do something for our kids that heals their relationship with food though – and that is giving them back their choice.
By seeing foods i.e carbs as ‘bad’, these kids with diabetes are not only being led, but PUSHED, into diet culture. We can’t tell our kids to love their bodies and have a healthy relationship with food, but then simultaneously ban foods from their diet and put their bodies and management under a microscope. To develop some sort of intuitive eating in people with diabetes, we need to make sure that their diabetes and the need for optimal management does not override their life experience and their mental health. People with diabetes are already more likely to develop an eating disorder – why are we adding fuel to the fire??
The study above was taken from an online low-carb group, and 42% of the participants were parents of kids with type 1 diabetes. Nearly half of the participants in this study do not have diabetes themselves – they want the best for their kids, but they are not the ones living each day with the condition. They are not the ones who sit with an overwhelming sense of guilt and shame if an item of food with a carb count >10g passes their lips. The question is begging to be asked – if 97% of the participants achieved target BGLs, how many of them also developed a disordered relationship with food?
I’m not saying it’s a given or a rule that kids eating a low-carb diet will develop an unhealthy relationship with food, I’m saying that it’s a definite possibility. Eating disorders are rife in our community, and I’m hesitant to push a certain way of eating onto everybody, when everyone’s attitude to and history with food is different. Other people with diabetes have talked at me at length about how I should go ‘totally low-carb’, and then don’t know what to do with themselves when I say “Oh, well actually, I had anorexia as a teenager so any sort of food restriction for me is a no-go”. IT 👏🏻 DOESN’T 👏🏻 WORK 👏🏻 FOR 👏🏻 EVERYONE 👏🏻
People with diabetes are all different, and while extolling the virtues of a low-carb approach we need to keep in mind that it won’t suit everyone, and that the decision rests solely on the person with diabetes – not their parents, not their diabetes team, THEM. Parents, loved ones, HCPs, are there to help us along, give us information, work with us as well as they can – but at the end of the day, you’re raising someone with diabetes who is going to make food choices for themselves. Kids are incredible human beings – I work with them every day, they will do the sensible thing most of the time, and when they don’t? They learn from it.
I’m not asking you to let your eight-year old loose in the confectionary aisle, or letting your fifteen-year old exist solely on cereal and ramen noodles. I’m asking you to talk to your kid about what they like to eat, what makes them feel good, and how you can help them manage diabetes together so they maintain a semblance of a normal relationship with food. Low carb might work for some kids, but it may not work for others – and that’s ok.
Giving kids some choice EMPOWERS them in their own diabetes! As a parent, you want to raise someone who will make their own decisions, who is independent, and who can take on the world, diabetes included right? By talking openly to your child, you can start that independence. Your child already makes more healthcare decisions in a day than their parents make in a year – so why not trust them?