Tro Kalayjian, MD, Matt Calkins MD, Laura Buchanan MD, David Dikeman, Mark Cucuzzella MD, and Eric Westman MD have raised significant concerns in response to the American Academy of Pediatrics’ (AAP) recent consensus statement on low carbohydrate diets, also known as Therapeutic Carbohydrate Reduction (TCR), for children with or with an increased risk for metabolic disease

In their paper, ‘Carbohydrate reduction for metabolic disease is distinct from the ketogenic diet for epilepsy’ they express disappointment in the AAP’s failure to highlight the unique benefits of Medical Nutrition Therapy (MNT), specifically TCR, in treating metabolic conditions.

They argue that the AAP missed a crucial opportunity to combat bias against TCR, which has shown efficacy and safety in various studies involving adults and pediatric populations.

Their concerns center around key biases identified in the AAP’s report.

By conflating a strict 4:1 ketogenic diet used for epilepsy with the more commonly used well-formulated TCR, the AAP distracts from the therapeutic potential from TCR. 

Dr. Calkins goes on to state, “All eating patterns need further research in pediatric patients. However, we must start from common terminology when reviewing evidence. As we laid out in our perspective, a 3:1 or 4:1 ketogenic diet is very different from a ketogenic diet to improve metabolic health. In the future, articles like this one should seek the assistance of clinicians who use therapeutic carbohydrate reduction in their practice to avoid errors in their conclusions”.

The publication from Calkins et al. underscores the need to address biases in the AAP’s approach and advocates for accurate depictions of Therapeutic Carbohydrate Reduction (TCR) to healthcare professionals and the public. It serves as a call to action for professional organizations to reevaluate their approach to dietary recommendations for children with metabolic conditions.

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, highlight the urgent necessity for effective clinical strategies and interventions.

Immediate action is imperative to address these epidemics.

For those interested in further details, the published paper can be accessed on the Journal of Metabolic Health.

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