Low carbohydrate diets in eating disorders and type 1 diabetes

Abstract

Dietary intake requires attention in the treatment of both eating disorders and type 1 diabetes (T1D) to achieve optimal outcomes. Nutritional management of both conditions involves encouraging a wide variety of healthful foods in the context of usual cultural and family traditions. In recent times, low carbohydrate diets have seen a rise in popularity, both in T1D and in the general population. Low carbohydrate diets involve dietary restriction, although the extent depends on the level of carbohydrate prescription. Although dietary restriction is a known risk factor for eating disorders, there is limited literature on the impact of following a low carbohydrate diet on the development and maintenance of eating disorders in T1D. The aim of this review is to discuss the impact of dietary restriction on the development and treatment of eating disorders and propose considerations to enable optimum health outcomes in individuals with T1D, an at risk group. In order to achieve this, clarity regarding strategies that allow both flexibility in dietary intake and facilitate healthy eating behaviours, whilst achieving glycaemic targets, are required.

Dietary fat intake is associated with insulin resistance and an adverse vascular profile in patients with T1D: a pooled analysis

“…In T1D, preference for high fat and protein over carbohydrate has been previously reported [10]. Within the T1D community, there is often a concern that increased carbohydrate intake increases IR and worsens glucose management and that carbohydrate intake should be restricted [22]. However, our cross-sectional data do not support this notion, Table 3 The changes in eGDR levels after isoenergetic substitution of one macronutrient (from 48-h weighed food diary) to another (in parenthesis) by 5% of total energy (n = 107) Model 1 is adjusted for energy intake; Model 2 is fit to estimate associations with adjustment for age, sex, and diabetes duration and energy intake.…”

“…In T1D, preference for high fat and protein over carbohydrate has been previously reported [ 10 ]. Within the T1D community, there is often a concern that increased carbohydrate intake increases IR and worsens glucose management and that carbohydrate intake should be restricted [ 22 ]. However, our cross-sectional data do not support this notion, whereby increased carbohydrate intake was associated with lower IR, improved glucose management (HbA1c), and a more favourable vascular profile.…”

Low-carbohydrate diets in type 1 diabetes: balancing benefits and risks

“…There are theoretical concerns for the negative impact of LCDs on mental health and disordered eating. Binge eating, restriction, self-induced vomiting, and laxative abuse are more common in PwT1Ds [42 ▪ ,43]. T1D management requires high-risk activities, known risks for disordered eating, and LCDs will likely enhance these; scrutiny and restriction in diet, carbohydrate counting, and portion control.…”

ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes

“…A specialist pediatric dietician will be able to complete a detailed dietary assessment with the family to understand the degree of carbohydrate restriction, discuss the risks associated with restrictive diets in children and adolescents, including eating disorders (ED), 48 and offer a range of strategies the family can use to ensure their goals align with their child's medical needs 8 . Regardless of the amount of carbohydrate in the diet, caregivers and young people with diabetes require strategies to minimize the postprandial excursions caused by carbohydrate.…”

“…If an individual child or family chooses to routinely consume a moderately low (<40% energy) or low (<26% energy) carbohydrate diet they should discuss this with a dietician to ensure the diet is nutritionally complete, particularly in regard to calcium, B vitamins, iron and fiber. 40 A specialist pediatric dietician will be able to complete a detailed dietary assessment with the family to understand the degree of carbohydrate restriction, discuss the risks associated with restrictive diets in children and adolescents, including eating disorders (ED), 48 and offer a range of strategies the family can use to ensure their goals align with their child's medical needs. 8 Regardless of the amount of carbohydrate in the diet, caregivers and young people with diabetes require strategies to minimize the postprandial excursions caused by carbohydrate.…”