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My daughter will be one year old soon and she is slowly adapting to eating 'normal' food.

My girlfriend and I follow a ketogenic diet (I have been doing this for almost 3 years now and my girlfriend for almost a year). I would like my daughter to also follow a (somewhat) ketogenic diet. I don't intend to leave out all the carbs but where I live there is a big tendency to go really high on the carbs. Eating a lot of bread and drinking a lot of milk and have a lot of potatoes or rice or pasta with your dinner.

In The Netherlands you have 'checkups' on your child for the first four years in a (google translate) 'clinic'. These people measure and weigh the child and give advice on the next period regarding food and mental and physical development. They are now basically saying she should switch from formula milk to regular cow milk. I am not really a big fan of milk (partially to my ketogenic lifestyle) and I was wondering what is in the cow milk that she really needs and can they easily be replaced by other things?

The internet only seems to give me information on ketogenic diets for a child if they suffer from certain types of epilepsy. I do not want to take the gamble and cut out carbs if they somehow are very important to her mental and physical development.

My concrete question would be how can I keep the carbohydrates to a minimum while still making sure my child will remain healthy?

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  • Is your one-year old epileptic? – HDE 226868 Dec 4 '15 at 1:07
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    Why would you restrict dairy intake to restrict carbohydrates? 100g of milk only has 5g. – YviDe Dec 4 '15 at 5:47
  • @YviDe That is only the 'direct' carbohydrates. Many more emerge while the lactose is being metabolized. See pubs.acs.org/doi/abs/10.1021/bk-1975-0015.ch006 – Jeroen Ubbink Dec 4 '15 at 7:39
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    And as lactose is a disaccharide sugar, it can't be somehow digested to form more carbohydrates while digested, which your comment kind of soudned like you were implying. It's split into glucose and galactose, sure, but there's no "emergence" of sugars going on, that's just a disaccharide being split into two monoaccharides – YviDe Dec 4 '15 at 8:46
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    The fact that you asked this, just shows that your common sense is worried about what you are doing. Applying your special diet sounds selfish and could be dangerous in long term. If your child doesn't suffer any illness, which makes a special diet necessary, you should not enforce a special diet.Treat your kid normal, until a qualified person (a doctor) or obvious circumstances told you something other. – Peter Dec 4 '15 at 16:20
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Your have three questions in one now:

  • Is a ketogenic diet appropriate for a one year old?
  • Is a carbohydrate reduced diet appropriate for a one year old?
  • Is milk really necessary for a one year old, or can I replace it with something else?

Milk

Milk is a very obvious nutritional choice for a small child. You mention that your child has been drinking formula so far, so the switch to cow milk makes sense. Milk is an excellent source of calcium, which kids need a lot of to promote growth. In many countries, it is also fortified with vitamin D, which enhances calcium absorption.

The Guidelines of the American family physicians recommends two or three servings (cups = approximately 600 milliliters in total) per day, to get around 700 milligrams of calcium. Except for fortified foods, dairy really is a very good source for calcium

Can it be replaced? Sure. There's children who are lactose tolerant or get eczema, for example, who can't have milk. Should you, with no physical reason to? I'd say no. For one thing, getting enough calcium without dairy really isn't all that easy, especially for a one year old. Two cups of milk are much easier to get into a toddler than 350 grams of broccoli.

Also, for the purpose of reducing carbohydrates, reducing milk intake is a weird choice. That 600 milliliters of milk has about 30 grams of lactose (the only carbohydrate in milk). That 350 grams of broccoli to replace it has about 25. Complex carbs instead of a disaccaride, but if you are concerned about carbohydrates, milk is just really not a bad choice anyway.

Carbohydrate-reduced diet

I don't think anyone would tell you to give your daughter pasta, rice, and nothing else. A child's diet should be balanced, so of course she can have lots of other things - vegetables, meat, etc. Without knowing what exactly you mean with a diet low in carbohydrates, it's hard to say for sure, though.

Ketogenic diet

Someone else already linked to the study Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet. The important part here is that this occurred even despite the children receiving calcium and vitamin D supplements and reducing their medication.

This study describes progressive loss of BMC in both the whole body and spine in children with IE treated with KD. These findings persisted after correction for both age and height. The decline in BMC occurred despite prescribed vitamin D and calcium supplementation and with a reduction in the number of AEDs used.

Most studies are of course done in kids with epilepsy - deviating from the recommended diet for children in such an extreme way is only done in studies where the benefits may outweigh the risks. Everything else is not defendable in front of an ethics committee.

However, in these studies, epileptic children on such a diet are compared to epileptic children on a normal diet. Differences between the groups are thus attributed to the diet.

Other problems associated with ketogenic diets in children are kidney stones.

Even in epileptic children, the ketogenic diet, despite its success, is only recommended after several medication options fail and includes regular checkups with a medical professional.

I think it helps to remember what ketogenesis is - fatty acid breakdown it order to get the body the energy it needs. That breakdown can lower the pH in the blood, leading to keto acidosis, which is dangerous. In a child, with a low body mass and a high energy need because of growth, this at least sounds very dangerous.

In summary, do not do this unless necessary. There is potentially no benefit at all, and a risk a parent should not be take on without medical need and supervision.

  • Thank you. I should have maybe put the emphasis in my question more on low carb and not strictly ketogenic. I am aware this is a bit vague but i'd just like to keep the carbs low and the fat higher so i specifically don't have to get low fat products which i am advised by the clinic now because she might get too heavy because the rest of her diet has so many carbohydrates in them. Also giving severely higher risk to diseases like type 2 diabetes... However I find your answer very thorough andit's food for thought. I don't expect an exact answer out of my question. – Jeroen Ubbink Dec 4 '15 at 17:49
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    @JeroenUbbink I think a thing to remember, though, is that your daughter might not actually want to eat what you want her to eat - milk is sweet and tastes close to breast milk and formula, so there's usually no problem getting children to get their calories and calcium from that. By all means, offer her a varied diet! You'll probably keep her away from the sweets, which is good :-) Just don't get overboard - while I get that you are concerned and want her to start with healthy habits, type 2 diabetes doesn't usually develop in one year olds who eat too much rice :-) – YviDe Dec 4 '15 at 17:53
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In general, no.

A ketogenic diet is one where carbohydrates are eliminated and protein is restricted, to force the body to obtain its energy from the metabolism of fatty acids and ketone bodies, rather than the normal method of glucose metabolism. It is used primarily to treat otherwise-intractible epilepsy, and to a lesser extent, to deal with certain metabolic disorders.

Long-term side effects of the diet in children include poor bone development, stunted growth, and kidney stones. In short, it's not something you should be subjecting a child to without a strong medical reason to do so, under the supervision of a doctor.

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    I would be much more emphatic in this important answer. If you can expand, it would be very helpful. – anongoodnurse Dec 4 '15 at 6:15
  • Thanks for your feedback. Even though these things do worry me i find that the study that resulted in poor bone development did not do anything to counter the lower intake on calcium from the eliminated dairy products. At least it doesn't say so, only that it was 'suboptimal'. The side effects listed on the other site have no statistics on how often they appear. Also these are things I (as an adult) am already familiar with and know how to combat. So even though i now have some more research entry points i find the 'facts' stated on these sites mediocre at best. – Jeroen Ubbink Dec 4 '15 at 7:46
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    @Joeren at the very least, they got supplementary calcium: "All children were supplemented with one multivitamin with minerals (at a vitamin D concentration approximately recommended for age) and additional calcium and phosphorous at recommended intake for age" - "The decline in BMC occurred despite prescribed vitamin D and calcium supplementation and with a reduction in the number of AEDs used." – YviDe Dec 4 '15 at 8:54
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I highly advise against such a restrictive and one-sided diet for a child! For children a balanced diet is important both for their physical and mental development. This means that malnutrition can cause permanent damage to both the mental and physical health of children. See for example this research article describing cognitive and physical retardation as a results of protein malnutrition in children. In contrast, the effects of malnutrition in adults are much less severe and more easily reversed.

A ketogenic diet puts particular stress on the neural development (and the brain as a whole), because neurons mainly metabolise glucose. Quoting the Wikipedia article about the brain: The brain typically gets most of its energy from oxygen-dependent metabolism of glucose. This is also the reason why a ketogenic diet is used to treat some forms of epilepsy, because there the energy deprivation helps reduce the chance of the neurons firing too much and causing a seizure. The effect of a ketogenic diet is again particularly strong in children because they use up to 40% of their total energy for the brain, while an adult uses only 20% of their energy for the brain.

Finally, it is simply impossible to properly compensate for a one-sided diet with food supplements. Very often, the uptake of a mineral or vitamin critically depends on the food that we eat together with the nutrient. Evolution has simply not prepared us for the uptake of pure nutrients in the form of pills! Examples where we know these relationships are:

  • Vitamin E can only be taken up together with fatty food.
  • Calcium can only be integrated into bones well if there is no shortage of vitamins D and/or K
  • Zinc can only be absorbed well together wit protein.
  • And many more (both known and unknown)...
  • What i do not understand is what you mean that it will be one-sided. It is a misconception that a ketogenic diet is onesided. The things that are the most important to keep an eye on (for adults at least) are calcium, potassium and magnesium. You can eat almost all the vegetables, all the meat and you have to pay attention to your water intake (should be a more than 2 liters spread out over the day). I am probably more aware of micronutrition than any average person on a 'normal' diet. The question remains if i can replace carbs with fat. I like you comment about glucose for the brain. Source? – Jeroen Ubbink Dec 4 '15 at 17:39
  • Glucose for brain: my physiology class, any physiology textbook and the wikipedia article I quoted. – Thawn Dec 4 '15 at 17:52
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    @JeroenUbbink - Glucose is the preferred substrate for energy for all body systems. The body turns to fat only when glucose is not available, which is why it takes so much work to stay in ketogenesis. I'll spare you my opinions on the efficacy of such an undertaking :) – JohnP Dec 4 '15 at 17:56
  • @JohnP you are right in general. For any tissue (ie muscle, etc.) Glucose is the fastest available source for energy. However, for the brain this is much more severe: Neurons almost exclusively metabolise glucose. This is believed to protect them from oxidative stress and slow down ageing because glucose metabolism (glycolysis) does not require oxygen. – Thawn Dec 4 '15 at 18:05
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    One-sided diet: any diet that tries to leave out one of the three main energy sources (carbohydrates, protein, fat) is by definition one-sided. This does not mean that eating a lot of vegetables is bad (on the contrary). But leaving out carbohydrates (or protein or fat) entirely is not a good idea. – Thawn Dec 4 '15 at 18:11

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