By Tamzyn Murphy
BSc Med(Hons) Human Nutrition and Dietetics, RD
We await the verdict of Prof Tim Noakes’ HPCSA trial over a tweet in which he “advised” a mother to wean her child onto LCHF food. In the meantime let’s take a closer look at the evidence regarding Banting and kids…
Today’s children are the first generation expected to live shorter lives than their parents . We are seeing more overweight children and adolescents than ever before [2, 3]. And we know that overweight children are likely to grow up into overweight adults, with associated health risks (e.g. heart disease and diabetes) . It is clear that the way most children are eating is not doing their health any favours.
If we always do what we’ve always done, we’ll always get what we’ve always got
Sickly sweet South African kids
Eating too much sugar is associated with dental caries and increased obesity risk . Both of which are prevalent health concerns amongst South African children.
We know that children and adolescents in South Africa, and across the globe, eat more sugar than adults. In fact one study reported that South African children eat about 50g (12.5 teaspoons) of sugar each day, while South African adolescents consume as much as 100g (25 teaspoons) per day . This represents 10-20% of daily calorie consumption . South African adults on the other hand, are thought to be eating approximately 38-51g (9-13 teaspoons) of sugar each day, contributing 10-15% of their calories . The World Health Organisation’s guidelines recommend a maximum of 5% of daily calories from sugar – that’s no more than 7 teaspoons daily from all sources. Reducing or even eliminating our children’s added sugar consumption can only be good for their health.
Most medical practitioners and scientists will agree that drastically reducing or even cutting out children’s sources of added sugar can only be good for them. But the question remains, can children safely following a low carbohydrate, high fat (LCHF) diet (popularly known as Banting in South Africa), that’s devoid of starches and wholegrains as well as sugar?
Evidence: very LCHF diets in children
Although, very little research has been done on LCHF eating in children, a few studies have shown that overweight kids and teens (6-18 years of age) who followed a LCHF, containing less than 60g of carbs each day, successfully lost weight, without negatively affecting the levels of fat and cholesterol in their blood [5, 6]. The authors suggest that reducing dietary carbohydrate may be a possible treatment for insulin resistance in children and adolescents.
Of note, a very low carbohydrate, ketogenic diet has been successfully used to treat childhood epilepsy for almost a century . A modified version of the Atkin’s diet, also very low in carbohydrates (it only contains 10g), but easier to follow than the ketogenic diet (as, unlike the ketogenic diet it doesn’t also limit calories and protein), has been used successfully for the same purpose for over a decade. Unlike protein and certain fats, dietary carbohydrates are not essential nutrients – our bodies can make them from scratch to use as fuel. So it’s not surprising that both the ketogenic and modified Atkin’s (probably more so than the ketogenic diet, which also limits protein and calories) diets are considered safe when used in conjunction with multivitamin and calcium supplementation [8, 9].
“Banting” for children needn’t be very low carb
It’s important to bear in mind that most children who follow a LCHF don’t need to drastically restrict carbohydrates to the ketogenic levels (<60g per day) investigated in the studies discussed above (A LCHF diet typically provides 20-120g of carbohydrate daily or 5-30% of total energy intake). So, while added sugar, starches and grains will be eliminated from their diets, other wholefood sources of carbohydrates won’t be excluded (e.g. dairy, starchy vegetables, nuts, seeds, fruit and even properly prepared legumes). I recommend that children only restrict their carbohydrates to below 60g under the supervision of a dietitian or knowledgeable medical doctor.
Provided that a child consumes the recommended 3 portions of dairy daily and eats enough vegetables, supplementation shouldn’t be any more necessary on this diet than with any other. While I don’t suggest being too restrictive about children’s starchy vegetable, fruit and nut consumption, excluding starches (in the form of grains) and added sugar from children’s diets shouldn’t pose any health risk and will likely come with a host of benefits. Especially considering that these restrictions are done in the context of a diet that emphasises avoiding processed food, while eating REAL, nutrient dense foods.
“Banting” for kids simplified
- Eat real food. Avoid processed food.
- Eat freely: Avocados, olives, other vegetables, dairy, fish, poultry, meat (including organ meats), eggs, butter, olive oil, coconut oil
- Eat moderate amounts: Fruit, nuts, seeds, properly prepared legumes (beans, peas, lentils)
- Exclude: Added sugar (in all its forms), processed food, grains (although it’s likely fine to include limited amounts of the less irritating grains such as oats or quinoa)
 Steyn N, Temple NJ et al. Evidence to support a food-based dietary guideline on sugar consumption in South Africa. BMC Public Health. 2012;12:502
 Gow ML, Ho M, Burrows TL, et al. Impact of dietary macronutrient distribution on BMI and cardiometabolic outcomes in overweight and obesechildren and adolescents: a systematic review. Nutr Rev. 2014 Jul;72(7):453-70.
 NICUS. The Ketogenic Diet…Fa(c)t or fiction? 2007