Diagnosing the diets: Health professionals urge caution when kids and teens want to restrict what they eat

So your kid wants to go vegetarian or vegan. Maybe even paleo or keto. What should parents know?

While a plant-based diet can be healthy, Spokane health professionals say it’s crucial that young people get key nutrients needed for growth and development.

But they also say parents should resist allowing their children to follow “fad” diets, such as paleo, which avoids carbohydrates, processed foods and dairy, or keto, a low-carb, high-fat diet aimed at shifting the body’s metabolism. Children especially need complex carbs from whole grains, fruits and vegetables.

Even a vegetarian diet can lead to nutrition deficiencies if kids aren’t replacing sources of protein and other essential minerals and vitamins, said Dr. Katheryn Hudon, a pediatrician at Providence Medical Group Pediatrics North.

“It’s really easy to be a potato, pasta and pizza vegetarian – especially as a teenager – and that definitely does not provide the nutrition that their developing bodies and brains need,” Hudon said.

“You can be vegetarian and still be unhealthy, so it’s making sure you’re getting all the things that normally come from animal sources – calcium, B12, vitamin D, iron, omega-3, protein – that you’re finding those in adequate numbers from plant-based sources, or from fortified foods.”

She said parents and doctors should talk to older children or teens about why they’re making the decision, and how they’ll get the nutrients they need. They also should watch for poor body image or potential eating disorders.

“I always make sure that I’m getting a good idea of why they want to start eating vegetarian,” Hudon said.

The answer might be to eat healthier, or for ethical reasons, but adults should listen for if the child is more concerned about restricting food. At least half of teen girls and about a third of teen boys are trying to or have tried to lose weight, she said.

But if eating healthy is the goal, that means eating lots of green leafy vegetables, lentils, beans, eggs, quinoa, dairy products, fortified foods and drinks, and perhaps fish, she said. Some replacement sources of iron also include lentils, leafy greens, the skins of potatoes and pumpkin seeds.

“It’s nice when they include some seafood, then they’re getting some omega-3, and if they include eggs, then again they’re getting omega-3 and they’re getting great protein. It’s just nice to have well-rounded ability to get all of your different essential vitamins and minerals.”

Carbohydrates from vegetables, fruits and whole grains provide much-needed energy and nutrition for growing kids, said Michelle Weinbender, a Spokane registered dietitian nutritionist.

“Never a no-carb or low-carb diet for kids and teens, unless under supervision of a medical or nutritional professional,” added Weinbender, because “they’re growing and developing, and the energy source is so important.

“A restriction over a long period of time can actually cause a stunted growth.”

As another caution, Weinbender said young people who decide to eat vegetarian still need the same daily calorie intake they previously got from food sources such as meat.

She does think that kids and teens are picking up on eating or diet trends they see on social media.

“I’d say right off the bat I wouldn’t recommend fad diets for kids or teens, and those would be paleo, low-carb, keto,” she said. “I think a vegetarian or vegan diet can be healthy, if they’re managed correctly.”

Ashley Randleman, a MultiCare pediatrics nurse practitioner, also makes sure to ask whether youth are getting enough iron, calcium and protein. She suggests that parents and kids talk about a youth’s dietary needs with a pediatrician, family doctor or even consult further with a nutritionist.

“Protein is a huge factor in child development, and that could be lacking, especially if they choose not to eat eggs or dairy, which is pretty much vegan at that point,” Randleman said.

“Iron helps maintain a healthy blood supply to your body … for girls who are menstruating, it’s a critical time when they’re most at risk for developing iron-deficiency anemia.”

She suggests protein alternatives such as tofu and tempeh, and a large amount of legumes, beans, and nuts and seeds, which also are sources of healthy fats. Iron sources can include a supplement and foods such as quinoa, oats, beans, lentils and green leafy vegetables, Randleman said.

“If they’re going to be vegetarians, the emphasis should be on getting a lots of vegetables and not a lot of processed foods,” she said. “A vegetarian can eat unhealthy if they eat Oreos and other processed foods.

“My recommendation is to eat a variety and really pay more attention to the quality of foods you’re eating, choosing fruits and vegetables, whole grain and lean meats over processed food.”

When she sees patients, Hudon also recommends against any fad diets. Keto diets, especially, surprise her.

As part of a medical team in a hospital, she’s only seen the effective use of a ketogenic approach under close supervision with a nutritionist, to help young patients who have ongoing seizures because of severe epilepsy.

“A true ketogentic diet is extremely difficult,” she said. “I think most people who are doing ketogentic diet, they aren’t truly in ketosis like they think they are.”

That’s because of the delicate balance of carefully restricting carbohydrates, and other implications, “because by depriving your body of carbohydrates, you’re essentially starving your brain,” she added.

“Your body is smart; it will go for what is most metabolically active or most costly in terms of energy and that is muscle, so your body will break down muscle before it breaks down fat in a true ketogenic diet.

“So instead of building muscle in a teenage body, you’re breaking it down and you’re losing it, and it’s impossible to provide energy the brain needs just from muscle; then it will go for fat.”

Interval fasting also isn’t good for kids or teens, all three professionals said, citing research showing that kids who skip meals tend to have poorer grades and difficulties concentrating when blood sugar is low. Regularly skipping meals can lead to unhealthy eating habits or overindulging later, they said.

Here is a quick glance at some key nutrition kids need:

Protein and carbohydrates

Protein is in everything in your body and particularly builds muscle in the growing body, Hudon said. “The breakdown components of protein are amino acids, and that is in every single cell … They truly are the building blocks of everything in your body.”

Carbohydrates are crucial because the brain uses glucose for energy, which is broken down very easily from carbohydrates, added Hudon.

“Without that, your brain goes into starvation mode, which is a problem for any brain, but it’s especially a problem for a developing brain,” she said. “Childhood is all about building connections and synapses – making lots and lots of nerve cells and making lots of connections between those nerve cells as you learn and have different experiences.”

Through adolescence, the brain is “pruning” to make connections more efficient, and it needs fuel as that develops further even as young people enter their early 20s.

Iron

Iron is an essential component of a lot of your body’s functions, but particularly blood, Hudon said. Consuming a lot of vitamin C can help the body absorb iron better. She also suggests that cooking with cast iron pots can add trace amounts of iron to food.

“Heme iron, which is iron that comes from animal sources, is more readily absorbed than non-heme iron like from plant sources, so you do need a little bit higher level of iron intake if you’re going only from plant based sources,” Hudon said.

The daily recommended amount of iron does vary by age group and other factors. She often refers families to ChooseMyPlate.org or the Harvard Healthy Eating Plate.

Vitamin B12

Vegans need to be mindful of getting enough B12.

“B12 is a vitamin that is exclusively found in animal products naturally,” Hudon said. “They do have some food products that have been fortified with B12. If you’re strictly vegan and you’re not taking any of those fortified foods, you’re not getting enough B12.”

That’s a concern if a severe vitamin B12 deficiency causes an irreversible degradation of nerve cells, potentially causing numbness or tingling such as in hands and feet, she said. “B12 deficiency anemia is a real concern. Any type of anemia is going to affect your mental clarity and your ability to grow and develop appropriately.”