5. Can a Ketogenic Diet Provide Enough Nutrition?

Removing bread, pasta, rice, cereals and many fruits can look restrictive. So it is reasonable to ask whether a ketogenic diet can provide everything the body needs. It can — but food quality and variety still matter.

THE SHORT ANSWER

A well-formulated ketogenic approach can include meat, fish, eggs, dairy, nuts, seeds, green vegetables, salads and small quantities of berries. These provide protein, essential fats, vitamins, minerals and other nutrients while keeping carbohydrate low enough to maintain nutritional ketosis.

Why nutritional ketosis?

Restricting carbohydrate sufficiently to maintain nutritional ketosis changes the fuels available to the body.

Instead of depending predominantly on dietary carbohydrate, the body can draw upon glucose, fatty acids and ketones. Glucose remains available from glycogen and can also be manufactured when required.

This ability to move between fuels is what I call multifuelling.

For someone with type 1 diabetes, less dietary carbohydrate generally means less mealtime insulin too. Smaller glucose and insulin inputs can mean smaller potential errors — the Law of Small Numbers.

This combination is why nutritional ketosis is my preferred approach.

But it isn't all or nothing

Some people find very low carbohydrate difficult to maintain or simply prefer more carbohydrate in their diet.

There can still be benefits from reducing carbohydrate without remaining continuously in nutritional ketosis. Glucose and insulin loads may be smaller even though more time is spent using glucose rather than ketones as fuel.

And if carbohydrate is included, there is an important distinction between minimally processed starchy foods — potatoes, beans, lentils and intact whole grains, for example — and ultra-processed foods rich in refined starches and sugars.

The former may mean spending less time in nutritional ketosis, but they aren’t nutritionally equivalent to biscuits, confectionery, sugary drinks and other ultra-processed foods.

The trade-off is that more carbohydrate generally means more glucose to manage and more is insulin required.

The aim isn’t simply the lowest carbohydrate number. It is natural, minimally processed, nutrient-dense food.

There is more to diabetes than food

Nutrition is important, but it isn’t the only influence on insulin sensitivity.

Physical activity, sleep and circadian rhythms, mindset, stress and our wider environment can all change insulin requirements. Understanding those relationships can support better diabetes management whatever level of carbohydrate someone chooses to eat.

My preference is nutritional ketosis because it combines multifuelling with smaller carbohydrate and insulin inputs.

THE LARGER PRINCIPLE

But the wider objective is Optimised Insulin —

as much insulin as needed, as little as possible.

That relationship between nutrition, multifuelling and the wider influences on insulin is explored in more detail in Shifting Gears.

The ability to move between fuels is what I call multifuelling.

COMMON TYPE 1 KETO QUESTIONS

Is It Safe to Reduce Carbohydrates?

Will a Keto Diet Cause DKA?

Does a Keto Diet Raise Cholesterol?

Will Reducing Carbohydrates Cause More Hypos?

Can a Keto Diet Provide Enough Nutrition?