By Rochelle Inwood / May 24, 2023 (Podcast guest)
Edited and Updated by Sandra Gentleman, RD
Key Differences Between Dirty, Lazy, and the Clean Keto Diet
The Clean Keto Diet is one of the latest versions of the ketogenic (keto)diet. With so much information swirling around about the various keto diets, you are probably feeling confused. You are not alone!
As you know, keto and low-carb diets are very controversial. As dietitians and nutrition experts, we try to steer our patients away from restrictive eating patterns because they are generally not sustainable.
Even with this basic philosophy, you probably wish you knew more about low-carb and keto diets.
So…what are the key differences between low carb, general keto, dirty keto, lazy keto, and the clean keto diet?
Your simplified answers are below!
Low Carbohydrate and Keto Diets
What are the differences between keto diets and low carbohydrate diets?
Keto Diets
Keto diets allow fewer daily carbohydrates due to the goal of reaching ketosis. Most adults can reach ketosis if they consume fewer than 50 grams of carbohydrate per day. Many people following a keto diet will consume 20-50 grams of carbohydrates per day.
Most keto diets take into account the other macronutrients (macros), fat and protein, as well. Those following a keto diet may calculate their macros using the following % calorie distributions:
- Carbohydrates <10% total calories per day
- Protein <25% total calories per day
- Fat >65% total calories per day
- 20 to 50 grams per day or <10% of total calories
When patients require a therapeutic version of the keto diet, please use the calculator provided by The Charlie Foundation for Therapeutic Keto.
Low Carbohydrate Diets
Low carbohydrate diets allow more carbohydrates per day than keto diets. Meaning, those following a low carbohydrate diet eat more carbohydrates than those following a keto diet.
Depending on your resource, low carbohydrate diets may have <26% of total daily calories coming from carbohydrates. These diets can range between 50-150 grams of carbohydrate per day.
Considerations for Defining Carbohydrates in the Diet. For more information on keto and low carb diets, check out this blog post: Is There a Difference Between Low Carb and Keto Diets?
Considerations for Defining Carbohydrate Intake
Based on a 2,000-calorie diet, the following definitions could be considered when discussing keto diets (very low-carb keto diet), low carbohydrate, moderate carbohydrate, and high carbohydrate diets:
Very low-carb keto diet
- 20 to 50 grams per day or <10% of total calories
Low-carb diet - <130 grams per day or <26% of total calories
Or 50-150 grams per day
Moderate-carb diet
- >130 grams per day or 26% to 45% of total calories
High-carb diet
- >225 grams per day or >45% of total calories (3, 5, 8, 10).
What is the Dirty Keto Diet?
Dirty Keto Diet followers focus on macros (example: <10% carb, <25% protein, >65% fat), but they do not worry about the quality of the foods they are eating. In fact, the dirty keto diet can include processed foods, snacks, and even sweets, if these foods fit into the calculated macros.
For example, someone eating a dirty keto diet will not flinch about eating fast-food, consuming fried foods, or taking in higher amounts of saturated and trans fats.
Foods Commonly Found on The Dirty Keto Diet
- Bunless bacon cheeseburger
- Sugar free beverages and sodas
- All cheese (including processed cheese)
- Lower carbohydrate snack foods (potato chips, tortilla chips, keto cookies)
- Pre-packaged meats
- Pork rinds
- Drive-thru coffees, etc.
What is the Lazy Keto Diet?
Those following the Lazy Keto Diet only track their carbohydrate intake. They do not account for how much protein and fat they are eating each day.
Typically, those following the Lazy Keto Diet will limit only their carbohydrate intake to <10% of their total energy intake or fewer than 50 net grams of carbohydrates per day.
What are Net Carbs?
Net carbs are calculated by subtracting fiber (and sugar alcohols – if you have that information) from the Total Carbohydrate number found on the food label.
Calculating Net Carbs. Net Carbs = (Total Carbohydrate – Dietary Fiber).
For this food item, you would subtract the Dietary Fiber (4 grams) from the Total Carbohydrate (37 grams) for a total of 33 net grams of carbohydrate.
Foods Commonly Found on The Lazy Keto Diet
Any food can be consumed on the lazy keto diet. Those following this eating pattern restrict their total net carbohydrate intake to <50 grams of carbohydrate per day, but they do not account for protein and fat intake.
What is the Clean Keto Diet?
Those following a Clean Keto Diet will calculate their macros, and they focus more on eating high quality whole foods. A “Clean Keto Diet” focuses on unprocessed, whole, nutrient dense foods.
Foods Commonly Found on the Clean Keto Diet
- Eggs
- Fish
- Full-fat dairy
- Healthy oils – olive oil, avocado oil, etc.
- Lean meats and poultry
- Low-glycemic fruits – like berries – in small portions
- Non-starchy vegetables
- Nuts and seeds
- Unsweetened beverages
Are There Possible Risks or Side Effects of following a Keto Diet?
Yes, there are risks and side effects that can occur from following a keto diet. These, and other side effects should be considered before anyone starts a keto diet.
Some of the most common side effects include:
- Headache
- Fatigue
- Fluid loss
- Constipation
- Muscle cramps
- Increased blood cholesterol
Are There Certain People Who Should Never Follow a Keto Diet?
The keto diet should not be considered a safe eating pattern if a person has a fatty acid oxidation defect, a carnitine or pyruvate deficiency, or disorders of the heme biosynthesis pathway (5, 16).
These conditions should be ruled out before anyone considers a keto diet.
Additional Considerations Before Starting a Keto Diet
In addition to the medical conditions above, there are several other diagnoses that should be considered potential risks for those thinking about following a keto diet. Medical conditions that should be reviewed and discussed by the patient with their medical team include, but not limited to:
- 18 years old or younger (or still growing)
- acid reflux
- cancer
- constipation
- diabetes (medication adjustments and monitoring required)
- digestion difficulties
- difficulty swallowing (dysphagia)
- eating disorders
- gallbladder disease or no gallbladder
- gout
- high blood pressure (medication adjustments and monitoring required)
- high cholesterol
- history of kidney stones
- inadequate nutrition intake
- kidney disease or failure
- liver disease or failure
- metabolic acidosis
- multiple food allergies
- noncompliance to other therapies
- osteopenia
- pancreatitis
- pregnancy or breastfeeding
- received bariatric surgery (because of possible issues w/ digesting fat)
- religious restrictions (5, 16).
Final Thoughts on Dirty Keto, Lazy Keto, and the Clean Keto Diet
There are several versions of low-carb and keto diets, which can be very confusing. Understanding the latest versions and differences between low carb, keto, dirty keto, lazy keto, and clean keto diets can help you understand what they are all about.
If you are a healthcare provider looking for more information on low carb and keto diets so you can have better conversations with your patients about low-carb and keto diets, consider checking out my book: The Keto Conversation – A Guide for Dietitians and Healthcare Providers.
*As an Amazon Associate, I earn a commission on qualifying purchases.
The Keto Conversation: A Guide for Dietitians and Healthcare Providers
Check out the My Wife The Dietitian podcast where I had the opportunity to speak with the fabulous Sandra and Rob Gentleman about this hot topic.
