Image of foods found on the keto diet

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 and your patients 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 you could address your patient’s questions with a more complete answer.

Because, let’s be honest, you would rather have them talk to you vs. trying to figure it out on their own using the worldwide web, right?

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
Image of a pyramid showing Macro Distribution Percentages
Visual representation of which foods provide the most energy when following a ketogenic diet.

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 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).
Image of diagram showing considerations for defining carbohydrates in the diet
Considerations for Defining Carbohydrates in the Diet.

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.

Image showing how to calculate Net Carbs.
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 (11, 8, 7, 12, 4, 13, 9)
  • Fatigue (1, 8, 2, 9)
  • Fluid loss (14, 13, 9)
  • Constipation (6, 11, 1, 14, 15, 7, 12, 4, 13, 9)
  • Muscle cramps (11, 8, 7, 13, 9)
  • Increased blood cholesterol (9, 14).

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 keep you ahead of the curve while strengthening rapport with your patients.

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 (Ep 76. Keto Diet with Author Rochelle Inwood, RD) via Apple or Spotify.

*As an Amazon Associate, I earn a commission on qualifying purchases.

Woman holding The Keto Conversation Book
The Keto Conversation: A Guide for Dietitians and Healthcare Providers

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More About Rochelle

Rochelle Inwood MS, RDN, ACSM EP-C

Hello there! I’m Rochelle Inwood, a Registered Dietitian Nutritionist (RDN) and Exercise Physiologist (ACSM EP-C). With over 14 years of experience, I have sharpened my expertise through diverse roles, including weight management program co-coordinator, patient/employee gym supervisor, outpatient dietitian, program manager, dietetic internship preceptor, and more. I am passionate about learning, creating, teaching, and supporting personal growth and development.