Keto devotees stay true to the diet 100 percent of the time, while others have found they need a little more carbohydrates or protein. That’s inspired some to tweak the low-carb, high-fat diet to meet their needs. As a result, several spins on the keto diet have emerged.
Quick, Short-Term Weight Loss Is an Appealing Factor of Keto
Kristen Kizer, RD, a registered clinical dietitian at Houston Methodist Hospital in Texas, says that all of these diets have one thing in common. “A keto diet to me would be any diet that gets a body into ketosis,” she says. RELATED: What Are the Benefits and Risks of the Keto Diet? Ketosis occurs when the body turns to fat as its main source of energy instead of carbohydrates, says Amy Shapiro, RD, the New York City–based founder of Real Nutrition. Keeping the body in ketosis for extended periods of time may lead to weight loss, according to a study published in the Fall 2014 issue of Experimental & Critical Cardiology. Ketosis is a natural metabolic state in which the body burns fat rather than carbs. “[The keto diet] is popular because in most cases it can produce very easy and effective weight loss — that’s the primary reason why people start it,” says Los Angeles–based Franziska Spritzler, RD, founder of Low Carb Dietitian. There are some other researched benefits beyond weight loss, including possibly acting as a mood stabilizer in those with bipolar disorder (per a very small study in Neurocase) and, more rigorously studied, lessening epileptic seizures (according to a study published in May 2016 in Epilepsy & Behavior).
Keto Isn’t Without Its Drawbacks, Health-Wise
But not everyone’s a fan. “For most people, going keto means jumping on the diet-of-the-moment bandwagon,” says Jackie Newgent, RDN, a culinary nutritionist in New York City and the author of The All-Natural Diabetes Cookbook. “For most, it’s a fad diet that will offer temporary results.” That runs counter to Newgent’s usual advice to find an eating plan you can follow for a lifetime. She also worries that reducing carbs as much as the original keto diet calls for will cut out nutrient-rich foods, like whole grains, certain veggies, and fruits. RELATED: 10 Healthy Foods You Can’t Eat on the Keto Diet Here, dive into six of the most popular types of the ketogenic diet. Kizer says to keep in mind that while there are many studies involving ketosis, these variations of the diet have not yet been researched.
1. A Strict Keto Diet Is Used for Epilepsy Treatment
How It Works When people say they’re on the strict version of keto, they’re likely referring to the one that’s been shown to help treat epilepsy. Sometimes called the “therapeutic keto diet,” this is the original version of keto, which was created in the 1920s to help treat seizures, according to a study published in Current Treatment Options in Neurology. “Strict ketosis was traditionally for those using ketosis as part of treatment for [people with epilepsy] who were nonresponsive to medication,” Kizer says. The original study found that sticking to the keto diet for one year led to improvements for 44 percent of study participants, with another 12 percent becoming seizure-free, per a study published in June 2016 in Practical Neurology. This version of the diet allows for the lowest amount of carbs (hence being the strictest). According to the Practical Neurology study, 90 percent of daily calories come from fat, 6 percent from protein, and just 4 percent from carbs. Who It’s Best For People who are trying the keto diet to treat epilepsy Risks to Note The most common side effects among children who followed the diet were constipation, weight loss, and growth problems or anorexia, found the Practical Neurology study. The growth problems among children may be the result of limited protein intake, Spritzler says. There’s also a risk for developing hypercalciuria (high calcium levels in urine), kidney stones, and low blood sugar. Even though the bulk of research has been on children, adults may experience the same issues — plus possibly high cholesterol, though levels should drop once you quit the diet and start eating normally again. Unsurprisingly, this strict version of keto also seems to be the toughest one to stick to: Research shows that the modified versions of the diet have lower drop-out rates. RELATED: 11 Health Conditions Keto May Help, and 6 It Won’t
2. The Standard Keto Diet Is the Most Common Version
How It Works This is the most common approach to keto and involves sourcing 75 percent of calories from fat, 20 percent from protein, and 5 percent from carbs. That means limiting carb intake to about 20 to 30 grams (g) of carbs per day, Shapiro says. It’s important to note that while this is the keto diet that most people follow, it’s not the original, or therapeutic, version of keto that an article in Canadian Family Physician showed can help children with epilepsy. That diet consists of slightly different percentages: 80 percent of calories from fat, 15 percent from protein, and 5 percent from carbs. Who It’s Best For People looking to accelerate their weight loss and tap into the other reported health benefits Risks to Note Kizer says there are a few groups who should not follow the standard version of keto (or any other version either): pregnant women, people with diabetes (at least not before discussing it with a physician), and those with a history of kidney stones. She notes that ketosis may result in bad breath, dizziness, constipation, and low energy levels (commonly called the “keto flu”) for the first few weeks. More concerning, drastic weight changes, from keto or otherwise, can increase your risk of mortality, says Kizer. Weight cycling, also called yo-yo dieting, may put particular strain on the heart, suggested a study published in February 2015 in Obesity Reviews.
3. Targeted Keto Is for Athletes Looking to Improve Their Performance
How It Works You’ll follow the keto diet as usual until 30 to 45 minutes before exercise — then it’s time to eat about 25 g of carbs, says Daniela Torchia, PhD, a registered dietitian based in Loma Linda, California. The idea is that you’ll have just enough carbs to fuel your workout and still be able to return to ketosis easily after you cool down. Choose carbs that are easy to digest (for instance, white bread or white rice) and be sure not to add calories to your daily total — simply redistribute them, Dr. Torchia says. A study published in 2019 in the Journal of Sports Medicine found that 28 days of a keto diet helped to increase some athletic endurance. But researchers added that the diet’s benefits were mainly seen in short-duration, vigorous-intensity exercise, and that results were inconsistent, so it may not be the go-to approach for all athletes. Who It’s Best For This approach is intended for people who frequently engage in intense, muscle-building workouts, according to Torchia. We’re talking high-intensity exercise, like running, swimming, or playing tennis for hours on end, Torchia says. Hitting the gym at a moderate pace a couple of times a week likely won’t cut it. Risks to Note Torchia says not to try targeted keto until you’ve been following a standard keto diet for a month or two. “This idea is called ‘keto adaptive,’ and once your body is used to using fat as fuel, it can go back and forth more readily with moderate carbs,” she says. She warns not to try this (or any version of keto) before talking with a physician if you have diabetes and are insulin dependent, as it could lead to a too-low blood sugar level. RELATED: 6 Things You Need to Know About Exercising on the Keto Diet
4. A High-Protein Keto Diet May Be Best for Bodybuilders
How It Works This version of keto calls for upping the protein intake just a bit. Protein should make up about 30 percent of calories, with the other 65 percent coming from fat and 5 percent from carbs, Spritzler says. Aim to source your protein from both animals (meat, fish, and dairy) and plants (nuts and seeds), Spritzler suggests. Who It’s Best For This is meant for those who need protein to help protect muscle mass, like bodybuilders and older people who need to prevent muscle breakdown, Spritzler says. It’s also a good option for those who show signs of a protein deficiency. Those signs include a loss of muscle or thinning hair, according to the subcommittee on the 10th edition of the federal recommended dietary allowances. Risks to Note Those with kidney issues need to be careful not to increase their protein intake too much, says Lisa Koche, MD, a Tampa, Florida–based senior medical adviser for Kegenix, a company that creates keto meal replacements and other keto-friendly products. People with kidney disease may experience waste buildup in the blood if they have too much protein, according to the National Kidney Foundation. High-protein keto may not be right for you if you’re following the diet for therapeutic reasons. “The reason protein is limited at all [in keto] is because the goal in therapeutic keto is to treat epilepsy and to have high ketone levels,” Spritzler says. “Protein will not kick you out of ketosis if you have a lot, but it will definitely lower the amount of ketones in your blood.” Since slightly more protein shouldn’t affect your body’s ability to stay in ketosis, this version of the diet delivers the same weight loss benefits as standard keto, Spritzler says.
5. A Cyclical Keto Diet (or ‘Keto Cycling’) Could Help You Stick With the Diet
How It Works On cyclical keto, also called keto cycling, you’ll cycle in and out of keto — usually staying on the diet for five days, followed by one or two days with more carbs. “The point of keto cycling is to make it easier for someone to follow,” Kizer says. “Every five to six days they can have the carbohydrates they’ve been entirely restricting.” There’s no set protocol of what your carb days should look like, but Kizer warns not to go overboard because that will make it more difficult for the body to return to ketosis. Who It’s Best For This is intended for those who have a tough time sticking to keto. “It can be helpful if someone wants to take a break and have carbs,” says Dr. Koche. That may not be easy for everyone. Kizer worries this approach may promote carb bingeing. You may have heard keto cycling recommended for athletes, who use the extra carbohydrates to fuel their workouts or competitions. For instance, that 2019 study in The Journal of Sports Medicine indicated some endurance benefits, but the results are mixed, and a study published in April 2018 in The Journal of Sports Medicine and Physical Fitness, have shown that the keto diet does hinder exercise performance. Risks to Note Koche says to hold off until you’ve adapted to keto, which means your body is used to turning to fat for fuel, before adding these high-carb days, as it can slow down the possible benefits and results of being in ketosis. Kizer notes that keto cycling can cause fluctuations in body water, which can lead to dizziness. “It can also be hard on the heart for those with some cardiac conditions,” she adds. RELATED: Can the Keto Diet Help Prevent or Manage Heart Disease?
6. The Lazy Keto Diet Could Be the Easiest Version
How It Works The purpose of the so-called “lazy keto” diet is to make keto easier to follow. Counting calories, fat, and protein intake — for some people, that’s all too complicated. “All you track is carbs in lazy keto,” Kizer says. You should still see results that are similar to regular keto, so long as you keep your carb intake low enough and don’t go overboard in the protein department, Kizer says. “As long as carbs stay low enough, which will vary by person but is usually below 50 g a day, one will stay in ketosis,” Kizer says. As a result, you’ll be able to see the effects associated with being in the metabolic state. Who It’s Best For This is meant for those who are interested in ketosis but don’t want to be bothered with tracking calories, protein, and fat. Risks to Note The same people who experts say should stay away from keto in general should also avoid this approach, such as pregnant women, people with diabetes who are using insulin or taking hypoglycemic medication, and people with type 1 diabetes who are at risk for ketoacidosis, Kizer says. Lazy keto can also be dangerous if you take it to mean that you sometimes follow a keto diet and sometimes don’t. “Ketosis is all or nothing — you’re either in ketosis or you’re not,” Kizer says. “What concerns me is when people say they’re following a keto diet but not all the way or something along those lines. This could lead to weight gain and increased blood lipid values if someone just starts eating a high-fat diet and borrowing concepts from ketosis.” For example, a small, preliminary study published in February 2019 issue of Nutrients suggested those who take a “cheat day” on keto could be harming their blood vessels.
7. A Mediterranean Keto Diet May Be a Heart-Healthier Way to Eat
How It Works Think of Mediterranean keto as a combination of two popular approaches to eating: sticking to standard keto macro amounts, while emphasizing Mediterranean diet elements like fatty fish and olive oil. The main emphasis is on the quality of fats you’ll be eating, says Madeline McDonough, RDN, who is based in Boston. “Unlike the standard keto diet, which doesn’t specify which fats to prioritize, Mediterranean keto diets emphasize options like monounsaturated fatty acids, which may help lower LDL cholesterol, and omega-3s that are anti-inflammatory,” she says. Who It’s Best For This is for those who want a flexible approach to healthy eating that is sustainable long term, notes McDonough, and who want more emphasis on Mediterranean elements like nonprocessed food and high nutrient density. If you’re a huge fan of salmon and sardines, this may be your favorite keto choice. Risks to Note The standard Mediterranean diet — which is not keto, thanks to its amount of whole grains and fruits — has many elements that are worth shuttling into a keto plan, so the risks are minimal, says McDonough. If you want to get truly Mediterranean, incorporate social time into your meals, rest after eating, and get regular physical activity. RELATED: A Complete Mediterranean Diet and 14-Day Meal Plan
8. Keto 2.0 Is a Lower-Fat Type of the Standard Diet
How It Works The latest revamp of the keto diet is Keto 2.0, which is gaining traction for those who feel the standard keto diet is too restrictive and difficult to sustain in the long run, says Penny Scholl, RD, in Avon, Massachusetts, who covers keto approaches on her blog, Remake My Plate. With Keto 2.0, the amount of fat is decreased, while carbs and protein are increased — with the idea that you’ll be able to eat a wider variety of carbs, such as fruit, vegetables, beans, and whole grains. Leaner cuts of meat, as well as seafood, are also emphasized in Keto 2.0. The breakdown here is 50 percent fat, 30 percent protein, and 20 percent carbs. “In general, this diet allows for more variety when compared with the traditional keto diet,” says Scholl. One caveat is that there doesn’t seem to be any research yet that indicates this is effective for weight loss. Who It’s Best For This approach is intended for people who are looking to lose weight, but have a hard time sticking to the very low carb amounts in the standard keto diet, says Scholl. “The only effective diet for weight loss is one you can follow long term,” she adds. “Including more carbs may make it easier for some people to follow through on lifelong changes to what they eat.” Risks to Note Despite the name, this isn’t really keto, Scholl says. With the higher carb intake, you’ll no longer be in ketosis, with your body using fat for energy instead of carbs. The macros with Keto 2.0 make it closer to a moderately low-carb diet, such as the maintenance phase of the Atkins diet, according to Scholl. So the risk is that you’re not actually doing keto and getting into ketosis, which may lead to weight gain, but that said, this might be a nice bridge from higher-carb eating toward more traditional keto approaches.
9. Dirty Keto Is Similar to the Standard Diet but Expands the Menu
How It Works Is this diet as fun as it sounds? Depends on whom you ask. The macronutrient distribution in the “dirty keto” approach is the same as in the standard keto plan, according to Melissa Nieves, RD, an advisor for HealthyMeals Supreme who is based in Puerto Rico. The big difference is that the source of these macros can come from any kind of food, including highly processed and prepackaged meals. For example, instead of getting healthy fats and low carbs from almonds, you can hit your macro amounts with BBQ pork rinds instead. “The main point of dirty keto is that, since the macronutrient amounts it follows support a ketogenic state, it doesn’t matter where those macros come from,” she says. Who It’s Best For This variation is for those who need a high level of convenience and lack the time or interest for cooking and meal prep, Nieves says. This may also be the easiest route to follow for those just getting into keto, she adds, since you can stick to keto even when traveling or dealing with a busy schedule — you just need to read package labels carefully rather than going deep into meal planning. Risks to Note Although it does sound fun to get dirty, Nieves cautions that too many ultraprocessed foods — which have additives like sugar, preservatives, and artificial flavors — can lead to nutritional deficiencies over time, and load you up with too much sodium and unhealthy fats. A diet high in convenience foods has also been associated with an increase in overall mortality, according to a May 2019 study published in BMJ. Nieves advises those with preexisting health conditions like diabetes and cardiovascular disease to tread with caution, but even if you don’t have those issues, be aware of the health drawbacks. In general, she adds, if you plan on going keto, consider the dirty version only when you need the convenience, and not as a long-term approach. RELATED: 10 Keto Diet-Friendly Convenience Foods for Carb Lovers
10. Clean Keto Calls for Eating Organic (and Other ‘Healthy’) Versions of Foods
How It Works Swinging in the opposite direction of the dirty keto approach is, naturally, clean keto. But it’s not a full 180, because you can still focus on convenience, says Raymore, Missouri-based Randy Evans, RD, consultant for Fresh n’ Lean, a meal delivery service specializing in keto foods. You also will still stick to the same macronutrient distribution as standard keto. The difference is that clean keto is based on sourcing the healthiest versions of foods. That means you’ll look for terms like organic, grass-fed, pasture raised, and cold-pressed. You’ll also lean heavily towards whole plant foods, Evans says. Who It’s Best For This approach is for those who focus on food quality just as much as they do on macro tracking. Also, clean keto may involve more financial investment, since grass-fed meats and cold-pressed extra-virgin olive oil tend to be pricier than lower-quality options, especially those packaged for convenience. Risks to Note Focusing on the healthiest possible foods — and bringing in a fridge-load worth of plants in the process — doesn’t include many cautionary notes, according to Evans. That said, because plant foods still contain carbs, you’ll need to keep your macros in mind. If you can, this can be a relatively healthier way to do the fad diet.
A Final Word on How to Pick the Right Type of Keto Diet for You
It’s a good idea to meet with your doctor or a registered dietitian any time you switch up your diet — whether you’re on keto or another eating plan. And above all, Torchia says to listen to your body and assess your energy level and how you’re feeling on the diet. “You will be your best teacher,” she says. Additional reporting by Elizabeth Millard.
