Latest revision as of 15:15, 30 January 2016

MCTs are claimed by some to be miraculous cure-alls and by others as dietary abominations. The truth is probably a little more complex, as is so often the case with these things. MCT stands for Medium Chain Triglycerides, with the "medium chain" meaning that they are shorter in length than most normal dietary fats (sometimes called Long Chain Triglycerides or LCTs). MCT is a saturated fat, leading many to decry them as unhealthy. However, almost all research into saturated fat focuses on the common Long Chain Triglycerides, not MCT's. It seems likely that the health concerns around normal saturated fat don't apply to MCT's, as they are metabolized in very different ways. MCTs are found in coconut oil, palm kernel oil and butter, as well as being available in pure form. There is reasonable evidence that:

• MCT can be used in the dietary treatment of Epilepsy.
• There are initial indications that MCT will reduce the symptoms of Alzheimer's and other memory problems.
• MCT produces Ketones even without being part of a Low Carbohydrate Diet.
  • Ketone levels are higher when MCT is combined with a Low Carbohydrate Diet.
  • Carbohydrate consumption with the MCT will reduce ketone levels.
  • Higher intake of MCT will produce higher ketone levels.
  • Fasting will increase ketone levels from MCT.
• MCT can produce nausea, vomiting, stomach cramps and diarrhea. Adaptation and mixing with other foods can reduce the problems and the MCTs should be taking in an MCT Shake.
• MCT does not improve exercise performance.

1 MCT and the Ketogenic Diet

Because MCT will increase Ketone Levels without needing Carbohydrate restriction, they are often used for epilepsy treatment. Small amounts of MCT can be used to increase the ketone levels, or to reduce elevated cholesterol levels while on the Ketogenic Diet^[1]. Larger amounts of MCT are the basis of the MCT Diet, which allow for a greater carbohydrate intake than the traditional Ketogenic Ratio Diet and therefore more food choices.

2 MCT Cost

MCT is expensive. I've used pure MCT products like Premium MCT Gold and Dr. Bernd Friedlander MCT Oil, and they are all around $1/oz. You can buy coconut oil, which is about 60% MCT (see below for details), but products like Nutiva Organic Extra Virgin Coconut Oil are about $0.50/oz, which works out around the same price. The best option if you are prepared to buy in bulk is from http://www.bulknaturaloils.com that sells MCT Oil 60/40 for $25/Gallon ($0.19/oz). (Note that products like TwinLab Mct Fuel contain only about 50% MCT.)

3 MCT and digestive distress

MCT frequently causes digestive problems, including nausea, vomiting, stomach cramps and diarrhea. There may be several factors that influence the level of digestive distress^[2]:

• Quantity. Higher quantities of MCT are more likely to cause digestive distress. One study found that 50g of MCT caused all subjects digestive problems, but 30g only caused problems in 10% of subjects.
• Adaptation. There is adaptation that occurs with consumption of MCT over several days. Two studies showed a reduction in digestive distress over time; in one, subjects were given 34g/day for 7 days and the other, 60g/day for 14 days. By the end the subjects' distress had reduced or disappeared.
• Other Foods. Consuming MCT with other foods reduces the digestive distress.

Personally, I found that even after weeks of taking MCT, I could not consume it on its own without incurring dramatic digestive problems. Mixing MCT with other foods greatly reduced, but did not completely remove, the issues.

4 MCT Shake

The recommendation is to take MCT in a Ketogenic Shake with the MCT mixed with milk (cow, soy, or goat), oils (such as canola), plus sugar (or polycose), and protein powder^[3]. For the MCT Diet, a shake containing the daily dose of MCT is taking over 6 meals^[3]. The dose of MCT start off at 1/3^rd the full dose, building up slowly based on digestive tolerance^[3]. An example is 108g MCT, 375g skim milk, plus 13g Canola oil.

5 MCT and Athletic Performance

The available evidence suggests that MCT most likely hinders athletic performance, probably because of digestive discomfort.

5.1 Confounding Factors

The effect of MCT on exercise is not easy to study as there are many factors that might influence the outcome:

• When is the MCT administered? MCT during exercise is likely to have a different result to MCT taken as part of a routine diet.
• Are the subjects on a ketogenic diet? It seems reasonable that Ketoadaptation might change the effect of MCT.
• How long is the trial? There are clear indications that adaptations occur over a period of some days that reduce the side effects of MCT consumption.
• Are the subjects trained athletes or sedentary? Often trained subjects respond differently to their sedentary counterparts.
• What intensity and duration of exercise is used? High intensity exercise usually burns more carbohydrate than fat.
• How much MCT is consumed?
• Is the MCT taken alone or with other fuels? Typically MCT in isolation causes far more digestive problems than when taken with other foods. Also, taking carbohydrate with MCT has been shown to reduce the levels of Ketones produced.
• What is the MCT compared to? Is the MCT compared with the same calorie intake of another fuel, or to no calories?

5.2 Available Research

The table below summarizes the studies on the impact of MCT on exercise.

6 MCT and Alzheimer's

There is evidence that MCT can help reduce peoples' memory impairment without carbohydrate restriction^[17]. A study using elderly dogs showed a long lasting improvement in cognitive ability with MCT supplementation^[18]. There are other anecdotal reports of MCT helping with Alzheimer's symptoms^[19].

7 Types of MCT

The 'medium chain' in 'medium chain triglycerides' refers to the length of the chain carbon atoms. Generally, chain lengths of 6 to 12 carbon atoms (C6 to C12) are considered 'medium'. The most common source of MCTs is in Coconut Oil, and typically pure MCT is refined from Coconut Oil. The mixture of oils in most MCT reflects that of Coconut Oil. MCT oils are fully saturated.

7.1 Sources of MCT

The composition of common sources of MCTs is shown below:

8 Calories in MCT

An animal study has shown that overfeeding that includes large quantities of MCT produced 20% less weight gain than the same level of overfeeding with LCT^[22]. The rats were fed a diet of 50% of calories as fat, with the MCT diet providing 45% of calories from MCT. The rats had similar levels of activity and insulin. This may because MCTs are raise body temperature (thermogenesis)^[23]. MCT has is often considered to have a slightly lower calorie density of 8.3 Calories/gram compared with 9.1 Calories/gram for LCT^[24]. However, if thermogenesis is taken into account, a value of 6.72 Calories/gram would be more appropriate^[24]. This may be critical when using the MCT Diet if calorie intake is restricted. Given the density of MCT is 0.93 - 0.96 grams/ml^[25], 15ml of MCT would be 95 Calories assuming 6.72 Calories/gram rather than 118 Calories assuming 8.3 Calories/gram.

9 MCT and Ketone Levels

A 1969 study looked at how ketone levels changed with MCT^[26]. Subjects were non-obese healthy adults, mostly on a high carbohydrate diet who did not perform any exercise beyond slow walking after taking the MCT. Unless otherwise stated, the subjects consumed only water after taking the MCT. The study measured breath acetone, which is likely to peak sometime after blood AcAc or BOHB levels. (Note that from another study^[27], Acetone at 1.0 µg/100ml breath might indicate blood ketones of BOHB 1.5 mmol/L and AcAc of 0.7 mmol/L, 5.0 µg/100ml might be BOHB 2.7 mmol/L and AcAc of 1.4 mmol/L. See below for details.)

This is the time course of a single 30ml dose of MCT. You can see the peak occurs after 6 hours, though the blood AcAc levels probably peak sometime earlier.	The effects of different doses of MCT on breath acetone. The 10, 30, 50, and 75ml doses produced a linear, proportional increase in Ketones, but the 100ml is disproportionately large. Also note that the peak occurs later for larger doses.
Even though MCT produces ketones without carbohydrate restriction, it is clear from this graph that carbohydrate taken at the same time as the MCT will inhibit ketone production. Note that from a low carbohydrate perspective, this is quite a lot of sucrose that is ingested.	This shows the linear relationship between maximum breath acetone and the sucrose dose.
The effect of 78g of sucrose on the dose/response of MCT on Ketones. The sucrose reduces ketone levels for all doses of MCT, but the effect is greater at higher MCT levels.	The effect of fasting on response to 30ml MCT. The dotted line and triangles show the ketone levels from fasting alone. The ketone levels in response to MCT are larger after fasting, and the study noted that a low carbohydrate response resulted in a larger ketone response than a mixed diet. (There was only one subject on a low carbohydrate diet, so no statistical inference can be drawn.)

A study showed that giving 40ml of MCT raised blood BOHB levels to 0.43-0.68 mmol/L^[17]. Another study showed that 1mg/Kg body weight of MCT raised blood ketone levels to 0.4 mmol after 30 minutes and 0.8 after 120 minutes, falling to 0.7 after 300 minutes^[28]:

The ketone levels after 1mg/Kg body weight. The units are in mg/dl, so divide by 10 to get the more usual mmol (both BOHB and AcAc have similar conversion ratios).

9.1 Calculating Blood Ketone Levels from Breath Acetone

To understand the above studies, we need to be able to estimate Blood Ketone Levels from Breath Acetone. In a study that looked at the correlation between breath acetone and blood ketone levels the results indicated the following relationships between breath acetone in nmol/L and blood ketone levels in mmol/L^[27].

• Acetoacetate (AcAc): Y = AX^B + C, where A = 3.4884, B = 0.0803, C = -4.6065.
• Hydroxybutyrate (BOHB): Y = AX^B + C, where A = 5.1365, B = 0.0864, C= -6.5048.
• Acetone: Y = AX^B + C, where A = 2.2177, B = 0.1900, C = -5.6040.

To convert from µg/100ml used above to nmol/L:

• 1 ug/100 ml is 0.001 mg/dL.
• 0.001 mg/dL is 0.000172 mmol/L.
• 0.000172 mmol/L is 172 nmoml/L.

Plugging this conversion into the above equations, we get:

10 MCT and Weight Loss

MCTs are sometimes recommended for weight loss. One study compared MCTs with Olive Oil and found a greater weight loss with MCTs^[29]. There is some evidence from an animal study that MCTs may be less palatable than other fats^[30]. However, an analysis of animal studies indicates that generally, replacing other fats with MCT does not reduce calorie intake^[31]. Based on my personal experiences with MCT, I would suspect that any weight loss benefit comes from the appetite reduction that comes from the associated Nausea.

11 MCT Safety

MCT is considered safe at 1mg/Kg of body weight, and MCT has been shown as effectively non-toxic in high dose (9-12g/Kg) animal studies^[32].

12 My Experiences with MCT

Below are my thoughts on MCT while on the Ketogenic Diet, with an update further down the page on using MCT as part of a normal diet.

• I've found that taking MCT on its own will often produce digestive problems, including nausea and apocalyptic diarrhea. Mixing MCT with other foods can reduce the problems, and I take MCT with cream or other foods.
• I found that MCT in larger doses (3+ tablespoons) can produce obvious thermogenesis, resulting in the perception that a cold room is actually overly warm. There is also a sensation of warmth radiating from my stomach, rather like I'd just consumed strong alcohol.
• There seem to be changes in mental functioning, especially with larger doses. MCT can alleviate some feelings of tiredness and improve mental acuity, but it can also result in an unpleasant feeling that is hard to describe. The sensation is a little like how I feel when a migraine is imminent.
• I've found that MCT taken during exercise seems to impair my running. I performed a simplistic experiment with MCT during a run to try to evaluate the effect.
  • At the time of the experiment I was adapted to the Ketogenic Diet, having blood ketones above 1.0 for the previous 10 days.
  • I started the run fasted, with my last dose of MCT at 2 PM the previous day.
  • For the first 8 miles, I felt really good, with my heart rate and breathing where I'd expect them to be.
  • At 8 miles I took 3 tbsp. of MCT with 2 tbsp. of Nutella. The Nutella was to prevent GI problems, as I've found that 2 tbsp. of MCT taken on its own can produce debilitating diarrhea. The Nutella contained 21g of sugar, but there is research that indicates that 50g of carbohydrate taken before or after a 20 Km/12.4 mile run at a fast (7:15 min/mile) will not impact ketosis^[33].
  • By mile 10 my breathing had become strained, and I had to slow up slightly to keep things under control. My heart rate was slightly higher, but not enough to explain the breathlessness. My breathing problem peaked at about mile 11, before gradually easing off, though it never returned to normal.
  • At mile 19 I stopped for a drink and my blood pressure dropped dramatically. Even crouched down with my head between my knees I was dizzy. After a few minutes things returned to some semblance of normality and I was eventually able to stand up and continued to run.
  • A few days later I repeated the test, but took 3 tbsp. of Macadamia Nut Oil with 2 tbsp. of Nutella at mile 8. My breathing remained normal and I had no other problems.

The comments above are from using MCT during my Ketogenic Experiment in 2013. In late 2015 I started to experiment again with MCT while losing weight on a relatively normal diet. During this time I was eating a high-fiber diet that was predominantly plant based. Over a period of a couple of months I gradually introduced MCT into my diet. Initially I had some minor nausea and digestive disturbances, but they settled down and by the end of the period I was able to consume several tablespoons of MCT without any issues. I would either mix the MCT with a high protein/high-fiber smoothie, or blend the MCT into a little milk and add a couple of shots of espresso. Adding 2 tablespoons of MCT to my coffee before running was possible without G.I. problems. I did notice that while running on a cold morning after taking the MCT I could feel the thermogenic effect. There was a sense of warmth spreading out from my midriff, rather like having drunk a short of strong alcohol. Unlike the mental effects I had when I was on the ketogenic diet, I had no issues this time around.

13 See Also

• The classifications and types of Low Carbohydrate Diet.
• An introduction to the Ketogenic Diet.
• My experiences with ultrarunning on the Ketogenic Diet
  • How the Ketogenic Diet can be used for the treatment and management of disease.
    • Using the Ketogenic Diets to mitigate and treat Epilepsy
    • How Ketogenic Diets might help with Cancer
    • A look at the possible mechanisms of action of the Ketogenic Diet
  • Health Risks of the Ketogenic Diet
    • Health Checks for the Ketogenic Diet
    • Supplements for the Ketogenic Diet
  • The time frame and changes that occur with Ketoadaptation
  • What are Ketones
    • How to measure Ketones
    • What ketone levels to aim for
  • The pros and cons of the Ketogenic Diet for athletes
    • The Science of Ketogenic Exercise
  • The Types of Ketogenic Diet
    • The "traditional" Ketogenic Diet based on the Ketogenic Ratio
      • The ways the Ketogenic Ratio can be calculated
        • The different definitions of Net Carbohydrates
    • Low Glycemic Index Treatment
    • MCT Diet
      • MCT
    • Modified Atkins Diet (M.A.D.)
• My Ketogenic Recipes
• Non-Ketogenic Low Carbohydrate Diets

14 References

1. ↑ Eric. Kossoff, Ketogenic diets : treatments for epilepsy and other disorders, date 2011, publisher Demos Health, location New York, isbn 1-936303-10-8, Kindle Offset 1809
2. ↑ First Author Ira Wolinsky, Second Author Judy A. Driskell, Nutritional Ergogenic Aids, date 25 June 2004, publisher Taylor & Francis, isbn 978-0-203-50770-4, pages 196–
3. ↑ ^{3.0 3.1 3.2} YM. Liu, HS. Wang, Medium-chain triglyceride ketogenic diet, an effective treatment for drug-resistant epilepsy and a comparison with other ketogenic diets., Biomed J, volume 36, issue 1, pages 9-15, doi 10.4103/2319-4170.107154, PMID 23515148
4. ↑ CG. Van Zyl, EV. Lambert, JA. Hawley, TD. Noakes, SC. Dennis, Effects of medium-chain triglyceride ingestion on fuel metabolism and cycling performance., J Appl Physiol (1985), volume 80, issue 6, pages 2217-25, Jun 1996, PMID 8806933
5. ↑ DJ. Angus, M. Hargreaves, J. Dancey, MA. Febbraio, Effect of carbohydrate or carbohydrate plus medium-chain triglyceride ingestion on cycling time trial performance., J Appl Physiol (1985), volume 88, issue 1, pages 113-9, Jan 2000, PMID 10642370
6. ↑ AE. Jeukendrup, JJ. Thielen, AJ. Wagenmakers, F. Brouns, WH. Saris, Effect of medium-chain triacylglycerol and carbohydrate ingestion during exercise on substrate utilization and subsequent cycling performance., Am J Clin Nutr, volume 67, issue 3, pages 397-404, Mar 1998, PMID 9497182
7. ↑ JH. Goedecke, VR. Clark, TD. Noakes, EV. Lambert, The effects of medium-chain triacylglycerol and carbohydrate ingestion on ultra-endurance exercise performance., Int J Sport Nutr Exerc Metab, volume 15, issue 1, pages 15-27, Feb 2005, PMID 15902986
8. ↑ JH. Goedecke, R. Elmer-English, SC. Dennis, I. Schloss, TD. Noakes, EV. Lambert, Effects of medium-chain triaclyglycerol ingested with carbohydrate on metabolism and exercise performance., Int J Sport Nutr, volume 9, issue 1, pages 35-47, Mar 1999, PMID 10036340
9. ↑ D. Massicotte, F. Péronnet, GR. Brisson, C. Hillaire-Marcel, Oxidation of exogenous medium-chain free fatty acids during prolonged exercise: comparison with glucose., J Appl Physiol (1985), volume 73, issue 4, pages 1334-9, Oct 1992, PMID 1447077
10. ↑ JF. Horowitz, R. Mora-Rodriguez, LO. Byerley, EF. Coyle, Preexercise medium-chain triglyceride ingestion does not alter muscle glycogen use during exercise., J Appl Physiol (1985), volume 88, issue 1, pages 219-25, Jan 2000, PMID 10642384
11. ↑ AE. Jeukendrup, WH. Saris, R. Van Diesen, F. Brouns, AJ. Wagenmakers, Effect of endogenous carbohydrate availability on oral medium-chain triglyceride oxidation during prolonged exercise., J Appl Physiol (1985), volume 80, issue 3, pages 949-54, Mar 1996, PMID 8964761
12. ↑ J. Ivy, D. Costill, W. Fink, E. Maglischo, Contribution of Medium and Long Chain Triglyceride Intake to Energy Metabolism During Prolonged Exercise, International Journal of Sports Medicine, volume 01, issue 01, 2008, pages 15–20, ISSN 0172-4622, doi 10.1055/s-2008-1034624
13. ↑ Vahur Ööpik, Saima Timpmann, Luule Medijainen, Harry Lemberg, Effects of daily medium-chain triglyceride ingestion on energy metabolism and endurance performance capacity in well-trained runners, Nutrition Research, volume 21, issue 8, 2001, pages 1125–1135, ISSN 02715317, doi 10.1016/S0271-5317(01)00319-0
14. ↑ J. Décombaz, MJ. Arnaud, H. Milon, H. Moesch, G. Philippossian, AL. Thélin, H. Howald, Energy metabolism of medium-chain triglycerides versus carbohydrates during exercise., Eur J Appl Physiol Occup Physiol, volume 52, issue 1, pages 9-14, 1983, PMID 6360681
15. ↑ Sabatin P, Portero GD, Bricout J, Guezennec CY. Metabolic and hormonal responses to lipid and carbohydrate diets during exercise in man. Med Sci Sports Exerc 1987;19:218-23
16. ↑ AE. Jeukendrup, WH. Saris, P. Schrauwen, F. Brouns, AJ. Wagenmakers, Metabolic availability of medium-chain triglycerides coingested with carbohydrates during prolonged exercise., J Appl Physiol (1985), volume 79, issue 3, pages 756-62, Sep 1995, PMID 8567514
17. ↑ ^{17.0 17.1} Mark A. Reger, Samuel T. Henderson, Cathy Hale, Brenna Cholerton, Laura D. Baker, G.S. Watson, Karen Hyde, Darla Chapman, Suzanne Craft, Effects of β-hydroxybutyrate on cognition in memory-impaired adults, Neurobiology of Aging, volume 25, issue 3, 2004, pages 311–314, ISSN 01974580, doi 10.1016/S0197-4580(03)00087-3
18. ↑ Yuanlong Pan, Brian Larson, Joseph A. Araujo, Winnie Lau, Christina de Rivera, Ruben Santana, Asa Gore, Norton W. Milgram, Dietary supplementation with medium-chain TAG has long-lasting cognition-enhancing effects in aged dogs, British Journal of Nutrition, volume 103, issue 12, 2010, pages 1746–1754, ISSN 0007-1145, doi 10.1017/S0007114510000097
19. ↑ Doctor says an oil lessened Alzheimer's effects on her husband, http://www.tampabay.com/news/aging/doctor-says-an-oil-lessened-alzheimers-effects-on-her-husband/879333, Accessed on 20 October 2013
20. ↑ ^{20.0 20.1} author Richard D. O'Brien, Fats and Oils: Formulating and Processing for Applications, Third Edition, date 12 December 2010, publisher Taylor & Francis, isbn 978-1-4200-6167-3, pages 49–
21. ↑ NDL/FNIC Food Composition Database Home Page, http://ndb.nal.usda.gov/, Accessed on 18 November 2013
22. ↑ A. Geliebter, N. Torbay, EF. Bracco, SA. Hashim, TB. Van Itallie, Overfeeding with medium-chain triglyceride diet results in diminished deposition of fat., Am J Clin Nutr, volume 37, issue 1, pages 1-4, Jan 1983, PMID 6849272
23. ↑ EA. Mascioli, S. Randall, KA. Porter, G. Kater, S. Lopes, VK. Babayan, GL. Blackburn, BR. Bistrian, Thermogenesis from intravenous medium-chain triglycerides., JPEN J Parenter Enteral Nutr, volume 15, issue 1, pages 27-31, PMID 1901104
24. ↑ ^{24.0 24.1} D.L. Ingle, A. Driedger, K.A. Traul, D.K. Nakhasi, Dietary Energy Value of Medium-chain Triglycerides, Journal of Food Science, volume 64, issue 6, 1999, pages 960–963, ISSN 0022-1147, doi 10.1111/j.1365-2621.1999.tb12259.x
25. ↑ http://www.sternchemie.de/englisch/b02a1_mct_oil_analytik.html, http://www.sternchemie.de/englisch/b02a1_mct_oil_analytik.html, Accessed on 2 December 2013
26. ↑ G. Freund, RL. Weinsier, Standardized ketosis in man following medium chain triglyceride ingestion., Metabolism, volume 15, issue 11, pages 980-91, Nov 1966, PMID 5922367
27. ↑ ^{27.0 27.1} K. Musa-Veloso, SS. Likhodii, E. Rarama, S. Benoit, YM. Liu, D. Chartrand, R. Curtis, L. Carmant, A. Lortie, Breath acetone predicts plasma ketone bodies in children with epilepsy on a ketogenic diet., Nutrition, volume 22, issue 1, pages 1-8, Jan 2006, doi 10.1016/j.nut.2005.04.008, PMID 16183255
28. ↑ FX. Pi-Sunyer, SA. Hashim, TB. Van Itallie, Insulon and ketone responses to ingestion of medium and long-chain triglycerides in man., Diabetes, volume 18, issue 2, pages 96-100, Feb 1969, PMID 5763665
29. ↑ MP. St-Onge, A. Bosarge, Weight-loss diet that includes consumption of medium-chain triacylglycerol oil leads to a greater rate of weight and fat mass loss than does olive oil., Am J Clin Nutr, volume 87, issue 3, pages 621-6, Mar 2008, PMID 18326600
30. ↑ NK. Edens, MI. Friedman, Response of normal and diabetic rats to increasing dietary medium-chain triglyceride content., J Nutr, volume 114, issue 3, pages 565-73, Mar 1984, PMID 6699737
31. ↑ AC. Bach, Y. Ingenbleek, A. Frey, The usefulness of dietary medium-chain triglycerides in body weight control: fact or fancy?, J Lipid Res, volume 37, issue 4, pages 708-26, Apr 1996, PMID 8732772
32. ↑ K.A Traul, A Driedger, D.L Ingle, D Nakhasi, Review of the toxicologic properties of medium-chain triglycerides, Food and Chemical Toxicology, volume 38, issue 1, 2000, pages 79–98, ISSN 02786915, doi 10.1016/S0278-6915(99)00106-4
33. ↑ JH. Koeslag, LI. Levinrad, JD. Lochner, AA. Sive, Post-exercise ketosis in post-prandial exercise: effect of glucose and alanine ingestion in humans., J Physiol, volume 358, pages 395-403, Jan 1985, PMID 3884775