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MCT
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{{DISPLAYTITLE:MCT - Medium Chain Triglyceridesand Epilepsy, Running and Weight Loss}}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 (MCTs) are fats , 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 [[Ketogenic Diet as a Treatment| reduce the symptoms of Alzheimer's and other memory problems]].
* MCT produces [[Ketones]] even without being part of a [[Low Carbohydrate Diets| Low Carbohydrate Diet]].
** Ketone levels are higher when on 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. * There are initial indications that and the MCTs should be taking in an MCT will reduce the symptoms of Alzheimer's and other memory problemsShake.
* MCT does not improve exercise performance.
=MCT and the Ketogenic Diet=
Because MCT will increase [[Ketones|Ketone Levels]] without needing [[Low Carbohydrate Diets| Carbohydrate restriction]], they are often used for [[Ketogenic Diets for Epilepsy| 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<ref name="Kossoff-2011-1809"/>. 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.
=MCT Cost=
MCT is expensive. I've used pure MCT products like [http://www.amazon.com/gp/product/B000GK11HK Premium MCT Gold] and [http://www.amazon.com/gp/product/B0019LWIOU 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 [http://www.amazon.com/gp/product/B001EO5Q64 Nutiva Organic Extra Virgin Coconut Oil] are about $0.50/oz, which works out around the same price. (Note that products like The best option if you are prepared to buy in bulk is from [http://www.amazonbulknaturaloils.com/Twinlab-Fuel-Orange-Fluid-Ouncehttp:/dp/B001G7R6IU TwinLab Mct Fuel] contain only about 50% MCTwww.)=MCT and Ketone Levels=A 1969 study looked at how ketone levels changed with MCT<ref name="Freund-1966"/>bulknaturaloils. 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 com] that from another study<ref name="Musa-Veloso-2006"sells [http:/>, Acetone at 1.0 µg/100ml breath might indicate blood ketones of BOHB 1www.5 mmol/L and AcAc of 0bulknaturaloils.7 mmolcom/L, 5.0 µgProducts/100ml might be BOHB 2.7 mmol/L and AcAc of 1.4 mmol/L. See below for details.){| class="wikitable" |15778- valign="top"|[[File:Freundbulk-1966mct-SingleDose.jpg|none|thumb|500px|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.]]|[[File:Freundmedium-1966chain-DoseResponsetriglycerides.jpg|none|thumb|500px|The effects of different doses of aspx 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 Oil 60/40] for larger doses.]]|- valign="top"|[[File:Freund-1966-Sucrose.jpg|none|thumb|500px|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.]]|[[File:Freund-1966-SucroseDoseResponse.jpg|none|thumb|500px|This shows the linear relationship between maximum breath acetone and the sucrose dose.]]|- valign="top"|[[File:Freund-1966-MCTSucroseDoseResponse.jpg|none|thumb|500px|The effect of 78g of sucrose on the dose$25/response of MCT on Ketones. The sucrose reduces ketone levels for all doses of MCT, but the effect is greater at higher MCT levels.]]|[[File:Freund-1966-Fasting.jpg|none|thumb|500px|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. Gallon (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 mmol19/L<ref name="RegerHenderson2004"/>oz). Another study showed (Note 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<ref name="Pi-Sunyer-1969"/>:products like [[Filehttp:MCTKetones1969.jpg|none|thumb|500px|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)www.]]==Calculating Blood Ketone Levels from Breath Acetone==A study looked at the correlation between breath acetone and blood ketone levels<ref name="Musa-Veloso-2006"/>amazon. The results indicated the following relationships between breath acetone in nmolcom/L and blood ketone levels in mmol/L.* Acetoacetate (AcAc): Y = AX<sup>B</sup> + C, where A = 3.4884, B = 0.0803, C = Twinlab-Fuel-4.6065.* Hydroxybutyrate (BOHB): Y = AX<sup>B</sup> + C, where A = 5.1365, B = 0.0864, C= Orange-6.5048. * Acetone: Y = AX<sup>B</sup> + C, where A = 2.2177, B = 0.1900, C = Fluid-5.6040.To convert from µgOunce/100ml used above to nmoldp/L:* 1 ug/100 ml is 0B001G7R6IU TwinLab Mct Fuel] contain only about 50% MCT.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:{| class="wikitable"! ug/100 ml! mg/dL:! mmol/L:! nmoml/L! BOHB! AcAc! Acetone! Total|-| 1.0| 0.001| 0.000172| 172| 1.5| 0.7| 0.3| 2.5|-| 2.0| 0.002| 0.000344| 344| 2.0| 1.0| 1.1| 4.1|-| 3.0| 0.003| 0.000516| 516| 2.3| 1.2| 1.7| 5.1|-| 4.0| 0.004| 0.000688| 688| 2.5| 1.3| 2.1| 5.9|-| 5.0| 0.005| 0.00086| 860| 2.7| 1.4| 2.4| 6.5|})
=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<ref name="WolinskyDriskell2004"/>:
* '''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.
=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 [http://www.amazon.com/s/ref=cm_cr_pr_pdt_bl_sr?ie=UTF8&field-keywords=Polycose polycose]), and protein powder<ref name="Liu-2012"/>. For the [[MCT Diet]], a shake containing the daily dose of MCT is taking over 6 meals<ref name="Liu-2012"/>. The dose of MCT start off at 1/3<sup>rd</sup> the full dose, building up slowly based on digestive tolerance<ref name="Liu-2012"/>. An example is 108g MCT, 375g skim milk, plus 13g Canola oil.
=MCT and Athletic Performance=
The available evidence suggests that MCT most likely hinders athletic performance, probably because of digestive discomfort.
==Available Research==
The table below summarizes the studies on the impact of MCT on exercise.
{| class="wikitable"
! Study
! Subjects
==Sources of MCT==
The composition of common sources of MCTs is shown below:
{| class="wikitable"
!
! colspan="2"colspan="2"|
Coconut Oil<ref name="O'Brien2010"/>
! colspan="2"colspan="2"|
Palm Kernel Oil<ref name="O'Brien2010"/>
! Butter<ref name="usda"/>
=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<ref name="Geliebter-1983"/>. 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)<ref name="Mascioli-1991"/>. 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<ref name="IngleDriedger1999"/>. However, if thermogenesis is taken into account, a value of 6.72 Calories/gram would be more appropriate<ref name="IngleDriedger1999"/>. 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<ref name="density"/>, 15ml of MCT would be 95 Calories assuming 6.72 Calories/gram rather than 118 Calories assuming 8.3 Calories/gram.
=MCT and Ketone Levels=
A 1969 study looked at how ketone levels changed with MCT<ref name="Freund-1966"/>. 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<ref name="Musa-Veloso-2006"/>, 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.)
{| class="wikitable"
|- valign="top"
|[[File:Freund-1966-SingleDose.jpg|none|thumb|500px|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.]]
|[[File:Freund-1966-DoseResponse.jpg|none|thumb|500px|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.]]
|- valign="top"
|[[File:Freund-1966-Sucrose.jpg|none|thumb|500px|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.]]
|[[File:Freund-1966-SucroseDoseResponse.jpg|none|thumb|500px|This shows the linear relationship between maximum breath acetone and the sucrose dose.]]
|- valign="top"
|[[File:Freund-1966-MCTSucroseDoseResponse.jpg|none|thumb|500px|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.]]
|[[File:Freund-1966-Fasting.jpg|none|thumb|500px|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<ref name="RegerHenderson2004"/>. 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<ref name="Pi-Sunyer-1969"/>:
[[File:MCTKetones1969.jpg|none|thumb|500px|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).]]
==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<ref name="Musa-Veloso-2006"/>.
* Acetoacetate (AcAc): Y = AX<sup>B</sup> + C, where A = 3.4884, B = 0.0803, C = -4.6065.
* Hydroxybutyrate (BOHB): Y = AX<sup>B</sup> + C, where A = 5.1365, B = 0.0864, C= -6.5048.
* Acetone: Y = AX<sup>B</sup> + 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:
{| class="wikitable"
! ug/100 ml
! mg/dL:
! mmol/L:
! nmoml/L
! BOHB
! AcAc
! Acetone
! Total
|-
| 1.0
| 0.001
| 0.000172
| 172
| 1.5
| 0.7
| 0.3
| 2.5
|-
| 2.0
| 0.002
| 0.000344
| 344
| 2.0
| 1.0
| 1.1
| 4.1
|-
| 3.0
| 0.003
| 0.000516
| 516
| 2.3
| 1.2
| 1.7
| 5.1
|-
| 4.0
| 0.004
| 0.000688
| 688
| 2.5
| 1.3
| 2.1
| 5.9
|-
| 5.0
| 0.005
| 0.00086
| 860
| 2.7
| 1.4
| 2.4
| 6.5
|}
=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<ref name="St-Onge-2008"/>. There is some evidence from an animal study that MCTs may be less palatable than other fats<ref name="Edens-1984"/>. However, an analysis of animal studies indicates that generally, replacing other fats with MCT does not reduce calorie intake<ref name="Bach-1996"/>. 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[[Nausea]].
=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<ref name="TraulDriedger2000"/>.
=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 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.
=See Also=
{{KetoSeeAlsoKetoList}}
=References=
<references>
<ref name="RegerHenderson2004">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 [http://www.worldcat.org/issn/01974580 01974580], doi [http://dx.doi.org/10.1016/S0197-4580(03)00087-3 10.1016/S0197-4580(03)00087-3]</ref>
<ref name="PanLarson2010">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 [http://www.worldcat.org/issn/0007-1145 0007-1145], doi [http://dx.doi.org/10.1017/S0007114510000097 10.1017/S0007114510000097]</ref>
<ref name="WolinskyDriskell2004">First Author Ira Wolinsky !!author1!!, Second Author Judy A. Driskell !!author2!!, Nutritional Ergogenic Aids, date 25 June 2004, publisher Taylor & Francis, isbn 978-0-203-50770-4, pages 196–</ref><ref name="O'Brien2010">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–</ref>
<ref name="usda">NDL/FNIC Food Composition Database Home Page, http://ndb.nal.usda.gov/, Accessed on 18 November 2013</ref>
<ref name="Geliebter-1983"> 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 [http://www.ncbi.nlm.nih.gov/pubmed/6849272 6849272]</ref>
<ref name="Van Zyl-1996"> 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 [http://www.ncbi.nlm.nih.gov/pubmed/8806933 8806933]</ref>
<ref name="Koeslag-1985">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 [http://www.ncbi.nlm.nih.gov/pubmed/3884775 3884775]</ref>
<ref name="Liu-2012">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 [http://dx.doi.org/10.4103/2319-4170.107154 10.4103/2319-4170.107154], PMID [http://www.ncbi.nlm.nih.gov/pubmed/23515148 23515148]</ref>
<ref name="Kossoff-2011-1809">Eric. Kossoff, [http://www.amazon.com/Ketogenic-Diets-Eric-H-Kossoff/dp/1936303108 Ketogenic diets : treatments for epilepsy and other disorders], date 2011, publisher Demos Health, location New York, isbn 1-936303-10-8, Kindle Offset 1809</ref>
</references>
