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MCT
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{{DISPLAYTITLE:MCT - Medium Chain Triglyceridesand Epilepsy, Running and Weight Loss}}
Medium Chain Triglycerides (MCTs) are fats that are shorter in length than most normal dietary fats (Long Chain Triglycerides or LCTs). MCTs are found in coconut oil, palm kernel oil and butter, as well as being available in pure form.
* 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 be used in the dietary treatment of Epilepsy.
* MCT can produce nausea, vomiting, stomach cramps and diarrhea. Adaptation and mixing with other foods can reduce the problems.
* There are initial indications that MCT will [[Ketogenic Diet as a Treatment| reduce the symptoms of Alzheimer's and other memory problems]].
* 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"/>:
{| 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"/>.
