Medium chain triglycerides (MCTs) are ketogenic and might reduce adverse effects of keto-induction and improve time to ketosis and the tolerability of very low carbohydrate diets. This study investigates whether MCT supplementation improves time to nutritional ketosis (NK), mood, and symptoms of keto-induction. We compared changes in beta-hydroxybutyrate (BOHB), blood glucose, symptoms of keto-induction, and mood disturbance, in 28 healthy adults prescribed a ketogenic diet, randomised to receive either 30 ml of MCT, or sunflower oil as a control, three times per day, for 20 days. The primary outcome measured was the achievement of NK (≥0.5 mmol·L−1 BOHB). Participants also completed a daily Profile of Mood States and keto-induction symptom questionnaire. MCT resulted in higher BOHB at all time points and faster time to NK, a result that failed to reach significance. Symptoms of keto-induction resulted from both diets, with a greater magnitude in the control group, except for abdominal pain, which occurred with greater frequency and severity in the MCT-supplemented diet. There was a possibly beneficial effect on symptoms by MCT, but the effect on mood was unclear. Based on these results, MCTs increase BOHB compared with LCT and reduce symptoms of keto-induction. It is unclear whether MCTs significantly improve mood or time to NK. The trial was registered by the Australia New Zealand Clinical Trial Registry ACTRN12616001099415.

BackgroundAdaptation to a ketogenic diet (keto-induction) can cause unpleasant symptoms, and this can reduce tolerability of the diet. Several methods have been suggested as useful for encouraging entry into nutritional ketosis (NK) and reducing symptoms of keto-induction. This paper reviews the scientific literature on the effects of these methods on time-to-NK and on symptoms during the keto-induction phase.MethodsPubMed, Science Direct, CINAHL, MEDLINE, Alt Health Watch, Food Science Source and EBSCO Psychology and Behavioural Sciences Collection electronic databases were searched online. Various purported ketogenic supplements were searched along with the terms “ketogenic diet”, “ketogenic”, “ketosis” and ketonaemia (/ ketonemia). Additionally, author names and reference lists were used for further search of the selected papers for related references.ResultsEvidence, from one mouse study, suggests that leucine doesn’t significantly increase beta-hydroxybutyrate (BOHB) but the addition of leucine to a ketogenic diet in humans, while increasing the protein-to-fat ratio of the diet, doesn’t reduce ketosis. Animal studies indicate that the short chain fatty acids acetic acid and butyric acid, increase ketone body concentrations. However, only one study has been performed in humans. This demonstrated that butyric acid is more ketogenic than either leucine or an 8-chain monoglyceride. Medium-chain triglycerides (MCTs) increase BOHB in a linear, dose-dependent manner, and promote both ketonaemia and ketogenesis. Exogenous ketones promote ketonaemia but may inhibit ketogenesis.ConclusionsThere is a clear ketogenic effect of supplemental MCTs; however, it is unclear whether they independently improve time to NK and reduce symptoms of keto-induction. There is limited research on the potential for other supplements to improve time to NK and reduce symptoms of keto-induction. Few studies have specifically evaluated symptoms and adverse effects of a ketogenic diet during the induction phase. Those that have typically were not designed to evaluate these variables as primary outcomes, and thus, more research is required to elucidate the role that supplementation might play in encouraging ketogenesis, improve time to NK, and reduce symptoms associated with keto-induction.

Objective: Investigate the relationship between body mass index (BMI) and intake of sugars and fat in New Zealand adults and children. Design: Secondary analyses of National Nutrition Survey (1997) and Children's Nutrition Survey (2002) data for the New Zealand population. BMI calculated from height and weight; fat, sugars and sucrose (used as a surrogate for added sugars) intakes estimated from 24-hour diet recall. Ethnic-specific analyses of children's data. Relationships (using linear regression) between BMI and sugars/ sucrose intakes; per cent total energy from fat; mean total energy intake from sucrose. Subjects classified into diet-type groups by levels of intake of fat and sucrose; relative proportions of overweight/obese children in each group compared with that of normal weight subjects using design-adjusted x 2 tests. Setting: New Zealand homes and schools. Subjects: 4379 adults (151 years); 3049 children (5-14 years). Results: Sugars (but not sucrose) intake was significantly lower among obese compared to normal weight children. In adults and children, those with the lowest intake of sugars from foods were significantly more likely to be overweight/obese. Sucrose came predominantly from beverages; in children, 45% of this was from powdered drinks. Sucrose intake from sugary beverages was not related to BMI. Per cent total energy (%E) from sucrose was significantly inversely related to %E from fat among adults and children. Proportions of overweight/ obese adults or children in each diet-type group did not differ from that of normal weight individuals. Conclusions: Current sugars or sucrose intake is not associated with body weight status in the New Zealand population.

Objective To use the Analysis Grid for Environments Linked to Obesity (ANGELO) framework to determine the barriers and promoters of healthy eating and physical activity in children aged 5-12 years, as a basis for the development of a pilot community-based programme for preventing obesity in children (APPLE project: A Pilot Programme for Lifestyle and Exercise). Methods Semi-structured interviews were held with nine community stakeholders including doctors, school staff and food outlet operators. This information was used to develop a telephone-administered questionnaire to 101 parents of children in the intervention communities. Finally, structured interviews were undertaken with intervention school principals (n=4) regarding the school environment pertaining to physical activity and healthy eating. Results Major barriers to physical activity identified included lack of facilities, coaches and equipment. Work commitments prevented 40 per cent of parents being physically active with their children. Shared transport would increase opportunities for activity. Socio-cultural influences included family support for sport, lack of initiative to instigate activities and preference for more sedentary options; 70 per cent of parents thought their child preferred TV or computers over sport/games. Cost Health Education Journal 65 65 65 65 65(2) 2006 135-148 M Williden et alprevented one-third of children being involved in activity and 45 per cent of parents buying healthier foods. Political barriers to healthy eating included the absence of parental rules regarding purchasing less healthy food options, using treat foods to coerce children to behave and the lack of fruit and vegetable advertising. Over two-thirds of parents thought banning particular foods would have a positive effect on eating habits. One third of parents said their children didn't like healthy foods and 25 per cent thought it did not matter what their child ate as long as they were growing properly.Conclusions The ANGELO framework used in this assessment identified potential environmental barriers to healthy eating and physical activity in children and provides the basis for an obesity prevention programme in youngsters aged 5-12 years.

The impact that psychological distress, physical inactivity, and smoking have on productivity suggests that employers may benefit from contributing to health promotion within the workplace.