The Effect of Medium Chain Triglycerides on Time to Nutritional Ketosis and Symptoms of Keto-Induction in Healthy Adults: A Randomised Controlled Clinical Trial

Abstract

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.

Ketosis After Intake of Coconut Oil and Caprylic Acid—With and Without Glucose: A Cross-Over Study in Healthy Older Adults

“…Ketosis may ideally be described as a continuous variable, but certain cut-off points may be useful in clinical or scientific settings. BHB ≥0.5 mmol/L, measured by capillary finger pricks, has been used as a cut-off for ketosis clinically (23) and as a research outcome (5,24). As previously reported (21), exploratory analyses on our data revealed that a cut-off at 0.5 for capillary blood corresponded to 0.3 in venous blood (the outcome of the current article).…”

Consumer Reports of “Keto Flu” Associated With the Ketogenic Diet

“…Reported timing of symptoms was typically within several days of starting KD, peaked in the first week and dwindling after 4 weeks. The range of symptoms reported in online forums compares with Harvey's RCT of KD with and without dietary supplementation with medium-chain triglycerides (MCT) in healthy adults (N = 28), examining the effect of MCT on the incidence and duration of keto-induction (23). The authors used a 5-point Likert scale to assess the occurrence of symptoms/effects of KD in a period of 20 days.…”

“…Side effects were associated with higher levels of ketosis (9). In adults, two reviews (21,22) and two empirical studies (14,23) have noted short term adverse effects of KD including gastrointestinal, muscular, and nervous system symptoms.…”

Changes of Plasma Fatty Acids in Four Lipid Classes to Understand Energy Metabolism at Different Levels of Non-Esterified Fatty Acid (NEFA) in Dairy Cows

“…The divergence of our results from the data reported in the literature, could be explained by the different type of absorption that exists between medium hydrocarbon chain fatty acids (MCFAs) and LCFAs. MCFAs do not require the action of bile salts nor the absorption mediated by micelles and chylomicrons contrary to what occurs for LCFA absorption [ 59 ]. The increase in SFA, consisting of medium hydrocarbon chain, could derive from the absorption without bile salts which decreases in conditions of liver lipidosis [ 15 ].…”