The Ketogenic Effect of Medium-Chain Triacylglycerides

Abstract

Medium-chain triacylglycerides (MCTs) are dietary supplements that can induce ketosis without the need for a traditional ketogenic diet or prolonged fasting. They have the potential to marginally delay the progression of neurodegenerative diseases, such as Alzheimer's disease. However, there have been inconsistencies in reports of the MCT dose–response relationship, which may be due to differences in MCT composition, participant characteristics, and other factors that can influence ketone generation. To resolve these discrepancies, we reviewed studies that investigated the ketogenic effect of MCTs in healthy adults. Aside from the treatment dose, other factors that can influence the ketogenic response, such as accompanying meals, fasting duration, and caffeine intake, were assessed. Based on the available literature, four practical recommendations are made to optimize the ketogenic effect of MCTs and reduce unwanted side effects (primarily gastrointestinal discomfort and diarrhea). First, the starting dose should be either 5 g of octanoic acid [caprylic acid (C8); a component of MCTs] or 5 g of a combination of C8 and decanoic or capric acid (C10; another component of MCTs), and the dose should be progressively increased to 15–20 g of C8. Second, MCTs should be consumed after an overnight fast, without an accompanying meal if tolerable, or with a low-carbohydrate meal. Third, the addition of caffeine may slightly increase the ketogenic response. Fourth, emulsifying the MCTs might increase their ketogenic effect and alleviate side effects.

Medium-Chain Triglycerides (MCTs) for the Symptomatic Treatment of Dementia-Related Diseases: A Systematic Review

“…While a linear dose-response relationship was initially suggested [ 68 ], other studies in the low-dose range (10–20 g) failed to find such a relationship [ 69 ]. Although a 20 g dose of MCTs has a greater ketogenic effect than 10 g, it does not necessarily double plasma ketones [ 70 ]. The circumstances of consumption are also important, as the ketogenic effect varies when MCTs are taken with or without a meal [ 71 ].…”

Alternative Substrates in the Critically Ill Subject (ASICS): Safety, Feasibility, Tolerability and Metabolic Profiling of a Novel Ketogenic Feed

“…We had not pre-specified the definition of diarrhoea, and several such definitions exist. Diarrhoea is common in critically ill patients 22 , and it is not clear if the high medium chain triglyceride load led to an increased incidence although diarrhoea is a well-known consequence of enteral feeding when there is a high proportion of medium chain triglycerides 48 . Future trials should pre-specify such definitions for monitoring purposes.…”

A Comparison of the Impact of Restrictive Diets on the Gastrointestinal Tract of Mice

“…Interestingly, ketone bodies signal to stem cells, altering differentiation and regeneration [ 49 ]. Whereas medium-chain triglycerides, known for their ketogenic properties [ 50 ], are also applied to increase villi length and, therefore, enhance nutrient absorption and body weight gain [ 51 ].…”