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Alternative Medicine Review
Volume 7, Number 5
Medium Chain Triglycerides
In chronically ill patients receiving totalparenteral nutrition, preparations containing 50percent of fat calories from MCTs led to asignificantly lower production of tumor necrosisfactor-alpha (TNF
) compared to a solution with 100percent LCTs.
is a cytokine thought to beresponsible for at least some symptoms of cachexia.MCTs have been used as part of a ketoge-nic diet to treat children with intractable seizures andcancer. The ketogenic diet varies, but generally con-tains 60 percent of calories from MCT oil, 20 per-cent from protein, 10 percent from carbohydrate, and10 percent from other dietary fats. Although somepreliminary data are available showing reduced sugarmetabolism at tumor sites,
use of ketogenic diets totreat active cancers remains unproven. A small studyshowed an enteral formula containing MCTs and hy-drolyzed casein protein led to better weight mainte-nance during radiation therapy than an ad libitumdiet.
Weight Loss Programs
In a randomized, crossover trial, 12 non-obese women fed a diet providing 80 percent of fat calories as MCTs (40% of total calories fromfat) exhibited a greater rate of oxidation of long-chain saturated fats for energy.
Another studydemonstrated an increased metabolic rate in re-sponse to substitution of just 20 percent of fat calo-ries with MCTs.
Obese women fed an 800 kcal/ day diet with 24 percent of calories from MCTshad no more weight loss than women eating a simi-lar diet without MCTs.
While some authors havetheorized a role for MCTs in weight control,
thisrole has yet to be fully defined.
It has been theorized that MCTs improveenergy utilization during exercise, but this has notbeen conclusively demonstrated in clinical trials.One study found similar exercise performanceamong subjects fed 400 kcal as MCTs, LCTs, orcarbohydrates.
Subjects used MCTs as an energysource more efficiently than LCTs, but lessefficiently than carbohydrates. Another clinicaltrial found cyclists ingesting a five-percent MCTsolution actually had decreased exerciseperformance compared to those taking acarbohydrate solution or placebo.
This decreasein exercise performance was thought to be due togastrointestinal upset. When MCTs were givenconcurrently with carbohydrate, no negative effecton performance was noted.
In the inpatient setting, an experimentaldiet containing 78 percent of fat calories as MCTs(31% of total energy intake) increased glucosemetabolism in patients with type 2 diabetes mel-litus.
In five outpatients with type 2 diabetes, anexperimental diet containing 18 percent of calo-ries from MCTs led to a slight reduction in post-prandial blood sugar and no effect on fasting bloodsugar.
The role of MCTs in the management of diabetes remains to be decided.
Side Effects and Toxicity
Due to its unique absorption characteris-tics, MCTs tend to be well tolerated, even in indi-viduals with severe malabsorption. While fat mal-absorption symptoms are generally fewer withMCTs than with LCTs, some steatorrhea canoccur.
Mild gastrointestinal upset has beenreported in trials using high doses of MCTs.
MCTs significantly raised serum choles-terol in subjects with prior mild hypercholester-olemia.
In another study, MCT administrationled to an increase in serum lipids compared to cornoil, but a decrease in serum lipids when comparedto butter.
MCTs significantly increased serumtriglycerides and decreased HDL cholesterol com-pared to LCTs in one study,
and significantlylowered plasma triglycerides versus LCTs inanother study.
MCT administrationhas been associated with a slight increase inserum insulin.
Appropriate doses of MCTs vary withcondition. Studies involving MCTs have typicallyused 15-30 mL of MCTs per day in children, and50-100 mL per day in adults. Higher doses maybe required in patients with severe cachexia.