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Medium-chain triglycerides (MCTs) in medical nutrition therapy - trumacro Nutrition

Medium-chain triglycerides (MCTs) in medical nutrition therapy

Medium-chain triglycerides (MCTs) are made up of a glycerol molecule attached to three fatty acid chains that range between six to 12 carbons (1).  

Historically, it has been recognized that MCTs are of clinical value in decreasing the steatorrhea associated with a number of malabsorptive disorders, including pancreatic insufficiency, extrahepatic biliary tract obstruction, post-gastrectomy steathorrhea, A-β-lipoproteinemia, intestinal lymphangiectasia, cystic fibrosis of the pancreas and massive small-bowel resection (1-4). 

Unlike other lipids, which require a complex digestive process, MCTs are more easily absorbed into the bloodstream from the gastrointestinal tract (1) and, as a result, MCTs convey unique benefits in the management of gastrointestinal disorders (1,3).  

Over the last decade, research has been building in support of medical use of MCTs in cognition, dementia and Alzheimer’s disease, partly due to the recognition that MCTs provide an alternate energy substrate for the brain that is neuroprotective (5). 

Dementia and Alzheimer’s disease 

Clinical studies 

In a 2019 clinical trial from Japan, researchers assessed the effects of an MCT-based ketogenic diet in 20 patients with mild-to-moderate Alzheimer’s disease (5). 

After eight weeks, patients showed significant improvements in the following parameters compared to baseline scores: immediate and delayed memory function; digit-symbol coding; and immediate logical memory. The researchers noted that these improvements represent positive effects on verbal memory and mental processing speed in Alzheimer’s disease (5). 

In 2018, a group of researchers set out to determine what effects MCT formulas would have in a group of patients with mild-to-moderate Alzheimer’s disease after one month (6). The results were that the brain ketone levels doubled, signifying that MCT supplementation “increased total brain energy metabolism.”  

In 2004, scientists gave 20 patients with Alzheimer’s disease or mild cognitive impairment (MCI) a beverage containing MCTs or a placebo (7).  

Significant increases in levels of the ketone body, beta hydroxybutyrate (BHB), were seen 90 minutes after treatment, when cognitive tests were administered.  

The authors found that MCT treatment improved performance on the Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-cog) in some of the patients. In addition, higher ketone values were linked to greater improvement in paragraph recall in all subjects (7).  

Experimental research 

In a 2008 animal study, researchers investigated the metabolic and inflammatory effects of MCTs on the brains of aged dogs (8).  

After receiving MCTs for two months, assays were conducted on the frontal, parietal and occipital lobes. The dogs which received MCTs, compared to aged-matched controls, exhibited “dramatically improved mitochondrial function,” an effect that was most prominent in the parietal lobe.  

In addition, levels of amyloid beta (Aβ or Abeta) were decreased. The authors concluded that short-term administration of MCTs improved energy metabolism and decreased amyloid plaque formation in this experimental group (8). 

Other conditions 

As noted, MCTs are known to help with a host of conditions (1-4), including, but not limited to, seizure control in Angelman syndrome (9). 

Weight loss and body composition are other areas in which evidence has been building. In a 2015 meta-analysis of thirteen randomized controlled trials comparing the effects of MCTs to those of long-chain triglycerides (LCTs), the authors note that MCTs show promise for reductions in body weight and composition without negatively impacting lipid profiles. 

Acute diarrhea is another indication, and is an extension of the benefits cited above. A trend toward weight gain was seen in a group of 17 children with acute diarrhea (10). 

Pain associated with chronic pancreatitis is another area where MCT therapy is showing some benefit. In 2003 study out of Harvard, researchers observed the effects of an enteral formulation containing MCTs for a 10-week period (11).  

References

  1. Shah ND and Limketkai BN. “The use of medium-chain triglycerides in gastrointestinal disorders.” Pract Gastroenterol. February 2017;Series 160:20-28.
  2. Greenberger NJ, et al. “Use of medium chain triglycerides in malabsorption.” Ann Intern Med. 1967;66(4):727-734.
  3. Bach AC and Babayan VK. “Medium-chain triglycerides: An update.” Am J Clin Nutr. 1982;36(5):950-962.
  4. Jarnum S and Jensen H. “Medium chain triglycerides (MCT) in the treatment of protein-losing enteropathy and malabsorption syndromes.” Scand J Gastroenterol. 1966;1(4):306-313.
  5. Ota M, et al. “Effects of a medium-chain triglyceride-based ketogenic formula on cognitive function in patients with mild-to-moderate Alzheimer’s disease.” Neurosci Lett. 2019;690:232-236.
  6. Croteau E, et al. “Ketogenic medium chain triglycerides increase brain energy metabolism in Alzheimer’s disease.” Alzheimers Dis. 2018;64(2):551-561.
  7. Reger MA, et al. “Effects of beta-hydroxybutyrate on cognition in memory-impaired adults.” Neurobiol Aging. 2004;25(3):311-4.
  8. Studzinski CM, et al. “Induction of ketosis may improve mitochondrial function and decrease steady-state amyloid-beta precursor protein (APP) levels in the aged dog.” Brain Res. 2008;1226:209-217.
  9. Grocott OR, et al. “Low glycemic index treatment for seizure control in Angelman syndrome: A case series from the Center for Dietary Therapy of Epilepsy at the Massachusetts General Hospital.” Epilepsy Behav. 2017;68:45-50.
  10. Tanchoco CC, et al. “Diet supplemented with MCT oil in the management of childhood diarrhea.” Asia Pac J Clin Nutr. 2007;16(2):286-292.
  11. Shea JC, et al. “An enteral therapy containing medium-chain triglycerides and hydrolyzed peptides reduces postprandial pain associated with chronic pancreatitis.” Pancreatology. 2003;3(1):36-40. 

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