Supplement Review: Medium-Chain Triglycerides (MCTs) and MCT Oil

Medium-chain triglycerides (MCTs) are exactly what you would think; triglycerides (i.e. fat molecules) with medium chain lengths of molecules. Some triglycerides have long chains, containing 13+ carbon atoms, whereas others have short chains, containing 5 or fewer carbon atoms. MCTs are right in the middle, and contain 6-12 carbon atoms in their chains [1-4].

What Are MCTs?

Medium-chain triglycerides (MCTs) often come in the form of oil, likely because MCTs are liquid at room temperature [5, 6]. MCTs are nothing revolutionary or novel to the diet; they’ve been used in enteral and parenteral diets for more than 50 years [4, 7].

In layman’s terms, medium-chain triglycerides (MCTs) are fats with an unusual chemical structure which allows them to be digested more easily. In contrast to customary long-chain triglycerides (LCTs), MCTs are soluble in water, have a relatively lower melting point and, thus, are liquid at room temperature and can be digested more rapidly [4, 8, 9].

Note: You may have noticed that a few words are highlighted in blue; abbreviations for these words are used extensively in this article.

LCTs take a long time for the body to digest and absorb, but MCTs are metabolized at a much faster rate. While LCTs are broken down in the intestine and remade into a special form that can be transported in the blood [10], MCTs are absorbed intact and delivered straight to the liver without being broken down, where they can be immediately used for energy [10]. At its core, the rapid rate of MCT digestion and absorption more closely resembles those of carbohydrate, as opposed to other common fats (i.e. triglycerides/LCTs). Also, unlike long-chain triglycerides (LCTs), medium-chain triglycerides (MCTs) are not directly deposited in adipose tissue or muscle [8]. This feature has fueled the hypothesis that MCTs may reduce fat deposition, and it is often claimed that MCTs can, therefore, reduce fat mass (i.e. improve body composition). In this article, I discuss the impact that medium-chain triglycerides (MCTs) have on athletic performance, body composition, and health. But first, I want to briefly point out an interesting “MCT” called Lauric acid.

MCT1

Lauric Acid: MCT or LCT?

Lauric acid (C12) is an interesting fatty acid because the way it’s metabolized in the body resembles both a long-chain and medium-chain triglyceride [11, 12]. MCTs are 95% absorbed through the portal route, or delivered straight to the liver, whereas only <5% of palmitic acid (C16), the most common LCT in many foods, is absorbed that way [11, 13]. Lauric acid falls right in the middle, with 25-30% of dietary lauric acid being sent directly to the liver for potential use as immediate energy [11, 12, 14]. Whether the 12-carbon lauric acid is considered a medium-chain or long-chain fatty acid is still up for debate [4, 9].

Common Sources of MCTs

The most well-known source of medium-chain triglycerides (MCTs) is coconut oil, which contains the highest MCT content (per 100g) of all common food products. MCTs are present in 15%, 7.9%, 6.8%, 6.9%, 6.6% and 7.3% (of total fatty acid content) in coconut oil, palm kernel oil, butter, milk, yogurt and cheese, respectively [15-17]. Because 1) MCT content makes up 50% of its entire composition [18], and 2) MCTs have been manufactured through the hydrolysis of coconut oil or palm kernel oil since the 1950s [8], coconut oil is commonly used in frying and baking and is included as part of a variety of food products, including breads and salad dressings [4, 19]. Coconut oil and MCT are terms that are sometimes used interchangeably. It’s extremely important to note that there are a few significant differences between medium-chain triglycerides (MCTs) and coconut oil [20, 21], thus, the two should not be considered to be the same [4, 20].

MCT

Impact of MCTS on Body Composition and Satiety

Medium-chain triacylglycerol (MCT) oil has been reported to promote satiety [22-27] and improve weight loss and body composition outcomes [28-34].

In overweight children, MCT oil consumption resulted in lower leptin and triglyceride concentrations, compared with corn oil [25]. In overweight adults, MCT oil consumption resulted in lower rises in triglycerides and glucose, higher rises in hormones that indicate fullness, peptide YY and leptin, compared LCT consumption [24]. Following consumption, these adults ate an ad libitum meal, and lower caloric intake at this meal was observed with MCT oil compared with LCT [24]. A similar response was observed in healthy participants [22]. Subjects who consumed MCT oil had lower caloric intakes during the following ad libitum meal, compared with subjects who consumed either coconut oil or vegetable oil, instead [22]. The MCT group also experienced less perceived hunger and greater perceived fullness [22].

A group of healthy adults who substituted MCTs for LCTs each morning at breakfast for 12 weeks experienced greater reductions in body weight and body fat, compared with healthy adults who did not make the change [29]. Similarly, overweight adults who consumed MCT oil for 16 weeks experienced greater reductions in body mass and fat mass, compared with their counterparts who consumed olive oil (LCTs), instead [27].

Although there is strong evidence suggesting beneficial effects on weight loss and body composition by replacing long-chain triglyceride (LCT) sources with medium-chain triglyceride (MCT) sources [28-34], more research is warranted prior to coming to that conclusion. Two recent meta-analyses (Mumme et al, 2015; Bueno et al, 2015) reported statistically significant body composition benefits for replacing dietary LCTs with MCTs [33, 34], but one of the analyses suggested that the quality of evidence was low-quality [34]. Since the authors reported that the available evidence isn’t of the highest quality, they suggest that the results of their analysis should be interpreted cautiously [34]. Another meta-analysis (Rego Costa et al., 2012) reported inconclusive results regarding satiety and body composition parameters [35].

Impact of MCTs on Athletic Performance

The prolonged absorption period and oxidation time for long-chain triglycerides (LCTs) make them a poor source of readily available energy during exercise [36]. Since medium-chain triglycerides (MCTs) are digested at a much more rapid rate [37], it has been suggested that MCTs may be able to improve athletic performance during longer exercise bouts by providing an alternative energy source during exercise, and potentially sparing muscle glycogen stores [38-41].

Although this sounds good in theory, most studies have not found evidence that supports this purported glycogen-sparing effect of MCT provision [40-43]. Consequently, most studies have observed no direct performance benefit with MCT supplementation [42-44], even when glycogen stores were depleted prior to exercise [20]. Much of the research has even reported observations of performance decrements with MCT supplementation [38, 40, 45-47]. These performance decrements are thought to be at least partially due to gastrointestinal (GI) disturbances that are often associated with larger doses (approximately 85g/h) of MCT [48]. Extensive reviews by Clegg [48] and Jeukendrup et al. [3] provide a lot of detail regarding the research on MCT consumption and exercise performance; in general, MCT consumption has minimal effects on plasma fatty acid availability and has no effect on muscle glycogen breakdown, ultimately resulting in no endurance performance enhancement[3].

Health and Disease

Some people struggle to gain weight because they’re unable to comfortably metabolize long-chain triglycerides (LCTs) and, thus, can’t consume fats that are most commonly found in foods. Since medium-chain triglycerides (MCTs) have similar caloric density compared with LCTs (8.3 kcal/g and 9.2 kcal/g, respectively), MCTs may be a suitable alternative. For example, those that suffer from HIV or AIDS may, oftentimes, have difficulty digesting fat and struggle to gain weight; MCTs provide a comparable energy-dense source of nutrients and may be easier to digest than LCTs, in this cohort [49, 50]. Although research suggests that MCTs can promote weight loss and favorable body composition outcomes, there have also been reports of increased hormone concentrations associated with hunger (i.e. ghrelin, neuropeptide Y) in healthy adults [51] and individuals with anorexia nervosa [52].

People with pancreatic insufficiency lack the appropriate enzymes to metabolize LCTs. Although MCTs may serve as a viable, energy-dense alternative, consuming digestive enzymes instead of using MCTs may work better and is a more cost-effective approach [53]. In any case, it appears that those with pancreatic insufficiency require enzyme supplements in order to digest MCTs [53-56]. In recent guidelines set forth for those with chronic pancreatitis (i.e. pancreatic insufficiency), MCTs are not indicated [56, 57].

There have also been reports that coconut oil, which contains a high concentration of MCTs, may improve cardiovascular disease (CVD) risk factors [58, 59]. While 72% of the American general public believes that coconut oil is “healthy”, only 37% of nutrition experts do [60]. The total body of research errs on the side of the nutritionists.

In a recent review, Eyres et al. (2016) concluded that the totality of evidence suggests that replacing coconut oil with cis unsaturated fats reduces CVD risk [61], not the other way around. Despite the popular claims purporting that coconut oil is a healthy oil in terms of reducing the risk of CVD, research suggests otherwise. Avoidance of coconut oil was recently advised by the American Heart Association (AHA) and others, as well. A recent statement released by the AHA said, “because coconut oil increases LDL cholesterol, a cause of CVD, and has no known offsetting favorable effects, we advise against the use of coconut oil,” [62]. This sentiment was echoed by Freeman et al. (2017) in an analysis of recent nutritional controversies [63].

MCT3

As I touched on in a previous section, it’s important to note that coconut oil and MCTs are different [20, 21], despite coconut oil containing a high concentration of MCTs [64]. MCTs are not coconut oil, and coconut oil is not composed entirely of MCTs, and thus, the two should not be referred to interchangeably [4, 20].

Summary

It appears that medium-chain triglyceride (MCT) consumption can promote favorable body composition changes. Although more research is warranted, it appears that weight loss, fat loss, and improved satiety are all supported when MCTs as substituted for LCTs… and ONLY when MCTs are replacing LCTs. In other words, simply adding MCTs to the diet will likely result in weight gain, as opposed to weight loss.

Despite MCTs having been postulated to enhance athletic performance by sparing muscle glycogen stores during exercise, this notion is unsupported. In fact, most studies report no performance benefits or performance decrements with MCT supplementation. Dietary fats have high caloric density and, since MCTs are no exception, MCT supplementation could potentially help individuals who lack the appropriate enzymes to digest fat, such as those with pancreatic insufficiency. MCT supplementation may also help those who have difficulty digesting fat and would like to gain weight, such as those with HIV or AIDs. However, research suggests that using digestive enzymes is a more cost-effective approach for these populations.

Coconut oil, the most popular coconut product which is being widely used for frying and baking and as a component of bread spreads and salad dressings, contains a high proportion of MCTs. Although it’s a common belief that coconut oil can help reduce risk for cardiovascular disease (CVD), research suggests that this is not the case. Recently, the American Heart Association (and others) have advised against the use of coconut oil for attempting to reduce CVD risk factors.

To sum up, MCTs are neither good, nor bad for athletic performance and/or health. Replacing LCTs with MCTs may improve satiety and aid in weight loss, but simply adding MCTs into the diet is likely to bring you further away from your goals, as opposed to bringing you closer to them.


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