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

Cliff J D C Harvey,Micalla Williden,Joseph A Mcquillan,Grant M Schofield

doi:10.1155/2018/2630565

Cliff J D C Harvey, Micalla Williden + Show 2 more

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https://doi.org/10.1155/2018/2630565

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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.

Highlights

Very-low-carbohydrate ketogenic diets (VLCKDs) appear to offer specific benefits for health conditions ranging from neurological disorders, cancer, and obesity, diabetes, and other metabolic conditions [1,2,3,4,5,6,7,8,9,10,11]
Ketone bodies are utilised by tissue as a source of energy, with acetoacetate, the primary ketone body, and BOHB, not technically a ketone body, functions as the primary fuel during ketosis resulting in two molecules of acetyl-CoA which enter the Krebs cycle
We proposed this threshold for nutritional ketosis (NK) (≥0.5 mmol·L−1) based on the level of BOHB observed in those following a VLCKD[14] and as used as a cutoff point for ketosis by Guerci and colleagues [15]

Summary

Introduction

Very-low-carbohydrate ketogenic diets (VLCKDs) appear to offer specific benefits for health conditions ranging from neurological disorders, cancer, and obesity, diabetes, and other metabolic conditions [1,2,3,4,5,6,7,8,9,10,11]. A restriction of carbohydrate, either by fasting or by restricting dietary carbohydrate, results in reduced insulin levels, thereby reducing lipogenesis, fat accumulation, and glycogen reserves. Us, when glycogen reserves become insufficient to supply the glucose requirement of the central nervous system (CNS), and for fat oxidation, an alternative fuel is required. Acetoacetate accumulates and is converted into acetone and beta-hydroxybutyrate (BOHB), leading to the presence of these ketones in the blood and urine (ketonaemia and ketonuria, resp.) and in the breath. Blood glucose (BG) levels stay within normal physiological limits due to the creation of glucose from glucogenic amino acids and via the liberation of glycerol during fatty acid oxidation

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