Medium-chain triglycerides (MCTs) are lipid molecules, which have a good reputation as they assist with weight loss. They are different as they are more readily absorbed and oxidised. Current research also shows that it plays a role in the management of several gastrointestinal disorders. In this article, its potential role in the treatment of gastrointestinal disorders would be discussed.
How are they different from LCTs?
The fatty acid groups of MCTs include caproic acid, caprylic acid, capric acid, and lauric acid.
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Characteristics |
Medium Chain Triglycerides |
Long Chain Triglycerides |
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Properties |
Water-soluble |
Lipid soluble |
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Lower smoking point |
Higher smoking point |
|
|
Structure |
6-12 hydrocarbons, all saturated fatty acids |
13 to 21 hydrocarbons (long chain). |
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Caloric Value |
8.3 Calories per gm |
9.2 calories per gm |
|
Sources |
MCTs are extracted from coconut oil and palm kernel oil, as they also contain LCTs |
Fish oil Avocados, nuts, seeds, peanut, soybean oil. |
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Digestion/ Absorption |
Doesn’t stimulate CCK (cholecystokinin) hormone responsible for the release of bile from gallbladder for emulsification of fat. |
It stimulates CCK, responsible for the release of bile from gallbladder for emulsification of fat. |
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Passive Diffusion - Directly absorbed into portal circulation bound to albumin. |
Need to be incorporated into micelles, then into chylomicrons for entry into the lymphatic system. |
|
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Do not require carnitine for transport into the mitochondria. |
Does require carnitine for transport into the mitochondria. |
|
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More rapid, simple and efficient metabolism. |
Complex and less efficient metabolism comparatively. |
|
|
Storage |
Adipose tissues (less) |
Adipose Tissues (more) |
Why are they preferred in Gastrointestinal Disorders?
They are unique as they help in digestion, absorption and oxidation required for the management of gastrointestinal disorders.
Since they do not require bile or pancreatic enzymes, it makes them important to be used when there are fat malabsorption and steatorrhea from diseases like bile insufficiency. For example Short Bowel syndrome, MCTs can be efficiently absorbed with minimum need for prior digestion.
Chyle is a fluid consisting primarily of LCT containing chylomicrons, lymphatic fluid, it originates in the small bowel where chylomicrons are formed and absorbed in the lymphatic system. Any injury or obstruction in the lymphatic system results in a chyle leakage. The clinical nutritional management requires the consumption of fat-restricted, enteral nutritional formulation with MCTs and protein.
Suggested guidelines for using MCTs
- Do not exceed 4-7 tablespoons per day (60-100 ml/day) for gastrointestinal tolerance.
- Divide the daily dosage equally between all meals.
- If eating 3 meals a day, this can be 1-2 tablespoons per meal.
- Do not heat MCT oil over 150°C (302°F); otherwise, it will affect the flavour of the food.
- Mix MCT oil into a variety of foods and beverages (e.g. hot cereals, soups, sauces, broth, smoothies, fruit/vegetable juices, hot chocolate, coffee, tea, etc.).
- If administered through a feeding tube in patients, one tablespoon of MCT oil can be given with a water flush of 30 ml before and after its administration.
- MCT supplementation should never be the sole source of fat > 3 weeks.
- After 3 weeks, high EFA containing vegetable oil should be included in the diet to reduce risk of EFA deficiency. Why? It is because MCTs do not contain EFAs.
To conclude, studies are limited but MCTs are being used as nutritional intervention strategies when it comes to gastrointestinal disorders, especially related to malabsorption of fat as they can be metabolised easily.
REFERENCES
- Gropper, S. A. S., & Smith, J. L. (2013). Advanced nutrition and human metabolism. Sixth edition. Belmont, CA: Wadsworth/Cengage Learning.
- Symersky, T., Vu, M. K., Frölich, M., Biemond, I., & Masclee, A. A. (2002). The effect of equicaloric medium-chain and long-chain triglycerides on pancreas enzyme secretion. Clinical physiology and functional imaging, 22(5), 307–311. https://doi.org/10.1046/j.1475-097x.2002.00435.x
- Shah, Neha D., Limketkai, Berkeley N., (2017).The Use of Medium-Chain Triglycerides in Gastrointestinal Disorders.PRACTICAL GASTROENTEROLOGY