Effect of Butter & MCT Oil on Lipoproteins - A RCT

Effects of Daily Butter & Medium-Chain Triglyceride Oil on Lipoproteins When Added to Baseline Diet a Randomized Controlled Trial

Determine the effects on lipoprotein profiles of high dose concentrated dietary SFA (saturated fatty acids) (from MCT (medium-chain triglyceride) oil + butter) in combination added to coffee. The study will be conducted as a RCT in healthy adults without cardiometabolic disease or conditions that influence lipoprotein metabolism or other specific dietary recommendations.

Research Design A prospective randomized controlled interventional study Methodology /Technical Approach A total of up to 60 subjects will be recruited to allow for completion of the study by a minimum of 17 subjects per arm. Subjects will be randomized to one of two groups in a 1:1 ratio. Recruited subjects will be adult coffee drinkers between the ages of 18-45 without hyperlipidemia and without criteria for diabetes or pre-diabetes. Subjects will have baseline weight, waist circumference (WC), and blood-pressure (BP) measurements obtained. Subjects will have baseline fasting lipids,, CMP,HbA1c,TSH,and hsCRP. The subjects will be stratified by gender and randomized to receive one of two dietary regimens: 1) coffee (< 50 kcal of added creamer/sweetener) or 2) coffee with butter + medium-chain triglyceride (MCT) oil combination (2 tbsp. MCT containing 230kcal and 28gm fat+ 2 tbsp butter containing 200kcal and 22gm fat). The drink will be consumed daily over a 4 week period. Dietary history will be evaluated by via the ASA24website (http://appliedresearch.cancer.gov/asa24/). At 6 and 12 weeks post-consent, baseline labs will be repeated. The primary outcome is change in apolipoprotein B between groups. Secondary outcomes include changes in lipids, WC, BP, HbA1c, and FBG. Exploratory analysis will include changes in dietary macronutrient load and subgroup analysis of effects related to dietary patterns. Primary objective: 1. Evaluate clinically and statistically significant changes of apoB number in healthy adults who consume coffee with butter and MCT oil. Secondary objectives: 1. Evaluating change in: non-HDL-c LDL-c triglycerides BP waist circumference FBG HbA1c Exploratory objective: 1. Change in macronutrient profiles of dietary patterns. Our null hypothesis is that the addition of butter and medium-chain triglyceride oil at proposed doses has no clinically significant effects on atherogenic lipoproteins, namely apo lipoprotein B particles (apoB).

This group will continue to drink their normal daily coffee with < 50kcal of creamer and/or sweetener.

2 tablespoons medium-chain triglyceride oil + 2 tablespoons butter added to 2-4 cups of coffee similar to their usual intake prior to 1200 daily over a 4 week period after a 2 week run-in phase during which the doses of butter and MCT oil will be titrated up (1 Tbsp. of each butter + MCT x 5 days, 2 Tbsp. butter + 1 Tbsp. MCT x 5 days, then 2 Tbsp. of each x 4 days) followed by 6 weeks of washout without treatment.

Evaluate clinically and statistically significant changes of apoB number in healthy adults who consume coffee with butter and MCT oil.

Inclusion Criteria: DoD healthcare beneficiaries willing to drink 2 to 4 cups of coffee daily between the ages of 18 to 45 serum LDL-c < 160, non-HDL-c < 190 apoB < 120 Exclusion Criteria: BMI > 30kg/m2 or < 20kg/m2 or waist circumference > 102cm (males) or 88cm (females) Triglycerides > 150 Hypertension defined as SBP > 150, DBP > 90 or on treatment for high blood pressure Chronic liver disease defined by any clinical or a history of serum AST or ALT > 3 times ULN Kidney disease defined as a GFR <90 ml/min or history of nephritic syndrome Impaired glucose metabolism defined as HbA1c > 5.6, FBG > 99, or 2-hour OGTT > 139 Any known malignancy Known malabsorption disorder to include inflammatory bowel disease, celiac disease, cystic fibrosis, history of gastric bypass Hypothyroidism per lab evaluation at baseline Pregnancy Polycystic Ovary Syndrome or irregular menstrual periods Subjects taking certain medications such as glucocorticoids, immunosuppressants (cyclosporine, sirolimus, etc.), tamoxifen, androgens, antipsychotics, hydrochlorothiazide, retinoids, beta-blockers, statins, bile acid sequestrants, niacin, fibrates, ezetimibe, high dose fish oil (>1gm/day epa + dha), or any other supplement or pharmacologic agent known to alter lipoproteins a. If on hormonal contraceptives, lipid panel must be stable over the past 12-24 months Cushing's syndrome per medical history or clinical suspicion HIV per medical history Chronic Inflammatory Disorders such as, but not limited to, SLE, RA, IBD per medical history History of tobacco use within the previous 12 months to include cigarettes, e-cigarettes, chewing tobacco, cigars, and pipes. History of marijuana use within the previous 12 months Active intentional weight loss of over 5% in the past 3 months