Medium chain triacylglycerols (MCTs) are a unique class of lipids that contain fatty acids of primarily eight and ten carbons in chain length. Since they first became commercially available in 1955, MCTs have found an increasing number of uses because of their unique properties. Historically, they have been used in the treatment of patients with various fat malabsorption syndromes, surgical patients, cancer patients, and preterm infants. With the filing of a generally recognized as safe (GRAS) petition for medium chain triacylglycerols, they are increasingly gaining the interest of food formulators because of their unique metabolic and physical properties. This paper gives an overview of the manufacture of medium chain triacylglycerols, their nutritional benefits and their use in various food applications. MCT derivatives are also discussed.