TMAO and Its Link To Diet

The food that you choose to consume is entirely a personal preference. For the most part, I don’t promote a strict paleo, keto, mediterranean, low fat, low fodmap, high carb, low carb, plant based, fruitarian, raw, vegetarian, vegan etc way of eating (WOE).

I will rarely suggest that a patient follows a special WOE unless it is absolutely necessary. Under such circumstances, it generally involves a temporary or more permanent elimination of foods that are contributing to, or exacerbating a medical condition.

In my opinion, it is more about what makes you, as an individual, feel nourished (body, mind and soul), mentally alert and vibrant.

What I do encourage is that the food is predominantly fresh and unprocessed. I am also a fan of local organic produce and lots of variety. Eating seasonally is wonderful. If you do consume meat, I do suggest grass fed or organic wherever possible.


So this leads me to an interesting and perhaps controversial article that was recently published in the European Heart Journal (Dec 10, 2018).

The article reported that “chronic dietary red meat increased systemic TMAO levels through:

(i) enhanced dietary precursors; 
(ii) increased microbial TMA/TMAO production from carnitine, but not choline; and 
(iii) reduced renal TMAO excretion.

Discontinuation of dietary red meat reduced plasma TMAO within 4 weeks.”


So you may wonder what this all means and how it may apply to you.

The Cleveland Clinic summarises it well:

“Here’s how it works: When people ingest certain nutrients, such as choline (abundant in red meat, egg yolks, and dairy products) and L-carnitine (found in red meat as well as some energy drinks and supplements), the gut bacteria that break it down produce a compound called trimethylamine (TMA). The liver then converts TMA into the compound, trimethylene N-oxide (TMAO).

The trouble with TMAO is that data shows that high levels contribute to a heightened risk for clot-related events such as heart attack and stroke – even after researchers take into account the presence of conventional risk factors and markers of inflammation that might skew the results.

In their most recent analysis, scientists showed that high blood levels of TMAO were associated with higher rates of premature death in a group of 2235 patients with stable coronary artery disease. Those found to have higher blood levels of TMAO had a four-fold greater risk of dying from any cause over the subsequent five years.

The implications are intriguing. Taken together, the new studies suggest that positively altering the gut microbiota may help to reduce damage to blood vessels, resulting in a stronger cardiovascular system, and they point to targets for potential new heart disease therapies.

The insights also underscore the potential power of TMAO testing, which can help patients determine if their gut microbiome is contributing to their risk for heart disease and whether they might benefit from limiting foods that contain the building blocks of TMAO. TMAO tests are currently only available through the Cleveland Heartlab.”

Despite the results of the above publication, it is always important to do your own research and find the food that is YOUR medicine. Moderation also seems to be key.

Wishing you wellness,

Mary Clark…/10.1093/eurheartj/ehy799/5232723……/the-gut-the-heart-and-t…/