TMAO – The Heart of the Matter

When you eat foods high in carnitine, choline or phosphatidylcholine (eggs, cheese, red meat, fish and chicken), and you have gut bacteria adapted to dealing with them, the bacteria turn them into TMA (trimethylamine). This chemical, TMA, makes you smell like rotting fish if it hangs around, so your liver gets rid of the smelly substance by turning it into TMAO (trimethylamine oxide). Unfortunately, TMAO is seriously bad news.

It promotes the development of plaques in the heart and blood clots. It worsens heart failure. It has even been shown in a recent study to predict death accurately over a few weeks, a few months or a few years.

“Although nutrition has always been linked to outcomes of cardiovascular patients, the pivotal role of the gut microbiome has only recently been recognized in this context. Hence, we have sought to assess the impact of the gut microbiome dependent metabolite, TMAO, on cardiovascular outcomes in patients with ACS [Acute Coronary Syndrome].”

This quote is from a study in the European Heart Journal. It looked at two populations, one Swiss and one in Cleveland, Ohio. The Ohio population fared far worse. Out of 530 eligible patients, the ones with TMAO levels over 4.8 had double the death rate over the next seven years. Out of 237 patients originally in this group, only 141 were still alive at the end of the seven years.

It’s important to understand that this is a better predictor of heart risk than cholesterol or any other established risk factor.

The blood test for TMAO is now readily available and isn’t particularly expensive. So I would strongly recommend that patients with high heart disease risk, blood clots or heart disease get tested and then make the changes necessary to get their level as low as possible.

Unfortunately, those changes mean largely abandoning the foods that contain the carnitine, choline and phosphatidylcholine. The low-fat, lean, nonfat or other versions of these foods still contain the negative nutrients.

The choice is yours, but when a high level predicts a risk of death of nearly 50% over seven years in patients in their sixties, this is nothing to play around with.

Of course the levels of carnitine, choline and phosphatidylcholine are almost zero in healthy fresh fruits, green and yellow vegetables like peppers, summer squashes and carrots and starchy vegetables like potatoes, sweet potatoes, corn, peas, beans, lentils and rice.

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