Almost all heart attacks and strokes start out with the same process. A localized area of inflammation develops in an artery. This damages the inner lining of the artery, called the endothelium. When the endothelium is damaged it can sometimes act as a focus for millions of microscopic platelets to clump together and form a blood clot. When the blood clot forms, it can block an artery leading to the death of any tissue that relies on that artery for oxygen.
We’ve already discussed in a past article how the gut bacteria can create trimethylamine (TMA) out of carnitine and choline in food. The liver converts this to the toxic metabolite trimethylamine oxide (TMAO). TMAO has been shown to be a cause of the actual blood clots that create heart attacks and strokes.
How this works was shown in a recent study published by Dr. Hazen and his colleagues at the Cleveland Clinic. People with higher blood levels of TMAO had much higher risks of heart attack and stroke, which we already knew. But they went on to place TMAO in suspensions that contained human platelets undergoing tests of clotting.
The presence of TMAO in samples tested for clotting in different circumstances markedly increased the speed at which those clots formed. The amount of total clotting was tested in conditions where the blood was flowing and where it was not with the same results.
Here is the mechanism. When platelets are exposed to TMAO, it makes the platelets react more quickly by changing how rapidly and completely they release calcium, which creates the clotting effect.
TMAO was the main problem. They gave some mice TMAO and they all clotted quickly. Then they gave some mice the food precursors to TMAO, but gave antibiotics that killed the bacteria so TMAO levels didn’t rise and those mice clotted normally. Interestingly, the worst combination was when they gave TMAO and antibiotics.
What does this mean?
We know that eggs, meat and dairy products contain precursors that your body turns into TMAO. We know that the process is started by bacteria in your gut. We now know TMAO is a major risk factor for heart attack and stroke, and additionally, we know one of the mechanisms: Platelets clot more quickly and thoroughly in the presence of TMAO.
Our office can order a blood test for you to find out your own TMAO level, and then we can work with you to get your level down if it is high. Let us know if you are interested.