“How to ReduceYour TMAO Levels” Eating choline and carnitine-richfoods – meat, eggs, and dairy – can be converted by gut flora into trimethylamine, which can then be turned into TMAO, in our liver, a toxic compound which mayincrease our risk of heart failure, kidney failure, and atherosclerosis(heart attacks and strokes).
The good news is, though, that thisopens up exciting new nutritional and interventionalprospects for prevention.
OK, so how are wegoing to do it? If our gut bacteria can take meat, dairy, and eggs and turn them into TMAO, all we have to do isdestroy our gut flora.
We could give people antibiotics toeliminate the production of TMAO.
However, that could also kill ourgood bacteria and facilitate the emergence of antibiotic-resistant strains.
How about probioticsupplements? Maybe if we add good bacteria, itwill crowd out the ones that take the meat, egg, and dairy compoundsand turn them into the TMA which our liverturns into TMAO.
But, it doesn’t work.
Adding good bacteria doesn’tseem to get rid of the bad.
What if we added a new bacteriathat could somehow siphon off the TMA made bythe bad bacteria? Well, there’s a bacteria insidethe guts of cows and sheep that turns trimethylamineinto methane.
So, maybe we could use the bacteria to get rid of some of it from our gut, like a cow fecaltransplant.
The problem is, if it didn’t take, you’d have to keep giving it to people; so, maybe the fact that Consumer Reports found fecal contamination in every sample of beef theytested may be a good thing! No.
Methane-producing bacteriamay be able to eat up our TMAO, but unfortunately, these bacteria may be associated with a variety of diseases, from gum disease downto colorectal cancer.
So, if antibiotics and probiotics aren’tgoing to work to prevent gut bacteria from taking meat, dairy, and eggs andturning them into the trimethylamine which our liver makes TMAO out of, I guess we have no choice but to cut down on…our liver function! That was the billion dollaranswer to cholesterol.
These same foods raise our cholesterol, but dietary change isn’t very profitable.
So, the drug industrycame up with statin drugs, that cripple the liver'senzyme that makes cholesterol.
So, hey, pharmacologic inhibition of the enzymes in our liver that make TMAO could potentially serve as a therapy forcardiovascular disease risk reduction.
But, there’s a genetic condition inwhich this enzyme is naturally impaired, called trimethylaminuria, in which there is a build-up of trimethylamine in the bloodstream.
The problem is thattrimethylamine is so stinky, it makes you smelllike dead fish.
So, given the known adverse effectsfrom sufferers of this fish odor syndrome, the untoward odorous side effects makeit a less attractive drug target.
So, do we have to choosebetween smelling like dead fish or suffering from heartand kidney disease? If only there was some other way we couldsomehow stop this process from happening.
Well, what do those with trimethylaminuriaoften do to cut down trimethylamine levels? They stop eatinganimal products.
About a third of those whocomplain of really bad BO despite good personal hygienetest positive for the condition, but reducing or eliminating meat, egg, and dairy intake can be a real lifesaver.
But, given what we now know about how toxicthe end product TMAO can be for normal people, cutting down on animal products maynot just save the social lives of people with a raregenetic disorder, but help save everyoneelse’s actual lives.
The simplest point of intervention isto just limit the consumption of foods rich in cholineand L-carnitine, which can be an effective strategyto limit circulating TMAO.
But, wait, we could alwaystry to genetically engineer a bacteria that eats up trimethylamine, but the simplest, safest recommendation may just be toeat healthier.
You can completely eliminate carnitine fromthe diet, since our body makes all we need, but choline is anessential nutrient.
So, we need some, and we can get all we needin fruits, vegetables, beans, and nuts.
However, excess choline, such as thatfound in eggs, may be worth avoiding.
Need we worry about high-cholineplant foods, like broccoli? Cruciferous vegetable consumption isassociated with a significantly longer life, less cardiovasculardisease mortality.
To see what was going on, researcherstook the vegetable highest in choline, Brussels sprouts, and had peopleeat 2 cups a day for three weeks, and their TMAO levelsactually went down.
It turns out that Brussels sprouts appearto downregulate that TMAO liver enzyme naturally—not enough to make youstinky but just enough to drop TMAO.
And, people who eat completely plant-based may not make any TMAO at all.
Even if you try, you can give a vegan a steak, which contains choline and carnitine, and not even abump in TMAO, since vegetarians and vegans havedifferent gut microbial communities.
If we don’t eat steak, then we don’t fosterthe growth of steak-eating bacteria in our gut.
So, hey, forget the cow, how aboutgetting a fecal transplant from a vegan? From a TMAO standpoint, maybe wedon’t have to eat like a vegan as long as wepoop like one.