What you don't know can harm you.

You may not have heard about trimethylamine-N-oxide (TMAO), but this is an interesting substance, especially since research indicates that it is causing atherosclerosis.

TMAO increases the accumulation of cholesterol in macrophages (a type of white blood cell) also causing foam cell formation (Wang Z, et al. 2011). This results in increased inflammation and oxidation of cholesterol which is deposited in atherosclerotic plaque (Wang Z, et al. 2011).

Where do we find TMAO?

TMAO is produced by the bacterial flora in the gut by metabolizing trimethylamine (TMA) found in dietary phosphatidylcholine, choline and L-carnitine (Brown JM, Hazen SL, 2014). Sources of phosphatidylcholine, choline and L-carnitine are especially meats, egg yolk and high fat dairy products.

The following is a study published in the New England Journal of Medicine, one of the most prestigious medical journals in the world.

When 4007 patients having coronary angiography were followed for 3 years, increased levels of TMAO were associated with an increased risk of major cardiovascular events (Tang WH, et al. 2013). Angiography is a medical imaging technique used to visualize the inside, or lumen of blood vessels.

What can you do?

A plant based diet will not produce high levels of TMAO because it contains less phosphatidylcholine, choline and L-carnitine , but also because of another interesting reason.

When omnivores and vegans were given the same amount of carnitine it was found that vegans had a markedly reduced capacity to produce TMAO because their bacterial flora was very different (Koeth RA, et al. 2013).

By eating a plant based diet you can avoid high levels of TMAO.

Learn to Eat:

Recommendations that work. This is not a regular diet program.

Brown JM¹, Hazen SL. Metaorganismal nutrient metabolism as a basis of cardiovascular disease. Curr Opin Lipidol. 2014 Feb;25(1):48-53. doi: 10.1097/MOL.0000000000000036.

Koeth RA¹, Wang Z, Levison BS, Buffa JA, Org E, Sheehy BT, Britt EB, Fu X, Wu Y, Li L, Smith JD, DiDonato JA, Chen J, Li H, Wu GD, Lewis JD, Warrier M, Brown JM, Krauss RM, Tang WH, Bushman FD, Lusis AJ, Hazen SL. Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med. 2013 May;19(5):576-85. doi: 10.1038/nm.3145. Epub 2013 Apr 7.

Tang WH¹, Wang Z, Levison BS, Koeth RA, Britt EB, Fu X, Wu Y, Hazen SL. Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. N Engl J Med. 2013 Apr 25;368(17):1575-84. doi: 10.1056/NEJMoa1109400.

Wang Z¹, Klipfell E, Bennett BJ, Koeth R, Levison BS, Dugar B, Feldstein AE, Britt EB, Fu X, Chung YM, Wu Y, Schauer P, Smith JD, Allayee H, Tang WH, DiDonato JA, Lusis AJ, Hazen SL. Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease. Nature. 2011 Apr 7;472(7341):57-63. doi: 10.1038/nature09922.