A molecule that is produced by the liver in response to the intake of certain dietary components, particularly choline and L-carnitine, which are found in high amounts in animal products such as red meat, poultry and fish is TMAO. This molecule is also produced by gut bacteria when they break down these dietary components. TMAO is produced when the liver converts trimethylamine (TMA).

   Researchers at the Cleveland Clinic determined that the more TMAO people had in their blood, the greater the odds they had of heart disease and the worse their heart disease was. Four thousand people were followed for three years. Those with the highest TMAO levels went on to have significantly more heart attacks, strokes or even death. Those found to have higher levels of TMAO had a four-fold greater risk of dying from any cause over the subsequent five years.

   The new studies suggest that positively altering the gut microbiota may help to reduce damage to blood vessels, resulting in a stronger cardiovascular system. They point to targets for potential new heart disease therapies. Artery hardening, failing kidneys and cancer have all been shown to increase with higher TMAO levels

    Carnitine and choline are two components known to facilitate production of TMAO. Carnitine is concentrated in red meat, certain energy drinks and carnitine supplements. Major dietary sources of choline are eggs, milk and meat, including liver, poultry, shellfish and fish. Choline is also present in lecithin supplements.

   A group of researchers based in Poland explored the TMAO levels in rats that had heart disease because of bad genes and not a bad diet. After looking at everything, they found that something was wrong in the gut of the animals. This research suggests the TMAO problem has little to do with diet and everything to do with being tired and hungry. The tired and hungry starts with the heart and leads to a tired and hungry colon, which then leaks.

   It’s important to get the blood flowing. There are lots of ways to do this, moving more will help, so will dietary changes. But the right changes need to be made.

   TMAO is a toxic compound that may increase our risk of heart failure, kidney failure and atherosclerosis, but might there be nutritional or interventional prospects for prevention?

   Antibiotics could be given to eliminate the production of TMAO, but that could also kill our good bacteria and foster the emergence of antibiotic-resistant bacterial strains. Probiotic supplements would add good bacteria and perhaps they would crowd out the bad bacteria? That doesn’t work as adding good bacteria doesn’t seem to get rid of the bad.

   Then there is methane-producing bacteria that may be able to eat up our TMAO. Unfortunately, these bacteria may be associated with a variety of diseases, from gum disease to colorectal cancer.

   Big Pharma used the billion-dollar strategy to lower cholesterol by developing statin drugs that cripple the enzyme in our liver that makes cholesterol. Could that be used to combat TMAO? There is a problem. The TMA is so stinky that it makes you smell like dead fish. So, given the known adverse effects from sufferers of fish odor syndrome, the untoward odorous side effects of inhibiting this enzyme make it less attractive.

   We could stop eating animal products, which is what those with trimethylaminuria often do to lower their TMA levels. About a third of those who complain of bad body odor despite good personal hygiene test positive for the condition, but reducing or eliminating meat, egg and dairy intake can be a real lifesaver. Given what we know about how toxic TMAO can be, cutting down on animal products may not just save the social lives of people with a rare genetic disorder, but could help save everyone else’s actual lives.

   Simply limiting the consumption of foods rich in choline and carnitine may effectively limit the amount of TMAO circulating in our body. The best recommendation is to eat more healthily. Our body makes all the carnitine we need, so we can completely eliminate it from our diet. Choline is an essential nutrient, so we need some. We don’t need to get it from eggs. We can get all we need from fruit, vegetables, beans and nuts. Consumption of cruciferous vegetables is associated with a significantly longer life and less cardiovascular disease mortality.

   Vegetarians and vegans have different gut microbial communities. If we don’t eat steak, then we don’t foster growth of steak-eating bacteria in our gut. How about getting a fecal transplant from a vegan? From a TMAO standpoint, we may not have to eat like a vegan as long as we poop like one.

   Focus on minimizing the consumption of full-fat dairy products, including whole milk, egg yolk, cream cheese and butter; both processed and unprocessed meat (beef, pork, lamb and veal), as well as nutritional supplements and energy drinks containing choline, phosphatidylcholine and or L-carnitine. Consuming a diverse diet rich in plant foods and fiber may be helpful. Regular exercise has been shown to have a number of health benefits, including reducing TMAO levels,