Ought to we be involved about high-choline plant meals reminiscent of broccoli producing the identical poisonous TMAO that outcomes from consuming high-choline animal meals reminiscent of eggs?

Choline- and carnitine-rich meals—meat, eggs, and dairy—will be transformed by our intestine flora into trimethylamine, which in our livers is then become TMAO, a poisonous compound that will improve our threat of coronary heart failure, kidney failure, and atherosclerosis, or coronary heart assaults and strokes. The excellent news, although, is that this “opens up thrilling new dietary and interventional prospects” for prevention, as I talk about this in my video How to Reduce Your TMAO Levels.

Okay, so how can we do it? Properly, if our intestine micro organism can take meat, dairy, and eggs and switch them into TMAO, all now we have to do is…destroy our intestine flora! We may give individuals antibiotics to remove the manufacturing of TMAO. Nevertheless, that would additionally kill our good micro organism and “facilitate the emergence of antibiotic-resistant bacterial strains.”

What about probiotic dietary supplements? Possibly if we add good micro organism, they’ll crowd out those that take the meat, egg, and dairy compounds and switch them into the TMA that our liver turns into TMAO. However, that doesn’t work. Including good micro organism doesn’t appear to do away with the unhealthy. What if we added new micro organism that would someway siphon off the TMA made by the unhealthy micro organism? Properly, there’s a bacterium inside the heart of cows and sheep that turns trimethylamine into methane. May we use that bacterium to do away with among the trimethylamine from our intestine, like a cow fecal transplant? There’s an issue with that. If it didn’t take, you’d must preserve giving it to individuals: “Steady administrations could also be vital if topics don’t turn into colonized.” So, may the truth that Client Stories found fecal contamination in each pattern of beef it examined be a superb factor? No. Methane-producing micro organism could possibly eat up our TMAO, however, sadly, these micro organism could also be associated with quite a lot of ailments, from gum illness right down to colorectal most cancers, as you may see at 2:15 in my video.

If antibiotics and probiotics aren’t going to work to forestall intestine micro organism from taking meat, dairy, and eggs and turning them into the trimethylamine, which our liver makes TMAO out of, I assume now we have no alternative however to chop down on…our liver operate!

That was the billion-dollar reply to ldl cholesterol. The identical meals—meat, dairy, and eggs—increase our ldl cholesterol, however dietary change isn’t very worthwhile. So, the drug trade developed statin medicine that cripple the liver’s enzyme that makes ldl cholesterol. May “pharmacologic inhibition” of the enzymes in our liver that make TMAO “probably function a remedy for CVD [cardiovascular disease] threat discount”? Trimethylaminuria is a genetic situation during which this enzyme is naturally impaired, in which there’s a build-up of trimethylamine within the bloodstream. The issue is that trimethylamine is so smelly it makes you smell like “useless fish.” So, “given the identified opposed results…from victims of fish odor syndrome, the untoward odorous unwanted side effects of inhibiting this enzyme make it a much less engaging [drug] goal.”

Do now we have to decide on between smelling like useless fish or affected by coronary heart and kidney illness? If solely there have been another manner we may cease this course of from taking place. Properly, what do these with trimethylaminuria typically do to chop down trimethylamine ranges? They stop consuming animal merchandise.

A couple of third of those that complain of unhealthy physique odor regardless of good private hygiene check optimistic for the situation, however decreasing or eliminating meat, egg, and dairy consumption could be a actual lifesaver. However, given what we now learn about how poisonous the tip product TMAO will be for regular individuals, chopping down on animal merchandise could not simply save the social lives of individuals with a uncommon genetic dysfunction, however assist save everybody else’s precise lives.

The “easiest level of intervention” is to easily restrict the consumption of meals wealthy in choline and L-carnitine, which “will be an efficient technique to restrict circulating TMAO.” However, wait! We may all the time attempt to genetically engineer a bacterium that eats up trimethylamine, however “the only and most secure advice” could be to eat extra healthfully. You possibly can utterly remove carnitine from the weight loss program, since our physique makes all we’d like, however choline is a vital nutrient so we do want some. Fortunately, we will get all we’d like in fruits, greens, beans, and nuts. “Nevertheless extra choline, reminiscent of that present in eggs, could also be price avoiding.”

Want we worry about high-choline plant meals, like broccoli? Consumption of cruciferous greens is related to a considerably longer life and much less heart problems mortality, as you may see at 5:34 in my video. To see what was occurring, researchers took the vegetable highest in choline, brussels sprouts, and had individuals eat two cups a day for 3 weeks. What occurred? Their TMAO ranges truly went down. It seems that brussels sprouts seem to naturally downregulate that TMAO liver enzyme—not sufficient to make you smelly, however simply sufficient to drop TMAO.

And, individuals who eat utterly plant-based could not make any TMAO in any respect—even in case you strive. You can provide a vegan a steak, which incorporates each choline and carnitine, and there is not going to even be a bump in TMAO as a result of vegetarians and vegans have totally different intestine microbial communities. If we don’t eat steak, then we don’t foster the expansion of steak-eating micro organism in our intestine. So overlook the cow—how about getting a fecal transplant from a vegan? From a TMAO standpoint, we could not must eat like a vegan so long as we poop like one.


Are you able to sense my frustration as I learn paper after paper proposing these ridiculous (however worthwhile!) solutions when the secure, easy, side-effect-free answer was staring them within the face the entire time? It makes me consider so many parallels, not the least of that are:

For extra on TMAO, the “smoking gun” of diet-microbiome-disease interactions, see:

In well being,

Michael Greger, M.D.

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