Trimethylamine N-oxide (TMAO)-- An Underrated Yet Important Cardiovascular Lab MarkerRonald Grisanti D.C., D.A.B.C.O., DACBN, MS, CFMP

More than 30% (1.38 billion) of the global adult population suffer from hypertension and the leading cause of death worldwide.

It is of the utmost importance to have a better understanding of the underlying mechanisms causing hypertension and other cardiovascular events.

Although there are numerous factors contributing to hypertension and other cardiovascular issues, one under-rated novel contributor is the incidence of elevated TMAO.

A study published in the journal Hypertension looked at the presence of trimethylamine-n-oxide (TMAO), a byproduct from digesting certain meat-based proteins in 100 adults and 22 young adults

Trimethylamine N-oxide (TMAO) is derived from foods rich in choline, phosphatidylcholine, and betaine (e.g., red meat, eggs, milk, etc.)

The researchers found that meat-eaters' TMAO levels rose significantly with age, as did signs of health-threatening tissue and blood vessel damage. This was independent of the damage excess saturated fat in meats can do to your health.

Another study in the Journal of the American Heart Association found that the risk of major cardiovascular events in people with elevated TMAO was 60% greater than for those with normal TMAO.

Additional studies have demonstrated that TMAO is important for the development and progression of cardiovascular diseases (e.g., hypertension, atherosclerosis, coronary artery disease, and heart failure)

It is commonly agreed that TMAO acts as an independent risk factor and a prognostic index for patients with cardiovascular disease and been found to induce aortic stiffening and increases systolic blood pressure.

Studies provide evidence of a causal relationship of TMAO and elevated blood pressure and it is suggested that mediating the production of TMAO would be beneficial for lowering blood pressure.

What also concerned me was evidence that elevated TMAO compromises the release of nitric oxide release in endothelial cells thereby interfering with the vasodilatory mechanism which can contribute to hypertension.

Compliments from the Journal of Hypertension-July 2021

How to Lower TMAO and Reduce Your Cardiovascular Risk Factors

To reduce TMAO levels, you need to minimize and in some people actually eliminate red and processed meats from your diet. In addition, limit lean, skinless poultry to one 3- to 6-ounce serving. Additional recommendations to lower TMAO include diets high in soluble fiber as does supplementation with specific probiotics

Instead, eat fish such as salmon and sea trout, which are loaded with heart-healthy omega-3 fats, twice weekly.

Focus on a Plant Based-Mediterranean diet

Therefore, such dietary-based strategies may help to suppress TMAO production thereby mitigating aortic stiffening and increases in systolic BP.

To be quite honest there are some that will state the studies may indeed be empirical studies and not interventional and data simply does not hold up.

Quite the contrary from my below experience and the experience with several patients.

Dr. Grisanti Personal Comments: 

Back in early 2022 I decided to give the carnivore diet (heavy meat based diet) a three month try and was shocked and disappointed with the fact that almost all of the cardiovascular markers (LDL, Lipoprotein Fractionation (LDL Particle Numbers), ApoB and Lp-PLA2 Activity) all were off the charts.:( What was even worse was the fact that my blood pressure stayed significantly elevated. When I changed to a strict Plant Based Diet ALL of my cardiovascular markers and Blood Pressure (now stays around 118/65)) markedly improved.

Click Here to See My TMAO numbers over the course of my experience from eating a strict carnivore diet to a plant based diet.

https://www.functionalmedicineuniversity.com/TMAO4.pdf

My conclusive thoughts are a plant based diet with some emphasis on the Mediterranean diet should take precedence when looking to help patients with cardiovascular issues.

Codes for ordering TMAO:

TMAO (Trimethylamine N-Oxide) Code from Labcorp--123413
TMAO (Trimethylamine N-Oxide) Code from Quest-94154

** Always consult with a physician or healthcare practitioner with significant integrative or functional medicine training.

You can find a qualified and certified functional medicine practitioner by going to: www.FunctionalMedicineDoctors.com

References

https://pubmed.ncbi.nlm.nih.gov/34387163/
https://www.functionalmedicineuniversity.com/TMAO.pdf
https://www.frontiersin.org/articles/10.3389/fcvm.2022.922441/full
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354484/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8408632/
https://pubmed.ncbi.nlm.nih.gov/35409341/
https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.16895
https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-022-02282-5