In 1970, the unheralded Swedish band Festfolket (“Party People” in English) made their tv debut on an odd selection present known as “Five Minute Saloon.” The quartet — Agnetha Fältskog, Björn Ulvaeus, Benny Andersson, and Anni-Frid Lyngstad — sang a frankly cringe-worthy rendition of “California Here We Come” (you possibly can watch it right here) whereas decked out in ridiculous Western put on. The opinions have been largely adverse, for this efficiency and in addition for his or her stage present.

But they didn’t quit. A number of years later, they obtained their huge break by qualifying for and in the end profitable the 1974 Eurovision Song Contest.

Festfolket turned out to be a precursor to one of the vital profitable and in style musical acts in historical past: the band ABBA, an anagram constructed from the primary letter of the 4 singers’ first names.

Which brings me to at the moment’s matter, one other highly effective, four-letter entity derived from seemingly inconsequential precursors. I’m speaking, after all, about TMAO, a compound our our bodies make with uncooked substances that come from meals of animal origin. That’s the place the similarity ends, although; TMAO is as worrisome and doubtlessly hazardous as ABBA is enjoyable and joyful.

A Newly Discovered Dietary Hazard: TMAO

Many research inform us that individuals who eat a complete meals, plant-centered food regimen that’s low in meat and different animal merchandise are likely to stay longer, and have decrease charges of a lot of the main power ailments of our occasions — together with coronary heart illness, sort 2 diabetes, most cancers, dementia, and weight problems.

But why? Is it ldl cholesterol? Saturated fats? The nature of animal protein? Is it as a result of animal merchandise ship heme iron — and most of the people are already getting an excessive amount of iron? Is it as a result of animal merchandise characterize a missed alternative to reap the benefits of the fiber, antioxidants, and different phytonutrients which can be so considerable in complete plant meals?

In actuality, it’s most likely a mixture of all of these items, at the side of different more healthy way of life habits. But diet-wise, there’s now a brand new issue to contemplate, and it deserves much more consideration than it’s been getting.

TMAO, or trimethylamine-N-oxide, is a poisonous compound produced by human intestine micro organism. Its manufacturing can have a significant affect on the event of power illness and general well being. In reality, the results of TMAO are so vital that it’s getting used as a medical indicator to assist predict danger for coronary heart assault, stroke, and dying. 

But what precisely is TMAO? Why is it so unhealthy for you? And what are you able to do to stop it from forming within the first place?

What is TMAO?

Trimethylamine N-oxide (TMAO) is a metabolite that your physique produces should you eat sure meals. Here’s the way it works: while you devour meals wealthy in TMAO precursor compounds, the micro organism in your intestine convert them right into a molecule known as trimethylamine (TMA). Your liver then grabs that TMA, does some fancy chemical stuff to it (apologies for that technical sidebar), and generates TMAO.

What Foods Form TMAO in Your Body?

ingredients for protein diet

The dietary precursors to TMA formation, which embody L-carnitine and choline, in addition to betaine and lecithin, are discovered virtually solely in meals of animal origin. Red meat like beef, pork, eggs, and lamb, in addition to salt-water fish, result in the very best concentrations of TMAO in our our bodies. Liver, dairy merchandise, and shellfish are additionally TMAO producers.

L-carnitine dietary supplements may improve TMAO ranges within the physique. One 2015 examine discovered that when 31 sufferers on hemodialysis obtained L-carnitine dietary supplements, it was modified to trimethylamine (TMA) by their intestinal microbiota, after which additional metabolized to TMAO.

Why Is TMAO Bad for Your Health?

Researchers are discovering increasingly associations between TMAO ranges and the event of a number of inflammatory situations. These embody coronary heart illness, sort 2 diabetes, power kidney illness, most cancers, and liver illness.

senior male patient in a modern hospital

Heart Disease

We’ve identified in regards to the connection between TMAO and coronary heart illness for some time. People with greater ranges of TMAO of their blood might have greater than double the danger of coronary heart assault, stroke, or different critical cardiovascular issues, in contrast with individuals who have decrease ranges.

The dietary world was rocked in 2013 by a examine by which researchers discovered that intestinal micro organism metabolize L-carnitine from meals like purple meat and switch it into TMAO, selling atherosclerosis. They additionally discovered that omnivores produce considerably extra TMAO than vegans and vegetarians do after consuming L-carnitine.

Why would vegans and meat-eaters differ in how a lot TMAO they make in response to the very same meals or complement? Because what you eat determines the make-up of your intestine microbiome. If you eat meat regularly, you’ve seemingly obtained a intestine stuffed with micro organism that flip TMAO precursors into TMAO. If you’re a vegan, you lack these micro organism as a result of they will’t survive in your food regimen.

A 2017 multi-center examine examined TMAO ranges of 530 adults who went to the ER for chest ache. The information confirmed that the sufferers who had the very best TMAO ranges after they arrived on the hospital have been roughly six occasions extra prone to die, have a coronary heart assault or stroke, or want surgical procedure on blood vessels throughout the subsequent month. They have been additionally six occasions extra prone to die or have a coronary heart assault throughout the subsequent six months, and have been twice as prone to die in the course of the seven years of follow-up in comparison with the sufferers who offered with the bottom TMAO ranges on admission.

A 2019 examine discovered that greater TMAO ranges have been related to worsened severity of peripheral artery illness (PAD) — a situation which places individuals at greater danger for coronary heart assault, stroke, and associated dying in comparison with individuals who don’t have the illness — and the next danger of dying from coronary heart illness.

TMAO has additionally been proven to immediately trigger atherosclerosis, the dangerous buildup of plaque in your arteries. Having greater plasma TMAO ranges predicts main adversarial cardiovascular occasions, like coronary heart assault, stroke, and dying. And TMAO seems to advertise immune and inflammatory responses within the physique that facilitate atherosclerosis and different coronary heart issues.

In a 2020 meta-analysis revealed in BMC Cardiovascular Disorders, researchers examined information from seven papers, with information from 9 cohort research involving a complete of 10,301 sufferers. They concluded that elevated plasma TMAO ranges elevated the danger of main adversarial cardiovascular occasions amongst sufferers with coronary heart illness by 58%.

Type 2 Diabetes

High TMAO ranges may intrude with blood sugar management, even to the purpose of accelerating the danger of growing sort 2 diabetes.

A 2017 examine revealed within the American Journal of Clinical Nutrition — involving 1,346 newly identified instances of sort 2 diabetes and 1,348 controls — discovered a constructive affiliation between plasma ranges of TMAO and sort 2 diabetes.

This hyperlink was additionally present in a 2016 examine, by which the authors concluded that excessive TMAO ranges are related to diabetes. 

Another examine revealed in 2014 examined the results of TMAO on glucose tolerance amongst mice fed a high-fat food regimen. Based on their findings, the authors concluded that dietary TMAO worsens already-impaired glucose tolerance, interrupts signaling pathways within the liver, and promotes irritation in fatty tissues amongst mice fed a high-fat food regimen. (Our view on the usage of animals in medical analysis is right here.)

Chronic Kidney Disease

Chronic kidney illness (CKD), or power kidney failure, is a situation that includes the worsening of kidney perform, ultimately ensuing within the failure of 1 or each kidneys. The presence of TMAO within the physique might play a job in well being outcomes of CKD.

One 2015 examine discovered that CKD sufferers had greater concentrations of TMAO than controls with out CKD. Furthermore, greater ranges of circulating TMAO have been related to a worsened CKD prognosis and poorer long-term survival.

A 2016 examine involving 80 controls and 179 sufferers with stage Three-5 CKD concluded that greater TMAO ranges have been related to the next danger for mortality.


How a lot TMAO is circulating in your blood may affect your danger for sure kinds of cancers.

For occasion, a 2014 examine discovered a constructive correlation between greater TMAO ranges and danger for colorectal most cancers. The affiliation of the 2 is so vital 2017 examine known as TMAO “a new prognostic marker for colorectal cancer.” The researchers discovered that median TMAO ranges have been considerably greater in sufferers with most cancers than within the wholesome controls. Plus, those that had excessive TMAO ranges had considerably shorter disease-free survival (a measure of how lengthy sufferers survive after therapy that utterly eliminates signs, however might not “cure” the illness) in comparison with sufferers with low ranges of TMAO.

But it isn’t simply colorectal most cancers that seems to be impacted by TMAO. A 2015 examine discovered that extreme TMAO was associated to the next danger for aggressive types of prostate most cancers. And a 2018 examine discovered that prime blood ranges of TMAO have been related to elevated danger for main liver most cancers.

Why? A 2021 literature assessment concluded that TMAO might promote irritation, oxidative stress, and DNA injury — all of which might contribute to most cancers mortality.

Liver Disease

Non-alcoholic fatty liver illness (NAFLD) is the presence of extreme fats buildup within the liver with out alcohol abuse or one other apparent trigger. NAFLD is turning into more and more prevalent around the globe, and TMAO seems to affect how unhealthy NAFLD can develop into.

A 2019 examine revealed within the journal Molecular Nutrition & Food Research concluded that prime ranges of TMAO worsen NAFLD by interrupting signaling pathways within the liver that handle bile acid metabolism.

Plus, the authors of a 2021 cohort examine known as PREVEND (Prevention of Renal and Vascular End-stage Disease), by which 6,415 individuals have been adopted for a median of eight.2 years, concluded that plasma concentrations of TMAO have been independently related to all-cause mortality in individuals with NAFLD.

TMAO Testing

doctor team

In people, blood ranges of TMAO stem from plenty of components, together with food regimen, intestine microbial flora, and liver metabolism exercise. But how are you aware if the quantity of TMAO in your physique is problematic? A TMAO take a look at could also be completed in an emergency room setting to verify a cardiac occasion if somebody arrives with chest ache or different regarding signs. It may be ordered to find out danger of coronary heart illness or stroke. Use of the TMAO take a look at typically happens for extra correct danger prediction of a significant cardiac occasion in sufferers present process elective coronary angiography and sufferers with acute coronary syndromes.

Clinical information additionally helps utilizing TMAO testing to get a clearer concept of the danger for all-cause mortality in sufferers with peripheral artery illness, coronary heart failure, power kidney illness, and after a myocardial infarction.

To bear the TMAO blood take a look at, sufferers quick in a single day and chorus from consuming fish or different seafood — together with fish oil or krill oil dietary supplements — the day earlier than the blood draw to keep away from false elevations in TMAO.

After a blood draw, TMAO ranges are assessed in micrometers (μM). A studying of lower than 6.2 μM signifies low danger of a significant cardiac occasion, and the upper that quantity, the higher the danger.

How Can You Reduce TMAO Levels in Your Body?

green vegetarian buddha bowl lunch with grilled vegetable and quinoa spinach avocado

Minimizing meals which can be very excessive in choline, L-carnitine, and different TMAO precursor compounds is the best approach to cut back TMAO ranges. And the best means to try this is to keep away from the meals they arrive from — swapping animal-based meals for complete meals, plant-based ones.

A 2021 examine revealed in The Journal of Nutrition requested the query, “What happens to TMAO levels when we put meat-eaters on a vegan diet?” Researchers requested 23 common meat-eaters, all of whom have been overweight or had markers for diabetes, to eradicate all animal merchandise for eight weeks, after which they may eat an unrestricted food regimen for the subsequent 4 weeks. Their plasma TMAO was measured at baseline, and once more at weeks one, eight, and 12.

The common TMAO within the examine individuals was over 10 μmol/L after they began the examine, which put them within the highest danger class. Just one week later, a vegan food regimen had minimize that quantity virtually in half, to five.7. Just like that, the individuals have been within the lowest danger class. Their TMAO ranges remained pretty fixed after eight weeks on the vegan food regimen. At week 12, nevertheless, following 28 days of rebound consuming that included animal merchandise, their TMAO ranges had additionally rebounded, averaging a whopping 17.5 μmol/L.

In a 2020 randomized managed trial known as SWAP-MEAT, which is a stunningly punny title for a vitamin examine, researchers discovered that when individuals swapped out animal merchandise for plant-based options, their danger components for coronary heart illness improved — together with their TMAO ranges.

Plant-based diets have additionally been confirmed efficient for decreasing gut-derived TMAO manufacturing amongst sufferers with power kidney illness. This is very essential as a result of people with kidney illness are already at the next danger of growing coronary heart illness.


So, what are you able to do along with your food regimen to assist cut back your manufacturing of TMAO? First, you possibly can cut back your direct carnitine consumption. Carnitine, which comes from the identical root because the phrase “carnivore,” is, not surprisingly, highest in purple meat. A four-ounce beef steak can have between 56 mg to 162 mg of carnitine.

Since carnitine is made within the physique from the important amino acids lysine and methionine, while you devour meals excessive in these amino acids (that are in plant-based meals reminiscent of legumes, quinoa, nuts, and seeds), your physique can produce all of the carnitine that it wants with out having to get it immediately from meals like meat and dairy. This can be why there’s no Recommended Daily Allowance (RDA) for carnitine.


Choline can be strongly linked to TMAO manufacturing. The key, nevertheless, is to get the correct amount (and never an excessive amount of). The highest dietary sources of choline are meat, fish, dairy, and eggs. More modest quantities of choline seem to fulfill human wants with out inflicting extreme TMAO manufacturing and may come from consuming fruits, greens, beans, nuts, and soy meals.

And it seems that plant-based sources of choline may need a unique affect within the physique than those who come from animals. In a outstanding 2004 examine revealed within the Journal of the American Dietetic Association, researchers had individuals eat two cups a day of the vegetable highest in choline — Brussels sprouts — for 3 weeks. At the tip of the examine, the individuals’ TMAO ranges decreased from baseline. The researchers concluded that maybe Brussels sprouts naturally downregulate the liver enzyme that converts TMA to TMAO, sufficient to successfully drop ranges in your physique.

To reduce the TMAO your physique produces, the only strongest technique is to eat a complete meals plant-based food regimen, free from animal merchandise. Because it seems that individuals who usually eat a completely plant-based food regimen might not make any TMAO in any respect — even when they intentionally attempt to make them by, say, consuming a beef steak that’s excessive in each carnitine and choline.

Why is that? The make-up of a vegan intestine microbiome incorporates very completely different bacterial communities than an omnivore’s. If purple meat isn’t usually consumed, the intestine doesn’t include any micro organism that act on purple meat to advertise the creation of TMAO.

A plant-based food regimen can shield you from the formation of TMAOs to such an extent that even should you do eat the occasional hamburger, your TMAO ranges seemingly won’t rise.

Anti-TMAO Recipes

Swapping some (or all!) animal-based protein for plant-based protein will be scrumptious and satisfying to your style buds when you will have easy and flavorful recipes to observe, like those under.

Easy Tofu Breakfast Muffins exchange eggs and create an easy-to-make savory breakfast that may additionally substitute as a protein-packed grab-and-go snack. Ditching dairy has by no means been simpler for the reason that discovery of plant-based substances’ potential to show into umami, creamy goodness. Cashew Mozzarella Cheese is just like dairy in that it tastes unimaginable and delivers creaminess, however it’s completely different in that it’s good for you! You may create a satisfying plant burger to interchange a purple meat burger — utilizing lentils, flax meal, and plenty of flavorful spices with the Hearty and Healing Lentil Burgers. As you ditch animal protein, you’ll ditch the TMAO-generating compounds. Plus, by including high-fiber plant-based substances, you’ll construct a wholesome microbiome that protects towards extra TMAO.

1. Easy Tofu Breakfast Muffins

Swap eggs for tofu in these easy-to-prepare, savory breakfast muffins that you would be able to make forward of time for an “I’m running late” breakfast (it occurs to the very best of us) — or to get pleasure from as quickly as they arrive out of the oven. Not solely are you changing choline-rich eggs derived from an animal, however you’re changing them with heart-healthy, fiber-rich substances like onions, mushrooms, and kale that assist to feed wholesome intestine micro organism. Add a bit of floor turmeric on prime of all that, and you’ve got your self an anti-inflammatory, powerhouse breakfast!

2. Cashew Mozzarella Cheese

Ditch choline-packed dairy cheese for this plant-based cashew model that delivers creamy texture, umami taste, and tons of vitamin. Use it as a plant-based pizza topping, complete grain pasta sauce, or steamed veggie dip — you gained’t really feel such as you’re lacking out one bit!

Three. Hearty and Healing Lentil Burgers

Red meat is the largest offender in terms of TMAO manufacturing on account of its excessive content material of each choline and carnitine. Swapping purple meat with a hearty lentil or bean burger can create a giant — by that, we imply constructive — affect in your well being. These burgers are hearty, tasty, and maintain collectively properly for outside grilling. Layer them with all your favourite toppings for a scrumptious and satisfying meal.

A Plant-Based Defense Against TMAO

TMAO has been implicated as a marker in heart problems and plenty of different inflammatory power ailments. It’s a poisonous compound produced by intestine microbiota from consuming meals excessive in choline and carnitine, in addition to betaine and lecithin, that are primarily animal merchandise like purple meat. But the excellent news is that you would be able to cut back your ranges, and stop TMAO from forming within the first place, by adopting a complete meals, plant-based food regimen that adjustments your intestine microbiome for the higher. Eating this fashion additionally has the good thing about decreasing your danger of all-cause mortality and the event and development of coronary heart illness, power kidney illness, sort 2 diabetes, most cancers, and liver illness.

Tell us within the feedback:

  • Were you conscious of the hyperlink between animal merchandise and TMAO?
  • What are some methods you possibly can assist reduce TMAO formation in your food regimen?

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