More and more research now points to the connection between an unhealthy gut and increased risk of cardiovascular disease.  One of the recent key findings is a metabolite called trimethylamine N-oxide (TMAO). Turns out that certain type(s) of gut bacteria excrete a bi-product called TMA after we eat foods like fish, red meat, eggs and cheese.  The liver then converts TMA to TMAO and this is where things get dangerous.

Elevated levels of TMAO increase atherosclerosis within the vascular system leading to a rise in the risk of cardiovascular disease.  Some doctors have picked up on this and have begun recommending that patients with high TMAO decrease intake of foods that increase TMA levels.  While this makes sense, it is complicated than just adjusting diet.

The problem is that foods like halibut, which raise TMAO to very high levels temporarily, are also considered “heart healthy” sources of omega-3.  While vegans and vegetarians do experience lower levels of TMAO, in reality, a temporary rise in TMAO is not a singular problem. The compounding issue is in those with elevated levels of TMAO, the gut has too many of the bacteria that produce TMA.   Secondarily that the body cannot handle the burden of TMAO and is not efficiently clearing it out of the system.

The Functional Approach to TMAO

While focusing on a primarily plant-based diet, in effect reducing TMA production, may be an effective first step for those at high risk of cardiovascular disease, this is not the only intervention that is critical for those with high TMAO levels.  We also must improve the gut microbiome and overall digestive health by addressing nutrition and gastrointestinal integrity. The aim is to reduce the microbial species in the gut that increase TMAO while increasing species that promote improved vascular health.

In fact, this is why Resveratrol seems to be a beneficial treatment for decreasing TMAO levels.  Resveratrol is the plant extract found in the skin of grapes. In concentrated and therapeutic doses, it remodels the microbiome and reduces TMAO production while simultaneously increasing healthy strains of microbial gut species.  The beneficial impact of resveratrol on the microbiome may be the underlying reason that it is not only linked to better cardiovascular health but also reduced risk of Alzheimer’s disease, too!

We can’t just stop at the gut, though.  The other area that needs attention when TMAO levels are high is kidney and liver function.  The liver is responsible for converting TMA to TMAO but it, along with the kidneys, are also critical for breaking down and clearing TMAO from the system.  Overburdened or nutrient-deficient kidneys and liver can’t keep up.

This is why it is crucial that our patients support their detoxification pathways by maintaining  balanced blood sugar, focusing on nutrient-dense foods, taking supplements aimed at reversing vitamin and mineral deficiency, and staying hydrated with purified water.  With the right therapies, TMAO levels can be decreased, reducing the overall risk of cardiovascular disease and improving overall health and longevity.