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The Hidden Heart Killer

What you need to know about a tiny compound that might be increasing your risk for a heart attack.


Of the many factors that can contribute to coronary artery disease, there are ones you’ve heard of, like hypertension, diabetes, and high serum cholesterol. Then there are factors you probably haven’t heard of, like high levels of trimethylamine oxide, or TMAO.

Here’s what you need to know: red meat, high fat dairy products, AND egg yolks are high in dietary choline. These foods—and some sports supplements—are also the most popular sources of carnitine. Once these foods are eaten, certain bacteria in your gut break choline and carnitine down to trimethylamine or TMA. TMA is then converted to TMAO in the liver.

TMAO accumulation can be a result of the aforementioned dietary factors, as well as a reaction to stress, and it can cause a number of adverse reactions in the body and is an independent predictor of cardiovascular disease. Higher levels of obesity and insulin resistance are associated with higher TMAO levels. Kidney disease can impair the excretion of TMAO and raise the plasma levels of TMAO.

TMAO can alter cholesterol metabolism, weakening it, and increase the risk of arterial plaques. It can make platelets more adhesive and make us more prone to blood clots. This can contribute to strokes, heart attacks and peripheral vascular disease. TMAO can cause and worsen chronic kidney disease leading to the need for dialysis.

There are some things we can do to reduce some of the effects of TMAO. Aspirin can help reverse the platelet aggregation effects. Resveratrol in grape juice and red wine can help cholesterol metabolism and protect against some of the vascular effects. Probiotics can help change the bowel flora and reduce the bacteria that produce TMA. Antibiotics have been used to change the bacteria in the gut but can have side effects.

Dietary changes can also affect the production of TMAO. Reducing red meat and high fat dairy consumption while increasing vegetable consumption can reduce TMAO. Avoiding carnitine supplements can also reduce TMAO.

TMAO appears to have adverse effects on many systems in the human body. Current ongoing research will eventually give us a better, more complete picture. In the meantime, if you have concerns about it or have a family history of heart disease, you should contact your physician.

Dr. Michael Schutz is a urologist practicing at the Jersey Urology Group in Somers Point, NJ.

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