How to Reduce Your TMAO Levels

How to Reduce Your TMAO Levels
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Should we be concerned about high-choline plant foods, such as broccoli, producing the same toxic TMAO that results from eating high-choline animal foods, such as eggs?

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Choline and carnitine-rich foods—meat, eggs, and dairy—can be converted by gut flora into trimethylamine, which can then be turned into TMAO in our liver—a toxic compound which may increase our risk of heart failure, kidney failure, and atherosclerosis (heart attacks and strokes). The good news is, though, that this “opens up exciting new nutritional and interventional prospects” for prevention.

Okay, so how are we going to do it? If our gut bacteria can take meat, dairy, and eggs and turn them into TMAO, all we have to do is destroy our gut flora. We could give people “antibiotics to eliminate the production of” TMAO. However, that could also kill our good bacteria, and “facilitate the emergence of antibiotic-resistant…strains.”

Hmm. How about probiotic supplements? Maybe if we add good bacteria, it will crowd out the ones that take the meat, egg, and dairy compounds, and turn them into TMA, which our liver turns into TMAO. But, it doesn’t work. Adding good bacteria doesn’t seem to get rid of the bad.

What if we added a new bacteria that could somehow siphon off the TMA made by the bad bacteria? Well, there’s a bacteria inside the guts of cows and sheep that turns trimethylamine into methane. So, maybe we could use the bacteria to get rid of some of it from our gut, like a cow fecal transplant. The problem is, if it didn’t take, you’d have to keep giving it to people. So, maybe the fact that Consumer Reports found “fecal contamination” in every sample of beef they tested may be a good thing! No. Methane-producing bacteria may be able to eat up our TMAO, but unfortunately, these bacteria may be associated with a variety of diseases, from gum disease down to colorectal cancer.

So, if antibiotics and probiotics aren’t going to work to prevent gut bacteria from taking meat, dairy, and eggs, and turning them into the trimethylamine which our liver makes TMAO out of, I guess we have no choice but to cut down on—our liver function!

That was the billion-dollar answer to cholesterol. These same foods raise our cholesterol, but dietary change isn’t very profitable. So, the drug industry came up with statin drugs that cripple the liver enzyme that makes cholesterol. So, hey, “pharmacologic inhibition of” the enzymes in our liver that make TMAO could “potentially serve as a therapy for [cardiovascular disease] risk reduction.” But, there’s a genetic condition in which this enzyme is naturally impaired, called trimethylaminuria, in which there is a buildup of trimethylamine in the bloodstream. The problem with that is that trimethylamine is so stinky, it makes you smell “like dead fish.” So, “given the known adverse effects…from sufferers of [this] fish odor syndrome, the untoward odorous side effects…make it a less attractive [drug] target.” So, do we have to choose between smelling like dead fish, or suffering from heart and kidney disease?

If only there was some other way we could somehow stop this process from happening. Well, what do those with trimethylaminuria often do to cut down trimethylamine levels? They stop eating animal products.

About a third of those who complain of really bad BO, despite good personal hygiene, test positive for the condition, but reducing or eliminating meat, egg, and dairy intake can be a real lifesaver. But, given what we now know about how toxic the end product TMAO can be for normal people, cutting down on animal products may not just save the social lives of people with a rare genetic disorder, but help save everyone else’s actual lives.

“The simplest point of intervention is to [just] limit [the] consumption of” foods rich in choline and L-carnitine, which can be an effective strategy to limit circulating TMAO. But, wait, we could always try to genetically engineer a bacteria that eats up trimethylamine, but the simplest, safest recommendation may just be to eat healthier. You can completely eliminate carnitine from the diet, since our body makes all we need. But choline is an essential nutrient. So, we need some, and we can get all we need in fruits, vegetables, beans, and nuts. “However, excess choline, such as that found in eggs, may be worth avoiding.”

Need we worry about high-choline plant foods, like broccoli? Cruciferous vegetable consumption is associated with a significantly longer life: less cardiovascular disease mortality. To see what was going on, researchers took the vegetable highest in choline, Brussels sprouts, and had people eat two cups a day for three weeks, and their TMAO levels actually went down. It turns out that Brussels sprouts appear to downregulate that TMAO liver enzyme naturally—not enough to make you stinky, but just enough to drop TMAO.

And, people who eat completely plant-based may not make any TMAO at all—even if you try. You can give a vegan a steak, which contains choline and carnitine, and not even a bump in TMAO, since vegetarians and vegans have different gut microbial communities. If we don’t eat steak, then we don’t foster the growth of steak-eating bacteria in our gut. So, hey, forget the cow—how about getting a fecal transplant from a vegan? From a TMAO standpoint, maybe we don’t have to eat like a vegan, as long as we poop like one.

Please consider volunteering to help out on the site.

Image credit: Sally Plank via Flickr. Image has been modified.

Motion graphics by Avocado Video

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Choline and carnitine-rich foods—meat, eggs, and dairy—can be converted by gut flora into trimethylamine, which can then be turned into TMAO in our liver—a toxic compound which may increase our risk of heart failure, kidney failure, and atherosclerosis (heart attacks and strokes). The good news is, though, that this “opens up exciting new nutritional and interventional prospects” for prevention.

Okay, so how are we going to do it? If our gut bacteria can take meat, dairy, and eggs and turn them into TMAO, all we have to do is destroy our gut flora. We could give people “antibiotics to eliminate the production of” TMAO. However, that could also kill our good bacteria, and “facilitate the emergence of antibiotic-resistant…strains.”

Hmm. How about probiotic supplements? Maybe if we add good bacteria, it will crowd out the ones that take the meat, egg, and dairy compounds, and turn them into TMA, which our liver turns into TMAO. But, it doesn’t work. Adding good bacteria doesn’t seem to get rid of the bad.

What if we added a new bacteria that could somehow siphon off the TMA made by the bad bacteria? Well, there’s a bacteria inside the guts of cows and sheep that turns trimethylamine into methane. So, maybe we could use the bacteria to get rid of some of it from our gut, like a cow fecal transplant. The problem is, if it didn’t take, you’d have to keep giving it to people. So, maybe the fact that Consumer Reports found “fecal contamination” in every sample of beef they tested may be a good thing! No. Methane-producing bacteria may be able to eat up our TMAO, but unfortunately, these bacteria may be associated with a variety of diseases, from gum disease down to colorectal cancer.

So, if antibiotics and probiotics aren’t going to work to prevent gut bacteria from taking meat, dairy, and eggs, and turning them into the trimethylamine which our liver makes TMAO out of, I guess we have no choice but to cut down on—our liver function!

That was the billion-dollar answer to cholesterol. These same foods raise our cholesterol, but dietary change isn’t very profitable. So, the drug industry came up with statin drugs that cripple the liver enzyme that makes cholesterol. So, hey, “pharmacologic inhibition of” the enzymes in our liver that make TMAO could “potentially serve as a therapy for [cardiovascular disease] risk reduction.” But, there’s a genetic condition in which this enzyme is naturally impaired, called trimethylaminuria, in which there is a buildup of trimethylamine in the bloodstream. The problem with that is that trimethylamine is so stinky, it makes you smell “like dead fish.” So, “given the known adverse effects…from sufferers of [this] fish odor syndrome, the untoward odorous side effects…make it a less attractive [drug] target.” So, do we have to choose between smelling like dead fish, or suffering from heart and kidney disease?

If only there was some other way we could somehow stop this process from happening. Well, what do those with trimethylaminuria often do to cut down trimethylamine levels? They stop eating animal products.

About a third of those who complain of really bad BO, despite good personal hygiene, test positive for the condition, but reducing or eliminating meat, egg, and dairy intake can be a real lifesaver. But, given what we now know about how toxic the end product TMAO can be for normal people, cutting down on animal products may not just save the social lives of people with a rare genetic disorder, but help save everyone else’s actual lives.

“The simplest point of intervention is to [just] limit [the] consumption of” foods rich in choline and L-carnitine, which can be an effective strategy to limit circulating TMAO. But, wait, we could always try to genetically engineer a bacteria that eats up trimethylamine, but the simplest, safest recommendation may just be to eat healthier. You can completely eliminate carnitine from the diet, since our body makes all we need. But choline is an essential nutrient. So, we need some, and we can get all we need in fruits, vegetables, beans, and nuts. “However, excess choline, such as that found in eggs, may be worth avoiding.”

Need we worry about high-choline plant foods, like broccoli? Cruciferous vegetable consumption is associated with a significantly longer life: less cardiovascular disease mortality. To see what was going on, researchers took the vegetable highest in choline, Brussels sprouts, and had people eat two cups a day for three weeks, and their TMAO levels actually went down. It turns out that Brussels sprouts appear to downregulate that TMAO liver enzyme naturally—not enough to make you stinky, but just enough to drop TMAO.

And, people who eat completely plant-based may not make any TMAO at all—even if you try. You can give a vegan a steak, which contains choline and carnitine, and not even a bump in TMAO, since vegetarians and vegans have different gut microbial communities. If we don’t eat steak, then we don’t foster the growth of steak-eating bacteria in our gut. So, hey, forget the cow—how about getting a fecal transplant from a vegan? From a TMAO standpoint, maybe we don’t have to eat like a vegan, as long as we poop like one.

Please consider volunteering to help out on the site.

Image credit: Sally Plank via Flickr. Image has been modified.

Motion graphics by Avocado Video

Doctor's Note

That was a fun video to record. Can you hear the frustration in my voice reading paper after paper proposing these ridiculous (but profitable!) answers, when the safe, simple, side effect-free solution was staring them in the face the whole time? Makes me think of so many parallels, not the least of which are:

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

If you haven’t yet, you can subscribe to my videos for free by clicking here.

130 responses to “How to Reduce Your TMAO Levels

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  1. I am wondering how long after eliminating animal products does the gut flora turn into that of a vegan?

    I believe this was answered in another video but I am having trouble finding it.




    8
    1. Nina, the video you may be looking for could be this one:

      https://nutritionfacts.org/video/how-to-change-your-enterotype/

      It states that the microbiome “starts” to change in 1 day after switching from a plant based diet to an animal based diet! And after only 4 days, the ratio of bacteria changed. I imagine the reverse is also true (changing from an animal to a plant diet.).

      “Remarkably, the animal-based diet inverted the vegetarian’s Prevotella to Bacteroides ratio, causing the Bacteroides to outnumber the Prevotella within just four days on the animal-based diet. His entire gut flora got turned on its head.”




      15
      1. Nina, Here is a video that partially answers your question:

        https://nutritionfacts.org/video/how-to-develop-a-healthy-gut-ecosystem/

        In this video it states that after about 2 weeks, the microbiome changes significantly.

        “On the other hand, meat-free diets “have been demonstrated to have a profound influence on human metabolism.” You can analyze a urine sample, and tell what kind of diet people eat, based on measurements like how low the TMAO levels are in the urine of those eating egg-free vegetarian diets. You can even take the same people, and rotate them through three different diets, and you can tell who is who; who is on a high-meat, low-meat, or no-meat diet—in part, based on the different compounds churned out by the different gut flora, or different flora activity, after just about two weeks on the different diets. It’s possible that some of the beneficial effects of whole plant foods may be mediated by the effects they have on our gut bacteria. At the same time, the Standard American Diet may increase the relative abundance of undesirables that produce toxic compounds, including the cardiotoxicant TMAO.”




        14
        1. While we’re on the subject of gut bacteria, I have a question for anyone who can remember. Somewhere I learned there is a type of gut bacteria which, while it may produce gas, the gas is odorless. I used to have odorless gas after eating beans. It didn’t matter how many years I’d been eating beans, there was always gas, but it didn’t smell, and bowel movements had little odor as well. After a week of antibiotics following surgery last November my microbiome has never returned to making this odorless gas. Does anybody recall what that is? Maybe I could use probiotics with that particular strain for awhile. Help!




          6
      2. Unfortunately, in the study in question, switching from baseline (typical Western) diets to a wholly plant based diet had much lower, or slower, effects on microbial composition than switching to a wholly animal based diet. However bad Western diets are, they typically contain some fiber, and don’t derive most of their energy from fat.

        An early 1992 study found dramatic changes in fecal bacterial fatty acids upon shifting to a raw vegan diet in the first 5 days. Arthritis patients on a vegetarian diet had maximal changes in this marker after 1 month. In the modern 16S
        rRNA sequencing era, we have my first cited study, as well as a Korean study where bacterial composition changed markedly in 1 month of a vegan diet, and an Italian study where gut microbiota of type 2 diabetics exhibited marked changes after 21 days of a macrobiotic vegan diet. It appears that the shift in microbiome composition seen in shifting from Western to plant based diets isn’t significant in 5 days, but is within 3-4 weeks. This accords with my personal experience of adaptation when I went vegan 7 years ago.




        12
      3. So…has there been research involving giving basic carnitine and choline supplements to vegans to see IF their TMOA levels rise? Is there a video on this? Think I remember one.

        If you are over 65…might want to think again?

        http://warddeanmd.com/ribonucleic-acid-part-one/

        Dr. Frank believed that one cause of inadequate concentrations of RNA and nucleotides for repair and production of energy is an age-related increase in enzymes that destroy nucleic acids (i.e., nucleases—specifically, ribonuclease, which breaks down RNA). As people grow older, ribonuclease enzyme activity has been reported to increase. Consequently, just as the requirement to repair damaged cells increases, the substances required for this repair (nucleic acids) are being degraded by higher concentrations of destructive enzymes. Consequently, Dr. Frank believed older people have an even higher requirement for nucleic acids than younger people. Thus, the older we get, the greater our need for nucleic acids, both for replacement and for repair.

        The decline in physical function results directly from a loss of muscle strength. Let that sink in for a moment…the loss of muscle strength is the primary reason we institutionalize older people. It gets worse.

        Studies have now shown that three simple tests involving muscle strength can predict with astounding accuracy which middle-aged adults are less likely to live a long and healthy life. (BMJ 14 Apr 29;348:g2219)

        Dr. Rachel Cooper from the University College of London performed these tests on a group of 1,355 men and 1,411 women (all aged 53). She then analyzed their mortality data through 2012, when they turned 63 years old. During that period, 177 died.
        After evaluating the data, Dr. Cooper and her colleagues adjusted for all kinds of complicating variables, such as lifestyle, health status, socioeconomic position, etc. Even after the adjustments, those in the lowest quintile (1/5th) of physical capability were 3.68 times more likely to die than those in the highest quintile. Those who were unable to perform any of the tests had a death rate 12 times higher than those able to perform all three tests.
        So basically, muscle loss won’t just get you institutionalized, it also significantly increases your risk of dying earlier.

        https://www.lef.org//Magazine/2013/3/Carnitine-Restores-Cellular-Function/Page-01

        The impact of acetyl-L-carnitine is especially important in Alzheimer’s disease, the leading cause of dementia and mild cognitive impairment in the United States. One early study showed that supplementing with acetyl-L-carnitine every day for a year led to improvements on the cognitive portion of a standard Alzheimer’s disease rating scale in patients younger than 61.43

        Human volunteers who took 3 grams/day of L-carnitine for 10 days had favorable changes in body composition.36 Patients taking L-carnitine used their fat for energy, burning it 22% faster than control patients, and without any increase in muscle protein breakdown. Another study using 2 grams/day demonstrated a loss of total fat mass of 4 pounds, with a gain in lean muscle mass of 8.4 pounds.37

        More recent studies have shown good effects even in older patients, but, as with all forms of prevention, the earlier you start taking carnitine, the more powerful the effects on memory. Doses ranging from 1.5 to 3 grams/day of acetyl-L-carnitine have consistently been shown to produce treatment effects several-fold greater than placebo alone, with the greatest impact in patients in the earlier stages of the disease.44-46 Improvements from acetyl-L-carnitine supplementation can be seen as early as 3 months, and continue to increase over time.

        https://www.ncbi.nlm.nih.gov/pubmed/26362762

        A recent analysis of the National Health and Nutrition Examination Survey (NHANES) III cohort has revealed that relatively low protein intakes in mid-life (under 10 % of calories) are indeed associated with decreased subsequent risk for mortality. However, in those over 65 at baseline, such low protein intakes were associated with increased risk for mortality. This finding accords well with other epidemiology correlating relatively high protein intakes with lower risk for loss of lean mass and bone density in the elderly.




        2
        1. Look doctor….no carnitine or choline!

          https://www.amazon.com/Master-Amino-Acid-Pattern-MAP/dp/B0081KWNHY/ref=cm_cr_arp_d_product_top?ie=UTF8

          This is an amino acid formula based on the (MAP) Master Amino Acid Pattern® (U.S. Patent No. 5,132,113) a unique pattern of essential amino acids in a highly purified, free, crystalline form. The essential amino acids in such a composition are present in the following ratios: L-valine 1.0, L-arginine 1.77, L-isoleucine .91, L-lysine 1.03, L-phenylalanine 1.03, L-histidine .44, L-leucine 1.43, L-methionine .93, L-threonine .91, L-tryptophan .28. From What I can gather the formula contains approximately 2g leucine, 1.6g valine, 1.5g isoleucine, 1.4g lysine, 1.3g phenylalanine, .7g methionine, and .4g tryptophan per 10 tabs. According to the company, it contains no fat, sodium, sugar, yeast, gluten, soy, corn, wheat, milk products or preservatives. You can search for the patent and find out more specifics.

          http://www.patents.com/us-5132113.html

          I am trying this at 5 tabs in the morning…at first a bit hard on the stomach…but OK now.




          1
          1. Excellent posts, baldandretired. This is exactly what I talked about when people just take literally at face value what the doctor said about TMAO and choline without questioning and then trash anyone who presents other information, because that’s what the doctor said .




            4
            1. Unfortunately Jerry, you don’t present “other information. All you do is present your opinions which you describe in a way that implies that they are incontrovertible and absolute facts.

              It is hardly surprising that people who know something about the evidence are outraged when you present crank opinions as facts. This is a website about nutrition facts. It is not about woo and wishful thinking. There are plenty of websites out there that pander to people like you, yet you choose to bombard people here with your intolerantly expressed opinions. In many people’s minds, what you do is perilously close to trolling.




              2
            1. Exercise? Don’t leave home without it. When you get older….an exercise program might be the only thing between you and a cane or wheelchair.




              0
    2. nina
      just from memory , i think it was 2 weeks
      a lot of people are not 100 per cent vegan , that is they consume some meat at say celebrations and such , so if you did consume some animal product at least two weeks apart , you should be ok , that sort of answered your question i hope
      i’m sure someone else can answer maybe better i’m sure




      4
    3. “You can give a vegan a steak, which contains choline and carnitine, and not even a bump in TMAO…” A vegan steak-eater is a contradiction in terms.

      So another question is the converse of yours: how often does a recent vegan have to eat steak in order to start producing TMAO?




      2
      1. Hello, brec,

        I think it’s impossible to estimate that, since everyone’s microbiome is different.

        By the way, yes, those involved in the study are vegans, it was just experiment.

        Hope this helps,

        Moderator Adam P.




        2
  2. Another excellent video! It’s almost comical how some researchers were searching for a “supplement” to reduce TMAO. And the video provides a good explanation of the synergistic effect of plant foods, showing that a high choline food doesn’t necessarily result in the formation of TMAO. An excellent example of the dangers of focusing too much on isolated nutrients.




    16
    1. My personal take is that I applaud the search for alternate therapies. Reason is there are a lot of pipple who just too set in their ways to make the obvious changes. These are the ones who need an alternate solution to something like TMAO that will let them continue their tried and “true” way of living without it causing illness.

      Science sounds redundant at times, but for the masses their work-arounds can be huge.




      4
  3. “If only there were a way” … “If only there were a way” …. YES, quit eating cancer causing crap! The science is clear. It is disgusting to see these white-coat wearing doctors promoting the latest chemical lab concoction designed to fix what shouldn’t even be a problem. Millions of people are scammed everyday through their own ignorance, and also lack of willingness to make changes that may save their lives. My own copy of “How Not to Die”, as well as at least 10 other books, are well marked up. And put into practice as well.




    19
  4. IT IS very important for those new to Nutrition Facts and Dr. Greger to note that you should NOT be overly influenced by any one commenter in these comment sections, especially when their comments are contrary to the years of videos collected here, and they offer nothing but links to largely disproven articles and videos produced by others (with other motivations in some cases).

    Please make a note of it.




    46
    1. Wade so true. And who has the energy to constantly correct that person. But if we don’t this section is no better than the blogs that post unresearched information. Quite the dilemma.

      Make a comment-link a reliable research article. It shouldn’t be that difficult!




      16
  5. I didn’t like the whole tone of this video. It seemed sarcastic to me. I didn’t need to hear about all the ways that don’t work to lower TMAO levels. But then the message would have be so short: Stop eating animal products. But wait…. we already knew this. So what was the real reason for making this video?




    3
    1. I found it fascinating to learn about some/all of the options that are being researched, when the answer is right in front of us. As Dr. Greger states above, he was frustrated. I am too by all the time, energy, and often taxpayer resources that are devoted to finding the “magic pill” when lifestyle options can be very/completely effective.




      26
    2. Yeah, I think I see the sarcasm, but I’d define it as humor with a point. What I got from the video is that there are multiple solutions for suppressing TMAO production ranging from the ineffective to the hazardous to ONE sensible choice. I like the humorous tone, even the nuance of sarcasm. (The Pharma industry deserves it.)

      Speaking for myself – boldly now, since all the thumbs-down icons appear to have been dismissed… =] – I would say that Dr.Greger is a Leave-No-Stone-Unturned kind of researcher. I like that. One of the objectives of this video, as I see it, is to present alternates for TMAO suppression and analyze them for truthfulness and efficacy. I personally would like to know about the other options – and I trust Dr. Greger’s analysis to accurately report the findings.

      Also, you get a mini science lesson when you watch these videos, learn a little about metabolism and physiology. Remember the video about what happens inside cells when you have diabetes? https://nutritionfacts.org/video/what-causes-insulin-resistance/ There is a great animation in that video showing what happens to “jam up the lock” so insulin cannot be effective and reducing blood sugar. I’ve never understood this before and I’ve never seen a better presentation.




      30
      1. Great reply dr! I agree completely that the tone and humor in this video was refreshing, and made the analysis of the TMAO issue clear and enjoyable to watch.




        10
    3. That’s why I usually skim the transcripts to get to the bottom line quickly. If the details seem of interest to me, or I want to see the charts/graphs, then I watch the video.




      6
    1. Helga, I’ve been a vegetarian for more than 45 years — and I’ve been constantly “teased” about it, for all those years. Actually, I know realize that it was food bullying. But perhaps my response when asked “Why?”, that it was for sustainability reasons, was an implicit criticism of a meat-based diet. Which I also now realize it was. I have recently transitioned to vegan for health reasons — or, as I prefer to say, Whole Foods, Plant Based, but most people have no clue to what that means. It means I don’t live a vegan life or subscribe completely to the vegan philosophy, and that yes, I do eat honey. And no, I am not “gluten free.” Enjoy your food, there’s lots to like in a WFPB diet, and good luck with those around you.




      9
      1. I eat a teaspoon of honey every other day on my hot wholegrain cereal — blackstrap molasses on alternate days. The only veggie I don’t much like is Brussels sprouts.




        3
      2. Veganism isn’t a diet, so it makes sense for you to say you’re a WFPB eater, and not vegan.

        This also helps to avoid confusing those that definitely aren’t vegan or vegetarian and also those that are new to veganism.




        3
        1. Yes, it is also worth noting that Dr Greger’s argument is that the evidence shows that a WFPB diet is the healthiest. To my knowledge he has never argued that the evidence shows that a whole food exclusively plant diet is the healthiest (although that is his opinion). By definition, WFPB diet does not necessarily exclude all animal foods.
          In this vein, people may be interested in a recent Medscape/JAMA article (you may need to register – free – to gain access) by Kim Williams
          http://www.medscape.com/viewarticle/883571




          5
          1. TG, I am surprised by your reply. If I understand what you said then we are all in agreement, and I quote you “To my knowledge he has never argued that the evidence shows that a whole food exclusively plant diet is the healthiest (although that is his opinion). By definition, WFPB diet does not necessarily exclude all animal foods”. So myself, and all the so-called “meat eater” doctors, Dr Mercola, Hyman, Axe, Chris Kresser, Sears, Berg, etc. all talk about eating tons of WFPB foods and then eat some and I stress the word “some” animal foods to complete the diet for optimal health. If you go deep into eating for optimal health then you will see that there are a lot of nutrients that you cannot either get from plant foods, or get not in sufficient quantity, or not the right kind, or it require conversion by the body, or if you have to eat a lot of certain foods to get enough of certain nutrients then you get into another problem (such as Omega 6, PUFA, anti nutrients, inflammation in nut and seed, bean for protein) and I can go on and on with this. So most of the times, these doctors talk about WFPB foods, even more than Dr G because of the frequency and numbers of their daily articles, and whenever they talk about animal foods then it is in the context of eating clean, organic, natural raised, animal foods, and then which parts to eat (joint, bone, organ, fatty parts), or strategy to consume them (such as bone broth which is loaded with nutrients), etc.

            In fact, Dr G. was invited and appeared several times on Mercola site to promote WFPB. Do you think that Dr G went to their site if they talk about eating unhealthy?

            I see everyday people on this board asking advice for their health problems and what I see most people answer is that if you eat WFPB then you must be OK like this is the perfect diet and it is their fault not eating this diet and then get sick. No, it is not as simple because everybody are different, and there is not one size fit all diet. It is so indoctrinated to say that there is only one single diet for everybody.

            The following article from Dr Berg gives a good answer about meat eating or vegetarian diet. By the way, Dr Berg is a vegetarian himself. He explained about how people can eat the wrong foods by being vegan or vegetarian.

            https://www.drberg.com/blog/meat-eater-or-vegetarian-what-is-better

            And the following article talks about how other cultures in the world can be healthy by eating more meat and milk than vegetables – not that I suggest people to do so but to just show that there are more than one healthy diet.

            https://www.westonaprice.org/health-topics/traditional-diets/out-of-africa-what-dr-price-dr-burkitt-discovered-in-their-studies-of-sub-saharan-tribes/




            3
            1. Jerry Lewis: If the diets of all those doctors that you admire so much ( “… Dr Mercola, Hyman, Axe, Chris Kresser, Sears, Berg, etc. all talk about eating tons of WFPB foods …”) are so great, then why are every single one of them selling a boat load of SUPPLEMENTS” on their websites? I would think that if there diets were so complete, one would be getting all the nutrition they needed from the food they were eating. Check out all the products they’re selling:

              Dr Mercola: https://products.mercola.com/

              Dr Hyman: https://store.drhyman.com/

              Dr Axe: https://store.draxe.com/

              Chris Kresser: https://store.chriskresser.com/collections/all

              Dr Sears: http://drsearssupplements.com/

              Dr Berg: https://shop.drberg.com/

              For example, from Dr Mercola’s site, one can get a 90 day supply of Berberine micro PQQ for just $58.97 plus shipping and handling!

              Do we really need an isolated and modified chemical compound extracted from the Amur cork tree (or probably more likely mimicked in a laboratory)? Where did the Paleolithic humans get this wonderful compound to stay healthy? I thought you said these doctors emphasized a WFPB diet with a little meat. They must be using a different definition of WHOLE Food from the rest of us. ;-)




              5
            2. Thanks for the detailed reply/comment. I am not sure why it is a surprise – a plant-based diet by definition is simply based on plants. Sure, it can include but is not limited to an exclusively plant diet. And the evidence to date seems fairly conclusive that a whole food plant based diet is the healthiest. The evidence that an exclusively plant diet is the healthiest diet is just not there yet. Possibly because there are so few people who eat that way, that the data is simply missing. The evidence at the moment is suggestive but not conclusive in favour of a WF exclusively plant diet. I think the Medscape article I linked made the same point.
              And Dr G acknowledges that people eating a whole food exclusively plant diet should supplement for optimal health
              https://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/

              Anyway, I have to go now but will try to respond to your other points later




              0
    1. And TMAO is harmless anyway.

      I am sure that people will jump on your post and say that you don’t provide scientific evidences, that you are biased, paid shill from the meat industry, blah blah blah…




      3
        1. Hi Jason the articles you posted are written by a guy that has a website that promotes the benefit of eating high cholesterol diets.

          To be clear. It is not important what this Chris guy says or what Dr. Greger’s opinion is either. You don’t hear him saying anything about his opinion. It is what the current best science says.




          2
      1. All I am saying is the choline -> TMAO -> CVD is still a hypothesis. They fed mice 5 to 10 times higher concentrations of choline chloride than normally feeds. For carnitine -> TMAO -> CVD, it only showed steak + carnitine supplement but no data on steak alone.




        3
      2. Jerry I think you are not quite getting what people are complaining about with your posts. If you have had even one science class (resent) you would know that you must post your sources. It’s really that simple.

        For example TMAO is not harmless. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290910/pdf/jtim-2016-0005.pdf

        BYW I did a quick search for something that said TMAO was harmless and all I could find were Paleo sites. Those do not count as reliable sources.

        Anyhow we are never too old to learn a new skill.




        6
        1. WFPBRunner, take a look at Darryl post and educate yourself rather than spending time to insult at people.

          Darryl says:

          SEPTEMBER 8TH, 2017 AT 4:48 PM

          I’d agree that the Hazen lab’s focus on TMAO is a bit misplaced. Yes, its possible to accelerate atherosclerosis in rodent models by feeding them enough choline or carnitine that their plasma TMAO rises 100-fold that typical in human omnivores, but if it was a primary cause of CVD/CKD, we’d see higher rates of those diseases in fish eaters, who consume a bunch of preformed TMA.

          Personally, I think plasma TMAO, which associated CVD and CKD mortality, isn’t so much a primary cause of these diseases, but a coincident marker of the effects of animal product heavy diets on the gut microbiota composition. And that has its effects through other mechanisms, like metabolic endotoxemia.




          2
          1. You still don’t get it. Don’t get me wrong I love Darryl but again this is his opinion. Which I appreciate but I wouldn’t say “Darryl thinks.”

            Read the entire second article I posted.




            2
            1. “To summarize, recent studies point to the potential contribution of gut microbiota-derived production of TMAO from the metabolism of dietary choline and L-carnitine and the increased risk of developing atherosclerotic heart disease. Interestingly, TMAO plays an important physiological role in lower animals, but in humans it is merely a remnant of the evolution of the osmolyte system. It is possible that accumulation of TMAO in humans in disease state may be an adaptation of cells to stress and, hence, a marker rather than a mediator of disease. On the other hand, there is accumulating clinical and laboratory-based studies attributing a pathogenic role to this molecule. It is important to undertake studies examining intracellular concentrations of TMAO in mammals, cellular signaling and also determine the effects of TMAO on enzymes and other proteins in order to establish the role of TMAO in health and disease in humans.”

              Conclusion from above article. So much more to learn about TMAO. You just can’t say it’s harmless.




              3
              1. I wouldn’t say TMAO is harmless either. At high doses of choline or carnitine supplements, TMAO accelerates atherosclerosis and kidney disease in animal models. Just that while it may contribute, at the doses most omnivores are exposed to, I don’t believe its more than a very secondary or tertiary causal factor.

                Dietary precursors of trimethylamine in man: a pilot study

                “Of 46 different foods investigated, only fish and other sea-products gave rise to signifcant increases in urinary trimethylamine and N-oxide.”

                Beef and eggs were among the foods assayed, but 227 g of either didn’t elevate urinary TMA + TMAO over background. Meanwhile 20 of 21 seafoods significantly elevated urinary TMA + TMAO over background: haddock (54 times control), squid (37x), skate (36x), cod (34x), prawn (24x), swordfish (18x), mackerel, octopus (17x), whiting (11x), crab (10x), sardine (9x), plaice, cod roe (5x), trout, clam (3x), tuna, lumpfish roe (2x). These aren’t the foods associated with poor cardiovascular health in the general population.

                Scientists often pursue research alleys that belie common sense, and that’s a good thing. However, the Hazen lab’s work on TMAO came out when reviewers and the general media were hungry for stories on the microbiome and health, and I think this inflated its perceived importance beyond what more critical eyes see. I see the human epidemiology from the Hazen lab on CVD and CKD as establishing TMAO as a marker of a microbiome associated with bad health, but the causality likely lies through other mechanisms.

                There were already reasons to avoid supplemental choline or Monster energy drinks (high in carnitine) before the Hazen lab studies.




                0
                1. All very interesting and I believe this video was mostly sarcasm about ways to continue to eat animal products but find ways to decrease TMAO. Our system at its best. Matter of fact…how about take a choline supplement and then take something else to counter its affects.

                  Think of how far this science has come regarding the role of microbiota. It truely is amazing and so much more to learn.




                  0
    1. Before you supplement, note that the US adequate intake (AI) for choline is based on rather limited evidence. There isn’t evidence in the general population of choline deficiency, however early patients on total parenteral (intravenous) nutrition without choline developed liver disorders. 100-170 mg/d choline is enough to prevent this. In healthy men, Very low choline & betaine synthetic diets, with ~13 mg/d, cause elevated ALT, a marker of liver damage, but 500 mg prevented it. As the actual requirement is somewhere in that very broad range, there’s no RDA and for the AI the nutrition board just added a margin to 500 mg. Moreover dietary betaine (rich in spinach and beets) spares much of the choline requirement, as much choline is converted to betaine as a methyl donor in the methionine cycle. The choline requirement may be limited to the needs for phosphatidylcholine in new cell membranes and acetylcholine, a neurotransmitter.

      Other videos on NF cover the association of high choline intake with prostate cancer. High choline intake is also associated with diabetes, which hasn’t been covered yet.




      11
      1. Hi Darryl,

        My boyfriend and I have recently gone plant based (3 months or so). I use cron-o meter to log my food and make sure we are getting all our vitamins/minerals. Choline is the only one I have been having a very hard time getting. We normally get at least 150mg/day at a minimum fairly easy. On days when I really try to push our choline up we might get about 300mg. Cauliflower, cabbage, brussel sprouts, peanut butter, and black beans are our biggest choline contributors. We don’t use soy very often and I would like to keep it that way. I was considering supplements and even brought it up to my doctor but she didn’t seem too concerned (she’s very young and to be honest I’m not sure she knew right away what Choline was because she looked it up on her phone).

        I guess I’m just looking for some advice… plant foods that have a lot of choline which we could incorporate.

        What does this mean with regard to choline?

        Moreover dietary betaine (rich in spinach and beets) spares much of the choline requirement, as much choline is converted to betaine as a methyl donor in the methionine cycle.

        How much spinach and/or beets should we eat to help with our missing choline? Should we consider a small choline supplement, around 250mg/day? Would it be safer to eat an egg each day (not ideal at all but I’m not sure how bad one egg per day would be for the choline trade off).

        I love the way we eat now and coming off an Atkins/keto diet I have seen HUGE drops in my cholesterol (188 to 118!) plus amazing strength gain in my body especially with regard to running. Choline is the one thing that has been keeping me up at night.




        1
        1. I similarly range between 200-300 mg choline, and having done yearly blood tests for years, my ALT remains in the low-normal range: my liver appears fine.

          I can’t say what the actual choline requirement is (within that 13-500 mg range) for certain, but neither can nutrition academics. We don’t know. I take comfort in quotes like: “Choline is ubiquitous in the diet, and deficiency in free living individuals, even those on vegan diets, has not been reported outside of specific research settings where a choline-deficient diet was administered”, from The addition of choline to parenteral nutrition




          4
          1. Thanks so much for your response. That makes me feel a lot better that your intake about the same as ours and your tests have be good. I just had mine done and everything was great so I will continue getting choline from plants and just get the tests done each year.




            0
    2. Hey Anthony, thanks for writing! Regarding “how harmful” it would be, consider that when we isolate nutrients and ingest them in pharmacological amounts, drug-like effects are possible – and drugs can have harsh side-effects. A better question to ask might be, “How strong is the evidence that supplementing with this nutrient is going to effectively treat (or cure) my health problem?” If you can’t find well-controlled clinical trials for it, I would either avoid it or use it in small amounts only. I hope this helps!




      0
  6. “How Not to Die” has 130 pages of references in small type. Plus many researchers to dig and dig. How many references in your book, Jerry Lewis? What was the name of your book again? I assume your name is meant to be sarcastic. It reminds me of the nutty professor. NutritionFacts moderators, are you paying attention … can we please move on??




    12
    1. Does Nutrition Facts have moderators that do anything but answer a ? on occasion. No one from NF seems concerned with the content of the comments like they used to.




      11
      1. AdamP: Thank you for your efforts.

        However, a random sampling of the results googling “carnitine Saccharomyces cerevisiae”:

        Carnitine metabolism and biosynthesis in the yeast Saccharomyces cerevisiae
        http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.978.4943&rep=rep1&type=pdf

        Saccharomyces cerevisiae carnitine shuttle
        https://pathway.yeastgenome.org/YEAST/new-image?object=PWY3O-4

        Reconstruction of the carnitine biosynthesis pathway from Neurospora crassa in the yeast Saccharomyces cerevisiae.
        https://www.ncbi.nlm.nih.gov/pubmed/25851717

        Carnitine-dependent metabolic activities in Saccharomyces cerevisiae: three carnitine acetyltransferases are essential in a carnitine-dependent strain.
        https://www.ncbi.nlm.nih.gov/pubmed/11329169

        …so…

        Something is going on with carnitine and yeast!




        0
  7. Great video on TMAO! Here’s my burning question, so if a NutritionFacts support or research person sees this and knows the answer, I would love to hear (read) it. I have been a vegetarian for over 30 years, and a whole foods vegan for 5 or more. A few years ago, I and a few friends of mine who eat similarly discovered that lecithin from soy, added to foods, gives them a real boost in flavor, so we started eating a fair amount of soy lecithin every day (a few tablespoons). And then we saw the research on how carnitine and choline consumption could result in heightened TMAO levels. It wasn’t clear whether lecithin was implicated (though it does deliver a jolt of choline), but to be safe, we all decided to give it up pending more research results. But I have never seen lecithin either further implicated or exonerated, so we continue to avoid it. Sadly! (We have since started using nutritional yeast and peanut butter powder as a substitute – works almost as well). We would love to start back on lecithin, though, if we could. Still, we want to wait till the research says vegans can eat several tablespoons a day of lecithin safely before we start back. Has the research found this, does anyone out there know?




    1
    1. I once considered lecithin but then researched its production methods, and ran in the other direction. It’s so overprocessed and damaged, like vegetable oils are, that I would be careful using it.




      5
    2. Hi Timothy Miller, thanks for your question. I am one of the volunteer moderators at the website. I refer you to this video of Dr Greger that indicates how much soy is too much.”The bottom line is that legumes should be a part of everyone’s daily diet, which means lentils, peas, and/or beans, ideally with each of our meals—of which soy is an excellent choice. But, I recommend that we should probably stick to no more than 3 to 5 servings a day”. In the literature I found positive effect of soy lecthine

      Positive Effects of Soy Lecithin-Derived Phosphatidylserine plus Phosphatidic Acid on Memory, Cognition, Daily Functioning, and Mood in Elderly Patients with Alzheimer’s Disease and Dementia
      How Much Soy Is Too Much?




      4
      1. Thanks spring03. Interesting study.

        Let me run another line of thinking past you:

        Omnivores develop a mix of gut flora that eating animal products encourages. Not necessarily because of the L-carnitine and choline, but likely due to the prevalence of other stuff in animal foods. Vegans have a different mix of gut flora, and when fed meat, they do not produce TMA from the L-carnitine and choline in the meat. Even if you fed a little meat (say 1/2 ounce) to an otherwise-vegan daily, that would (theorizing here) not be enough to change the gut flora composition enough so that it would start converting the L-carnitine and choline from the 1/2 ounce into TMA. So eating a few TBSP of veg-based lecithin daily should not rewire a vegan’s gut flora enough to make it so the L-carnitine and choline in the lecithin gets converted to TMA as would happen with an omnivore. Does that reasoning sound sound?




        2
        1. Timothy Miller, I was interested in your question as its something I looked into some time ago. I did remember reading a warning about the supplements, choline, l-carnitine as well as the lecithin . This article should explain more https://nutritionfacts.org/2013/11/14/avoid-carnitine-and-lethicin-supplements/
          Also, under the video Dr Greger lists the other videos dealing with tmao that you might find interesting. The comment sections (as I recall) contain further discussions. Whole foods rule ! Hope this helps.




          4
          1. Thanks Susan. That’s how I was thinking about it until today’s video. That made me realize that it isn’t necessarily the choline or L-carnitine that encourages the growth of the type of gut flora that then turns those chemicals into TMA for the liver to turn into TMAO. Hence vegans may be able to consume choline every day (from lecithin, say) and never produce TMA and TMAO. But the studies aren’t definitive yet (if ever). It’s a nice theory, in other words, but until I see confirmation from a well-designed study, I’m not going to risk taking lecithin, however nice it tastes in various recipes.




            3
            1. Thanks for your thoughts on this Timothy, and I see what you are saying re keeping everything vegan-sourced. Just as an aside, I did check out soy lethicin on nutrition data http://nutritiondata.self.com/facts/custom/2846940/2 to see what they said re choline. For 16 gm, the choline content is 515mg. Check out respected forum contributor, ‘Darryl’ , for comments on dietary choline. All the best to you in health




              1
        2. Hi Timothy Miller, I would say yes to your comment and I seem to remember Dr Greger did mention this in one of his recent video about the vegan gut microflora being different from an omnivore and therefore if for any reason a small amount of animal food was consumed it would not have that much deleterious effect.”Apparently, the vegans don’t develop those TMAO-producing bacteria in their gut. And, why should they? It’s like the whole prebiotic story. You eat a lot of fiber, and you select for fiber-consuming bacteria. And, some of the compounds they make with fiber are beneficial, like the propionate I’ve talked about, that appears to have an anti-obesity effect”.
          Carnitine, Choline, Cancer, & Cholesterol: The TMAO Connection




          2
        3. I’d agree, and also note that there are differences in the metabolism of free choline, and bound choline (in lecithin). I’ll flog this study again:

          “It has been suggested that ingested lecithin is hydrolysed in the gut by phospholipase A, found in pancreatic juice, to produce lysolecithin, which is absorbed. Further degradation does not occur in the upper gut and there is no release of choline for further metabolism. Previous reports of increased
          urinary trimethylamine excretion after lecithin ingestion are most likely explained by the usage of lecithin which was contaminated with choline.”




          0
      2. Note that the above study was funded by, and partly authored by, the manufacturer and distributor of the product tested — as detailed in the “Acknowledgements” section and the “Conflict of Interest” section at the end of the study.

        This doesn’t mean that the findings are biased, but it does indicate further research might be required.




        1
  8. I would really like to see the “offending” foods broken out into degrees of problem rather than lumping meat, dairy and eggs into one.

    Reason is, I don’t deserve to live in a perfect world, so I will resign myself to living in an imperfect one. And in that imperfect world I am resigned to eating ice cream and or yogurt in order to keep my stool well formed and ample.

    It would really be helpful to understand the degree of producing something like TMAO from different sources as well as the AMOUNT of the source. That is, are a few chik’n nuggets or a bowl of beef broth an acceptable trade off in nutrition vs adverse events?

    Please don’t anyone say “Just suck it up Wuss and go total vegan.” Some of us just aren’t he-man or she-woman enough to bite the bullet and deny ourselves.




    4
      1. I was hoping you were sending me funny video but after seeing the first 25 seconds, I aborted. I’m not a crusader nor do I need something to shed tears over.

        Warning to others… this is an attempt to shame or guilt you into some sort of animal mistreatment despair. Kind of like when they tug at your heartstrings I suspect, like they do when they show sad eyed animals or little black African kids with flies on their fat little bodies.

        Don’t know if this video is asking for a donation or not but I do remember those donation-seekers asking for money from continuing donations to feed the animals/kids always asked for more money to feed the animals per day.
        Probably thought they would bring in more donations than a black African kid.

        If being manipulated to send money to these pimple makes you feel good, go ahead and watch… maybe I’m wrong about the video but I’ll never watch to find out.




        2
        1. Out of sight, out of mind eh Lonie.

          The video simply shows the realities of what the innocent animals we SHARE this planet with go through at the hands of humans. It’s a harrowing watch and one that made me cry (38yr old male at the time). I linked it in the hope u might view it and make the connection with your complicity in the processes involved in animal agriculture. The time isn’t right for you obviously, but someday I hope you’ll find it in your heart to change.

          I know full well that people hate be told what to do and how they should feel etc. However, when the lives of innocents are at stake then I feel it is now my duty to provide information and resources to those that haven’t yet realised the truth.




          8
          1. Scott, I don’t object to your being a caring, empathetic person. To the contrary I admire people like you.

            But I spent some 25 years in an over-caring mode as I looked after my Mother after my Dad died. And I came to the conclusion that if you care too much, it can be detrimental to ones health… that is, you actually feel someone else’s pain or mood.

            It’s not that I’m incapable of caring… it’s just that I’m pretty much spent in that regard and avoid situations where I get into that sorrow pit again. And yes I once thought I could save the world, but have evolved into someone just trying to have a good place in it.

            All I’m sayin’ is when anyone posts a video or link (of any kind) they should briefly describe what the subject is so one doesn’t feel ambushed.




            3
            1. And I don’t want to hear your pathetic ramblings about loving ice cream, mum & dad. Past caring about people like you. Tough world, heh!




              0
              1. OOOOwwww… La dulce vitrol, don’t know if that is tough love or flocculent hate, but either way, glad to hear I am no longer on your radar. ‘-)




                2
    1. Lonie, the kind of information you are asking someone to put together for you is a boatload of work and pertinent to, . . .well, . . .probably mostly just you. Perhaps you could research those questions about how much each individual meat or dairy or whatever produces how much TMAO (or whatever) and develop a hand-dandy little table and share the work here on this site. Maybe contribute a little . . . .




      5
      1. Orrrrrrrrrrr…. Dr. Greger and his enormous staff could do the work beforehand and actually put out a detailed video rather than throwing out generalities backed up by a few generalized graphs.

        Annnnnddddd…. if you read my posts you will see I contribute much of my book of knowledge gained over some 40 odd years when I first began to realize I had to take my health in my own hands.

        Come to think of it, I’ve only been on the site for less than a year and I don’t recall any great contribution you’ve made?




        3
  9. Good video. There is an unmentioned source of TMAO that comes lecithin in for example soy or sunflower seeds

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701945/

    “Recent studies in animals have shown a mechanistic link between intestinal microbial metabolism of the choline moiety in dietary phosphatidylcholine (lecithin) and coronary artery disease through the production of a proatherosclerotic metabolite, trimethylamine-N-oxide (TMAO). We investigated the relationship among intestinal microbiota-dependent metabolism of dietary phosphatidylcholine, TMAO levels, and adverse cardiovascular events in humans.”




    0
    1. Your article is on egg lecithin not soy.

      We quantified plasma and urinary levels of TMAO and plasma choline and betaine levels by means of liquid chromatography and online tandem mass spectrometry after a phosphatidylcholine challenge (ingestion of two hard-boiled eggs and deuterium [d9]-labeled phosphatidylcholine) in healthy participants before and after the suppression of intestinal microbiota with oral broad-spectrum antibiotics. We further examined the relationship between fasting plasma levels of TMAO and incident major adverse cardiovascular events (death, myocardial infarction, or stroke) during 3 years of follow-up in 4007 patients undergoing elective coronary angiography. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701945/




      5
      1. You can read more here:

        http://www.nejm.org/doi/full/10.1056/NEJMoa1109400#t=articleDiscussion

        “participants were given two large hard-boiled eggs including yolk (containing approximately 250 mg of total choline each) to be eaten within a 10-minute period together with 250 mg of deuterium-labeled phosphatidylcholine (d9-phosphatidylcholine).

        The high-purity d9-phosphatidylcholine (>98% isotope enrichment) that was provided was synthesized from 1-palmitoyl-2-palmitoyl-sn-glycero-3-phosphoethanolamine after exhaustive methylation with d3-methyliodide (Cambridge Isotopes Laboratories). ”

        CONCLUSION: “The production of TMAO from dietary phosphatidylcholine is dependent on metabolism by the intestinal microbiota. Increased TMAO levels are associated with an increased risk of incident major adverse cardiovascular events”




        2
  10. @Jerry Lewis –
    The first link does not support your claim that “there is no evidence it causes diseases”. Rather, it claims that this area of research still has open questions, in particular, whether TMAO is really a mediator or just a marker of disease. Here’s the summary for those interested (note the sentence I put in asterisks):

    “To summarize, recent studies point to the potential contribution of gut microbiota-derived
    production of TMAO from the metabolism of dietary choline and L-carnitine and the increased
    risk of developing atherosclerotic heart disease. Interestingly, TMAO plays an important physiological
    role in lower animals, but in humans it is merely a remnant of the evolution of the osmolyte system.
    It is possible that accumulation of TMAO in humans in disease state may be an adaptation of cells to
    stress and, hence, a marker rather than a mediator of disease.

    ***On the other hand, there is accumulating clinical and laboratory-based studies attributing a pathogenic role to this molecule.***

    It is important to undertake studies examining intracellular concentrations of TMAO in mammals, cellular signaling
    and also determine the effects of TMAO on enzymes and other proteins in order to establish the role of
    TMAO in health and disease in humans.”

    >>> ” It is essential that everyone, meat eater or vegan, to maintain a good microbiome environment. When they do then TMAO is not an issue since the body is supposed to balance out everything. ”

    Who would disagree with the view that it is “essential to maintain a good microbiome environment”? The issue is what kind of diet promotes a healthy microbiome. Whole food plant diets do this.

    >>>’Choline in abundance in eggs in particular, is one of the most beneficial nutrients of all. The accusation that choline produces TMAO is false and TMAO is vt itself harmless as described above.’

    How does the Whole Foods link support your claims? If you are claiming that vegans are necessarily choline deficient, you need an actual argument, not some link to a Whole Foods chart showing foods rich in choline. Just because Whole Foods claims certain foods are among the healthiest, does not make it so. Nothing in your post or your links demonstrates that TMAO is harmless.

    >>> One type of foods does not exclude the other type.
    Of course, everyone knows the dose makes the poison. How much animal food are you talking about? Less than, say, 5% of calories might put one into a “fairly safe zone”, statistically speaking. Still that would not show such a diet is either necessary or ideal.

    And in general, for all your talk about the importance of eating animal products of the “right kind”, you never — ever — deal with the opposing arguments provided by Dr. Greger or others, e.g. Thea.




    26
  11. Jerry Lewis PLEASE make your own website since you think you are so much smarter than the science presented here. You are free to believe and act on anything at all, but the rest of us don’t care about your personal OPINIONS and find your commentary egotistical and annoying!




    23
  12. Hi Michael McKee, thanks for your question. I am one of the volunteer dietitian at the website. I like to point out that every individual is different as far as absorption and digestion of food. The new studies points us all towards the gut microbial function and how they break down the food that one consume. I don’t know how these individual studies that you refer in the above link were designed but one can argue that there could be a number of studies that would disagree with their findings.
    I can include this study that indicates the adverse effect of l-carnitine from animal source. Also Dr Greger always indicates the amazing power of Plant based food. I refer you to this Video which has a powerful message.

    Treating Advanced Prostate Cancer with Diet: Part 1
    γ–Butyrobetaine is a pro-atherogenic intermediate in gut microbial metabolism of L-carnitine to TMAO




    1
  13. I’d agree that the Hazen lab’s focus on TMAO is a bit misplaced. Yes, its possible to accelerate atherosclerosis in rodent models by feeding them enough choline or carnitine that their plasma TMAO rises 100-fold that typical in human omnivores, but if it was a primary cause of CVD/CKD, we’d see higher rates of those diseases in fish eaters, who consume a bunch of preformed TMA.

    Personally, I think plasma TMAO, which is associated CVD and CKD mortality, isn’t so much a primary cause of these diseases, but a coincident marker of the effects of animal product heavy diets on the gut microbiota composition. And that has its effects through other mechanisms, like metabolic endotoxemia.




    8
  14. I have difficulty digesting fats. I am vegan. My acupuncturist advised me to take choline during a fatty meal. Is a vegetarian source of choline a problem? It certainly helps my fat digestion.
    Thanks.




    1
    1. Just eat a low-fat diet.

      I know Dr. Greger really pushes the fatty foods like nuts and seeds, but a number of prominent doctors recommend against fatty plant foods, including Dr. Caldwell Esselstyn, Jr., Dr. Neal Barnard, Dr. Dean Ornish, and Dr. John McDougall. Plant foods high in fat seem to play a role in diabetes, which Dr. Neal Barnard discusses in his newest book, The Cheese Trap, and Dr. Caldwell Esselstyn, Jr. continues to insist that nuts make heart disease worse. He’s been treating it for decades, so I trust his judgment.

      I tried the Daily Dozen for almost a year but it just made me fat and tired. I have finally lost the 15 pounds I gradually gained on the Daily Dozen thanks to giving up nuts and seeds. My energy levels went back up to normal as well. I still follow the rest of the Daily Dozen but for me it’s now the Daily Ten.

      Keep in mind that Dr. Greger is presenting us with his interpretation of the science, not the science itself. The doctors I mentioned above have read the same literature and come to different conclusions.

      Good luck!




      7
      1. Dr. Ornish has now updated his recommendations regarding nuts and seeds based on the current nutritional science – https://www.ornish.com/zine/new-scientifically-validated-guidelines-nuts-and-seeds/ – per Dr. Fuhrman and Dr. Greger, you don’t need very much of these to reap the health benefits – Dr. Esselstyn has said that he is concerned about his patients with heart disease being able to keep their consumption modest so he chooses to tell them to avoid them instead of following the science – apparently, he does not trust his patients to control themselves – perhaps warranted in a life and death situation such as advanced heart disease




        3
        1. You dont need that much nuts to impair your health and energy level also…extremely high in fat and very hard to digest for most peoples, avocadoes are much better and easier and less rich in fat or even better fatty acids from every others fruits/vegetables/stachy foods., including omega ones~




          0
  15. I don’t eat meat, dairy or grains but I just started drinking high quality bone broth that is 100% grass fed and organic.
    Is bone broth bad for you as well, like meat?




    2
    1. How is bone broth not considered meat?

      If I were you, I’d get my lead levels checked ASAP. You don’t want to mess around with lead poisoning. I’ve seen what it can do to adults, and it’s not pretty.




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  16. Do those who do not make TMAO from TMA live longer or have fewer cardiovascular events??

    My understanding is Coach Alberto Salazar gave Carnitine IV (Dr. Administered) to improve fat burning levels in athletes (Dathan Ritzenheim was one), I think glucose may have been administered with the carnitine as there is some evidence insulin helps with carnitine absorbtion into the muscle. I also understand carnitine levels decrease with aging. I would think administration of carnitine IV would avoid the synthesis of TMAO. Would it be worthwhile to administer carnitine in this way in order to restore youthful levels to those who are aging??? Benefits??? Drawbacks??? The New york Times is where I originally read about the Salazar connection to carnitine.

    Do Vegans, who manufacture little or no TMA with carnitine administration, progress to TMA synthesis with carnitine supplement administration over time??? How long does this take??

    I understand there is not a lot known about this yet and the answers to these questions may not be there yet.




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  17. How come Dr. Wallach eats a dozen eggs a day and tell people to eat eggs? And why Mark’s Daily Apply doesn’t talk about this? Who to believe? I’m so confused! Is Mark and Dr. Wallach both killing themselves slowly?




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    1. I wouldn’t trust anything claimed by Wallach. He has a doubtful reputation

      https://www.quackwatch.org/01QuackeryRelatedTopics/DSH/colloidalminerals.html
      http://skepdic.com/wallach.html

      And Mark Sisson is just another paleo low carber with a talent for selling pills. potions, books and courses online. Why should anyone believe him when there are free evidence-based online reports on nutrition and health from the World Health Organization, the World Cancer Research Fund and the US Dietary Guidelines expert scientific advisory panel.

      To my mind, those to people are just internet marketers whose advice isn’t consistent with the actual evidence but it attracts attention and helps their sales..

      .Basically, every credible health authority in the world states that people should be eating more whole grains, fruits and vegetables. – essentially a whole food plant based diet. I am not aware of anyone telling us us to eat eggs, let alone to eat them every day.




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      1. I wouldn’t trust anything claimed by Wallach. He has a doubtful reputation

        https://www.quackwatch.org/01QuackeryRelatedTopics/DSH/colloidalminerals.html
        http://skepdic.com/wallach.html

        And Mark Sisson is just another paleo low carber with a talent for selling pills. potions, books and courses online. Why should anyone believe him when there are free evidence-based online reports on nutrition and health from the World Health Organization, the World Cancer Research Fund and the US Dietary Guidelines expert scientific advisory panel.

        To my mind, those two people are just internet marketers whose advice isn’t consistent with the actual evidence but it attracts attention and helps their sales..

        .Basically, every credible health authority in the world states that people should be eating more whole grains, fruits and vegetables. – essentially a whole food plant based diet. I am not aware of anyone telling us us to eat eggs, let alone to eat them every day.




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    2. Leo53B,

      Indeed nutritional reality is confusing. A couple of considerations.

      Everyone is different and some people can tolerate a completely unusual diet, to their betterment. With that said there appears to be enough literature to document the need for a wide range of interactive nutrients and not a focus on a singular food, be that eggs, etc.

      Not unlike any of the other nutritional researchers we can pick and choose what to highlight and make a case for literally any diet. One of the best indications for clarity…. how do you feel and function. You might consider trying changes to your diet and then testing appropriately….biological age, blood, wide genetic panel, hormones and other objective measures. Couple this with how your body and mind work and you can find direction.

      I would be most interested in seeing some of their lab work, including inflammatory markers and cholesterol fractionation for these two folks. Yes it’s an N of 1 but that’s why we (NF) take the time to search the literature and try to find the most appropriate studies and their meaning to help make sense of the evolving science. I encourage you to continue to question what makes sense and experiment with your body to optimize it’s function.

      Dr. Alan Kadish moderator for Dr. Greger http://www.Centerofhealth.com




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  18. I LOVE the way you write. Just as if you’re talking with someone (us). Makes it easier to read and learn the important stuff. Keep it up! : ))




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