According to a report on Endocrine Web, research from the Cleveland Clinic shows that a com­pound called trimethy­lamine N‑oxide (TMAO) has been linked to higher risk for ath­er­o­scle­ro­sis, heart attacks, heart fail­ure, kid­ney fail­ure and strokes.

Apparently, “TMAO threat­ens heart and brain health by encour­ag­ing the deposit of more cho­les­terol in artery walls. It also inter­feres with the process that whisks LDL cho­les­terol out of the body for elim­i­na­tion in the stool.” In fur­ther stud­ies, researchers found a “clear link between higher TMAO lev­els and ele­vated three-year risk of heart attack, stroke and death.”

The con­cept that gut flora con­tribute to ath­er­o­scle­ro­sis, heart fail­ure and chronic kid­ney dis­ease opens up excit­ing new nutri­tional and inter­ven­tional prospects.- Stanley Hazen, Cleveland Clinic

From the research con­ducted to date, it is known that cer­tain gut bac­te­ria, also known as the micro­biome, can con­vert two spe­cific nutri­ents, choline and l‑carnitine, into trimethy­lamine (TMA), which then makes it’s way to the liver where an enzyme con­verts TMA to TMAO. From there TMAO ends up in the blood­stream, affect­ing the heart, brain and other organs. Choline and l‑carnitine are found in red meat, egg yolks, high-fat dairy prod­ucts and some other foods.

However, researchers agree that peo­ple should not imme­di­ately assume that you should not eat red meat, eggs, or some of the other foods just men­tioned, as it is not yet clear exactly what increases TMAO. “It is pos­si­ble that other dietary sources may also increase TMAO includ­ing processed foods and car­bo­hy­drates,” Mente says on the Endocrine Web report.

At this stage there is an asso­ci­a­tion between choline and l‑carnitine, how­ever, this does not mean these food sources are the cau­sa­tion of higher rates of heart attack and so forth. In fact, the con­sump­tion of eggs has been shown to be healthy and even ben­e­fi­cial for car­dio­vas­cu­lar health in some stud­ies. Therefore, before any spe­cific dietary exclu­sions can be rec­om­mended, more research is needed into var­i­ous other dietary sources that could increase TMAO.

The impor­tant thing to keep in mind is that stud­ies are in fact link­ing the impor­tance of gut bac­te­ria to heart fail­ure, kid­ney dis­ease, brain health and var­i­ous other aspects of health. And, they also know that dietary inter­ven­tions can mod­ify the gut bac­te­ria, too.

Stanley Hazen, Chair of Cellular and Molecular Medicine and Section Head of Preventive Cardiology and Rehabilitation at the Cleveland Clinic sup­ports this view, say­ing that, “the con­cept that gut flora con­tribute not only to ath­er­o­scle­ro­sis but also to heart fail­ure and chronic kid­ney dis­ease, opens up excit­ing new nutri­tional and inter­ven­tional prospects.”

Altering TMAO pro­duc­tion is a case in point. In December 2015, the Cleveland Clinic reported they’d found a non-toxic chem­i­cal com­pound called DMB that could reduce TMAO.

According to the Endocrine Web report:

“DMB kept TMAO lev­els in the blood lower and also led to a shrink­ing of artery plaque and lower lev­els of TMA-pro­duc­ing gut bac­te­ria.”

Interestingly, extra vir­gin olive oil and red wine also con­tain the chem­i­cal com­pound DMB with one study show­ing, Hazen noted, “a Mediterranean diet was asso­ci­ated with lower TMAO lev­els.”

According to a study in Infectious Diseases and Translational Medicine, in mice, the DMB com­pound was shown to slow down the microbes pro­duc­tion of TMA, even when mice were fed a Western diet with high amounts of choline.

At this stage the only evi­dence avail­able is in mouse mod­els, but such research does pro­vide researchers with insight into how dietary inter­ven­tions such as the Mediterranean diet, a diet that has been shown to reduce car­dio­vas­cu­lar risk fac­tors, may alter gut microbes and pro­vide ben­e­fi­cial treat­ment for car­dio­vas­cu­lar and brain health. It is sug­gested that the alter­ation of gut microbes is per­haps one of the mech­a­nisms by which the Mediterranean diet exerts its many ben­e­fi­cial health effects.

When it comes to under­stand­ing the human gut bac­te­ria, researchers such as Hazen and oth­ers agree that there is still much left to be explored and answered.

Given that extra vir­gin olive oil con­tains the DMB com­pound, it is likely that many of its other phe­nols, polyphe­nols and antiox­i­dants could also exert pos­i­tive ben­e­fits on gut bac­te­ria, which we’ll likely see more research about in the future.



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