Reviewed by Stanley Hazen, MD, PhD, Department Chair of Cellular and Molecular Medicine and Section Head of Preventive Cardiology and Rehabilitation at the Cleveland Clinic.
A growing stack of research suggests that compounds in red meat, egg yolks and high-fat dairy products raise risk for heart disease—a leading health threat for people with diabetes—via a surprising route: Gut bacteria that help convert choline and carnitine from these foods into a chemical that crams heart-menacing plaque into artery walls.
TMAO harms heart 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 in bile acids. And it may also increase inflammation.
In late December, the Cleveland Clinic researchers announced they’d found a potential antidote. A chemical called DMB stops gut bacteria from converting choline and L-carnitine into TMA (trimethylamine— the compound that the liver turns into nasty TMAO). In lab studies, DMB kept TMAO levels in the blood lower and led to a shrinking of artery plaque. And in the intestines, levels of TMA-producing bacteria dropped. The study was published in the December 17, 2015 issue of the journal Cell.
DMB is found in some types of extra-virgin olive oil, grapeseed oil, balsamic vinegar and red wine, according to the study.
Lead researcher Stanley Hazen, MD, PhD, Department Chair of Cellular and Molecular Medicine and Section Head of Preventive Cardiology and Rehabilitation at the Cleveland Clinic says it’s too soon to for a specific TMAO-clobbering dietary prescription for people. In part, that’s because individual differences in gut bacteria make a big difference in TMAO levels. “It's more about the gut microbes than the diet, though chronic dietary efforts can change the gut microbe composition and lower TMAO” “Even so, many vegetarians have high TMAO,” he says. That is why Dr. Hazen suggests a that a person with a high blood TMAO level should consider more aggressive preventive efforts – such as keeping blood pressure, cholesterol and weight down to healthy levels.
In fact, Dr. Hazen and his team hope that someday soon, their work will lead to a TMAO treatment that targets gut bacteria. (An enthusiastic editorial published with the study was titled “Drug the Bug!”) Still, his research has turned up food clues that could help and can’t hurt:
People with diabetes may want to pay special attention to future news about TMAO, says Peter Clifton, PhD, Professor of Nutrition at the University of South Australia and lead author of the review on red meat and diabetes. “It should pose more risk for people with diabetes and low HDLs,” he said in an email interview.
More human studies are needed, Dr. Clifton adds. Some studies and reviews, for instance, suggest carnitine could play protective roles in the body and in cardiovascular disease. In the meantime, he says, “I think meat minimization and processed meat [ham, bacon, sausage] avoidance is good advice for all.”