I'm going to do another in the series on trimethylamine oxide. This is on a
an editorial that has to do with nature versus nurture. The editorial was
actually printed in the New England Journal at the same time as the article
by Tang and associates the April 2013 article that was a significant landmark.
It was a landmark regarding the whole issue around - cardiovascular risk
and TMAO. Now why is that not on a nature versus nurture? Well he's not
really arguing for nature or nurture He's saying it's a dumb question it's
it's naive and overly simplistic. Now why is he saying that? I'll get to that in a
minute but first of all there's you know maybe I get too focused on context but I
stay well very well focused on context let me introduce a couple of things: 1
myself my name is Ford Brewer. I'm a
physician- started off in the ER emergency department and that gets you
really focused on prevention. Iwent to to get training in prevention and have
actually ended up running the program and I've ended up training doc - primary
care docs and prevention for three decades since then. 2. An intro on the channel -
this is the prevention science Channel. A lot of people would say you know what
and I get a lot of this feedback well quick get to the bottom line just tell
me what to do well unfortunately right now there's a lot of things that you can
like TMAO egg yolks I could tell you it to eat them or I could tell you don't
eat them and I've got very good evidence on both sides to indicate that I'd be
right - ( so as you as you'll see in my channel) quite often I frustrate people
with giving you the facts - giving you what's known and what's not now and
leaving it to you to form your own conclusions you know this sort of like
reality you get the facts but then you still don't know what to do I think
you'll get some interesting information out of this and again enough information
to to make some of your own decisions The last thing I wanted to introduce
again is very briefly a lot of people don't even know of what I'm talking
about with TMAO lecithin think egg yolks and lecithin was discovered back in
the mid-1800s -1880 or so and it was part of egg egg yolk and lecithine - which
it was named after - is French for egg yolk phosphatidylcholine is one of the
major components of lecithin or egg yolk you find it in obviously eggs cheese and
meat take it in the diet bugs inside the diet will turn that into trimethylamine
which is then oxidized by the liver to try methyl amine oxide that has been
associated with atherosclerosis cardiovascular disease now as I said
there's still a lot of debate around that some people are saying you should
not only take choline you should supplement it I've got a video that
talked about some of that research recently others would say no there's
significant cardiovascular risk and this is the again as I mentioned the landmark
article by Tang and associates in April 2013 the New England Journal of Medicine
where they're saying," look ,intestinal microbial
metabolism - phosphatidylcholine is cardiovascular risk so just very briefly
I will also cover that summarize that very quickly this is a very interesting
study design they had patients come in three times
the first time they each time they gave him a phosphatidylcholine challenge and
then they measured it was radio actively identified or tagged and then they
measured the upcoming spike in trimethylamine oxide so therefore
indicating yes this phosphatidylcholine is being turned by the gut bacteria into
TMA which is then being turned into TMAO
"Wait ,"you might say , "how did they prove that the gut biome was doing that?"
Between the first and second visit they gave him antibiotics did the second
visit and saw a significant a huge decrease in fact a basic absence of the
spike in TMAO after the phosphatidylcholine challenge so without
the gut bacteria in the second visit the phosphatidylcholine was now being turned
into into TMA trimethylamine so there was nothing for the liver to oxidize a
few weeks later they came back for the third visit redid it and you could see
regrowth of the gut and reintroduction of that TMAO challenge what was scary
and interesting was they followed these people for three years after separating
them into the :highest, next to the highest next and then least TMO levels
in their spike. The people of the quartile that had the highest also had
the highest heart attack stroke and death rate over the next three years
they did some other things in terms of modeling and showed that it didn't
appear to be totally due to other cardiovascular risks (such as pre
diabetes diabetes & age). One of the other things that they showed - that they
indicated - they really didn't talk about it because they didn't know it was
significant at the time was that there was this significant in a different term
and there was significant interaction with kidney disease (and again we've seen
that in other more recent research which I've covered in a different video) so
back to the editorial as this editorial was in the same issue of the New England
Journal it was done by Joseph Loscalzo - and he said look this whole issue
of nature versus nurture is too simplistic that it was Galtonian
I'll read the sentence the Galtonian distinction between the influence of
genetics in the environment on the phenotype is now widely recognized as
overly simplistic - an overly simplistic dichotomy. Well first of all
- who is Galton? Francis Galton was a eugenicist in 1919 century England.
What he's talking about here is nature versus nurture. He was a major proponent
of that whole argument and what we're saying here is and I think this is the
key message in this video. This whole message and this whole argument about
nature versus nurture is dumb! It's overly simplistic. A couple of
reasons the first reason is this that assumes that there's no interaction
between the genes and the environment and the reality is there is interaction
between genes and the environment the second reason why nature versus nurture
alone as it stands is a dumb question is which genes are you talking about and
that's very appropriate for this whole issue of TMAO. He points out that there
are more genes in our bugs than in us!. In fact 100 times
more genes the bugs - that live on the bacteria viruses that live on our skin
and in orifices and by far the most - the biggest contribution of our microbiome
in terms of genetics - is our gut so he goes on to talk about a couple of other
things. There are other diseases where this has already been shown to be a big
issue. Our microbiome and the genetics associated with it one of them is with
periodontal disease. I've got several videos on that issue
Another one was rheumatoid arthritis. Rheumatoid arthritis, as I've mentioned
several times, is as much of a risk for heart attack and stroke as diabetes and
inflammatory bowel disease. now what what else does he cover? The rest
of the his article doesn't really cover a lot of major significance. He goes in
and reviews the Tang article which we've already done he does talk about in the
end something that's interesting he talks about potential mechanisms for
TMAO being associated with cardiovascular disease one being
oxidation-reduction. TMAO is a major oxidizer and it chews up glutathione
many of you have heard of glutathione as the mother of antioxidants. Another
potential mechanism has to do with its methyl us. It's got a significant role
in methyl metabolism. Many of you also know that methyl metabolism and
oxidation reduction are both very much related. There was a 3rd mechanism I'll
just check it out real quick and then we'll wrap up
oh and TMAO itself so those of you who've made it this far thank you very
much for your interest no I'm not going to tell you whether you can eat egg
yolks or not. Do I eat them? Yes I do thanks.