I'm going talk about trimethylamine oxidase TMAO. Now why is that important?
well before we'll talk about why it's important let me just read this quote
this is from a New England Journal of Medicine article that was that one of the
landmark articles in this area "increased TMAO levels are associated with an
increased risk of incident major adverse cardiovascular events" and we'll show you
the numbers actually let me just go right down and show you that real quick
because there's a there's a catch here this is the myocardial infarction rate
for people with higher levels of TMAO now having seen that and heard the quote
I just gave why is everybody or why are so many
people ignoring TMAO levels and you know that I tend to as well (tend to ignore it) so now that's
interesting isn't it so what does TMAO come from
it's trimethylamine oxide and it comes from a couple of precursors and here's
why this is important this gets to a major debate plank or a major debate
topic for vegans versus animal product eaters. Those egg
yellows those egg yolks right there are full of choline that bacon there has a
lot of carnitine in it this beef is full of carnitine salmon full of choline and
carnitine and all of these products even including the legumes the some of these
beans and the the almonds have choline in them and that sort of confuses that
vegan argument but let's leave that confusion aside and let's just
talk about TMAO and health and heart attack and stroke now before we get too
deep into this what is TMAO how is it formed and that should be somewhere on
this oh gosh let me see if I can find that TMAO is is
formed by bugs (bacteria) in our colon .we eat precursors which I just mentioned here
we eat precursors which I just mentioned
cheeses meats eggs and when we digest those and they get down to our
small intestine & colon the microbiota which is a fancy way of saying the bugs the germs the
bacteria in our colon act on those those precursors I believe they reduce them
and then the gut absorbs them. there's a thing called the splanchnic vasculature
all that that's another technical term all it means is the vessels that go from
the large & small intestines back up to to the liver so the liver is
a filter and stuff goes through the filter the liver before it gets put into
the rest of the bloodstream in the liver the liver oxidizes these. this TMA
trimethylamine to TMAO now why on earth would you see the kind of numbers that
we saw down here with increased (sorry about all this up and down) with this
increased level and the increased cardiovascular event
associated with a increased level of TMAO again we'll get to that in just a
minute but let's go back and just cover some of the aspects of this study to
make sure that you know. I've got a lot of physicians that watch
this channel and one of the things that I hear is I really appreciate you
covering this because I've never taken the time to look at the study so let's
just look at the study real quick as we get closer to
the end we'll talk about why so many people are ignoring this somewhat -
present company included - so again New England Journal April 25th
2013 and - and I'll put a link in the under the video in the description
"intestinal microbial metabolism of phosphatidylcholine and
cardiovascular risk" so they start out with a background comment which was
known prior to this study that people that have high levels of TMAO can have
some significant risk. it wasn't known. this is one one of the two studies in this
article actually helped confirm that. it was done at the Cleveland Clinic with
quantified plasma and urinary levels of TMAO and plasma choline &betaine,
(which is a related chemical) by some laboratory methods. now here's what they
did they did an interesting they did two
studies the first one was they took 40 people and they labeled did deuterium
labeling radioactive labeling of of hard-boiled eggs and choline and they
gave this to those 40 people they measured their TMAO level afterwards and
sure enough it increased now then they said oK we've proven that this dietary
choline is resulting in an increase in TMAO and the blood stream then
- they gave the patients a broad-spectrum antibiotic to wipe out
the bugs (bacteria) in the microbiome the bacteria in their intestines once they wiped out the
bacteria in their intestines they did this study again and guess what they did?
they not see an increase in blood TMAO so yes that showed a couple of things not only
did the TMAO come from dietary sources it also certainly appeared to happen and
as a result and dependent upon bacterial impact then after those two phases of
the study they went back to let these people go home for eight weeks
repopulate their intestines and they tried it again sure enough after that in
that third trial once again - they added choline back to the diet very soon thereafter
the TMAO levels increased so that was one of two studies they did they then
they did another study where they took about 4,000 people and they
followed them they first off started by measuring their TMAO levels and then
they followed them for heart attack and stroke so those are the basics of this
study now I want to make sure we see these are the statistics showing the peak
after the first time of TMAO and it was what three and a half hours after after
the eating the the choline challenge this visit to was do after the
antibiotic and visit 3 was after they had gone home for eight weeks and
repopulated they're good now let's go down and and deal with I think the
ringer in this issue the thing that the reason why
why people see these kind of numbers reacted to them and then begin to wonder
is this really a problem so here's the thing it has to do with kidney function
so what's been seen a few times is TMAO levels may be as much a function of
kidney kidney performance as it is of this in other words all of this does
appear to be true however in a healthy kidney if you have healthy kidneys it
appears you can clear TMAO quickly and therefore decrease the time that your
body's under the stress from increased levels of TMAO so I will be doing
another video it'll be coming out soon and it gets a lot more into detail
on this specific issue thank you very much for your interest and see in the
next video