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Gut Dysbiosis and Heart Health: Understanding the Role of TMAO

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Gut Dysbiosis

In recent years, trimethylamine N-oxide (TMAO) has garnered significant attention in medical and nutritional circles. TMAO is a compound produced in the liver from trimethylamine (TMA), which in turn is derived from dietary nutrients such as choline, phosphatidylcholine (lecithin), and L-carnitine found in animal products, particularly red meat, eggs, and fish. Elevated levels of TMAO in the blood have been linked to an increased risk of cardiovascular diseases (CVD) and other health issues. However, it’s crucial to understand that the problem lies not in the consumption of these foods per se, but in the health of our gut microbiota.

What is TMAO?

TMAO is a metabolite that originates in the gut. When we consume foods rich in choline and carnitine, certain gut bacteria convert these nutrients into TMA. The TMA is then absorbed into the bloodstream and transported to the liver, where it is converted into TMAO by hepatic enzymes. TMAO has been found to play a role in the development of atherosclerosis, the buildup of plaques in the arteries, which can lead to heart attacks and strokes.

The Risks of High TMAO Levels

High levels of TMAO have been associated with several adverse health outcomes:

1. Cardiovascular Disease (CVD): Studies have shown a strong correlation between elevated TMAO levels and increased risk of CVD. TMAO appears to enhance cholesterol deposition in arterial walls, promote inflammation, and impair the body’s ability to excrete cholesterol, thus accelerating atherosclerosis.

2. Chronic Kidney Disease (CKD): Elevated TMAO levels have also been linked to CKD. The kidneys play a crucial role in excreting TMAO, and impaired kidney function can lead to its accumulation, exacerbating kidney damage.

3. Thrombosis: TMAO has been implicated in promoting platelet hyperreactivity and clot formation, which can lead to thrombosis, a condition where blood clots form in blood vessels, posing risks of heart attacks and strokes.

Gut Dysbiosis: The Real Issue

While it might be tempting to conclude that avoiding foods rich in choline and carnitine could mitigate these risks, the real issue lies in the state of our gut microbiota. Gut dysbiosis, an imbalance in the gut microbial community, plays a pivotal role in the overproduction of TMA.

In a healthy gut, a diverse and balanced microbial population helps in the proper metabolism of various nutrients, including choline and carnitine. However, factors such as poor diet, stress, environmental toxins, antibiotic use, and lack of physical activity are just a few of the factors that can disrupt this balance, leading to an overgrowth of TMA-producing bacteria.

Vitamin D may help lower levels of trimethylamine N-oxide (TMAO), a compound associated with increased risk of heart disease, through several potential mechanisms:

1. Inhibition of TMA Production: Vitamin D might reduce the production of trimethylamine (TMA), the precursor to TMAO, by affecting the gut microbiota composition. Certain bacteria in the gut convert choline and carnitine from dietary sources into TMA, which is then converted to TMAO in the liver. Vitamin D could influence the growth of these specific bacteria or the expression of their enzymes required for TMA production.

2. Liver Enzyme Regulation: Vitamin D might modulate the activity of flavin-containing monooxygenase 3 (FMO3), the liver enzyme responsible for converting TMA into TMAO. Studies suggest that vitamin D can influence gene expression, including those genes involved in liver function and enzyme regulation.

3. Anti-inflammatory Effects: Vitamin D is known for its role in reducing inflammation. Since high TMAO levels are also associated with inflammatory states, vitamin D’s anti-inflammatory properties might indirectly contribute to lower TMAO levels by improving overall gut health and reducing systemic inflammation.

These mechanisms suggest a multifaceted role of vitamin D in regulating TMAO levels, potentially offering therapeutic benefits in reducing heart disease risk associated with high TMAO levels. Further research, however, is needed to fully understand these interactions and to confirm the clinical relevance of these effects.

Addressing Gut Dysbiosis

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Elevated TMAO levels and their associated health risks are more a reflection of gut dysbiosis than the mere consumption of meat and other animal products. By focusing on improving gut health through a balanced diet, responsible antibiotic use, and healthy lifestyle choices, we can mitigate the risks associated with high TMAO levels. It’s time to shift the narrative from demonizing specific foods to fostering a healthier gut microbiome for overall well-being.


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Frequently Asked Questions

I’d like to receive an online second opinion from Natural Heart Doctor. What do I do next?

You can initiate a second opinion online through our website at any time. To begin, select the team member you’d like to speak with and open an account.

Click here for cardiologist Dr. Jack Wolfson.

Naturopathic Medical Doctor Dr. Lauren Lattanza. Get details.

Naturopathic Medical Doctor Dr. Tonia Rainier. Get details.

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Alternatively, you can email A member of our care team will help guide you through the process of starting a second opinion.

What is the cost of a Natural Heart Doctor Online Second Opinion?

The cost for most second opinions varies by team member. This fee includes information collection, a phone or video consultation, a second opinion from a Natural Heart Doctor specialist and guidance throughout the process from your personal Care Team at Natural Heart Doctor.

Cardiologist Dr. Jack Wolfson’s Second Opinion Fee is $1500.

Holistic Physician’s Dr. Lauren Lattanza’s Second Opinion Fee is $250.

Naturopathic Physician Dr. Tonia Rainier’s Second Opinion Fee is $250.

Note: We apply the Online Second Opinion Call fee as a credit to any future consultations with Natural Heart Doctor, should you choose them.

Will my insurance cover the cost of a Natural Heart Doctor Online Second Opinion?

Most likely, no. Most health plans do not cover online second opinions or consultations. You are responsible for the cost of our second opinion. Natural Heart Doctor cannot file a claim with your insurance carrier, nor can we provide a procedure (CPT) code for this service.

What is the timeline to receive an online second opinion?

We do our best to schedule your second opinion as quickly as possible. Typically, it takes 5 to 7 business days after your information has been collected to receive your phone or video online second opinion.

What information do you need in advance of our call?

Our office will send you a short questionnaire to complete and return. We DO NOT need your complete medical records.

How many questions can I ask the expert during our call?

You may ask a maximum of five questions. This is to ensure that the expert has sufficient time to devote to each question. All questions must be finalized before your online meeting.

What should I expect to receive once my second opinion is complete?

You will receive a summary of our discussion along with our second opinion. The second opinion will be in written form. After you have reviewed the second opinion, a Natural Heart Doctor clinician will follow up with you by phone to address general medical questions about the information provided in the second opinion.

What if I have follow-up questions for the expert after I have reviewed my second opinion?

If you have a clarifying question about an expert’s response to one of the questions in your second opinion, and the Natural Heart Doctor clinician is unable to address it, then you may request a follow up session for an additional fee. 

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Natural Heart Doctor is strongly committed to protecting the privacy and security of all our patients. Our website meets all federal requirements for protecting personal health information under the Health Insurance Portability and Accountability Act (HIPAA). All financial transactions are processed by Natural Heart Doctor securely using industry standard payment processing tools.

I would rather visit Natural Heart Doctor for an in-person appointment. What should I do next?

If you would prefer an in-person appointment at Natural Heart Doctor instead of an online second opinion, please call (480) 535-6844 for details and scheduling.

Can I schedule a follow up appointment with the specialist who provided my online second opinion?

Yes, we’re happy to help you on an extended basis. Our clinician can discuss options with you when presenting our second opinion summary.