Does TMAO *cause* Heart Disease? | Kevin Klatt PhD RD

Is TMAO a cause of heart disease or an innocent bystander? What is TMAO and what foods raise it? Should we avoid foods high in TMAO (or foods that raise TMAO levels)?

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Animations: Even Topland @toplandmedia

References:
TMAO production from choline & carnitine:

TMAO & risk of disease:

TMAO genetics (mendelian randomization):

What fraction of TMAO level is explained by diet?

TMAO & microbiome:

TMAO, whole grains and fish:

Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author's knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!.

#NutritionMadeSimple #GilCarvalho

0:00 What is TMAO?
1:35 Cause or innocent bystander?
3:22 Randomized trials
4:16 Genetics
5:37 TMAO levels
7:14 Observational studies
10:37 Diet vs endogenous production
12:04 Whole grains and fish
15:42 Individual nutrients
19:25 Small effects

[ThomasMeli]

One can only hope your calm, rigor, candor, nuance, and open-mindedness sends a wave of inspiration to the rest of the YT community through your success. Thanks for doing what you do.

[alexsmith-gntp]

In general, the quality of the comments reflect the quality of this channel's content. ❤

[HakuCell]

18:20 good point: any food can be claimed to be bad based on some isolated components.
19:20 the effect of sodium on blood pressure is relatively small, but the dash diet is overall good to reduce blood pressure.

[Freeduradura]

Dr. Gil is a gift, make us think critically 🙏

[Teneab]

I WOULD LOVE an interview with someone about choline, specifically addressing 1. if it's really that essential and 2. if vegans or others with plant-based diets should worry about it. PLEASE.

[paulelkins]

Excellent discussion and explanations of the unresolved subject of TMAO.

IMO, TMAO is likely a surrogate at all normal physiologic levels. However, at some to be determined supraphysiologic level it can become causative of CVD. Like everything the dose makes the poison.

[RC-tmjo]

Nutrition Made Simple! was closer to Nutrition Made Difficult! with this topic. It's nobody's fault since there is no clear evidence for this. I appreciate the honesty and not pushing for one way or the other as a majority of nutrition channels are heavily biased and cherry pick data to support their biases.

[sukeshjph]

The question is even though I primarily eat vegetarian with occasional fish, chicken yet I do take few supplements with choline like CDP choline and Alpha GPC to improve my cognition. And these sources can also make TMAO so also L-Carnitin supplements

[chrisjenkins]

I take a garlic supplement to block some of the conversion as a precautionary measure, since garlic is good for the heart outside of that already.

[johnnyd]

I wonder if the reason that people with Diabetes have a higher level of the TMAO is because of the heavy push by diabetic educator and the medical community pushes the high protein/low carb diets which would provide much more carnitine & choline than a plant based diet would, rather than the disease itself? Who knows, but it's the first thing that comes to my mind.

[JP-ATexas]

I was on a 100% whole food plant based diet and my TMAO was 7umol/L - I added fatty fish back into my diet (66yo - increasing protein without calories) and TMAO went up to 12umol/L - thats it - my apoB is 45 so Im completely unbothered.

[DarthNoshitam]

Heard lots of discussion about carnitine and choline, but I missed the parts about lecithin... is sunflower lecithin safe?

[peterz]

Kidney function. Something trying to surface in my memory about the effect of kidney function on TMAO impact.

[uniktbrukernavn]

I'm considering taking l-carnitine as a supplement but I'm still on the fence. The absorption rate is really low, you have to take 3-5 grams of L-carnitine so the body can absorb 0.5 grams.
I wonder what happen to the stuff that doesn't get absorbed.

I also read that you can eat garlic to prevent the negative effects of TMAO.

[gg-xx-r]

You say that fish and whole grains have a healthy "net effect". But is that actually true, when you replace nuts and legumes with the aquivalent caloric amount of fish and whole grains? And does an egg have a healthy net effect, when you replace the aquivalent amount of legumes or nuts by an egg? Compared to nuts and legumes the net effect of eggs, whole grains and fish actually might be unhealthy and that might be due to the cholin and TMAO, right?

[sectionalsofa]

Grammar police here. Why do all you BRILLIANT health advocates say "less" instead of "fewer?" It's so easy to correct. I'm no brainiac and I did it. Once you get it you'll never go back.