TMAO (Trimethylamine N-Oxide)

Specialist

also —

What it isTMAO is produced when gut bacteria metabolize dietary choline, carnitine, and lecithin into trimethylamine, which the liver then oxidizes to TMAO. The microbiome composition determines how much gets made.

DoesPromotes cholesterol deposition in vessel walls, impairs reverse cholesterol transport, and increases platelet reactivity.

GoodLow TMAO signals a microbiome that doesn't aggressively convert dietary substrates and tracks lower cardiovascular risk.

BadElevated TMAO predicts heart attack, stroke, heart failure, and all-cause mortality independently of traditional risk factors.

Standard

<6.2 µmol/L.

Optimal

0.5–3.0 µmol/L (lower is good)

Modifiers

Rises with red meat, egg yolk, and fish intake; influenced by gut microbiome composition.

How to optimize

Lifestyle: Zone 2 cardio, weight loss.
Diet: Reduce red meat and processed meat; emphasize plants, fiber, polyphenols, olive oil; some plant-forward eaters show very low TMAO; fish raises it in some.
Supplements: Resveratrol, polyphenols, soluble fiber (psyllium 10g/day), allicin (garlic extract), berberine.
Peptides: —
Drugs: —

within Cardiovascular & BP