TMAO: A Toxic Substance Formed When You Eat Meat Can Make You … Dead Meat

Guest Post by: Robert Ostfeld, M.D., M.Sc. 

We can add another reason to the list of why we should not eat meat. If the saturated fat and cholesterol in meat were not enough, there is a newly identified toxic kid on the block: trimethylamineoxide (TMAO).^1,2

When we eat red meat, its carnitine interacts with our gut bacteria, forming trimethylamine, which is then metabolized by the liver into TMAO. And it appears that TMAO is not our friend.^1,2

TMAO promotes the formation of cholesterol plaques in our blood vessels, which make them less healthy and may lead to heart attack, stroke, and death. TMAO reduces our body’s ability to excrete cholesterol.^1,2 And, if that is not bad enough, TMAO may be linked to death from prostate cancer.³

The good news is that people who eat an exclusively plant-based diet appear to form little TMAO. In fact, when researchers fed steak to a vegan, virtually no TMAO was made.²  Why is that? Vegans, it seems, do not select for the specific gut bacteria that lead to the formation of TMAO, whereas meat eaters do. Hence, it’s as if plants create a coat of armor in our stomachs, protecting us when they are not even there.

So if we’re protected by plants, is it okay for us to eat steak for just a few days? Are we protected from TMAO? It appears that we may not be. The trillions of bacteria in our gut change very quickly. In fact, they may meaningfully shift even within one to two days!⁴ So aside from the many other deleterious effects of meat, even one day of steak could cut a chink in the natural armor afforded us by eating plants.

Notably, red meat is not the only source of TMAO. Choline, which is found in chicken, fish, dairy ― and even plants ― is another. Choline is structurally similar to the carnitine in red meat, and with the help of the same gut bacteria, also forms TMAO. Accordingly, when investigators fed omnivores an egg, they made TMAO.¹

Although we have no dietary need for carnitine, we do require dietary choline. So how can we get the choline we require without the unwanted company of toxic TMAO? The answer appears to be in the armor. Eating a plant-based diet selects for gut bacteria that do not lead to the formation of TMAO.² So even though we are eating choline in plants, our stomach’s plant-derived protection is in place, practically freeing us from concern about TMAO.

Science’s understanding of the interaction of our diet and gut bacteria and their influence on our health is at an early stage. However, evidence is mounting that a plant-based diet may be beneficial for this interaction in many ways. Yet another reason to go (or stay) plant based!

¹ N Engl J Med 2013; 368:1575-1584 April 25, 2013 DOI: 10.1056/NEJMoa1109400

² Nat Med. 2013 May;19(5):576-85. doi: 10.1038/nm.3145. Epub 2013 Apr 7

³ Am J Clin Nutr. 2012 Oct;96(4):855-63. Epub 2012 Sep 5

⁴ Nature 505, 559–563 (23 January 2014) doi:10.1038/nature12820

The original post can be found here.

Robert Ostfeld, M.D., M.Sc.

Cardiologist Robert Ostfeld, M.D., M.Sc. is the founder and director of theCardiac Wellness Program at Montefiore Medical Center in New York City, where he encourages patients to embrace a whole-foods, plant-based diet. He earned his M.D. at Yale and his M.Sc. in epidemiology at Harvard, and he is an associate professor of clinical medicine at the Albert Einstein College of Medicine.

As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice.

Robert Ostfeld, M.D. and the Cardiac Wellness Program

I am really excited to share this guest post from Robert Ostfeld, M.D. I got to meet Dr. Ostfeld at the recent NYCvegfest. Dr. Ostfeld is a cardiologist and the founder and director of the Cardiac Wellness Program at Montefiore as well as an Associate Professor of Clinical Medicine at the Albert Einstein College of Medicine in the Bronx, New York. It's a great honor to have Dr. Ostfeld share about his program! I hope you enjoy. 

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As a cardiologist, outside of an emergency medical condition that requires an urgent intervention, I have never seen anything come close to providing the breadth and depth of benefits that a whole-food, plant-based lifestyle offers.

However, ten years ago I would not have been writing this post or otherwise extolling the benefits of a plant-based diet. During my training at Yale and Harvard with many outstanding physicians and scientists, I learned little about this approach. For years after my training, I applied evidence-based medicine, recommended a “healthier” lifestyle, which typically included a Mediterranean-style diet, and watched as my patients’ diseases often progressed. I became frustrated. There had to be something more.

Fortunately, I was introduced to the work of Drs. Campbell and Esselstyn. Based on their research, I started a Cardiac Wellness Program at Montefiore Medical Center in New York City, where we encourage patients to embrace a whole-foods, plant-based diet. The results have been amazing. My patients’ chest pain and shortness of breath have dramatically improved. Their cholesterol has plummeted, they have lost weight, and they are able to eliminate or reduce the need for multiple medications for problems such as hypertension, diabetes, high cholesterol, and chronic pain.

I’d like to share a real-life example: A patient in his late 50s began to develop chest discomfort. It progressed to the point where he would feel it even as he sat still. Cholesterol blockages in his heart were the cause. He did not want any cardiac procedures, and he was started on all of the appropriate medications. However, he continued to have discomfort even walking a block or two. He then changed his lifestyle, embracing a whole-foods, plant-based diet. His cholesterol fell dramatically, he lost weight, and after just a few months he could walk over a mile. Now, two years and no procedures later, he is jogging over two miles and says he feels 30 years younger!*

Patients also describe benefits they may not have originally expected, such as more energy, improved complexion, clearer thinking, better sleep, fewer colds, improved erectile function, increased stamina, and more! In fact, patients have cried tears of joy from the results they have achieved. Frankly, I have fallen in love with being a physician all over again.

I am grateful that you are reading this, as the need for this type of lifestyle change is only growing. Heart and blood vessel disease is the number one killer of adult men and women in the United States,^{1, 2} and approximately two out of every three twelve-year- olds in the US has early signs of cholesterol disease in the blood vessels that feed their hearts with blood.³ We are literally killing ourselves from diet-driven disease.

Each of you influences many people in your family and community. Please join me in helping to spread awareness about the benefits of the whole foods, plant-based lifestyle.

In my years of practice I have learned that it is never too early to make this change, and it is never too late. When we are born, our bodies are like turbo engines. A few decades of animal products and processed foods later, we turn those bodies into clunkers. Let’s turn back the clock … because we can! 

*Patient identifiers have been changed. 

1. American Heart Association. Heart disease and stroke statistics–2004 update. Dallas, Texas: American Heart Association, 2003.

2. Heart disease and stroke statistics–2010 update: a report from the American Heart Association. Circulation. 2010;121:e46-e215.

3. Stary HC. Evolution and progression of atherosclerotic lesions in coronary arteries of children and young adults. Arteriosclerosis. 1989 Jan-Feb;9(1 Suppl):I19-32.

4. S Castle and A Goodman. Rethink Food: 100+ Doctors Can’t Be Wrong. Two Skirts Productions, Houston, TX, 2014.

Note: this post was originally published Here

As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice.

Sharping the Saw by Joel Kahn, M.D. Preventative Cardiologist

Today I have a really special post to share with you all. Joel Kahn, M.D. has written a special guest post for BYOL today on how and where a preventative cardiologist gets their information about health and nutrition. The advice he shares below is sound and can be a great resource to anyone regardless of their interest in nutrition. Dr. Kahn and I have been connected online for the past year, and being nearly done with his book, which I can’t recommend enough, I am greatly looking forward to meeting Dr. Kahn in person at the New York City Veg Fest.

Dr. Kahn is one of the nation’s most renowned interpreventional cardiologists. Having practiced invasive, interventional, and preventative cardiology since 1990, Dr. Kahn has years of clinical and research experience. He is a regular contributor for MindBodyGreen, Readers Digest magazine, and the recent author of The Holistic Heart Book.   

Sharpening the saw: How a teacher gets training:

I am excited to write a guest piece for BYOL and am looking forward to speaking at the NYC Vegetarian Food Festival March 1.  I am a cardiologist trained at the University of Michigan long ago (graduated summa cum laude due in part to my vegetarian diet!) and practicing in Detroit all these years. I do heart catheterizations, place stents, run to emergency rooms, see office patients, and answer a zillion calls and emails a day.

Long ago I chose a vegetarian lifestyle and then the big V over a decade ago. No burger, no cheese, no fish etc.  I have been on billboards across Detroit in my doctor coat announcing “Beat heart disease, diabetes and cancer, Go Vegan” and speak regularly on TV, radio and lectures on the health, environmental and ethical reasons that plant based lifestyles are the best and only choice for the future.

Increasingly I am looked upon to have the answers to tough question, tricky critics, anti-vegan blogsites, Paleo promoters and so on. So how does the teacher stay ahead of the rest and have as many answers as possible?  As Stephen Covey wrote in the Seven Habits of Highly Effective People, how do I sharpen my own saw to be able to cut more effectively?  Can these help you stay on top of trends in nutrition, animal rights and related topics?

One resource I used that may appeal to some readers was to formally go back to school. I chose a program in integrative cardiology offered at www.a4m.org in conjunction with the University of South Florida School of Medicine.  These year long curriculum of both online and classroom lectures is open to both physicians and others interested in an advanced training in many areas of health and wellness and offers the advantage of a university affiliation if so selected. Other resources for formal education can be found at www.functionalmedicine.org, www.abihm.org, and www.acam.org.   For those interested predominantly in nutrition, online programs offered at www.integrativenutrition.com, www.ecornell.com, and www.aryuvedicnutrition.com are available.

Not everyone has the time or interest to pursue these formal courses and still there are options, including ones I use, to stay current and engaged in the fast paced world of nutrition and health.  First on the list is to sign up for the daily emails from Dr. Michael Greger at www.nutritionfacts.org.   Dr. Greger is in Washington, D.C. and has been producing short and high quality videos on YouTube for several years.  There is no charge to receive his daily email and the number of videos exceeds 1,000.  Dr. Greger does very thorough research of the medical literature and all his videos are backed by multiple references drawn from the medical literature. He reviews about 14,000 articles on nutrition yearly and finds hidden gems. He presents the topics in vivid and clear formats and adds his special humor and slight sarcasm to provide a constant stream of enjoyable material. I watch his videos daily and often search his site for information. He produces one video a year that is an overview of a topic that lasts an hour and it has always been a highlight that I share liberally on social media. Sign up now if you have not.

Another site that will challenge and educate you is www.plantpositive.com. This site is shrouded in more mystery as the author is anonymous. I have emailed with him and he is a graduate student who chooses to keep his identity hidden.  He produces You Tubes which are free and last form about 8 to 30 minutes.  There are easily over 150 such videos so there are literally hours and hours of information.  Like Dr. Greger, this site relies heavily on medical references and not just opinion.  Plant Positive has taken the task of responding to Paleolithic blogger and authors, cholesterol confusionists, and all lovers of animal saturated fats.  There is a group of these people that are polished, practiced and vicious in their defense of eating animals for health. I listen and relisten regularly to these videos.  They provide a detailed analysis of the writings of Loren Cordain, Gary Taubes and others and identify false statements, distorted references, and logic fallacies on a regular basis.  This faction is not to be taken lightly and several physicians with best selling books promoting diets that are variations of Atkin’s ketogenic and pro-atherogenic venues are constantly confusing the public about the health risks of animal products.  I encourage you to jump into this site but be prepared for some of the topics to be very detailed and challenging.

My good friend Dr. Neal Barnard founded www.pcrm.org about 25 years ago. Trained as a psychiatrist, Dr. Barnard shifted to animal rights and plant based nutrition and set up this organization which does research, advocates for ethical treatment of animals, sues institutions fraudulently promoting unhealthy programs, and writes regular blogs that are shared on social media.  I learn so much from Dr. Barnard and am sure you will too.

A friend I have not yet met but hope to is Dr. John McDougall at www.drmcdougall.com.  Dr. McDougall worked in Hawaii decades ago and observed how the health of native Japanese started to deteriorate when they moved to Hawaii and starting to consume Western foods.  He established a clinic that promoted plant based diets rich in complex carbohydrates and whole grains and has treated tens of thousand of patients or more with these diets.  He regularly writes blogs, publishes book, and produces teaching videos and I have found these very helpful.

Another resource I bring to you is www.mindbodygreen.com. This site established in 2011 has grown at a meteoric speed and now 15 million or more visits occur monthly.  I began writing a weekly column for them a year ago and have contributed over 50 blogs on health and nutrition.  The authors are diverse and occasional blogs promoted non-vegan diets.  I respond to these vigorously for the often erroneous data they present.  Yoga, recipes, and life coaching are frequent other categories. 

And finally, www.bringyourownlentils.com.  This site is simply fun, diverse and of high quality. I am proud to be contributing and look forward to meeting you on March 1. Come say hello.  I will be talking about 10 Holistic Heart Tips and my new book The Holistic Heart Book www.holisticheart.com will be available.  

You can learn more at my website www.drjoelkahn.com or on Twitter at @drjkahn.  Ciao!

As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice.