Gut Bacteria Byproduct Predicts Heart Attack and Stroke (Video)

Research unveils a ‘gut’ reason for eating less egg yolks and red meat

stomach image

Bacteria in your gut can play a role in heart disease.

New research shows that choline, a nutrient found in foods like egg yolks and fatty meats, produces the byproduct TMAO when digested. TMAO is known to promote plaque accumulation in the arteries causing heart disease.

Similar to vitamin B, choline is a nutrient that helps in the development of our cell membranes. While our bodies need it, dietary recommendations discourage people from eating too much of certain high-choline foods.

So, why is too much choline bad for you? Cleveland Clinic’s Stanley Hazen, MD, PhD, Vice Chair of Translational Research for the Lerner Research Institute and Co-Section Head of Preventive Cardiology & Rehabilitation, and a team of researchers recently studied the effects of choline on more than 4,000 people to find out.

When choline is
digested, it produces
the byproduct TMAO, which is known to
cause heart disease.

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Dr. Hazen explains, “Bacteria that live in our intestines play a role in the digestion of certain types of food to form the compound TMAO, which promotes the accumulation of plaque in the arteries.”

Participants in the study were asked to eat two hard-boiled eggs and take a choline capsule. Results showed that TMAO levels in the blood increased after ingesting the eggs and the capsule. And when participants were given antibiotics to suppress their gut flora, their TMAO levels dropped. This illustrated how important gut flora is to the formation of TMAO.

Decoding the research

These study findings strongly suggest that further research into the involvement of gut flora in the development of cardiovascular disease could lead to new avenues of prevention and treatment of heart disease.

“Our goal is not to suggest dietary restrictions of entire food groups. Eggs, meat and other animal products are an integral part of most individuals’ diets,” says Dr. Hazen. “This study shows that measuring blood levels of TMAO could serve as a powerful tool for predicting future cardiovascular risk, even for those without known risk factors.”

Dr. Hazen goes on to say that more studies are needed to confirm that TMAO testing, like cholesterol, triglyceride or glucose levels, might help guide physicians in providing individualized nutritional recommendations for preventing cardiovascular disease.

Learn more about TMAO

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In the news

Complete findings for this study can be found in the New England Journal of Medicine.

Cleveland Clinic has a licensing agreement with a diagnostic company to develop and commercialize a blood test for cardiovascular disease based upon the gut flora metabolite, TMAO. Dr. Hazen is listed as a co-investigator on pending and issued patents held by the Cleveland Clinic relating to cardiovascular diagnostics. He also is a paid consultant to the company and has received royalty payments for technology that he developed.

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  • Mike

    Is this something someone with known CVD should have checked to see if they are successfully managing it through diet?

    • The_Beating_Edge_Team

      This research is demonstrating the importance of TMAO as a predictor of future cardiovascular events. At this time, the laboratory test to measure TMAO is not yet available as part of patient care. In the future, this test will be available for measurement. Our best estimate is the test will be available later this year. If you would like to send your contact information to we will keep a list of those who are interested.

      At this time continue to make sure you manage your cholesterol, blood sugar and blood pressure, as well as no smoking – and include regular exercise in your routine. betsyRN

  • Susan

    This article says that the participants ate two eggs AND took a choline capsule. Did the study include subjects who ONLY ate two eggs, and others who ONLY took the choline capsule? I’m suspicious as to just how much of the levels measured are attributable to the eggs, and how much to the choline capsule.

  • JUDY


    • The_Beating_Edge_Team

      Dear Judy. Dr. Hazen answered a similar question and the answer is that this is unknown based on this research – “Is there evidence or is it likely that probiotics may also inhibit the production of intestinal bacteria that produce TMAO in the liver, thereby reducing the harmful effects of red meat consumption?” We don’t have a probiotic that does this yet- of all we have screened – but we are hopeful, and pursuing finding a potential therapeutic approach to suppress TMAO production

      As of now – the best approach is cut back on animal products (go vegetarian – if that is something you are interested in and can accommodate/enjoy). betsyRN

  • Sandra

    I have been taking Vitamin D Complex for about 4 yrs. Is this bad for me or am I reading this article wrong? I am worried now, I am 72 yrs. old and my father had heart problems. Please let me know. Thank you!

  • jon johnson

    This is ridiculous! They are just trying to scare people! More and more people are becoming aware that clean eating is the best eay to feed your body. They think if we post this ridiculous study that people will stop eating eggs and go back to artery clogging cereal! Its all about money and big pharma. Eat paleo its your best bet to stay away from the hospital! You should look to see who funded this study btw!

    • Dillonvale1964

      This is a stupid comment. You are reading way too much into this yourself and drawing your own broad conclusions. Your own biases are getting in the way of rationally digesting and understanding the science. Take the study for what it is — another data point along the path toward the “truth.”

    • Nancy

      Jon, you are correct. The science here is debatable. Who funded this study is the criteria I always look for first. Theses are NOT FACTS. I just read an interesting article that countered some of this information.