Gut Bacteria Byproduct Predicts Heart Attack and Stroke

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

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

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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.”

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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.

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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