First, my take on TMAO.  Until the dust settles and studies confirm human dietary modulation of the microbiome that mitigates TMA and TMAO production,

Consider consuming condiment size red meat (and up to 2 eggs a day if desired) as described in the Pegan diet (detailed below) crafted by Dr. Mark Hyman, Director of Cleveland Clinic Center for Functional Medicine.

Further, consider integrating meat prep using these TMAO mitigation strategies (shown in recent mice studies, April 2016 and Dec 2015):

• Marinate meat in EVOO and/or balsamic vinegar,
• Consume along with salad dressing containing EVOO and/or balsamic vinegar, and
• Have that glass of red wine along with the red meat.
• Though not yet tested, add other antioxidant spices, phytonutrients, and flavonoids (see Drs. Mimi Guarneri and Jeff Blands thoughts below).
• Make certain the EVOO is unadulterated, organic, and cold pressed — for sourcing tips scroll to below the light-bulb on the post, Meet The Fats & Best Salad Dressing Oil, Part 1.
• For Balsamic vinegar insights… they are pricey and yet most are not “Real Balsamic Vinegar” due to insufficient barrel aging and crazy additives. The “real balsamic vinegar“ I recommend is Olivier Napa Valley which is SCD/GAPS legal as it is fermented properly (25 years) and free of additives.  Olivier’s was actually pulled from Williams-Sonoma stores a few years back as they introduced their own brand.  Due to customer demand, Olivier’s is now back in their stores or online, or get it direct from Olivier’s online.

A picture is worth a thousand words, so here are some pics of condiment meat meals we frequently have.  Test question from the Microbiome Awareness Seminar, “Do you spot the components actually nourishing your microbiome and know what they are called?” 

What is TMAO (trimethylamine-N-oxide) and TMA (trimethylamine)? 

TMAO is a metabolic end by-product of certain gut microbes (a.k.a. metabolites).  TMAO forms following ingestion of red meat and eggs no matter the quality (pastured or confined feed lot operations) unless you are vegan, in which case, little TMAO forms since the vegan microbiome either neutralizes it or keeps those microbes in check that produce the metabolite.  The exact mechanism is still unknown!  TMAO is a gut flora-dependent metabolite resulting from the oxidation of TMA.  The quality of the red meat or eggs, grass-fed or pastured,  means that the Omega-3 fatty acid profile improves but the same compounds that are used to produce TMAO, L-carnitine and choline, are still present regardless of quality.  

Berkeley Wellness, University of California, Carnitine in Meat: Heart Hazard explains carnitine and choline:

• The word carnitine comes from the Latin word for meat because red meat—even if it’s lean—is by far the richest dietary source. Pork and lamb also have fair amounts; chicken, fish and dairy products contain small amounts. The biologically active form is called L-carnitine. The body makes carnitine from amino acids (lysine and methionine), which are building blocks of protein.
• Carnitine plays a crucial role in the mitochondria—the energy-producing structures in cells—notably in muscles, including heart muscle. It also acts as an antioxidant. As we age, carnitine levels drop and mitochondrial function becomes impaired, which may contribute to some adverse effects of aging as well as to some diseases. Thus, it’s hoped, carnitine supplements may help prevent these problems.
• L-carnitine is sold as a supplement. It’s in many “healthy-aging” products and formulas claiming to improve athletic performance and build muscle. It’s also promoted as a treatment for many disorders, including heart disease, diabetes and dementia, and is supposed to boost energy, improve memory and promote weight loss. Most of this is just marketing hype or wishful thinking.
• Choline is a vitamin-like compound that plays key roles in the body.  It is found in many other healthful foods—salmon, sardines, broccoli, milk and beans—along with meat and poultry. 

Reducing dietary choline or carnitine would lower TMAO levels, but may have undesirable effects.

TMAO is implicated in vascular inflammation and formation of unstable plaques in arterial walls, and more. “TMAO levels predict risk for atherosclerosis [15, 112, 115], and are elevated in patients with chronic kidney disease (CKD) [116] and obesity [17, 98], and decreased in ulcerative colitis [117]... [While]upplementation with lower levels of l-carnitine than needed for TMAO formation may improve cardiovascular function [121]  A meta-analysis of 13 controlled trials (n = 3629) showed that l-carnitine supplementation reduces all-cause mortality by 27 % [122].  While potentially beneficial for cardiovascular health, choline deficiency markedly increases risk for non-alcoholic liver disease [NAFLD prevalence is 19.0% in US].”    — Microbial metabolism of dietary components to bioactive metabolites: opportunities for new therapeutic interventions, April 2016.

Dr. Rob Knight was asked in a class I took, “What are your thoughts on red meat?”  [–]DrRobKnight replied, “A Western diet, which often includes more meat has been linked repeatedly to differences in the gut microbiota (when compared with diets based more heavily on plant material). See, for example,  Human gut microbiome viewed across age and geography and Diet rapidly and reproducibly alters the human gut microbiome.  Also, a study by Stan Hazen’s group,  Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis… [which] showed that when gut microbes metabolize a certain compound (L-carnitine) found in red meat, they produce another compound (TMAO) that can lead to a hardening of the arteries.  So red meat affects both your gut microbiota and your health, and gut microbes appear to be playing a role in determining HOW red meat affects your health.

Berkeley Wellness, University of California, Carnitine in Meat: Heart Hazard explains:

• A week after the Cleveland Clinic study on carnitine appeared, an analysis in Mayo Clinic Proceedings looked at 13 clinical trials testing supplemental L-carnitine in people who had a prior heart attack. It concluded that the supplements reduce the risk of angina, serious arrhythmias and premature death. And it noted carnitine’s “excellent safety profile.” 
• How could carnitine be both good and bad for heart health?
  1. The proposed mechanisms (the negative one involving atherosclerosis, the positive one the heart muscle itself) are very different.
  2. The studies involved different populations.
  3. Finally, the supplements may be digested and absorbed somewhat differently than carnitine in meat.
• It’s known that heart muscle contains high levels of carnitine, that carnitine levels are depleted during a heart attack, and that carnitine deficiency can cause heart enlargement and rhythm abnormalities. In our 2009 article on carnitine supplements, we concluded that the evidence of cardiovascular benefits is promising, though not conclusive. We saw no research indicating cardiovascular risk even from high doses.

How Gut bacteria is Linked to Heart Disease

For generations, eggs and red meat have topped the list of foods implicated in cardiovascular disease because of their high levels of dietary cholesterol.  While dietary intake of cholesterol fat has been exonerated as the cause of elevated serum cholesterol — red meat and eggs are NOT off the hook.  Why?  A whole new line of investigation focusing on intestinal bacteria (our microbiome) is keeping red meat and eggs in the spotlight.  Note:  The studies related to intake of dietary fat cholesterol NOT altering serum cholesterol for most of us are in the section below titled Summary of Dr. Mark Hyman’s Pegan diet concept. 

Click here to read full article