Mixed
Dietary intake of choline (from phosphatidylcholine/egg yolk) and L-carnitine (from red meat) is metabolized by gut microbiota into trimethylamine (TMA), which is converted by hepatic FMO3 into TMAO, a metabolite that promotes atherosclerosis and increases cardiovascular disease risk.
High intake of red meat (L-carnitine) and egg yolks (choline/phosphatidylcholine) is linked to higher cardiovascular risk through a gut-liver metabolic pathway producing TMAO. While choline is essential, individuals with high cardiovascular risk may benefit from moderating intake of these specific precursors or discussing microbiome-targeted strategies with their provider, rather than relying solely on statins.
Our group recently discovered that certain dietary nutrients possessing a trimethylamine (TMA) moiety, namely choline/phosphatidylcholine and L-carnitine, participate in the development of atherosclerotic heart disease. A meta-organismal pathway was elucidated involving gut microbiota–dependent formation of TMA and host hepatic flavin monooxygenase 3–dependent (FMO3-dependent) formation of TMA–N-oxide (TMAO), a metabolite shown to be both mechanistically linked to atherosclerosis and whose levels are strongly linked to cardiovascular disease (CVD) risks.
Why this rating
Supported by multiple large-scale human cohorts (n=1,876 to >4,000), animal models, and mechanistic studies, though it is a review summarizing these findings rather than a single primary trial.
Source
The contributory role of gut microbiota in cardiovascular disease
W.H. Wilson Tang et al. · Journal of Clinical Investigation · 2014
DOI 10.1172/jci72331
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