Hormonal
High plasma levels of Trimethylamine N-Oxide (TMAO) promote atherosclerosis and cardiovascular disease risk by impairing reverse cholesterol transport (RCT) and promoting foam cell formation.
High levels of TMAO, produced when your gut bacteria process nutrients like choline (eggs, meat) and carnitine (red meat), are linked to higher cardiovascular risk. This happens because TMAO impairs your body's ability to remove cholesterol from arteries (Reverse Cholesterol Transport). While you can't easily change your genes, understanding that gut bacteria play a key role suggests that dietary strategies might need to consider microbiome health, not just nutrient content.
TMAO may promote foam cell formation by upregulating macrophage scavenger receptors, deregulating enterohepatic cholesterol and bile acid metabolism and impairing macrophage reverse cholesterol transport (RCT).
Why this rating
Supported by multiple large prospective human studies, mouse models, and mechanistic omics analyses, though some conflicting human data exists regarding HDL levels.
Source
Trimethylamine N-Oxide: A Link among Diet, Gut Microbiota, Gene Regulation of Liver and Intestine Cholesterol Homeostasis and HDL Function
Marina Canyelles et al. · International Journal of Molecular Sciences · 2018
DOI 10.3390/ijms19103228
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