Cardiovascular Health (TMAO)

This marker assesses the genetic capacity of your microbiome to produce Trimethylamine (TMA), the direct precursor of TMAO (Trimethylamine N-oxide). TMAO is one of the most important predictive biomarkers of cardiovascular risk discovered in the last decade. A high capacity for bacterial production indicates that your gut is transforming certain healthy nutrients into toxins that damage your arteries, while a low capacity is highly protective for your heart.

Foods like red meat, egg yolk, liver, and whole dairy are rich in essential nutrients called choline and L-carnitine. During digestion, some of these nutrients reach the large intestine without being absorbed.

This is where the intestinal ecosystem comes into play. If you have a balanced microbiome, these nutrients are simply excreted or used harmlessly. However, certain gut bacteria (the "TMA producers") possess a specific enzyme that human cells lack. This enzyme acts like molecular scissors, cutting choline and carnitine to generate a gas called Trimethylamine (TMA).

This TMA gas is absorbed by the intestinal wall and travels directly to your liver. The liver, trying to detoxify this gas, oxidizes it and converts it into TMAO. TMAO circulates back into the bloodstream, and it is here where it causes damage.

The accumulation of TMAO in the blood is an extremely potent pro-atherogenic (plaque-forming) factor, independent of traditional cholesterol levels:

• Accelerated Atherosclerosis: TMAO alters the way your cells handle cholesterol. It makes it easier for macrophages to "swallow" LDL cholesterol and stick to artery walls, forming dangerous atheromatous plaque and hardening blood vessels.
• Risk of Heart Attack and Thrombosis: Massive clinical studies have shown that TMAO interferes with blood platelets, making them "hyper-reactive" or stickier. This dramatically increases the likelihood of forming deadly clots, raising the risk of myocardial infarction or stroke.
• Renal Stress:The kidneys are responsible for filtering and eliminating TMAO from the blood. A chronically elevated TMAO level overburdens the kidneys, accelerating the progression of Chronic Kidney Disease in predisposed individuals.

The risk assessment associated with TMAO is not based on measuring the compound in blood (which varies drastically depending on what you just ate), but on quantifying the chronic genetic potential of your intestinal ecosystem through Shotgun metagenomics.

Our bioinformatics pipeline maps the abundance of key genes responsible for this molecular cleavage: mainly the cutC gene (choline TMA-lyase) and the cntA/B operon (carnitine oxidoreductase). Taxonomically, this metabolic capacity is dispersed, but it is enriched in opportunistic species of the genera Escherichia, Klebsiella, Desulfovibrio, and certain species of Clostridium and Enterococcus.

Low levels suggest a cardioprotective ecosystem. You can consume eggs and meat moderately without your flora generating significant amounts of TMAO. However, high levels indicate that your ecosystem has a great potential to convert choline/carnitine into vascular toxins. The clinical strategy requires reducing the raw material (severely limiting red meat and egg yolks) and introducing potent natural inhibitors of the bacterial TMA-lyase enzyme. Compounds such as DMB (3,3-dimethyl-1-butanol), which is naturally found in extra virgin olive oil, balsamic vinegar, and grapeseed oil, physically block TMA-producing bacteria without killing them, thus reducing cardiovascular risk.