Powerful new evidence from the Cleveland Clinic confirms a link between choline, a nutrient naturally found in foods like red meat, egg yolks and dairy products, and the risk of dangerous blood clotting. Choline interacts with gut bacteria to make the blood more prone to clotting by helping to produce a compound called, trimethylene N-oxide (TMAO).
Elevated blood levels of TMAO have been linked to an increased risk of heart attack, stroke, and death, and research shows that TMAO may directly contribute to the narrowing of artery walls through plaque build-up.
The new research, in the journal, Circulation, makes the case against choline even stronger, providing direct evidence that this essential nutrient is behind the rise in clot risk. In the study, researchers gave choline supplements to a group of people, half of whom were meat eaters; the remainder were vegetarians. After about two months, TMAO levels in the group rose ten times. And the tendency for blood platelets to clump together, which can cause clots to form, rose proportionately.
TMAO presents a clear threat to heart health. Previous data showed that high levels of the compound contribute to a higher risk for clot-related events such as heart attack and stroke—even after researchers accounted for the presence of common risk factors and inflammation markers that might skew the results. In another analysis, scientists showed that high blood levels of TMAO were associated with higher rates of premature death in a group of 2235 patients with stable coronary artery disease. Those found to have higher blood levels of TMAO had a four-fold greater risk of dying from any cause over the subsequent five years.
The latest insights emphasize the potential for TMAO testing, which can help patients determine if their gut microbiome is contributing to their risk for heart disease and whether they might benefit from limiting foods, supplements, and energy drinks that contain the building blocks of TMAO, namely choline, phosphatidylcholine, L-carnitine, and lecithin. TMAO tests, which are only available through the Cleveland Heartlab, help doctors and their patients get a clearer picture of heart risk so that they can work together to prevent cardiovascular events.
The new data suggests it’s wise to reduce consumption of choline-rich foods and think twice about taking a choline supplement unless a doctor has recommended it, particularly if you already have heart disease. Foods with substances that block TMAO formation include cold pressed extra virgin olive oil, balsamic vinegars and red wines. , In addition to assuring your TMAO levels are low, to reduce heart disease risk be aggressive about losing weight and lowering cholesterol and blood pressure, including taking medications prescribed to manage these risk factors. In the new research, the ability of TMAO to promote clot formation was reduced when subjects were taking low-dose aspirin (81 mg.) daily, but don’t take aspirin without checking with your doctor first.
If you haven’t already, give the Mediterranean Diet a try. It emphasizes abundant fruits and vegetables, lean protein like fish, whole grains, and healthy fats like olive oil. The eating pattern has been shown to lower the risk for heart disease overall, and it turns out to be key to cultivating a healthy gut microbiome—one that helps to keep TMAO levels in check.