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lauramalchowblog · 5 years

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What’s TMAO, and What Does It Have to Do With My Health?

With the last few weeks’ definitive guide and follow-up on fish, a reader asked me about trimethylamine N-oxide, or TMAO. What is it?

TMAO is the latest justification given for why eating meat just has to be bad for you. Saturated fat didn’t take. Animal protein didn’t work. Iron was a dud. IGF-1 hasn’t panned out. Methionine isn’t enough. So now they’re using TMAO to convince you not to eat that steak.

How’s it supposed to work?

How TMAO Happens

When certain gut bacteria encounter choline (found in eggs and liver) or carnitine (found in meat, especially red meat), some of it is converted to trimethylamine, or TMA. TMA is the compound that gives fish its “fishy odor.” Fish is actually extremely high in TMA, which I’ll discuss later on. Then, the liver converts a portion of the TMA to TMAO. Studies have shown that elevated serum levels of TMAO are linked to heart disease, type 2 diabetes, kidney disease, and even all-cause mortality. There’s definitely some heterogeneity among the studies, but enough have found a strong connection between TMAO and all manner of poor health conditions that researchers have focused on this compound.

Okay, so anything that contains choline or carnitine will increase TMAO, which should in theory increase your risk of heart disease. Right? Let’s go down the list.

Dietary TMAO Precursors and Their Effects On Health

Eggs. The best source of TMAO-precursor choline in our diet—eggs—should absolutely skyrocket TMAO levels. Except it doesn’t happen.

Three eggs a day has no effect on TMAO levels, even as it increases choline levels and HDL cholesterol.

Okay, so maybe the choline slipped past the TMA-producing gut bacteria in that study, but what about if you quickly switch people from eating oatmeal for breakfast to eating eggs. Surely bad things will happen, right?

No. Eating eggs instead of oatmeal has no effect on TMAO levels. It increases carotenoid and choline levels, though.

Liver. Okay, liver has to do the trick. It has high levels of both carnitine and choline. But no: feeding liver (among other foods) to men fails to increase TMAO levels above control.

Carnitine. Forget meat. What if you go straight to the offensive precursor itself and give actual human women a big daily dose of carnitine for, I don’t know, 24 weeks? Surely it will do something bad.

Nope. TMAO skyrockets, an indication that these ladies’ gut bacteria are converting carnitine to TMA and TMAO, but serum C-reactive protein, interleukin-6, L-selectin, P-selectin, vascular cell adhesion molecule-1, intercellular adhesion molecule-1 and lipid profile markers are completely unaffected. If gut bacterial conversion of carnitine to TMAO is the preeminent risk factor for heart disease, you’d think some of these ladies’ cardiovascular risk factors would have responded. They had half a year to respond. They did not.

Okay, but maybe there’s lag time between TMAO increases and deleterious changes to health. Nope. They followed those same ladies after cessation of carnitine supplementation. Their TMAO levels dropped, but their health markers stayed the same. No change.

And here’s a study where they used carnitine to increase TMAO levels in patients on dialysis. Not only did nothing bad happen, but the carnitine even reduced markers of vascular injuries. Higher TMAO, better health.

Seafood. As I mentioned earlier, fish and shellfish come pre-contaminated with the TMAO precursor TMA. It’s what gives the characteristic fishy odor, and it definitely gets converted to TMAO. In fact, a human study from a few years ago found that feeding people fish spiked TMAO levels by 60 times. A more recent study even concluded that elevated TMAO levels are a reliable marker for cod intake. The more fish you eat, the more TMAO your body will process.

If you’re going to claim that TMAO is dangerous and causes heart disease, you’ll have to make the case that fish is dangerous and causes heart disease. All the evidence we have points in the opposite direction—that fish and shellfish are protective against heart disease.

So, Why Is TMAO Linked To Poor Health Then?

How do we explain the connection between increased TMAO and poor heart health?

Here it is linked to atrial fibrillation.

Here it is linked to stroke.

Here it is predicting heart events.

The connection is there. And in animal models, TMAO even appears to mechanistically increase atherosclerosis. The mice they dosed with TMAO to increase atherosclerosis were genetically engineered to be ApoE knockouts, a strain of lab mouse that gets heart disease from almost everything, but still.

The connection isn’t causal. It’s an observation. There are no controlled studies giving people foods (or even supplements) that raise TMAO and increase disease or death. There aren’t even prospective observational studies where they track a group’s food intake, TMAO levels, and death/disease over time.

You know what I think (and have always thought)?

High TMAO can be a marker for metabolic disease. It could indicate inhibited kidney function, as the kidneys are response for disposing of excess TMAO. It could indicate poor health in general.

The latest evidence is confirming what I’ve long suspected: the reason high TMAO levels are linked to cardiovascular disease and overall mortality is that both type 2 diabetes and chronic kidney disease cause elevated TMAO levels. The causality is reversed.

What’s one of the kidney’s primary jobs? Excreting waste materials and toxins. What’s going to happen if the kidney begins to fail or lose its functioning? The stuff that used to be excreted starts backing up. TMAO is supposed to be excreted in the urine via the kidneys. If the kidneys aren’t working, TMAO levels skyrocket.

But even then, high TMAO isn’t even necessarily a bad thing. Check out that study I linked to earlier where women were given carnitine every day. Their TMAO levels skyrocketed but nothing bad happened. No health markers worsened. In one study, they even improved.

The Takeaways…

That’s the thing with biology. There are dozens of reasons TMAO could be elevated, some of them bad, some of them harmless, some of them good.

There simply exists no credible evidence that increased TMAO because you’re eating fish, or eggs, or liver, or meat, does anything untoward to your health. I’m not ruling it out. But the evidence just isn’t there. There’s far more evidence that eating fish, eggs, liver, and meat improve your health.

That’s it for today, folks. If you have any further questions about TMAO, leave them down below. Until then, enjoy your choline and carnitine!

Thanks for reading.

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References:

Schiattarella GG, Sannino A, Toscano E, et al. Gut microbe-generated metabolite trimethylamine-N-oxide as cardiovascular risk biomarker: a systematic review and dose-response meta-analysis. Eur Heart J. 2017;38(39):2948-2956.

Dimarco DM, Missimer A, Murillo AG, et al. Intake of up to 3 Eggs/Day Increases HDL Cholesterol and Plasma Choline While Plasma Trimethylamine-N-oxide is Unchanged in a Healthy Population. Lipids. 2017;52(3):255-263.

Missimer A, Fernandez ML, Dimarco DM, et al. Compared to an Oatmeal Breakfast, Two Eggs/Day Increased Plasma Carotenoids and Choline without Increasing Trimethyl Amine N-Oxide Concentrations. J Am Coll Nutr. 2018;37(2):140-148.

Zhang AQ, Mitchell SC, Smith RL. Dietary precursors of trimethylamine in man: a pilot study. Food Chem Toxicol. 1999;37(5):515-20.

Samulak JJ, Sawicka AK, Hartmane D, et al. L-Carnitine Supplementation Increases Trimethylamine-N-Oxide but not Markers of Atherosclerosis in Healthy Aged Women. Ann Nutr Metab. 2019;74(1):11-17.

Samulak JJ, Sawicka AK, Samborowska E, Olek RA. Plasma Trimethylamine-N-oxide following Cessation of L-carnitine Supplementation in Healthy Aged Women. Nutrients. 2019;11(6)

Fukami K, Yamagishi S, Sakai K, et al. Oral L-carnitine supplementation increases trimethylamine-N-oxide but reduces markers of vascular injury in hemodialysis patients. J Cardiovasc Pharmacol. 2015;65(3):289-95.

Svingen GFT, Zuo H, Ueland PM, et al. Increased plasma trimethylamine-N-oxide is associated with incident atrial fibrillation. Int J Cardiol. 2018;267:100-106.

Liang Z, Dong Z, Guo M, et al. Trimethylamine N-oxide as a risk marker for ischemic stroke in patients with atrial fibrillation. J Biochem Mol Toxicol. 2019;33(2):e22246.

Haghikia A, Li XS, Liman TG, et al. Gut Microbiota-Dependent Trimethylamine N-Oxide Predicts Risk of Cardiovascular Events in Patients With Stroke and Is Related to Proinflammatory Monocytes. Arterioscler Thromb Vasc Biol. 2018;38(9):2225-2235.

Jia J, Dou P, Gao M, et al. Assessment of Causal Direction Between Gut Microbiota-Dependent Metabolites and Cardiometabolic Health: A Bidirectional Mendelian Randomization Analysis. Diabetes. 2019;68(9):1747-1755.

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jesseneufeld · 5 years

Text

What’s TMAO, and What Does It Have to Do With My Health?

With the last few weeks’ definitive guide and follow-up on fish, a reader asked me about trimethylamine N-oxide, or TMAO. What is it?

How’s it supposed to work?

How TMAO Happens

Okay, so anything that contains choline or carnitine will increase TMAO, which should in theory increase your risk of heart disease. Right? Let’s go down the list.

Dietary TMAO Precursors and Their Effects On Health

Eggs. The best source of TMAO-precursor choline in our diet—eggs—should absolutely skyrocket TMAO levels. Except it doesn’t happen.

Three eggs a day has no effect on TMAO levels, even as it increases choline levels and HDL cholesterol.

No. Eating eggs instead of oatmeal has no effect on TMAO levels. It increases carotenoid and choline levels, though.

Liver. Okay, liver has to do the trick. It has high levels of both carnitine and choline. But no: feeding liver (among other foods) to men fails to increase TMAO levels above control.

So, Why Is TMAO Linked To Poor Health Then?

How do we explain the connection between increased TMAO and poor heart health?

Here it is linked to atrial fibrillation.

Here it is linked to stroke.

Here it is predicting heart events.

You know what I think (and have always thought)?

High TMAO can be a marker for metabolic disease. It could indicate inhibited kidney function, as the kidneys are response for disposing of excess TMAO. It could indicate poor health in general.

The Takeaways…

That’s the thing with biology. There are dozens of reasons TMAO could be elevated, some of them bad, some of them harmless, some of them good.

That’s it for today, folks. If you have any further questions about TMAO, leave them down below. Until then, enjoy your choline and carnitine!

Thanks for reading.

window.onload=function(){ga('send', { hitType: 'event', eventCategory: 'Ad Impression', eventAction: '74506' });}

References:

Zhang AQ, Mitchell SC, Smith RL. Dietary precursors of trimethylamine in man: a pilot study. Food Chem Toxicol. 1999;37(5):515-20.

Samulak JJ, Sawicka AK, Hartmane D, et al. L-Carnitine Supplementation Increases Trimethylamine-N-Oxide but not Markers of Atherosclerosis in Healthy Aged Women. Ann Nutr Metab. 2019;74(1):11-17.

Samulak JJ, Sawicka AK, Samborowska E, Olek RA. Plasma Trimethylamine-N-oxide following Cessation of L-carnitine Supplementation in Healthy Aged Women. Nutrients. 2019;11(6)

Svingen GFT, Zuo H, Ueland PM, et al. Increased plasma trimethylamine-N-oxide is associated with incident atrial fibrillation. Int J Cardiol. 2018;267:100-106.

Liang Z, Dong Z, Guo M, et al. Trimethylamine N-oxide as a risk marker for ischemic stroke in patients with atrial fibrillation. J Biochem Mol Toxicol. 2019;33(2):e22246.

The post What’s TMAO, and What Does It Have to Do With My Health? appeared first on Mark's Daily Apple.

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chromacomaphoto · 6 years

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Places to Shoot in Bangkok Part 11: 'Airlab'

Welcome all Chromacoma brethren, I am looking to try something new this month and going for a 'two for one' kind of deal involving a useful place to know for film photographers (digital too for sure) with good facilities, people and equipment that also happens to be a place you can shoot at (even if the area is small) as there is a studio for rent there too!

Airlab has already been mentioned in this blog and within the main guide article (click the banner at the top of this page) but I thought it might be nice for bit more detail and a dedicated round up this month in the style of 'Chromacoma meets Airlab!', so let's get it started. First up, I think that there might well be a parallel to be drawn between this entry to the guide and the 'Chang Chui' post last year. This place also being the brainchild of a fairly well known chap within photographic/artistic circles (and Thai society circles also) who decided to create and open up his own place as a sort of hangout and cool zone for his artistic vision. Just to be clear, this isn't the same person or in anyway connected to Chang Chui, it's just another, similar example of a Thai artistic type with the vision and resources to make a place like this happen in Bangkok. If you check out their website HERE, I'm pretty sure you will be able to see more details about this individual himself but for the sake of his modesty and protocol, I'm choosing not to name him specifically in this article. Suffice to say, if you choose to visit Airlab, you'll probably meet him yourself and find that he is very cool, laid back and relaxed with a nice, welcoming down to earth sort of vibe.

The location itself isn't exactly one you are likely to accidentally stumble over, even if you live in Bangkok, but the good news is that it really is easy for anyone to get to. So easy in fact that I am not including a map as there is one on their website and I have a very simple way of explaining it to you: Take the BTS skytrain out of Bangkok heading down the main (old) Sukhumvit line towards the East (Bearing etc) and get off at On Nut station. Go down one floor and keep walking in the same direction that the train was heading in before you disembarked. Walk all the way in this direction as far as you can go to the station's end before you go down to street level. Before you exit down, you should clearly be able to see Sukhumvit Soi 81 and its road sign ahead of you, on the left. Go down the stairs to street level, walk along to this street and turn down it (all on your left hand side), keep walking a little way and turn down the very first soi off of Sukhumvit 81 on the left hand side, follow that around a blind right hand corner and walk for a couple of hundred metres at the most, Airlab will come into view after a couple of minutes walk on the right hand side, it's a compound with a house inside and very clear signage. Trust me, it's very easy indeed and hard to go wrong, just wear a hat for the sun.

So, what did I find there? Well, lots of good stuff really. First up, there's a nice air con cafe with decent Thai food at local prices and proper fresh coffee on offer. So, even if you were to visit with people who might not be as keen on photography as you are such as with a partner or kids in tow, there's a haven for them to occupy for a while in relative comfort. There's also a huge all glass and air con shooting studio for rent plus a nice little leafy lawn area with some cool tiny artsy shops. Cool t shirts and the like were for sale here and there but it didn't come off as tacky, definitely a faint whiff of hipster (maybe that was coming from me) but overall this is only too much at busy times. Apparently however, such really busy weekends as I had seen before at this venue are not as common now. That said, they do hold events from time to time and these are not only 'Airlab' events per se but also sometimes things done in conjunction with outside companies and brands as crossover into advertising and brand hyping circles so I guess it all depends on what's on. There's a small shop selling very high end and good condition camera gear including lots of Leica and classic Rollei gear, bodies, lenses etc. but it opens towards the later part of the day and not in the morning time. I can't comment on that much more as I have never purchased here and so I'm simply putting it out there.

Meanwhile at the other end of the lawn area there's somewhere to sit in the shade and have your coffee or tea (even a smoking area) and this backs up to a really impressive and fully equipped darkroom facility inside an old (air conditioned) familiar looking metal cube shape. I guess one man's shipping container is another man's darkroom, this is also for rent to those who would like access to it. You'll have to contact them for details re. pricing

I would just like to say that I didn't inform Airlab that I was going to be dropping by and taking photos for inclusion into the guide or recommendations to others, rather preferring instead to just turn up on spec as a random foreigner to see what sort of reaction or welcome I received. I'm not saying that I was trying to be deliberately sneaky or judgemental (I really wasn't) but rather I merely wished to try and see what would happen if you, dear reader, were to do the same and how it would be. I'm delighted to say that people either left me alone (as was the case when I first strolled in around 11am) or they then eventually came up to me and politely spoke in English. This wasn't done to hassle me either, a couple of people were genuinely making sure I was okay and letting me know they would help me if I had any questions, was I looking to buy or develop film? etc. Expanding on that last point, there's film for sale of many different types and they do a whole load of processing here, colour and black and white and even some really long lost ancient wet plate processes which is really cool. Again I won't comment too much on pricing but its reasonably competitive at the time of publishing this post and suffice to say that they accept most kinds of film for processing including even slides (E6) and will do very accurate push and pull processing too. It's not a Mickey Mouse all hipster and no skills outfit, it's a proper lab. There's also an 'express' option for those maybe leaving Thailand soon, scans of a very high quality also available. The guy behind the whole endeavour is certainly deeply into film photography and so you are not just going to be handing your film over to a random outfit without any interest or skill. They have a lot of processing equipment, chems and machines actually onsite in addition to the fully set up darkroom. It's pretty full on. I deliberately didn't attempt to talk to the owner until the very end and he was very polite and friendly indeed. I am certain that if you turn up on spec and behave respectfully as you would at anybody's 'open house' kind of business, the people here will be very accommodating indeed. It's open daily from around 10am and goes on till about 7pm ish. You might even bump into a Thai celebrity here and there....

As an aside, there were some lovely quirks that had been really well thought out here and there. One personal favourite example was perhaps in the public toilets extending off from the garden lawn area where I noted that the toilet roll holder was actually an old style Polaroid camera body adapted to this new role (maybe that should be 'roll'? ha!). If you've ever felt like your photographic skills are slipping and your last roll was about as good as toilet paper, well hey...maybe you're not alone in such an assertion. Another nice touch was that the food menu of simple, classic Thai dishes was a full colour, medium format positive contact sheet showing the dish to be ordered, a simple but very effective idea that really caught my eye.

There's limited parking inside the compound but looks like you would be good to go on a weekday, although the street outside is legal to park on. Motorbikes would have no issues. Honestly though, it's probably easier to just take the BTS there. So, I hope this month's little entry proves useful both in terms of picking up film there, dropping it back off to have it devved or even booking their soft light, glasshouse (thankfully there's air con in there too!) kind of beauty/photo studio as a stunning location that is just crying out for great portraiture to be done there (as the owner has done many times and examples of which can be seen around). You could even then go on to rent their darkroom in which to develop the films that you've just shot in the studio at the same location. That's seriously cool and a fully contained (albeit 'shipping contained') 'one stop shop' option for serious dedicated film photographers in Bangkok. For that alone, and with no affiliation whatsoever, I have deemed it well worth inclusion in the places to shoot series for this month, enjoy.

CCP

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