TMAO

Choline and carnitine should not automatically be avoided because they are important nutrients. Fish can provide preformed TMAO and may contain much more TMAO than meat produces through choline and carnitine. Whole-food choline produces smaller TMAO spikes than concentrated supplements because absorption is slower. The article treats epidemiological links between TMAO and disease as observational rather than mechanistic. In people with metabolic syndrome, eating three eggs per day increased plasma choline without increasing plasma TMAO. Clinical evidence does not show that eggs uniformly increase TMAO. The article presents TMAO as an uncertain causal factor because high fish intake includes TMAO but is associated with lower heart disease rates. TMAO is produced when liver enzyme FMO3 converts trimethylamine. Gut bacteria can metabolize choline into TMA, which the liver converts into TMAO. Gut bacteria can convert ingested choline into TMA, which the liver oxidizes into TMAO. Higher TMAO may be a marker of insulin resistance rather than a cause of disease. TMAO production depends strongly on gut microbiome composition rather than eggs alone. Fiber and probiotics are presented as wa…