What does an increase in trimethylamine N-oxide (TMAO) mean?

Posted by tne @tne, Jul 20, 2022

My wife’s yearly bloodwork come back with a 32.3 TMAO when it was 2.3 last year and 1.3 the year before. The rest of her bloodwork was very good except her triglycerides were a tad high for the first time. Should I be worried about cardiovascular disease or even colon cancer or could this be no problem(our primary didn’t seemed concerned)? Thank you.

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Good morning, because TMAO is a fairly new discovery in the health field with helping to identify risks for coronary disease, there isn’t much I can find on what’s considered “normal” values. It looks as though Cleveland Clinic was instrumental in the research and I’ve found several articles from them about TMAO. https://www.clevelandheartlab.com/blog/horizons-tmao-testing-a-new-way-to-assess-heart-attack-and-stroke-risk/

Below is an excerpt from Cleveland Clinic’s site regarding: Blood Tests to Determine Risk of Coronary Artery Disease. This gives the normal blood ranges for various tests associated with diagnosing coronary issues.
(here’s the link to the full article. https://my.clevelandclinic.org/health/diagnostics/16792-blood-tests-to-determine-risk-of-coronary-artery-disease)
~~~~~~
The excerpt:
“Trimethylamine N-oxide (TMAO)
Why is the trimethylamine N-oxide (TMAO) test important?
Comes from bacteria in your gut.
High levels are found in meat, eggs and dairy foods.
Taking choine, lecithin, L-carnitine and other supplements can cause high levels of TMAO.
High levels in the blood increase the risk of heart disease, heart attack, stroke and clogged arteries (atherosclerosis).
If your levels are high, your doctor will likely be aggressive to lower your LDL and other risk factors, have you take low-dose aspirin twice a day, and have you follow a Mediterranean diet.
Levels:

Low risk: Less than 6.2 uM
Intermediate Risk: 6.2 – 9.9 uM
High risk: 10.0 uM or higher”
~~~~~~~~

A little more information on TMAO in case you’re interested. https://labs.selfdecode.com/blog/tmao/

And another article on TMAO and how to reduce the blood levels.
https://nutritionfacts.org/2021/03/02/how-to-reduce-your-tmao-levels/
If your wife’s level has increased substantially, along with her triglycerides it might be worth a little more research to see if a diet change is necessary with regards to some of the foods mentioned in the information on how to reduce those levels. If her other blood numbers are fine, then it might just mean a change in diet.
Has she had a calcium score test? Where her cholesterol levels good? Does she have any coronary issues or was this just routine bloodwork?

REPLY
@loribmt

Good morning, because TMAO is a fairly new discovery in the health field with helping to identify risks for coronary disease, there isn’t much I can find on what’s considered “normal” values. It looks as though Cleveland Clinic was instrumental in the research and I’ve found several articles from them about TMAO. https://www.clevelandheartlab.com/blog/horizons-tmao-testing-a-new-way-to-assess-heart-attack-and-stroke-risk/

Below is an excerpt from Cleveland Clinic’s site regarding: Blood Tests to Determine Risk of Coronary Artery Disease. This gives the normal blood ranges for various tests associated with diagnosing coronary issues.
(here’s the link to the full article. https://my.clevelandclinic.org/health/diagnostics/16792-blood-tests-to-determine-risk-of-coronary-artery-disease)
~~~~~~
The excerpt:
“Trimethylamine N-oxide (TMAO)
Why is the trimethylamine N-oxide (TMAO) test important?
Comes from bacteria in your gut.
High levels are found in meat, eggs and dairy foods.
Taking choine, lecithin, L-carnitine and other supplements can cause high levels of TMAO.
High levels in the blood increase the risk of heart disease, heart attack, stroke and clogged arteries (atherosclerosis).
If your levels are high, your doctor will likely be aggressive to lower your LDL and other risk factors, have you take low-dose aspirin twice a day, and have you follow a Mediterranean diet.
Levels:

Low risk: Less than 6.2 uM
Intermediate Risk: 6.2 – 9.9 uM
High risk: 10.0 uM or higher”
~~~~~~~~

A little more information on TMAO in case you’re interested. https://labs.selfdecode.com/blog/tmao/

And another article on TMAO and how to reduce the blood levels.
https://nutritionfacts.org/2021/03/02/how-to-reduce-your-tmao-levels/
If your wife’s level has increased substantially, along with her triglycerides it might be worth a little more research to see if a diet change is necessary with regards to some of the foods mentioned in the information on how to reduce those levels. If her other blood numbers are fine, then it might just mean a change in diet.
Has she had a calcium score test? Where her cholesterol levels good? Does she have any coronary issues or was this just routine bloodwork?

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Thank you so much. This was her yearly wellness exam. Her triglycerides were slightly elevated for the first time and that huge jump with the TMAO….everything else was excellent. Her calcium was also excellent (not sure if that is what you were referring to or not).

REPLY
@tne

Thank you so much. This was her yearly wellness exam. Her triglycerides were slightly elevated for the first time and that huge jump with the TMAO….everything else was excellent. Her calcium was also excellent (not sure if that is what you were referring to or not).

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Hi @tne, that was quite a jump in the tmao number and since it’s a relatively new test (since 2015-ish) it’s interesting her PCP ordered it as part of a routine annual and then isn’t raising an eyebrow with the elevated level. Have you asked them about that particular result? Again, this is way out of my area of experience so maybe it’s a non-issue.
During this past year has your wife’s diet changed to include more meats and dairy products? Those were on the list of items that can increase tmao level that I posted for you yesterday.
The triglyceride levels can often (not always) be lowered through diet and exercise as well. Here’s the Mayo Clinic informational site on that subject. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/triglycerides/art-20048186

The calcium test I as referring to is a Coronary Artery Calcium Score test. It’s a noninvasive scan using computed tomography to measure the quantity of calcium deposits in the heart, especially deposits in the coronary arteries.
An increase in deposits contributes to narrowing in the arteries and a reduction in heart function, which can lead to a heart attack.
There’s a heart clinic in my city that offers these for anyone for about $50. It was just a phone call to set up the appointment and we didn’t need to be patients of the clinic. My husband and I have both had them and I know most cardiac clinics in larger cities will offer patients this test.
https://www.mayoclinic.org/tests-procedures/heart-scan/about/pac-20384686
~~~~~
https://www.mayoclinic.org/medical-professionals/cardiovascular-diseases/news/coronary-artery-calcium-score-are-we-doing-too-many-or-too-few/mcc-20438011
From my experience if your wife’s other blood work results are excellent it doesn’t sound like there’s much to worry about. She might try following the guidelines for reducing tmao and triglycerides to see if it makes a change for next year. If either of you are concerned about future heart disease, the Calcium Score Test (scan) is a great tool to help predict future potential issues. You sound very proactive with your health, do you think this is something you might look into?

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Thank you once again…… her diet has not changed very much -and the things that are supposed to be the main culprits(fish-beef-dairy)-she doesn’t do much of anyway. I know that her blood work (including inflammatory markers) were awesome-except for her slightly elevated triglycerides. I am gonna get her to follow up and do more blood work in 3-6 months. I am also gonna ask about the calcium test. Thank you again-so much!

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@tne

Thank you once again…… her diet has not changed very much -and the things that are supposed to be the main culprits(fish-beef-dairy)-she doesn’t do much of anyway. I know that her blood work (including inflammatory markers) were awesome-except for her slightly elevated triglycerides. I am gonna get her to follow up and do more blood work in 3-6 months. I am also gonna ask about the calcium test. Thank you again-so much!

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You’re welcome and it’s my pleasure. We’re all here to help each other! It’s not a bad idea for a 6 month followup…peace of mind if for nothing else. ☺️ Never hurts to be proactive!
With all the bloodwork I’ve had done in the past 3 years, I don’t think tmao was ever on the list! Now you have me curious. 😉. Let me know what you find out.

By the way, welcome to Mayo Clinic Connect. I’m glad you you found us. There are over 70 groups with countless conversations on almost any medical issue. I hope you and your wife take the time to peruse other groups. Don’t be shy to pop into conversations on any subject where you can use your life experiences to help out other members by offering advice or encouragement. Is there anything else I can help you with?

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Thank you again so very much. I will be interacting some…….my wife is also right at her FIVE year mark as a breast cancer survivor 🙏

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@tne

Thank you again so very much. I will be interacting some…….my wife is also right at her FIVE year mark as a breast cancer survivor 🙏

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@tne, I hope you don't mind, but I expanded the original title of this discussion to "What does an increase in trimethylamine N-oxide (TMAO) mean?" and added it to the Heart & Blood Health group as well as the Cancer group. I did this because I think the questions you ask and the great resources that @loribmt provided will be helpful to members in both groups.

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