#294 9 Ways to Lower Your TMAO Afib and Heart Disease Risk

9 Ways to Lower Your TMAO Afib and Heart Disease Risk

TMAO is a toxic byproduct from an unhealthy gut microbiome.  Having the right gut bacteria may help to prevent atrial fibrillation and just about every other form of cardiovascular disease.  In this article, I’ll share 9 ways to lower your TMAO Afib and heart disease risk.

What is TMAO?

Simply put, TMAO or trimethylamine N-oxide, is a waste byproduct from your gut bacteria.  As your gut microbiome tries to break down lecithin and carnitine from meat, eggs, dairy, processed foods, some energy drinks, some supplements, and soy TMAO is increased.

What’s the Proof of a TMAO Cardiovascular Risk?

If you do a simple search for “TMAO cardiovascular” on Pubmed website, you will quickly come up with 248 studies at the time of this writing.  Every study I reviewed reported a link between TMAO and a wide array of cardiovascular diseases.

And it isn’t just heart disease.  High TMAO levels have been reported with premature death, diabetes, strokes, cancer, high blood pressure, obesity, and kidney failure.

How may TMAO cause atrial fibrillation?

As just about every form of cardiovascular disease is associated with high TMAO levels, Afib is no exception.  For example, a Norwegian study of nearly 7,000 people showed that the higher your level of TMAO the more likely you were to get atrial fibrillation.  Indeed, this study showed that TMAO independently predicted susceptibility to atrial fibrillation outside of all the traditional Afib risk factors.

TMAO may also directly damage the electrical system of your heart.  In particular, studies show that that TMAO may rewire your heart’s electrical system by altering the autonomic nervous system or by directly damaging the heart cells through inflammation.

Is there a blood test for TMAO?

Yes, you can absolutely test for TMAO.  However, like countless other biomarkers of health, this isn’t a blood test your doctor will probably be able to do for you.  If you really want to know your TMAO level, you can do a quick Google search and find many companies willing to help you with this.  From a practical standpoint, if you can optimize around the 9 ways to lower your TMAO Afib and heart disease risk, then your TMAO levels will probably be undetectable even if you wanted to do TMAO testing.

9 Ways to Lower Your TMAO Afib and Heart Disease Risk

Based on hundreds of studies, we know that TMAO is definitely not something you want in your bloodstream.  Interestingly, antibiotics completely destroy TMAO producing bacteria.  However, given all of the other potentially harmful effects of antibiotics, this is not a viable option.   Below are the 9 best-proven ways I have found to lower your TMAO.

1. Eat a Mostly Plant-Based Diet

As TMAO is made by having the wrong gut bacteria, the quickest way to reduce TMAO is to eliminate the source.  Indeed, studies show that people who don’t eat meat, dairy, or eggs can virtually eliminate TMAO from their blood.  Once these bad gut bacteria have been eliminated, a vegan could even eat an occasional steak and not get a TMAO spike.

One unexplained paradox of TMAO is fish consumption.  For example, we know from countless studies that fish may protect against cardiovascular disease.  However, eating fish causes a big rise in TMAO levels.  One possible explanation for this paradox is that the TMAO produced from fish may be metabolized differently than TMAO from animal products.

If you like eggs and don’t want to increase TMAO levels, the cut off seems to be about two eggs per day.  As long as you stay under two eggs daily, one study shows that you can keep your TMAO levels in a reasonable range.

Likewise, dairy studies aren’t 100% entirely clear either.  For example, some studies show dairy shoots up TMAO levels whereas other studies say it doesn’t.

The bottom line is that if you choose to eat meat, make sure you also eat large amounts of vegetables to neutralize TMAO spikes.

2. Avoid Lecithin and Carnitine from Processed Foods, Energy Drinks, and Supplements

As the wrong gut microbiome will quickly turn any lecithin or carnitine from processed foods, energy drinks, or supplements into TMAO, the simplest way to lower TMAO levels is to avoid lecithin and carnitine.  If you consume these things, be sure to read the labels closely.

3. Optimize Sleep

Sleep is essential for just about everything, including keeping your TMAO levels in check.  Indeed, one study showed that going 24 hours without sleeping could boost TMAO levels.

4. Eat More Fiber

As with LDL cholesterol and many other potentially toxic substances, a high fiber diet dramatically drops TMAO levels.  This is because fiber is the best thing you can feed your healthy gut bacteria.  For example, one study showed that TMAO levels came down by 60% with fiber.

5. Probiotics

Right up there with fiber, probiotics also feed the good bacteria in your gut.  Many studies, but not all studies,  have shown that probiotics may also reduce TMAO.

6. Keep Your Fat Calories Below 55%

Too much fat in your diet may also raise TMAO levels.  While the amount of fat required to boost TMAO isn’t clear, one study has pegged the value at 55% of your calories coming from fat.  To do this study, research participants supplemented their diets with vast amounts of dairy and coconut milk.  Thus, it is impossible to know if it was the dairy, or the actual fat calories, that boosted TMAO levels.

7. Optimize B and D Vitamins

Micronutrient deficiency may be another cause of an elevated TMAO.  Indeed, one study showed that by optimizing vitamins B and D you could lower TMAO.

8. Eat Resveratrol Rich Foods

Resveratrol was once the darling longevity food.  While resveratrol has lost its longevity luster, it may reduce TMAO.  To get more resveratrol in your diet be sure to eat peanuts, berries, grapes, nuts, and dark chocolate.

9. Get More DMB from Balsamic Vinegar and Olive Oil

DMB, or 3,3-dimethyl-1-butanol which is a substance found in balsamic vinegar and olive oil, may lower TMAO levels.

The Big Picture

A healthy gut microbiome may be the secret to health and longevity.  And the more I read about TMAO, the more I am convinced that I don’t want this potentially toxic byproduct in my bloodstream.  If you’re going to lower your TMAO levels, be sure to discuss anything you read in this article with your physician first.

Disclaimer Policy: This website is intended to give general information and does not provide medical advice. This website does not create a doctor-patient relationship between you and Dr. John Day. If you have a medical problem, immediately contact your healthcare provider. Information on this website is not intended to diagnose or treat any condition. Dr. John Day is not responsible for any losses, damages or claims that may result from your medical decisions.

  1. I’ve always been told that carnitine is good for the heart. Many quality heart supplements contain it.
    I’m currently talking a heart supp called MitoQ which supposedly gets CoQ10 directly into the mitochondria.
    They also have a formula that doesn’t include carnitine which I guess I’ll be switching to.

    • Hi Sam,

      Great question. Until the science is better understood it is probably best to minimize any supplements that haven’t fully been studied.

      Thanks for reading!


    • Hi Robert,

      Not yet although I’ll bet that many pharmaceutical and supplement companies are probably working on it…

      Thanks for reading!


  2. I found the article on TMAO very interesting but when I went to Google a blood test which could be bought online I really couldn’t find an companies available. If anyone knows where you can buy a test for TMAO and have the blood drawn locally please let me know. Jim

    • Hi Jim,

      It can be a challenge. You have to call the number for the company then arrange for a local blood draw and then mail your sample…


  3. Dear Dr John Day
    Thank you for sharing your knowledge. I also highly recommend buying a Keyton Massage chair The best in the market made in Europe also leather. Generally, people who suffer from Afib are nervous people and get stressed easily if they use it every day. It can help them to relax. Also to detox the body Therasage.com they produce a full spectrum infrared Sauna with no EMF The name of the man that designed and produce it in America is Robby Besner and it is manufactured in America. That is what I am doing to improve my AFib My chad equals – 0 I hope I can eventually cure my AFib anyway I will keep trying to keep it stable if I do not manage to cure it. You have been a wonderful help to me. May God bless your work.
    Kind Regards

  4. I was taking acid blockers for over 10 years. Has any study been done on the effect of acid blockers on gut bacteria? Don

    • Hi Don,

      Yes, proton pump inhibitors (Prilosec, omeprazole, Prevacid, Nexium, etc.) all deplete stomach acid and change the gut flora.

      Hope this helps!


  5. I was Googling to find out if eating soy is bad for this and came across an article about a study by doctor Zhu of Cleveland Clinic. it said that even vegans and vegetarians can have this undesirable substance due to its being put out by the gallbladder or something to that effect . They also said that taking baby aspirin can reduce the impact of tmao on platelets by 40%. People on blood thinners however are advised not to take baby aspirin for the most part. Could you comment on these comments and put them in context please? Are those on plant-based diet at risk or not and should they eat soy? thank you so much for this new information and all you’re wonderful, helpful articles!

    • Hi Jean,

      Thanks for reading and commenting. As with any topic, you often find mixed results if you dig deep enough. However, the preponderance of data seems to suggest that vegans have very low levels of TMAO in the bloodstream.

      Regarding soy, the data are limited at best and I couldn’t determine if it was a soy isolate, like that found in processed food, or the whole bean. However, eating the whole bean, like they do in Asia, appears to be very protective from cardiovascular studies done on these people.

      As far as the gallbladder and aspirin studies, these were just single studies and I don’t know what to make of them. The field is rapidly developing and further research is required to see if the results are real or not.

      Hope this helps!


  6. As my A-Fib is caused by scar tissue(prior open heart surgery) will any changes to living style help? Although I try to eat healthy food, I think my gut bacteria is way off the scale.

    • Yes, open heart surgery does take a toll on the heart and arrhythmias can be a long-term complication from the surgery. However, lifestyle optimization can minimize the risk and if you do develop arrhythmias, make them easier to treat.

      Hope this helps!


  7. It’s all so interesting but also seems a bit difficult to remember and to follow, but I will try my best. God bless you and Jane if you are able to keep track of everything, and most likely you will!

    • Sorry, Sue. I try to come up with new topics that I find interesting based on the latest research. At the end of the day, it all comes down to some simple principles. Maintain a lean healthy weight. Eat a diet very high in vegetables and avoid sugar and processed carbohydrates. Exercise every day. And optimize your sleep and stress levels.

      Hope this helps!