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Yes, open heart surgery does take a toll on the heart and arrhythmias can be a long-term complication from the surgery. that the more TMAO people had in their blood, the greater the odds they had heart disease and the worse their heart disease was. There are a number of genetic variants affecting the activity of . As my A-Fib is caused by scar tissue(prior open heart surgery) will any changes to living style help? After being produced in the proximal gut by one set of microbes, the -butyrobetaine is converted into TMA lower in the gut by a distinct set of microbes. immediately or shortly after exposure to Trimethylamine: * Contact can irritate and burn the skin and eyes. In reversed-phase chromatography the solutes are nonpolar ad . The present study was to investigate the effects of hawthorn fruit extract (HFE) on TMAO-exacerbated atherogenesis. What if we introduce new bacteria that could somehow siphon off the TMA made by the bad bacteria already in our gut? Whats the Role of Gut Bacteria in the Body? The condition seems to be more common in women than men, but scientists don't know why. So, the drug industry came up with statin drugs that cripple the liver enzyme that makes cholesterol. It turns out that brussels sprouts appear to naturally downregulate the TMAO liver enzymenot enough to make you stinky, but just enough to drop TMAO. So, Big Pharma developed statin drugs that. June 21, 2022 Its all so interesting but also seems a bit difficult to remember and to follow, but I will try my best. The urine test can be done in two different ways. Yes. Not yet although Ill bet that many pharmaceutical and supplement companies are probably working on it, I found the article on TMAO very interesting but when I went to Google a blood test which could be bought online I really couldnt find an companies available. But, it doesnt work. Choline is also present in lecithin supplements. To bookmark this site, press the Ctrl + D keys on your Windows keyboard, or Command + D for Mac. The easiest and safest recommendation? Every study I reviewed reported a link between TMAO and a wide array of cardiovascular diseases. If you have trimethylaminuria or high levels of TMAO, you may be able to reduce the presence of the compounds in the body with the following: 1. Note: some of the resources below may be affiliate links, meaning I get paid a commission (at no extra cost to you) if you use that link to make a purchase. The trimethylamine gets released in the person's sweat, urine, reproductive fluids, and breath, giving off a strong fishy odor. Interestingly, antibiotics completely destroy TMAO producing bacteria. Modern science puts its mark on a rare but ancient body-odor disease Eat more healthfully. Trimethylamine has been described as smelling like rotten or decaying fish. National Center for Biotechnology Information, Lister Hill National Center for Biomedical Communications, Chemical Hazards Emergency Medical Management, https://www.phmsa.dot.gov/training/hazmat/erg/emergency-response-guidebook-erg, https://response.restoration.noaa.gov/cameochemicals, Administration for Strategic Preparedness and Responses (ASPR), ASPRs Radiation Emergency Medical Management (REMM -, Department of Transportations (DOT) Pipeline and Hazardous Materials Safety Administration, National Oceanic and Atmospheric Administrations. Carriers of trimethylaminuria excrete 20-30 percent of total trimethylamine as the free unmetabolized amine and the rest as trimethylamine N-oxide. Finding Reliable Health Information Online How to Reduce TMAO Levels Consider a TMAO Test to Gauge Your TMAO Levels Limit Your Consumption of Foods High in TMAO Decrease Your Intake of Red Meat to Reduce Risk of Heart Disease Eat More Vegetables to Bring Down TMAO Levels Consider a Mediterranean Diet Since It's Very Balanced Be Cautious About Supplements as This Can Shoot Up TMAO Levels Contact with the unconfined liquid can cause frostbite from evaporative cooling or chemical type burns. They stop eating animal products. Can you hear the frustration in my voice as I read paper after paper proposing those ridiculous (but profitable!) There are several reports that the condition worsens around puberty. Sign up for wikiHow's weekly email newsletter, Tips and tricks to effectively manage and treat trimethylaminuria. Trimethylaminuria is usually inherited in an autosomal recessive fashion, which means that two non-functioning FMO3 genes are usually needed for a person to have symptoms. Trimethylaminuria (TMAU, Fish Odor Syndrome) Trimethylaminuria, or TMAU, is a very rare condition that makes your sweat, breathe, saliva and pee smell like rotten fish or rotten eggs. To find out more about this laboratory, select the 'GeneTests' icon at the top of the page at the following URL: www.geneclinics.org. Read our important information about translations here. May God bless your work. Why not pharmacologically inhibit the enzymes in our liver that make TMAO and thereby possibly help reduce our risk of cardiovascular disease? You may not use our material for commercial purposes. Photosynthetic response curves examine photosynthetic rates and maximum irradiance. Use and store only outdoors or in a well ventilated . [3] 3 Take supplements. DMB, or 3,3-dimethyl-1-butanol which is a substance found in balsamic vinegar and olive oil, may lower TMAO levels. There is. Improved Heart Health: According to a study published in PLoS One, fasting is effective at improving cholesterol levels, which could potentially help reduce the risk of heart disease. Thus, it is impossible to know if it was the dairy, or the actual fat calories, that boosted TMAO levels. Circ Cardiovasc Genet. Taking laxatives can decrease intestinal transit time and reduce the amount of trimethylamine produced in the gut. use anti-perspirant wash your clothes frequently Treatments from a doctor Your doctor may recommend: short courses of antibiotics - this can help reduce the amount of trimethylamine produced in your gut taking certain supplements - such as charcoal or riboflavin (vitamin B2) Support Many people find living with trimethylaminuria difficult. 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. [4] 4 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. Based on hundreds of studies, we know that TMAO is definitely not something you want in your bloodstream. Last Updated: October 27, 2022 In the Womens Health Initiative study, women with the highest TMAO levels in their blood. After this, one or more samples of urine are collected (20 mL . It is the chemical that gives rotten fish a bad smell. in Psychology and Biology from the University of California, Los Angeles, his M.D. As with any topic, you often find mixed results if you dig deep enough. span measurement in gear; firefighter residency programs washington; cash paid jobs in brampton kijiji; melrose international catalog; seborrheic keratosis small white bumps on ankles and feet Atherosclerosis. That was the billion-dollar strategy employed by Big Pharma to lower our cholesterol. If we dont eat steak, then we dont foster the growth of steak-eating bacteria in our gut. In that case, might the fact that, fecal contamination in every sample of beef it tested be a good thing? The gut microbial endocrine organ: bacterially derived signals driving cardiometabolic diseases. He completed his B.S. Trimethylamine (TMA) has been used in the preparation of poly[9,9-bis(6-N,N,N-trimethylammonium)hexyl)fluorene-co-alt-4,7-(2,1,3-benzothiadiazole) dibromide] (PFBT), a water-soluble, cationic conjugated polymer used in label-free DNA microarrays. about the troublesome transformation from choline into trimethylamine (TMA) for more than 40 years, but that was long before we learned about its connection to heart disease. Because these methylamines might form nitrosamines, which have cancer-causing activity. In rats, meldonium reduces the production of TMA from L-carnitine and, thus, decreases TMAO levels. However, excess choline, such as that found in eggs, may be worth avoiding.. 2015 Sep;242(1):141-4. Should we give that a try to lower our TMAO levels? Powered by Mai Theme. Limitations. If youre going to lower your TMAO levels, be sure to discuss anything you read in this article with your physician first. Written By When applied on the skin on a regular basis, acidic body lotions and soaps fully convert excreted TMA to the non-smelling conjugate acid, reducing the body odor. Trimethylaminuria [rarediseases.info.nih.gov] By subscribing, you will automatically receive the latest videos emailed to you or downloaded to your computer or portable device. Acid soaps and body lotions to remove secreted trimethylamine by washing; Activated charcoal and copper chlorophyllin to sequester trimethylamine produced in the gut; Antibiotics (metronidazole, amoxicillin, and neomycin) to suppress production of trimethylamine by reducing bacteria in the gut; When the normal metabolic process fails, trimethylamine accumulates in the body, and its odor is detected in the person's sweat, urine and breath. Biochem Pharmacol. Not all of the functions of the FMO3 enzyme are known, so physicians don't know what other symptoms besides odor may be associated with trimethylaminuria. 8600 Rockville Pike Subscribe to our free newsletter and receive The Evidence-Based Eating Guide: A Healthy Living Resource from Dr. Greger and NutritionFacts.org. Use 'trimethylaminuria' as your disease search term and click on either the 'Research' or 'Testing' icon for the laboratory's contact information. 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. All rights reserved. all deplete stomach acid and change the gut flora. The TMA just doesnt get oxidized into TMAO. Jim, It can be a challenge. Having the right gut bacteria may help to prevent atrial fibrillation and just about every other form of cardiovascular disease. Other. By signing up you are agreeing to receive emails according to our privacy policy. Smelling like dead fish: a case of trimethylaminuria in an adolescent. Trimethylamine Section 2. less polar in reversed-phase chromatography, whereas eluent strength increases as solvent becomes more polar in normal-phase chromatography? As with LDL cholesterol and many other potentially toxic substances, a high fiber diet dramatically drops TMAO levels. Real Living. The method is processed according to the following steps of: 1) accurately weighing a sample containing triethylamine salt, evenly shaking in a separating funnel containing water, adding methyl red indicating liquid; 2) dropwise adding a sodium hydroxide solution while adding until a proper amount of solution is . In vitro and in vivo inhibition of human flavin-containing monooxygenase form 3 (FMO3) in the presence of dietary indoles. Adding good bacteria doesnt seem to get rid of the bad. In the Womens Health Initiative study, women with the highest TMAO levels in their blood had approximately three times greater risk of rectal cancer, suggesting that TMAO levels may serve as a potential predictor of increased colorectal cancer risk. It is also a degradation product of plants that have high nitrogen contents and a distillation product of sugarbeet residues. The body needs choline to synthesize phosphatidylcholine and sphingomyelin, two major phospholipids vital for cell membranes. Probiotics can help control the populations of neutral, opportunistic or pathogenic microbes so that less TMA is released from foods and drinks. Work in conjunction with a health care provider or genetics professional to contact the laboratory and learn more about the clinical diagnostic testing the laboratory offers. Cruciferous vegetable consumption is associated with a significantly longer life:less cardiovascular disease mortality. Methane-producing bacteria may be able to eat up our TMAO, but unfortunately, these bacteria may be associated with a variety of diseases, from gum disease down to colorectal cancer. When we eat foods with high concentrations of choline, a nutrient I discuss in more detail below, certain bacteria in our gut make trimethylamine, or TMA. In fact, halibut generated over 53 times as much TMAO as eggs! This is why Akkermansia is effective in chronic disease prevention and treatment. There has been mixed success at reducing TMAU symptoms by taking vitamin B2, zinc, kelp pills, or copper chlorophyllin. TMAO is a toxic compound that may increase our risk of heart failure, kidney failure, and atherosclerosis, but might there be nutritional or interventional prospects for prevention? Flammable gaseous hydrogen may be generated in combination with strong reducing agents, such as . You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment. How about getting a fecal transplant from a vegan? Busby MG, Fischer L, da Costa KA, Thompson D, Mar MH, Zeisel SH. World J Gastroenterol. It is concentrated in red meat, certain energy drinks, and carnitine supplements. Generally, people who suffer from Afib are nervous people and get stressed easily if they use it every day. A baked sweet potato is one of Dr. Movassaghi's favorite sidesit's a vehicle for protein, fiber, and potassium for electrolyte benefits, making it a good suggestion for a bladder-friendly dinner,. Kathleen, I was taking acid blockers for over 10 years. TMA is so stinky that it makes you smell like dead fish. Mendelsohn AR, Larrick JW. Likewise, dairy studies arent 100% entirely clear either. Probiotics can help with GERD or reflux. From a TMAO standpoint, maybe we dont have to eat like a vegan, as long as we poop like one. But, given what we now know about how toxic the end product TMAO can be for normal people, cutting down on animal products may not just save the social lives of people with a rare genetic disorder, but help save everyone elses actual lives. Need we worry about high-choline plant foods, like broccoli? You can give a vegan a steak, which contains both choline and carnitine, and there will not even be a bump in TMAO. Accessibility EPA ORCR is in the process of transitioning existing SW . Simply put, TMAO or trimethylamine N-oxide, is a waste byproduct from your gut bacteria. It turns out that Brussels sprouts appear to downregulate that TMAO liver enzyme naturallynot enough to make you stinky, but just enough to drop TMAO. So, it really is a measure of which factor is more dominant or which factor outweighs the other. On cooling the crystals of triethyl amine formed removed by simple filtration of the reaction mixture. The same foodsmeat, dairy, and eggsraise our cholesterol, and changing our diet may lower it, but that isnt very profitable. Email: LabClientServices@childrenscolorado.org. Reduced clearance of uremic solutes and imbalance in gut bacteria increase IS, pCS, and TMAO levels in the serum of CKD and AKI patients [61] . false. If only there were some other way we could stop this process from happening. However, given all of the other potentially harmful effects of antibiotics, this is not a viable option. This is not surprising, because although all species of seafood contain lower amounts of choline than eggs, they do contain trimethylamine and TMAO. The events listed on the calendar are currently up to date! The test measures the ratio of trimethylamine to trimethylamine N-oxide present in the urine. No. High levels of this compound are tied to coronary artery disease, so this may help reduce your risk. To get more resveratrol in your diet be sure to eat peanuts, berries, grapes, nuts, and dark chocolate. Weve known about the troublesome transformation from choline into trimethylamine (TMA) for more than 40 years, but that was long before we learned about its connection to heart disease. How to Reduce LPS Naturally Spore Probiotics: The primary strategy to deal with endotoxemia is to support the integrity of the gut lining and gut mucosa. Recommended intake is 30-40mg taken 3-5 times per day with food. So, forget the cow. If you look back at the table further up the page, you will see that the trimethylamine has a much lower boiling point (3.5C) than 1-aminopropane (48.6C). Increased Weight Loss: Studies show that fasting can reduce body weight and body fat while also helping to retain muscle mass to improve body composition. Taking supplements to decrease the concentration of free trimethylamine in the urine. This field is for validation purposes and should be left unchanged. Dr. Nazarian specializes in comprehensive physical examinations, IV Vitamin therapies, hormone replacement therapy, weight loss, platelet rich plasma therapies. Dr. Hazen's team was aware of this study, because they referenced it briefly in the discussion section of the NEJM paper. Disclaimer Policy: This website is intended to give general information and does not provide medical advice. Hazards identification Prevention :Wear protective gloves. Not at all. Kind Regards When we eat foods with high concentrations of choline, a nutrient I discuss in more detail below, certain bacteria in our gut make trimethylamine, or TMA. It can help them to relax. Indeed, one study showed that by optimizing vitamins B and D you could lower TMAO. Can we get too much choline from plants? What laboratories offer testing for trimethylaminuria. As this compound builds up in the body, it causes affected people to give off a strong fishy odor in their sweat, urine, and breath. Nat Med. The bottom line is that if you choose to eat meat, make sure you also eat large amounts of vegetables to neutralize TMAO spikes. Using an array of different technologies, the researchers. Genetics Home Reference: Trimethylaminuria [ghr.nlm.nih.gov] Take probiotics. As methylamine has the least number of alkyl groups, the inductive effect by the alkyl group is the least out of methylamine, dimethylamine, and trimethylamine. However, eating fish causes a big rise in TMAO levels. Check the concentration of the sample, injection volume, solvent you are using to prepare your sample, cycle time and scan time if using MS, all the fitings. Trimethylamine N-oxide (TMAO), an important proatherogenic uremic toxin, is oxidized by hepatic-flavin monooxygenases from gut microbiome-generated trimethylamine (TMA). There is a problem, though. A regular 24-hour fast may help reducetrimethylamine N-oxide levels in the long term. When researchers followed kidney patients over time and assessed their freedom from death, they found that those with higher TMAO lived significantly shorter lives, even after controlling for kidney function. The following are some ways a person with trimethylaminuria can lower symptoms of odor: Avoiding foods containing trimethylamine and its precursors (choline, lecithin and trimethylamine N-oxide). HCl . Copyright 2023 Dr. John Day, LLC. This laboratory is located in Canada. Therefore, it is recommended that you work with a medical or genetics professional to contact the laboratories for further information. He has over 16 years of medical training and facilitation and is a Diplomate of the American Board of Internal Medicine. 1. Uncovering the trimethylamine-producing bacteria of the human gut microbiota In this study, we developed a diagnostic framework that enabled the quantification and comprehensive characterization of the TMA-producing potential in human fecal samples. Ive always been told that carnitine is good for the heart. 2011 Jul;94(1):240-6. J Clin Invest. Dietary modification of the microbiome affects risk for cardiovascular disease. The chemical is derived in part from nutrients that are abundant in red meat. Do we have to choose between suffering from heart and kidney disease or smelling like dead fish? One unexplained paradox of TMAO is fish consumption. Trimethylamine N-oxide is present in seafood (fish, cephalopods, crustaceans). So, given the known adverse effectsfrom sufferers of fish odor syndrome, the untoward odorous side effects of inhibiting this enzyme make it a less attractive [drug] target.. Image credit: Sally Plank via Flickr. It is common to compare basicity's of amines by using the K a 's of their conjugate acids, which is the corresponding ammonium ion. Biochemical Genetics Lab In a tertiary amine there aren't any hydrogen atoms attached directly to the . A colorless gas with a fishlike odor at low concentrations changing to ammonia-like odor at higher concentrations. This page is no longer being updated as of February 28, 2023. Image has been modified. No. These studies are of interest, Dr. Hazen notes, because they identify a new set of microbial targets to help curb the TMAO generation in response to dietary L-carnitine. Four thousand people were followed for three years, and, as you can see in the graph below and at 3:10 in my video Egg Industry Response to Choline and TMAO, those with the highest TMAO levels went on to have significantly more heart attacks, strokes, or even death. Cashman JR, Xiong Y, Lin J, Verhagen H, van Poppel G, van Bladeren PJ, Larsen-Su S, Williams DE. They should not attempt to self-administer. Too much fat in your diet may also raise TMAO levels. Vegetarians and vegans have different gut microbial communities. the growth of steak-eating bacteria in our gut. Trimethylamine N-oxide (TMAO) is a metabolite generated from gut microbial degradation of choline, betaine, and carnitine. Indeed, this study showed that TMAO independently predicted susceptibility to atrial fibrillation outside of all the traditional Afib risk factors. I would love to hear from you! . Has any study been done on the effect of acid blockers on gut bacteria? preti@monell.org Do we need to worry about high-choline plant foods, like broccoli? I can answer general health questions and will do my best to answer your questions in my blogs, podcasts, or videos. And, plant-based eating gives us other benefits: For more on TMAO, the smoking gun of diet-microbiome-disease interactions, see: A founding member and Fellow of the American College of Lifestyle Medicine, Michael Greger, MD, is a physician, New York Times bestselling author, and internationally recognized speaker on nutrition. Well, there is a bacterium inside the guts of cows and sheep that, that to get rid of some of the TMA in our gut? So, if antibiotics and probiotics arent going to work to prevent gut bacteria from taking meat, dairy, and eggs, and turning them into the trimethylamine which our liver makes TMAO out of, I guess we have no choice but to cut down onour liver function! Thanks to all authors for creating a page that has been read 58,012 times. The intensity of the odor may vary over time. Shipped as a liquid under its own vapor pressure. Hmm. In women, symptoms can worsen just before and during menstrual periods, after taking oral contraceptives, and around menopause. Taking low doses of antibiotics to reduce the amount of bacteria in the gut. And it isnt just heart disease. Where can we find carnitine? eating animal products, which is what those with trimethylaminuria often do to lower their TMA levels. could there be a pre-biotic gut freindly to help eliminate this toxic bacteria? For example, some studies show dairy shoots up TMAO levels whereas other studies say it doesnt. However, that could also kill our good bacteria, and facilitate the emergence of antibiotic-resistantstrains.. March 2, 2021 In fact, consumption of cruciferous vegetables is associated with a significantly longer life and less cardiovascular disease mortality, as you can see at 5:34 in my video. What happened? This is the enzyme that converts trimethylamine to to trimethylamine N-oxide. A dosage of 750 mg of activated charcoal twice daily for 10 days has been shown to reduce urinary free TMA and shift the TMA:AO ratio to values similar to those seen in healthy patients. Monell Chemical Senses Center Thankfully, we can get all we need from fruits, vegetables, beans, and nuts. Changing your gut culture to have healthy and beneficial bacteria is seen as a good way to improve the digestive enzymes and be able to detoxify trimethylamine in the system. While the amount of fat required to boost TMAO isnt clear, one study has pegged the value at 55% of your calories coming from fat. If our gut bacteria can take meat, dairy, and eggs and turn them into TMAO, all we have to do is destroy our gut flora. By minimizing the consumption of full-fat dairy products (including whole milk, egg yolk, cream cheese, and butter); both processed and unprocessed red meat (beef, pork, lamb, and veal), as well as nutritional supplements and energy drinks containing choline, phosphatidylcholine, and/or L-carnitine. Ferrari ND 3rd, Nield LS. This time to make a fair comparison you would have to compare trimethylamine with its isomer 1-aminopropane. What if we added a new bacteria that could somehow siphon off the TMA made by the bad bacteria? A change of split ratio only affected the signal intensity of the analytes, and the amount of injected sample matrix remained the same. This is because fiber is the best thing you can feed your healthy gut bacteria. They also said that taking baby aspirin can reduce the impact of tmao on platelets by 40%. Adding good bacteria doesnt seem to get rid of the bad. The first two steps involve eating a diet low in choline and trimethylamine (TMA) for three days. Dr. David Nazarian is a board certified Internal Medicine Physician and the Owner of My Concierge MD, a medical practice in Beverly Hills California, specializing in concierge medicine, executive health and integrative medicine. 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. TMAO may also directly damage the electrical system of your heart. Consider the reactions for a conjugate acid-base pair, RNH 3+ RNH 2: (3) RNH 3 + ( a q) + H 2 O ( l) RNH 2 ( a q) + H 3 O + ( a q) K a . This suppresses the production of trimethylamine. So, given the known adverse effectsfrom sufferers of fish odor syndrome, the untoward odorous side effects of inhibiting this enzyme, Do we have to choose between suffering from heart and kidney disease or smelling like dead fish? People with trimethylaminuria have an impaired version of the enzyme flavin-containing monooxygenase 3 (FMO3). Carnitine and choline are two components known to facilitate production of TMAO. One possible explanation for this paradox is that the TMAO produced from fish may be metabolized differently than TMAO from animal products. What happened? Click the card to flip . true. The problem with that is that trimethylamine is so stinky, it makes you smell like dead fish. So, given the known adverse effectsfrom sufferers of [this] fish odor syndrome, the untoward odorous side effectsmake it a less attractive [drug] target. So, do we have to choose between smelling like dead fish, or suffering from heart and kidney disease? 2013 May;19(5):576-85. We could give people antibiotics to eliminate the production of TMAO, but that could also kill our good bacteria and foster the emergence of antibiotic-resistant bacterial strains. To see what was going on, researchers took the vegetable highest in choline, Brussels sprouts, and had people eat two cups a day for three weeks, and their TMAO levels actually went down. Michael Greger M.D. Enter your email address to receive updates about the latest advances in genomics research. 1 / 9. Using soaps with a moderate pH, between 5.5 and 6.5. 2014 Jan-Feb;5(1):5-10. Maybe if we add good bacteria, it will crowd out the ones that take the meat, egg, and dairy compounds, and turn them into TMA, which our liver turns into TMAO. Why Are Choline and Carnitine Bad for the Health Then? Since this condition usually requires two altered genes to cause symptoms, typically neither parent of an individual with trimethylaminuria has any symptoms. Meat-loving microbes: do steak-eating bacteria promote atherosclerosis? The new test now available through Cleveland HeartLab measures blood levels of TMAO, a compound produced . Search ClinicalTrials.gov [clinicaltrials.gov], Additional Resources for Trimethylaminuria. Trimethylamine builds up in the body of patients with trimethylaminuria. Avoid breathing gas. Real Food. May be incompatible with isocyanates, halogenated organics, peroxides, phenols (acidic), epoxides, anhydrides, and acid halides. Rejuvenation Res. To lower your TMAO levels, consider minimizing the consumption of full-fat dairy products, including whole milk, egg yolk, cream cheese, and butter; both processed and unprocessed red meat (beef, pork, lamb, and veal), as well as nutritional supplements and energy drinks containing choline, phosphatidylcholine (lecithin), and/or L-carnitine. Trimethylamine CAS RN: 75-50-3 Disposal Methods. In this article, Ill share 9 ways to lower your TMAO Afib and heart disease risk. 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.