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TMAO: A Health Danger You Need To Be aware Of (Updated 2021)

TMAO: A Health Danger You Need To Be aware Of (Updated 2021)

TMAO is short for “trimethylamine N-oxide.” It is a compound made by the liver when you ingest particular foods and drinks.

There is persuasive scientific evidence that TMAO causes significant inflammation in your body, the root of many chronic diseases and ailments. It can also cause cancer and neurological disorders, atherosclerosis, and heart disease.

Let’s look at what TMAO is and how it can severely affect your health.

Foods And Nutrients That Can Cause Unhealthy Levels Of TMAO

Foods And Nutrients That Can Cause Unhealthy Levels Of TMAO

Specific Nutrients That Cause An Increase In TMAO Levels

Four specific nutrients can cause your liver to produce high levels of TMAO. They are:

  1. choline (an essential nutrient that is neither a vitamin or an amino acid
  2. L-carnitine (an amino acid)
  3. Betaine (a nutrient that is neither a vitamin or an amino acid)
  4. Ergothioneine (an amino acid)

Top Foods High In Choline 

  1. Beef liver (fried, 3 oz.) – 356 mg. per serving, 65% DV (Daily Value)
  2. Egg (hard-boiled, 1 lg. egg) – 147 mg. per serving, 27% DV
  3. Beef Top Round (Steak) (lean only, 3 oz.) – 117 mg. per serving, 21% DV
  4. Soybeans (roasted, 1/2 cup) – 107 mg. per serving, 18% DV
  5. Chicken Breast (roasted, 3 oz.) – 72 mg. per serving, 13% DV
  6. Ground Beef (93% lean meat, broiled, 3 oz.) – 72 mg. per
  7. Cod Fish (cooked, Atlantic, 3 oz.) – 71 mg. per serving, 13% DV
  8. Whole Red Potato (baked, 1 lg.) – 57 mg. per serving, 10 DV

Note: Only the egg yolk contains the choline. Egg whites have zero quantity. However, a recent 2021 study indicates that the entire hard-boiled egg may be safe to eat because it did not significantly increase TMAO levels in humans. See also this study.

Top Foods High In L-Carnitine 

  1. Beef Steak (cooked, 4 oz.) – 56 – 163 mg. per serving
  2. Ground Beef (cooked, 4 oz.) – 87 – 99 mg. per serving
  3. Energy Drinks – many are incredibly high in L-carnitine, up to 3000 mg. per serving. See the following links: (1), (2), (3)

Note: Numerous supplements being sold also may contain high amounts of L-carnitine. Check their labels for this info.

Top Foods High In Betaine 

The following betaine content is for 100 grams per serving:

  • Quinoa (uncooked) – 630mg 
  • Spinach (cooked, boiled, drained, with salt) – 577mg 
  • Spinach (cooked, boiled, drained, without salt) – 577mg
  • Spinach (raw) – 550mg 
  • Spinach (canned, drained solids) – 540mg
  • Cereals (ready-to-eat, KELLOGG, KELLOGG’S ALL-BRAN Original) – 360mg 
  • Lambsquarters (raw) (Northern Plains Indians) – 332mg 
  • Cereals (ready-to-eat, KRAFT, POST Raisin Bran Cereal) – 291mg 
  • Beets (canned, drained solids) – 256mg 
  • Cereals (ready-to-eat, UNCLE SAM CEREAL) – 248mg 
  • Beets (canned, regular pack, solids, and liquids) – 228mg 
  • Beets (canned, no salt added, solids and liquids) – 220mg 

Top Foods High in Ergothioneine

Mushrooms appear to have the highest content of ergothioneine.

See Table 1 here for an extensive list. 

Here are the top five food sources (which are edible mushrooms) based on 100 grams of dry weight:

  • Boletus edulis (cepes) – 181.24 mg
  • King Oyster – 54.17 mg
  • Buna Shimeji – 43.26 mg
  • Shiitake – 35.35 mg
  • Enoki – 34.64 mg

The Process your Body Uses To Make TMAO 

In short, when you ingest foods, drinks, supplements, etc., that contain large amounts of choline or L-carnitine, betaine, or ergothioneine, particular types of bacteria found in your gut break them down, producing an organic compound called “trimethylamine” (TMA).

The TMA then travels to your liver and gets converted into TMAO by the Flavin-containing monooxygenases (FMO) gene.

Everyone possesses five functional FMOs. FMO3 is the gene responsible for regulating TMAO levels.

With this said, the higher the levels of TMAO, the more will remain in your body, resulting in adverse health effects if your diet continually feeds it with high choline, L-carnitine, betaine, or ergothioneine foods.

Note: Your “age, gender, diet, intestinal microflora composition, kidney function, and also liver flavin monooxygenase activity” play an essential part in determining how much TMAO is ultimately produced by your liver. 

The older you get, the more naturally the TMAO levels increase in your body. More critical, ingesting high levels of TMAO could speed up the aging of your arteries.

For example, one study on mice showed that just feeding them with TMAO foods for several months made a 12-month-old mouse look like a 27-month-old one, equivalent in adult years to a 35-year-old person looking like 80.

How Can High Levels Of TMAO Harm Your Body?

How Can High Levels Of TMAO Harm Your Body?

scientific report published by Nature.com put it like this:

In humans circulating TMAO and its precursors have been associated with atherosclerotic burden, increased risk for cardiovascular (CV) disease, and Major adverse CV events (MACE) and death in coronary and peripheral arterial diseases.

The report also stated that numerous studies on humans and animals showed that TMAO could promote other chronic diseases.

2021 study connected high levels of TMAO to:

  • cardiovascular diseases
  • cardiorenal disorders
  • atherosclerosis
  • hypertension
  • ischemic stroke
  • atrial fibrillation
  • heart failure
  • acute myocardial infarction
  • chronic kidney disease
  • diabetes mellitus 
  • metabolic syndrome 
  • cancers (stomach, colon)
  • neurological disorders
  • blood clots

Blood Test That Measures TMAO Levels In Your Body

If you have an underlying condition or disease, maybe you should get your TMAO levels checked. There may be a connection.

In addition, a TMAO blood test can effectively “predict future risk for heart attack, stroke, and death in patients who appear otherwise healthy,” according to clinical research. So, even if you feel good, it may be wise to take this test, especially if you are older.

Scientists have confirmed that testing for TMAO levels in people “could give them a quick and reliable way of assessing the risk of death and other major heart problems in patients who arrive in hospital emergency departments with chest pains.” It is apparent how important this test is. More interesting, a TMAO blood test can predict your risk of death as far as seven years into the future.

Here, you will find the guidelines, and here are further details that should be followed when taking this blood test. It would be prudent to ask your doctor for this test to determine your present TMAO levels and possible future risk of severe disease.

The great news is that this particular blood test is a simple procedure and inexpensive, costing around $50 in the USA.

How To Naturally Reduce TMAO In Your Body?

If you discover that you have high levels of TMAO, it is often recommended that you modify your diet to a Meditteranean or Vegan one.

The first thing you should do is immediately reduce or stop consuming products containing high levels of choline, L-carnitine, betaine, and ergothioneine.

Scientists have used numerous medical approaches to lower TMAO levels. (See the potential therapies list here). Below you will find some natural ways to possibly reduce TMAO.

Natural Ways To Lower TMAO

Below you will find a list of natural substances that may help lower high TMAO levels. They are all safe and contain many other health benefits besides the TMAO reducing properties.


Resveratrol is a potent antioxidant found in abundance in wines and grapes, but you can easily purchase it on Amazon in supplemental form. It is one of my favorite supplements.

Many studies have already established that it is:

  • anti-inflammatory
  • anticarcinogenic
  • cardioprotective
  • vasorelaxant
  • phytoestrogenic  
  • neuroprotective
  • anti-cancer
  • antibacterial
  • antifungal
  • anti-aging

Research done on mice concluded that resveratrol could reduce TMAO levels by decreasing TMA production in the gut. (Please reread “The Process your Body Uses To Make TMAO” earlier in the article to get a clearer understanding of this).

2021 study acknowledged that resveratrol is a potent regulator of gut bacteria and can reduce TMAO levels by “remodeling intestinal flora.”

In another human study, Taurisolo® was successful in reducing TMAO levels after four weeks of treatment. The main content of Taurisolo® is resveratrol.

Hawthorn Fruit Extract

Another natural product that has been shown to reduce TMAO is Hawthorn fruit extract, which can also easily be purchased on Amazon.

Hawthorn has been used worldwide for millennia to treat many ailments. In the last 20 years, over 150 health-related essential compounds have been found in this fruit berry.

Studies show that it is:

  • anti-atherosclerosis
  • antioxidant
  • anti-inflammatory

Clinical studies showed that it vigorously protects your heart and cholesterol levels.

Applying it to TMAO problems, a 2021 study showed that hawthorn fruit extract reduced TMAO in mice due to its potent anti-inflammatory and antioxidant properties.


In a laboratory experiment, the Western blot test showed that nobiletin could reduce TMAO levels.

Nobiletin is a flavonoid compound found in citrus peels like oranges, lemons, limes, etc. Flavonoids possess potent antioxidant benefits that can protect your health.

Studies show that the benefits of nobiletin include:

  • neuroprotection
  • cardiovascular protection
  • antimetabolic disorder
  • anti-cancer
  • anti-inflammation
  • and antioxidation

Nobiletin is another fantastic, natural supplement you can easily purchase on Amazon.


Ginger has been used for medicinal purposes for 1000s of years. Not only does it taste great, but studies have shown how beneficial it is for your health.

2021 review again confirms its health benefits. They are:

  • common cold
  • headaches
  • anti-inflammatory 
  • antioxidant
  • antiemetic
  • antiulcer
  • and anti-cancer
  • antiplatelet
  • anti-diabetic 
  • lipid-lowering (lowers cholesterol)

Add another health benefit to the list. It can lower TMAO. A study showed that ginger extract was able to reduce high TMAO levels in mice fed with a high cholesterol diet.

Extra Virgin Olive Oil

Extra Virgin Olive Oil (EVOO) contains a unique Omega-7 fatty acid called “3,3-Dimethyl-1-Butanol (DMB), proven to lower TMAO levels. 

study published in 2018 by nature.com reported that EVOO demonstrated that it was able to reduce TMAO.

2021 study explained the significance of 3,3-Dimethyl-1-Butanol when combating high TMAO levels.

What DMB does is inhibit the production of TMA activity, causing less TMAO to be produced.

As explained earlier in the article, TMA goes to the liver; it gets converted to TMAO by the FMO3 gene. By DMB inhibiting the production of TMA, the liver has less of it to make TMAO.

Take a look at the figure below. It details the process of how DMB would work. (Free access to the image is found here). 

TMAO: A Health Danger You Need To Be aware Of (Updated 2021)

The bottom line is that EVOO is an excellent natural source of DMB. Everyone should include a tablespoon per day in their diet. 

Black Seed Oil

This therapy is my opinion only. However, with scientific evidence, I will support my conclusion that black seed oil (BSO), also known as Nigella Sativa, can lower TMAO. Would you please do your further research on this?

BSO has an extensive history of health benefits spanning 100s of years. For a review on the benefits of black seed oil, please read my previous article, “The Potent Benefits Of Black Seed Oil – Updated 2021.

There is indirect evidence that BSO can lower TMAO. One study showed that it reduced trimethylamine-N-oxide (TMAO) when an experiment was conducted on rats.

In addition, there is a ton of evidence that thymoquinone, BSO’s main compound, can ameliorate (make better) bacteria and inflammation found in the gut and liver. 

See also this research report detailing the multitude of studies on how thymoquinone protects and regulates your gut and liver, two central locations for the process of TMAO production.


If you have persistent disease, maybe you should get your TMAO levels checked. There may be a connection. 

Your medical provider can guide you on how to get this test.

Your diet is deeply correlated to the state of your health. The evidence is clear, high levels of TMAO can cause many diseases.

It would be best if you investigated all avenues as to the cause of any disease. You only have one body. Protect it at all costs.