TMAO and Nature vs Nurture – FORD BREWER MD MPH

TMAO and Nature vs Nurture – FORD BREWER MD MPH

I’m going to do another in the series on
trimethylamine oxide. This is on a an editorial that has to do with nature
versus nurture. The editorial was actually printed in the New England
Journal at the same time as the article by Tang and associates the April 2013
article that was a significant landmark. It was a landmark regarding the whole
issue around – cardiovascular risk and TMAO. Now why is that not on a
nature versus nurture? Well he’s not really arguing for nature or nurture
He’s saying it’s a dumb question it’s it’s naive and overly simplistic. Now why
is he saying that? I’ll get to that in a minute but first of all there’s you know
maybe I get too focused on context but I stay well very well focused on context
let me introduce a couple of things: 1 myself my name is
Ford Brewer. I’m a physician- started off in the ER
emergency department and that gets you really focused on prevention. Iwent to to
get training in prevention and have actually ended up running the program
and I’ve ended up training doc – primary care docs and prevention for three
decades since then. 2. An intro on the channel – this is the prevention science Channel. A
lot of people would say you know what and I get a lot of this feedback well
quick get to the bottom line just tell me what to do well unfortunately right
now there’s a lot of things that you can like TMAO egg yolks I could tell you it
to eat them or I could tell you don’t eat them and I’ve got very good
evidence on both sides to indicate that I’d be right – ( so as you as you’ll see in my
channel) quite often I frustrate people with giving you the facts – giving you
what’s known and what’s not now and leaving it to you to form your own
conclusions you know this sort of like reality you get the facts but then you
still don’t know what to do I think you’ll get some interesting information
out of this and again enough information to to make some of your own decisions
The last thing I wanted to introduce again is very briefly a lot of people
don’t even know of what I’m talking about with TMAO lecithin think egg yolks
and lecithin was discovered back in the mid-1800s -1880 or so and it was part
of egg egg yolk and lecithine – which it was named after – is French for egg
yolk phosphatidylcholine is one of the major components of lecithin or egg yolk
you find it in obviously eggs cheese and meat take it in the diet bugs inside the
diet will turn that into trimethylamine which is then oxidized by the liver to
try methyl amine oxide that has been associated with atherosclerosis
cardiovascular disease now as I said there’s still a lot of debate around
that some people are saying you should not only take choline you should
supplement it I’ve got a video that talked about some of that research
recently others would say no there’s significant cardiovascular risk and this
is the again as I mentioned the landmark article by Tang and associates in April
2013 the New England Journal of Medicine where they’re saying,” look ,intestinal
microbial metabolism – phosphatidylcholine is
cardiovascular risk so just very briefly I will also cover that summarize that
very quickly this is a very interesting study design
they had patients come in three times the first time they each time they gave
him a phosphatidylcholine challenge and then they measured it was radio actively
identified or tagged and then they measured the upcoming spike in
trimethylamine oxide so therefore indicating yes this phosphatidylcholine
is being turned by the gut bacteria into TMA
which is then being turned into TMAO “Wait ,”you might say , “how did they prove
that the gut biome was doing that?” Between the first and second visit they
gave him antibiotics did the second visit and saw a significant a huge
decrease in fact a basic absence of the spike in TMAO after the
phosphatidylcholine challenge so without the gut bacteria in the second visit the
phosphatidylcholine was now being turned into into TMA trimethylamine so there
was nothing for the liver to oxidize a few weeks later they came back for the
third visit redid it and you could see regrowth of the gut and reintroduction
of that TMAO challenge what was scary and interesting was they followed these
people for three years after separating them into the :highest, next to the
highest next and then least TMO levels in their spike. The people of the
quartile that had the highest also had the highest heart attack stroke and
death rate over the next three years they did some other things in terms of
modeling and showed that it didn’t appear to be totally due to
other cardiovascular risks (such as pre diabetes diabetes & age). One of the other
things that they showed – that they indicated – they really didn’t talk about
it because they didn’t know it was significant at the time was that there
was this significant in a different term and there was significant interaction
with kidney disease (and again we’ve seen that in other more recent research which
I’ve covered in a different video) so back to the editorial as this editorial
was in the same issue of the New England Journal it was done by Joseph Loscalzo – and he said look this whole issue of nature versus nurture is too
simplistic that it was Galtonian I’ll read the sentence the Galtonian
distinction between the influence of genetics in the environment on the
phenotype is now widely recognized as overly simplistic – an overly
simplistic dichotomy. Well first of all – who is Galton? Francis Galton was
a eugenicist in 1919 century England. What he’s talking about here is nature
versus nurture. He was a major proponent of that whole argument and what we’re
saying here is and I think this is the key message in this video. This whole
message and this whole argument about nature versus nurture is dumb! It’s
overly simplistic. A couple of reasons the first reason is this that
assumes that there’s no interaction between the genes and the environment
and the reality is there is interaction between genes and the environment the
second reason why nature versus nurture alone as it stands is a dumb question is
which genes are you talking about and that’s very appropriate for this whole
issue of TMAO. He points out that there are more genes
in our bugs than in us!. In fact 100 times more genes the bugs – that live on the
bacteria viruses that live on our skin and in orifices and by far the most – the
biggest contribution of our microbiome in terms of genetics – is our gut so he
goes on to talk about a couple of other things. There are other diseases where
this has already been shown to be a big issue. Our microbiome and the genetics
associated with it one of them is with periodontal disease. I’ve got several
videos on that issue Another one was rheumatoid arthritis.
Rheumatoid arthritis, as I’ve mentioned several times, is as much of a risk for
heart attack and stroke as diabetes and inflammatory bowel disease. now what what
else does he cover? The rest of the his article doesn’t really cover
a lot of major significance. He goes in and reviews the Tang article which we’ve
already done he does talk about in the end something that’s interesting he
talks about potential mechanisms for TMAO being associated with
cardiovascular disease one being oxidation-reduction. TMAO is a major
oxidizer and it chews up glutathione many of you have heard of glutathione as
the mother of antioxidants. Another potential mechanism has to do with its
methyl us. It’s got a significant role in methyl metabolism. Many of you also
know that methyl metabolism and oxidation reduction are both very much
related. There was a 3rd mechanism I’ll just check it out real quick and then
we’ll wrap up oh and TMAO itself so those of you
who’ve made it this far thank you very much for your interest no I’m not going
to tell you whether you can eat egg yolks or not. Do I eat them? Yes I do

16 thoughts on “TMAO and Nature vs Nurture – FORD BREWER MD MPH”

  1. Some say eggs are a perfect food with their nutrients, protien and fat. Even those that told us not to eat them in the past have since changed their mind. So this study show gut bacteria can cause tmao, but it's more important how the body deals with it, and has been said kidney function to the rescue. But beyond that – from web md – When Cleveland Clinic researchers fed mice a diet rich in TMAO producing nutrients, they identified a compound called DMB capable of minimizing TMAO produced from their gut microbiota. In fact, when DMB was added to their drinking water, they found TMAO levels and the formation of arterial plaques both declined. DMB may be found naturally in many Mediterranean diet foods, including red wine and extra virgin olive oil.

  2. It seems every time you hear of one study about what is or can be unhealthy for you there is another one that says the opposite. What I'm getting out of all this is that oxidation is inevitable, however, ways to minimize or counter the effects of oxidation coupled with inflammation should be the focus of every diet and health plan.

  3. I love the analysis of the facts and figures but as a non medical professional I look for both the breakdown of the clinical implications and the "personal opinion" of professionals in the field.

  4. Ford, I recall that, among other factors, regular meat eaters cultivated gut microbiota which helped create the TMAO more TMAO than people who ate meat infrequently. This 2018 paper mentions this –

  5. i like hearing the facts. i think with the research either theres nothing conclusive or the response depends on genetics have any of these studies tested for variations on cyps

  6. Here's a 2015 paper on "Dietary allicin reduces transformation of L-carnitine to TMAO through impact on gut microbiota". Allicin is found in garlic while higher concentrations are found in aged garlic. You can take aged garlic supplements (lookup "Kyolic aged garlic" on Amazon).

  7. The Vegan Diet, Keto Diet, and Carnivore Diet all exclude man made seed & vegetable oils/fat and processed grains. All of them lean towards whole foods and variety. I suspect that what we ate when we worked a farm is best… Otherwise nobody would have continued to produce that food.

  8. Ok some foods are worse than others and some foods in excess are not good. I think you could have approached this vid with the good and bad of eggs and yolk and perhaps recommendations for eating them a few times a week, every day, or not at all, depending on whether you are healthy, have kidney or heart disease, or even cancer. Maybe there is a way of preparing them like frying compared to poached that can effect these things as well. I don’t know. But I think your videos are great but in the last couple you are getting lost in the woods. I am not sure what to make of them other than your observation on genetics being influenced by environment is right on, I believe.

  9. The gutbiome type is critical to the formation of TMA. Pity that the research paper did not address this point. Every individual has a different gutbiome, which is influenced by diet and lifestyle. It would not surprise me if someone on a high fibre based diet would have a significantly reduced risk of formation of TMA whether or not eggs , fish or meat are consumed.

  10. I took the anticholinergic, benadryl, for 18 years. (half to 1.5 tablets, 6 to 18 mg). I noticed, others noticed, it affects the setting of long term memory. Then Dale Bredeson brought the Alzheimer's connection to my attention this summer. Also, back in February, 23andme, said my brother needs to eat more eggs, as he has a gene which could cause poor choline synthesis. So, I really wish some doctor or scientist would cover choline metabolism, choline brain receptors. I definitely seem to think more clearly, make memories better, even need less sleep, eating fish, eggs, taking fish oil supplements, choline supplements, not taking benedryl, even going keto and antioxidants (less reactive oxygen species in the brain, especially burning ketones). My daily caffeine (possibly a brain antioxidant?) intake must be no more than 100 to 200 mg Caffeine, first thing in morning, else it affects my sleep-and all synthetic sleep meds are anticholinergic. But the brain chemistry is stil vaguely described. Will my choline receptors regenerate? There is no point to life without a brain. People can worry about tmao, if they wish. I am far from satisfied that a healthy kidney can't clear as much tmao as you can throw at it. Beyond the obvious insulinemia underlying cause, we know that certain foods, in combination catalyze each other, for very ill bodily effects. Of all the grandparents, friends and relatives, I have witnessed dying, diabetes and Alzheimer's, was the cruelest. I absolutely have spare tire genes, t2d. The struggle is on, for me, to keep my kidney (and liver function) up by getting out the excess sugar storage from my visceral organs. Then, try to convince all my relatives that their visceral fat storage will affect their kidneys. And then, tmao does matter – big time….. Come to think of it, I have at least 3 cousins on kidney dialysis, ALL, still maintain that eating carbs, every 3 hours, is vital – because, the doctors and nurses told them so.

  11. Here is another angle on why eggs are good. Egg yolks and organ meat are good sources of choline. Interpreting my 23andme genetic testing results led me to understand that choline is an important nutrient that multiple genes (e.g. PEMT, FADS1, and MTRR) use related to making/level of phosphatidycholine which is necessary for cell membranes and the neurotransmitter acetylcholine signaling in the brain. Depending upon a person's genetics, they may well experience an additional challenge with their health as they age if they don't consume enough choline.

  12. you know.. all of this is so complicated, I feel like driving a car off a cliff like Rebel Without a Cause.. LOL I would love if you wrote a book on the conclusions of all your studies.. and just gave us a menu and eats and don't eats list.. I would pay 50 dollars for it..

  13. I want to congratulate you on a your a YouTube. I am an M.D. With MPH. I wish you could put your visuals up in a better format . They are barely readable.
    This video on TMAO is still too reductionist. Science isolates a substance and then sees an association. Like all biological issues they never work in isolation. I like that you show the controversy in the science. There are other things that modulate TMAO like DMB o love oil reversaltol in wines and probably a lot of other factors. The microbiome is affected by diet…would a keto diet be different microbiome than a vegan. Of course. Giving an antibiotic only showed that you knocked out the first metabolic step but we always have our microbiome present.
    I hate when some people especially like vegans (Dr Gregor)) vilify animal products to help booster their own ideology.
    It does not matter about a particular food. You should eat seasonally, with variety and avoid overconsumption. They promote the Mediterranean diet but fail to mention that the people studies were Greek Orthodox that fasted. Medicine always neglects the latter.
    I very appreciate that you are trying to inform the public about a lot of misinformation out on the internet. As you know population studies cannot be attributed to N=1. Each of us have a lot of variables. That is why the younger population is engaging in biohacking.

  14. Dear Dr Brewer, I’m HAPPY that you go into detail (even when it’s over my head) and I just keep listening, relistening, watching and rewatching because I use what you present (and other doctors and scientists I listen to) AS MY UNIVERSITY EDUCATION. I have acquired so much knowledge but there is so much more to learn and I’m also becoming aware of what areas interest me the most – some of these tend to be covered by the topics you present and then I compare that to the presentations I watch of others. It’s all invaluable learning – I can’t afford the degree education or the idea of the stress of assessment geared to a limited learning window …. but here it’s limitless and calm/friendly and I love it and what’s best of all I actually learn and begin to understand what you’re talking about. Just 4 months ago I went to a medical appt with my father and the hospital doctor asked me what my back ground was. I was embarrassed at first replying “I’m self taught” …. now I’m cautiously pleased with myself that I have this education to understand something very dear to me and that is human body health and I can have a layperson conversation with a doctor where what they’re saying I completely understand and can ask educated questions which is the best feeling.

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