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Here we go again.

The “what to eat and why” plot thickens. So do our artery walls if we’re not careful.

According to the CDC (Centers for Disease Control), heart disease is the leading cause of death in the US for both men and women. Back in my exercise physiology days, I had a fascination with heart disease. I wrote my thesis paper on the effects of exercise on coronary collateralization, worked in cardiac rehab, helped develop an outpatient exercise program, watched up-close-and-personal heart procedures, and was convinced I’d make an awesomely fantastic cardiac surgeon (some of the docs back then were alpha males and not the best listeners). If not for that sternal saw thing, I might have given it more thought.

What I did learn from that experience, though, is that heart disease is a complex condition and doesn’t always follow a direct line to diagnosis or treatment. Researchers are now questioning some of the basic assumptions about causes, lab biomarkers (blood chemistry), nutrition protocols, drug therapies, and invasive surgeries. Some in the medical community are even rethinking our obsession with low cholesterol and statin drugs. I’ll resist picking up that rope, but suffice to say, there’s no easy answer. Throw in genetics and lifestyle choices and there’s a lot to consider.

And now, like there’s not enough to think about regarding heart health and that all-too-common side effect known as sudden death, researchers have discovered those pesky gut bacteria are also playing a role. It appears there’s a type of meat- and egg-loving microbe that produces a substance, which in turn, increases the risk for heart disease. It’s a convoluted pathway, but these microbes convert carnitine (in meat) and choline (in eggs) into a chemical the liver quickly converts to TMAO (trimethylamine N-oxide). TMAO ends up in circulation and is associated with an increased risk for atherosclerosis. That’s not good.

For a variety of reasons, I’ve never been much of a meat fan. I’ve always felt we’re better off sticking to a diverse, plant-based diet. If I eat red meat at all, it’s on very rare occasions and in condiment-sized portions. Plants high in beneficial fiber encourage the proliferation of good gut bacteria. Those are the microbes I want on my disease-fighting team, not the carnitine-fueled, gas-belching, TMAO-producing critters. There’s also growing evidence that carnitine and choline supplements promote higher TMAO levels. Beware.

The conclusion from the scientific and medical community might be (is) to develop antibiotics to eliminate these microbes. If we wipe out the bacteria that play a part in TMAO production, we solve the problem, right?

Hmmm? I wonder what the unintended consequences of that will be? How about we support the magic of our own innate healing power and skip the drugs?

Bottom line (in my humble opinion)? Eat more plants and rethink the use of supplements and energy drinks.

If you’re on a meat-laden Paleo diet, you might want to read the research.

For more information about plants, fiber, and gut bacteria, check my last post.
Plants, peels, fiber, and gut bugs

If you’re still with me, thank you. I’ll post some recipes that promote good bacteria later this week. No science talk, I promise. Just good food.

We’re all in this together. Peace, love, and plant power.


Husten, L “Researchers Find New Path Linking Heart Disease to Carnitine.” Forbes, online. (accessed April 7, 2013)

Kolata, G “Culprit in Heart Disease Goes Beyond Meat’s Fat.” The New York Times, online. (accessed April 7, 2013)

Wang Z, et al. “Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease.” Nature 472, 57-63 (April 2011).

Willyard, C “Pathology: At the heart of the problem.” Nature 493, S10-S11 (January 2013).

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14 Responses to “Bacteria, metabolites, and a big juicy steak”

  1. Maggie says:

    You are getting cheekier and cheekier and I love it 🙂 Sometimes I feel like we take a great step forward, only to take five steps back…argh! Let’s just make an antibiotic. Really? That solution is coming from intelligent and educated people? Yup, it drives me bonkers. Now you’ve got me all worked up Melissa! Namaste. xo

    • Melissa says:


      As always, you brighten my day(s). I wish we could meet for lunch and go bonkers together. Or go for a run and figure all this out (what to eat, when, and why). Actually, you can run and I’ll ride my bike. =)

      Thank you, thank you!

  2. Lexie says:

    Thought you might be interested in this … while on the topic of red meat 🙂

    • Melissa says:

      Thanks Alexa. I had read that one. In fact, I read so many articles when I write a blog post that it’s ridiculous. I’m always up for new research though. Keep that thought in mind and point me in any interesting direction you see fit. =)

  3. Lexie says:

    Oh duh, skipped over the paragraph you wrote that included carnitine.

  4. Isabella says:

    As someone who sticks to the Paleo diet, I find this really concerning. I have eggs for breakfast every morning and red meat 3 to 4 times a week.

    I would appreciate your advice on how, if I cut down on the eggs and meat, I don’t end up spending the entire day starving.

    – Isabella

    • Melissa says:


      Thank you for your comment. I also eat eggs (poached). I’m not that concerned about it. If you read the studies, you’ll see that the researchers were surprised, but more research needs to be conducted. It’s just more information to add to the pile. This topic has been all over the NYTimes, the Huffington Post, Science Daily, etc. There are probably people who disagree with the findings. I can’t offer any dietary advice other than the basics, which is stick with whole foods and skip the processed stuff. You could ask your doctor what he/she suggests.


    • Amy says:

      Isabella and Melissa, I too have been afraid of being hungry on a plant based diet. I find though, that if I include avocado’s, olive oil and eat a snack between meals I’m full. Also adding no wheat grains and lentils helps a lot! I have to eat more often, which I used to think was not good but it does work. My metabolism leads me to need more protein and fat but I have to watch my weight too. I get hypoglycemic when I don’t eat enough protein. I do include yogurt and tofu in my smoothies…. I’m not meat or egg free but very little red meat and trying to keep cutting back on the free range, local chicken and I really need to cut back on the eggs. My weight goes down as soon as I do and back up when I add them back in. ~Amy

      • Melissa says:

        Thanks for your thoughtful comment, Amy. Great points, all the way around. I’m with you on eating a predominantly plant based diet. Very little red meat is my preference, as well. Avocado’s, olive oil, and coconut are some of my favorite fats. Adding a little high-quality fat does help. I love my Redwood Hill Farms vanilla goat yogurt. =)


  5. Jess says:

    Hi Melissa,
    Thanks so much for sharing this information. It has been fascinating to come across all of the recent research linking gut microbes to health and illness. I was unaware of the research which you wrote about on TMAO levels and atherosclerosis. I am continually amazed by how much is unknown about common diseases, like heart disease.
    Thank you also for providing references! It seems like most bloggers do not, and I appreciate being able to read the journal papers myself. I am looking forward to reading more of your posts. I am an M.D. and I have Celiac Disease and a bunch of other food intolerances which I am trying to figure out.

    • Melissa says:


      You’re SO welcome, and thank you for taking the time to leave a comment. I appreciate it. I’m a research junkie and spend hours pouring over various studies. Then one study leads to another and I’m spiraling all over the place. I think it’s important to cite your sources so people can make their own conclusions.

      I’m with you on “trying to figure” things out. It’s not easy, but we’re all in this together. Wishing you the best.


  6. Alisa says:

    As usual, excellent food for thought from you Melissa! I have to admit, sometimes I just feel at a loss with food.

    • Melissa says:

      Thank you, Alisa. I think we’ve made everything more complicated than it should be. In my mind, Michael Pollan was right. Eat food (real food), not too much, mostly plants. We could add “organic” to that, just to be safe. It’s interesting, no one has to tell a grasshopper or an antelope what to eat. They innately know what’s good for them. I think we do too, we’ve just lost our way. Too many choices.


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