He has over 16 years of medical training and facilitation and is a Diplomate of the American Board of Internal Medicine. Enter your email address to receive updates about the latest advances in genomics research. could there be a pre-biotic gut freindly to help eliminate this toxic bacteria? Carnitine is a metabolite found in red meat. Yamazaki H, Fujieda M, Togashi M, Saito T, Preti G, Cashman JR, Kamataki T. Life Sci, 74(22):2739-47. 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. In this article, Ill share 9 ways to lower your TMAO Afib and heart disease risk. 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. answers when the safe, simple, side-effect-free solution was staring them in the face the whole time? You may be familiar with the popular American television show Breaking Bad.In the show, the lead characters make the drug methamphetamine from phenylacetone and methylamine, an analogue of trimethylamine where two of the methyl groups are replaced by hydrogens.As methylamine is a controlled chemical in the US, several episodes revolved entirely around obtaining the hard-to-get reagent. Term. Taking supplements to decrease the concentration of free trimethylamine in the urine. Concentrations shall be lower than applicable environmental discharge or disposal criteria. If you like eggs and dont want to increase TMAO levels, the cut off seems to be about two eggs per day. If any changes are made to the original text or video, you must indicate, reasonably, what has changed about the article or video. Zhang X, Shu XO, Xiang YB, Yang G, Li H, Gao J, Cai H, Gao YT, Zheng W. Cruciferous vegetable consumption is associated with a reduced risk of total and cardiovascular disease mortality. less polar in reversed-phase chromatography, whereas eluent strength increases as solvent becomes more polar in normal-phase chromatography? [1] 2004. X 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. Not at all. Okay, so how are we going to do it? Real Happiness. Trimethylaminuria may be caused by a variety of genetic changes to the FMO3 gene. See more at 4:44 in my video How to Treat Heart Failure and Kidney Failure with Diet. That doesnt work. true. A urine test is used to diagnose trimethylaminuria. Yes, open heart surgery does take a toll on the heart and arrhythmias can be a long-term complication from the surgery. Choline is also present in lecithin supplements. It is also a degradation product of plants that have high nitrogen contents and a distillation product of sugarbeet residues. Its all so interesting but also seems a bit difficult to remember and to follow, but I will try my best. By signing up you are agreeing to receive emails according to our privacy policy. University of Pennsylvania Probiotics can help with GERD or reflux. No. brooke posch wedding; cockatiel breeders nsw Men umschalten. Activated charcoal taken at a dose of 750mg twice daily for ten days. 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. Should we give that a try to lower our TMAO levels? They should not attempt to self-administer. The same foodsmeat, dairy, and eggsraise our cholesterol, and changing our diet may lower it, but that isnt very profitable. the ability of inflammatory cells within the atherosclerotic plaque in our artery walls to bind to so-called bad LDL cholesterol. I try to come up with new topics that I find interesting based on the latest research. 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. If our intestinal bacteria and liver can make TMAO from meat, dairy, and eggs, should we destroy our gut flora? Taking low doses of antibiotics to reduce the amount of bacteria in the gut. Adding good bacteria doesnt seem to get rid of the bad. Trimethylaminuria [rarediseases.info.nih.gov] 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. This involves giving an individual a 600 dmg pill of trimethylamine (TMA). He completed his B.S. Disclaimer Policy: This website is intended to give general information and does not provide medical advice. You may republish this material online or in print under our Creative Commons licence. 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. The breakdown of TMG in the body can make trimethylamine. Trimethylaminuria, has been around for centuries, but has only gained scientific recognition and support in the past 30 years. Shipped as a liquid under its own vapor pressure. What if we added a new bacteria that could somehow siphon off the TMA made by the bad bacteria? So, we need some, and we can get all we need in fruits, vegetables, beans, and nuts. Monell Chemical Senses Center In that case, might the fact that Consumer Reports found fecal contamination in every sample of beef it tested be a good thing? Read our important information about translations here. Meat-loving microbes: do steak-eating bacteria promote atherosclerosis? Last updated: General Description. Trimethylamine has also been prepared by a reaction of ammonium chloride and paraformaldehyde: [14] A colorless gas with a fishlike odor at low concentrations changing to ammonia-like odor at higher concentrations. Gene testing is currently available only through research laboratories. It is important that a person who has trimethylamuinuria follow the treatment advice of their health care provider. So, hey, forget the cowhow about getting a fecal transplant from a vegan? Choline and carnitine-rich foodsmeat, eggs, and dairycan be convertedby gut flora into trimethylamine, whichcan then be turned into TMAO in our livera toxic compound which may increase our risk of heart failure, kidney failure, and atherosclerosis (heart attacks and strokes). Simply put, TMAO or trimethylamine N-oxide, is a waste byproduct from your gut bacteria. Thats the topic of my video. That was the billion-dollar answer to cholesterol. Carriers of trimethylaminuria excrete 20-30 percent of total trimethylamine as the free unmetabolized amine and the rest as trimethylamine N-oxide. Meldonium is an anti-ischemic medication that increases blood flow and oxygen supply to the body. - No smoking. The contributory role of gut microbiota in cardiovascular disease. Contact with the unconfined liquid can cause frostbite from evaporative cooling or chemical type burns. Indeed, studies show that people who dont eat meat, dairy, or eggs can virtually eliminate TMAO from their blood. To do this study, research participants supplemented their diets with vast amounts of dairy and coconut milk. . Well, what do those with trimethylaminuria often do to cut down trimethylamine levels? Yes, you can absolutely test for TMAO. What if we introduce new bacteria that could somehow siphon off the TMA made by the bad bacteria already in our gut? People who eat completely plant-based may not make any TMAO at alleven if they try. For example, we know from countless studies that fish may protect against cardiovascular disease. I also highly recommend buying a Keyton Massage chair The best in the market made in Europe also leather. Jim, It can be a challenge. You have been a wonderful help to me. We use cookies to make wikiHow great. Do we need to, about high-choline plant foods, like broccoli? 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. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. Users who have downloaded and installed the WISER app on a mobile device or downloaded the WISER system to a desktop computer will still have access, although the data will no longer be updated. 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. The EPA Office of Resource Conservation and Recovery (ORCR) that publishes the SW846 test methods manual no longer uses the MDL, and promotes the use of the Lower Limit of Quantitation (LLOQ) approach for establishing the reporting limit for a respective test method or laboratory SOP. Image credit: Sally Plank via Flickr. Therefore, all plant and animal cells need choline to preserve their structural integrity [ 1, 2 ]. Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. How about getting a fecal transplant from a vegan? Your trimethylamine N-oxide levels can be influenced by a number of factors including: Diet Gut microbiome composition and activity I can answer general health questions and will do my best to answer your questions in my blogs, podcasts, or videos. 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. 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. One unexplained paradox of TMAO is fish consumption. Trimethylaminuria is a metabolic condition in which an individual is not able to convert trimethylamine into a compound called trimethylamine N-oxide. 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. If you have any questions, please Contact Us. Trimethylamine-N-oxide (TMAO) is an independent risk factor for atherosclerosis. How about probiotic supplements? from the Sackler School of Medicine, and a residency at Huntington Memorial Hospital, an affiliate of the University of Southern California. Their TMAO levels actually went, . Cashman JR, Xiong Y, Lin J, Verhagen H, van Poppel G, van Bladeren PJ, Larsen-Su S, Williams DE. In women, symptoms can worsen just before and during menstrual periods, after taking oral contraceptives, and around menopause. Trimethylamine is the compound that gives fish the fishy odor. Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0), Carnitine, Choline, Cancer, and Cholesterol: The TMAO Connection, Egg Industry Response to Choline and TMAO, How to Treat Heart Failure and Kidney Failure with Diet. Fortunately, the K a and K b values for amines are directly related. So, maybe the fact that Consumer Reports found fecal contamination in every sample of beef they tested may be a good thing! You must attribute the article to NutritionFacts.org with a link back to our website in your republication. National Library of Medicine 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. Am J Med. Trimethylamine (TMA) is a chemical compound that smells like rotting fish. By using our site, you agree to our. That doesnt work. Probiotics can reduce constipation, speeding up the transit time of food in the intestines so that there is less time for TMA to be released from food. Since this condition usually requires two altered genes to cause symptoms, typically neither parent of an individual with trimethylaminuria has any symptoms. 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. This website does not create a doctor-patient relationship between you and Dr. John Day. May God bless your work. How Does Trimethylamine Increase Cardiovascular Risk? Sometimes, "carriers" of one copy of an FMO3 mutation may have mild symptoms of trimethylaminuria or have temporary episodes of fish-like odor. God bless you and Jane if you are able to keep track of everything, and most likely you will! 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. If we dont eat steak, then we dont foster the growth of steak-eating bacteria in our gut. This article was co-authored by David Nazarian, MD. Children's Hospital Colorado However, given all of the other potentially harmful effects of antibiotics, this is not a viable option. 2011 Jul;94(1):240-6. Activated charcoal taken at a dose of 750mg twice daily for ten days. You can see a graphic illustrating this process below and at 2:19 in my video Egg Industry Response to Choline and TMAO. Michael Greger M.D. 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. Taking laxatives can decrease intestinal transit time and reduce the amount of trimethylamine produced in the gut. What if we introduce new bacteria that could somehow siphon off the TMA made by the bad bacteria already in our gut? Search ClinicalTrials.gov [clinicaltrials.gov], Additional Resources for Trimethylaminuria. Contact: George Preti, Ph.D. 2014 Oct;124(10):4204-11. Indeed, rather than trying to genetically engineer a bacterium that eats up trimethylamine or ingesting a gut enzyme from cows and sheep to convert it into methane, simply limiting the consumption of foods rich in choline and carnitine, perhaps specifically L-carnitine, may effectively limit the amount of TMAO circulating in our body. Elevated TMAO could reflect dietary trimethylamine or TMAO from seafood, but it could also reflect impaired excretion into the urine, or enhanced conversion of trimethylamine to TMAO in the liver. Genetic testing is also available, though usually not necessary to make a diagnosis. Adding good bacteria doesnt seem to get rid of the bad. Wise PM, Eades J, Tjoa S, Fennessey PV, Preti G. Individuals reporting idiopathic malodor production: demographics and incidence of trimethylaminuria. 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. 8600 Rockville Pike Trimethylaminuria is a genetic condition in which this enzyme is impaired naturally, so there is a build-up of trimethylamine in the bloodstream. Gene testing called gene sequencing can be used to look for mutations in the FMO3 gene. 2013 May;19(5):576-85. Taking laxatives can decrease intestinal transit time and reduce the amount of trimethylamine produced in the gut. Can Vegan Fecal Transplants Lower TMAO Levels? Tang WH, Hazen SL. Some people with trimethylaminuria have a strong odor all the time, but most have a moderate smell that varies in intensity over time. It's produced in the gut, often from certain dietary amines. 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). Note: This laboratory does not accept direct contact from patients. how to reduce trimethylamineindependent baptist church near new york, ny Posted by under south gippsland markets this weekend Comments Off on how to reduce trimethylamine Dr. Greger has lectured at the Conference on World Affairs, testified before Congress, and was invited as an expert witness in the defense of Oprah Winfrey in the infamous meat defamation trial. World J Gastroenterol. Gaci N, Borrel G, Tottey W, O'Toole PW, Brugre JF. 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 J. Using an array of different technologies, the researchers. If you have a medical problem, immediately contact your healthcare provider. These same foods raise our cholesterol, but dietary change isnt very profitable. Both parents of an individual with trimethylaminuria are "carriers" of the condition, in other words, they both carry one copy of an altered gene for FMO3. There are several reports that the condition worsens around puberty. 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. 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. Trimethylamine oxide (TMAO) is found largely in most marine fish; in contrast, its presence is negligible or nil in freshwater fish. But choline is an essential nutrient. 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? Be Cautious with Choline and Carnitine Supplements An individual pours pills into their hand Avoid breathing gas. It's responsible for the pungent odor given off by fish and other marine and aquatic animals. HCl . Do we have to choose between suffering from heart and kidney disease or smelling like dead fish? . Because these methylamines might form nitrosamines, which have cancer-causing activity. Note: This laboratory may have a long waiting list of patients. Trimethylamine is notable for its unpleasant smell. This drug decreased blood TMAO levels in eight healthy adults on TMA-rich diets by increasing the elimination of TMAO through urine [ 68 ]. Subscribe to Videos Discuss Republish View Transcript Sources Cited Using an array of different technologies, the researchers determined that the more TMAO people had in their blood, the greater the odds they had heart disease and the worse their heart disease was. Pills, supplements, and the like may be profitable for Big Pharma, but we already have a safe, simple, and side-effect-free solution: a plant-based diet. To subscribe, select the "Subscribe via E-Mail" button above. Every study I reviewed reported a link between TMAO and a wide array of cardiovascular diseases. From a TMAO standpoint, maybe we dont have to eat like a vegan, as long as we poop like one. For example, some studies show dairy shoots up TMAO levels whereas other studies say it doesnt. And it isnt just heart disease. Many studies, but not all studies, have shown that probiotics may also reduce TMAO. From a TMAO standpoint, we may not have to eat like a vegan as long as we poop like one. As of February 28th, 2023, NLM has discontinued the Wireless Information System for Emergency Responders (WISER). * Breathing Trimethylamine can irritate the lungs causing coughing and/or shortness of breath. The TMA just doesnt get oxidized into TMAO. Smelling like dead fish: a case of trimethylaminuria in an adolescent. Dietary Cure for Hidradenitis Suppurativa. Eat more healthfully. that the more TMAO people had in their blood, the greater the odds they had heart disease and the worse their heart disease was. Currently, NHGRI is not conducting studies on Trimeththylaminuria. So, forget the cow. A listing of information and links for finding comprehensive genetics health information online. Unfortunately at this time, enzyme replacement therapy with the enzyme FMO3, which when absent, is believed to cause the condition, is not an option in the management of trimethylaminuria. Carnitine, Choline, Cancer, and Cholesterol: The TMAO Connection, How Our Gut Bacteria Can Use Eggs to Accelerate Cancer. In that case, might the fact that, fecal contamination in every sample of beef it tested be a good thing? Regarding soy, the data are limited at best and I couldnt determine if it was a soy isolate, like that found in processed food, or the whole bean. Thank you for sharing your knowledge. That was the billion-dollar strategy employed by Big Pharma to lower our cholesterol. 2006 Nov;45(9):864-6. eating animal products, which is what those with trimethylaminuria often do to lower their TMA levels. Yes, proton pump inhibitors (Prilosec, omeprazole, Prevacid, Nexium, etc.) The good news is, though, that this opens up exciting new nutritional and interventional prospects for prevention. These core functions are linked to the production of essential and extremely diverse metabolites such as vitamins (vitamin B 12, folic acid or vitamin K), bile acids, neurotransmitters (serotonin, dopamine, acetylcholine) and SCFA (acetic acid, propionic acid and butyric acid). These small commissions help us to partially pay for the costs of maintaining a website, newsletter, and podcast. 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 . The person's urine is tested to look for higher levels of trimethylamine. Diplomate, American Board of Internal Medicine. So, maybe we could use the bacteria to get rid of some of it from our gut, like a cow fecal transplant. On cooling the crystals of triethyl amine formed removed by simple filtration of the reaction mixture. Or subscribe with your favorite app by using the address below: To subscribe, select the "Subscribe on iTunes" button above. To find out more about this laboratory, select the 'GeneTests' icon at the top of the page at the following URL: www.geneclinics.org. Using soaps with a moderate pH, between 5.5 and 6.5. Why Are Choline and Carnitine Bad for the Health Then? Eat more healthfully. A cup of milk or yogurt already counts as one. TMAU can't be cured. Brugre JF, Borrel G, Gaci N, Tottey W, O'Toole PW, Malpuech-Brugre C. Archaebiotics: proposed therapeutic use of archaea to prevent trimethylaminuria and cardiovascular disease. Not at all. Thanks to all authors for creating a page that has been read 58,012 times. Recently, our group reported a topical odor-quenching formulation based on polymeric vesicles of the diblock poly (isoprene)- b-poly (ethylene glycol). A change of split ratio only affected the signal intensity of the analytes, and the amount of injected sample matrix remained the same. Their TMAO levels actually went down. The problem is, if it didnt take, youd have to keep giving it to people. 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. TMA is so stinky that it makes you, like dead fish. There is a problem, though. A new blood test that measures levels of TMAO (trimethylamine-N-oxide) a metabolite derived from gut bacteria can powerfully predict future risk for heart attack, stroke, and death in patients who appear otherwise healthy, according to pioneering Cleveland Clinic research. Recommended intake is 30-40mg taken 3-5 times per day with food. What are the signs and symptoms of trimethylaminuria? They also have a formula that doesnt include carnitine which I guess Ill be switching to. The test measures the ratio of trimethylamine to trimethylamine N-oxide present in the urine. Quantitative Analysis HPLC. What happened? Who Are at Risk of Producing Trimethylamine? Because these methylamines might form nitrosamines, which have cancer-causing activity. But, wait, we could always try to genetically engineer a bacteria that eats up trimethylamine, but the simplest, safest recommendation may just be to eat healthier. is the queen taller than the king in chess; all inclusive wedding venues under $5,000; david meade obituary in Psychology and Biology from the University of California, Los Angeles, his M.D. Higher exposures can cause a build-up of fluid in the lungs (pulmonary edema), a As long as you stay under two eggs daily, one study shows that you can keep your TMAO levels in a reasonable range. Indeed, one study showed that by optimizing vitamins B and D you could lower TMAO. The GeneTests Web site lists one laboratory as performing clinical diagnostic testing. Can you hear the frustration in my voice as I read paper after paper proposing those ridiculous (but profitable!) What's That Smell? Taking supplements to decrease the concentration of free trimethylamine in the urine. Atherosclerosis. TMAO is a toxic byproduct from an unhealthy gut microbiome. Do we need to worry about high-choline plant foods, like broccoli? EPA ORCR is in the process of transitioning existing SW . Methane-producing bacteria may be able to eat up our TMAO, but, unfortunately, these bacteria may be, with a variety of diseases, from gum disease down to colorectal cancer, as you can see at 2:15 in my, That was the billion-dollar strategy employed by Big Pharma to lower our cholesterol. An electronic catalog of human genes and genetic disorders, developed by the National Center for Biotechnology Information (NCBI). The simplest point of intervention is to [just] limit [the] consumption of foods rich in choline and L-carnitine, which can be an effective strategy to limit circulating TMAO. Circ Cardiovasc Genet. So, Big Pharma developed statin drugs that cripple the enzyme in our liver that makes cholesterol. Am J Clin Nutr. Conversion of choline methyl groups through trimethylamine into methane in the rumen. However, it may be possible to reduce the bad odor by taking different steps. In a study (RCT) of 3,000 individuals, those with lower TMG levels were more likely to have diabetes. This field is for validation purposes and should be left unchanged. Could you comment on these comments and put them in context please? The easiest and safest recommendation? To make sure you do not miss my answer to your question, please sign up for my newsletter. As TMAO is made by having the wrong gut bacteria, the quickest way to reduce TMAO is to eliminate the source. No. The first two steps involve eating a diet low in choline and trimethylamine (TMA) for three days. Annu Rev Med. The invention relates to a method for determining content of triethylamine salt. Triethyl amine in a reaction can be removed by treating the reaction mixture with Conc. People on blood thinners however are advised not to take baby aspirin for the most part. There is a problem, though. Kathleen, I was taking acid blockers for over 10 years. Our system absorbs the compound, and our liver oxidizes it into TMAO. 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. Additionally, using supplements or medications that lower trimethylamine levels can also be effective. Dietary modification of the microbiome affects risk for cardiovascular disease. As my A-Fib is caused by scar tissue(prior open heart surgery) will any changes to living style help? Contact: Lab Client Services downregulate the TMAO liver enzymenot enough to make you stinky, but just enough to drop TMAO. TRIMETHYLAMINE Label abbreviations descriptions TRIMETHYLAMINE * All sampling instructions above are recommended guidelines for OSHA Compliance Safety and Health Officers (CSHOs), please see the corresponding OSHA method reference for complete details. true. TRIMETHYLAMINE, AQUEOUS SOLUTION neutralizes acids in exothermic reactions to form salts plus water. Trimethylamine oxide, more commonly known as TMAO, is considered the smoking gun of microbiome-disease interactions. An article about trimethylaminuria, written by Damaris Christensen, and published by ScienceNewsOnline, Volume 155, Number 20 (May 15, 1999), Effects of the dietary supplements, activated charcoal and copper chlorophyllin, on urinary excretion of trimethylamine in Japanese trimethylaminuria patients. The gasis corrosive and dissolves in water to form . The lower intracellular pH compared to extracellular should lead to their preferential intracellular sequestration with volumes of distribution exceeding total body water. 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 . Last Updated: October 27, 2022 The urine test can be done in two different ways. So, hey, pharmacologic inhibition of the enzymes in our liver that make TMAO could potentially serve as a therapy for [cardiovascular disease] risk reduction. But, theres a genetic condition in which this enzyme is naturally impaired, called trimethylaminuria, in which there is a buildup of trimethylamine in the bloodstream. Below are the 9 best-proven ways I have found to lower your TMAO.