Is Your Gut Wrecking Your Heart?

You’ve probably heard that what you eat can make or break your heart health. But here’s what most people don’t know—your gut microbiome (aka the trillions of bacteria in your digestive tract) plays a major role in whether your heart stays strong or struggles.

The catch? Not everyone is at risk for gut-driven heart disease. That’s why testing is key. In my practice, I use my special Advanced Heart Labs to measure TMAO (trimethylene N-oxide)—a compound linked to higher risks of heart attack, stroke, and even early death. If your levels are high, that’s your cue to make strategic shifts in your diet. If they’re low? You’re in the clear of this significant factor being at play brewing heart disease behind the scenes in your body!

Before you start overhauling your diet, let’s find out if you even need to.

Why TMAO Matters for Your Heart

Here’s how it works: When you eat red meat, egg yolks, or full-fat dairy, your gut bacteria break down certain nutrients—specifically choline and L-carnitine. In the process, they produce a compound called trimethylamine (TMA). Your liver then converts that into TMAO.

And here’s the problem: High levels of TMAO have been linked to a greater risk of blood clots, heart attacks, and strokes—even in people without traditional heart disease risk factors.

One study followed 2,235 people with heart disease and found that those with high TMAO levels were 4 times more likely to die within five years. That’s a serious wake-up call.

So, if you want to know whether your gut bacteria are putting your heart at risk, testing your TMAO levels is step one.

Got High TMAO? Here’s What to Do

If your results show high TMAO, don’t panic! You can turn things around with a few simple diet tweaks.

1. Minimize TMAO-Producing Foods

To lower TMAO levels, cut back on foods that fuel it:
-Red meat (beef, pork, lamb, veal)
-Full-fat dairy (whole milk, egg yolks, cream cheese, butter)
-Certain supplements & energy drinks (anything containing choline, phosphatidylcholine/lecithin, or L-carnitine)

Fun fact: Vegetarians and vegans naturally produce little to no TMAO because they avoid these foods. Does that mean I am a vegan or vegetarian advocate, absolutely NO. I see long term deficiencies when those diets are employed over the long haul. Bottomline, you’ve heard me say it before, there is NO one diet for everyone.

2. Load Up on Gut-Friendly, Heart-Boosting Foods

A diverse, fiber-rich diet helps keep your gut microbiome balanced (and your TMAO levels in check). Focus on:
✔ Leafy greens
✔ Cruciferous veggies (think cauliflower, cabbage, and Brussels sprouts)
✔ Nuts and seeds
✔ Fiber-packed foods (flax, chia, lentils)

3. Sip Your Way to a Healthier Heart

Scientists have also discovered a compound called DMB, which helps block TMAO production. It’s naturally found in red wine and extra virgin olive oil—two staples of the Mediterranean diet, one of the most heart-friendly eating plans out there.

So, a little EVOO on your salad and a SMALL glass (ie, 3 oz) of sulfite-free, organic red wine with dinner? Cheers to that! 🍷

4. Consider TMAO Testing

Want to know if your gut is pumping out too much TMAO? There’s a test for that! I run it in my practice and it can help you assess your risk and make smarter diet choices. To learn more about that, schedule yourself for a complimentary 15-Minute “Healthy Heart Consult” and I’ll tell you all about it.

Here’s to your healthy heart AND gut!

Warm Regards,

Sarah Reilly, CFMHC, FMACC