In Blog, Diet, Health, Health Professionals, Lifestyle

Increased blot clotting, heart disease risk…and eggs?

I have seen an uptick in inquiries surrounding blot clotting, cardiovascular health, and eggs as these are current topics of interest and have surfaced in a number of articles—both research-based and sensationalized. I want to address a Cleveland Clinic study from 2017 specifically.

In this study,  researchers showed that a dietary choline and gut bacteria byproduct was linked with increased blood clotting risk and Heart disease. They warned that eggs cause severe elevations of TMAO (trimethylamine n-oxide) and higher rates of atherosclerosis because of their high choline content. Choline, which is found in eggs and meat, is a key brain nutrient that is important in memory and focus. Higher levels of TMAO have resulted in higher rates of heart disease.>

The study subjects were dispensed supplements.

Choline, Carnitine, and TMAO risk

TMAO levels are linked to gut microbial metabolism of choline, carnitine (also found in meat), and betaine (found in plants). Our brains need choline, so a choline free-diet is not an option. We also need protein for our muscles, bones, and organs, so eliminating protein is not an option either. Our mitochondria generate more energy if we have carnitine in our diet. My carnivore colleagues would argue that one could avoid the TMAO problem by avoiding betaine (found in plants), but I would not go that far.

Our TMAO levels are a reflection of foods eaten and microbes living in our gut.

So the question is: which microbes are leading to elevated TMAO? Is the problem with the meat, eggs, and plants we’re eating or is it caused by all the sugary beverages and fast food we also eat? Would those who are asking us to stop eating meat and eggs be perfectly fine with people continuing to have lots of sugary beverages and fast food? I hope not.

If we eat a diet with 100 to 150 grams of fiber each day, like our ancestors ate before the dawn of agriculture, would we have high TMAO levels and higher risk of heart disease? I think not.I expect the TMAO problem is more likely a reflection of how unhealthy the modern microbiome has become.

Many Americans consume a high-fat, high-protein, high-sugar diet that is low in non-starchy vegetables. The average intake of fiber for Americans is less than 15 grams per day, with less than 3 servings of vegetables and fruit. As a result, we have a very different microbiome than traditional hunter-gatherers who ate 200 different plant species in a year and 100 to 150 grams of fiber each day. Our microbiomes are very different from theirs, and so is our TMAO metabolism.

There’s a paper that linked a high-fat, high-sugar diet to increased production of TMAO.2 Diets that are high in sugar and low in fiber increase the risk for obesity, pre-diabetes, diabetes, and metabolic syndrome, all of which increase the risk of heart disease. We need more research to confirm that the high sugar, high-fat diet drives TMAO and that eating meat, eggs, and at least 50 grams of fiber while avoiding added sugars and processed foods prevents elevations of TMAO.

Before we tell people to stop eating eggs and meat, we should tell them to stop eating added sugar, fast food, and ultra-processed foods. We should encourage a diet with a diversity of plants and animal products and plenty of fiber. There are already plenty of studies that document the health benefits of those recommendations.

***In the Wahls Protocol®, I explain how eggs are one of the most common food allergens and I recommend eliminating them from your diet for 90 days to determine if they are a factor in your inflammation. Eggs can be a tremendously healthy food for those who are lucky enough to tolerate them. 




  2. James K, Newman J, Stephensen C, Bennett B. TMAO Response to a High-Fat High-Sugar Meal Challenge in Generally Healthy United States Adults.Curr Dev Nutr. 2022 Jun; 6(Suppl 1): 1113. Published online 2022 Jun 14. doi: 10.1093/cdn/nzac078.007
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