Does TMAO Cause Heart Attacks and Kidney Failure for Those with Type-1 Diabetes?

Heart disease and kidney disease. This devlish duo often strikes those with type-1 diabetes. It’s typically assumed that high blood sugars cause the kidney disease. The kidney disease raises blood pressure. And the high blood pressure causes heart disease. Sounds probable but it may not be the cheif offender

“People with chronic kidney disease and end-stage renal disease tend to die of heart disease,” says Dr. Stanely Hazen in a report from Cleveland Clinic’s Sydell and Arnold Miller Family Heart & Vascular Institute. “Even when their kidney function is replaced, they still die of heart disease.

So you give a kidney failure patient a new kidney and they are still just as likely to have a heart attack. That certainly puts into question whether kidney failure causes heart attacks. Or whether another factor is causing both the kidney and heart problems.

Indeed, research is now indicating that choline and carnitine may be to blame. When we consume foods containing these two substance they end up in the colon. In the colon bacteria bacteria consume them. In return the bacteria produc trimethylamine (TMA). Being rather toxic, TMA is sent to the liver for oxidation. Here it becomes the notorious TMAO ((trimethyl-amine-N-oxide). Leaving the liver TMAO causers “vascular inflammation” and “formation of unstable plaques in the arterial walls.”

In the same report Dr. Hazen says: “We’ve found that the TMAO pathway seems to be mechanistically linked not only to atherosclerosis but also to the development of chronic kidney disease, based on animal model data and some human studies.”

A study of 3,166 humans with normal kidneys and 521 with chronic kidney disease found that higher blood levels of TMAO correlated with less kidney function. High TMOA levels also led to more deaths.

Fortunately (depending on your dietary philosophy) humans can function just fine without eating foods that feed TMAO-producing bacteria. Don’t eat those foods, starve the bad bacteria and TMAO levels will drop. The two subtances TMAO-producing microbes thrive on are choline and carnitine.

Carnitine, sharing the same root as “carnal,” is found in flesh foods (meat) and some protein powders and supplements. According to the National Institute of Health, carnintine is not an essential nutrient. We can live fine without it “as the liver and kidneys produce sufficient amounts from the amino acids lysine and methionine to meet daily needs.”

Choline is found most abundantly in beef, egg yolks and dairy fat. Very small amounts are present in some plant food, however, which is a good thing. “Choline was officially recognized as an essential nutrient by the Institute of Medicine (IOM) in 1998,” explains a study from University of North Carolina at Chapel Hill. A little is essential. Excess becomes deadly.

Considering how many people with type-1 diabetes end up suffering and dying from cardiovascular disease and kidney failure, it may be worth considering excluding all animal foods from the diet. Such research has certainly supported our decisions to continue with our long-term experiment of consuming only plant foods (mainly grains, beans, nuts and vegetables).

Thinking Outside the T1D Matrix,
–John C. A. Manley

P.S. For more on why we stopped eating all animals products check out How Much (Or Little) Protein Should One Have While on Dialysis?.

P.P.S. If you value the information, ideas, research and tips shared in the Diabetic Dharma e-letter, please consider supporting us by making a donation. Time is money. And research and writing take plenty of time.

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