Can we forget the medication for cholesterol and instead reach for the antibiotics to prevent heart attacks? A new study in Nature Medicine poses this interesting question. This novel idea may not be so far-fetched! It seems that the bacteria in our gut, especially in those of us who love our meat, may play a key role in promoting heart disease.
Lead researcher Dr. Stanely Hazen of the Cleveland Clinic found that there is an increased risk of heart disease related to a chemical called carnitine. Carnitine is derived from amino acids, which are the building blocks of proteins. It is produced and found in almost every cell of our body, so essentially we don't need to consume it in food or supplements.
However, it is also found in almost all animal products, such as meat, poultry, fish and dairy. Red meat contains the highest levels. People who eat our typical American diet probably consume an extra 60-180 milligram of carnitine a day, as opposed to vegans, who would only take in an extra 10-20 milligrams a day by avoiding meat.
The excess carnitine is not really the problem -- prior research has found that the carnitine like another similar looking nutrient choline is metabolized by bacteria in the gut to a chemical called TMAO, or trimethylamine-N-oxide, that is then released in the blood. It is the TMAO that has been shown in mice to accelerate hardening of the arteries.
In humans, higher levels of this TMAO were found to predict risk of heart attack irrespective of traditional risk factors such as smoking, high cholesterol and high blood pressure. This new study found that vegans had lower concentration of TMAO in their blood even after they took a carnitine supplement in pill form.
Further research is needed to determine exactly which bacteria are responsible and if vegans actually do have less of these bacteria in their gut because they don't eat meat. The researchers did find that if they suppressed the bacteria in the gut of the mice with antibiotics, these mice did not produce TMAO and concomitantly they did not have accelerated hardening of their arteries with plaques.
For me as a physician, reading this exciting study harkens back to another discovery in the '80s that also found a link between bacteria and a chronic disease. Stomach ulcers were long attributed to diet, smoking and stress. However, in 1982 Drs. Robin Warren and Barry Marshall discovered a link between a new bacteria they named H pylori and stomach ulcers.
The medical community was very slow to acknowledge that ulcers could be caused by a bacterial infection. In fact, it took over a decade before it was accepted that many ulcers are in fact a curable bacterial infection that can be treated with antibiotics.
But before you throw out your statins, resign from your gym membership and start your tour of Delmonico's, Ruth's Chris, and Peter Luger Steakhouse with a prescription of antibiotics in hand: While the notion is intriguing, there still is no magic bullet.
Heart disease is a much more complex chronic disease than stomach ulcers. In a recent discussion with Dr. Hazen on my radio show "ER101: the 411 on your 911," he alluded to the fact that ulcers can be eradicated with antibiotics because they are caused by just one type of bacteria,H pylori. The conversion of carnitine in our gut is done by many different bacteria and we can't eradicate all the bacteria in our gut because they also perform other important functions. However, there is the hope to develop a medication that works at the molecular level in all the bacteria to stop the chemical conversion of carnitine to TMAO.
This fascinating link found in Dr. Hazen's study is really is just one more piece to the puzzle in heart disease prevention. And sadly, as a carnivore lover myself, I have to report: It still means more vegetables, less meat and back to the treadmill for us!
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