POSTED ON MARCH 17, 2014 IN WELLNESS

TMAO: A Toxic Substance Formed When You Eat Meat

Can Make You Dead Meat
BY ROBERT OSTFELD, MD, MSC

We can add another reason to the list of why we should not eat meat. If the saturated fat and cholesterol in meat were
not enough, there is a newly identified toxic kid on the block: trimethylamineoxide (TMAO). 1,2
When we eat red meat, its carnitine interacts with our gut bacteria, forming trimethylamine, which is then metabolized
by the liver into TMAO. And it appears that TMAO is not our friend. 1,2
TMAO promotes the formation of cholesterol plaques in our blood vessels, which make them less healthy and may
lead to heart attack, stroke, and death. TMAO reduces our bodys ability to excrete cholesterol. 1,2 And, if that is not bad
enough, TMAO may be linked to death from prostate cancer.3
The good news is that people who eat an exclusively plant-based diet appear to form little TMAO. In fact, when
researchers fed steak to a vegan, virtually no TMAO was made.2 Why is that? Vegans, it seems, do not select for the
specific gut bacteria that lead to the formation of TMAO, whereas meat eaters do. Hence, its as if plants create a coat
of armor in our stomachs, protecting us when they are not even there.
So if were protected by plants, is it okay for us to eat steak for just a few days? Are we protected from TMAO? It
appears that we may not be. The trillions of bacteria in our gut change very quickly. In fact, they may meaningfully
shift even within one to two days!4 So aside from the many other deleterious effects of meat, even one day of steak
could cut a chink in the natural armor afforded us by eating plants.
Notably, red meat is not the only source of TMAO. Choline, which is found in chicken, fish, dairy and even plants
is another. Choline is structurally similar to the carnitine in red meat, and with the help of the same gut bacteria,
also forms TMAO. Accordingly, when investigators fed omnivores an egg, they made TMAO. 1
Although we have no dietary need for carnitine, we do require dietary choline. So how can we get the choline we
require without the unwanted company of toxic TMAO? The answer appears to be in the armor. Eating a plant-based
diet selects for gut bacteria that do not lead to the formation of TMAO. 2 So even though we are eating choline in
plants, our stomachs plant-derived protection is in place, practically freeing us from concern about TMAO.
Sciences understanding of the interaction of our diet and gut bacteria and their influence on our health is at an early
stage. However, evidence is mounting that a plant-based diet may be beneficial for this interaction in many ways. Yet
another reason to go (or stay) plant based!
1

N Engl J Med 2013; 368:1575-1584 April 25, 2013 DOI: 10.1056/NEJMoa1109400

Nat Med. 2013 May;19(5):576-85. doi: 10.1038/nm.3145. Epub 2013 Apr 7

Am J Clin Nutr. 2012 Oct;96(4):855-63. Epub 2012 Sep 5

Nature 505, 559563 (23 January 2014) doi:10.1038/nature12820

ABOUT THE AUTHOR

Cardiologist Robert Ostfeld, MD, MSc is the founder and director of the Cardiac Wellness Program at Montefiore Medical Center in New York City,
where he encourages patients to embrace a whole-foods, plant-based diet. He earned his MD at Yale and his MSc in epidemiology at Harvard,
and he is an associate professor of clinical medicine at the Albert Einstein College of Medicine.
View all contributions by Robert Ostfeld, MD, MSc

What Is a Whole-Food, Plant-Based Diet?

By Alona Pulde, MD and Matthew Lederman, MD
A whole-food, plant-based diet is centered on whole, unrefined, or minimally refined plants. Its a diet based on
fruits, vegetables, tubers, whole grains, and legumes; and it excludes or minimizes meat (including chicken and
fish), dairy products, and eggs, as well as highly refined foods like bleached flour, refined sugar, and oil.
We know thats a mouthful! Rest assured, though, that youll be eating in a way that people have thrived on for
thousands of years. We believe that you will findas we dothat the diet and foods are very tasty and satisfying.
Following are the food categories from which youll eat, along with a few examples from each. These include the
ingredients youll be using to make familiar dishes, such as pizza, mashed potatoes, lasagna, and burritos:

Fruit: mangoes, bananas, grapes, strawberries, blueberries, oranges, cherries, etc.

Vegetables: lettuce, collard greens, broccoli, cauliflower, kale, carrots, etc.

Tubers and starchy vegetables: potatoes, yams, yucca, winter squash, corn, green peas, etc.

Whole grains: millet, quinoa, barley, rice, whole wheat, oats, etc.

Legumes: kidney beans, chickpeas, lentils, lima beans, cannellini beans, black beans, etc.
Now that you know generally what sorts of foods youll be eating, lets delve further into what the diet is and what it
most definitely is not.

A Whole-Food, Plant-Based Diet Is Not a Diet of Vegetables

You may have heard that people living this way eat lots of spinach, kale, and collard greens, and that this is, in
fact, the primary basis for many of the meals. You may even think we live only on leafy and raw vegetables.
However, nothing could be further from the truth.
While leafy vegetables are an important part of the whole-food, plant-based diet, they are a very poor calorie, i.e.,
energy, source to be sustainable. We would need to eat almost 16 pounds of cooked kale to get 2,000 calories of
food! We certainly dont eat this way, and we wouldnt blame you for thinking it sounds crazywe think so, too! In
fact, it is virtually impossible to get enough calories from leafy vegetables alone to form a sustainable diet.
Perhaps the most common reason for failure in this lifestyle is that people actually try to live on leafy vegetables
alone. If you try to live on these vegetables, you become deficient in calories. Not eating enough calories leads
you to feel hungry, which over time may result in decreased energy, feelings of deprivation, cravings, and even
binges. These issues are not caused by switching to a plant-based dietrather, they are all related to not eating
enough.
Dont get us wrong: We certainly recommend you eat generous amounts of leafy vegetables. But these are
complementary foods that you eat regularly. They are not the energy source on your food plate.
So if leafy vegetables arent the basis of a whole-food, plant-based life- style, what is?

Starch-Based Foods and Fruit Form the Basis of the Whole-Food,

Plant-Based Diet
In America most of us are accustomed to building our dinner plate around meat. This will change with your new
lifestyle. The center of your plate is now going to be the starch-based comfort foods most of us have always loved,
but that have long been relegated to side dishes or stigmatized because of a misperception that they are
unhealthy. Yet these are the foods that people around the world have thrived on for generations: tubers like
potatoes and sweet potatoes; starchy vegetables like corn and peas; whole grains like brown rice, millet, quinoa,
and buckwheat; and legumes like chickpeas, black beans, kidney beans, and lima beans.
They may be prepared a bit differentlyleaving out oil and dairy, for examplebut most of them will nonetheless
be familiar. Those that arent may become delightful new discoveries youll make as part of embarking on your
new lifestyle. They come in the form of delicious dishes like Sweet Potato Lasagna, Mashed Potatoes and Gravy,
Tuscan White Bean Burgers, Easy Thai Noodles, Lima Bean Soup, Shepherds Pot Pie, Black Bean and Rice
Burritos, Polenta Curry, and Spicy French Fries. (Recipes for all these dishes can be found in The Forks Over
Knives Plan.) In addition to starch-based foods, you can enjoy as much whole fruit as you like.

No More Eating For Single Nutrients . . . Focus on the Package

and the Foods You Enjoy
The idea of eating a particular food for one nutrient is pervasive in our culture. We have been led to believe we
should eat meat for protein, dairy for calcium, fish for omega-3 fatty acids, and even tomatoes for lycopene,
among many others. This sort of thinking is misguided and has caused grave harm to human health. The quest for
protein, for example, has steered us toward meat consumption. In this quest, we not only consume protein
in excess of our needs, but also many harmful substances like dietary cholesterol that are only present in animal
foods.

No food is a single nutrient, and we should never think of foods in that way. Any given food
has countless nutrients. What matters most is the overall nutrient profile, i.e., the whole package. Whole, plantbased foods contain all the essential nutrients (with the exception of vitamin B12), and in proportions that are
more consistent with human needs than animal-based or processed foods. So our question is really this: Why
waste any of what we eat on inferior packages? As long asover timewe choose a variety of whole, plantbased foods, we will easily meet our nutritional needs.
Even on this diet, people sometimes tend to worry about eating a certain type of green vegetable for calcium,
beans for protein, nuts for fat, and so on. We ask you to let go of that kind of thinking. The most important thing in
this lifestyle is to choose the whole, plant-based food you enjoy most!
To learn more about the whole-food, plant-based lifestyle, and how to make a successful transition, be sure to
check out The Forks Over Knives Plan.

Nutrition Questions
Matthew Lederman, MD and Alona Pulde, MD

Alona Pulde, MD, is a family practitioner and Matthew Lederman, MD, is a board-certified Internal
Medicine physician. Both specialize in nutrition and lifestyle medicine. They appeared in Forks
Over Knivesand are authors of The Forks Over Knives Plan and Keep It Simple, Keep It Whole.
Drs. Pulde and Lederman joined Whole Foods Market in 2010 where they serve as health and
wellness medical experts.

Will I get enough protein?

Dont I need to consume dairy to ensure I get enough calcium?
Isnt fish healthy? Why is it not recommended?
Will I get enough omega-3s?
Why should I avoid oil? Isnt oil healthy?
Do I need to take supplements?
Do I need to take a vitamin B12 supplement?
Do I need to eat organic for the diet to work?
What about organic, grass-fed animal products?

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Eu am participat personal la zeci si zeci de constelatii familiale cu diversi

facilitatori romani si straini. Am peste saizeci de volume despre constelatiile
familiale si peste patruzeci de DVD-uri cu constelatii filmate, conduse de
fondatorul metodei, Bert Hellinger, un om de o modestie cum rar am vazut in
viata mea si de o probitate ireprosabila, un cunoscator de cea mai mare clasa a
sufletului uman. Fenomenul care se manifesta in constelatiile familiale este
considerat marea provocare a stiintei secolului XXI si este strict natural, si de
acea metoda constelatiilor este deplin stiintifica. Cine nu a participat personal de
cateva ori la constelatii familiale si nu a studiat nimic direct de la sursa, nu poate
avea calitatea de a emite nicio parere despre acest domeniu fascinant. Eu am
absolvit filosofia si toata viata am studiat asiduu si psihologia, biochimia si

medicina stiintifica. La 61 de ani se poate considera ca am discernamantul

necesar formularii unei opinii obiective asupra constelatiilor familiale pe care
dealtfel le studiez de trei ani cu toata asiduitatea. Sper ca autoarea acestui
articol atat de nedrept sa-si revizuiasca atitudinea pe baza observarii
participative a constelatiilor familiale si a studiului acestora. Pentru cine doreste
si in primul rand pentru Feli Popescu, stau la dispozitie cu doua carti exceptionale
ale lui Bert Hellinger in care se poate vedea limpede si cine este acest gigant al
psihologiei contemporane precum si in ce consta uluitoarea si originala metoda a
constelatiilor familiale.