Ordering TMAO (trimethylamine N-oxide) blood testing

TMAO has been in the headlines recently (including my favorite breathless overexaggeration, "THIS blood test will predict how long YOU will live") as a probably-useful predictor of cardiovascular events.

As far as I can tell, the only company that can do TMAO testing is Cleveland HeartLab. They can send a phlebotomist to you (at a cost of $100-$300), or you can arrange your own blood draw for $35. The test itself is $90, and also includes HbA1c, insulin, adiponectin, and uric acid. It looks like the best way to order is to call them: 866-358-9828.

They provide a sheet with information for your practitioner, including diagnosis codes to help with justifying "medical necessity (things like type 2 diabetes, hypercholesterolemia, hypertension, and metabolic syndrome).

I have a suspicion that the news interest in TMAO may be an example of a submarine PR-generated story by Cleveland HeartLab and/or Proctor & Gamble (who is working on products for managing TMAO's effects). That said, I'd personally toss it in my test regimen if money was no object.

My notes on TMAO

• TMAO might actually have some positive effects: see this recent experiment tackling heart failure and fibrosis.
• Chris Masterjohn's arguments that dietary choline sources like eggs and liver don't actually increase TMAO.
• Chris's additional arguments that carnitine from red meat is probably not the culprit that most articles about TMAO imply, and that many forms of seafood are probably worse.
• Another tidbit from Chris's article above: it seems the enzyme that ultimately makes TMAO has significantly lower activity in males.
• Paul Jaminet and Chris Kresser (1, 2) also discuss diet's effects on TMAO.
• A recent scientific review is a good overview of the difficulty of drawing strong conclusions about TMAO.
• Something called DMB that's in balsamic vinegar and red wine might help reduce TMAO production.
• Low-dose aspirin may decrease both TMAO levels and its effect on clotting, at least with supplemental choline.
• Plant sources of choline might avoid raising TMAO, but I think that might only be because of indole-3-carbinol content that appears to inhibit the enzyme that produces TMAO rather than something inherently bad about animal products.
• "Archaebiotics" might be a promising treatment.