Is TMAO from Fish, Meat and Eggs Harmful?

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In another confusing nutrition story that should be titled “is there anything left for us to eat?” recent research threw a curveball. Fish, a staple of the Mediterranean diet, as well as meat and eggs may be doing more harm than good thanks to a compound called trimethylamine-N-oxide (TMAO). TMAO is found in fish and produced in the body after eating meat and eggs. TMAO is linked to greater risk for heart attack, stroke and death; yet the research isn’t crystal clear. Is it time to give up fish meat and eggs or ignore the recent media headlines?

This post will cover:

  • TMAO: More than a Gut Reaction—What gives us higher TMAO levels?
  • TMAO and health?
  • The bottom line

TMAO: More than a Gut Reaction

Blood levels of TMAO are ~ 50 times higher after eating fish compared to eggs or beef. The human body absorbs intact TMAO like the kind found in fish, easily. However, the human body’s production of TMAO, after eating foods containing the essential nutrient choline (found in eggs and meat) and the compound l-carnitine (found in meat and pork and in much smaller quantities in chicken breast and dairy products), depends on the makeup of bacteria in your gut, kidney functioning and genetics.

In one study, regular meat eaters produced more TMAO than a vegetarian did after eating steak (which contains ~ 180 mg of l-carnitine). After wiping out their gut bacteria with antibiotics, the carnivores didn’t produce any TMAO after consuming 250 mg l-carnitine. The makeup of gut bacteria in the habitual meat eaters was presumably responsible for greater TMAO production compared to the vegetarian, yet this was a small study and we don’t know anything else about the participants’ diet. Was it the meat that altered gut bacteria or something else in their diet? After all, a steady diet of red meat may mean double cheeseburgers on white bread with regular servings of French fries and soda on the side. This isn’t exactly the diet you want for promoting good bacteria in your gut.

Another study found blood levels of TMAO were greater in those with a less diverse makeup of microbes and greater amounts of a less healthy type of bacteria (firmicutes), compared to one that is healthy (bacteroidetes). A diet higher in saturated fat will promote this environment.

While bacteria seem to influence TMAO production from l-carnitine, l-carnitine also influences the makeup of gut bacteria. A study in mice found those with their gut bacteria wiped out thanks to antibiotics produced a different makeup of bacteria in the gut after consuming l-carnitine while also doubling the risk of plaque buildup in their arteries.

Higher TMAO levels come from:

  • Eating fish
  • Less diverse array of gut bacteria and increased levels of bad versus good bacteria
  • Consuming l-carnitine (mouse study)

TMAO and Health

A few human studies found higher blood levels of TMAO were associated with greater risk for heart disease. However, all research isn’t pointing in the same direction. One study in over 300 patients found blood TMAO levels were not associated with heart attack or heart disease over the course of eight years, following the initial test for TMAO. However, TMAO levels were higher in those with diabetes, patients with metabolic syndrome and those with declining kidney functioning. Another study examined over 800 people between the age of 33 and 55 and found blood TMAO levels were not associated with clogged arteries, insulin resistance (this comes before type 2 diabetes) and inflammatory markers or negative changes in blood lipids suggesting TMAO levels might not contribute significantly to the progression of clogged arteries. However, this study shows TMAO levels were significantly lower than in previous research, showing an association between TMAO and heart disease.

TMAO is considered a risk factor for cardiovascular disease. In those with type 2 diabetes, higher TMAO levels are associated with greater risk for death, heart attack, heart failure and unstable angina (chest pain). Also, higher levels of circulating TMAO are associated with higher risk of death in those with chronic kidney disease and greater risk of certain cancers. Yet, there are several confounding factors. Fish is the primary culprit for higher acute circulating TMAO levels, yet fish-based diets are associated with reduced risk for heart disease. Also, levels of TMAO are dependent upon disease state and the makeup of gut bacteria. Therefore, at this time it isn’t entirely clear which came first – does TMAO cause disease or does TMAO increase due to disease?

The Bottom Line

The story on TMAO isn’t crystal clear, so there’s no reason to avoid fish, meat and eggs in an effort to decrease TMAO levels. All three of these foods are good sources of several nutrients important for health. Though processed red meats are linked to higher risk of colorectal and stomach cancers, when cooked appropriately (lower, moist heat for example) red meat can fit into a healthy diet and deliver important nutrients including iron, zinc and vitamin B12. Eggs are an economical source of protein and contain many nutrients and compounds that contribute to health including two antioxidants important for eyesight.

Though there is no reason to completely avoid these foods, you can alter your diet to help diversify gut bacteria and also increase the amount of good versus bad bacteria. Probiotic rich foods such as yogurt and kefir with live and active cultures, miso soup, tempeh and other fermented foods contain good bacteria. Fiber-rich plant foods (fruits, vegetables, legumes) are important food sources for bacteria to thrive in your body.

Disclosure: this post was sponsored by USFRA. All views are my own and backed by research.

References
Koeth RA, Wang Z, Levison BS et al. Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med 2013 Apr 7.

Cho CE, Caudill MA. Trimethylamine-N-Oxide: Friend, Foe, or Simply Caught in the Cross-Fire? Trends Endocrinol Metab 2016 Nov 4. [Epub ahead of print]

Cho CE, Taesuwan S, Malsheva OV, Bender E, Tulchinsky NF, Yan J, Sutter JL, Caudill MA. Trimethylamine-N-oxide (TMAO) response to animal source foods varies among healthy young men and is influenced by their gut microbiota composition: A randomized controlled trial. Mol Nutr Food Res 2016 Jul 5.

Carnitine. Health Professional Fact Sheet, NIH. https://ods.od.nih.gov/factsheets/Carnitine-HealthProfessional/

Mueller DM, Allenspach M, Othman A, Saely CH, Muendlein A, Vonbank A, Drexel H, von Eckardstein A. Plasma levels of trimethylamine-N-oxide are confounded by impaired kidney function and poor metabolic control.Atherosclerosis 2015;243(2):638-44.

Meyer KA, Benton TZ, Bennett BJ, Jacobs DR Jr., Lloyd-Jones DM, Gross MD, Carr JJ, Gordon-Larsen P, Zeisel SH. Microbiota-Dependent Metabolite Trimethylamine N-Oxide and Coronary Artery Calcium in the Coronary Artery Risk Development in Young Adults Study (CARDIA). J Am Heart Assoc. 2016 Oct 21;5(10). pii: e003970.

What You Need to Know about Pork

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If visions of mistreated animals injected with a continuous supply of hormones and antibiotics leave you feeling confused and terrified about your food choices—this post is for you. I’m cutting through many myths about how pork is produced, so you can rest assured you are making the right choices. For this post I interviewed Wanda Patsche, a pig farmer from Minnesota.

Aren’t big farms owned by big agriculture companies?
Wanda: Family farmers own 97% of pig farms. Some farms are big some are small.

What are the greatest misperceptions consumers have about pigs?
Wanda: Many people think modern farms are less humane compared to small farms; niche farms, pasture raised. Actually, the opposite is true. With modern farms barns are designed so you can handle the pigs better; pigs have a social hierarchy where they fight with each other. Modern farms are specifically created to easily control this fighting by having pigs in individual pens. This means less stress for the pigs, plus the buildings are temperature controlled with fresh air. Pigs are given clean water and clean feed. The barns are pressure washed and sanitized between groups of pigs (when pigs move out and prior to new pigs coming in). Plus, pig farmers work closely with their veterinarians. Farms that have more pigs mean the famers continually grind feed because they have more mouths to feed. Continually grinding feed means the pigs get fresh feed. Their diets are designed for health and growth.

What you need to know about porkIs hormone-free pork better?
Wanda: No pigs are given hormones. Farmers are not allowed to give pigs hormones. Therefore, any pork labeled “hormone-free” has been given this label to try and make customers think it is better than other pork. However, there is no difference, all pork is free from added hormones.

Are there any antibiotics in my pork?
Wanda: Antibiotic-free is another labeling term to try to persuade customers to choose chose a specific pork product. All meat is free of antibiotics. If a pig is given an antibiotic, all traces of the antibiotic must leave the body—called the withdrawal period—before the pig is sent to off for pork production.

What do you think is driving these perceptions?
Wanda: In the U.S., less than 2% of people are farmers. Many people don’t know farmers, and they are 2 – 4 generations removed from farmers. If you’ve never been to a farm or know people who farm it is easier to believe the myths that circulate on the internet.

Tell us a little more about advances in pork production and the safeguards in place to ensure pork is safe.
Wanda: Forty years ago, pigs were all outside. They had clean air but many hazards including sunburn and the greater likelihood of getting worms (and therefore the vets would have to treat them with medicine for worms). Now, with the introduction of indoor facilities and individual pins, pigs are less stressed which keeps them healthier. Stress = greater likelihood of sickness.

In addition, antibiotics are used less, and there is a comprehensive vaccination program in place to keep pigs healthy. On farms that do not use antibiotics to treat animals when sick, the animals must be pulled away from the other pigs to prevent the illness from spreading.

Animal scientists are currently conducting studies examining ways to keep animals healthy including the use of essential oils, probiotics, and enzymes. Healthier pigs mean even fewer antibiotics are used.

Antibiotics are the last resort and only used when necessary.

Pigs are grouped together based on age. This is helpful as immune system functioning differs by age. This is just another step to keep pigs as healthy as possible.

Aren’t farms more concerned about quantity vs. quality?
Wanda: No. Every day I wake up and think, “what can I do to ensure my pigs are as healthy as possible?” Pig farmers get more money for higher quality meat. So, every pig farmer has an added incentive to produce healthy, high quality pigs. Lower quality pork goes to a secondary market for ground pork, pepperoni and similar process products. Farmers get considerably less money for lower quality pork.

Are there any concerns that consumers should have about pork?
Wanda: The biggest concern for consumers is how pork is handled and cooked. According to the USDA pork should be cooked to 145°F internally. Ground pork should be cooked to 160°F. It can be pink in the middle as long as these internal temperatures are reached.

What are the best cuts of pork?
Wanda: pork is 16% leaner than it was 20 years ago due to the way animals are fed and genetics. Pork tenderloin is just as lean as chicken breast. An easy way to remember this: loin = lean.

This post was sponsored by USFRA, all views are mine and Wanda’s.

 

Yikes! Are there Antibiotics or Hormones in Your Milk & Dairy Foods?

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milk

Are antibiotics and hormones used in dairy cows contributing to the obesity epidemic, early puberty and antibiotic resistance? Before going down that road, we have to first we have to first ask if there are any antibiotics or hormones in milk and dairy products.

In this blog post I will cover:

  • Why are antibiotics given to cows?
  • Antibiotics are not in milk, here’s why.
  • Why are growth hormones given to cows? Are there any hormones in my milk and dairy food?
  • What are the cows Eating?

Why are Antibiotics given to Cows?

Antibiotics are used on farms to treat animals who are sick just like you would give an antibiotic to your child if he or she gets sick or take one yourself. There is no reason for dairy farmers to give antibiotics to cows who are not sick. Doing so costs additional money,  serves no clear purpose and arbitrarily giving animals antibiotics could contribute to antibiotic resistance. Now imagine you are a farmer and your life depends on the health of your cows – would you want to run the risk of antibiotic resistance and your cows getting sick with fewer treatment options?

Some antibiotics are also used for animal growth. The FDA is phasing out this practice so medically important antimicrobial drugs (antibiotics) will no longer be allowed to enhance growth or feed efficiency. In the future antibiotics will only be allowed to treat, control or prevent disease and of course require a prescription from a licensed veterinarian. Regardless of whether or not the antibiotic is used for growth or treatment of disease, no traces of antibiotic residues are allowed in milk or dairy products.

Antibiotics are Not in Milk, Here’s Why.

Any cow that gets an antibiotic is milked separately from the rest of the herd and the milk is thrown out. That milk will never be sold or consumed. All antibiotics have a different period of time before all traces of the medication leaves the body (whether we are talking about a cow or a human). Once this period is up and the cow is completely healthy again, the farmer tests her milk. Milk cannot be sold until it is completely clear of all drug residues. Whether organic or conventional, all milk is tested several times before making it to market. It is tested on the farm and at the milk processing plant. Any milk that tests positive for any medication residue, including antibiotics, is thrown out (1).

According to national Milk Drug Residue Data Base compiled for the years 2013 to 2014, 0% of milk tested positive for drug residues. In 2015, the FDA’s Center of Veterinary Medicine surveyed 1,918 raw milk samples (before pasteurization) from across the country. Samples were tested for residues of 31 drugs including the antibiotics, NSAIDs (ibuprofen etc.) and an antihistamine. They found 99% of sampled milk was free of any drug residues. Keep in mind the 1% of milk with residues must be thrown out – it cannot be sold (1, 2).

Cheese and yogurt are made from milk and therefore, there are no antibiotics in your cheese or yogurt either.

If you want to learn more about what farmers are doing about antibiotic resistance, Minnesota Farmer Wanda Patsche wrote an excellent blog on this topic.

Growth Hormones in Dairy Cows

Growth hormones are approved for use in dairy cows to improve milk production. Greater milk production means fewer environmental resources used to raise cows for milk. Bovine somatotropin (bST; also called bovine growth hormone or rBGH) is perhaps the most well recognized growth hormone used on dairy farms. bST is “a protein hormone produced in the pituitary gland of animals, including humans, and is essential for normal growth, development, and health maintenance.” Very little bST is used in dairy cows and there is no test that can distinguish between cows treated with bST and naturally occurring bST (3). Humans do not have receptors for bST and therefore it is passed through your body intact without being absorbed (4). As a result, there are no known side effects or health issues associated with consuming dairy from cows treated with bST. IGF-1 (insulin like growth factor 1) concentrations are slightly higher in cows treated with bST. However, the human body synthesizes IGF-I and drinking 1.5 L of milk is equivalent to an estimated 0.09% of the IGF-I produced by adults each day (5, 6, 7, 8).

USDA organic dairy products are “produced without antibiotics fed or administered to the animal at any point in its life” (9). There are no meaningful nutrition differences between organic and conventional dairy products. I covered that topic in this post.

What are the Cows Eating?

Cows’ diets also vary depending on many of the same factors that influence your food choices. However, unlike humans, all cows have the benefit of seeing a nutrition expert (like dietitians, animal nutrition experts are specialists). Many consumers also have questions about how cows are fed. Cows are fed nutritious diet to ensure health of cow and nutrition of milk. Typical feed mixtures may include haylage (grass with a higher water content), corn silage, sugar beet pulp and a protein mineral mix.

Rest assured, your dairy products are safe. In fact, the dairy product that says it is made with cows not treated with antibiotics is the exact same as the one from a cow that may have been treated with antibiotics. Both contain no antibiotic residues. Growth hormones used in dairy also pose no known threat to human health. The human body does not even recognize the main hormone used in cows. So, regardless of what milk, yogurt, or cheese you choose, all have been produced and extensively tested to ensure they are safe for human consumption.

This post was written as part of my ongoing sponsored partnership with U.S. Farmers & Ranchers Alliance. All opinions expressed are my own and per the usual, took me hours to research and double check my facts.References (if not cited via a hyperlink in the text of this post)

References

1 Questions and Answers: 2012 Milk Drug Residue Sampling Survey. FDA.

2 NATIONAL MILK DRUG RESIDUE DATA BASE FISCAL YEAR 2014 ANNUAL REPORT October 1, 2013 – September 30, 2014 http://www.fda.gov/downloads/food/guidanceregulation/guidancedocumentsregulatoryinformation/milk/ucm434757.pdf

3 Bovine Somatotropin (BST) http://www.fda.gov/AnimalVeterinary/SafetyHealth/ProductSafetyInformation/ucm055435.htm

4 Bovine Somatotropin. National Institutes of Health, Technology Assessment Conference Statement. December 5-7, 1990. https://consensus.nih.gov/1990/1990BovineSomatotropinta007html.htm

5 Joint FAO/WHO Expert Committee on Food Additives (JECFA). 1998. Toxicological evaluation of certain veterinary drug residues in food; Summary and conclusions. 50th report of the Joint FAO/WHO Expert Committee on Food Additives. World Health Organization, Geneva, Switzerland.

6 Collier RJ, Bauman DE. Update on human health concerns of recombinant bovine somatotropin use in dairy cows. J Animal Sci 2013; 92(4): 1800 – 1807. https://www.animalsciencepublications.org/publications/jas/articles/92/4/1800

7 Recombinant Bovine Growth Hormone. http://www.cancer.org/cancer/cancercauses/othercarcinogens/athome/recombinant-bovine-growth-hormone                  

8 Report on the Food and Drug Administration’s Review of the Safety of Recombinant Bovine Somatotropin. Food and Drug Administration. http://www.fda.gov/animalveterinary/safetyhealth/productsafetyinformation/ucm130321.htm

9 Stacy Sneeringer, James MacDonald, Nigel Key, William McBride, and Ken Mathews. Economics of Antibiotic Use in U.S. Livestock Production, ERR-200, U.S. Department of Agriculture, Economic Research Service, November 2015. http://www.ers.usda.gov/media/1950577/err200.pdf

 

 

Where Does Your Milk Come From?

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Last week I had the fabulous opportunity to visit Mountain Valley Farm in beautiful Ellijay, GA. The picture above shows my colleague’s young son with Frank Wright whose family founded this farm in 1840 and he brought dairy cows here 40 years ago. First and foremost, this farm is beautiful. If you have the opportunity to go visit, it is worth the drive to Ellijay. And they have a Farm store open to the public on Friday evenings, Saturdays and Sundays with free range eggs, grass fed beef that is locally butchered, free range pork, raw milk (for pets) and more. They use no hormones, antibiotics (it is illegal to use antibiotics in the food supply), pesticides or commercial fertilizers. But what caught my eye the most is how much these farmers love the animals.  All animals are raised on pasture and treated humanely. They are taken care of the way you’d care for your very own pet. And farming is an operation like no other – especially dairy farming since dairy is the most regulated food in the country, everything is done on schedule, equipment properly sanitized, feed calculated and mixed and the milk held in a holding tank at 36 degrees F until it is picked up (and this tank is washed by a computer system after every single batch it holds).

A few more facts about the milk from your local dairy farm (Mountain Valley):

  • The sole responsibility of a dairy farmer is to raise healthy animals who produce good milk
  • Prior to being picked up, pasteurized and processed, the milk is checked. If there is anything detectible (bacteria etc.) in the milk, the farmer must pay for it and discard it.
  • Cows are milked from 11 am – 11pm (7-8 minutes per cow)
  • Each cow produces about 20,000 lbs of milk per year for 5-6 years
  • The colostrum (in the first few milkings after the baby is born) is vital for the newborn Heifer
  • Wright does not use hormones but dairy farms that do cannot sell their milk if the hormones are above a detectable level
  • Feeding these animals is a science (see sheet below) with exact amounts of specific feed mixed together to promote optimal health (gosh if humans ate this way we’d all be perfectly healthy!)

The numbers above are in lbs per day for just 230 cows (this farm has over 300 cows!)
Me petting the newborn twins:

Petting area, and this one loves attention and I enjoyed giving it to him:

Chickens so cute I had them in the palm of my hand:


Milk production is the most regulated food industry in America. And, I’m thrilled that local dairy farmers supply some of our milk. Farmers like Frank and Suzy Wright and their staff handle the animals with love and care and farm because they are passionate about it. And because of this, you and I get the chance to consume a nutrient-packed, quality beverage!