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Blog author, Solai Buchanan is an experienced Registered Dietitian and Certified Diabetes Educator with an MS from Columbia Teachers College. She specializes in treating heart disease, diabetes, hypertension, high cholesterol, polycystic ovarian syndrome,and other chronic diseases. She is a provider at a full-service cardiology practice accepting most insurance and staffed with a primary care MD, pediatrician, and cardiologist. Call: 718.894.7907. NYCC is lead by Interventional Cardiologist Sanjeev Palta, MD, FSCAI, FACC. He trained at Cornell-Columbia Presbyterian Hospital and the State University Hospital of Brooklyn. He currently is an Attending Cardiologist at New York Methodist Hospital and Maimonides Medical Center. He is also an Assistant Clinical Professor in the Department of Medicine at Mount Sinai Medical Center. Having performed over 2000 invasive cardiac procedures Dr. Palta’s patients know they are in trusted hands.

Tuesday, April 23, 2013

CARNITINE FOUND IN MEAT & SUPPLEMENTS LINKED TO HEART DISEASE


Diets high in red meat are known to be associated with greater risk of heart disease.  The association between red meat and heart health has been thought to be mostly due to the unhealthy fats found in red meat that raise blood cholesterol levels and contribute to atherosclerosis, clogging of the arteries.  Now, new research has uncovered an additional way in which red meat consumption promotes atherosclerosis.  Researchers have found that when carnitine, a compound plentiful in meat, is broken down by bacteria in the digestive tract, a substance that promotes arterial inflammation and clogging of the arteries, trimethylamine-N-oxide (TMAO), is produced. 

The research, led by Dr. Stanley Hazen, tested the carnitine and TMAO levels of meat-eaters, vegans and vegetarians, and examined the carnitine blood levels of 2,595 patients undergoing elective cardiac evaluations. Among those undergoing cardiac evaluations, they found that high carnitine levels were consistently associated with a raised risk of heart disease, heart attack, stroke and heart-related death.  Also, in an experimental trial they fed steaks to persons who regularly ate red meat and measured levels of TMAO before and after the meal.  They found sharp increases in TMAO blood levels following the meal and also found similar results when feeding these persons carnitine supplements.  Next, participants were given a course of antibiotics to wipe out gut bacteria, and then again fed steaks, and, on another occasion, carnitine supplements.  After the antibiotic treatment, neither the steak nor the supplements increased TMAO levels, indicating that indeed it was gut bacterial producing the TMAO.

The type of bacteria living in one's digestive tract is strongly influenced by one's long-term dietary patterns. Researchers found that a diet high in carnitine shifts the gut microbe composition to the types that digest carnitine.  Thus, TMAO production is increased in meat-eaters. In contrast, researchers found that levels of TMAO and the bacteria which produce TMAO were very low in persons who were following a vegetarian (no meat, fish, poultry) or vegan (no animal products including no eggs and dairy) diet. 

It is believed that TMAO contributes to atherosclerosis because it enables blood cholesterol to get into artery walls and cause damage.  It is also believed to interfere with the body's ability to eliminate excess blood cholesterol.  Thus, a diet high in meat not only increases blood cholesterol but increases the harm caused by the higher levels of cholesterol. 

Dr.  Hazen, reports that he has taken his findings to heart. He had been a lifelong meat lover eating large portions several times a week, but, convinced by his findings, he now limits his intake to 4-6 oz. once every two weeks. 

What to do:  Besides meat, carnitine also occurs naturally in chicken, fish, and dairy but levels are much higher in red meat.  Carnitine is also added to energy drinks and supplements because it has been thought to help build muscle.  While meat is a great source of protein, iron, and B vitamins, because of the risk it poses to heart health, try limiting its consumption to 2 times per week or less.  Opt instead for lean protein sources such as fish, skinless poultry, lowfat/nonfat dairy, eggwhites, and beans.  Make sure to avoid supplements or energy drinks containing added carnitine.

Adapted from articles available at: 

Source:
Koeth RA, Wang Z, Levison BS, et al.  Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis. Nature Medicine; 2013.  Doi:10.1038/nm.3145.  Available at: http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.3145.html

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