It is increasingly evident that the gut microflora is critically important for digestion, immunity, and proper weight maintenance. Changes to the bacterial content of the GI tract can lead to onset of obesity and various diseases due to changed immune function. In their latest paper in Nature, Wang et. al. show that gut microflora is an important regulator of cardiovascular disease as well. They identified small molecules in the plasma that are predictive of increased risk for cardiovascular disease (CVD). Of all the potential compounds found in the plasma, one in particular was associated with CVD. This was TMAO (trimethylamine N-oxide), a metabolite of choline. A diet rich in fat contains high levels of phosphatidyl choline (PC). In the small intestine, this PC is converted to choline. The bacterial microflora that resides in the intestine digests this choline turning it into trimethylamine (TMA). TMA is a gas that is absorbed through the intestinal tract and converted in the liver to TMAO. Interestingly, their data show that increased TMAO is correlated with increased risk for cardiovascular disease, peripheral artery disease (PAD), coronary artery disease (CAD), history of myocardial infarction and atherosclerosis. Further, when the bacterial content was altered with antibiotic treatment, TMAO levels decreased, as did the risk for CVD and other diseases. Taken together, these data suggest that development of a healthy bacterial microflora could dramatically impact the risk for many cardiovascular diseases.
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