From:  Comparison of short-term and long-term effects of peroral L-carnitine intake: clinical implications of elevated TMAO levels in cardiovascular complications
 

Summary of interventions to reduce the levels of TMAO

InterventionEfficacyPopulation
Plant-based diets (e.g., Mediterranean)Reduces TMAO by promoting beneficial gut bacteriaGeneral population, those with cardiovascular/metabolic issues
High-fiber dietReduces TMA-producing bacteriaGeneral population, those with metabolic/gut health issues
Reduced red meat consumptionLowers TMAO by reducing LC and cholineThose with cardiovascular/metabolic diseases
SeafoodIncreases TMAO levels; should be avoided for TMAO reductionGeneral population, those looking to lower TMAO
Legumes, soy, quinoa, fermented foodsDecreases TMAO by promoting beneficial bacteriaGeneral population, those with metabolic/cardiovascular concerns
ProbioticsSuppresses TMA-producing bacteria (e.g., Lactobacillus, Bifidobacterium)Those with high TMAO or gut dysbiosis
PrebioticsPromotes growth of TMA-independent bacteriaThose with gut health issues
Exercise (endurance/aerobic)Increases microbial diversity, reduces TMA-producing bacteriaGeneral population, those with cardiovascular/metabolic issues
Antibiotics (rifaximin & metronidazole)Reduces TMAO by targeting TMA-producing bacteriaShort-term use for those with high TMAO levels
Omega-3 supplementsCan help reduce TMAO levelsThose aiming to lower TMAO or improve metabolic health
Choline/LC-lowering drugsMay reduce TMAO levelsThose with elevated TMAO due to diet or metabolism
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LC: L-carnitine; TMA: trimethylamine; TMAO: trimethylamine-N-oxide