Paul Saladino· MD
I think what's going on here is that for people who have elevated TMAO levels they are probably insulin resistant more than anything and that elevated TMAO is probably a proxy for insulin resistance
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The evidence is convergent. Multiple independent sources reach the same conclusion, the underlying mechanism is well-characterized, and even the field's most cautious voices treat it as worth doing.
I think what's going on here is that for people who have elevated TMAO levels they are probably insulin resistant more than anything and that elevated TMAO is probably a proxy for insulin resistance
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the idea here is that if you are insulin resistant we see increased activity of the enzyme FM 3 or FM O 3 and you're going to get increased TMAO when your insulin resistance
there is an enzyme in the liver yes I believe that was right FM o3 FOMO 3 that is under the control of insulin that converts tma-2 TMAO so the idea here is that if you are insulin resistant we see increased activity of the enzyme FM 3 or FM O 3 and you're going to get increased TMAO when your insulin resistance
could TMAO just be a marker of insulin resistance in that podcast I talked about an enzyme called FM o3 which is used to convert tma-2 TMAO in the liver and wouldn't you know it hat tip to Nathan that this enzyme is under the control of insulin
there's recent data to suggest that reverse causality is probably what's going on there and it's not the TMAO that's toxic it's the insulin resistance that's causing TMAO it'll be high
TMAO is the formation of TMAO and the liver is under the control of an enzyme called FM o3 it gets flavin flavin mono oxygenase 3 that enzyme is under the control of insulin and so people who are insulin resistant have higher levels of insulin and make more FM o3 so it would follow that those who are insulin resistant would have a higher level of TMAO
the conversion of tea MA and the intestines to TMAO is really mediated by an enzyme in the liver called FMO 3 which is insulin dependent so if people are not insulin resistant they don't tend to have a lot of TMAO
Basically, what they're saying in this mini review is that there is that enzyme in the liver, FMO FMO3, that is essential for converting TMA to TMAO. Now, what is critical about this is that TMAO is only made when FMO3 is functioning, and increased FMO3 or FMO activity could increase TMAO. Well, what increases FMO activity? FMO3 happens to be an insulin-dependent enzyme, so insulin resistance with higher basal levels of insulin could increase FMO3.
TMAO is serving as a marker of hepatic insulin resistance. TMAO is not directly causal, but is a marker of hepatic insulin resistance, and that is why you're seeing elevated TMAO in these conditions.
yes tmao is serving as a marker of hepatic insulin resistance tmao is not directly causal but is a marker of hepatic insulin resistance
do not worry about tmao if you are insulin sensitive
if you have insulin resistance you're going to have higher levels of tmao doesn't mean insulin resistance it doesn't mean that insulin resistance is caused by tmao