Elevated TMAO levels are likely a proxy for underlying insulin resistance rather than a direct cause of disease.

“so I think amber O'Hearn did a great talk at the Carnival Con this year suggesting that many of these biomarkers are just a proxy for insulin resistance so elevated levels of TMAO one of the expressions one of the experiments it's carnivores checking their TMAO levels I'm gonna get mine check I've got a feeling we can take bets we can do it over under I don't think it's gonna be very high I think what's going on here is that for people who have elevated TMAO levels they are probably insulin resistant more than anything”

“I'm not convinced tmao is directly atherogenic I think that what we're seeing here is that it's just an indication of insulin resistance”

“they looked at genetic variation and in metabolism of things like betaine choline which will all you know linked into the production of TMAO and they basically found that tea TMAO itself had no direct causative role but that the opposite was true some people who had type 2 diabetes you know they had higher TMAO levels and that would directly go with that with that hypothesis of ever being under the control of insulin”

“we know that types of diabetes is one of the biggest risk factors for heart disease and for various for various and varied very interesting reasons but it exactly points to that to that idea that people who have who have types of diabetes or some kind of insulin resistance or metabolic disease they are going to have higher circulating levels of TMAO but that doesn't mean the TMAO itself is is causing the injury it's just the fact that it's associated with something that does increase the risk of heart disease”

“so our our position our hypothesis in the last podcast was the TMAO being elevated was probably just an indication of insulin resistance”