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What affects your TMAO level?
Trimethylamine N-oxide (TMAO) is a compound shaped by more than one process. Foods can supply TMAO directly or provide nutrients that gut microbes convert into trimethylamine, which the body then converts to TMAO. The kidneys help clear TMAO from the blood, so kidney function also affects the measured level. A result therefore cannot be attributed to a single food or interpreted as a stand-alone diagnosis. A 2023 review discusses these dietary, microbial, and renal influences.
Which dietary changes might help?
Choose a varied, plant-forward pattern
Emphasizing vegetables, fruit, legumes, whole grains, nuts, and other minimally processed plant foods is a sensible general eating pattern. A 2025 review of 27 clinical intervention studies found that plant-based and Mediterranean-style interventions were associated with lower TMAO in some studies. The studies were heterogeneous, however; they do not show that either pattern reliably lowers TMAO for everyone or functions as a treatment for a high result. Read the 2025 lifestyle review.
Consider reducing frequent red-meat intake
Eating less red meat may lower TMAO for some people, but the trial evidence is inconsistent. A 2025 systematic review included 13 randomized trials, 553 participants, and 15 diet comparisons; the median trial lasted 28 days. Six comparisons associated higher red-meat intake with higher circulating or urinary TMAO, seven found no serum or plasma difference, and two found lower TMAO with higher red-meat intake than with seafood comparators. The authors concluded that short-term effects were inconsistent and that more high-quality research is needed to establish their magnitude and clinical relevance. See the 2025 red-meat trial review.
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A controlled feeding study summarized by the NIH also reported that TMAO decreased after participants stopped the red-meat phase. That finding supports the possibility of a response in a particular study setting, not a promise that reducing red meat will lower every person’s level. Read the NIH summary.
Do not eliminate fish, eggs, or dairy solely to chase a number
Fish can contain preformed TMAO, but that does not make seafood a universal food to avoid. An international pooled analysis of 32,166 adults found that associations between circulating TMAO and fish, shellfish, eggs, and red meat varied across populations; animal protein was more consistently associated with TMAO. Because this was observational evidence, it cannot establish that eating a particular food caused a change. Read the pooled analysis.
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Likewise, do not cut out eggs, dairy, or choline-containing foods based on TMAO alone. The evidence does not establish a single food or nutrient restriction that reliably lowers the level, and unnecessary exclusions can make a diet less balanced.
Does exercise lower TMAO?
The available evidence here does not establish exercise alone as a reliable way to lower TMAO. In the 2025 lifestyle review, combined nutrition-and-exercise interventions had neutral results for TMAO. Physical activity can still be part of a healthy lifestyle, but it should not be presented as a proven TMAO-lowering treatment.
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How to make a practical change
- Start with your usual eating pattern. If red meat is a frequent choice, consider replacing some meals with legumes, vegetables, whole grains, or other foods that fit your nutritional needs.
- Favor variety over a restrictive “TMAO diet.” Build meals around a range of minimally processed plant foods while keeping appropriate sources of protein and other nutrients.
- Avoid interpreting a single test in isolation. Ask the clinician who ordered it how the result relates to your kidney function, health history, and the reason for testing.
- Get individualized advice when needed. If you have kidney disease or complex dietary needs, ask your clinician about a registered dietitian with renal nutrition expertise before making substantial changes.
What a TMAO result can—and cannot—tell you
The sources summarized here do not establish a universal TMAO target or show that lowering the number prevents heart attacks or other cardiovascular outcomes. A dietary change may affect a biomarker without proving a health benefit from changing that biomarker. If a result concerns you, discuss the test’s purpose and interpretation with a qualified clinician rather than treating the number as a diagnosis or trying to reach an unvalidated target.
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