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Red meat is the clearest dietary source linked to higher TMAO in controlled human research, while fish and shellfish can also raise measured levels. If you want to shift your diet, replace some red-meat meals with plant proteins such as beans, peas, or lentils. But TMAO is a biomarker, not a simple score of whether a food is healthy: a higher reading does not prove that a food is harmful or that lowering TMAO prevents heart disease.
What TMAO is—and why a food list can mislead
Trimethylamine N-oxide (TMAO) is produced through interactions between food, gut microbes, and the body. Some foods provide compounds that gut bacteria turn into trimethylamine, which the body then processes into TMAO. Seafood can also supply TMAO directly. As a result, a measured level can reflect both what someone eats and differences in their metabolism and gut microbes.
TMAO is not a stand-alone measure of food quality. Trials have recorded higher levels after fish and whole-grain intake as well as after red meat. The researchers reporting those findings cautioned that TMAO is not a universally valid cardiometabolic risk marker independent of dietary context (randomized trials of fish and whole grains).
Which foods can raise measured TMAO?
Red meat: the clearest controlled-diet signal
In a controlled feeding study of 113 healthy men and women, participants followed red-meat, white-meat, and non-meat protein diets. After one month, the red-meat-rich diet produced about three times the TMAO levels measured on either the white-meat or non-meat diet; levels fell after participants stopped the red-meat diet. This was a study-specific result, not a prediction for every person. NIH summarized the study in its report on the red-meat diet and TMAO.
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The broader picture is less uniform than that result alone suggests. A review of randomized red-meat trials included 15 publications reporting 13 trials, with 553 participants and a median trial duration of 28 days; the findings across comparisons were mixed (systematic review of red-meat randomized trials). The evidence supports limiting a red-meat-rich pattern, but not claiming that every red-meat meal causes the same change.
Fish and shellfish: TMAO can rise without proving harm
Fish and shellfish may raise circulating TMAO because seafood can contain the compound directly. Randomized trials have also recorded increased plasma TMAO after fish intake. An international analysis of 16 population-based studies found that seafood associations varied among populations and were stronger in Asian populations than in some Western populations (international pooled analysis; randomized trials).
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That biomarker response alone is not a reason to avoid fish. The available evidence does not show that avoiding fish to lower TMAO prevents cardiovascular disease.
Eggs, poultry, dairy, and plant foods: less consistent findings
Associations for eggs varied among populations, and evidence about specific foods remains limited. A review of 27 articles called for more research on food-level associations and cardiovascular risk, including the role of fish-associated TMAO (food-association review). Broader animal-protein patterns have been associated with higher TMAO, but that does not establish a uniform effect for every animal food or every person.
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Plant-based dietary patterns often lowered measured TMAO in a review that screened 447 studies and included 25, with literature searched through July 1, 2021. Six of the eight studies of plant-based diets in that review found beneficial effects on plasma or urinary TMAO; the authors called for more long-term comparisons among Mediterranean, vegetarian, and vegan diets (review of dietary patterns and TMAO). This pattern-level evidence does not mean one particular plant food reliably lowers TMAO.
What can you eat instead of red meat?
Try replacing some red-meat meals with plant proteins such as beans, peas, lentils, tofu, or nuts. NIH’s summary of the controlled trial recommends a heart-healthy pattern that includes plant proteins such as beans and peas. The trial’s short-term TMAO result followed a shift away from red meat; it does not show that a specific food treats disease or prevents a heart attack.
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- Make beans, lentils, or peas the main protein in a meal where you might otherwise serve red meat.
- Use tofu, nuts, or other plant proteins for variety rather than relying on one substitute.
- Think in terms of an overall eating pattern, not a single food or a TMAO reading.
A randomized crossover trial in generally healthy adults found improvements in several cardiovascular risk factors, including TMAO, during the plant-based-meat condition compared with the animal-based-meat condition (plant-based and animal-based meat crossover trial). That one study does not establish that all commercial plant-based meat products are equivalent or beneficial; minimally processed plant proteins are another practical option.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.What a TMAO result can—and cannot—tell you
Studies in this evidence base measure TMAO levels or examine associations; they do not establish that lowering TMAO through a particular food substitution prevents cardiovascular events. No universal clinical target, testing recommendation, or individual reduction estimate is established here. Do not eliminate fish, eggs, dairy, or all animal foods solely to change a TMAO reading.
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The more useful takeaway is dietary: if you want to reduce red meat, a varied pattern that includes plant proteins is supported by the available evidence. TMAO on its own cannot tell you whether an individual food is good or bad for your health.
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