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To try to lower TMAO, favor a varied, plant-forward eating pattern and consider reducing frequent red-meat intake—but neither change is guaranteed to lower your result. TMAO levels also reflect gut microbial activity and kidney clearance, and current evidence does not establish a universal target or show that lowering the number prevents heart disease. If you have kidney disease or an elevated test, discuss what it means with a clinician.
What affects TMAO levels?
Trimethylamine N-oxide (TMAO) is a compound shaped by more than what you ate most recently. Some foods provide precursors that gut microbes can convert into trimethylamine, which the body then converts into TMAO. Some foods, including fish, can also contain TMAO directly. The kidneys help clear TMAO, so reduced kidney function can contribute to higher levels. A measurement therefore cannot be attributed to red meat alone or used by itself to diagnose a condition. A 2023 review of dietary sources, gut microbes, kidney function and clinical outcomes describes these influences.
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Can eating less red meat lower TMAO?
It may, but the effect is not reliable across studies. A 2025 systematic review of randomized trials included 13 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 difference in serum or plasma TMAO, 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 evidence is needed on their size and clinical importance. Read the 2025 randomized-trial review.
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If you eat red meat frequently, reducing it is a reasonable option within a balanced diet, but do not assume that a lower intake will produce a particular test result. A controlled feeding study summarized by the NIH reported a decrease in TMAO after participants stopped the red-meat phase; that finding is one study, not a guarantee of an individual response. NIH summary of the controlled feeding study.
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Which eating pattern is worth trying?
A varied, plant-forward or Mediterranean-style pattern is a sensible approach to consider for overall diet quality and may affect TMAO, but it is not an established treatment for the biomarker. A 2025 review of 27 clinical intervention studies found lower TMAO in some studies of plant-based and Mediterranean patterns, among others. The studies differed, so the review does not prove that one regimen consistently lowers TMAO. See the 2025 review of lifestyle interventions.
Focus on a sustainable pattern with a range of vegetables, fruits, legumes, whole grains, nuts and other foods that meet your nutritional needs. Avoid replacing one restrictive diet with another solely to chase a TMAO number. High-protein and high-fat diets were linked to increases in some studies in the same review, but that does not establish that every such diet raises TMAO.
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Should you avoid fish, eggs or dairy?
No single food category should be eliminated solely to lower TMAO on the evidence available. Fish can contain preformed TMAO, but associations between fish and blood TMAO vary by population. In an observational pooled analysis of 32,166 adults, animal protein was consistently associated with circulating TMAO across populations, while associations for fish, shellfish, eggs and red meat varied. Observational associations cannot show that a food caused a change. Read the 2021 pooled analysis.
Do not cut out seafood, eggs, dairy or choline-containing foods just because of a TMAO result. Such restrictions can affect nutritional adequacy, and the evidence does not support treating these foods as universally harmful for TMAO.
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Does exercise lower TMAO?
The evidence summarized here does not establish exercise alone as a dependable way to lower TMAO. The 2025 lifestyle review found neutral results for combined nutrition-and-exercise interventions, which is not the same as proving exercise has no health benefit. Keep physical activity in your routine for its broader health benefits, but do not count on it to change a TMAO test.
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What to do about a high TMAO result
- Ask how the result should be interpreted. The sources reviewed do not establish a universal TMAO target or show that lowering it prevents heart attacks or other cardiovascular outcomes.
- Discuss kidney function. Because the kidneys clear TMAO, kidney disease can affect the level. Ask your clinician whether the result changes your care.
- Get tailored food advice if needed. A registered dietitian with renal nutrition expertise can help people with kidney disease or complex dietary needs make changes without compromising nutrition.
- Do not start a restrictive diet or supplement regimen solely for TMAO. The evidence does not establish supplements, probiotics or a particular food product as reliable TMAO-lowering treatments.
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