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July 6, 2021 •


Gut microbes directly impact stroke severity and stroke outcomes. That was the riveting conclusion from a first-of-its-kind laboratory study. This illuminating discovery is thanks to an esteemed group of Cleveland Clinic scientists with over a decade of experience unraveling the relationship between TMAO, a toxic compound created by certain species of gut microbes, and health outcomes. Based on prior clinical studies involving thousands of patients, this team of scientists and others from around the globe have shown that TMAO boosts the risk of heart attacks, strokes, and death.

As mentioned above, TMAO is produced by specific gut microbes. The precursor to TMAO is dietary choline, an essential nutrient found in highest quantities in meat and other animal-based foods. With choline, it is the specific bugs in your gut that make the poison. While adequate amounts of dietary choline are critical for health, regularly consuming choline-rich red meat drives levels of TMAO-producing gut microbes to pathologically high levels.
For this new study, the scientists conducted a series of lab experiments measuring blood levels of TMAO in lab animals and correlating it to stroke severity and stroke outcomes. They also looked at the relationship between choline in the lab animals’ diets and stroke severity and outcomes.

The results? Lab animals with the highest TMAO blood levels had more severe strokes and worse ongoing function post-stroke. Additionally, lab animals with the most choline in their diets also had more severe strokes and worse stroke outcomes. What’s more, when the researchers transplanted TMAO producing gut microbes into the lab animals’ intestines, they were able to significantly increase stroke severity. All in all, these experiments show that specific gut microbes via the production of TMAO as well as the consumption of excessive dietary choline influence stroke lethality and stroke recovery.

The take-home message for you? The bugs in your gut really matter! Work on cultivating the good ones and abolishing the bad ones by decreasing your intake of animal protein and increasing your intake of plant proteins. Your brain may really thank you one day.