Kidney Toxins Created by Meat Consumption

As I discuss in my video How to Treat Heart Failure and Kidney Failure with Diet, one way a diet rich in animal-sourced foods like meat, eggs, and cheese may contribute to heart disease, stroke, and death is through the production of an atherosclerosis-inducing substance called TMAO. With the help of certain gut bacteria, the choline and carnitine found concentrated in animal products can get converted into TMAO. But, wait a second. I thought atherosclerosis, or hardening of the arteries, was about the buildup of cholesterol. Is that not the case?

“Cholesterol is still king,” but TMAO appears to accelerate the process. It seems that TMAO appears to increase the ability of inflammatory cells within the atherosclerotic plaque in the artery walls to bind to bad LDL cholesterol, “which makes the cells more prone to gobble up cholesterol.” So TMAO is just “another piece to the puzzle of how cholesterol causes heart disease.”

What’s more, TMAO doesn’t just appear to worsen atherosclerosis, contributing to strokes and heart attacks. It also contributes to heart and kidney failure. If you look at diabetics after a heart attack, a really high-risk group, nearly all who started out with the most TMAO in their bloodstream went on to develop heart failure within 2,000 days, or about five years. In comparison, only about 20 percent of those starting out with medium TMAO levels in the blood went into heart failure and none at all in the low TMAO group, as you can see at 1:21 in my video.

So, those with heart failure have higher levels of TMAO than controls, and those with worse heart failure have higher levels than those with lesser stage heart disease. If you follow people with heart failure over time, within six years, half of those who started out with the highest TMAO levels were dead. This finding has since been replicated in two other independent populations of heart failure patients.

The question is, why? It’s probably unlikely to just be additional atherosclerosis, since that takes years. For most who die of heart failure, their heart muscle just conks out or there’s a fatal heart rhythm. Maybe TMAO has toxic effects beyond just the accelerated buildup of cholesterol.

What about kidney failure? People with chronic kidney disease are at a particularly “increased risk for the development of cardiovascular disease,” thought to be because of a diverse array of uremic toxins. These are toxins that would normally be filtered out by the kidneys into the urine but may build up in the bloodstream as kidney function declines. When we think of uremic toxins, we usually think of the toxic byproducts of protein putrefying in our gut, which is why specially formulated plant-based diets have been used for decades to treat chronic kidney failure. Indeed, those who eat vegetarian diets form less than half of these uremic toxins.

Those aren’t the only uremic toxins, though. TMAO, which, as we’ve discussed, comes from the breakdown of choline and carnitine found mostly in meat and eggs, may be increasing heart disease risk in kidney patients as well. How? “The cardiovascular implication of TMAO seems to be due to the downregulation of reverse cholesterol transport,” meaning it subverts our own body’s attempts at pulling cholesterol out of our arteries.

And, indeed, the worse our kidney function gets, the higher our TMAO levels rise, and those elevated levels correlate with the amount of plaque clogging up their arteries in their heart. But once the kidney is working again with a transplant, your TMAO levels can drop right back down. So, TMAO was thought to be a kind of biomarker for declining kidney function—until a paper was published from the Framingham Heart Study, which found that “elevated choline and TMAO levels among individuals with normal renal [kidney] function predicted increased risk for incident development of CKD,” chronic kidney disease. This suggests that TMAO is both a biomarker and itself a kidney toxin.

Indeed, when you follow kidney patients over time and assess their freedom from death, those with higher TMAO, even controlling for kidney function, lived significantly shorter lives, as you can see at 4:44 in my video. This indicates this is a diet-induced mechanism for progressive kidney scarring and dysfunction, “strongly implying the need to focus preventive efforts on dietary modulation,” but what might that look like? Well, maybe we should reduce “dietary sources of TMAO generation, such as some species of deep-sea fish, eggs, and meat.”

It also depends on what kind of gut bacteria you have. You can feed a vegan a steak, and they still don’t really make any TMAO because they haven’t been fostering the carnitine-eating bacteria. Researchers are hoping, though, that one day, they’ll find a way to replicate “the effects of the vegetarian diet…by selective prebiotic, probiotic, or pharmacologic therapies.”


For more on this revolutionary TMAO story, see:

For more on kidney failure, see Preventing Kidney Failure Through Diet and Treating Kidney Failure Through Diet.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Fermented or Unfermented Soy?

As you can see at the start of my video Fermented or Unfermented Soy Foods for Prostate Cancer Prevention?, there is an enormous variation in the rates of prostate cancer around the globe, with among the highest rates in the United States and lowest rates in Asia—though that may be changing. The largest increase in prostate cancer rates in the world in recent decades has been in South Korea, for example: a 13-fold increase in prostate cancer deaths nationwide. Researchers suggested the increase in animal foods may have played a role, since that was the biggest change in their diet over that period, with nearly an 850 percent increase.

This is consistent with what we know in general about foods and the prevention and management of prostate cancer. Tomatoes, cruciferous vegetables like broccoli, and soy foods appear to decrease risk, there’s no clear benefit from fish, but there is an increased risk associated with meat and dairy, as you can see at 0:52 in my video. This may be because a diet based around whole plant foods “may effectively reduce inflammation in the body.”

There is also a genetic factor. If you have a first-degree relative with prostate cancer, you may be at three-fold higher risk, but non-genetic factors may increase your risk 300-fold. How do we know the low rates in Asia aren’t genetic? Because when Asians move to the United States, their rates shoot up, “and by the second generation, the incidence rate [is] already approaching that of average Americans.” This may be because of more Burger Kings and Dairy Queens, but could also be because of eating fewer protective foods, such as soy.

A systematic review of all soy and prostate cancer population studies to date confirmed that soy foods are associated with lower the risk, but that’s a relatively broad category. There are all sorts of soy foods. There are fermented soy foods, like miso and tempeh, and unfermented ones, like tofu and soy milk. Which are more protective? Researchers sifted through the studies, and it turns out that only the unfermented soy seemed to help. Tofu and soy milk consumption was associated with about a 30 percent reduction in risk, whereas there didn’t appear to be any protection linked to fermented soy foods.


What about other healthy plant foods, like broccoli and turmeric? See what they can do in Best Supplements for Prostate Cancer.

Dean Ornish and his colleagues got amazing results, apparently reversing the progression of prostate cancer with a plant-based diet and lifestyle program. Do you think it could be because of the soy? It wasn’t just a vegan diet, but a vegan diet supplemented with a daily serving of tofu and a soy protein isolate powder. Find out in The Role of Soy Foods in Prostate Cancer Prevention and Treatment.

More on the number-one cancer among men:

What about soy and breast cancer? I’m glad you asked!

Who Shouldn’t Eat Soy? Watch the video to find out!

In health, 

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Garlic Powder to Lower Lead Levels

There are so-called chelation drugs that can be taken for acute, life-threatening lead poisoning—for instance if your two-year-old swallowed one of the little lead weights her grandma was using while sewing curtains and the doctor happened to miss it on x-ray, so it stayed lodged inside her until she died with a blood lead level of 283 mcg/dcl, a case I discuss in my video Best Foods for Lead Poisoning: Chlorella, Cilantro, Tomatoes, Moringa?.

However, for lower grade, chronic lead poisoning, such as at levels under 45 mg/dL, there were no clear guidance as to whether these chelation drugs were effective. When they were put to the test, the drugs failed to bring down lead levels long term. Even when they worked initially, in dose after dose, the lead apparently continued to seep from the patients’ bones, and, by the end of the year, they ended up with the same lead levels as the sugar pill placebo group, as you can see at 0:50 in my video. It was no surprise, then, that even though blood lead levels dipped at the beginning, researchers found no improvements in cognitive function or development.

Since much of lead poisoning is preventable and the drugs don’t seem to work in most cases, that just underscores the need “to protect children from exposure to lead in the first place.” Despite the medical profession’s “best intentions to do something to help these kids…drug therapy is not the answer.” Yes, we need to redouble efforts to prevent lead poisoning in the first place, but what can we do for the kids who’ve already been exposed?

The currently approved method, these chelating drugs that bind and remove lead from our tissues, “lack[s]…safety and efficacy when conventional chelating agents are used.” So, what about dietary approaches? Plants produce phytochelatins. All higher plants possess the capacity to synthesize compounds that bind up heavy metals to protect themselves from the harmful effects, so what if we ate the plants? “Unlike other forms of treatment (e.g., pharmacotherapy with drugs), nutritional strategies carry the promise of a natural form of therapy that would presumably be cheap and with few to no side effects.” Yes, but would it work when the drugs didn’t?

We had learned that a meal could considerably cut down on lead absorption, but “the particular components of food intake that so dramatically reduce lead absorption” were uncertain at the time. Although the calcium content of the meal appeared to be part of it, milk didn’t seem to help and even made things worse. What about calcium supplements? Some assert that calcium supplements may help in reducing lead absorption in children, but “recommendations…must be based on evidence rather than conviction.” What’s more, those assertions are based in part on studies on rodents, and differences in calcium absorption and balance between rats and humans make extrapolation tricky. What you have to do is put it to the test. Researchers found that even an extra whopping 1,800 mg of calcium per day had no effect on blood lead levels. Therefore, the evidence doesn’t support conclusions that calcium supplements help.

What about whole foods? Reviews of dietary strategies to treat lead toxicity say to eat lots of tomatoes, berries, onions, garlic, and grapes, as they are natural antagonists to lead toxicity and therefore should be consumed on a regular basis. Remember those phytochelatins? Perhaps eating plants might help detoxify the lead in our own bodies or the bodies of those we eat.

These natural phytochelatin compounds work so well that we can use them to clean up pollution. For example, the green algae chlorella can suck up lead and hold onto it, so what if we ate it? If it can clean up polluted bodies of water, might it clean up our own polluted bodies? We don’t know, because we only have studies on mice, not men and women.

So, when you hear how chlorella detoxifies, they’re talking about the detoxification of rat testicles. Yes, a little sprinkle of chlorella might help your pet rat, or perhaps you could give them some black cumin seeds or give them a sprig of cilantro, but when you hear how cilantro detoxifies against heavy metals, I presume you don’t expect the researchers to be talking about studies in rodents. If we’re interested in science protecting our children, not just their pets, we’re out of luck.

The same is true with moringa, tomatoes, flaxseed oil, and sesame seed oil, as well as black grapes, and black, white, green, and red tea. There are simply no human studies to guide us.

Dietary strategies for the treatment of lead toxicity are often based on rodent studies, but, for tofu, at least, there was a population study of people that showed lower lead levels in men and women who ate more tofu. The researchers controlled for a whole bunch of factors, so it’s not as if tofu lovers were protected just because they smoked less or ate less meat, but you can’t control for everything.

Ideally, we’d have a randomized, placebo-controlled study. Researchers would take a group of people exposed to lead, split them into two groups, with half given food and the other half given some kind of identical placebo food, and see what happens. It’s easy to do this with drugs because you just use look-alike sugar pills as placebos so people don’t know which group they’re in, but how do you make placebo food? One way to do disguised food interventions is to use foods that are so potent they can be stuffed into a pill—like garlic. There had been various studies measuring the effects of garlic in rats and looking at garlic as a potential antidote for lead intoxication distributed among different mouse organs, but who eats mouse organs? One animal study did have some direct human relevance, though, looking at the effect of garlic on lead content in chicken tissues. The purpose was to “explore the possible use of garlic to clean up lead contents in chickens which”—like all of us on planet Earth—“had been exposed to lead pollution and consequently help to minimize the hazard” of lead-polluted chicken meat.

And…it worked! As you can see at 1:59 in my video Best Food for Lead Poisoning: Garlic, feeding garlic to chickens reduced lead levels in the “edible mass of chicken” by up to 75 percent or more. Because we live in a polluted world, even if you don’t give the chickens lead and raise them on distilled water, they still end up with some lead in their meat and giblets. But, if you actively feed them lead for a week, the levels get really high. When you give them the same amount of lead with a little garlic added, however, much less lead accumulates in their bodies.

What’s even more astonishing is that when researchers gave them the same amount of lead—but this time waited a week before giving them the garlic—it worked even better. “The value of garlic in reducing lead concentrations…was more pronounced when garlic was given as a post-treatment following the cessation of lead administration”—that is, after the lead was stopped and had already built up in their tissues. We used to think that “the beneficial effect of garlic against lead toxicity was primarily due to a reaction between lead and sulfur compounds in garlic” that would glom on to lead in the intestinal tract and flush it out of the body. But, what the study showed is that garlic appears to contain compounds that can actually pull lead not only out of the intestinal contents, but also out of the tissues of the body. So, the “results indicate that garlic contain chelating compounds capable of enhancing elimination of lead,” and “garlic feeding can be exploited to safeguard human consumers by minimizing lead concentrations in meat….”

If garlic is so effective at pulling lead out of chickens’ bodies, why not more directly exploit “garlic feeding” by eating it ourselves? Well, there had never been a study on the ability of garlic to help lead-exposed humans until…2012? (Actually, I’m embarrassed to say I missed it when the study was first published. That was back when I was just getting NutritionFacts.org up and running. Now that we have staff and a whole research team, hopefully important studies like this won’t slip through the cracks in the future.)

The study was a head-to-head comparison of the therapeutic effects of garlic versus a chelation therapy drug called D-penicillamine. One hundred and seventeen workers exposed to lead in the car battery industry were randomly assigned into one of two groups and, three times a day for one month, either got the drug or an eighth of a teaspoon of garlic powder compressed into a tablet, which is about the equivalent of two cloves of fresh garlic a day. As expected, the chelation drug reduced blood lead levels by about 20 percent—but so did the garlic. The garlic worked just as well as the drug and, of course, had fewer side effects. “Thus, garlic seems safer clinically and as effective,” but saying something is as effective as chelation therapy isn’t saying much. Remember how chelation drugs can lower blood levels in chronic lead poisoning, but they don’t actually improve neurological function?

Well, after treatment with garlic, significant clinical improvements were seen, including less irritability, fewer headaches, and improvements in reflexes and blood pressure, but these improvements were not seen in the drug group. They weren’t seen after treatment with the chelation therapy drug. So, garlic was safer and more effective. “Therefore, garlic can be recommended for the treatment of mild-to-moderate lead poisoning.


 There are also some human studieson vitamin C. Check out Can Vitamin C Help with Lead Poisoning?.

For even more lead videos, see:

To learn more about chlorella, see:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations: