Part 11/15:
Recent advances, such as the discovery of PCSK9 inhibitors (which dramatically lower LDL cholesterol), and mechanisms like TMAO (trimethylamine N-oxide) produced by gut bacteria digesting choline or carnitine, are highlighted. Dr. Kahn points out that high TMAO levels, associated with animal foods, are biologically plausible pathways to atherosclerosis, although human data remain complex and sometimes contradictory.
He notes that fish—an often-recommended source of omega-3s—can raise TMAO, yet paradoxically is associated with decreased cardiovascular disease risk. This underscores the complexity of nutrient interactions and the importance of whole dietary patterns over single mechanisms.