Effect of exercise and nutrition on trimethylaminine n-oxide (TMAO ) and its precursors in patients with multiple sclerosis

Since microbiota is associated with many diseases, including Multiple Sclerosis (MS), its effect on diseases has been focused on. This study investigated the effects of nutrition and exercise on trimethylamine N-oxide (TMAO), choline, carnitine, betaine and lipopolysaccharide (LPS) levels in people with MS. A total of 23 people with MS were included in this study and resistance exercise was performed 3 times a week for 8 weeks. Demographic characteristics of the participants, body mass index (BMI), routine biochemical values, 7-day food consumption records, exercise-induced Maximum O2 consumption (VO2max) values and exercise-induced maximum heart rates, TMAO, Choline, Carnitine, Betaine and LPS values were compared. TMAO levels and their precursors decreased significantly compared to before exercise (p=0.005). Choline (p=0.0003), Carnitine (p=0.0001), LPS (p<0.0001) and Betaine (p=0.025) also showed statistically significant decreases compared to pre-exercise. Statistically significant results were found between pre- and post-exercise TMAO-Carnitine (p=0.02 r=0.476), TMAO-LPS (p=0.002 r=0.606) and TMAO-Choline (p=0.000 r=0.992) levels. As the MS disease score, that is, Expanded Disability Status Scale (GEDS), increases, TMAO (p=0.004 r=-0.566), Carnitine (p=0.012 r=-0.512), LPS (p=0.025 r=-0.466) and Choline A decrease in (p=0.002 r=-0.594) levels was observed. The relationship between the increase in maximum heart rate and TMAO (p=0.022 r=0.487), Carnitine (p=0.039 r=0.442) and Choline (p=0.023 r=0.483) was positively significant. The relationship between VO2max and TMAO (p=0.036 r=0.448), Carnitine (p=0.002 r=0.617), LPS (p=0.035 r=0.451) and Choline (p=0.029 r=0.465) was positively significant. When a comprehensive literature review was conducted, it was seen that this study, which investigated the relationship of TMAO and its precursors with nutrition and exercise in people with MS, was conducted for the first time. The findings show that high TMAO is important in the course of the disease in people with MS who have low VAS. Additionally, considering that exercise reduces the levels of TMAO and its precursors in people with MS, it is thought that exercise and nutrition may be an important treatment and management strategy in these patients, where they reduce the levels of TMAO and its precursors. However, these results need to be supported by larger and more comprehensive studies.