Prebiotic and probiotic use may help reduce TMAO production: Administration of probiotic Lacticaseibacillus paracasei , but not Lacticaseibacillus casei, or Lactiplantibacillus plantarum , may reduce circulating TMA and TMAO levels Enterobacter aerogenes ZDY01 increased Bacteroidales ( Bacterodetes phylum) and decreased Prevotellaceae and Helicobacteraceae families Supplementing with Archeobacteria phylum, may reduce TMA and TMAO The prebiotic Arabinoxylan oligosaccharide plus vitamins B and D showed a small reduction in serum TMAO Prebiotics such as resveratrol increased the Bacterodetes phylum, while Firmicutes , aside from Lactobacillus and Bifidobacterium genus, decreased along with TMAO plasma levels Physical activity has a favorable effect on gut microbiota composition Some natural products, including 3,3-dimethyldimetyl-1-butanol (DMB) from vinegar, olive oil, and grapeseed oil, may inhibit the conversion of choline, betaine, and carnitine to TMA

Two other groups received HF diet for 12 months accompanied by NAC for 12 months (HFD + NAC(112)) or 6 months (HFD + NAC(16))
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