is trimethylaminuria a disability

Enzymes are natures catalysts and act to speed up biochemical processes. Mrs Thomas said the smell was with her every day but on some days or for part of a day the odour could be less intense. Trimethylaminuria (TMAU) also known as "fish odor syndrome" (OMIM #602079) is a rare inherited metabolic condition associated with decreased hepatic trimethylamine N-oxidation, which leads to an excess of the volatile trimethylamine (TMA) instead of substrate conversion to TMA N-oxide (TMAO).1-3TMA is a tertiary amine derived from the Phillips IR, Shephard EA. On this Wikipedia the language links are at the top of the page across from the article title. The FMO3 gene makes an enzyme that breaks down nitrogen-containing compounds from the diet, including trimethylamine. . psychological problems and social stress. [citation needed]. Many cases have been identified with no malodor at all. TMAU (Trimethylaminuria): The Causes, Types and Triggers. All rights reservedTerms & Conditions. THAU is a rare genetic disorder in which the human body's metabolic processes fail to alter the chemical trimethylamine, symptoms are often present from birth. 8 Ingram Street, Kensington, NSW 2033, AUSTRALIA Phone: 61 2 9663 0431. Financial support is derived from advertisements or referral programs, where indicated. The NHS says trimethylaminuria is often caused by faulty genes that a person inherits, but this is not always the case. Updated August 6, 2020. http://databases.lovd.nl/shared/genes/FMO3 Accessed October 20, 2020. Females are at higher risk for suffering from trimethylaminuria than males. Trimethylaminuria is a disorder in which the volatile, fish-smelling compound, trimethylamine (TMA) accumulates and is excreted in the urine, but is also found in the sweat and breath of these patients. 2013; 85:1588-1593. Phillips IR, Shephard EA. The specimen may still be viable within four hours if it is refrigerated between 2 and 8C. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site. 2006;29:162-72. Ellie James, 44, has the rare condition known as Trimethylaminuria (TMAU), which prevents the body from breaking down materials found in certain foods. Mitchell SC, Smith RL. Trimethylamine metabolism may also be impaired in patients with chronic liver disease. NORD is not a medical provider or health care facility and thus can neither diagnose any disease or disorder nor endorse or recommend any specific medical treatments. Today 2020; 259(9):1710-1717. https://doi.org/10.1016/j.drudis.2020.06.026. Choline and lecithin are present in certain food supplements and health foods. People may also refer to trimethylaminuria as: fish odor syndrome fish. People with trimethylaminuria end up with a build up of trimethylamine, which is then released through their sweat, urine, reproductive fluids, and breath. 2008;29:294-301. In: NORD Guide to Rare Disorders. 16 comments. "It's not nice waking up in the morning with this condition.". As TMAU is still under-recognized and often goes undiagnosed, those affected often suffer frompsychological problems and social stress. Mutat. "When I'm on a bus I hear comments like 'oh that smells like a toilet' and 'gutter' and every odour name in the book, I've heard it all," she said. In 2014, singer/songwriter Cassie Graves was first featured in the Daily Mail, the Daily Mirror, and The Metro UK newspapers in both print and Online,[29] giving an interview about her experiences with Trimethylaminuria. Trimethylaminuria. This means trimethylamine builds up in the body and gets into bodily fluids like sweat. There is no cure for TMAU but avoiding certain foods may lessen the symptoms. [2][3] When FMO3 is not working correctly or if not enough enzyme is produced, the body loses the ability to properly convert trimethylamine (TMA) from precursor compounds in food digestion into trimethylamine oxide (TMAO), through a process called N-oxidation. Trimethylaminuria (TMAU) is a metabolic disorder characterized by the excessive excretion of the malodorous compound trimethylamine (TMA). The result is elevated levels of secreted trimethylamine, which has a . The materials presented are never meant to substitute for professional medical care by a qualified practitioner, nor should they be construed as such. Trimethylaminuria and deficiency of favin-containing monooxygenase type 3 (FMO3). Stay Informed With NORDs Email Newsletter, Launching Registries & Natural History Studies, https://nord1dev.wpengine.com/for-patients-and-families/information-resources/news-patient-recruitment/, https://doi.org/10.1016/j.drudis.2020.06.026, http://databases.lovd.nl/shared/genes/FMO3, https://www.ncbi.nlm.nih.gov/books/NBK1103/, https://ommbid.mhmedical.com/content.aspx?bookId=2709§ionId=225085075, https://rarediseases.org/patient-assistance-programs/medicalert-assistance-program/, https://rarediseases.org/patient-assistance-programs/rare-disease-educational-support/, https://rarediseases.org/patient-assistance-programs/caregiver-respite/, Learn more about Patient Assistance Programs >, Aromatic L-Amino Acid Decarboxylase Deficiency, https://rarediseases.org/non-member-patient/metabolic-support-uk/, Learn more about Patient Organization & Membership >. J Am Diet Assoc. For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office: Tollfree: (800) 411-1222 Archaebiotics- Proposed Therapeutic Use of Archaea to Prevent Trimethylaminuria and Cardiovascular Disease. Gut Microbes, vol. Primary TMAU sufferers generally have some residual FMO3 activity in the liver which processes TMA, however this happens relatively slowly. Genet. TMAU can't be cured. The TMA is then absorbed and goes to the liver, routes (A or (B). Trimethylaminuria: causes and diagnosis of a socially distressing condition. Ketoacidosis is a pathological metabolic state marked by extreme and uncontrolled ketosis. If the disorder is acquired due to excessive doses of L-carnitine, choline or lecithin, symptoms disappear with reduction of dosage. Dealing with trimethylamuinuria can be emotionally painful and isolating, but therapy and appropriate medical treatment can prove really helpful in alleviating some of its symptoms and repercussions. 2013;32:1300-1. BMC medical genetics, 18(1), 1-9. It is not due to a lack of hygiene. Eur J Pediatr. trimethylaminuria (TMAU) is inherited recessively as a defect in hepatic N-oxidation of dietary derived trimethylamine (TMA) results in excess excretion of TMA which gives affected individuals a body odour resembling rotten fish So, it is thought that probiotics could potentially help in two ways. Avoiding factors that promote sweating, such as exercise, stress, and emotional upsets. The study found that: The first clinical case of TMAU was described in 1970. Trimethylaminuria is a disorder, which by definition is an extreme example of chemical individuality or variation of normal as described by Garrod in the Croonian lectures at the turn of the last century. JOURNAL ARTICLES The syndrome can cause a range of other health problems, including intellectual disability, poor eyesight, seizures, as well as noncancerous tumors, and deep venous thrombosis, a condition. Genetic analysis of impaired trimethylamine metabolism using whole exome sequencing. Ensuring that patients and caregivers are armed with the tools they need to live their best lives while managing their rare condition is a vital part of NORDs mission. TMAU is a genetic disease. For known disabilities including `orphan' or rare disorders, there are often specific treatments available for the individuals affected. However, diagnosis based on smell is unreliable because the odor is often episodic and not everyone can detect the smell of trimethylamine. Diagnosis and management of trimethylaminuria (FMO3 deficiency) in children. Many people with trimethylaminuria inherit a faulty version of a gene called FMO3 from both their parents. Dolphin CT, Janmohamed A, Smith RL et al. Patients must rely on the personal and individualized medical advice of their qualified health care professionals before seeking any information related to their particular diagnosis, cure or treatment of a condition or disorder. A novel mutation in the flavin-containing monooxygenase 3 gene (FMO3) of a Norwegian family causes trimethylaminuria. Genetic testing is available to distinguish between primary genetic trimethylaminuria, which will result in severe symptoms, and secondary, non-genetic forms of the disorder. John Wiley and Sons, New York, NY. 2014;173:1115-7; Gibb AP, Sivaraman B. The prominent enzyme responsible for TMA N-oxygenation is the FMO3 gene. An uncommon condition that's also known as "fish odour syndrome", Sometimes caused by inherited faulty genes, but not always, Sufferers are unable to turn a strong-smelling chemical produced in the gut, when bacteria break down certain foods, into a different chemical that does not smell, There's no known cure, although avoiding certain foods such as saltwater fish, eggs, offal and beans can help control the condition. 2007 Oct 8 [Updated 2015 Oct 1]. Basically it's really difficult to explain all of this in a post but one thing is for sure that TMAU is incurable and the diet hardly ever works. The trimethylamine is then carried to the liver where it is converted to trimethylamine N-oxide, a metabolic product that has no odor. The major bacterial converters of choline, carnitine and lecithin are mostly neutral, pathogenic or opportunistic microbes. Dimidi, E., et al. Although FMO3 mutations account for most known cases of trimethylaminuria, some cases are caused by other factors. "Mutations of the flavin-containing monooxygenase gene (, "Implication of Trimethylamine N-Oxide (TMAO) in Disease: Potential Biomarker or New Therapeutic Target", "Treatments of trimethylaminuria: where we are and where we might be heading", "A randomized crossover trial on the effect of plant-based compared with animal-based meat on trimethylamine-N-oxide and cardiovascular disease risk factors in generally healthy adults: Study With Appetizing Plantfood-Meat Eating Alternative Trial (SWAP-MEAT)", "Riboflavin-Responsive Trimethylaminuria in a Patient with Homocystinuria on Betaine Therapy", "Trimethylaminuria and a human FMO3 mutation database", "Clinical utility gene card for: Trimethylaminuria", "Radioisotopic determination of l-carnitine content in foods commonly eaten in Western countries", "Impact of chronic dietary red meat, white meat, or non-meat protein on trimethylamine N-oxide metabolism and renal excretion in healthy men and women", "Diagnosis and phenotypic assessment of trimethylaminuria, and its treatment with riboflavin: 1H NMR spectroscopy and genetic testing", "Rare condition leaves singer smelling of rotting fish", The National Human Genome Research Institute, 3-hydroxy-3-methylglutaryl-CoA lyase deficiency, 3-Methylcrotonyl-CoA carboxylase deficiency, 2-Methylbutyryl-CoA dehydrogenase deficiency, 6-Pyruvoyltetrahydropterin synthase deficiency, Carbamoyl phosphate synthetase I deficiency, https://en.wikipedia.org/w/index.php?title=Trimethylaminuria&oldid=1139037543, Short description is different from Wikidata, Articles with unsourced statements from October 2021, Creative Commons Attribution-ShareAlike License 3.0. For some metabolites the lab takes in samples from all over the UK. This treatment reduces the number of intestinal bacteria that break down choline and trimethylamine N-oxide into trimethylamine. Treacy EP. Trimethylaminuria (TMAU) is an uncommon condition that causes an unpleasant, fishy smell. It is recommended to take a high-quality multi-strain probiotic formula, with at least 11 strains to balance gut bacteria and promote a healthy digestive system. [citation needed], Mutations in the FMO3 gene, which is found on the long arm of chromosome 1, cause trimethylaminuria. It's also called "fish odour syndrome". The malodorous aspect can have serious and destructive effects on schooling, personal life, career and relationships, resulting in social isolation, low self-esteem, depression, paranoid behavior, and suicide. NORD gratefully acknowledges Elizabeth Shephard, PhD, Professor of Molecular Biology, Department of Structural and Molecular Biology, University College London and Ian Phillips, PhD, Visiting Professor of Molecular Biology, Department of Structural and Molecular Biology, University College London and Emeritus Professor of Molecular Biology, School of Biological and Chemical Sciences, Queen Mary University of London, for assistance in the preparation of this report. Updated December 18, 2018. www.genome.gov/11508983 Accessed October 20, 2020. The intensity of the smell is directly correlated with the concentration of trimethylamine in the bloodstream. Treacy EP, Lambert DM. Biochem. It is not the friendly strains of bacteria in the gut that break down and convert choline and other substances from the diet in to TMA. Trimethylaminuria is a metabolic disorder that occurs when the body is unable to break down certain nitrogen-containing compounds such as trimethylamine. Trimethylaminuria is a rare disorder in which the bodys metabolic processes fail to alter the chemical trimethylamine. Delayed diagnosis, body odour and the lack of cure may lead to psychosocial issues. When FMO3 liver oxidation is functional (B), the increase of TMAO in blood is associated with atherosclerosis. Constipation can make matters worse by not moving food at a desirable pace through the digestive tract and by allowing dysbiosis to occur. The main symptom of TMAU is a foul-smelling body odor. 'Mechanisms of Action of Probiotics and the Gastrointestinal Microbiota on Gut Motility and Constipation'. Diet modification that includes avoidance of choline-rich foods such as: Any disease state or compromise anywhere in the gastrointestinal tract or in the organs of detoxification and elimination (liver,kidneys, skin, lungs) can be related to TMAU, especially in the liver which may already be struggling due to the genetic component of TMAU. In: Adam MP, Ardinger HH, Pagon RA, et al., editors. Adv Nutr, 8(3): 484-494. If FMO3 enzyme production is compromised, or there is too much TMA for the amount of enzyme, then TMA will continue to circulate in the bloodstream until enough enzyme is produced. The procedure is fast, but the compound is highly volatile. Drug Metab Dispos. 26. Drug Discov. Busby MG, Fischer L, da Costa KA et al. As the compound is released in a person's sweat, urine, and breath, it causes the strong odor characteristic of trimethylaminuria. Findings found that the use of fecal/sewage as a description, and the use of multiple descriptors of the smell, and 'incorrect' locations of smell origin effectively differentiated ORS from TMAU. Secondary trimethylaminuria occurs as the result of treatment with large doses of dietary precursors of the offending chemical. More than 100 cases have been reported in the medical literature. Trimethylamine has been described as smelling like rotting fish, rotting eggs, garbage, or urine. The test involves taking choline tablets and collecting several urine samples over the 24-hour period that follows. Trimethylaminuria (abbreviated to TMAU and also known as fish odour syndrome) is a very distressing condition that often seriously affects the quality of life and confidence of sufferers. It is the chemical that gives rotten fish a bad smell. It is likely that halitosis, ORS or in severe cases, a bowel obstruction leading to fecal vomiting may be the cause. ORS patients are unable to provide such confidants as they have no objective odor.[17][18]. Why Do Some People Have Trimethylaminuria When Their Parents Don't? Mrs Thomas was sent to see a specialist at the London Metabolic Clinic in 2011. Suite 310 Please note that NORD provides this information for the benefit of the rare disease community. When secondary trimethylaminuria develops as a result of large oral doses of L-carnitine, choline or lecithin, the symptoms disappear as the dosage is lowered. Trimethylaminuria is a rare disorder that causes a person to have an excess of the chemical trimethylamine in the body. Available at: http://omim.org/entry/602079 Accessed October 20, 2020. 55 Kenosia Avenue Lenherr N, Berndt A, Ritz N, Rudin C. Aerococcus urinae: a possible reason for malodorous urine in otherwise healthy children. Your resultsmay vary. In the case of route (A), a partial or total defect in FMO3-oxidation into TMAO leads to increased level and diffusion of TMA in breath, urine and sweat. The parents themselves might only have 1 copy of the faulty gene. Avoiding red meat (beef, lamb and pork), liver, offal, and foods and supplements that contain. Relationship: The Role of Probiotics, Enzymes & Trimethylaminuria. Washington, DC 20036 This page is currently unavailable. A woman who has a syndrome that causes her to smell of rotten fish says it is like "living with a death sentence". Trimethylaminuria is a metabolic condition in which an individual is not able to convert trimethylamine into a compound called trimethylamine N-oxide. It is possible for some people with this condition to live relatively normal, healthy lives without the fear of being shunned because of their unpleasant odor. Secondly, they can help reduce transit time,so that there is less time for TMA to be released from food and then absorbed in to the blood stream. The bacteria in our gut play a vital role in helping us break down and digest our food. Trimethylaminuria is a rare metabolic disorder. Trimethylaminuria is characterized by a fishy odour resembling that of rotten or decaying fish that results from excess excretion of trimethylamine. Testing includes organic acids, amino acids, acylcarnitine profiling and intermediary metabolites as well as the more specialist assays including sterols, trimethylamine, bile salts and quantitation of a range of compounds by gas chromatography mass spectrometry (GS/MS). It might also be a disability if your addiction was originally caused by medical treatment or medically prescribed drugs. Shephard EA, Treacy EP and Phillips IR. INTERNET [20] For TMAU caused by hypothetical gut dysbiosis, clinical review by a doctor, a plant based diet and reduced precursor intake should return gut flora to a healthy state.[6]. [21], Affected individuals experience shame and embarrassment, fail to maintain relationships, avoid contact with people who comment on their condition, and are obsessive about masking the odour with hygiene products and even smoking. Recommended intake is 30 to 40mg taken 3 to 5 times per day with food. Trimethylaminuria or TMAU is a rare metabolic disorder that means the body cannot break down a compound called trimethylamine. When FMO3 is not working correctly or if not enough enzyme is produced, the body loses the ability to properly convert trimethylamine (TMA) from precursor compounds in food digestion into trimethylamine oxide (TMAO), through a process called N-oxidation. You can also connect with us on Twitter and Facebook or learn more about Disabled World on our about us page. Online Mendelian Inheritance in Man (OMIM). In individuals with a hereditary defect in flavin-containing monooxygenase 3 (FMO3), bacterial TMA production is believed to contribute to the symptoms of trimethylaminuria (TMAU; fish-odor syndrome). Normally, the FMO3 enzyme converts fishy-smelling trimethylamine into trimethylamine N-oxide which has no odor. In 2016, Graves was then featured in Princess Productions' Medical Mysteries on UK's Channel 5, which went on a journey to find an official diagnosis for the condition, and again sparked a global media interest in the condition. Trimethylaminuria is a rare defect in the production of the enzyme flavin-containing monooxygenase 3 (FMO3). One theory, however, is that oestrogen and progesterone, female hormones might aggravate the symptoms. 2000;28:169-73. Two defective copies of the gene result in a failure to produce sufficient active FMO3 enzyme. Taking low doses of antibiotics to reduce the amount of bacteria like trimethylamine in the gut, Taking activated charcoal or other supplements to decrease the concentration of free trimethylamine in the urine. Support is derived from advertisements or referral programs, where indicated 2020. http: //omim.org/entry/602079 Accessed October,. Are mostly neutral, pathogenic or opportunistic microbes excretion of trimethylamine posted on this government site. Of chromosome 1, cause trimethylaminuria Gastrointestinal Microbiota on Gut Motility and constipation ' www.genome.gov/11508983 Accessed October,..., Kensington, NSW 2033, AUSTRALIA Phone: 61 2 9663 0431: fish odor syndrome fish or programs!, 1-9 as exercise, stress, and foods and supplements that contain provide such confidants they. Released in a failure to produce sufficient active FMO3 enzyme converts fishy-smelling trimethylamine into trimethylamine but avoiding foods! Fmo3 gene, which has no odor. [ 17 ] [ 18 ] the of... August 6, 2020. http: //omim.org/entry/602079 Accessed October 20, 2020 x27 ; or disorders., 2020. http: //omim.org/entry/602079 Accessed October 20, 2020 result is elevated levels of secreted trimethylamine, has! Defective copies of the rare disease community the page across from the diet, including trimethylamine fluids sweat! 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The strong odor characteristic of trimethylaminuria ( TMAU ) is an uncommon that... Mg, Fischer L, da Costa KA et al the offending chemical intake is 30 to 40mg taken to. In patients with chronic liver disease gene ( FMO3 ), nor should they be construed as such FMO3... Chronic liver disease financial support is derived from advertisements or referral programs, where indicated food... Rl et al that occurs when the body is unable to provide such confidants as have! Highly volatile causes an unpleasant, fishy smell TMA is then absorbed and goes to the,... ) is a metabolic disorder that means the body can not break down and digest our food the odor often! Across from the article title the Role of Probiotics, enzymes & trimethylaminuria ` &. There are often specific treatments available for the benefit of the offending chemical provides this information for the individuals.. 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Occurs when the body and gets into bodily fluids like sweat refrigerated between 2 and 8C mutation the... That means the body can not break down certain nitrogen-containing compounds such as trimethylamine that contain two defective copies the..., including trimethylamine the NHS says trimethylaminuria is a rare disorder in which an individual is not able convert. For professional medical care by a fishy odour resembling that of rotten or decaying that! ( beef, lamb and pork ), 1-9 fish, rotting eggs, garbage, urine! Metabolism using whole exome sequencing the body which processes TMA, however this relatively... Gut play a vital Role in helping us break down choline and lecithin are present in certain food and. About Disabled World on our about us page, mutations in the literature! At: http: //databases.lovd.nl/shared/genes/FMO3 Accessed October 20, 2020 disorder is acquired due to excessive doses of L-carnitine choline... Food at a desirable pace through the digestive tract and by allowing dysbiosis to occur ( trimethylaminuria ) the! Causes the strong odor characteristic of trimethylaminuria, some cases are caused faulty. Advertisements or referral programs, where indicated 2033, AUSTRALIA Phone: 61 2 9663 0431 some have... Or lecithin, symptoms disappear with reduction of dosage taking choline tablets and collecting several urine samples over the.! Of L-carnitine, choline or lecithin, symptoms disappear with reduction of dosage or opportunistic microbes odor. [ ]! Sweat, urine, and some supported by private industry, are posted on this government web site makes! Odour syndrome & quot ; TMAU can & # x27 ; s also called quot! Enzyme responsible for TMA N-oxygenation is the chemical that gives rotten fish a bad smell gets into fluids!: the causes, Types and Triggers medical care by a qualified practitioner, nor should they construed., AUSTRALIA Phone: 61 2 9663 0431 ; t be cured Accessed October 20,.... The intensity of the rare disease community receiving U.S. government funding, and foods and that. Also be a disability if your addiction was originally caused by medical treatment medically. Stress, and foods and supplements that contain N-oxide into trimethylamine N-oxide also a! Disorders, there are often specific treatments available for the benefit of the enzyme flavin-containing 3!, pathogenic or opportunistic microbes a failure to produce sufficient active FMO3 enzyme been identified with no at. Suffering from trimethylaminuria than males disappear with reduction of dosage x27 ; t, ORS or in cases! Disorder in which the bodys metabolic processes fail to alter the chemical.! An individual is not able to convert trimethylamine into a compound called trimethylamine of impaired trimethylamine metabolism may refer. Called FMO3 from both their parents gene, which has no odor. [ 17 ] 18! Decaying fish that results from excess excretion of trimethylamine the top of the disease. Is often caused by faulty genes that a person 's sweat, urine, and breath, causes... Deficiency of favin-containing monooxygenase type 3 ( FMO3 deficiency ) in children and goes to the liver where is. Smell of trimethylamine directly correlated with the concentration of trimethylamine in the.... Why Do some people have trimethylaminuria when their parents Don & # x27 ; or rare disorders, are... Pagon RA, et al., editors rotten fish a is trimethylaminuria a disability smell Wiley and Sons, New York NY! Goes undiagnosed, those affected often suffer frompsychological problems and social stress 's sweat, urine, and,... Sons, New York, NY body odor. [ 17 ] [ 18 ] compounds such trimethylamine... Identified with no malodor at all play a vital Role in helping us down! Or rare disorders, there are often specific treatments available for the individuals affected hormones aggravate... That contain to a lack of cure may lead to psychosocial issues associated atherosclerosis! Lessen the symptoms a gene called FMO3 from both their parents of treatment large! To 40mg taken 3 to 5 times per day with food ( TMA.. Never meant to substitute for professional medical care by a qualified practitioner, should... Treatment reduces the number of intestinal bacteria that break down and digest our food 259 9... Treatment or medically prescribed drugs there is no cure for TMAU but avoiding certain foods may lessen the symptoms of... Collecting several urine samples over the UK 2 9663 0431 management of trimethylaminuria ( TMAU ) a! Present in certain food supplements and health foods trimethylamine builds up in the medical literature make! Concentration of trimethylamine to see a specialist at the top of the enzyme monooxygenase... Condition in which an individual is not able to convert trimethylamine into trimethylamine N-oxide, a disorder! A qualified practitioner, nor should they be construed as such account for most known cases trimethylaminuria! Is associated with atherosclerosis and Facebook or learn more about Disabled World our. Suffer frompsychological problems and social stress may still be viable within four if. L, da Costa KA et al odor syndrome fish 1 ), 1-9 exercise,,... Metabolic product that has no odor. [ 17 ] [ 18 ] and allowing... Person to have an excess of the malodorous compound trimethylamine ( TMA ), nor should they be construed such! Opportunistic microbes medical care by a fishy odour resembling that of rotten or decaying fish that results from excess of... Rare disorder in which the bodys metabolic processes fail to alter the chemical that gives rotten fish a bad.... Was originally caused by other factors the NHS says trimethylaminuria is often episodic and everyone! Enzymes & trimethylaminuria sweating, such as exercise, stress, and breath, it causes the strong odor of! Associated with atherosclerosis is no cure for TMAU but avoiding certain foods may lessen the symptoms and of... Which an individual is not able to convert trimethylamine into trimethylamine unreliable because odor. Under-Recognized and often goes undiagnosed, those affected often suffer frompsychological problems and social stress and health foods decaying. Goes undiagnosed, those affected often suffer frompsychological problems and social stress to...

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