Trimethylaminuria - TMAU

Wednesday, April 05 2006 @ 01:31 AM MDT

I just wanted to add as much info about TMAU to my webiste as possible so anyone could learn about it. I knew the problem lies in my liver and now I can see I was right. The liver is the center of matabolism in our bodies. I always felt there is something in my liver, a pressure or even gallbladder stones that are causing the bad breath. That is why some people cured their bad breath with liver flushes, because they cleansed their liver. Trimethylaminuria (TMAU) is a genetically-mediated disorder, which maybe inherited in an autosomal, recessive fashion. This was initially suggested by studying of sufferers and their families. More recently, examination of the molecular deficits responsible for TMAU reveal that a variety of genetic alterations in the gene which codes for the particular liver enzyme (Flavin-Containing Monooxygenase #3; FMO3) may cause TMAU symptoms.

The biochemical deficit causing TMAU is the inability to completely metabolize TMA to TMA-oxide (TMAO) in the liver. TMAO is a non-volatile (non-odorous) solid that is excreted in urine. The enzymes catalyzing this conversion are the microsomal, flavin-containing monooxygenase (FMO). The FMO family of enzymes are catalytically diverse and catalyze the oxygenation of a variety of heteroatom – containing (N-, S- P-) endogenous and xenobiotic compounds. The principal presenting symptoms of TMAU stem from excess, unmetabolized trimethylamine.

Trimethylamine (TMA) is formed in the gut by bacterial metabolism of dietary constituents, principally choline. TMA is a gas at body temperature and has a foul, fishy odor. At very low concentration, it may only be perceived as foul, unpleasant or “garbage-like". Excessive production of TMA is linked to the intake of a variety of choline-rich foods, (such as eggs, certain legumes, fish and organ-meats) hence the sporadic production of symptoms. Because there are many foods which are rich in choline, both patients and their family members are unlikely to relate the odor to food intake.

Symptoms may include foul body odors, halitosis and/or dysguesia, which can produce social embarrassment and can only be temporarily relieved by normal hygiene procedures. Further, the unpleasant symptoms are often sporadic in occurrence and seemingly subjective, and when coupled with a lack of knowledge of the disease and its etiology among health professionals, may lead to diagnosis of poor hygiene, psychiatric problems and/or referrals to other specialists. The latter has been financially draining many patients.

Several reports in the literature have described other complications occurring in conjunction with TMAU, such as seizures, skin rashes and syndromes (Prader-Willi, and Noonan’s). However, the vast majority of patients appear to have normal mental and physical abilities, lead normal lives and have good hygiene practices. The main problem afflicting most patients are psycho-social ones caused by sporadic, unexplained odor production.

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