This will one day cure everything
http://www.bbc.co.uk/news/health-15272081
INTERESTING AFFILIATE LINKS
DESTROY DEPRESSION
BAD BREATH FREE FOREVER
TEETH WHITENING 4 YOU
CANDIDA CRUSHER
HEARTBURN & ACID REFLUX REMEDY REPORT
TMAU
-
caramiamine98
- Advanced
- Posts: 190
- Joined: Mon Aug 17, 2009 4:35 am
- Location: Canada
YouTube has an excellent channel called The Calmwaves which features videos about TMAU. Some of the videos have already been posted on this forum but there are some that have not. Anyone who is interested in learning more about TMAU should definitely check these out.
http://www.youtube.com/user/TheCalmwaves
http://www.youtube.com/user/TheCalmwaves
I think its Malory's page but not sure . Theres also the MEBO channelcaramiamine98 wrote:YouTube has an excellent channel called The Calmwaves which features videos about TMAU...
http://www.youtube.com/user/TheCalmwaves
http://www.youtube.com/user/meboresearch#p/u
i want to read through all the comments and send youtube commenters the link to the TMAU petition .
http://mebopetition.org/
-
caramiamine98
- Advanced
- Posts: 190
- Joined: Mon Aug 17, 2009 4:35 am
- Location: Canada
TMAU Paper
TMAU paper entitled “Trimethylaminuria: Causes and Diagnosis of a Socially Distressing Condition”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052392/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052392/
-
caramiamine98
- Advanced
- Posts: 190
- Joined: Mon Aug 17, 2009 4:35 am
- Location: Canada
Someone on the CureZone forum with TMAU claims to have gotten rid of their odour by using hydrogen peroxide therapy. I have tried this myself a couple of years ago and didn’t think it helped. The diet and the supplements work better for me. If anyone is interested in trying this PLEASE read as much as you can first before trying it.
http://www.the-natural-path.com/hydroge ... erapy.html
More info:I just want to share what has worked for me. I have SEVERE TMAU and had a strong, constant fishy odor since birth but worsened with the onset of puberty and seemed to get worse with time.
The diet alone only reduces the odor a little for me. I was reading about hydrogen peroxide therapy and decided to try it. It worked! Don't try unless you research it thoroughly. I'll be brief in this post. Basically, H2O2 is water with an extra oxygen atom. The metabolic function of the flavin-containing monooxygenase enzyme (FMO3) is to oxygenate TMA to TMA-O, the odor-free molecule. Monooxygenation is 'the incorporation of a single atom of molecular oxygen into a substrate, the other atom being reduced to water'. And this is what H2O2 therapy does. We don't have enzyme replacement therapy or gene therapy yet. To me, the H2O2 was the treatment to try NOW.
I did take the internal treatment at first (it also kills the gut bacteria, which is good) but I took huge amounts of acidophilus (good bacteria) afterwards to replace gut flora and lots of riboflavin (B2) and it was the first time in my life that I didn't smell. I could never smell myself but I could always feel it around me and see people's reactions. After the internal treatment, I used it in the bath... it really helps in the bath. Don't do both at once. There are instructions for ingestion:
Dosage Schedule Using 35% Food Grade H202
Day 1...........3 drops, 3 times daily
Day 2...........4 drops, 3 times daily
Day 3...........5 drops, 3 times daily
Day 4...........6 drops, 3 times daily
Day 5...........7 drops, 3 times daily
Day 6...........8 drops, 3 times daily
Day 7...........9 drops, 3 times daily
Day 8..........10 drops, 3 times daily
Day 9..........12 drops, 3 times daily
Day 10.........14 drops, 3 times daily
Day 11.........16 drops, 3 times daily
Day 12.........18 drops, 3 times daily
Day 13.........20 drops, 3 times daily
Day 14.........22 drops, 3 times daily
Day 15.........24 drops, 3 times daily
Day 16.........25 drops, 3 times daily
ONLY 35% FOOD GRADE HYDROGEN PEROXIDE FOR INTERNAL USE! Day 17 on, stay at 25 drops, 3 times daily for 3 weeks. Reduce dosage to 25 drops, 2 times daily until the problems go away. This may take 1 to 6 months. Drink hydrogen peroxide solution one hour before or three hours after a meal. Always dilute using a glass of distilled water. Don't take near bed time.
Here is where I get the 35% food grade H2O2 from:
http://www.dfwx.com/h2o2.htm
Again, this is when you've tried everything else and nothing has worked... Research it more before you go and try it. Thank you. I hope it helps someone!
http://curezone.com/forums/am.asp?i=1456260
http://www.the-natural-path.com/hydroge ... erapy.html
-
caramiamine98
- Advanced
- Posts: 190
- Joined: Mon Aug 17, 2009 4:35 am
- Location: Canada
Interview with Nigel Manning who is the Principal Clinical Scientist of the
Dept. of Clinical Chemistry at
Sheffield Children's Hospital
in Sheffield and the tester of almost all TMAU urine samples in the UK from Mar 2009
Almost every patient sample in the UK (including by 3rd parties such as medichecks and The Doctors Laboratory) for Trimethylaminuria (urine test) will be tested by Nigel Manning at the Sheffield Children's Hospital. His hospital is also the only patient TMAU genotype tester (the DNA test) in the UK.
Could you tell us a bit about what you and your lab's role is, and is TMAU testing only part of your work in the lab?
I work for the Department of Clinical Chemistry at Sheffield Children’s Hospital where we provide a 24 hour diagnostic service for children at the hospital as well as specialized services for both our hospital and others from all over the country. Our specialty is the field of inherited metabolic disorders or inborn errors of metabolism. These are a wide ranging group of diseases which can present from birth to adulthood and have a genetic basis, so our field is often also known as ‘Biochemical Genetics’. We use a variety of techniques to identify and quantify biomarkers to diagnose disorders and hopefully lead to successful management of life-long conditions. We also provide prenatal testing for some of the most severe disorders.
My particular role is the development and running of tests by mass spectrometry, either coupled to another device known as a gas chromatograph (GCMS) or using an instrument known as a tandem mass spectrometer (MS/MS). My work measuring TMA has been developed over the years using GCMS. Originally the TMA test was carried out on an instrument which required me to manually inject the vapour taken from above a heated urine sample directly into the mass spectrometer, a technique known as ‘headspace’ sampling. Fortunately I now use a much more automated system which allows me to load prepared samples in special vials and let an automatic sampler introduce the headspace samples into a more modern GCMS. TMA testing represents about 5% of my workload in the laboratory.
How did your lab come about testing for TMAU?
Before 1997 we used to send our TMAs to a research lab for analysis, but their grant funding ran out so the service was withdrawn. At the time I had an idea for a method using our existing mass spectrometer. Fortunately when I experimented with this method of directly injecting headspace vapour into the mass spec, it worked. By adding a stable isotope of TMA to samples it was possible to measure TMA by monitoring the ratio of the patient’s TMA to the isotope. A published method provided more detail of how to measure both TMA and TMA-oxide (TMO) in a sample and this formed the basis for a TMA service.
In 2007, our colleagues at Sheffield Molecular Genetics Service set up a pilot project to look at mutations in the FMO3 gene in a group of UK TMAU patients. This quickly transferred to a diagnostic service that now complements the biochemical testing.
What are your TMAU testing 'parameters' and who set them? (e.g. what reading constitutes a fail? what constitutes Secondary TMAU?)
The ‘normal’ ranges were established early on by asking for volunteers (from the staff here at the hospital). TMA is regarded as normal if the concentration is below 11 micromoles per millimole of creatinine. TMA-oxide’s normal range is below 147 and the ratio of TMA to TMO is normal below 0.21.
Secondary TMAU is a very broad term, but essentially relates to any TMAU where normal TMA oxidation appears to be indicated. Increased TMA and TMO are usually markers for TMAU2, however we have seen TMAU1 patients (with proven FMO3 enzyme deficiency by DNA mutation analysis) whose samples also showed this pattern – albeit only temporarily. This makes the differentiation between TMAU1 and TMAU2 difficult without more than one sample to assess and without DNA analysis to confirm a mutation for the FMO3 gene. In general – if the TMA is consistently increased the patient has TMAU.
Do you use a choline challenge?
Some doctors who send me samples prefer to use a choline challenge as a good way of diagnosing TMAU. Choline itself is sometimes difficult to obtain for medical purposes and so dietary challenge is used. Fish and beans are useful, although marine fish contain high amounts of TMO so this may, if absorbed by the intestine, result in a high urinary TMO. As a laboratory scientist I don’t see patients but if a doctor asks me what constitutes a good choline challenge I would suggest 2 eggs with baked beans (420g). Soya beans and liver are other good sources of choline.
With regards samples already tested, do you know how many you have tested and how many were positive for Primary TMAU and how many for Secondary TMAU?
Over the last 10 years I’ve analysed over 919 samples from people who complain of an odour. To date 306 patients have shown significantly raised TMA (ie TMAU) with 201 showing a raised TMA/TMA-oxide ratio (possible primary TMAU) and 106 with a normal ratio (possible secondary TMAU).
Has there been an increase in testing?
Yes, in 1998 I received 13 TMA requests and in 2008 there were 214. Increased publicity through a BBC3 TV documentary in 2007 may account for a dramatic rise as in 2006 requests numbered just 81.
What advice do you have to anyone having difficulty being authorized for testing by their G.P.?
I can send a letter or email to any enquirer explaining the test and giving some background information about TMAU. Hopefully this information they can show to their GP who can phone me if they need more information. Obviously I must respect the professional opinion of any GP, but as I cannot accept any samples without an official request, the patient may wish to seek another primary care practitioner if they can’t get tested through their current GP.
Do you think someone could repeatedly pass the urine test but still have TMAU in practice? (e.g. the DNA result predicts Primary TMAU)
This can happen in circumstances when a TMAU sufferer experiences a fluctuating or occasional odour, as in the milder TMAU cases and those who are genetic ‘carriers’ for TMAU1 (FMO3 deficiency). Dietary load and hormonal changes such as experienced during menstruation are known to result in a temporary but significant odour. TMA testing outside this time produces completely normal TMA result. It’s important to test for TMA when the odour is at its strongest – so timing of the sample collection is very important. Anyone with a periodic odour must wait until the odour occurs to collect some urine (preferably over 24 hours) or use a choline challenge before collecting a sample.
Secondary TMAU only seems to be tested in the UK that we know of. Why do you think this is so?
Secondary TMAU or TMAU2 has been recognized for many years, although much of the TMAU interest has been in the inherited metabolic disorder FMO3 deficiency ie TMAU1. Very early on in the TMA service I received a urine from a pre-school age boy who was very odorous after eating fish. This was especially problematic because fish fingers were his favourite food and his parents had to persuade the parents of his friends to not serve fish fingers at birthday parties. The prospect of this going on when he started school was worrying, but after finding out about TMAU the parents arranged for the test to be done here. When I saw the very high TMA and TMO I suggested to the GP that a short course of the antibiotic metronidazole might help. After this dose this 4 year old had no more problems and could enjoy fish and chips with his family with no resulting odour – and still does ten years on. His TMAU had been cured and it convinced me that TMAU2 was an important part of the differential diagnosis.
TMAU2 from overproduction of TMA by bacterial overgrowth can be experienced for many years but if the correct antibiotic therapy is applied, can be cured by eradication of the bacteria responsible. Testing for TMAU1 or 2 is essentially the same, but results can usually differentiate one from the other. As I mentioned before there have been several occasions when a patient with marked increases in both urinary TMA and TMA-oxide (a TMAU2 pattern) then tests positive for TMA but with normal TMA-oxide (a TMAU1 pattern). This is why the DNA follow-up is so important.
Is someone keeping a database of the test results (UK/World) including DNA testing?
Not to my knowledge.
Do you think there are many more FMO3 mutants/polymorphisms to be discovered?
Most genetic conditions have seen an ever expanding number of mutations discovered, so I would expect the same for FMO3 deficiency. The DNA testing here looks at the whole FMO3 gene and is estimated to detect >95% of mutations, though the number of studies carried out is relatively small.
There are certain mutations/polymorphisms that are more common in the population, and so these tend to account for most cases of TMAU1.
Have you's discovered any novel mutants/polymorphisms?
No – my geneticist colleagues in our hospital have been testing for just 2 years, so it’s early days yet. So far, all the mutations found have been seen in other TMAU1 patients.
Do you think Primary TMAU may not be just an autosomal recessive problem?
As far as is known, FMO3 deficiency has always been shown to be an autosomal recessive condition, though mild or intermittent symptoms can sometimes occur in carriers of FMO3 mutations.
Do we know what bacteria is responsible for gut Trimethylamine (TMA) production?
There are more than 400 species of bacteria in the colon but only a few described as TMA-producing. The fishing industry’s research microbiologists have published many papers on TMA and ‘fish-spoiling’ and cite species such as Vibrio harveyi, Vibrio fischeri, Photobacterium leiognathi and Shewanella baltica. The last of these is also know to generate hydrogen sulphide – or ‘ rotten egg’ gas. Whether these microbes are those responsible for human TMA production is a good question, but they may represent a small portion of the total.
Is the bacteria in the colon or small intestine?
The distal part of the colon is responsible for protein and amino acid breakdown and I suspect the area for TMA production. Although there are hundreds of intestinal bacterial species there may be just 30 or 40 species which represent more than 90% of the microbes in number. If a TMA-producing species becomes predominant, eradication with antibiotics may prove to be very difficult. Apparently there are ten times as many bacterial cells in the human gut as cells making up the entire human body – making the gut flora a powerful metabolic force. Attempts at eradication with antibiotics such as metronidazole have been successful for TMAU2 sufferers – leaving them odour-free after a single course in some instances (as I mentioned earlier). Other antibiotics include neomycin and amoxicillin. Without specific identification of bacterial species involved (and their severity of overgrowth) the choice of an effective antibiotic for TMAU2 is often a question of trial and error. TMAU1 sufferers can also benefit from periodic antibiotic therapy as well as dietary choline restriction. Both TMAU1 and 2 can be controlled in similar ways, although the secondary (acquired) form has the possibility of a complete cure. TMAU1 may be controlled to some degree by antibiotics, restriction of choline (eggs, liver, beans) carnitine (meat) and TMA-oxide (seafood). The odour effects of TMA may also be reduced by activated charcoal or copper chlorophyllin tablets to absorb TMA in the gut and the use of pH5 skin creams to neutralize TMA in sweat.
Do you think if someone has excess TMA, it could indicate that their gut flora is abnormal? For instance small intestine bacteria overgrowth?
[see previous answers]
Is there a particular antibiotic/treatment you think may be best to control excess bacteria in Secondary TMAU?
[see previous answers]
Do you have any advice to Primary TMAU sufferers?
Any advice to Secondary TMAU sufferers?
To both of these questions I would recommend seeking the advice and guidance of a metabolic physician who specialises in TMAU – such as Robin Lachmann at The National Hospital for Neurology and Neurosurgery in London. There are several other metabolic specialists across the UK with increasing experience of TMAU, supported by dieticians, who can help TMAU sufferers with a variety of treatments from antibiotics and dietary regimens to odour-reducing tablets and low pH skin creams.
Do you think a Secondary TMAU diagnosis means in theory they should be able to be 'cured'?
Yes, with the correct antibiotic therapy a patient with normal FMO3 activity but an overproduction of TMA by gut flora may be effectively cured.
Do you expect Primary TMAU positives to have problems with other FMO3 substrates?
FMO3 may have up to 1000 substrates ie compounds that can be oxidized by this enzyme in the liver. With deficient oxidation these compounds may stay in the body longer and have unwanted consequences. Many drugs may be included in this list and are currently know to include codeine, tamoxifen, ketoconazole, nicotine, cimetidine, ranitidine and phenothiazine. High blood pressure is also a known complication due to foods which contain large amounts of the neurotransmitter tyramine (cheese, red wine and chocolate are examples). FMO3 deficiency should be taken into account whenever drugs are prescribed in case of an adverse reaction.
Do you think with Primary TMAU, the person may have other health weaknesses, such as chronic fatigue?
It’s not possible to speculate about this – TMAU1 sufferers are individuals prone to conditions that all of us may encounter. Adverse reactions to FMO3 substrates may add complications under certain circumstances, such as hypertension (high blood pressure).
Many people, including people with primary or secondary TMAU diagnosis, as well as those who are negative, have wide ranging odors. From gas/fecal to rotten egg and all sorts. Do you have a theory on this?
Body odour is caused by the release of volatile compounds from the skin in sweat. Just as TMA is produced in the gut by bacteria, there are probably many other volatile compounds which are naturally produced – like skatole which has a faecal odour. Only when the production of these compounds are produced in excess that the odour can become a problem. There may be other conditions like TMAU which are caused by an unusual gut flora as well as a lack of a detoxifying enzyme. Unfortunately we only have the ability to test for TMA at the moment.
Do you think with a TMAU diagnosis, they will only smell of 'fish body odor'?
It may be possible to be afflicted with overproduction of more than one volatile compound if conditions in the gut are such that excesses of different species of odour-causing bacteria are pre-dominant. Other bacteria may be responsible for a mixture of volatiles. Some species of Shewanella are known to produce both TMA and hydrogen sulphide (rotten egg gas).
Are there any recent advances in TMAU?
I’m not aware of any major breakthroughs in the treatment of TMAU, although as with many areas of medicine change is gradual and new therapies may be some time in development. Riboflavin treatment to boost the activity of FMO3 was mentioned a few years ago, although I’ve yet to see the results of any trial published.
Our advances in diagnostics have been in establishing a DNA service here at Sheffield Children’s Hospital. Recent increased awareness of the condition can certainly count as an advance – with it comes the prospect of increased chances to diagnose and treat TMAU sufferers.
What do you think sufferers could do to get research going?
Perhaps by joining organisations such as the TMA Foundation (based in New York and ably run by Sandy) TMAU sufferers could channel efforts into fundraising to support researchers in the field of FMO3 function or antibiotic therapy trials.
Do you think it may be feasible for a manufacturer to develop a 'home
maintenance' TMAU test like they have for diabetes? whether its TMAU test strip papers or a breathalyzer etc?
There have been attempts at measuring TMA in sweat, although this is a long way from a commercial kit as a mass spectrometer was still required to detect the TMA. When it comes to future developments – ‘never say never’ may be the best answer I can give.
Are there any ideas you have of possible 'money no object' lines of research, such as genetic engineering?
There are many hundreds of genetic conditions for which genetic engineering still remains the ultimate goal. Stem cell therapy with the correction of an abnormal gene, its re-introduction to the body and then normal function of the previously deficient enzyme may be possible in the future for many of these disorders….maybe even FMO3 deficiency.
http://www.bloodbornebodyodorandhalitos ... er-of.html
Almost every patient sample in the UK (including by 3rd parties such as medichecks and The Doctors Laboratory) for Trimethylaminuria (urine test) will be tested by Nigel Manning at the Sheffield Children's Hospital. His hospital is also the only patient TMAU genotype tester (the DNA test) in the UK.
Could you tell us a bit about what you and your lab's role is, and is TMAU testing only part of your work in the lab?
I work for the Department of Clinical Chemistry at Sheffield Children’s Hospital where we provide a 24 hour diagnostic service for children at the hospital as well as specialized services for both our hospital and others from all over the country. Our specialty is the field of inherited metabolic disorders or inborn errors of metabolism. These are a wide ranging group of diseases which can present from birth to adulthood and have a genetic basis, so our field is often also known as ‘Biochemical Genetics’. We use a variety of techniques to identify and quantify biomarkers to diagnose disorders and hopefully lead to successful management of life-long conditions. We also provide prenatal testing for some of the most severe disorders.
My particular role is the development and running of tests by mass spectrometry, either coupled to another device known as a gas chromatograph (GCMS) or using an instrument known as a tandem mass spectrometer (MS/MS). My work measuring TMA has been developed over the years using GCMS. Originally the TMA test was carried out on an instrument which required me to manually inject the vapour taken from above a heated urine sample directly into the mass spectrometer, a technique known as ‘headspace’ sampling. Fortunately I now use a much more automated system which allows me to load prepared samples in special vials and let an automatic sampler introduce the headspace samples into a more modern GCMS. TMA testing represents about 5% of my workload in the laboratory.
How did your lab come about testing for TMAU?
Before 1997 we used to send our TMAs to a research lab for analysis, but their grant funding ran out so the service was withdrawn. At the time I had an idea for a method using our existing mass spectrometer. Fortunately when I experimented with this method of directly injecting headspace vapour into the mass spec, it worked. By adding a stable isotope of TMA to samples it was possible to measure TMA by monitoring the ratio of the patient’s TMA to the isotope. A published method provided more detail of how to measure both TMA and TMA-oxide (TMO) in a sample and this formed the basis for a TMA service.
In 2007, our colleagues at Sheffield Molecular Genetics Service set up a pilot project to look at mutations in the FMO3 gene in a group of UK TMAU patients. This quickly transferred to a diagnostic service that now complements the biochemical testing.
What are your TMAU testing 'parameters' and who set them? (e.g. what reading constitutes a fail? what constitutes Secondary TMAU?)
The ‘normal’ ranges were established early on by asking for volunteers (from the staff here at the hospital). TMA is regarded as normal if the concentration is below 11 micromoles per millimole of creatinine. TMA-oxide’s normal range is below 147 and the ratio of TMA to TMO is normal below 0.21.
Secondary TMAU is a very broad term, but essentially relates to any TMAU where normal TMA oxidation appears to be indicated. Increased TMA and TMO are usually markers for TMAU2, however we have seen TMAU1 patients (with proven FMO3 enzyme deficiency by DNA mutation analysis) whose samples also showed this pattern – albeit only temporarily. This makes the differentiation between TMAU1 and TMAU2 difficult without more than one sample to assess and without DNA analysis to confirm a mutation for the FMO3 gene. In general – if the TMA is consistently increased the patient has TMAU.
Do you use a choline challenge?
Some doctors who send me samples prefer to use a choline challenge as a good way of diagnosing TMAU. Choline itself is sometimes difficult to obtain for medical purposes and so dietary challenge is used. Fish and beans are useful, although marine fish contain high amounts of TMO so this may, if absorbed by the intestine, result in a high urinary TMO. As a laboratory scientist I don’t see patients but if a doctor asks me what constitutes a good choline challenge I would suggest 2 eggs with baked beans (420g). Soya beans and liver are other good sources of choline.
With regards samples already tested, do you know how many you have tested and how many were positive for Primary TMAU and how many for Secondary TMAU?
Over the last 10 years I’ve analysed over 919 samples from people who complain of an odour. To date 306 patients have shown significantly raised TMA (ie TMAU) with 201 showing a raised TMA/TMA-oxide ratio (possible primary TMAU) and 106 with a normal ratio (possible secondary TMAU).
Has there been an increase in testing?
Yes, in 1998 I received 13 TMA requests and in 2008 there were 214. Increased publicity through a BBC3 TV documentary in 2007 may account for a dramatic rise as in 2006 requests numbered just 81.
What advice do you have to anyone having difficulty being authorized for testing by their G.P.?
I can send a letter or email to any enquirer explaining the test and giving some background information about TMAU. Hopefully this information they can show to their GP who can phone me if they need more information. Obviously I must respect the professional opinion of any GP, but as I cannot accept any samples without an official request, the patient may wish to seek another primary care practitioner if they can’t get tested through their current GP.
Do you think someone could repeatedly pass the urine test but still have TMAU in practice? (e.g. the DNA result predicts Primary TMAU)
This can happen in circumstances when a TMAU sufferer experiences a fluctuating or occasional odour, as in the milder TMAU cases and those who are genetic ‘carriers’ for TMAU1 (FMO3 deficiency). Dietary load and hormonal changes such as experienced during menstruation are known to result in a temporary but significant odour. TMA testing outside this time produces completely normal TMA result. It’s important to test for TMA when the odour is at its strongest – so timing of the sample collection is very important. Anyone with a periodic odour must wait until the odour occurs to collect some urine (preferably over 24 hours) or use a choline challenge before collecting a sample.
Secondary TMAU only seems to be tested in the UK that we know of. Why do you think this is so?
Secondary TMAU or TMAU2 has been recognized for many years, although much of the TMAU interest has been in the inherited metabolic disorder FMO3 deficiency ie TMAU1. Very early on in the TMA service I received a urine from a pre-school age boy who was very odorous after eating fish. This was especially problematic because fish fingers were his favourite food and his parents had to persuade the parents of his friends to not serve fish fingers at birthday parties. The prospect of this going on when he started school was worrying, but after finding out about TMAU the parents arranged for the test to be done here. When I saw the very high TMA and TMO I suggested to the GP that a short course of the antibiotic metronidazole might help. After this dose this 4 year old had no more problems and could enjoy fish and chips with his family with no resulting odour – and still does ten years on. His TMAU had been cured and it convinced me that TMAU2 was an important part of the differential diagnosis.
TMAU2 from overproduction of TMA by bacterial overgrowth can be experienced for many years but if the correct antibiotic therapy is applied, can be cured by eradication of the bacteria responsible. Testing for TMAU1 or 2 is essentially the same, but results can usually differentiate one from the other. As I mentioned before there have been several occasions when a patient with marked increases in both urinary TMA and TMA-oxide (a TMAU2 pattern) then tests positive for TMA but with normal TMA-oxide (a TMAU1 pattern). This is why the DNA follow-up is so important.
Is someone keeping a database of the test results (UK/World) including DNA testing?
Not to my knowledge.
Do you think there are many more FMO3 mutants/polymorphisms to be discovered?
Most genetic conditions have seen an ever expanding number of mutations discovered, so I would expect the same for FMO3 deficiency. The DNA testing here looks at the whole FMO3 gene and is estimated to detect >95% of mutations, though the number of studies carried out is relatively small.
There are certain mutations/polymorphisms that are more common in the population, and so these tend to account for most cases of TMAU1.
Have you's discovered any novel mutants/polymorphisms?
No – my geneticist colleagues in our hospital have been testing for just 2 years, so it’s early days yet. So far, all the mutations found have been seen in other TMAU1 patients.
Do you think Primary TMAU may not be just an autosomal recessive problem?
As far as is known, FMO3 deficiency has always been shown to be an autosomal recessive condition, though mild or intermittent symptoms can sometimes occur in carriers of FMO3 mutations.
Do we know what bacteria is responsible for gut Trimethylamine (TMA) production?
There are more than 400 species of bacteria in the colon but only a few described as TMA-producing. The fishing industry’s research microbiologists have published many papers on TMA and ‘fish-spoiling’ and cite species such as Vibrio harveyi, Vibrio fischeri, Photobacterium leiognathi and Shewanella baltica. The last of these is also know to generate hydrogen sulphide – or ‘ rotten egg’ gas. Whether these microbes are those responsible for human TMA production is a good question, but they may represent a small portion of the total.
Is the bacteria in the colon or small intestine?
The distal part of the colon is responsible for protein and amino acid breakdown and I suspect the area for TMA production. Although there are hundreds of intestinal bacterial species there may be just 30 or 40 species which represent more than 90% of the microbes in number. If a TMA-producing species becomes predominant, eradication with antibiotics may prove to be very difficult. Apparently there are ten times as many bacterial cells in the human gut as cells making up the entire human body – making the gut flora a powerful metabolic force. Attempts at eradication with antibiotics such as metronidazole have been successful for TMAU2 sufferers – leaving them odour-free after a single course in some instances (as I mentioned earlier). Other antibiotics include neomycin and amoxicillin. Without specific identification of bacterial species involved (and their severity of overgrowth) the choice of an effective antibiotic for TMAU2 is often a question of trial and error. TMAU1 sufferers can also benefit from periodic antibiotic therapy as well as dietary choline restriction. Both TMAU1 and 2 can be controlled in similar ways, although the secondary (acquired) form has the possibility of a complete cure. TMAU1 may be controlled to some degree by antibiotics, restriction of choline (eggs, liver, beans) carnitine (meat) and TMA-oxide (seafood). The odour effects of TMA may also be reduced by activated charcoal or copper chlorophyllin tablets to absorb TMA in the gut and the use of pH5 skin creams to neutralize TMA in sweat.
Do you think if someone has excess TMA, it could indicate that their gut flora is abnormal? For instance small intestine bacteria overgrowth?
[see previous answers]
Is there a particular antibiotic/treatment you think may be best to control excess bacteria in Secondary TMAU?
[see previous answers]
Do you have any advice to Primary TMAU sufferers?
Any advice to Secondary TMAU sufferers?
To both of these questions I would recommend seeking the advice and guidance of a metabolic physician who specialises in TMAU – such as Robin Lachmann at The National Hospital for Neurology and Neurosurgery in London. There are several other metabolic specialists across the UK with increasing experience of TMAU, supported by dieticians, who can help TMAU sufferers with a variety of treatments from antibiotics and dietary regimens to odour-reducing tablets and low pH skin creams.
Do you think a Secondary TMAU diagnosis means in theory they should be able to be 'cured'?
Yes, with the correct antibiotic therapy a patient with normal FMO3 activity but an overproduction of TMA by gut flora may be effectively cured.
Do you expect Primary TMAU positives to have problems with other FMO3 substrates?
FMO3 may have up to 1000 substrates ie compounds that can be oxidized by this enzyme in the liver. With deficient oxidation these compounds may stay in the body longer and have unwanted consequences. Many drugs may be included in this list and are currently know to include codeine, tamoxifen, ketoconazole, nicotine, cimetidine, ranitidine and phenothiazine. High blood pressure is also a known complication due to foods which contain large amounts of the neurotransmitter tyramine (cheese, red wine and chocolate are examples). FMO3 deficiency should be taken into account whenever drugs are prescribed in case of an adverse reaction.
Do you think with Primary TMAU, the person may have other health weaknesses, such as chronic fatigue?
It’s not possible to speculate about this – TMAU1 sufferers are individuals prone to conditions that all of us may encounter. Adverse reactions to FMO3 substrates may add complications under certain circumstances, such as hypertension (high blood pressure).
Many people, including people with primary or secondary TMAU diagnosis, as well as those who are negative, have wide ranging odors. From gas/fecal to rotten egg and all sorts. Do you have a theory on this?
Body odour is caused by the release of volatile compounds from the skin in sweat. Just as TMA is produced in the gut by bacteria, there are probably many other volatile compounds which are naturally produced – like skatole which has a faecal odour. Only when the production of these compounds are produced in excess that the odour can become a problem. There may be other conditions like TMAU which are caused by an unusual gut flora as well as a lack of a detoxifying enzyme. Unfortunately we only have the ability to test for TMA at the moment.
Do you think with a TMAU diagnosis, they will only smell of 'fish body odor'?
It may be possible to be afflicted with overproduction of more than one volatile compound if conditions in the gut are such that excesses of different species of odour-causing bacteria are pre-dominant. Other bacteria may be responsible for a mixture of volatiles. Some species of Shewanella are known to produce both TMA and hydrogen sulphide (rotten egg gas).
Are there any recent advances in TMAU?
I’m not aware of any major breakthroughs in the treatment of TMAU, although as with many areas of medicine change is gradual and new therapies may be some time in development. Riboflavin treatment to boost the activity of FMO3 was mentioned a few years ago, although I’ve yet to see the results of any trial published.
Our advances in diagnostics have been in establishing a DNA service here at Sheffield Children’s Hospital. Recent increased awareness of the condition can certainly count as an advance – with it comes the prospect of increased chances to diagnose and treat TMAU sufferers.
What do you think sufferers could do to get research going?
Perhaps by joining organisations such as the TMA Foundation (based in New York and ably run by Sandy) TMAU sufferers could channel efforts into fundraising to support researchers in the field of FMO3 function or antibiotic therapy trials.
Do you think it may be feasible for a manufacturer to develop a 'home
maintenance' TMAU test like they have for diabetes? whether its TMAU test strip papers or a breathalyzer etc?
There have been attempts at measuring TMA in sweat, although this is a long way from a commercial kit as a mass spectrometer was still required to detect the TMA. When it comes to future developments – ‘never say never’ may be the best answer I can give.
Are there any ideas you have of possible 'money no object' lines of research, such as genetic engineering?
There are many hundreds of genetic conditions for which genetic engineering still remains the ultimate goal. Stem cell therapy with the correction of an abnormal gene, its re-introduction to the body and then normal function of the previously deficient enzyme may be possible in the future for many of these disorders….maybe even FMO3 deficiency.
http://www.bloodbornebodyodorandhalitos ... er-of.html
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caramiamine98
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Some people diagnosed with secondary TMAU have been completely cured with a single course of antibiotics. For others though the TMA producing bacteria grows back and requires repeated treatments. One of the possible reasons for this may be hypochlorhydria (low stomach acid). Adequate stomach acid is required to stimulate the pancreas to produce digestive enzymes needed to break down choline. When stomach acid is low choline is not digested properly it then produces TMA generating bacteria. Adequate stomach acid is also needed to keep the digestive tract free of unwanted bacteria and when in short supply bacterial overgrowths can occur with the resultant odour. It makes sense that there could be a connection between the two. If anyone has secondary TMAU or suspects that they do they might want to look into this possiblity.
There is a self test for stomach acidity which can be done at home. Not exactly sure how accurate this is but at least it should give some indication. There are other tests for stomach acidity but they require a trip to the doctor and are fairly invasive.
There is a self test for stomach acidity which can be done at home. Not exactly sure how accurate this is but at least it should give some indication. There are other tests for stomach acidity but they require a trip to the doctor and are fairly invasive.
I tested myself 5 different times and each time came back with the exact same result-low stomach acid. I’ve started taking betaine HCL and have been taking them for a couple of weeks now. I've tried all these things in the past but never stuck with any of them (with the exception of the vitamins and chewing thoroughly) I guess this time I'll have toSelf Test
You can also easily test at home with a simple and inexpensive stomach acid test. For this test, you will need to mix together a solution of one-quarter teaspoon of baking soda and eight ounces of cold water. The solution should be consumed soon after waking up, before any other foods or drinks are consumed. After drinking the solution, measure the amount of time it takes before you belch. If you belch within two to three minutes, your stomach is producing adequate amounts of hydrochloric acid for digestion. If you belch sooner than this or if you continue to belch, you are likely producing too much stomach acid. And if you do not belch within five minutes, your stomach is not producing enough acid.
Read more: Alternatives for a Stomach Acid Test | eHow.com http://www.ehow.com/way_5645330_alterna ... z1FPkUS8tv
Natural treatments for hypochlorhydria
Chew thoroughly - One of the most simple things you can do to lessen the job of your digestive juices is to chew your food thoroughly.
Multivitamin - Because hypochlorhydria can cause malabsorption of many vitamins and minerals, it's important to take a good multivitamin/mineral supplement.
B complex - An extra B complex supplement may be necessary for some. Vitamins B1 and B5 help to repair the stomach glands, vitamin B3 helps increase acid release, and folic acid and vitamin B12 are often deficient in someone with hypochlorhydria.
Bitter herbs - Bitter herbs stimulate the secretion of stomach acid and digestive enzymes. Examples of bitter herbs are gentian and dandelion. To have the full effect, they must be taken in liquid form (vs. capsule), because it's the bitterness that triggers the release of the digestive juices. Add up to 3 ml of the herb tincture to room temperature or warm water and sip. Drink 15 to 30 minutes before eating. Another option is to buy a herbal tea containing bitter herbs and drink one cup before eating.
Digestive Enzymes - Look for a blend that includes lipase to digest fat, protease to digest protein, and amylase to digest carbohydrates.
Betaine Hydrochloride - Look for a capsule (not tablet) that contains both betaine hydrochloride and pepsin. It should be taken at the start of a meal, and the dose depends on the size of the meal. I only recommend taking this under the supervision of a health care practitioner, because too much can lead to stomach bleeding or ulcers even in the absence of symptoms. Betaine hydrochloride also should not be taken by people taking cortisone, NSAIDS, or aspirin. People who have peptic ulcer disease or abdominal pain also shouldn't take betaine hydrochloride. If abdominal pain, burning, discomfort, dark stools occur, it should be discontinued immediately.
Herbal antimicrobial- If there is bacterial or yeast overgrowth (a typical symptom is bloating after eating carbohydrates) grapefruit seed extract, clove, peppermint may help eradicate unwanted bacteria and yeast.
Ginger Tea - Ginger aids digestion and elimination, and reduces bloating. In Ayurvedic medicine and traditional Chinese medicine, ginger is a digestive tonic. Learn how to make ginger tea.
http://www.badbreathhalitosis.com/artic ... hlorhydria
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caramiamine98
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Choline
I found an interesting article about choline. Although it’s about heart disease it makes some interesting points about choline and trimethylamine 
http://www.westonaprice.org/blogs/cmast ... t-disease/
http://www.westonaprice.org/blogs/cmast ... t-disease/
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caramiamine98
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Research paper about the efficacy of lactic acid bacteria and trimethylamine-nitrogen reduction.
http://www.academicjournals.org/AJB/PDF ... 0Manja.pdf
http://www.academicjournals.org/AJB/PDF ... 0Manja.pdf
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Archimonde
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halitosisux
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Malory from this forum has been diagnosed with TMAU and only suffers with breath odour.
Many youtube videos of people describing their TMAU odours seem to refer predominantly to their breath odour.
I think it totally depends on what's causing the TMAU and how susceptible a person is for internal odours to come through their lungs and secretions. For example, some people can eat garlic and nothing comes out of their lungs yet others will stink for hours after eating only tiny amounts. TMA gets into saliva and mucus so the odours from that could easily build up on the tongue and in the nose and that may be the only place it becomes an issue in minor cases of TMAU.
Many youtube videos of people describing their TMAU odours seem to refer predominantly to their breath odour.
I think it totally depends on what's causing the TMAU and how susceptible a person is for internal odours to come through their lungs and secretions. For example, some people can eat garlic and nothing comes out of their lungs yet others will stink for hours after eating only tiny amounts. TMA gets into saliva and mucus so the odours from that could easily build up on the tongue and in the nose and that may be the only place it becomes an issue in minor cases of TMAU.
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halitosisux
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If I remember correctly, Malory said she sometimes experiences some under-arm odour on one side. (something like that anyway).
The point is, TMAU has many different manifestations and different underlying causes behind it. In some cases it can be full-blown worst-type primary TMAU (rare) where it's certain to cause body odour because of the levels that build up in the blood.
But in many cases it may be secondary TMAU where gut flora or diet are responsible, and the levels of TMA in the blood could be low enough where it only affects mucus/saliva or the air coming from the lungs.
And then there's other chemicals that can build up in the bloodstream, in a similar mechanism to TMAU.
The point is, TMAU has many different manifestations and different underlying causes behind it. In some cases it can be full-blown worst-type primary TMAU (rare) where it's certain to cause body odour because of the levels that build up in the blood.
But in many cases it may be secondary TMAU where gut flora or diet are responsible, and the levels of TMA in the blood could be low enough where it only affects mucus/saliva or the air coming from the lungs.
And then there's other chemicals that can build up in the bloodstream, in a similar mechanism to TMAU.
Archi , which researcher did you ask ?Archimonde wrote:I asked a TMAU researcher if it was possible to have TMAU if your only symptom is bad breath (no body odor), he said 'no'.
If anyone has a peer-reviewed article that claim otherwise, please link it. I personally have never seen any evidence that there is a link between TMAU and BB (without B.O).
Probably as good as a peer reviewed paper is the hundreds of people with BB and No significant BO ,test Positive for TMAU
It can be emitted via the alveolar .
