TMAU

TMAU

What is TMAU?

Trimethylaminuria (TMAU), often referred to as “fish odour syndrome”, was first detected in 1970 by a group of doctors in Colorado who tested a child who was said at times to have a “fishy odour”.

Primary TMAU (also known as genetic TMAU) is caused by a defect of the FMO3 enzyme that should turn the (smelly) trimethylamine (TMA) into the odourless TMA-oxide.

Secondary  TMAU is not genetic. The main cause is an overgrowth of bacteria in the gut that produce TMA.

Symptoms are caused by a build up of the smelly TMA which is the excreted via the urine, sweat, breath and reproductive fluids leading to the characteristic fishy odour.

There are no physical symptoms associated with TMAU other than an unpleasant odour, but social and psychological symptoms are common due to the nature of the condition. Many people with TMAU seem to suffer intermittent or transient odour symptoms.

Where does TMA come from?

Primary TMAU

A genetic inability to convert TMA into TMAO will lead to a build up of TMA and the characteristic odour.

Secondary TMAU

Secondary TMAU is formed in the gut by the action of bacteria on certain foods that primarily contain choline and carnitine – for example, eggs, certain legumes, fish and organ-meats. It can also be naturally found in certain seafood as TMA-oxide, which is broken down in the gut to TMA.

Symptoms of TMAU 

In small quantities, a build up of TMA can cause halitosis (bad breath) – a fishy or garbage-like odour – but a greater build up of TMA can cause a smell of rotting fish as well as being sulphurous.

Symptoms can be present from birth, but most people seem to develop symptoms around puberty and through the teens. TMAU can also develop much later in life.

In women, symptoms can be more severe just before and during menstruation, after taking oral contraceptives and around the time of menopause.

Useful links to help you find out further information about TMAU

www.ncbi.nlm.nih.gov

www.sciencenews.org

Important
Please note: Not all causes of malodour are ruled out by this test. Malodour can be caused by other volatiles such as hydrogen sulphide, methanethiol and dimethyl sulphide. Unfortunately we cannot test for these at this time.

Free Trimethylamine (TMA) /Creatinine ratio
TMA-N-Oxide Creatinine ratio
% N-Oxidation
Urine Creatinine

Urine.

 

The samples for the TMAU test must be collected over a 24 hour period.

Please stop all current supplements for a 3 to 4 days before completing the test.

Many people restrict their diets in an attempt to control and reduce odour, but this may affect the test results so we do not recommend you do this before testing.

For diagnostic clarity, we recommend that the sample is collected when odour is at its maximum. This may mean increasing dietary intake of choline (eg. pulses, eggs, liver) and carnitine (red meat) a few days before you take the test. Dietary ‘loading’ is possibly most effective with a simple high choline meal of 2 eggs and 400g baked beans the evening before completing the test. Your test will come with full instructions about this.

Please avoid cruciferous vegetables – cabbage, broccoli, cauliflower and Brussel sprouts before completing the test. Indoles in these vegetables naturally inhibit the FMO3 enzyme which would skew the result.

If you are worried about odour at certain times, such as around menstruation, it is important to collect urine at that time.

DO NOT collect urine when you have a UTI – Urinary tract infection – such as cystitis – the bacteria causing the UTI will impact on the test results and you will be asked to retest alongside a urine test for a UTI – unfortunately, there will be a charge for a retest, this is outside of our hands and the charge is required by the lab. If you are unsure you can always do a microbiology just before / on the same day as the TMAU test.

 

Adults and children.

Children must be able to supply a sample of urine that is free from nappy fibres and stool samples.

 

You can post your samples back to the lab.

7 weeks.

Your TMAU test results will be emailed to you.

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To Book an appointment at one of our UK IBS clinics in London, Brighton, telephone or Skype  please call 01273 775480 or email [email protected]

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To Book an appointment at one of our UK IBS clinics in London, Brighton, telephone or Skype  please call 01273 775480 or email [email protected]

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To Book an appointment at one of our UK IBS clinics in London, Brighton, telephone or Skype  please call 01273 775480 or email [email protected]

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To Book an appointment at one of our UK IBS clinics in London, Brighton, telephone or Skype  please call 01273 775480 or email [email protected]

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To Book an appointment at one of our UK IBS clinics in London, Brighton, telephone or Skype  please call 01273 775480 or email [email protected]

PUT YOURSELF to the TEST

Please do not return samples to the laboratories that may arrive after Wednesday 27th March and up to and including Monday 2nd April.

The laboratories are closed from the 28th March – 2nd April for the Easter Holiday.