Trimethlymanuria Diet                            Plans 


Once the diagnosis has been established, there are a number of potentially helpful treatment options; however, no single regimen seems universally efficacious. Furthermore, no systematic study has been performed to test the various recommendations

Another logical solution to FOS is to exclude or reduce TMAO, a TMA precursor, from the diet, which is found in high concentration in marine fish. While deprivation of marine fish is unlikely to have major repercussions, the same does not apply to choline, another TMA precursor. Choline deficiency may result in hepatocellular injury, neurological disease, and even a predisposition to cancer. Notably, pregnant women have an increased choline requirement so restricting intake may be even less desirable in this demographic. Foods with high concentrations of choline include eggs, mustard seeds, chicken and beef liver, and raw soybeans. Busby have developed diets with defined amounts of choline that patients may find useful. Also, limiting the ingestion of Brussels sprouts, among other vegetables, may be beneficial, as they may inhibit the enzyme FMO3. Carnitine and glycine betaine are two other substrates that may theoretically produce a fishy odor; however, whether restricting the ingestion of these substances is of benefit in FOS is unknown. It would behoove any patient considering dietary restriction as a treatment for FOS to consult a professional dietitian to ensure that all essential nutrients are accounted for prior to beginning a new diet. If restriction is not a viable option, a theoretical benefit may be derived from supplementation with riboflavin since FMO3 has a flavin cofactor; however, this has not been substantiated with any clinical study.

The following are some ways a person with trimethylaminuria can lower symptoms of odor:

  • Avoiding foods containing trimethylamine and its precursors (choline, lecithin and trimethylamine N-oxide).

  • Trimethylamine is present in high levels in milk obtained from wheat-fed cows

  • Choline is present in high amounts in:

    • Eggs

    • Liver

    • Kidney

    • Peas

    • Beans

    • Peanuts

    • Soy products

    • Brassicas (brussel sprouts, broccoli, cabbage, and cauliflower)

    • Lecithin and lecithin-containing fish oil supplements

  • Trimethylamine N-oxide is present in seafood (fish, cephalopods, crustaceans). Freshwater fish have lower levels of trimethylamine N-oxide.

nhs tmau dIET pLAN