someday : 'fecal body odor' debate in Parliament ?

Someday politicians could be having a debate about 'fecal body odor' 'metabolic body odor' 'systemic body odor' 'TMAU' in their parliament / senate / congress etc.

Recently a 'M.E.' debate was held in the UK Parliament.

Here is the UK 'request for debate' stage (to show the interest of the MPs of all parties)


 
Someday they could be talking about (choose your label) :
FECAL BODY ODOR
METABOLIC / SYSTEMIC BODY ODOR
MET-BO
TMAU
etc

It shows that politicians are very aware of M.E. and realise it is ignored.
Perhaps the same politicians who have sympathy with ME would be sympathetic to FBO.

What can be done ?
One could write their local politician about FBO etc.
e.g. MP, Senator, Rep, UK, USA, Canada, anywhere.

Also could look for politicians sympathetic to M.E. etc and write them.

Health systems and researchers are not interested in FBO/TMAU etc.
They need to be forced by politicians to act.

In UK
MPs make All Party Parliamentary Groups.
M.E. seems to have a group (2016) ME APPG

Full video :
Recent UK Parliament M.E. debate (in backroom, not main chamber)


Other awareness ideas :
Bus ad
Write to high profile 'TV Dr's/naturopaths'

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By sysbodyodor

campaign, community, fecal body odor, metabolic/systemic malodor

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Comment on the NEW UK TMAU Test (Sheffield)

NEW TEST

In early March the 'Sheffield TMAU Test Team' kindly gave a lecture at the UCL Adult Metabolic Unit in London to a group of TMAU patients.

Below is an abridged version of the lecture

Sheffield NEW TMAU Test lecture slides (hosted on SCH site)

The main 'changes' seems to be :
Almost no TMAU2 cases (this used to be a very large group).
A large amount that had no detectable TMA (this is a new category).
A big drop in TMAU1 cases (?)

Here's some thoughts on the old/new test.  The views may be inaccurate.
Maybe over time things will become clearer.

Interference :
A main reason given for the 'changes' is that the old test was prone to interference.
In effect saying there were many false 'positives'.
This may be true or not, but for some reason IMHO the old test was better at spotting the METBO smell disorder most people have.
Perhaps the incorrectly detected volatiles were a better measure of the disorder the person has.
Who knows ?

OLD TEST

Liberal (and fair) new ref range :
The new test has what could be termed a 'very liberal reference range' (TMAU1 = <94%).
The old test was very conservative. (TMAU1 = < 79%).
With the new test ref-range, old test results would maybe have been 70% positives ... which I think is likely in a group who identify with systemic body odor.
Instead, the new test gives 16% positives.

TMA and TMAO levels
New TMA levels are way lower than the old test levels :
TMAO seems slightly lower but not much,
but TMA levels in general seem way lower on average.

You'd think there would be many more TMAU1's but it's not the case.
Old test 'positive' rate : around 33%
New test : around 16%

I accept that the new test may be more 'precise' at detecting TMA, but have long guessed most metBO cases are not based around TMA anyway.
TMA should still be an excellent biomarker of FMO3 function, but I have doubts too.

For some reason I think the new test now misses the vast majority of FMO3 smellies, the 'mild genetic transients'.

New Sheffield ref ranges.

TMA:  < 7.7 µmol/mmol creatinine
TMANO: < 119µmol/mmol creatinine
% N-oxidation: > 90-94%

Old Sheffield ref ranges.

TMA:  2.5 - 10 µmol/mmol creatinine
TMANO: 17 - 147 µmol/mmol creatinine
% N-oxidation: > 79%

TMAU2
A new explanation for the lack of TMAU2's is that in fact most might be 'mild genetic TMAU1's'.
I tend to agree with this theory.
I don't think 'normals' ever fall into the 'zone'.

New big group of 'non-detectable TMA' cases
Of 722 tests, 147 had no detectable TMA level.
The old test thought that a normal human would have at least >2.5umol TMA.
I tend to agree with the old test. Humans probably have some TMA in them.

Old and New test can't be compared
It's been said the old and new test can't be compared.
Both use Gas Chromatography/Mass Spectrometry and have the same scale for ref range.
So to me they are directly comparable.

What can be done to change the UK system ?

TMAU / metBO people are poorly served by their societies.
It will be by miles the biggest 'rare disorder' (i.e. not rare).
Any Health Service test labs that offer the TMAU test regard it as very charitable and to question is an insult.
Their set-ups suit the department workers.

Any change to an acceptable minimum standard will have to come from politicians.
Examples :
People can write to their MPs
e.g.
Let people test direct and self-pay for the TMAU test.
If only one lab tests, it is the national lab, and has a  responsibility to do more ... e.g. have a website and contact point.

Perhaps if anyone lives in the Sheffield area they can contact their politician to insist of minimum levels of help.
Ultimately the test should be done at all NHS 'rare disorder' test labs.     

TMAU / MetBO people worldwide should always remember our current help is below a minimum standard.   

That said, thank you to Sheffield CH for the slides and lecture.

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By sysbodyodor

campaign, main points, tmau, TMAU stats, tmau test

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Potential 2 year FMO3 Study

A Metabolic Consultant has offered to do a 2 year study on 2 ways to improve FMO3 function.

Part 2 (part 1 in the paper). would focus on NONSENSE mutations, which are rare but usually severe.
Part 1 would focus on MISSENSE mutations, which will be the vast majority of TMAU1 cases.
Speculation suggests that TMAU2 cases could also possibly be mild missense cases.

I make MISSENSE part 1 as this will be the vast majority
e.g. E158K E308G etc

What's needed for the study to happen :
A TRUSTED PARTY to set up a CROWDFUNDING PAGE.
Youcaring is suggested as it's free and has few clauses : Youcaring
But any crowdfund site would do.

Study cost : about $US 100,000

Why ? 
Someone will be hired fulltime for 2 years.
Plus equipment etc

Study basics :
1. Using ATALUREN to see if it helps with NONSENSE mutations.
2. DRUG REPURPOSING : going through many drugs in FMO3 cells to see if any improve FMO3 function. This would help with MISSENSE mutations.

Drug Repurposing often happens in pharma-world.
Such as viagra originally being for heart disease.
Often multi-uses are found for drugs accidentally.

The study needs funding

A best option would seem to be crowdfunding.
possible scenarios :
A trusted individual or collective to take on the crowdfund.
e.g. A group of respected older women ?
or
Using the REACT Fund as a trusted proxy (if they let the consultant have the money)
RE(ACT) TMAU FUND
or
Any other ideas

Fuller outline of the potential study

 Time-lines for the project (at half-yearly milestones):

Study component	Year 1		Year 2
Generation of a range of FMO3 nonsense and missense mutations and the in vitro tools for their functional analysis in a cell culture system	X	X
Evaluation of the efficacy of read-through agents and other drugs in our in vitro cell culture system, including acquisition of structural and functional evidence			X	X

2.  Repurposing of existing drugs:

TMAU is caused by a functional deficiency of the FMO3 protein.  Many of the missense mutations of the FMO3 gene are hypomorphs, ie there is some residual activity of the enzyme, albeit not enough to prevent the accumulation of TMA.  Augmenting expression of the faulty gene through activation of the FMO3 promoter, could improve overall FMO3 enzyme expression, with significant amelioration of the disorder(19).  Libraries of known therapeutic agents are commercially available that can be used in high throughput screening assays to screen for possible opportunities to “repurpose” the drug, ie apply it in a therapeutic context for which it was not originally designed.

We propose to use the cell culture models developed by us in a high throughput screening approach to identify new potential therapeutic agents that could augment expression of the FMO3 gene.

If we demonstrate potential in vitro efficacy of specific well-established therapeutic agents, we will then potentially be in a position to move to clinical trials in patients with trimethylaminuria, particularly if the therapeutic agent identified has an existing therapeutic track record in other disorders.

1.  Read through of premature termination mutations: (Nonsense mutations)

Premature termination or nonsense mutations arise as a result of a single nucleotide change in a gene where the change leads to the conversion of an amino acid in the protein sequence to a premature stop codon.  Such mutations often result in the protein losing most if not all of its functional capacity.  It was recognised a number of years ago that aminoglycoside antibiotics can force the transcriptional machinery to read through the premature stop mutations, and allow the normal protein to be made, restoring activity of the protein(13).  However, aminoglycoside antibiotics have significant side effects and are not a viable therapeutic option.  More recently a new class of drugs has been developed that has the capacity to promote read through of premature termination mutations, and which appear to be totally non-toxic(14).  One in particular, PTC124, has been shown to result in the production of normal dystrophin in the mdx mouse model of Duchenne muscular dystrophy(14), and has been used in clinical trials in human subjects with cystic fibrosis, with clear benefits being found(15).  In addition, there are a number of other read-through agents currently being evaluated for potential in vitro and in vivo use. An inborn error of metabolism like TMAU would be an excellent candidate for this type of therapy, as an increase of enzyme activity to perhaps as little as 10% of normal should be enough to overcome the biochemical block.

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By sysbodyodor

announcement, campaign, crowdfunding, fecal body odor, fmo3, FMO3 research, tmau

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Sheffield TMAU survey : Old and New Test

Quick update on anecdotal SHEFFIELD TMAU Test Survey.
Aim : To show differences in trends between OLD test (Nigel's pre-2017 test)
and the NEW post-2016 test.

Measurement is umol/mmol creatinine.

Conclusions :

1. TMA is 10-80 times lower for NEW test ??

TRIMETHYLAMINE levels seems to be 10  to nearly 100 times less than the old test, even though they both use GAS CHROMATOGRAPHY as the method.
The reason given so far is that the old test had 'false positives', which means many were told they were positive wrongly.

For whatever reason, the old test was more in line with numbers I would expect to be positive. My suspicion is the new test spots only GENETICALLY SEVERE TMAU cases now, whereas the bulk of us were GENETICALLY MILD or even borderline or 'carriers'.

Paper of concept 1999 : susceptibility of heterozygotes

2.

There's 5 NEW tests in the survey of 22 (viable answers). So apart from the TMA difference trend, it's hard to make other conclusions.
TMAO levels seem similar but slightly lower. Does not have the huge variance where the OLD test had TMAO levels in the 100's. It looks like none will be over 100 in NEW test.

The 2 above comments are to do with the MACHINE METHOD ; not the 2nd part, the reference range.

SHEFFIELD TMAU Survey :
Anyone can take part in the survey if their TMAU urine test was done at SHEFFIELD CHILDRENS HOSPITAL.
This would be anyone who has tested on the NHS.

AIM : To show difference in patterns of OLD and NEW TMAU test.

LINK TO SHEFFIELD/NHS TMAU SURVEY

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By sysbodyodor

announcement, campaign, important, join in, tmau, TMAU stats, trimethylaminuria

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Donate to RE(ACT) TMAU Fund

What is RE(ACT) ?
It's part of the Swiss charity 'Blackswan', for rare disorders, founded by Dr Olivier Menzel. It's intended as a neutral transparent Crowdfunding site for rare disorder communities.

REACT TMAU FUND

Who is Dr Olivier Menziel ?
He is a Swiss pediatrician who saw the need for a site to help self-funding for rare diseases.

What happens to the money ?
Researchers will put forward a research proposal to the REACT review committee. If approved, the research would get the funding they request.
It also works in reverse, a study is put forward. and a page is created for that study. All funds in this case would go to the study.
THERE IS A 5% FEE FOR REACT.

What is the current fund for ?
It is a TMAU GENERAL Fund, waiting for research proposals.

Why should I donate ? 
The money will sit there either forever or until a study is put forward and approved.
You can see the total.
Blackswan is a registered charity

How does this compare to the NORD Fund ?
The NORD Fund does not tell you the total.
My understanding is that if no donations are made to a fund after a certain time, the money transfers to the NORD General Fund,

Have any TMAU studies been put forward to  REACT ?
One was put forward that involved drug repurposing.
It got approved, but for some reason it never appeared.
At the time the REACT site looked very amateur, and contact was patchy.
It looks more professional now.
Whatever the case, the money seems to be secure.

Any catches ?
When in the Donate process, make sure you choose 'TMAU fund'
and not 'REACT General Fund' (i.e. a fund that helps running REACT).
5% UPKEEP FEE.

Donation suggestions :
Money scarce : 5 euro/$ ?
Average money : 10 - 20 euro/$ ?
Well-off : 100+ euro/$ ?

Total at time of writing : 35 Euros

Blackswan charity

Success Story :
Research study raises 150,000 Euros  via REACT

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By sysbodyodor

announcement, campaign, crowdfunding, tmau, TMAU research

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Sheffield New TMAU test : everyone is normal !

Old SCH TMAU ref range

It seems the new TMAU urine test at SCH seems to make all the results 'normal',
whereas their previous test had maybe 15-25% abnormals.
This is a very worrying situation.
You could say worse than having no test at all.

The official line is :
The number of true positives will be the same as the old assay, however there will be less false positives. This is because the new assay is more accurate and has less interference from other volatile substances.

Basically saying the old test was unreliable and gave too many false 'positives'.
My first impression from comparing old results to new is that it's more likely the new test method which is wrong.

Sheffield Children's Hospital UK has a long history of TMAU testing :
1997 : TMAU Test started by lab member Nigel on his own volition (it seems).
est. 2015 : Nigel retires.
2016 : Machine breaks.
2017 :  New machine and method used (still GC), with more 'liberal' ref range in line with consensus.
2018 : Do not make stats public, but the trend seems to be everyone gets very low TMA levels and everyone is 'normal'.

Some comparison of the old and new :

old test : minimum TMA level possible for a human was >2.5.
TMA levels could be from 5 - 80+.
new test : most TMA results are under 2.5, even under 1.

old : TMAO levels could be like from 20 - 500+.
new : TMAO levels probably around 10 ?

I would guess for any other disorder there would be much head-scratching at the difference, but the test has been running a year with no sign of concern or loss of belief.

What is SCH attitude  ?
Defensive.
Resistant to change. May give crumbs.
Community should be grateful (Oliver Twist style).

What can be done ?

1. Until now we have relied on kindness of lab members for a National TMAU Test (at all).
This is unacceptable.
The Gov need to order a National TMAU Test endorsed by the community.

Individuals can contact MPs about this.
Maybe longer term we need a campaign (e.g. petition etc) lobbying selected politicians.

The 2 lab staff who oversee the test will be attending the next UCL meetup.
Only UCL patients can attend (looks like it will be full, maybe 20 attending ?).
This is the chance to start afresh with a spirit of mutual respect,
Or they could be defensive.

Stats to be made public
A promise has been made to make stats PUBLIC, but of course theres stats then stats.
Lets hope its in the spirit of complete transparency.

SCH TMAU test LAB Dept

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By sysbodyodor

campaign, TMAU stats, tmau test

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Bus Ad Campaign idea : BO ? Test for TMAU

A quickfire high profile outdoor ad campaign seems a good impact/cost ratio.

Examples :
Side ad on a bus going through central city for 4 weeks.
(e.g. London, New York).
Ad at a main subway station for 4 weeks.

Prices for these don't seem too high (e.g. $1000 for 4 weeks ?).

Thinking of a subject for a systemic odor ad can be awkward as :
1. No volunteer faces for the ad (for obvious reasons).
2. Got to get most impact from a few words.

An idea is perhaps to base it around advising people to test for TMAU.
This would give potential 'sufferers' direction, and raise awareness of TMAU.

So something like :
BO ? Test for TMAU

My own view is that for 'FMO3 body odor', there might be perhaps 1% population 'at risk' of 'FMO3 smells' at some point in their lives. This is taking into account the commoness of carrying the 3 main FMO3 'variants' (at codons 158,308, and another).
About 20-40% of whites are estimated to carry 158 variant and it changes the base.
My view is that perhaps many have a combo of variants which like carrying little injuries can compound and maybe put them at risk of smelling at times.

Say it was 1%, then these people would fit different categories :
1. Genetic severe are very rare (as we are taught).
2. Transient (minor genetic faults) will make the bulk.
3. Some will never know they smell (or care).
4.  Some will know of TMAU and test etc, or identify with the concept 'systemic body odor'.

5. A lot of this 1% will know that there is something wrong with them, but won't know of TMAU ore the concept etc. This would be the 'sufferer' target of the ad campaign.

More testers means more pressure on health system, and hopefully more health-system work to organize help for 'BO'.

The other main aim is to raise awareness and get into the public domain the idea if someone has BO they should test for TMAU.

This is a floated idea to think about.

Current situation for TMAU people :
Health system decision-makers doesn't care. (consultants, labs etc).
Politicians not heard of it nor care.
P&G 'tmao pill' will probably be am excellent therapy but could take years to reach market.

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By sysbodyodor

campaign, tmau, trimethylaminuria

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UK Campaign : Template letter to Politicians

UK Campaign to get Politicians involved with TMAU.

Here is an idea of a campaign that people can do if they want. Involves writing to your/a MP or member of House of Lords. A main aim would be to get a TMAU All Party Parliamentary Group (chance : 5%).

When writing to a politician, the rules are :
MP : MP's may say they can only reply to constituents.
But the website says you can contact any : Link .
1 strategy is : contact your own MP first.

House of Lords : you can contact anyone.

Some random ideas of aims for the politician :
To be a TMAU 'patron'.
To form/join a TMAU All Party Parliamentary Group.
To do general things that may promote awareness/research/ease of testing.

Of course, people can write their own emails.
Find your MP : link

Example email :
Can be altered or totally changed etc.
May be of inspiration for other countries.

Example Letter (can be used/altered if you wish)

---

Dear

re Trimethylaminuria (TMAU)

TMAU is the only systemic/metabolic body/breath malodor currently documented.

While the severe form is rare, the 'mild' transient type could be fairly common. The 2 common polymorphs, about 10% Caucasians are estimated to carry. This does not mean 10% have 'smell issues, but among this group a fair amount may be 'prone' to transient smells.
It also appears to be across both genders and all ethnicities.

TMAU origins (1970)
TMAU was a 'guess' at a volatile to test for a 'fishy smell' back in 1970. Since then no other smelly volatile has been tested. Most TMAU people do not identify with a fishy smell, but rather a broad spectrum of 'bowel' smells.

While many sufferers don't think TMA alone is the sole volatile, or even a main player, it should be a good biomarker of FMO3 function, and for now is the only 'volatile' to rally round the concept of 'systemic body odor'.
So for now we will focus our aims on TMAU.

FMO3
FMO3 is the enzyme regarded as meant to neutralize TMA. It is an oxidizing enzyme that neutralizes/activates many smelly volatiles/compounds in humans.
You could say TMA oxidation is a good biomarker of FMO3 function.

TMAU ignorance
Probably about 20 researchers have ever taken an interest in TMAU. None are actively interested for maybe 10 years or more.
There were 2 conferences set up in 1999 and 2002, but these fizzled out.
Probably only a handful of health professionals know of TMAU.
About 99.999% will not.
For GPs it may be higher.

A consensus among the group is :
The understanding of TMAU is very basic and the 'treatment' does not work and may be bad for your health (choline being important for liver function).
Currently nothing is being done research-wise.

A few points about TMAU
1. the person usually cannot smell themselves.
2. most cases would seem to be transient.
3. Unlike probably all other 'rare disorders', the person will start seeking answers as an adult or teen. It is not a Dr-led diagnosis.
4. The group are pretty disorganised (partly to do with shame) and could use help to get organised.

UK Political Help
Here is a list of ways a UK politician may help the TMAU cause :
In reply, you may use this list with your answer if you want.

1. Become a TMAU UK group 'Patron' (or similar title. Could be from title-only to some extra duties).

2. Form/Join a TMAU All Party Parliamentary Group.
This could perhaps be for a few meetings only, or a trial basis. Mainly to have a thorough look at the subject in the House.

3. Attend a Charles Dent UCL 'TMAU Group'  quarterly meeting.
There have been 2 meetings so far (perhaps a new NHS law ?). Since it's near the House, perhaps you could attend. Or attend one at a regional metabolic unit (so far only Birrmingham known).

4. Help in finding a broker for the TMAU test to subvert the 'NHS professional-only' testing law.
HIV testing is now available via direct-testing. Since TMAU is an 'adult' disorder, and GPs won't know of it, people want to test direct and self-pay. If you could help us in source an agreed method of testing this would take away our greatest anxiety.

5. Ask a TMAU question in the House

6. Help with publicity, advice etc.

7. Help us organise.

Or any other ideas you care to mention.

There are 2 things regarding potential treatment :
1. What could be done now.
Possibly a lot could.
e.g. using enzymes to metabolize TMA in the gut. TMA can be put down the 'methane route' by enzymes in certain microbes. Also an 'FMO3 pill' has been suggested, as most of the load may be in the gut.

2. What could be done in the future (gene therapy etc)

So probably things could be done now, which are not of interest to researchers, pharma companies etc.

Thank you

Some links about TMAU
https://youtu.be/7IPV72B4-3c
https://youtu.be/qrW_QYk6zRI
https://youtu.be/U8RriLVkXdw (severe case)
https://youtu.be/FnETAQHepX8
https://youtu.be/SN-7KWLqjMw   
https://youtu.be/4Iqb42_pVk0

http://middleeast.thelancet.com/journals/lancet/article/PIIS0140-6736(05)77067-7/fulltext
https://www.ncbi.nlm.nih.gov/books/NBK1103/

TMAU testing among a random group from Imperial College.
https://www.ncbi.nlm.nih.gov/pubmed/8893042
Back then, <80% was the '+ve' ref. range. This is now  <94% for '+ve'.
This would make 3.8% of this 421 now 'TMAU +ve'.
  

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By sysbodyodor

announcement, campaign, community, important, join in, raising awareness

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UK Campaign : Aim for TMAU APPG

Campaign Idea (UK).

Aim : TMAU UK All Party Parliamentary Groups.
What is this ? A group of MP's and/or Members of the Lords who take an interest in a subject and have meetings on it (e.g. quarterly).

How ?
Contact your MP and/or House of Lords members.
Contact your MP : link
Contact House of Lords member : link

Ask them if they may set-up/join a TMAU APPG.

Note :
You can only contact your OWN MP, not any MP.
House of Lords : You can contact anyone.
HoL listed as having an interest in 'health' : link.

Chances of TMAU APPG : 5% ?
There is a 'rare disorder and undiagnosed' group : link.
There is also a group for 1 rare disorder : link.
Brief reading suggests it was set up by a MP due to a constituent who runs a charity for the disorder, but it says they reckon the MP wants out of it now.

An example email will follow in a follow-up post.

Other countries :
Perhaps others can try in other countries too.
Example : A TMAU 'Patron' or house group etc.

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By sysbodyodor

campaign, community, trimethylaminuria

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Idea : TMAU Awareness week ... every 6 months

notion of a TMAU AWARENESS WEEK every 6 months.

Most disorders have a yearly awareness week. TMAU would do well to have such a week, as it is possibly the most 'unknown' documented 'rare' disorder (I don't think it is rare. Severe TMAU1 may be, but transient cases might be 1%+ imho).

But why wait yearly ?
If you live to 80 you will see only 80 'rare disease' days.
In many countries political parties now have twice yearly conferences. This will be due to party member pressure, feeling yearly too long a gap, and they are right. A year is a long time for causes.

So it would be great if the TMAU community could arrange :
TMAU AWARENESS WEEK (every 6 months)
(in my opinion)

What would it involve ?
An ad campaign (funded by specific crowdfund campaigns).
Maybe lobbying politicians or getting a patron politician involved.
Perhaps test labs releasing latest test result stats.
Maybe someday a conference (like the 1999, 2002 conferences which were meant to be bi-annual, 2001 moved due to 9/11)

An example of a disorder awareness week (UK Downs Syndrome)

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By sysbodyodor

campaign, fecal body odor, fund raising, ideas, join in, patient advocacy, raising awareness

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TMAU : Choline status should be tested

Campaign.
TMAU test protocol.
Add CHOLINE status as part of a 'TMAU profile screen'. 
Who to campaign to : National Health Systems.
My hope of success : currently about 5% ?

Currently those who think they have TMAU (trimethylaminuria) do the TMAU clinical test (the urine test). This tests levels of trimethylamine and it's oxide (TMAO).

It is known that choline is closely associated with TMAU. The theory is choline gets changed to TMA in the gut. This makes me wonder if TMAU people may often have a natural blood choline deficiency despite taking choline.

Choline currently seems to have a quasi status as an essential nutrient, Probably in time it will be regarded essential. It seems to be a good emulsifier of fats in the liver. This makes me wonder if TMAU people may be naturally prone to non-alcoholic fatty liver.

Many 'normal' people have NAFL, but it would be interesting to see what the % was in TMAU people. Maybe it will turn out low choline plasma is a cause.

Targeted TMAU profiles tests :
So my first 3 tests for a TMAU profile test would be :
TMAU urine test (I would do DNA test as well).
Choline plasma test.
Liver ultrascan (to look for NA- fatty liver)

---

Other speculative tests I can think of  (quickly written) :

Very speculative other tests for a TMAU profile :
Leaky gut test.
Ethanol test (to detect candida). Now no longer available (from Biolab UK).
Microbiome stool DNA test.
Biotin test (as I was once deficient in biotin).

I would add many others, but perhaps the first 3 are a realistic aim to convince conservative metabolic consultant for a TMAU profile.

Re ethanol test.
This was a test done by Biolab UK where you had to attend the lab. Ethanol is proposed as being generated only by yeast in humans.
I see now they have discontinued it, and refer people to do microbe organic test by Great Plains, which I don't think is as accurate (or at least, not a decade ago).  

Ultimate biochemical test for Systemic Body Odor :
A broad screen of volatiles known to cause systemic body odor. Currently they don't know the list of volatiles, so at this time this would be EXPLORATORY.
Once it was known what volatiles cause systemic body odor, they could then create a profile test with these volatiles.
Likely suspect volatiles (my guess) : dimethylsulfide, dimethyldisulfide, trimethylamine (small player).

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By sysbodyodor

campaign, gut dysbiosis, metabolic malodor, metabolic/systemic malodor, systemic body odor, systemic malodor syndrome, tmau test, trimethylaminuria

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