News & Views on Systemic Body Odor and Halitosis such as trimethylaminuria TMAU. If you have fecal odors or bowel odors it may be metabolic/systemic

Showing posts with label trimethylaminuria. Show all posts
Showing posts with label trimethylaminuria. Show all posts

8 March 2018

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.




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22 September 2017

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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3 September 2017

Mice on high choline diet deficient in choline : Paper

This could be a very important paper for the following malodor problems :
TMAU (if you believe that TMA is the sole source of your malodor).
Possibly 'FMO3 malodors' (if you think many FMO3 substrates cause your smells).
Possibly (in theory), if low blood choline caused smells (this is an unknown).

2017 Paper :
Metabolic, Epigenetic, and Transgenerational Effects of Gut Bacterial Choline Consumption
Romano KA et al
Unis of Wisconsin and Harvard

in the news : link


Summary
Choline is an essential nutrient and methyl donor required for epigenetic regulation. Here, we assessed the impact of gut microbial choline metabolism on bacterial fitness and host biology by engineering a microbial community that lacks a single choline-utilizing enzyme. Our results indicate that choline-utilizing bacteria compete with the host for this nutrient, significantly impacting plasma and hepatic levels of methyl-donor metabolites and recapitulating biochemical signatures of choline deficiency. Mice harboring high levels of choline-consuming bacteria showed increased susceptibility to metabolic disease in the context of a high-fat diet. Furthermore, bacterially induced reduction of methyl-donor availability influenced global DNA methylation patterns in both adult mice and their offspring and engendered behavioral alterations. Our results reveal an underappreciated effect of bacterial choline metabolism on host metabolism, epigenetics, and behavior. This work suggests that interpersonal differences in microbial metabolism should be considered when determining optimal nutrient intake requirements.
in the news : link

My interp
It seems they wanted to see how mice differed between groups that had 1:abundant bacteria that turn choline into TMA ... and 2: mice that had a cloned enzyme that blocked microbes changing choline into TMA.

The results were
The TMA-microbe rich mice had low choline blood levels even on a normal choline rich diet.
This is because the gut microbes COMPETE with the host for choline (and microbes get first go).
This caused significantly lower METHYL DONOR metabolite levels in blood and liver, as choline is one of our main methyl donors.
The low blood methyl/choline levels in blood seemed to cause behavioral problems (e.g. anxiety).

Choline
Seems to be one of our main METHYL DONORS (in the blood).
Is an important fat decongestant for the liver.
As we can make some, it was regarded a non-essential nutrient, but now it is accepted that we cannot make anywhere near the amount we need, so is in effect an essential nutrient.

Behavior problems
It's interesting they report the 'low choline blood' mice as having behavior issues such as anxiety, as many with TMAU report of anxiety.

My thoughts
I have thought this before, that low choline blood may be an issue for anyone with 'TMAU' who eats a high choline diet, or even worse for someone following a low choline diet.
As said, choline is important for the liver and as a methyl donor.

NAFLD
I do wonder if perhaps those with TMAU are prone to non-alcoholic fatty liver disease. Perhaps in general or in a particular way. Very speculative.
Many Drs feel that most westerners will have some fatty liver say over 40+, due to diet and lifestyle. But perhaps low choline could be an issue.

Appropriate tests :
1. I guess a liver ultrasound to see how the liver is. (mainstream test)
2. Choline blood test. This is not mainstream and seems very hard to find. It should be mainstream but it's not.

What can a TMAU person do to raise choline blood levels ?
It would seem impossible as the choline will be altered to TMA before it is absorbed.
One choline expert suggested phosphatidylcholine was less easy for microbes to alter, and may be worth a try (unlikely ??).
My own view is that testing for choline blood level would be the best option, so we could see if there was a 'syndrome' common to us.

TMAU low choline predicament (my theory)
2 scenarios
1. High  choline diet (normal west diet) > TMA microbes eat the choline before they are absorbed > person has low blood choline.
2. Person goes on low choline diet > even lower in blood choline level.

They cloned an enzyme in the microbes that did not produce TMA
I note they mention they had an enzyme cloned and put into microbes that stopped production of TMA.
My guess is this approach would be an obvious therapy for TMAU.
Something we should certainly investigate.
My opinion : PROBIOTIC THERAPY with CLONED MICROBES that don't carry CHOLINE-TMA enzyme is one of our best hopes.

Could low choline blood levels cause the smells ?
I guess it's possible that LOW CHOLINE BLOOD levels could cause the smells for metabolic/systemic malodors to do with related enzymes (e.g. FMO3) , but for now it must be deemed an outside chance but definitely one worth following up.

My advice for now 
Try and find a test supplier to do the choline blood test (possibly very difficult).
And perhaps a liver ultrasound to see if you have some fatty liver.

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20 April 2017

Finnish study : TMAO and gut flora

A new study to do with the TMAO - Heart Disease theory put forward by Hazen et al from Cleveland Clinic in 2011.
By A Finnish group, probably with help by the Cleveland Clinic team.

My context for the study :
Currently of limited interest to me.
Posted moreso that others can read it thorough if they wish.
I am skeptical about the microbes listed as being associated with TMA production.

The Study (in terms of TMAU interest) :
531 Finnish men had their gut flora DNA tested to 16S standard.
Presumably they had a connection with CVD.
Since TMAO will probably require therapies to lower TMA levels, it will very likely mean therapies for TMAU.  

Since the theory is TMA-oxide is associated with CVD, they looked at microbes that may be associated with high TMAO levels.

The microbes they associate with  TMA-oxide
Peptococcaceae
Prevotella  
unknown Clostridales

Looking at my Ubiome results, which are 16s standard testing :
I had :
Peptococcacae : none.
Prevotella : about 0.18%.

Understanding of gut flora :
I view the knowledge of the gut flora as at the very early stages. A bit like before America discovered.

Final thoughts on the study :
I believe TMA is only a biomarker of FMO3 function, and a small player in the range of FMO3 volatiles someone with a FMO3 isssue may smell of.
So I am sceptical that a therapy that may only reduce TMA in humans will solve what I regard the most common type of systemic/metabolic body odor (FMO3 substrates body odor). BUT HOPEFULLY I AM WRONG.
But it may be that reducing TMA levels reduces the load greatly on FMO3 to levels where the enzyme can handle all smelly substrates.

Back to this study, it's great so much research is going into understanding TMA metabolism in humans, and for sure it will result in 'TMA therapies' as they are associating it with heart disease. So we can expect many more studies like this, and much greater understanding of TMA metabolism in humans.
Compare this to pre-2011, where we were lucky to get a TMA paper every 5 years.  

Paper :
Relationships between gut microbiota, plasma metabolites, and metabolic syndrome traits in the METSIM cohort : Link 


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6 April 2017

4 April 2017

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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5 March 2017

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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1 March 2017

New paper : TMAU might not just be FMO3 disorder

New TMAU paper by Monell et al.
Conclusion (?) : TMAU might not just be because of FMO3 enzyme.
Paper funded by NORD grant crowdfunded by TMAU community in 2011.

Around 2009-2011 a TMAU community group spearheaded a crowdfunding campaign to get the NORD TMAU grant past it's $25K trigger point so that researchers could put forward proposals for the grant. The grant was awarded in 2011 to a Monell Chemical Senses proposal. This month the paper has been published in a peer journal.

NORD grant TMAU paper : Genetic analysis of impaired trimethylamine metabolism using whole exome sequencing

Conclusions
Thus, variants in genes other than FMO3 may cause TMAU and the genetic variants identified here serve as a starting point for future studies of impaired TMA metabolism.

My interp of the paper 

My interp is they are saying genetic TMAU may not just be just to FMO3 enzyme flaws. In particualr they mention PYROXD2 enzyme, which has been mentioned in TMAU circles before (can't recall why).  

My own view on the paper (bad analogy ... suspects and safehouses)
If you think of 'volatiles' as the suspects, and FMO3 as the safe-house, they are saying the suspect (TMA) stays at various safehouses, TMA is to blame for all the smells, and only TMA should be followed about even when it leaves FMO3 'house' to other safehouses.

My own current view is the only safehouse to watch is FMO3, and note all the 'volatiles' that stay there. In fact I reckon TMA is a 'small player' and other FMO3 'safehouse' suspects are more likley to blame for smells. Probably the likes of dimethylsulfide.

So this new paper has went in a direction that doesn't fit with my current thinking, but it is 'new' in that they are suggesting TMA might be metabolized by enzymes other than FMO3 (?).

Paper view
Current Safehouse : FMO3
Suspect : TMA is only suspect.
Paper : TMA might have other safehouses.

My View
Safehouse : FMO3
Suspect : many. TMA a small player
My view : No need to follow TMA. FMO3 is only safehouse that matters, Keep an eye on the all suspects at FMO3 house.

Overall, I think so little research has gone into FMO3 and TMA that we may be at 'chapter 1' of understanding them. As this was a small one-off study, I don't expect much more 'TMAU' research on it. But since TMA has been suggested as having a connection with cardiovascular disease, perhaps TMAU people will be able to read on such research from this aspect in future.

Other comments on the paper :

None of the 10 people seem to report fishy smell. Most report 'sulfury'/fecal smells
My impression is that Monell feel TMA causes a fishy smell, but through influence have broadened this to saying TMA might cause smells more broader than that. Personally I think the smells are not due to TMA, but to other volatiles (e.g. sulfides), and in a way TMA is probably a 'small player' but a good biomarker of FMO3 function (? not even sure about that).    

Only one has FMO3 mutations that would be regarded by clinicians as TMAU1 
In academia and the clinical world, the teaching is that genetic TMAU is caused by serious FMO3 mutations. But in this paper only one has taught 'serious' mutations (at codon 148). Or at least, I think faults at 148 are bad. I note that they are not the worst TMAU result in the paper (at about 56%).

All the other FMO3 faults listed are carriers of common 'benign' FMO3 faults

Common FMO3 variants carried by whites by %  :
codon 158 : 20-50% ?
codon 308 -  up to 20% ?
codon 257 -  up to 15% ?

As can be seen, many people carry common FMO3 variants. Currently they are taught as being 'benign'. But in the paper, of the 10 tested, many of them only carry one of these FMO3 faults (mainly 158). Obviously 50% of whites don't have metabolic smells, so it's still an unknown full picture to understand.

The worst TMAU urine result seemed to only carry a PYROXD2 DNA fault.
In this paper, the worst result was #52 who only carried a fault in PYROXD2 enzyme.

Worst result in paper : #52 ... TMAO% output 13% ... FMO3 faults : none ... PYROXD2 faults : carries one

The worst TMAU result had no FMO3 faults and only carried 1 PYROXD2 fault. This throws up more questions than answers. 5 carried PYROXD2 faults (3 were homozygous, 2 heterozygous).

PYROXD2 faults listed : Not in coding part of PYROXD2
To make a PYROXD2 protein, you need an amino acid code. These are the codons on the exons.
Genes also have introns, which are generally regarded as 'junk' or unknown.
In this paper, the PYROXD2 faults listed are in the intronic region (not the exons). So they are not even in the coding part of the enzyme gene.

example of how gene makes a protein.
FMO3 has 532 amino acid code to make the FMO3 protein
this means 532 codons.
Genes also have intron part.
Introns not needed to form the protein, but faults there seem to be able to disable the protein.

PYROXD2 
This enzyme has been listed before in one TMAU paper. I can't recall at the moment.

Final thoughts 
The paper is certainly interesting in that it raises questions about current TMAU  teaching. How much impact it will have ... possibly not much due to lack on interest in TMAU.

I will be looking around at PYROXD2 again in a mild way. My mind is currently too set on FMO3 and all it's sulfide/amine volatiles, rather than TMA.

I have no expertise and my interp and thoughts could be wildly wrong.
My impression is Monell can be sensitive about opinions.

My own current theory on systemic body odor/halitosis
Most people identify with 'fecal body odor'. I think this is due to sulfides, maybe some amines. I think it is due to problems with the FMO3 enzyme. Probably often a combo of FMO3 slight weakness and 'FMO3 substrate gut dysbiosis'.

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20 February 2017

Youtube : UK lady with TMAU, workmates smell her



A professional UK video production (Barcroft TV).
Only lasts 6 minutes.
UK Lady with diagnosed TMAU.
Her workmates can smell her.
Barcroft TV have done TMAU videos before.

Full TMAU story in Daily Mail

This video was just published on the Barcroft TV youtube channel. My impression was that Barcroft usually did productions for TV and later put them on their youtube, but this one is only 6 minutes long and I have not heard of it on TV. Perhaps it was on TV as part of a mix of health disorders.



Barcroft TV has a history of TMAU stories for TV. Examples :
'Help I smell of fish' documentary. (youtube)
2016 video of young London lady for Channel 5 'health-disorder' programme (click for youtube video)

Barcroft
It seems they have 2.5 million youtube subscribers, so any video on there gets a lot of exposure. Barcroft is a small UK production team originally set up to provide TV channels with programs. Perhaps now they are also specialising in short stories for their youtube channel too.
Barcroft story 2016
2014 news article

Comments on this video :

A workmate can smell her.
One workmate says they can smell her. and have had complaints. This is good 'witness' evidence as usually in the videos (or in any platform) no-one reports of smelling them. It shows how for example, a TMAU person may struggle in a workplace. Despite TMAU, she is married and working, though she seems to have picked nightshift to avoid people.

Not aware of  this lady.
I am not aware of this lady on the various TMAU online social hubs (e.g. forums etc). It goes to show that there are more out there we never hear of. Personally I think 'systemic malodor syndrome' could be perhaps 1-4% of any population.

Many thanks for the publicity to the disorder. She joins the TMAU 'Hall of Heroes'.

Current stats (day 2 of the video upload, 20 Feb 2017)
220k views.
Barcroft has 2.6 million subscribers.
5th most read story over last 30 days in Daily Mail Health Section (could go higher).
2nd most read Health Section story in Daily Mail over 7 days (could go higher).
322 Daily Mail comments.
9.4k Daily Mail shares.

Other links :
IBTimes article
   

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systemic BO/halitosis important links

MEBO Research malodor study 2016

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email :
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Do you have systemic body odor ?

FMO3 Survey Form

FMO3 DNA test result survey
for those who have FMO3 DNA tested
survey still OPEN

TMA blocker pill (links)

P&G - Cleveland press release aug 2015
1st mention of 'DMB pill' dec 2015
FMO3 DNA testing
Update Aug 17 :
Genos is back with it's EXOME test
link

Note :
Exome/Genome testing may be better option than single gene testing.

See this post : link

Note : Genos Exome Testing.

Exome testing is almost the same price now as single gene testing. Also Genos is consumer friendly, which standard DNA labs are not.

So the blog offer to test solely for FMO3 is almost obsolete, and so no longer offered.


Does Genos fully sequence FMO3 gene ?

At the moment it is not clear, but hoped this will become clear over the next few months

Note : possible 'wild west' way of testing FMO3
Use an ancestry dna site and rummage through the raw data

TMAU Webinar #5 : Preti et al