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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18785
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I think I have trimethylaminuria. I have bad breath, it sometimes

Resolved Question:

I think I have trimethylaminuria. I have bad breath, it sometimes smell of faeces, or "doggy". Please advise, as it causing me great distress.
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. D. Love replied 3 years ago.
Hello from JustAnswer I will be glad to assist you today.
How long has this been bothering you?
Have you have any previous evaluation?

Customer: replied 3 years ago.

I'm not sure how long, but certainly in the last 3-4 years?

Expert:  Dr. D. Love replied 3 years ago.
Thank you You do not mention any evaluation, so I assume that none has yet been done.

If you have done research on the topic, then you have probably already learned that this condition is rare, but obviously also have read the symptoms, since you suspect that you may have the condition.

The first step in consideration of trimethylaminuria is to perform an evaluation to make the diagnosis. This typically first involves measurement of the trimethylamine level in the urine. This is actually a measurement of the actual trimethylamine and the primary metabolic by product of the trimethylamine, the oxide derivative. Since the people with trimethylaminuria are deficient in the ability to metabolize the trimethylamine to the trimethylamine-oxide, then when comparing the relative amounts, there is relatively more of the trimethylamine and less of the trimethylamine-oxide.

Since this is simply looking at the relative amounts in the urine, this can be done on a random urine specimen; it does not require collection of the urine for 24 hours. If the test cannot be done quickly in your local lab, it will probably need to be frozen soon after collection, but that is the issue of the office at which the specimen is collected.

If you are found to have trimethylaminuria, the primary management is to avoid foods that are high in trimethylamine and similar compounds, such as choline. This will include restrictions of many foods, including milk, eggs, liver, kidneys, peas, beans, cabbage and related vegetables, seafood, and fish oil supplements. If this is ineffective, then there may need to be interventions to limit the production of trimethylamine by the natural germs in the gut, such as using activated charcoal to avoid absorption of the trimethylamine, using a laxative to speed transit time through the gut, or antibiotics to decrease the level of germs in the gut. A B vitamin, riboflavin, also may help improve the metabolism of trimethylamine.

It is important to note that the urine test will be more accurate if the person is eating a standard diet, so it would be better to not implement the dietary restrictions until after the urine testing is done.

So, the first step is to see your doctor to discuss testing the urine for levels of trimethylamine. Further management will depend upon the results of the urine test.

If I can provide any further information, please let me know.

Customer: replied 3 years ago.

Thank you, ***** ***** notice my urine has a funny odour. I am on a diary free diet. Also I do take cod liver oil, Evening primrose, flaxseed, so I will now stop these. I have high cholesterol hence the diary free. I also have gallstones. Trying to keep everything under control. I will see my G.P and get sorted. Thank you again,

Expert:  Dr. D. Love replied 3 years ago.
You're welcome. But again, don't follow too restrictive a diet, or the urine test will not be accurate. It is fine to continue the current diet restrictions, since your symptoms are occurring on the current diet, but don't change it otherwise, as it may cause a false test result.

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