Foods That Help with Trimethylamine Reduction

Trimethylaminuria (TMAU), or 'fish odor syndrome,' is a metabolic condition characterized by the body's inability to break down the compound trimethylamine (TMA), leading to a distinctive odor. Dietary changes are the primary management strategy for this condition, focusing on reducing foods high in TMA precursors like choline and carnitine. Understanding which foods to incorporate and which to limit is crucial for individuals seeking relief from the associated symptoms.

Quick Summary

This article outlines a dietary approach for managing trimethylamine levels by focusing on low-choline and low-carnitine foods. It details food groups to restrict, highlights beneficial plant-based options and gut-supporting nutrients, and explains other supportive measures to help manage symptoms.

Key Points

• Low-Choline Diet: Focus on consuming foods low in choline, such as egg whites, freshwater fish, and most fruits and vegetables, to reduce TMA production.

• Avoid High-Choline Foods: Limit or eliminate marine fish, egg yolks, liver, legumes, and brassicas like broccoli and cabbage, which contain high levels of TMA precursors.

• Enhance Gut Health: Increase intake of dietary fiber and consider probiotics to promote beneficial gut bacteria and improve overall digestion.

• Incorporate Natural Inhibitors: Consider adding compounds like DMB, found in olive oil and red wine, which can inhibit microbial TMA production.

• Support with Supplements: Supplements like activated charcoal or riboflavin can offer supportive benefits by sequestering TMA or boosting FMO3 enzyme function.

The Link Between Diet and Trimethylamine

Trimethylamine (TMA) is a volatile, pungent chemical produced in the gut by bacteria metabolizing specific dietary compounds. In individuals with a functional flavin-containing monooxygenase 3 (FMO3) enzyme, TMA is converted into the odorless trimethylamine N-oxide (TMAO). However, for those with genetic or secondary trimethylaminuria (TMAU), the FMO3 enzyme is compromised, leading to an excess of TMA. The key dietary strategy is to limit the intake of TMA precursors to reduce the load on the body's metabolic system.

Foods to Favor for Trimethylamine Reduction

An effective dietary plan to manage TMA involves shifting towards a plant-based diet rich in low-choline foods, fiber, and certain phytochemicals.

Low-Choline Protein Sources

Focus on protein sources naturally lower in choline:

• Egg whites
• Tofu and lentils
• Freshwater fish (trout, some farm-raised salmon)
• Small portions of meat

Fiber-Rich Plant Foods

Promoting beneficial gut bacteria with fiber can help regulate TMA production.

• Most fruits and vegetables are low in choline.
• Legumes in moderation.

Probiotics and Fermented Foods

Modulating gut microbiota can help balance the gut ecosystem.

• Yogurt, kefir, kimchi, and kombucha.
• Specific Lactobacillus and Bifidobacterium strains.

Other Beneficial Foods and Supplements

• Riboflavin (Vitamin B2) may enhance FMO3 activity.
• Activated charcoal and copper chlorophyllin can sequester TMA in the gut.
• DMB (3,3-dimethyl-1-butanol), found in balsamic vinegar, red wine, and olive oil, may inhibit microbial TMA production.

Foods to Limit or Avoid

Limit foods high in TMA precursors.

Table: Foods to Restrict vs. Favor on a Low-Choline Diet

Food Category	Foods to Limit/Avoid	Foods to Favor (Lower in Choline)
Protein	Egg yolks, beef liver, kidney, beef, pork, marine fish (cod, tuna, shellfish)	Egg whites, freshwater fish (trout), tofu, lentils, beans (in moderation)
Vegetables	Brassicas (broccoli, cauliflower, Brussels sprouts, cabbage)	Lettuce, spinach, carrots, potatoes, onions, mushrooms, celery, peppers
Dairy	Milk from wheat-fed cows, high-fat dairy products	Regular cow's milk (not wheat-fed), cheese, yogurt (monitor tolerance), nut or rice milks
Supplements	Choline, L-carnitine, lecithin, most fish oil supplements	Riboflavin (Vitamin B2), activated charcoal, copper chlorophyllin, lipid-soluble choline in supplements like krill oil (less effect on plasma TMAO)
Other	Soy products (including soybeans and some soy milks)	Most grains (bread, rice, pasta, oats), most fruits, non-soy plant-based foods

Management Strategies Beyond Diet

Diet is key, but other measures can help. Short courses of specific antibiotics can reduce gut bacteria. Using slightly acidic soaps can minimize TMA volatilization on skin. Reducing stress and avoiding excessive sweating can also help. Consulting a dietitian is recommended.

Conclusion

A focused dietary strategy is the most effective approach for managing trimethylaminuria symptoms. Limiting high-choline and high-carnitine foods and prioritizing low-choline alternatives can significantly reduce TMA production. Supporting gut health and considering certain supplements can also aid in odor control. Professional consultation is recommended for a tailored plan.

Frequently Asked Questions

What foods should I avoid if I have high trimethylamine?

You should avoid or limit foods high in TMA precursors, including egg yolks, marine fish and shellfish, liver and kidney, soy products, and legumes like beans and peas.

Can a plant-based diet help with trimethylaminuria?

Yes, a plant-based diet can be very helpful as it naturally restricts many high-choline animal products. Plant-based proteins generally contain less choline, and a high fiber intake promotes beneficial gut bacteria.

Are there specific supplements that help reduce trimethylamine?

Activated charcoal and copper chlorophyllin are supplements that can bind to and sequester TMA in the gut. Riboflavin (Vitamin B2) can also be used to enhance residual FMO3 enzyme activity.

Should I avoid all fish to reduce trimethylamine?

No, you do not need to avoid all fish. Marine fish and shellfish contain high levels of TMAO, which is converted to TMA, but freshwater fish and some farmed salmon have significantly lower levels and may be tolerated.

What role do gut bacteria play in trimethylamine levels?

Gut bacteria metabolize precursors like choline and carnitine into TMA. For individuals with TMAU, an overgrowth of specific bacteria can lead to excessive TMA production.

How can I check my tolerance to certain foods?

Monitoring your body's response to different foods and working with a dietitian to adjust your diet is the best approach. Keeping a food journal can help identify individual triggers.

Are brassica vegetables always bad for TMAU?

Some brassicas like Brussels sprouts and cauliflower can contain indoles that may inhibit the FMO3 enzyme, worsening symptoms for some. Test your tolerance and moderate intake, or choose low-FODMAP options like kale or bok choy.