I have experienced this.
I think it happens if you ate something wrong a day before and your
system is already clogged.
My other bad experiences were drinking hot herbal teas - better if cold
(OK do drink it hot in the evening).
Sugar is a killer, of course. wheat is not good either. a bite of
orange could be OK, but would create noise in my stomach (can you
imaging having it in a cubicle, surrounded by lots of people!). a piece
of banana was OK, unless I was stressed.
Hard to say what is a perfect breakfast when your body is in the
congested mode. I tried to eat just a small carrot. sometimes it was
Ok, sometimes it was not. What about a serving of white rice (no salt,
no butter)?

I hope everyone is doing well.

Question - Has anyone experienced an odor immediately after eating?
If so, does the odor eventually subside? Also, if this has happened
to you, what were you eating (food type, amount, temperature, etc.)
and how do you eat lunch at work without causing a disruption? Also,
is the odor worse in the morning when you arrive to work? If so, how
do you manage it? Do you have success with eating breakfast and
taking supplements as a part of your morning routine?

Over the years, I've greatly improved these "odor outbreaks" by diet
and daily exercise. However, every now and again, I get too busy to
be mindful of my routine. I'm looking for other ways of managing this
issue.

Thanks for any advice you have and if you have any questions for me,
feel free to ask.

Much love and many blessings to all of you,

Tweet

Try to remain strong at the appointment. Just say I would like this
test and are you willing to help me.

You have done your research now so it is your doctors turn. Either send
it in ahead or ask them to call you after they review the material.
Most likely they won't know about TMAU and will need time to read it.

Congradulations on getting to this point and let us know how it goes
and any advise you would give to someone.

Sharon+

--- In Trimethylaminuria@yahoogroups.com, "reneeme41" <reneeme41@...>
wrote:
>
> Hi,
>
> I am going to see the doctor on Monday I sent him a copy of the info
on
> your site but I want to know if there is anything else I can do or
say
> to the doctor that will make him look into my problem deeper.  In the
> past he only checked to see if I had a yeast infection.
>

Hi,

I am going to see the doctor on Monday I sent him a copy of the info on
your site but I want to know if there is anything else I can do or say
to the doctor that will make him look into my problem deeper.  In the
past he only checked to see if I had a yeast infection.

They usually have a waiting list,I would be surprised if they can see you in
March but you can certainly try. When I called a couple of years ago,there was a
6 month wait. I ended up mailing my urine samples to Colorado.


---- sharnsk <sharnsk@...> wrote:
> Mercy,
>
> You will give it to them at your visit. Here is their link and look
> under TMAU diagnostic protocol.
>
> Sharon+
>
>
>
> --- In Trimethylaminuria@yahoogroups.com, mercy kimani
> <kanyoni16@...> wrote:
> >
> > Hi Sharon;
> > I didn't know monnell had put a hold on testing. I'll contact them
> again to see if I can get tested in March which is around the time
> I'll be visiting my family who live in the area. The one thing I
> really dread is going back to eating all those problem foods which
> I've avoided like the plague for months now.  Anyway; thats the
> stinky price I have to pay to find out once and for all.  
> > one more question; will they require me to send the samples
> beforehand? I know I can buy supplies and dry ice, etc; and the
> instructions on collecting are very clear; but I'm still so afraid of
> contaminating and causing false results.
> > I'll keep you posted.
> > Mercy.
> >
>
>

Mercy,

You will give it to them at your visit. Here is their link and look
under TMAU diagnostic protocol.

Sharon+



--- In Trimethylaminuria@yahoogroups.com, mercy kimani
<kanyoni16@...> wrote:
>
> Hi Sharon;
> I didn't know monnell had put a hold on testing. I'll contact them
again to see if I can get tested in March which is around the time
I'll be visiting my family who live in the area. The one thing I
really dread is going back to eating all those problem foods which
I've avoided like the plague for months now.  Anyway; thats the
stinky price I have to pay to find out once and for all.  
> one more question; will they require me to send the samples
beforehand? I know I can buy supplies and dry ice, etc; and the
instructions on collecting are very clear; but I'm still so afraid of
contaminating and causing false results.
> I'll keep you posted.
> Mercy.
>

Several of us have had our computers hacked and worse. I found these two free programs for a PC that seem to be helpful. Any  suggestions of things to do to prevent this please let us know.

Changing security settings is helpful but too complicated for me to explain. The hackings were not done at Yahoo, MSN or the new Body Odor site.

Free Windows® Defender by Microsoft for Windows XP.  Already included in the Vista versions. You may need to copy and paste this link as it is too long.

http://www.microsoft.com/windows/products/winfamily/defender/default.mspx

Free SPYBOT: the best according to PC World, PCMag
http://www.safer-networking.org/en/home/index.html

Mercy,

Monell's testing, as well as Colorado's, was on hold. I am sure when
they finish the back log they will contact you. Just to be safe I
would contact them again.

You still do the collecting of the urine to give them. If you need
help with understanding that let me know.

You can also be seen in person at the Arkansas Children's Hospital
but need a doctors to refer you there.

Do you live in the US?

Sharon+

--- In Trimethylaminuria@yahoogroups.com, mercy kimani
<kanyoni16@...> wrote:
>
> No; Monnell center totally stopped communicating with me; even
after I told them I could wait for as long as it would take. I've
read about places where you can send your urine sample in but I'm not
comfortable doing this as I may contaminate and cause a false
negative/positive. At monnell you have to go in in person. It would
be the cheapest option for me  not to mention, I have family in the
area that I can stay with. I will try and convince them again and see
what happens.
> Thanks,
> mercy
>

Do you mean Monnell in Pensylvania? You don't have to go in person,you can if
you want but you have to make an appointment and you could be waiting a while.
You can mail them your urine sample if you choose.


---- mercy kimani <kanyoni16@...> wrote:
> No; Monnell center totally stopped communicating with me; even after I told
them I could wait for as long as it would take. I've read about places where you
can send your urine sample in but I'm not comfortable doing this as I may
contaminate and cause a false negative/positive. At monnell you have to go in in
person. It would be the cheapest option for me  not to mention, I have family
in the area that I can stay with. I will try and convince them again and see
what happens.
> Thanks,
> mercy
>
>
>

The Sydney 'Sunday Telegraph' ran a story this month that called for
the immediate removal of Alcohol-based mouthwash from supermarket
shelves.

Mouthwash linked to cancer
By Clair Weaver
January 11, 2009 12:00am

AUSTRALIA'S top-selling mouthwashes can cause oral cancer and should
be pulled from supermarket shelves immediately.

Leading independent experts have issued this strong warning after
investigating latest scientific evidence linking alcohol-containing
mouthwashes to the deadly disease.

Their review, published in the Dental Journal of Australia, concludes
there is now ``sufficient evidence'' that "alcohol-containing
mouthwashes contribute to the increased risk of development of oral
cancer''.

The ethanol in mouthwash is thought to allow cancer-causing
substances to permeate the lining of the mouth more easily and cause
harm.

Acetaldehyde, a toxic by-product of alcohol that may accumulate in
the oral cavity when swished around the mouth, is also believed to be
carcinogenic.

Listerine, the nation's biggest-selling mouthwash and a brand
endorsed by the Australian Dental Association (ADA), contains as much
as 26 per cent alcohol.

Mouthwash is one of the fastest-growing grocery products in
Australia, with the category now worth more than $75 million,
according to latest Nielsen market research.

Lead review author ProfessorMichael McCullough has told The Sunday
Telegraph alcohol-containing mouthwash should be reclassified as
prescription-only and carry written health warnings.

Prof McCullough, chair of the ADA's therapeutics committee and
associate professor of oral medicine at the University of Melbourne,
is calling on the ADA to urgently re-assess its seal of approval on
mouthwashes containing alcohol.

"We see people with oral cancer who have no other risk factors than
the use of alcohol-containing mouthwash, so what we've done in this
study is review all the evidence that's out there,'' he said.

"Since this article came out, further evidence has come out too. We
believe there should be warnings.

"If it was a facial cream that had the effect of reducing acne but
had a four- to five-fold increased risk of skin cancer, no one would
be recommending it.''

Oral cancer is a gruelling and mutilating disease that afflicts more
than 800 Australians each year and kills half of them within five
years of being diagnosed.

Smoking and alcohol consumption are well-established risk factors,
but alcohol-containing mouthwash use is more controversial.

Prof McCullough and co-author Dr Camile Farah, director of research
at the University of Queensland's School of Dentistry, recommended
mouthwash be restricted to ``short-term'' medical use or replaced by
alcohol-free versions.

"(We) further feel it is inadvisable for oral health-care
professionals to recommend the long-term use of alcohol-containing
mouthwashes,'' they concluded.

The review reported evidence from an international study of 3210
people which found daily mouthwash use was a "significant risk
factor'' for head and neck cancer, irrespective of whether users also
drank alcohol or smoked.

But the effects of mouthwash were worst in smokers, who had a nine-
fold increased risk of cancers of the oral cavity, pharynx and larynx.

Those who also drank alcohol had more than five times the risk - and
even those who neither drank nor smoked still ran a four- to five-
fold risk of contracting cancer.

A Brazilian study has also found regular mouthwash use is associated
with oral cancer regardless of alcohol or tobacco consumption.

"Mouthwash products are in contact with the oral mucosa as much as
alcoholic beverages, and may cause chemical aggression of the
cells,'' researchers from the University of Sao Paulo said.

They said the role of ethanol in causing DNA damage needed to be
explored further.

A review in the Journal of Occupational Medicine and Toxicology last
year said it would be "prudent, precautionary public-health policy to
generally refrain from using ethanol in (mouthwash) products''
because of  "doubts about the safety of alcohol-containing oral
products''.

Prof McCullough said the most popular mouthwashes contained higher
concentrations of alcohol than drinks such as wine or beer.

"If you have a glass of wine, you tend to swallow it,'' he said.

"With mouthwash, you have a higher level of alcohol and spend longer
swishing it around your mouth.

"The alcohol that is present in your mouth is turned into
acetaldehyde.''

Regular alcohol consumption was a cancer risk, Prof McCullough said,
but usually did not involve swishing it around the mouth.

Eating while drinking increased salivation, which lowered the risks,
he said.

"The most significant difference (between alcohol and alcohol-
containing mouthwash) is that one is for pleasure and the other is
being recommended as a health product.''

Cancer Council NSW chief executive Andrew Penman said the review
was "interesting'', but called for further research.

"I think it's quite a well-thought-out proposition, but it does
warrant further investigation,'' he said.

Copy and paste this whole link to reach original news article.

http://www.news.com.au/dailytelegraph/story/0,22049,24896583-
5001021,00.html

27 January 2009

Hey Team:

I do NOT care how rough things, get-----y'all have to stay positive.
Over 70,000 jobs were slashed on 26 January 2009

It is probably going to get worse before it gets better (just being
real here).  However the story below [suicide] is so very sad and I
hope no one on this e-mail list is even considering doing something
like this, team it AIN'T worth it!   Team it's going to rain in your
life, but trust me the sun really does come peeping through the
clouds and it gets better.  (Trust me, I have been there and done
that!)

Remember life can throw you some strange twists and turns, but it is
only TEMPORARY, it can not last forever.

You may not have any money today in your checking account, your house
is going into foreclosure, you just got laid off without notice from
your job, your car is being towed by the repo man/woman as you read
this e-mail, your income tax refund check has been withheld by the
IRS, your telephone/cellphone has been cut off, tomorrow your water
will be cut off,  the kids need new clothes, you have no medical
insurance (so that severe pain in your chest will just have to wait
another month or so), you have received notice that in four days your
gas/lights will be shut off, you just received a certified letter
stating your paycheck is going to be garnished this pay period (but
you just got laid off today!), your phone is ringing constantly as
the bill collectors call from 8am to 9pm EVERYDAY, you hate to go to
your mailbox because it is filled with past due bills (and you just
got laid off!), you are afraid to answer your front door it could be
the landlord with an eviction notice (again), you and the kids are
hungry there just is not enough food to go around (you have not had a
decent meal in months as you try to conserve energy, food resources,
and your budget), your spouse/significant other bolts out on you---
leaving even more unpaid bills, you try to apply for food
stamps/welfare and you do not qualify; there appears to be no HOPE
for you-----but even through all of this you all have to find
the "POSITIVE", side.

IF it helps sing the old gospel song (one of my late
Grandmother's/"Granny's favorites!), "I Won't Complain".

It helps me on my good and bad days.  I could have more (and who
doesn't want a 2009 customized Rolls Royce sitting in front of their
home?), but I also know I could be sleeping in my car or worse under
a bridge with just the clothes on my back, thus; I WON'T COMPLAIN,
about anything!

I am Blessed and Happy!

The key is staying happy with yourself.  I am content, happy, and
satisfied.  I am REAL with myself, nothing fake about me.  None of
that phony baloney mess.  The only thing about "faking it" is that at
the end of the day when you look in the mirror, you see yourself in
the real light anyway!  So why fake it.  Acknowledge your situation,
access your options, and take a positive stand to change your
situation.  Be proactive and encourage/empower yourself.  (Trust me
ain't no one going to send you a million dollars or a million dollars
will not fall out of the sky, team.)

Just think about other people and the terrible times they are
having.  You may not have what you want right now, but trust me it
could be a lot worse.

I can't imagine not having something to eat (although I may eat way
too much, but I am eating! lol!).  I can't imagine not being able to
turn on a light or watch cable TV, yeah simple basic stuff, but yet
some of us still complain.  Remember the song team "I Won't Complain,
remember each day how Blessed you are.  Print this out and place on
your forehead if you need to remind yourself.  (Well okay, maybe not
your forehead, but maybe on the ice box!)

Very Sincerely,
Respectfully,


Cheryl "StillStanding"  Fields, MBA, Ph.D. (ABD)
(425)-282-4738-Home/Voice-mail

----------------------------------------------------------------------
----------

By THOMAS WATKINS, Associated Press Writer Thomas Watkins, Associated
Press Writer – 37 mins ago, 27 January 2009 {Yahoo! News}



LOS ANGELES – A man who fatally shot his wife, five young children
and himself Tuesday had earlier faxed a note to a TV station claiming
the couple had just been fired from their hospital jobs and together
planned the killings as a final escape for the whole family. "Why
leave the children to a stranger?" Ervin Lupoe wrote, according to
KABC-TV.

The station called police after receiving the fax, and a police
dispatch center also received a call from a man who stated, "'I just
returned home and my whole family's been shot."

Officers rushed to the home in Wilmington, a small community between
the ports of Los Angeles and Long Beach, about 8:30 a.m., apparently
within minutes of the killings. Officers could still smell the
gunshot residue in the air.

Although the fax asserted that Ana Lupoe planning the killings of the
whole family, police Lt. John Romero said Lupoe was the suspect. A
revolver was found next to his body.

Ana Lupoe's body was found in a downstairs bedroom with the bodies of
the couple's twin 2-year-old boys. The bodies of an 8-year-old girl,
twin 5-year-old girls were found alongside Lupoe's in an upstairs
bedroom.

It was the fifth mass death of a Southern California family by murder
or suicide in a year. Police urged those facing tough economic times
to get help rather than resort to violence

"Today our worst fear was realized," said Deputy Chief Kenneth
Garner. "It's just not a solution. There's just so many ways you find
alternatives to doing something so horrific and drastic as this."

Lupoe removed three of the children from school about a week and a
half ago, saying the family was moving to Kansas, the school
principal told KCAL-TV. Crescent Heights Elementary School Principal
Cherise Pounders-Caver said nothing seemed to be troubling Lupoe at
that time; she did not ask why the family was moving.

Kaiser Permanente Medical Center West Los Angeles released a
statement confirming both Lupoe and his wife worked there; both were
medical technicians.
"We are deeply saddened to hear of the deaths of the Lupoe family,"
it said in a statement.

In the letter he faxed to a TV station, Ervin Lupoe claimed he and
his wife both had been fired and that she suggested they kill
themselves and their children, too. Police described the fax but did
not release the details.

KABC reported that the man claimed in the fax that a medical center
administrator rebuffed them when they showed up to work, told them to
file a union grievance and said, "You should have blown your brains
out."

Lupoe wrote that they filed a grievance but nothing was done and two
days later they were fired, KABC said.

"They did nothing to the manager who started such and did not attempt
to assist us in the matter, knowing we have no job and five children
under 8 years old with no place to go. So here we are," the note said.

At the bottom of the note, Lupoe wrote, "Oh lord, my God, is there no
hope for a widow's son?"

The Kaiser Permanente statement made no comment on the claims in
Lupoe's fax.

"He was going through some critical situations at the job, that's
what he described in that two-page letter, ongoing problems at the
job, and that's what prompted him to take his own life and his
family's, from what was said in the fax letter," Garner said.

The two-story home, much larger than its one-story neighbors, sits in
front of a railroad track in Wilmington, a small community about 18
miles south of downtown. A children's playset stood in the backyard.

Retired truck driver Jaime Solache, who lives a few doors down, said
many of these newer, larger homes in the neighborhood had gone into
foreclosure. The Lupoe house, which has a sign hanging above the
driveway reading "The Lupoe's Pad," is about 6 years old, Solache
said.

News of the killings sent shivers through the community, and several
neighbors came to the yellow police tape to watch a steady procession
of officials enter and leave the home.

"This area right here is quiet, calm," said Armando Chacon, who lives
one block north. "People like to sit out at weekends and barbecue.
Other than this, no problems at all."

A community meeting was planned later Tuesday in a local church.

It was the fifth mass death of a Southern California family by murder
or suicide in a year.

On Dec. 24, a man dressed up as Santa Claus invaded a Christmas Eve
party at his ex-wife's parents' home in suburban Covina. His ex-wire
and eight of her relatives died from gunshots or in the house fire he
set. The man later killed himself.

In October, an unemployed financial manager despairing over extreme
money problems shot and killed his wife, three children, mother-in-
law and himself in their home in the Porter Ranch area of the San
Fernando Valley.

In June, five members of a Turkish-American family, clad in black,
were found dead in an upscale home in San Clemente. Investigators say
it was apparently a suicide pact but the reason is a mystery.

This article can be found in our file section but lately we have had
several requests for it. Woman want to copy this and bring it to
their MD.

So just to share this again here it is:

http://www.femalepatient.com/html/features/031_03_010.asp

Trimethylaminuria: A Noninfectious Cause of Vaginal Odor

S.C. Mitchell, DSc, FRCPath; R.L. Smith, DSc, (Hon)MRCP; J.R. Harris,
FRCP, FRCP(I)

The distinctive –fishy" vaginal odor—traditionally linked with a
number of infections of the lower genital tract—is emerging as a
disorder in its own right.



ABSTRACT

Two patients who were previously diagnosed with inherited (primary)
fish-odor syndrome (trimethylaminuria) were examined for the presence
of trimethylamine in their vaginal secretions. Their samples were
compared with those obtained from a healthy control group and a
cohort of patients with bacterial vaginosis (BV). As expected, those
with BV secreted larger amounts of trimethylamine than the control
group. However, the two patients with trimethylaminuria—although
presenting with no vaginal/cervical pathology—secreted trimethylamine
levels that were at least double those found in the patients with BV.
This suggests that trimethylaminuria may be an underlying but
unappreciated cause of vaginal malodor (especially fish-like odor) in
patients found to be infection-free.

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----------------------------------------------------------------------
----------


INTRODUCTION

Vaginal malodors are usually associated with infection. An odor
resembling decaying fish is almost diagnostic of BV—ie, anaerobic
vaginosis, nonspecific vaginitis, Gardnerella vaginalis vaginitis,
Haemophilus vaginalis vaginitis—one of the most common conditions
diagnosed in women attending genitourinary clinics in England and the
United States.1-5 Biochemical examination of vaginal-wash specimens
obtained from patients with BV have shown increased amounts of
acetate and succinate, together with occasional higher levels of
other short-chained organic acids such as propionate, butyrate,
isobutyrate, and isovalerate.5,6 The two alkyldiamines, putrescine
and cadaverine, have also been identified, as have elevated amounts
of the monoamine compounds methylamine, trimethylamine,
isobutylamine, phenylethylamine, tyramine, and histamine.7-9.

Many of these compounds (which are thought to arise from bacterial
metabolism) may contribute to vaginal malodor. However, it is the
amine components—particularly the volatile trimethylamine—that are
probably responsible for the distinctive fish-like aroma.9,10

One condition that is particularly associated with a fish-like odor
is trimethylaminuria. In its primary genetic form, trimethylaminuria
is caused by the failure of an isoform of the hepatic flavin-
containing monooxygenase enzyme 3 (FMO3) to oxidize trimethylamine,
provided via enterobacterial action on dietary precursors, into
nonodorous trimethylamine N-oxide.11 The resulting excess volatile
trimethylamine leaves the body via the sweat and urine, and affected
women often seek treatment for distressing vaginal malodors.12-14

Until recently, trimethylaminuria was thought to be a rare condition.
However, a clearer understanding of the problem (particularly at the
genomic level), plus the development of relatively simple diagnostic
procedures, has led to the identification of more cases.11,15,16 To
determine whether women with this condition may have problems with
vaginal malodor, the authors examined the trimethylamine levels in
normal vaginal secretions from two trimethylaminuria patients and
compared them with those found in a healthy control population and in
subjects with BV.

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----------------------------------------------------------------------
----------


METHODS

Subjects

Two patients who were previously diagnosed with primary
trimethylaminuria following extensive investigation—together with
their parents and siblings—volunteered for the study.13,17-19
Subjects for the comparison groups were selected from women attending
the Department of Genito-Urinary Medicine at Saint Maryês Hospital,
London, England. Women were excluded from the study if they were
younger than age 16 years, were menstruating or pregnant, were
receiving or had received antibiotics or topical vaginal treatments
within the previous month, or had a high risk of hepatitis B or human
immunodeficiency virus infection. All patients gave their informed
consent, and the local ethics committee approved the study.

Diagnosis

Trimethylaminuria.—The two female patients with trimethylaminuria
were referred via their physicians after presenting with a history of
body odor and urine smelling of rotting fish. Quantitative analysis
of their urine (0 to 24 hours) for trimethylamine and its N-oxide
showed that these subjects were relatively deficient in N-oxidation
capacity. A subsequent oral trimethylamine load test confirmed this N-
oxidation deficiency, and also indicated the heterozygous status of
their parents.18,19 Examination of nucleic acid samples taken from
the patients, their siblings, and their parents demonstrated the
presence of a point mutation within the chromosome region encoding
for FMO3, and this was associated with a dysfunctional enzyme. This
particular chromosome region has subsequently been shown to be highly
polymorphic.11,13,15

Bacterial Vaginosis.—Secretions were collected from the lateral
vaginal fornix with a cotton-wool-tipped swab to measure pH using
indicator paper. A positive amine-test result was recorded when a –
fishy" odor was released following addition of vaginal secretions to
a small volume of 20% aqueous potassium hydroxide. Specimens were
taken from the urethra and endocervix with plastic culture loops (10
mcL) for preparation of gram-stained smears and saline wet mounts
that were examined by oil-immersion and phase-contrast microscopy.
Additional aliquots of these secretions were transported to the
microbiology laboratory for subsequent culture for Neisseria
gonorrhoeae and yeasts, specifically Candida albicans. Chlamydial
infection was sought by a positive reaction with an enzyme-linked
immunosorbent assay (ELISA) for Chlamydia trachomatis antigen.
Cultures for herpes simplex virus and serologic tests for syphilis
were performed when clinically indicated. Bacterial vaginosis was
diagnosed in women meeting three of four criteria—ie, a thin,
homogenous vaginal discharge; vaginal pH > 4.5; a positive amine-test
result; and the presence of –clue cells" (squamous vaginal epithelia
covered with bacteria) on saline wet mount.

Trimethylamine Analysis

Secretions were collected from the lateral vaginal fornix using a
cotton-wool-tipped wooden swab that was then placed in an airtight,
screw-capped vial containing hydrochloric acid (0.5 mL). The vials
were immediately frozen at -20çC and transported to the laboratory
for subsequent analysis by head-space gas chromatography.20 All
analyses were undertaken in duplicate, with high-amine samples
diluted as appropriate.20

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----------------------------------------------------------------------
----------


RESULTS

As the amount of vaginal secretion initially collected onto the swab
and the amount of secretion subsequently extracted from the swab into
the hydrochloric acid solution undoubtedly varied from patient to
patient, quantitative analyses of these samples were not attempted.
However, the integrated peak areas provided an accurate measure of
trimethylamine presented to the analysis procedure, and thus served
as a semiquantitative guide (rank) for the relative amount of amine
initially present in the vaginal secretions (Table).

For the control (N = 39) and BV (N = 38) groups, no significant
statistical differences were found between the age of the patients
and the presence of trimethylamine in their vaginal secretions
(product moment correlation coefficient, Studentês t-test between
subgroups). Also, no statistically significant differences were
observed when groups of smokers (control N = 10, BV N = 24) versus
nonsmokers, or oral contraceptive users (control N = 9, BV N = 12)
versus nonusers were compared (x-squared test). There were more
patients in the BV group with higher trimethylamine levels (20 to 39
mcg) than would be expected when compared with healthy controls (P
< .01, x-squared test). The two patients with trimethylaminuria, who
were both nonsmokers and free from any vaginal/cervical pathology,
had trimethylamine levels that were very high (> 80 mcg)—ie, at least
100% greater than the patients with BV and 300% greater than controls
(Table).

Table not available online
  Table. Trimethylamine Levels in Subjects' Vaginal Secretions


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----------------------------------------------------------------------
----------


DISCUSSION

The observation that the group of patients diagnosed with BV had
higher levels of trimethylamine in their vaginal secretions than
would have been expected when compared with healthy subjects supports
the view that trimethylamine is a major contributor to the malodor
associated with this condition.9 This is not surprising, as a –fishy"
odor (especially in an alkaline environment) is almost diagnostic of
BV. That trimethylamine is generated by the vaginal microbial flora
is implied in the successful treatment of BV with metronidazole and
the subsequent loss of malodor. Indeed, studies have shown the
disappearance of short-chained organic acids following such
treatment, suggesting alterations in the vaginal microbial
ecosystem.5 It is also possible that oral metronidazole may decrease
the enterobacterial liberation of trimethylamine from dietary
precursors, thereby reducing gastrointestinal absorption and the
subsequent amount of amine available for secretion into the vagina.
This hypothesis appears to be contradicted by previous observations,
where no significant association was evident between the urinary
trimethylamine concentration and that in the vaginal discharge,9
although another published study intimates in its favor.21

Nevertheless, in the present investigation, the two patients with
trimethylaminuria exhibited levels of trimethylamine far greater than
those seen in the patients with BV—who also typically complain of a
fishy vaginal odor. The absence of vaginal/cervical pathology in
patients with trimethylaminuria precludes bacterial infection as a
cause, and implies that excessive amounts of trimethylamine must be
reaching the vaginal secretions from other sources. A single large
dose or a weekês course of oral metronidazole (or tinidazole), a
standard treatment for BV, may well be initially effective for
treating trimethylaminuria, decreasing the ability of the
gastrointestinal microbes to liberate trimethylamine from dietary
precursors and hence reducing trimethylamine uptake and circulatory
levels.16 However, with the cessation of medication and the
reestablishment of the gastrointestinal microorganisms, the vaginal
malodor will reappear.

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CONCLUSION

The possibility of trimethylaminuria as an underlying, but
unappreciated, cause in patients who present with fish-like vaginal
malodor should be considered —especially when no infectious cause can
be identified. Although the two patients reported here displayed the
primary genetic form of trimethylaminuria, thereby inheriting a
relatively inefficient flavin monooxygenase system, 11 the
consequences may be partially offset by decreasing the substrate load
that the enzyme has to process. Modification of the diet to decrease
trimethylamine intake has led to a reduction in odor problems, and
appears to be an appropriate step in the management of this
condition. 22-24

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ACKNOWLEDGEMENT

The authors would like to thank Dr R. Ayesh and staff in the Genito-
Urinary Clinic of Saint Maryês Hospital, London, England, for
assistance in the collection of clinical samples.

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S.C. Mitchell, Dsc, FRCPath, is a reader in drug metabolism, Faculty
of Medicine, Division of Biomedical Sciences. R.L. Smith, DSc, (Hon)
MRCP, is emeritus professor of pharmacology, Faculty of Life
Sciences, Division of Biomedical Sciences. Both are at the Imperial
College, Sir Alexander Fleming Building, South Kensington, London,
England. J.R. Harris, FRCP, FRCP(I), is consultant physician in
genitourinary/HIV medicine, Saint Mary's Hospital, Faculty of
Medicine, Imperial College, Paddington, London, England.


References

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KK. Diagnosis and clinical manifestations of bacterial vaginosis. Am
J Obstet Gynecol. 1988;158(4):819-828.
Hillier S, Holmes KK. Bacterial vaginosis. In: Holmes KK, Mardh PA,
Sparling PF et al, eds. Sexually Transmitted Diseases. 2nd ed. New
York, NY: McGraw-Hill; 1990:547-559.
Martius J, Krohn MA, Hillier SL, Stamm WE, Holmes KK, Eschenbach DA.
Relationships of vaginal Lactobacillus species, cervical Chlamydia
trachomatis and bacterial vaginosis to preterm birth. Obstet Gynecol.
1988;71(1):89-95.
Winceslaus SJ, Calver G. Recurrent bacterial vaginosisãan old
approach to a new problem. Int J STD AIDS. 1996;7(4):284-287.
Spiegel CA, Amsel R, Eschenbach D, Schoenknecht F, Holmes KK.
Anaerobic bacteria in nonspecific vaginitis. N Engl J Med. 1980;303
(11):601-607.
Hill LV. Anaerobes and Gardnerella vaginalis in non-specific
vaginitis. Genitourin Med. 1985;61(2):114-119.
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fluid from untreated and treated patients with nonspecific vaginitis.
J Clin Invest. 1979;63(5):828-835.
Chen KC, Amsel R, Eschenbach DA, Holmes KK. Biochemical diagnosis of
vaginitis: determination of diamines in vaginal fluid. J Infect Dis.
1982;145(3): 337-345.
Brand JM, Galask RP. Trimethylamine: the substance mainly responsible
for the fishy odor often associated with bacterial vaginosis. Obstet
Gynecol. 1986;68(5): 682-685.
Clay JC. The odour of non-specific vaginitis: a review. Eur J Clin
Microbiol. 1982;1(5):317-319.
Mitchell SC, Smith RL. Trimethylaminuria: the fish malodor syndrome.
Drug Metab Dispos. 2001;29(4 pt 2):517-521.
Ayesh R, Mitchell SC, Zhang A, Smith RL. The fish odour syndrome:
biochemical, familial, and clinical aspects. BMJ. 1993;307(6905):655-
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Missense mutation in flavin-containing mono-oxygenase 3 gene, FMO3,
underlies fish-odour syndrome. Nat Genet. 1997;17(4):491-494.
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(4):514-526.
Cashman JR, Camp K, Fakharzadeh SS, et al. Biochemical and clinical
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related to trimethylaminuria. Curr Drug Metab. 2003;4(2):151-170.

Mercy, suggest or offer the following to your physicians as a possibility:

Dimethylglycine dehydrogenase

This gene encodes an enzyme involved in the catabolism of choline, catalyzing the oxidative demethylation of dimethylglycine to form sarcosine. The enzyme is found as a monomer in the mitochondrial matrix, and uses flavin adenine dinucleotide and folate as cofactors. Mutation in this gene causes dimethylglycine dehydrogenase deficiency, characterized by a fishlike body odor, chronic muscle fatigue, and elevated levels of the muscle form of creatine kinase in serum.

--- In Trimethylaminuria@yahoogroups.com, mercy kimani <kanyoni16@...> wrote:
>
> As for the chronic fatigue, I've not been tested for it. The problem is I've been seeing general practitioners who don't know how to diagnose or treat metabolic conditions. Also, I look very healthy and vibrant and all my tests come back negative so the doctors think I'm being a pain sometimes some tell me everyone experiences exhaustion every once in a while. One even suggested depression as a cause LOL. I'll see a specialist who was recommended by my colon therapist.
> Mercy.
>

Mercy,

Have they ruled out Chronic fatigue syndrome? Adrenal fatigue seems
very similar. Interesting to read about the adrenal fatigue though.
Let us know how you make out and what you think is causing these
symptoms?

Sharon+

--- In Trimethylaminuria@yahoogroups.com, mercy kimani
<kanyoni16@...> wrote:
>
> Thanks Sharon for this info. I've been dealing with some weird
health problems for years but all my blood work comes back negative
for thyroid, low blood sugar, syndrome X etc. My symptoms include
lightheadedness, nausea insomnia, lethargy, brain fog, headache,
muscle aches, and numerous digestive issues. I've completely changed
my diet (no processed foods, dairy or gluten) but some of the
symptoms still linger. My colon therapist took my case file to
doctors at Vanderbilt and they suspect I may have adrenal fatigue. My
next step is to see an endocrinologist who specializes in metabolic
disorders. This website you provided is very helpful and I'll make
good use of it.
>  
> Mercy.
>