About the leaky gut test (intestinal permeability test)

Intestinal permeability lactulose/mannitol urine test

lactulose : big molecule : not absorbed (much)

mannitol : small molecule : absorbedThere is some interest in the 'intestinal permeability' ("leaky gut") urine test in connection to fecal body odor syndrome. It is hoped this post explains the test to some degree. It is not known if 'leaky gut' is a factor at all in fecal body odor, or if it is typical but not an issue. At this stage of understanding fecal body odor, like many things it is an unknown factor. However, it cannot be good to have 'leaky gut' at all.

Originally the 'leaky gut' test was one of the tests chosen for the MeBO-Biolab gut dysbiosis study, but was dropped to keep the price under £100. However, since the volunteers are paying for their own tests, it was thought sensible to add it as an option. The Biolab 'leaky gut' test uses a different molecule from other testers of 'leaky gut', who normally use lactulose and mannitol as the test molecules. However they all have the same principle.

Someone recently did the lactulose/mannitol intestinal permeability test, and we will look at their results to explain the test. Although people think of the test as the 'leaky gut' test, it does in fact test both for leaky gut and how well mannitol is absorbed as well. This is why it is officially known as the 'intestinal permeability' test.

The 2 test molecules for most 'intestinal permeability' tests are lactulose and mannitol. Lactulose is a large sugar, and should not be absorbed (much) in a normal gut. Mannitol is a small sugar, and should be absorbed in a controlled manner. Neither are changed by the body (i.e. metabolized). The person takes a liquid with both sugars and then over the course of a few hours collects their urine.

Leaky gut : normally the gut lining acts as a filter, allowing only molecules of a certain size to be absorbed into the bloodstream. Molecules of a larger size should not get through (unless they are broken down further in the intestine to smaller molecules). The theory about leaky gut is, the cells lining the intestine normally have a tight junction between them, and if for any reason this junction becomes split, then large molecules can slip into the bloodstream through the gap. These molecules will be regarded as 'aliens' by the body, and may trigger immune responses. The body will not recognise them as normal. In most 'leaky gut' tests, lactulose is used as the test molecule, and a raised amount in the urine constitutes 'leaky gut'.

Mannitol absorption : Normally molecules small enough to be absorbed into the bloodstream are absorbed through the gut lining in various ways. Some by simple diffusion. Many by a complex 'active transport' system. They go through the cell lining directly (not the juction). Mannitol should be relatively well absorbed, in a controlled manner. If absorption is too low, then there is an issue with mannitol absorption (and so probably with most type of gut absorption). If it is too high, it implies some issue in the controlled method of absorption.

Now to look at the test results of someone :

Intestinal permeability lactulose/mannitol urine test results:
analytical-chemistry
intestinal permeability
lactulose recovery 2.37 *H (normal range less than 0.30)
mannitol recovery 69.2 *H (normal range 9.5-25.0)
lactulose:mannitol ratio 0.034 (normal range less than 0.035)
6 hour urine volume 1.700 litres

In this case, both the lactulose and mannitol absorption are too high. Both by quite a bit. Ironically, this makes the 'ratio' almost normal, but this is because both are so high. So there seems to be leaky gut for sure, and also possibly an absorption issue. More about the lactulose/mannitol intestinal permeability test can be seen in these links from Genova Diagnostic website:

Genova intestinal permeability test explanation (PDF document)
Genova intestineal permeability test sample report (PDF document)

So, in summary, it is not known if intestinal permeability is a factor in fecal body odor syndrome, but at this early stage of understanding the problem, it may be worth ruling out as a potential factor.

The Biolab intestinal permeability test is one of the test options in the MeBO-Biolab gut dysbiosis study.

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More about leaky gut :
'About Medicine' article on intestinal permeability test by Liz Lipski
Genova Diagnostic intestinal permeability test through Crohns.net for $90
Leaky gut syndrome : Leo Galland 1995 article
1999 Pubmed paper : Leaky gut in alcoholic cirrhosis: a possible mechanism for alcohol-induced liver damage

New store for ATF fundraising : tmaustore.com

A helper to Rob Brown's efforts with the Australian Trimethylaminuria Foundation has come up with the idea of selling common supplements for TMAU and body odor in order to get a profit from the sale, with the proceeds going to the ATF fund. Many more products related to TMAU and body odor will be added within the next few weeks, so please be sure to fill out the email form on the website to stay updated. Eventually, the website will expand to other fund raising efforts, directly benefiting the TMAU community.

Also, if you click through the links and buy anything (for instance from drugstore.com), the commision to the fund will still apply.

The store is here :
http://tmaustore.com/

The Australian Trimethylaminuria Foundation would like to thank everyone within the community for their support.

All proceeds from affiliate links from this website will be donated to the AUSTRALIAN TRIMETHYLAMINURIA FOUNDATION, a non-profit organization actively pursuing a cure for TMAU

Pubmed paper 2009 : Actions of Cree anti-diabetic plants on human cytochrome P450 isoforms and flavin-containing monooxygenase 3

Actions of ethnobotanically selected Cree anti-diabetic plants on human cytochrome P450 isoforms and flavin-containing monooxygenase 3
http://www.ncbi.nlm.nih.gov/pubmed/19665535

Regular readers will know that FMO3 enzyme is always of special interest to the blog. This is the latest pubmed paper about the enzyme, albeit only in a limited way.

The testers were testing the phase1 xenobiotic metabolizing enzymes to see how they are affected by natural medicines used by Cree Indians in Canada.Normally when researchers check reactions in phase 1 xenobiotic metabolizing enzymes, they only check the Cytochrome P450 super-family, even though the FMO family come into this category. This is probably because at the moment the FMO enzymes are perceived as unimportant. So it was good to see FMO3 tested in this test as well.

Probably the main reason for interest in these enzymes is that drugs are metabolized by them, and they can also have an inhibitive or inducing effect on the enzymes. Probably one priority to pharmaceutical industry testers is the thought of lawsuits. These enzymes have only been properly known about for about 50 years, and so a lot has still to be learnt about them, especially the FMO family. Presumably the tests were done 'in vitro' at a lab, rather than 'in vivo'.

The 'textbook' definition of FMO enzymes will say it can neither be induced or inhibited, even though those using the same definition have found a compound in cruciferous vegetables to be very inhibitive. In this study, FMO3 seemed to be 'middling' inhibited by the plant extracts used. However, it's not known how conclusive such studies can be, since often there are other conflicting papers published. Perhaps the 'behaviour' of a xenobiotic metabolizing enzyme isn't accepted until a definite trend in papers is seen.

Herbs and spices are of special interest in FMO3 because most are likely FMO3 'substrates' and also may have an inhibitive/inducing effect (currently unknown). This may explain why when taking herbs/spices/medicines, some may feel 'strange' and perhaps get pain around the liver (since the liver is the most prominent place where such enzymes are based).

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concepts:
phase1 : modify a compound
phase2 : add a molecule to a compound; conjugate

These enzymes deal with internally produced compounds (neurotransmitters, hormones etc) as well as external compounds (from diet and environment etc)

The most abundant area for these enzymes is the liver, but they are everywhere.

More about the MeBO-Biolab dysbiosis tests

The MeBO-Biolab gut dysbiosis study, as well as being useful, hopes to set a precedent and an example of what sufferers can do with the power of the internet.

It has been decided to add the 'gut permeability' test to the group of tests, or as most people would know it, the 'leaky gut' test; since the volunteers are paying and they can pick which tests to leave out. This test is £75, which is why it was originally left out. There are other tests MeBO would have liked to have done, but these 4 tests seem a good choice from Biolabs list of tests for gut dysbiosis in particular.

Usually people cannot test direct using Biolabs test, but the management is kindly co-operating with us in this study. A form has been set up for anyone who wishes to be part of the study, but if people don't feel comfy giving all their details on the form, please let us know privately. The personal details are what Biolab require, whereas MeBO does not require identifiable information. MeBO hopes to collect information that is hopefully relevant to looking for a pattern.

The procedure for testing will be : to contact MeBO. MeBO will ask you to fill out the form. Then MebO will contact Biolab and yourself to see how you wish to test.

Biolab normally does not send the results direct to the patient. In this case, Biolab asked us to have the results sent to an 'expert' of relevancy. This has been arranged, and then the results will be sent to the patient along with some advice on the results. MeBO will collect the results data and will not use identifiable information.

The form to test in MeBO-Biolab Gut Dysbiosis Study is here :
MeBO-Biolab gut dysbiosis in body odor or halitosis study form-REVISED

Below is some more information on the tests chosen. The study should be seen as the first of many studies (preferably paid for by external funding), rather than the one and only necessary test. The only likely outcome in the study is that many people with fecal body odor may have dysbiosis of one or more types tested. No final conclusions can be made from such a study. For example, it cannot be deduced that this causes an odor.

Gut fermentation test : This tests checks for alcohols and short chain fatty acids in the blood after a glucose dose in a hardened shell, so that the glucose is not absorbed until it is released in the small intestine. Then a blood sample is drawn and tested. Ethanol in the blood is supposedly only likely from yeast fermentation in the gut (or alcohol consumption). The other alcohols are associated as metabolites from bacterial dysbiosis. It is vital that the person does not ingest alcohol near the test, because this will be detected and make the results void.

The alcohols are:
ethanol
methanol
2-propanol
1-propanol
2-methyl-2-propanol
2-methyl-1-propanol
2,3 butylene glycol

The short chain fatty acids tested for are associated as 'good' metabolites from colon bacterial fermentation from 'good bacteria'. In gut dysbiosis, it would generally be expected for these fatty acids to be too low, due to 'nasty' bacteria or fungus being dominant and minimizing the 'good' bacteria.

The short chain fatty acids are:
Acetate
Propionate
Butyrate
Succinate
Valerate

The patient is given 1 gramme of glucose in hardened gelatine capsules (2 x 500mg capsules) with 4 grammes of glucose dissolved in 80-100ml of water. The glucose solution prevents the capsules from disintegrating in the stomach and this ensures that an adequate amount of glucose passes into the duodenum. A blood sample is taken one hour later and the plasma is analysed for simple and complex alcohols along with short chain fatty acids. Comments are added when abnormalities of bacterial fermentation or a possible yeast overgrowth are indicated by the results. [Grey top fluoride oxalate tube (DO NOT USE ALCOHOL SWAB), No food for 3 hours and no alcohol for 24 hours before the test, kit available from the laboratory]
£46.00

1993 Abstract: Abnormal Gut Fermentation: Laboratory Studies Reveal Deficiency of B Vitamins, Zinc and Magnesium
1990 Abstract: Gut Fermentation (or the "Auto-brewery") Syndrome: A New Clinical Test with Initial Observations and Discussion of Clinical and Biochemical Implications
Biolab document: Gut Fermentation test (PDF)
http://www.biolab.co.uk/gutferm.html

Gut permeability test : This test involves taking polyethylene glycol (PEG400) which has various molecule sizes and is inert and excreted in the urine. Only the smallest molecules should be absorbed show up in the urine. If they don't, it implies an under-absorption issue. If the larger molecules turn up in the urine, it implies 'leaky gut'; that is, molecules that should normally be too large to be absorbed through the small intestine have been absorbed.

http://www.biolab.co.uk/docs/peg.pdf
http://www.biolab.co.uk/docs/pegrep.pdf
http://www.biolab.co.uk/docs/peginst.pdf

Indicans would be a straightforward and inexpensive way of looking for intestinal toxaemia and overgrowth of anaerobic bacteria, and would be an interesting approach, requiring a mid-stream, early morning, urine sample.
Tryptophan fermentation by bacteria produces a metabolite known as indicans. The test is thought to imply a problem with protein-eating bacteria.

D-lactate is a specific bacterial metabolite and would not normally be found in blood unless there is a bacterial infection. So for patients with gut symptoms it looks as if this might be an interesting way of looking for intestinal infections. The symptoms of such infections can be quite wide-ranging and a recent publication found a correlation with chronic fatigue (suggesting there may be a bacterial cause). Lactic acid producing bacteria produce d-lactic acid. this is poorly metabolized and can cause d-lactic acidosis. it is not the same as l-lactic acid. Its not often tested for or considered a problem except with people with part of their small intestine removed/missing, but a recent paper on chronic fatigue associated it with chronic fatigue. It's also known to give off H2S under certain circumstances.

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The form to test in MeBO-Biolab Gut Dysbiosis Study is here :
MeBO-Biolab gut dysbiosis in body odor or halitosis study form-REVISED

Donate to MeBO Research

What MeBO is doing

MeBO Research aims to become a charity focusing on systemic body odor and systemic sourced halitosis, particularly 'bowel smells' body door, since it is the most common. Any donations are welcome to primarily reach MeBO's aim of charity status. As a charity, MeBO can then pursue grants and endowments in order to carry out large-scale international studies.

Conference Call Topic: Mebo-Biolab Gut Dysbiosis Study

Please join me on this Sunday's Conference Call, August 23rd, at 2:00p.m. EDT.

For USA-based : (712) 432-1620 then type the access code on your phone keypad: 391629#
Non USA : prefix above with 001 but check to see if it is free with your supplier

Featuring special topic:

MeBO Research’s 6th week update, including initialMeBO-Biolab Gut Dysbiosis Study in the UK, what tests have been selected and why, how the results will be interpreted and documented, future MeBO efforts of studies in the U.S., international fund raising efforts underway, social and political awareness projects to be organized and initiated toward the end of this year, and any other topic you may wish to discuss regarding the direction you would like to see our community heading.

I would like very much to hear from sufferers what they would like to see take place to improve our quality of life until a cure is found. Please be thinking about this question, and bring your ideas to the call. I look forward to speaking with all of you.

María de la Torre

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UPDATE 26NOV09:

The form to test in MeBO-Biolab Gut Dysbiosis Study is here :
MeBO-Biolab gut dysbiosis in body odor or halitosis study form-REVISED

Donate to MeBO Research

What MeBO is doing

MeBO Research aims to become a charity focusing on systemic body odor and systemic sourced halitosis, particularly 'bowel smells' body door, since it is the most common. Any donations are welcome to primarily reach MeBO's aim of charity status. As a charity, MeBO can then pursue grants and endowments in order to carry out large-scale international studies.

clinicalconnection.com TMAU forum

With the internet, the ways to approach solving health problems seems limitless. At clinicalconnections, the aim seems to be to act as a bridge between ailments and researchers. Thanks to someone asking for a TMAU forum, such a forum has been created. It's not clear how co-operative researchers are with the site. Possibly it is a new concept yet to take off.

ClinicalConnection was founded by a team of pharmaceutical research professionals whose experience in clinical research led directly to the formulation of an entirely new process of Study Participant recruitment. Since 1998, ClinicalConnection has worked with some of the best and most well-known Clinical Investigators in the US to expedite the clinical research process while lowering the total cost of patient enrollment.

TMAU forum : www.clinicalconnection.com/forums/forumdisplay.php?f=69
homepage: www.clinicalconnection.com/

Background to the MeBO-Biolab gut dysbiosis study

Note : In no way will the results of this study be expected to mean someone will be cured of metabolic body odor or halitosis by correcting any abnormalities shown. MeBO's view is that such odor problems may be 'syndromes', and a few factors may be worth ruling out, but that genetics likely is the main factor for most, at least in terms of predisposing the individual to the 'syndrome'. MeBO wishes to understand every aspect of metabolic body odor syndromes.

With the advent of the internet, for many people over 10 years now, it has become very possible for sufferers to unite and promote their own research into problems, as opposed to relying on the system to instigate research. The typical pattern on health forums for undefined 'low-priority' health problems is for there to be a 'supplement culture', where posters usually do not test and compare supplements used. MeBO hopes to promote a 'testing culture', in the same way that top athletes and sports teams use tests for optimum fitness (despite being healthy already), so that nothing is left unnoticed. Long-term, MeBO hopes for the research community to pay for all costs for studies and trials, but at this early stage, MeBO has decided to initiate research itself, with unfortunately, each volunteer having to pay for his/her own tests.

Biolab is a niche lab in London that tests for biochemical markers that are mostly neglected by the main health system (such as vitamin or mineral status). They have kindly offered to co-operate in our first 'self help' study, which was chosen using the parameters of price-sensitivity, relevance, choice and practicality.

At first the plan was to test one person thoroughly using many of Biolabs tests on offer (with MeBO hopefully paying), but then it was decided to make the first study about gut dysbiosis; and since funds were so low, to allow the volunteer to pay. The study will be open for a few months, and we are hoping to get as many volunteers as we can (a 'dream' goal would be 20 testers). The aim is to see if those with body odor or halitosis (especially fecal body odor) often have a 'gut dysbiosis' problem (at least, of the sort detected by the biomarkers used in these tests). Nothing more could be concluded from the results, other than this. It must also be remembered that the tests do not test for all states of gut dysbiosis (for instance; parasites). The tests were limited to what Biolab offers. MeBO hopes to continue this approach in further studies, hopefully in other countries as well.

Two experts have kindly offered to help oversee the results, one in USA with a biochemical/biophysics background, and another in the UK with a background in the human biotransformation enzymes (not specifically FMO3, although that is one of this group of enzymes). The USA expert will comment on each set of results and the volunteer will then receive their results.

To do the testing, the volunteer must fill in two short forms, a questionaire for MeBO, and the Biolab requisition form. The MeBO questionaire is to look for any pattern amongst the volunteers with regards to body odor and halitosis (particularly fecal body odor). The Biolab form requires identifiable details, but the MeBO survey does not.

The 3 tests chosen are:

Indicans urine test
D-lactate blood test
Gut fermentation test

Originally, due to costs and to promote easy testing, the indicans test was selected. It was suggested that the D-lactate test was worthy of testing due to recent evidence in a chronic fatigue paper, and then other tests were considered before deciding to only add the gut fermentation test as well, since it tests for 'fungal dysbiosis'. The Biolab gut fermentation test is regarded as probably the most accurate functional 'fungal-dysbiosis' test there is (it tests for ethanol after a glucose load). The leaky gut test, or gut permeability test was also going to be added, but this would have taken the price to around £148. Anyone interested may take the leaky gut test at this time, if they like, however, MeBO considers the leaky gut to definitely be a test for the future.

More will follow about the tests chosen in a following post, but for now here is a summary about the tests :


In an effort to understand the possible underlying conditions of chronic body odor, the following preliminary tests will be the focus of MeBO's attention as a preliminary study of gut dysbiosis.

1. Indicans test: Indicans would be a straightforward and inexpensive way of looking for intestinal toxaemia and overgrowth of anaerobic bacteria, and would be an interesting approach, requiring a mid-stream, early morning, urine sample.
2. D-lactate test: D-lactate is a specific bacterial metabolite and would not normally be found in blood unless there is a bacterial infection. So for patients with gut symptoms it looks as if this might be an interesting way of looking for intestinal infections. The symptoms of such infections can be quite wide-ranging and a recent publication found a correlation with chronic fatigue (suggesting there may be a bacterial cause).
3. Gut fermentation profile: Involves gas chromatography technique. Patient must attend the lab. The test measures blood alcohols, including ethanol which is assumed to be only from fungal fermentation. Other alcohols suggest bacterial fermentation.
4. Gut permeability profile: using polyethylene glycol 400 as a test substance for gut absorption. This test was originally added (urine test that can be done from home) but it was thought it would be too costly to add for now (test is £75). It tests 6 levels of absorption, including 'leaky gut' and malabsorption. Such a test will be part of MeBOs list of studies at some point for sure.
   

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UPDATE 26NOV09:

The form to test in MeBO-Biolab Gut Dysbiosis Study is here :
MeBO-Biolab gut dysbiosis in body odor or halitosis study form-REVISED

Donate to MeBO Research

What MeBO is doing

MeBO Research aims to become a charity focusing on systemic body odor and systemic sourced halitosis, particularly 'bowel smells' body door, since it is the most common. Any donations are welcome to primarily reach MeBO's aim of charity status. As a charity, MeBO can then pursue grants and endowments in order to carry out large-scale international studies.

Alice Mata TMAU book now available as an ebook

The book, When Bathing Is Not Enough, published by a TMAU sufferer, Alice Mata, in 1999 is now available as an ebook from the publisher (Authorhouse). Current price $3.95

Ebook by Alice Mata : when bathing is not enough

Also printed book: When Bathing Is Not Enough

Interest in MeBO gut dysbiosis study in the UK

Are you interested in the MeBO gut dysbiosis study in the UK ?

MeBO is currently setting up a small study through Biolab in London for the testing of a few biomarkers of various types of gut dysbiosis. At the moment, MeBO cannot cover funding of such testing, since it has only been in operation for one month, so anyone volunteering would need to pay for their own tests.

The 4 tests chosen are the following (with financial concerns in mind), and sufferers may test for any or all of them :

Indicans urine test £13 (can be done from home)
D-lactate blood test £12 (requires a blood sample)
Biolab gut fermentation test £46 (must attend Biolab)
Gut permeability test £75 (urine test. can be done from home)

The results will be collated to see if there are any patterns. Two researchers have kindly accepted to oversee the project and interpret the results. Each person will receive a copy of his or her results.

If anyone is provisionally interested they could send an email to meboresearch@gmail.com expressing interest and indicating which tests they would like to do. MeBO will sort out the testing procedure in the next few weeks. Since Biolab is in London, it seems it may only be viable for testers in the UK & Ireland and neighbouring countries. The indicans test can be done from home, but blood must be drawn for the d-lactate test, and the lab must be attended for the gut fermentation test. Biolab could also do the d-lactate test there on the same day.

The study is especially aimed at investigating 'fecal body odor syndrome', including anyone who has been diagnosed positive for TMAU, but since testers are paying, anyone with a body odor or halitosis problem may test. Testers will be required to fill out a short questionnaire so as to determine what type of odor problem each tester has.

More details will follow later

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Overview:
The object of the study is to test some biomarkers for general gut dysbiosis.

At the moment, for 'fecal body odor syndrome', it is not known what the factors are, but the suspicions lie within the following areas :
genetics : FMO3 in particular
metabolism : Possible metabolic weakness
detoxification : especially the biotranformation enzymes
gut ecology : especially gut dysbiosis
vitamin/mineral status

This study is looking at certain biomarkers of gut dysbiosis, including gut candidiasis.

1. Indicans test: Indicans would be a straightforward and inexpensive way of looking for intestinal toxaemia and overgrowth of anaerobic bacteria, and would be an interesting approach, requiring a mid-stream, early morning, urine sample.
2. D-lactate test: D-lactate is a specific bacterial metabolite and would not normally be found in blood unless there is a bacterial infection. So for patients with gut symptoms it looks as if this might be an interesting way of looking for intestinal infections. The symptoms of such infections can be quite wide-ranging and a recent publication found a correlation with chronic fatigue (suggesting there may be a bacterial cause).
3. Gut fermentation profile: Involves gas chromatography technique. Tests for alcohols associated with gut candidiasis and bacterias.

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UPDATE 26NOV09:

The form to test in MeBO-Biolab Gut Dysbiosis Study is here :
MeBO-Biolab gut dysbiosis in body odor or halitosis study form-REVISED

Donate to MeBO Research

What MeBO is doing

MeBO Research aims to become a charity focusing on systemic body odor and systemic sourced halitosis, particularly 'bowel smells' body door, since it is the most common. Any donations are welcome to primarily reach MeBO's aim of charity status. As a charity, MeBO can then pursue grants and endowments in order to carry out large-scale international studies.

related links :
http://www.biolab.co.uk/
Dr Myhill article on Biolab gut fermentation test
Interview with Mark Howard : Biolab manager

Free genome testing by Trugenetics

UPDATE : The trugentics test does not look as comprehensive as first anticipated. It seems to only looks for variants, and so mutants likely will not be noted. Also , it only details variants associated with certain health conditions. This likely will not include TMAU. It's likely they do not test FMO3 at all
see terms and conditions

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http://www.trugenetics.com/

At the moment, the reasons for what is known on the forums as 'fecal body odor'(syndrome) is still undefined, but a genetic factor is suspected, with FMO3 being one of the main suspects.

DNA testing will in the long-term likely prove to be important both for individuals and the group.

Currently, a lab called Trugenetics is offering people the chance to test their whole genome (all of their DNA) for free. Presumably this is so they can build up a database which later on they can use to compare fee-paying samples etc.

How useful this will be to those with metabolic body odor cannot be predicted here; for instance we don't have a full understanding of what the results will actually mean (e.g. does the FMO3 info give the same info that the TMAU DNA test does ?).

Nevertheless, it is free, so it was thought worthy of mention. The lab is in Seattle and the samples are taken from saliva. Also be aware that it will likely show any predisposition for other illnessess perhaps, and so may be life-changing. It is mentioned here mainly as a potential shortcut for FMO3 DNA testing and perhaps may show info on other smell-associated enzymes too (such as Isovaleric acidemia).

D-lactate acidosis in chronic fatigue syndrome

A recent paper on chronic fatigue syndrome tried to prove a hypothesis that a subset of chronic fatigue syndrome sufferers could possibly be due to d-lactate acidosis, which is produced by lactic acid producing bacteria in the gut. The theory they have is these bacteria can also produce hydrogen sulfide in certain circumstances, which many body odor sufferers will know as 'rotten egg' smell.

This paper was conducted by a few researchers, including the Belgian researcher Dr Kenny De Meirleir, mentioned on the blog recently. He has a track record in researching dysbiosis as a factor in chronic fatigue syndrome.

D-lactic acid is very similar to the L-lactic acid we build up when exercising, but the difference is that L-lactic acid is very easily metabolized into a nontoxic excretable product, whereas D-lactate is very slowly metabolized. D-lactate acidosis is known to be a danger in those with parts of their small intestine surgically removed or missing, presumably because the lactic acid producing bacteria that normally reside at the ileum, are forced to move higher up to the more absorptive jejunum area.

An interesting point about d-lactic acid is that normally it is gram-positive bacteria that produce it, including lactobacillus, which is often in probiotics.

The Belgian researcher, Dr Kenny De Meirleir, has developed a home test where he tests for metabolites of excess hydrogen sulfide (presumably hydrogen sulfate). However this test is currently very new and experimental. It relies on color-change for diagnosis.

MeBO is hoping to arrange a small number of inexpensive 'gut dysbiosis' studies in the UK totalling £71 each for anyone who wants to test, including a D-lactate blood test for £13. More will be posted about this later. MeBO hopes to check various areas of testing to see if there are one or more factors involved in 'fecal body odor syndrome'. In this case looking at gut dysbiosis as a possible factor.

Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome.

Sheedy JR, Wettenhall RE, Scanlon D, Gooley PR, Lewis DP, McGregor N, Stapleton DI, Butt HL, DE Meirleir KL.

Vrije Universiteit Brussel, MFYS, Pleinlaan 2, 1050 Brussels, Belgium. Kenny.De.Meirleir@vub.ac.be.

Patients with chronic fatigue syndrome (CFS) are affected by symptoms of cognitive dysfunction and neurological impairment, the cause of which has yet to be elucidated. However, these symptoms are strikingly similar to those of patients presented with D-lactic acidosis. A significant increase of Gram positive facultative anaerobic faecal microorganisms in 108 CFS patients as compared to 177 control subjects is presented in this report. The viable count of D-lactic acid producing Enterococcus and Streptococcus spp. in the faecal samples from the CFS group (3.5x10(7) cfu/L and 9.8x10(7) cfu/L respectively) were significantly higher than those for the control group (5.0x10(6) cfu/L and 8.9x10(4) cfu/L respectively). Analysis of exometabolic profiles of Enterococcus faecalis and Streptococcus sanguinis, representatives of Enterococcus and Streptococcus spp. respectively, by NMR and HPLC showed that these organisms produced significantly more lactic acid from (13)C-labeled glucose, than the Gram negative Escherichia coli. Further, both E. faecalis and S. sanguinis secrete more D-lactic acid than E. coli. This study suggests a probable link between intestinal colonization of Gram positive facultative anaerobic D-lactic acid bacteria and symptom expressions in a subgroup of patients with CFS. Given the fact that this might explain not only neurocognitive dysfunction in CFS patients but also mitochondrial dysfunction, these findings may have important clinical implications.

http://www.ncbi.nlm.nih.gov/pubmed/19567398

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related links:
pdf file of original 'H2S' proposal : http://aboutmecfs.org/Rsrch/H2S.pdf
Blog post about CFS and H2S theory : http://aboutmecfs.org/blog/?p=613
http://www.prohealth.com/library/showarticle.cfm?libid=14579
http://www.prohealth.com/library/showarticle.cfm?libid=14579
http://cfsandmeawareness.com/blog/?p=659

Annual UK Meetup London, Sept 12/13th 2009

Hi guys, I want to invite you to the annual UK Meetup, which has been arranged to coincide with the Thames Festival 2009, which is on that whole weekend.

Outdoors, at the downstairs cafe of the Guoman 'The Tower' Hotel, Tower Bridge, London at 12pm Sat 12th September and 12pm Sun 13th September.
We will meet for coffee outside The Tower Hotel, right next to Tower Bridge, London at 12pm Sat 12th September and 12pm Sun 13th September too. The event lasts the whole day (both days) but members can come and go as they see fit.

This is a social gathering for all people with odour conditions. Advice and stories are shared and is usually a good day out. It is running over two days. Although it is not an official meeting with an agenda, it is an opportunity to meet others and build networks.

London meet-up : are you going ?

I am expecting around 15-20 members in all, including 2 members from the U.S and 2 from Norway. There will of course be discussions about helpful products, testing, diet etc. But it will also be largely a social event to get to know each other so that we can be more effective and for Group support too.

In the evening, you will have a lot of fun. There will be fireworks on the river, floats, carnival, Afro-Carribean steel bands, barbecue, international food stalls etc etc. ENJOY!

http://www.thamesfestival.org/weekend/highlights/

For those Group members who are traveling from far, I would suggest you book your hotel ASAP. The one I am recommending is the Travelodge in Tower Bridge, London :-

E-mail address: ArunNagrath@hotmail.com
Phone (land line): +44 (0) 1375 484 269
Mobile 07753 492 759

N.B. - I will have my mobile with me the whole weekend and will be checking for texts frequently.

(Only dial the 0 digit if calling FROM the U.K, otherwise leave it out). If calling from the U.S or Canada then prefix the above with 011. If calling from elsewhere then prefix with 00

Please Note - Strictly no photography is allowed of other members although you may take photos or videos of me or Maria if strangely inclined!

Arun Nagrath

Three main protocols of TMAU diet

There is some confusion about food issues regarding TMAU and other possible metabolic BO conditions because usually what works for one person may not necessarily work for another. However, it is always best to ‘arm’ ourselves with knowledge about the content of foods, then to try to ‘read’ our respective body to determine what our saturation point is for the various foods with respect to our body’s ability or inability to metabolize them. Unfortunately, without more scientific tests to help us with the process of understanding the physiology of our bodies, we just have to experiment on ourselves using the trial and error method.

...the choline content alone of the foods is not the only factor to consider in a TMAU odor-management effort; instead, the trimethylamine-N-oxide/trimethylamine (TMAO/TMA) content of the foods as well as their inhibiting effects of FMO3 enzyme activity need to be taken into account as well. An attempt is made in this post to shed some light on this question by presenting 3 different points of interest, but in the end, each sufferer will have to ‘test’ their respective saturation levels to determine how much choline and TMAO rich foods can be ingest without the body odors going off the roof. We as sufferers also have a choice as to when and how much we are willing to smell in order to enjoy foods every once in a while and in order to provide the nourishment our bodies need.

Feeling physically ill while smelling: One important thing we do need to keep in mind is that when our bodies do fail to metabolize TMA and the TMA builds up in our blood, we may be in an unhealthy state with a high level of compounds that should not be in our blood, as our bodies will try very hard to clean it out. These compounds makes some of us feel sluggish, sort of ‘hangoverish’ and some may even develop ‘Chronic Fatigue Syndrome,’ anxiety and depression, and possibly other more serious physical and emotional/mental conditions as a result of toxins flowing around our bodies in our blood. Some sufferers have found that as their odor increases, so do their allergies and chemical sensitivities also increase. See post, TMA and Epilepsy, learning disabilities, anxiety, and more, which presents studies of high TMA serum levels triggering seizure activity, increased symptoms of learning disabilities; and it also discuses a case of a small boy with severe seizures linked to a metabolic condition controlled with diet.

Point #1:
http://www.nal.usda.gov/fnic/foodcom...ne/Choln02.pdf
“In 1998, the Food and Nutrition Board of the Institute of Medicine established dietary recommendations for choline intake, estimating an Adequate Intake (AI) at 550 mg per day for men and 425 mg per day for women.”

*(Discussion) For a sufferer with a weak or deficient FMO3 enzyme, or a gut dysbiosis consisting of an overgrowth of TMA-producing bacteria, perhaps taking this recommended level of choline will produce high under-metabolized TMA level in the blood, which would not only produce strong odor, but also may make the person feel sick as described above. Therefore, each person needs to find ways to weigh the options and make the necessary decisions to consume the amount of choline recommended without over-saturating the metabolic enzymes too much, so as not to trigger negative side effects.

Point #2:
The NIH recommended Trimethylaminuria Management Protocol.

Treatment of manifestations recommended by NIH: dietary restriction of: (1) trimethylamine (present in milk obtained from wheat-fed cows) and its precursors including choline (present in eggs, liver, kidney, peas, beans, peanuts, soya products, and brassicas [Brussels sprouts, broccoli, cabbage, cauliflower]), lecithin and lecithin-containing fish oil supplements, (2) trimethylamine N-oxide (present in seafood [fish, cephalopods, and crustaceans]), (3) inhibitors of FMO3 enzyme activity such as indoles (found in brassicas)…

*(Discussion) Note that this recommendation is broken up into three parts.

Part #1: refers to choline being a Trimethylamine precursor in this food group. A precursor is a substance, cell, or cellular component from which another substance, cell, or cellular component is formed. In this case, the choline is the precursor that is broken down by bacteria which then produces trimethylamine. A person with this bacteria producing excessive amounts of TMA may overwhelm a healthy FMO3 metabolic enzyme level. This form of TMAU is referred to Secondary TMAU. In this case, a low choline diet and possibly antibiotic treatment is recommended. See Treatment of Manifestations of the Gene Reviews article on Trimethylaminuria

PART #2: refers to the trimethylamine N-oxide (TMAO)ALREADY PRESENT IN SEAFOOD. This is a different precursor. So in this case, we are more concerned with the actual TMAO content of the food as well as the choline content.

In a Google book, Advances in Fish Processing Technology, by D.P. Sen 2005 (pg 240, #6.4.2 Trimethylamine) it states,

Trimethylamine (TMA) is a most known compound to indicate freshness quality and degree of spoilage of marine fish. TMA is associated with “fishy” odour and with the odour of fish spoilage and is clearly a part of the spoilage pattern of many fish species; odour goes, more or less, hand in hand with TMA concentration…

TMA is formed from trimethylamine oxide (TMAO) [in fish] which is an osmoregulatory and buffering compound found in many marine teleosts, elasmobranchs and shellfish…

Small amount of TMA may be produced by the endogenous enzymes* of fish. But main degradation of TMAO to TMA is due to enzymes of psychrotrophic bacteria particularly Achromobacter that invade the fish after death…

*Definition of endogenous enzymes: Developing or originating within the organisms or arising from causes within the organisms.

PART #3: refers to foods that act as inhibitors of FMO3 enzyme activity. This concern is independent of the choline content or TMAO content of the food, because this food group actually inhibits FMO3 enzyme activity, which can be very detrimental to someone who has a weakness or deficiency of this enzyme. It is most detrimental to Primary TMAU, which is a genetic metabolic disorder inherited in an autosomal recessive manner. This type of TMAU, is determined by DNA mutation analysis of the FMO3 gene indicating a deficiency in the FMO3 metabolic enzyme produced in the liver. This deficiency of FMO3 enzyme results in an inefficient FMO3 function with a failure to metabolize (add an oxygen molecule)to the chemical Trimethylamine(TMA), which smells of rotting fish, as well as other compounds that contain nitrogen, sulfur or phosphorous. Symptoms are usually present from birth and may worsen during puberty. In females, symptoms are more severe just before and during menstruation, after taking oral contraceptives, and around the time of menopause. This condition benefits from reduction in all three diets, low choline, low TMAO/TMA-rich foods, and low consumption of inhibitors of FMO3 enzyme activity, such as indoles (found in brassicas)…

IN SUM, It is important that we understand how these three food groups differ and how the choline content of the foods alone is not the only factor to consider in a TMAU odor-management effort; instead, the TMAO/TMA content of the foods and their inhibiting effects of FMO3 enzyme activity need to be taken into account as well.

Translated into Spanish
by Natalia


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Stinky? It's not his sweat, it's your nose

Reuters, Sep 16, 2007

Androstenone is in the sweat of men and women, but it is more highly concentrated in men. How one perceives its smell appears to have a lot to do with variations in one odor receptor gene called OR7D4.

...When it comes to a man's body odor, the fragrance -- or stench -- is in the nose of the beholder, according to U.S. researchers who suggest a single gene may determine how people perceive body odor.

The study, published online in the journal Nature, explains why the same sweaty man can smell like vanilla to some, like urine to others and for about a third of adults, have no smell at all.

Matsunami and colleagues at Duke [Durham, North Carolina] and Rockefeller University in New York focused on the chemical androstenone, which is created when the body breaks down the male sex hormone testosterone.

Androstenone is in the sweat of men and women, but it is more highly concentrated in men. How one perceives its smell appears to have a lot to do with variations in one odor receptor gene called OR7D4.

http://www.reuters.com/article/scienceNews/idUSN1522717720070916?feedType=RSS&feedName=scienceNews&sp=true