How do you remove odor after choline load for TMAU Test?

Q & A on the Cleveland Clinic TMAU Test Program
Posted in the MEBO Forum

Please read the Question and Answer Section of the MEBO Forum to see what sufferers who are testing/have tested through this program had to say. Here is a sample of one Q & A about, “WAYS TO CLEAN UP ODOR AFTER THE CHOLINE LOAD?”

QUESTION:

Like many I'm guessing there is hesitancy to choline load because of the complications involved in detoxing and reeking for months thereafter - any recommendations on how to alleviate that other than anticipating to be a social recluse until the odor wanes again?

ANSWER:

Based on what sufferers have shared in forums with the community, what seems to work best is to go back on the low choline diet (chart begins on page 12) and to do a lot of cardiovascular exercise that produce a lot sweating and heavy breathing as the blood circulates through the kidneys and lungs. Of course, this would require that you drink a lot of water to hydrate and to help the kidneys and skin wash away the odorous chemicals too, and for the lungs to breath them out as well. Rinsing your sinuses with the Neti Pot and tongue scraping is also helpful as the salt in the water and tongue scraping helps remove the TMA-containing mucous that may have built up.

Some sufferers prefer to repeat the TMAU Odor Management Protocol noted in the U.S. National Institutes of Health webpages, while others find that going on the diet, drinking a lot of water and doing cardiovascular exercise does the trick. You might want to read a post in MEBO’s Blog that has Q & A between the blogs readers and me.

My sons and I have found that cardiovascular exercise that makes us perspire profusely is the BEST way to clean out our system. The key is to drink a lot of water as part of the “washing” process and to ingest as little choline as possible until the odor is somewhat controlled again.

MEBO and the Cleveland Clinic lab have an agreement that I can only send them a batch of a minimum of 20 samples at a time, and I am just shy of the 20 samples right now. I am expecting a few this coming week from persons shipping them on Monday or Tuesday, to go over the 20 sample count. However, since the samples can only be shipped on a Monday or Tuesday to avoid weekend delays, I have to wait until October 10th to ship them to the lab. There have been 52 already purchased samples sent out to sufferers around the world, so for those who don't return their samples until after October 10th, their samples will be sent as the 2nd batch to the lab when I receive at least 20 of them.


María de la Torre
Founder and Executive Director

A Public Charity
www.meboresearch.org
maria.delatorre@meboresearch.org
MEBO's Blog (English)
El Blog de MEBO (español)
The MEBO Forum Please sign the MEBO Petition

MEBO Research

Update on the new MEBO International TMAU Program

MEBO Research launched a new International TMAU Test Program with the Cleveland Clinic this month, and the 20 "normal" control group samples have already been sent to the lab. The first shipment of 35 kits went out to sufferers on September 2, 2011. As of today, there have been 52 kits shipped to sufferers, of which I have received 15 specimens back. I am expecting 3 or 4 more tomorrow, and that makes it just shy of the required 20 sample batch to be able to be sent the lab for analysis. Since MEBO has been asking the persons testing to ship their samples on a Monday or Tuesday in order for me to receive them during the week and avoid weekend delays, I expect more persons will be shipping theirs this coming Monday or Tuesday, October 3rd and 4th. Therefore, I expect the kits to arrive later that week.

I will then be sending the Cleveland Clinic lab all the kits in my possession on Monday, October 10th, at which time the lab will run the test of all the samples and send MEBO the results to be emailed to each person with the Test Results Form approved by Dr. Hazen. If anyone who has the sample in their possession and wishes to ship their sample in to me on Monday or Tuesday, Oct. 3rd or 4th, I’ll include them in Monday’s shipment of Oct. 10th to the lab. The remaining approximate 25 to 30 kits that are already shipped out to sufferers will be sent to the lab after I receive the minimum of 20 specimen to complete the second batch.

I am most impressed and encouraged at the great enthusiastic response this program has received with so many sufferers testing!

If anyone wishes to be tested, you can place your order now by filling out the online TMAU Test Requisition Form, and I will send you a PayPal invoice for your information, without obligation on your part, with the breakdown of the test cost ($150.00) and the shipping cost to the address where you would like it shipped by FedEx. If interested in testing, you can use the PayPal button on the invoice, and as soon as I receive your payment, I will send you your kit.

I am most impressed and encouraged at the great enthusiastic response this program has received with so many sufferers testing! I would like to express my sincere gratitude to everyone for your support. I do hope this test give everyone involved the answers they are looking for.


María de la Torre
Founder and Executive Director

A Public Charity
www.meboresearch.org
maria.delatorre@meboresearch.org
MEBO's Blog (English)
El Blog de MEBO (español)
The MEBO Forum Please sign the MEBO Petition

DIA conference on Rare Diseases and Orphan Drugs : Washington 11-13 October

DIA Rare Diseases and Orphan Drugs Conference : Washington 11-13 October

The Drug Information Association is holding a conference in Washington DC this October 11-13 on Rare Diseases and Orphan Products.

Committee's Message

The Rare Diseases and Orphan Drugs Summit 2011 is the first annual program representing a collaboration among academic researchers, clinical researchers, pharmaceutical and biotechnology companies, regulatory and health agencies, patient organizations, payors and venture capital/private equity concerns to address the need for effective therapies for rare diseases. The Summit will provide a forum for all participants to share of state-of-the-art knowledge and to explore issues and needs from multiple perspectives. Through these dialogs, we hope to facilitate accelerated development of new therapies and improved access to these and existing therapies for rare diseases.

The goals of the program are to:

Provide education and updates on regulatory requirements and clinical trial issues relevant to rare disease research
Examine and discuss the changing and future orphan drugs landscape from the US and other regional regulatory perspectives
Discuss strategies for successful development, approval, authorization, and reimbursement of orphan drug products
Explore the benefits, approaches, and opportunities for patient partnerships in rare disease therapy development
Engage in open dialogs about challenges and concerns for rare disease treatment development
Encourage and Improve interactions among stakeholders across the full spectrum of the rare diseases community
— Peter L. Saltonstall, Wayne L. Pines, Deborah Dolan, Diane Edquist Dorman, & Trent McLaughlin

Survey for the conference

The conference has an online survey for people with rare disorders and will be drawing attention to the survey at the conference. You can fill out the survey on their special website

Rare Diseases Survey for 11-13 Oct conference

Systemic body odors are probably not that rare a disorder, but at the moment they are regarded as such, so this is a chance to show how common a problem it is. Then we can move on from it being classed a rare disorder.

New paper about TMAU involving a different enzyme ? : PYROXD2

TMAU - PYROXD2 : read paper

The current evidence is that genetic TMAU is caused by a deficiency of the FMO3 enzyme and the evidence that this is the only enzyme assciated with TMAU is overwhelming. However a new medical paper seems to suggest that another enzyme could also affect trimethylamine levels in humans. The enzyme is known as PYROXD2 (a probable pyridine nucleotide-disulphide oxidoreductase gene).

The paper is by a group of geneticists, none of whom have a history of TMAU research, looking at a few compounds they think is associated with genetic 'positive selection'. In the case of slightly raised TMA levels, They say a single nucleotide polymorphism (SNP) common in those of 'european' ancestry is commonly associated with slightly raised TMA levels.

It may prove productive to relate the TMAu mQTL finding to the rare recessive genetic disorder trimethylaminuria, in which mutations at FMO3 disrupt conversion of TMA to TMAO, resulting in high physiological levels of TMA and an accompanying fish-odour phenotype [47]. Trimethylaminuria cases exhibit relatively low values of the ratio TMAOu/(TMAOu + TMAu), where TMAOu denotes urine TMAO concentration. Subjects in the current study have values of this ratio that are within the range typical of trimethylaminuria controls (Figure S6 and [50]). It will be interesting to investigate the effect, if any, of genetic variation at the TMAu mQTL on TMA levels among trimethylaminuria cases.

The SNP ( rs7072216) is a TT in the PYROXD2 enzyme gene sequence, as opposed to CC (the lowest TMA level type) or TC. It is estimated perhaps 75% of 'european' one T allelle at least.

The raised level of TMA is not seemingly expected to be much higher, and still within 'normal' TMA limits, so even if it was correct perhaps it would not play a significant role. At this stage we do not know. The puzzling question is why they did not test FMO3 and how they came to think PYROXD2 would be associated with TMA levels.

It's all a bit too much new information for us, so at the moment it is probably best to not think it plays too signigicant a role, if any, to the understanding that FMO3 deficiency is responsible for genetic TMAU. We are investigating further and will let you know of any updates.

Paper : A Genome-Wide Metabolic QTL Analysis in Europeans Implicates Two Loci Shaped by Recent Positive Selection

Where are all of MEBO Research's online site?

Since MEBO Research has multiple sites, it seems to be confusing for some people to determine where to find information. Therefore, I would like to give a brief description of each site:

1. MEBO Research's website, www.meboresearch.org : This site focuses on the Organization itself, including the English Not-For-Profit company aspiring to become a Charity, and the US Public Charity. This website also presents a very brief outline of the various types of body odor conditions. The Navigation menubar links to other MEBO Research sites as well as to other community sites.


2. The MEBO Forum, www.meboresearch.org/forum: This forum is not intended to replicate the topics and "style" of communication used in other forums; each style of communication is valuable to our community, and we need diversity - not more of the same. Instead, the MEBO Forum is a place that attempts to organize the various MEBO Programs under the direction each director of MEBO's Board of Directors. The community is welcomed to participate in these programs either by posting in the MEBO Forum with recommendations, in a Private Message (PM) in the MEBO Forum, a phone call to the respective director of the program of interest, or in the bi-weekly conference calls. The Navigation menubar of the main MEBO sites refer visitors to various multilingual forums of our international community; a similar menubar will soon be put in this forum as well.


3. The English MEBO Blog, www.bloodbornebodyodorandhalitosis.com : This is where the founders of MEBO Research initiated our Mission, back in 2008, before MEBO was an organization registered in England in 2009, and eventually a registered Public Charity in the United States in 2010. Currently, this blog has 935 posts. Visitors may use the "Search posts through Labels" and the "Search this Blog" engines found on the upper right sidebar, to look for keywords on topics of concern.


4. The Spanish MEBO Blog, www.olorcorporalyhalitosis.com : This is the Spanish version of MEBO's Blogs also started in 2008.

PLEASE SIGN THE PETITION TO,

• raise awareness of systemic body odor conditions in the medical community
• governments to increase direct federal funding
• make scientific research of various types of body odor diseases a high-priority; including but not limited to, Trimethylamimuria (TMAU)
• efforts so that effective treatments and cures can be found.

PLEASE ASK YOUR FAMILY, FRIENDS, AND SUPPORTERS TO SIGN.
Anyone can select to either display or not display
his or her signature publicly on the petition.
PLEASE INDICATE YOUR COUNTRY OF RESIDENCE TO REPRESENT
A UNITED INTERNATIONAL COMMUNITY.

María de la Torre
Founder and Executive Director

A Public Charity

www.meboresearch.org
maria.delatorre@meboresearch.org
MEBO's Blog (English)
El Blog de MEBO (español)

MEBO Research

Quick update on MEBO - Cleveland Clinic TMAU test program

A quick update about the TMAU urine testing program that MEBO Research is introducing in co-operation with the Cleveland Clinic. The test lab requested that we send 20 'normal' samples for them to set a reference range as is the custom when starting up a new test service. The 20 normal samples have now been collected and sent to the lab for testing, meaning the actual testing service itself should follow soon thereafter. Anyone can apply for the TMAU test program by reading more about it in the right-hand sidebar.

WHY TEST FOR TMAU?

Benefits of the MeBO TMAU Urine Test Program

A note from MEBO Research's Director of Finance

If you subscribe to the blog or have visited the site you understand that systemic body odor is a devastating disease that can strike anyone. As you have come to realize there is little to no research regarding the pathobiology of body odor disorders, effective treatments, or even cures. We are grasping even at a diagnosis so that we can try to understand and treat our specific conditions. So you may be asking yourself why should I spend money to test for TMAU?

It’s the process of elimination that will increase your chances of answering questions related to your body odor condition.

We’ll the answer is simple, you have to eliminate possible causes of body odor or halitosis with known testing. Currently, you can screen for TMAU by measuring the ratio of trimethylamine to trimethylamine oxide. This will give you an idea of how well your body breaks down trimethylamine from compounds in food digestion into TMAO, a non-odorous state. A TMAU test will identify the production level of your FM03 and will suggest any deficiencies. It’s the process of elimination that will increase your chances of answering questions related to your body odor condition.

Many general practitioners are unaware of TMAU or consider TMAU a very rare disorder. Unfortunately, it unknown how many people truly suffer from TMAU because testing is limited or sufferers are not sure whether to test or not because they do not smell like fish. As noted by MEBO and by Karen James, who spearheaded the raising awareness campaign in the UK, TMAU produces many other odor types.

To those that have already tested, we strongly encourage you to voluntarily submit your results to the MEBO database online.

We encourage everyone that suffers from body odor symptoms including individuals that feel they have a high toxin load to test for TMAU. We are fortunate to have a heavily discounted TMAU testing program available with Dr. Stanley Hazen of the well-known Cleveland Clinic. Results will be given for primary and secondary TMAU. Since the Cleveland Clinic is testing purely for research purposes, we move one step closer in future research for the community as whole!

To those that have already tested, we strongly encourage you to voluntarily submit your results to the MEBO database online. This can be found in the blog. A compilation of the community’s results, without any personal information, will allow the community and researchers to have insight into other results so that advances can be made. It will also give each person the tools needed to investigate trends, contribute ideas into a collective process that allows progression, and insight into body odor causes.

With our investigative know-how, we can contribute as a community to find a treatment or a cure.

MEBO Research

The 2 ladies in recent UK magazine articles about Trimethylaminuria

TMAU story in Chat Magazine

Thanks to the bravery of 2 English ladies last week, TMAU has got more media coverage that breaks down the taboo about the subject of metabolic body odors and/or halitosis. Karen, who is a now well-known pioneer for raising awareness of and campaigning for research into metabolic odors and has recently appeared on TV, now follows up that appearance with an article in the popular weekly UK 'Chat Magazine'. Thanks again Karen.

TMAU story in 'That's Life'

In the 2nd article, a brave lady tells her story to the popular weekly UK magazine "That's Life". We thank her for her courage. The 2 images are scanned copies of the articles and can be read, which we hope the ladies involved do not mind us posting. We also waited until the magazine copies were no longer available, so that any journailsts reading can see that sales will not be affected and probably increased due to the publicity here.

---

TMAU article in Chat : magnify-able
TMAU article in 'That's Life' : magnify-able

Note : A lot of these articles offer volunteers money (not much) for their stories, which is quite right. If anyone wishes to tell their story they are entitled to ask if they will receive a payment. They deserve it.

A word from Karen James, our "ambassador" in itv.com/this morning

GREAT THINGS ARE HAPPENING
WITH THE UK RAISING AWARENESS CAMPAIGN

It has been a pleasure and an inspiration working with Karen James, as she is truly a great "ambassador" for our international community. Karen spearheaded the mail/email 'Raising Awareness Campaign UK General Medical Council (GMC) and others'' in March 2011, and has been relentlessly following up with emails to the proper authorities until she has managed to get a few very important steps accomplished through GMC. These accomplishments will be highlighted in future posts as publications are being made by the Royal College of General Practitioners (RCGP).

These accomplishments will be highlighted in future posts as publications are currently being made by the Royal College of General Practitioners (RCGP)...and UK DUETS.

Mark Fenton, Project Manager of the UK Database of Uncertainties about the Effects of Treatments (UK DUETS), has also been very instrumental in helping us prioritise new research questions/uncertainties, to assist us in obtaining research. By publishing our questions in their Database regarding body odor conditions, NHS is validating our concerns and our need for additional research, and thus, raising awareness. We consulted with experts in the TMAU field, who have been very willing to help our community, to assist us in forming these question, and they are finally compiled to everyone's satisfaction. As soon as they are entered in this Database, we will be posting more about it in this blog.

I asked Karen if she would like to tell us a little about her plight living and dealing with this condition to post in MEBO's Blog, and this is what she says,

My initial inspiration for wanting to work towards bettering the lives of malodour sufferers originally came from my frustration; having searched for over a decade for a reason for my appalling odour, I was eventually diagnosed with TMAU and then...NOT CURED! I also discovered that I was not alone and that I was one of many invisible people with an odour problem. I was outraged to find that odour conditions were considered an awkward taboo among the medical communities and decided that I should be invisible no more. I truly believe that if we work collectively and persistently we can change things. I am very disciplined in trying to manage my odour but cannot control it at all with the treatment protocols currently on offer. My only consolation is to try to change things for future generations of people like me.

On finding Maria and learning about the incredible things she was doing in the USA, I was inspired even more and found that, as a team, we could collaborate most effectively and combine different strategies to get things done. My work is very low level in comparison to that of MEBO Research: I try to contact the main British medical organisations and health politicians and appeal to their humanity through persuasive letters, e-mails and follow-up phone calls. Then Maria reinforces my efforts by contacting the same people and delivering a much more slick, scientific, professional message in the name of a registered charity. It works!! Somehow, we have managed to capture the interest of some important organisations and it has been a real pleasure to find a few committed, compassionate individuals among them (such as Mark Fenton of DUETS) in our search for recognition. I am truly grateful for their reactions to my persistent e-mails and also to the team of professionals who liaise with Maria to help our cause. Maria's efficiency, knowledge and dedication has helped us all and her positivity always makes me want to do more. And we will do more....

Karen has also represented us in the This Morning Show of ITV in the UK, and did a fantastic job at it. Thank you Karen. You are truly an inspiration to us all.

María

María de la Torre
Founder and Executive Director

A Public Charity
www.meboresearch.org
maria.delatorre@meboresearch.org
MEBO's Blog (English)
El Blog de MEBO (español)
The MEBO Forum Please sign the MEBO Petition

Launching the MEBO International TMAU Test and Research Program with Cleveland Clinic

One of America's Top 4 Hospitals
U.S. News and World Report 2011-12 'Best Hospitals' Rankings.

TMAU Test Requisition Form

TMAU Test Instruction Sheet

On Friday, September 2, 2011, MEBO Research took 35 TMAU Urine Test sample kits to the FedEx Office bound for sufferers in the US, Canada, and Europe. It had only been two days that these kits had arrived in MEBO’s Headquarters in Miami, and now they were all gone, while even more sufferers were expressing interest in testing with the renowned Cleveland Clinic. Much to the lab’s surprise, a new order was placed right away for more kits, and now there is another batch of 50 kits being sent to MEBO’s Headquarters to meet the new orders placed by sufferers. In addition to the three countries/continent to where the kits were shipped five days ago, additional interest in testing has been expressed by persons in the Philippines, Malaysia, Israel, the Caribbean, Mexico, and South America. It simply was not realistic for the lab to send us only 35 kits on the second order, and instead, the lab opted to send MEBO 50 additional kits, as the waitlist is growing quickly.

MEBO Research and the Cleveland Clinic have arrived at a very low rate offer for this test with the condition that MEBO Research perform the administrative logistics aspect of the program, such as taking orders, invoicing, shipping, and to transpose the test results provided by the lab into individual Test Results Reports to be emailed to sufferers. This report can be used by each sufferer to show his or her physician. This Test Results Form will also contain information on the interpretation and comparison of test results of other test programs, and wil make references to the genetic (Primary) and acquired (Secondary) types of Trimethylaminuria as approved by Dr. Stanley Hazen, MD, PhD, who oversees this program. Dr. Hazen will not receive the names or personal information of any person testing, and instead will receive an identifying number. He will compile the data of these test results for potential future research. Anyone not comfortable with these conditions should not test.

WHAT MAKES THE MEBO / CLEVELAND CLINIC TEST AND RESEARCH PROGRAM SO ATTRACTIVE?

1. PRESTIGEOUS INSTITUTION: The distinguished reputation the Cleveland Clinic has earned through the years amongst the medical and research communities around the world would probably be the primary reason this program has had such an enthusiastic response from sufferers. This institution has been ranked “One of America’s Top 4 Hospitals” by the U.S. News and World Report 2011-12 ‘Best Hospitals’ Ranking.
2. DISTINGUISED EXPERT OVERSEEING THE PROGRAM: The prominent credentials of the medical doctor/researcher in charge of this program, Dr. Stanley Hazen, M.D., Ph.D. His very brief introductory biography can be found in a post in this blog, MEBO's new International TMAU Test Program with the Cleveland Clinic
3. THE VERY LOW COST OF THE TEST: only $150 plus round trip shipping using special rates FedEx offers MEBO Research. For example, the International Priority 3 Business Days shipping cost from Miami to Manila, Philippines is $33.54, and the return 2 Business Days shipping cost is $44.72. The total cost for someone in Manila to do a urine test with Cleveland Clinic is $228.26/USD. To compare with other continents, to Israel it is $229.50/USD, to Italy, it is $215.29/USD, and most within the US is less than $200/USD including round trip shipping costs
4. PERIODIC SPECIAL RATE OFFERS: From time to time, when the demand for the test allows it, MEBO will offer the option of requesting a second test collection kit in the same shipment for an additional $100/USD
5. PRIMARILY AIMS TO REACH ALL SUFFERERS FROM AROUND THE WORLD: What sets this international program apart from any other TMAU Test/Research Program is that its primary focus is to include all sufferers from anywhere in the world to participate in initiating and taking advantage of testing and research opportunities.

For additional reading on this program and a brief biography of Dr. Stanley Hazen, see the post in this blog,

MEBO's new International TMAU Test Program with the Cleveland Clinic

María de la Torre
Founder and Executive Director

A Public Charity
www.meboresearch.org
maria.delatorre@meboresearch.org
MEBO's Blog (English)
El Blog de MEBO (español)
The MEBO Forum Please sign the MEBO Petition

What VOCS cause the odor of feces ?

What makes up the smell of feces ?
There has to be a good chance that there is no overwhelmingly agreed list of what volatile organic compounds make up the odor of feces, given how our research systems are set up. It's the kind of research which would probably be overlooked. This paper from 1987 was an attempt to define what VOCs made the 'fecal odor' and gave an interesting list. However case studies like these should not be regarded as correct or generally agreed by researchers. It's not until the evidence is overwhelming that conclusions are accepted.

1987 paper says the methyl sulfides methanethiol, dimethyl disulfide and dimethyl trisulfide 
The paper came to the conclusion that the odor of feces was mainly caused by the methyl sulfides methanethiol, dimethyl disulfide, and dimethyl trisulfide. We have been unable to confirm if these make good FMO3 substrates but a suspicion is that they are. Dr Cashman said in his interview in the blog that dimethyl disulfide was a good FMO3 substrate. A guess would be the 2 other methyl sulfides are too. This is not evidence of anything, merely pointing out that they are probably good FMO3 substrates.

Only Trimethylamine has no alternative route
It should be remembered that enzymes are set up to deal with changing chemical compounds of certain structures, but that usually if they cannot be metabolized by that enzyme then they can go through another enzyme less suited to metabolizing them. The only exception for FMO3 is trimethylamine, which is why researchers currently think only this causes an odor in someone with a compromised FMO3 enzyme.

Gas-chromatographic and mass-spectrometric analysis of the odor of human feces.Moore JG, Jessop LD, Osborne DN.
Source
Department of Medicine, Salt Lake Veterans Administration, Medical Center, Utah 84148.
Abstract
Gas-chromatographic and mass-spectrometric analysis of human fecal samples was performed to identify the volatile compounds responsible for fecal odor. The compounds identified with fecal odor were the methyl sulfides methanethiol, dimethyl disulfide, and dimethyl trisulfide. Skatole and indole, the benzopyrrole volatiles believed to be responsible for fecal odor, in fact elaborated a napthalenelike "mothball" odor in the crystalline state as well as after purging from feces. A small amount of hydrogen sulfide gas was also identified in fecal samples. The components responsible for fecal odor are complex and may be influenced by dietary and endogenous contributions. However, the major components are methyl sulfide compounds rather than skatole and indole as is currently believed.

Two TMAU articles in UK magazines

2 brave ladies are appearing in articles about TMAU in UK magazines. Karen (who appeared on 'This Morning' recently) is in 'Chat' Magazine issue 37 dated 10th Sept (probably available now) and Ellie is in 'That's Life' magazine dated 8th Sept (already available). Thank you ladies.

Media coverage of the recent TMAU paper published by Monell Institute

We recently posted about the new TMAU paper published by the Monell Institute in Philadelphia. There has been some interesting (but seemingly limited) media coverage.

Science Daily TMAU Article
Science Daily always do comprehensive articles on medical papers. The paper itself is premium content, so the media articles provide free insight into the full paper. A quote of interest from the Science Daily is about the seeming variation of odor. The quote seems to imply they are concluding the variation is down to trimethylamine

"Although the scientific and popular literature typically describes TMAU sufferers as smelling fishy, our sensory exams demonstrated this not to be so," said study author George Preti, Ph.D., an analytical organic chemist at Monell. "The odors are diverse and only after a choline challenge do the most severe cases have a fish-like odor."

Washington Post TMAU article
In this article, of particular interest is that the journalist says that between 1-11% could have trimethylaminuria. Presumably most would be the transient kind.

An estimated 1 percent to 11 percent of the population may have trimethylaminuria, notes the study, published in August in the American Journal of Medicine.

Unfortunately there does not seem to be much more media coverage in the story that was quick to find in a google news search.

You can buy the paper here : Monell 2011 TMAU paper $31.50

---

Updated : New links on story
Huffington Post
MyFoxDetroit
Healthcanal.com