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Wednesday, October 3, 2012

What to eat on a TMAU Low-Choline Diet


PLEASE READ THE FOLLOWING POSTS
On this blog and RareConnect


PROBLEM WITH TMAU DIETS:

The main problem one encounters with recommending specific diet foods for TMAU is that not all TMAU+ persons do well with the TMAU protocol, implying that there might be (probably are) other concerns, as noted in the powerpoint presentation by Dr. Colin HW, MEBO’s Scientific Director in UK, Dimethylsulfidemia, section on TMAU. Some sufferers speculate that their symptoms are triggered because they have adverse reactions to sulfides, dairy products, sweets, carbs, in addition to, or instead of choline.

Unfortunately, if we took into account what every single sufferer thinks triggers their respective odor symptoms, the diet would list one word only – WATER, and a water alone will not sustain life for very long. Therefore, the diet discussed in this post is strictly for TMA produced body/breath odor, and is based on the published TMAU protocol discussed and recommended in the article, Trimethylaminuria, written by Drs. Ian Phillips and Elizabeth Shephard. It seems that even some experts go modifying some of their opinions through time. Also, as we know, we have plenty of expert sources that tell us what NOT to eat, but very few that tell us what WE CAN eat.

ADEQUATE INTAKE (AI) OF CHOLINE:
First, the question is, what is the recommended dietary intake for persons who do not have a malodor condition? What is the Adequate Intake (AI) of choline established by the Food and Nutrition Board of the Institute of Medicine of the National Academies of Sciences? Although the AI for adult men is 550 mg daily and 425 mg daily for women, there are AIs for various age groups as well:

• 0-6 months: 125 milligrams
• 6-12 months: 150 milligrams
• 1-3 years: 200 milligrams
• 4-8 years: 250 milligrams
• males 9-13 years: 375 milligrams
• males 14 years and older: 550 milligrams
• females 9-13 years: 375 milligrams
• females 14-18 years: 400 milligrams
• females 19 years and older: 425 milligrams
• Pregnant females of any age: 450 milligrams
• Lactating females of any age: 550 milligrams

Choline is an essential nutrient neccessary for a number of vital biological functions:
  1. Structural integrity of cell membranes
  2. Cell signaling
  3. Nerve impulse transmission
  4. Lipid (fat) transport metabolism. "Without adequate phosphatidylcholine, fat and cholesterol accumulate in the liver." "Men and women fed intravenously (IV) with solutions that contained adequate methionine and folate but lacked choline have developed a condition called "fatty liver" and signs of liver damage that resolved when choline was provided."
  5. Choline is a major source of methyl groups
  6. Choline may be oxidized in the body to form a metabolite called betaine. Betaine is a source of methyl (CH3) groups required for methylation reactions. Methyl groups from betaine may be used to convert homocysteine to methionine. Elevated levels of homocysteine in the blood have been associated with increased risk of cardiovascular diseases (5).
    Source: Linus Pauling Institute, Oregon State University, http://lpi.oregonstate.edu/infocenter/othernuts/choline/


The TMAU low-choline diet is very much a personalized development based on individual needs. The important thing is to not think that a low choline diet means to eliminate choline all together.
IMPORTANT NOTE: Children and pregnant mothers should not decrease their choline consumption, and should consult with their physicians before modifying their diets.

Of course, this AI may not be (most probably is not) tolerated by some TMAU+ adult individuals without triggering odor symptoms. Nonetheless, it is a goal to reach for, and each sufferer must stop short when symptoms are triggered. The TMAU low-choline diet is very much a personalized development based on individual needs. The important thing is to not think that a low choline diet means to eliminate choline all together, this is not a healthy choice.


FOOD GROUPS:
The pyramid food groups previously used as a guideline for a well-balanced diet has been replaced by the Right Sized Portion Plate. Please note that the food noted on the image are for persons who do not have a malodor condition, but the intent here is to show the food groups and portions of each that sufferers should strive to consume per meal, and note that fruits and vegetables should fill half of your plate.

Protein - Meat, poultry, or fish:
1 oz of poultry is usually the best choice. Only fresh water fish, such as Tilapia, is lower in choline content.
(See post, Three main protocols of TMAU diet, on TMA precursor and fish)

Consult with the USDA Database for the Choline Content of Common Foods, Release Two, chart starts on page 12, see Total Cho (total choline) column.  To find an item in the chart, do Ctrl+F and type in the name of the food.  If not found in the chart, type in the type of food, i.e., vegetable, fruit, etc. You can also find more information on nutrients provided by the USDA with this tool.


A low choline diet is innately a low protein diet by default. Nonetheless, if one is not a vegetarian, chicken and turkey should fill this quarter of the plate as opposed to red meats. See some tasty protein options below.

*Nuts are high in choline, but some people tolerate one teaspoon, or maybe even a tablespoon in some cases, of peanut butter a day (would make a nice peanut butter and jelly/jam sandwich).


Some tasty protein options:
  1. Spaghetti with ground turkey and small amount of beef (optional) in lots of tomato sauce. Adds little beef flavor if beef is used, but the amount of beef per serving would be small if cooked in a large pot.
  2. Breaded chicken breasts, dipping the thin cut chicken breast or chicken tenders in egg whites and bread crumbs or flour and fried in Canola oil. Can serve with pasta.
  3. Chicken fricassee with chopped potatoes and/or rice(white or with yellow coloring using a dash of Achote or Annato (bijol in Spanish). Can substitute chicken breast or chicken tenders for ground turkey or ground chicken. Chop potatoes into small cubes. Saute small amount of green and red peppers strips with very small amount of onion. Season chicken tenders cubed with lemon pepper and salt and cook until almost done. Add cubed potatoes until tender. Add 2 TB of tomato paste with 1/2 cup (or more as needed) of water to make sauce (not too much), or 1 to 2 can(s) of tomato sauce. If tolerated, 1/4 cup or less of red wine for flavor(optional). Cook long enough for sulfur in onion and wine to evaporate, and it's done. Cook rice on the side, can add yellow coloring to the rice (optional). Serve rice with sauteed chicken & potatoes.
  4. Chicken tempura. See recipe online.
  5. Tacos with the chicken fricassee with chopped up tomatoes and lettuce. Avoid hot (spicy) sauce because it has sulfurs.
Grains and High fiber foods, i.e., breads, cereals, pastas, : 1 slice of bread, 1 cup of breakfast cereal, or 1/2 cup of cooked rice, cereal, or pasta is considered a 1 oz equivalent from the grains group. Although high fiber foods are recommended for gastrointestinal health, we do need to keep in mind that whole grain barley or rye and cooked brown rice are richer in choline, but if you limit most of your choline intake to these foods, then you might be able to have some of these once in a while, or even daily. So, if you have IBS and need to eat more fiber, you do need to observe your odor symptoms while adding high fiber - less processed grains, while attempting to consume as much fiber in your diet as possible. Again, not every sufferer's FMO3 enzymes function the same; and even in one individual, the enzyme function may fluctuate depending on hormonal changes, lifestyle, stress, etc.

Dairy: Milk as tolerated. 1 cup of yogurt. Non-odorous cheeses, such as crumbly white cheeses like Greek Feta are best, depending on individual reactions. Some people have learned to live without dairy foods, and others love their cheese on bread, and milk or cream in their coffee. We see on choline food content charts that milk and coffee are higher in choline content. Yet, there are alot of people who feel deprived without them, and usually succumb to the temptation to consume them. Some sufferers are pleasantly surprised to see that they can have one cup a day, maybe for breakfast? Others are not as lucky. Again, this diet is individualized according to personal symptoms. Each person needs to test his or her malodor "threshhold" as much as possible to be able to eat a healthy and satisfying diet. If one is not satisfied with the diet, one will inevitably break it, and usually break it badly. The aim is to set a lifestyle of successful malodor management and a well balanced diet, as much as possible.

Fruits and Vegetables: 1 cup raw or cooked vegetable, such as carrots, celery, tomatoes, sweet potato, squash zucchini including skin, sauerkraut, radishes, cucumber, green and red peppers. (See USDA Chart pages 21&22)

Some tasty fruits and vegetable meals and snack options:
  1. Vegetable tempura with carrots, squash, and zuccini. See recipe.
  2. Raw fruits listed on page 18 of USDA Chart with sherbert (or very little ice-cream as tolerated, preferably fat free and no sugar, see page 31 of USDA Chart)
  3. Homemade vegetable and fruit juice (need fruit juicer):
    Fruits: pineapple, strawberries, apples, bananas, blackberries, blueberries, cranberries, guava, kiwi, lime juice, orange, peaches, pears - preferably all raw; can be added to vegetable juicer with celery and carrots.
    However, juices have less fiber than the raw or slightly cooked vegetables and fruits.

"Simply Delicious: A low Choline Recipe Book."

by Sonya McClinton


Click here for Amazon US
Click here for Amazon UK






AVOID:
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)…
  1. Organ meats from any animal, including liver, kidneys, brains, etc.,
  2. Legumens
  3. Soy products
  4. Egg yolk or whole egg. (OK to eat egg whites, but keep in mind contains sulfur, which might not be a problem for some).

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9 comments:

Anonymous said...

would be good to see examples of daily meals . I've seen many complain of getting under 2500 calories on diet .

October 6, 2012 at 1:44 AM
Maria de la T., Founder and Executive Director, MEBO Research said...

I know it would be expensive in most cases, but the ideal thing would be for individual sufferers to consult with a dietitian. I know there are sufferers who either have symptoms much more readily with a great deal of foods, and thus they eat less than 2500 calories, and there are other sufferers who select foods from the USDA Database list noted in this post that have caused them to put on some pounds, like lots of potatoes, pastas, and rice. I agree that it is challenging to try to eat a low choline, but also a healthy diet. To be honest, I don't think it's really possible, and that's where I think the 9 inch plate concept is helpful.

October 6, 2012 at 1:51 AM
Anonymous said...

I have trouble smelling fishy if I eat fish,so even though I love fish I have stopped eating it. I also have trouble with other bad odors and have given up all things containing gluten and foods high in sulfur, although I am going to try green beans in limited quantities. I find that drinking coffee at all is very bad for causing a bad vaginal area odor. this is where most of the odor issues come from and sweaty crotch area. I think it helps to be a normal weight as excess weight will make you sweat more and therefore have more odor issues. I ate a large double cheeseburger one evening and the next morning my crotch area was very sweaty and definitely smelled fishy. I am sure I have some degree of this condition. It makes sense to not eat the foods high in choline, sulfur or gluten. I really think gluten and yeast and sugar make the condition worse. also it seems very helpful to have really good daily bowel movements as this gets all that rotting food out of the gut so the odorous stuff can't get into your system.

April 10, 2013 at 2:29 AM
Anonymous said...

Potatoes should be avoided if you have TMAU. High choline content, as well. I was surprised you recommended it.

April 19, 2013 at 4:58 AM
Maria de la T., Founder and Executive Director, MEBO Research said...

Perhaps I’m missing something here. According to the USDA Database for Choline Content of Common Foods, http://www.nal.usda.gov/fnic/foodcomp/Data/Choline/Choln02.pdf, on page 23, they have listed nine different descriptions of potatoes, ranging from 11.0 to 24.0 mg of choline moiety/100 g of food. These descriptions include French fries, frozen, home prepared, mashed , red, flesh and skin, baked, etc.

I think that people forget that choline is an essential nutrient, and that even those with TMAU have some FMO3 function, as is noted in their TMAU test. I haven't heard of anyone have zero (0) level of TMAO.

It is unrealistic and unhealthy to completely eliminate choline from one’s diet. Unrealistic in the sense that your mind will make you crave choline rich foods if you deprive yourself completely from it, and thus you will be more likely to binge on it one day. It is healthier to consume low levels of choline, and then TO do cardiovascular exercise to help your body’s cleansing organs remove TMA from your body, IF low levels of choline produce odor, which it probably doesn't.

There is a very good chance that if you are on a low choline diet and follow the protocol, that either your enzyme would be extremely deficient, or that you have other causes of odor as well. I doubt very much that low amounts of potatoes will produce intense odor, even in TMAU positive patients, based on the choline content of this food. If it does in your case, perhaps you might want to look at other possibilities, such as having other types of odor conditions, or perhaps there are other foods you are eating to be the culprit, while you blame it on potatoes.

April 19, 2013 at 10:37 AM
Anonymous said...

I've recently started juicing and was dismayed to find that a juicing web site says cucumber juice is 7% choline! They were saying that like it's a good thing, the same for Pineapple juice. For me it's a disaster! I can't seem to eat anything that doesn't make me stink. I don't eat animals, so chicken etc is out for me. I refuse to eat white refined carbs as they are so unhealthy. Sometimes I just feel like giving up and eating whatever I want. I'm going to stink anyway :(

August 9, 2013 at 8:23 AM
Maria de la T., Founder and Executive Director, MEBO Research said...

If you look at the chart of choline content of foods made by the US Department of Agriculture, on pages 18 and 19, http://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/Choline/Choln02.pdf
you will see on column "Total Cho" (total choline) that the choline content of the juices and fruits listed is relatively low. Also, keep in mind that the Total Cho noted is per 100g of food.

Have your doctor done a glucose tolerance test for you? Persons with diabetes have odor as their sugar levels vary. I would consult with your doctor if this is not your case.

August 11, 2013 at 7:39 AM
Anonymous said...

I suffer from bad breath, body odour, smelly discharge, gas, basically anything that my body can emit, smells terrible, I cant eat anything without passing gas. I floss and is smells like I've flossed the arse-crack of a dead rat. My relationships break up because the pungent fishy smell down there is just unbearable.

Right so, I do not know what is wrong with me - I am mortified, hopeless, feeling horrid, depressed, exhausted and don't want to die alone. I am a normal mid thirties woman with a great career, fit and healthy, wonderful friends and family and very aware of personal hygene.

Systemic Candida VS TMAU ???
The diets for each are quite different.

Is there a CLEAR test for each to see what is causing this bacterial war!!??

Sobbing :(

September 26, 2013 at 10:49 AM
Anonymous said...

TMAU is a gas - take Gas Relief pill after each meals.

TMAU thrives in acid - take an acid reducer after each meals.

pay attention on the dose instructions for drugs.

I usually only each two meals a day. hopes this helps

October 3, 2013 at 10:28 AM
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