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:
- Structural integrity of cell membranes
- Cell signaling
- Nerve impulse transmission
- 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."
- Choline is a major source of methyl groups
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.
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:
- 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.
- 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.
- 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.
- Chicken tempura. See recipe online.
- Tacos with the chicken fricassee with chopped up tomatoes and lettuce. Avoid hot (spicy) sauce because it has sulfurs.
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:
- Vegetable tempura with carrots, squash, and zuccini. See recipe.
- 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)
- 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|
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)…
- Organ meats from any animal, including liver, kidneys, brains, etc.,
- Soy products
- Egg yolk or whole egg. (OK to eat egg whites, but keep in mind contains sulfur, which might not be a problem for some).
María de la Torre
Founder and Executive Director
A Public Charity
MEBO's Blog (English)
El Blog de MEBO (español)
The MEBO Forum