TMAU Low-Choline Diet

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Food NameCholine
Butter, salted18.8
Butter, whipped, with salt18.8
Butter oil, anhydrous22.3
Cheese, blue15.4
Cheese, brick15.4
Cheese, brie15.4
Cheese, camembert15.4
Cheese, cheddar16.5
Cheese, colby15.4
Cheese, cottage, creamed, large or small curd18.4
Cheese, cottage, creamed, with fruit17.5
Cheese, cottage, nonfat, uncreamed, dry, large or small curd17.9
Cheese, cottage, lowfat, 2% milkfat16.3
Cheese, cottage, lowfat, 1% milkfat17.5
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  • Abbreviations: g = gram, mg = milligram, mcg = microgram, kcal = kilocalorie, kJ = kilojoule.





Trimethylaminuria or TMAU or Fish Odor Syndrome

information from the National Institutes of Health

Trimethylaminuria is characterized by a fishy odor resembling that of rotten or decaying fish that results from excess excretion of trimethylamine in the urine, breath, sweat, and reproductive fluids. No physical symptoms are associated with trimethylaminuria. Affected individuals appear normal and healthy; however, the unpleasant odor often results in social and psychological problems. 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.

Dietary Treatment of TMAU

Restriction of dietary trimethylamine and its precursors such as choline. In some cases the disorder can be successfully managed by dietary restriction of precursors of trimethylamine. This is particularly true of "mild" or moderate forms of the disorder. Affected individuals respond differently to different forms of dietary restriction; thus, urinary excretion of trimethylamine and trimethylamine N-oxide should be monitored to identify the most effective dietary regimen for an individual.

Choline: One of the most important dietary sources of trimethylamine is choline. Dietary choline is absorbed through the small intestine; however, when the absorptive capacity of the small intestine is overloaded, gut bacteria metabolize choline into trimethylamine, which is readily absorbed into the blood stream.

Foods rich in choline include eggs, liver, kidney, peas, beans, peanuts, soya products, and brassicas (Brussels sprouts, broccoli, cabbage, cauliflower) as well as rapeseed products such as oil and flour.

Affected individuals should avoid lecithin (an important dietary source of choline) and lecithin-containing fish oil supplements.

Trimethylamine N-oxide: Affected individuals should avoid eating seafood (fish, cephalopods, and crustaceans) because of its high content of trimethylamine N-oxide, which is reduced to trimethylamine in the human gut. Babies with trimethylaminuria who are breastfed after their mothers have eaten seafood may develop a fishy odor.

Note: Freshwater fish have a lower content of trimethylamine N-oxide and thus are not a problem.

Other: Milk obtained from wheat-fed cows may have significant amounts of trimethylamine and thus should be avoided.

In addition to being a source of trimethylamine precursors, brassicas (Brussels sprouts, broccoli, cabbage, and cauliflower) contain indoles, which may increase urinary excretion of trimethylamine. Intake of such vegetables should be restricted.

Note:

Because choline is essential in the fetus and in young infants for nerve and brain development, it should not be over-restricted in infants, children, and pregnant or lactating women. Large amounts of choline are transferred to the fetus via the placenta and to the newborn infant via the mother's milk, thus potentially depleting maternal choline reserves. Dietary restriction of choline increases the requirement for folate, a methyl donor.

Dietary regimens should be planned and monitored to ensure that the daily intake of choline and folate meet recommendations for the age and sex of the individual.
For adults, adequate daily intake of choline is 550 mg for males and 425 mg for females.

Foods to Avoid in TMAU Diet

Choline content is in mg per 100 g of food weight.



Choline (mg)
Foods to avoid in TMAU low-choline diet (100 g)

2403.3
Egg, yolk, dried

1266.7
Egg, whole, dried

820.2
Egg, yolk, raw, fresh

705.0
Egg, yolk, raw, frozen, salted, pasteurized

669.3
Egg, yolk, raw, frozen, sugared, pasteurized

639.3
Egg, yolk, raw, frozen, pasteurized

602.5
Egg Mix, USDA Commodity

513.2
Beef, variety meats and by-products, kidneys, cooked, simmered

490.9
Beef, variety meats and by-products, brain, cooked, simmered

490.9
Fish, caviar, black and red, granular

471.0
Pork, fresh, variety meats and by-products, chitterlings, cooked, simmered

426.0
Beef, variety meats and by-products, liver, cooked, braised

418.2
Beef, variety meats and by-products, liver, cooked, pan-fried

411.0
Veal, variety meats and by-products, liver, cooked, pan-fried

398.9
Veal, variety meats and by-products, liver, cooked, braised

350.0
Oil, soybean lecithin

335.4
Fish, roe, mixed species, raw

333.3
Beef, variety meats and by-products, liver, raw

326.8
Chicken, liver, all classes, cooked, pan-fried

317.1
Egg, whole, cooked, fried

310.0
Veal, variety meats and by-products, liver, raw

297.0
Egg, whole, raw, frozen, salted, pasteurized

293.8
Egg, whole, raw, fresh

293.8
Egg, whole, cooked, hard-boiled

291.3
Fish, cod, Atlantic, dried and salted

290.0
Chicken, liver, all classes, cooked, simmered

268.3
Egg, whole, raw, frozen, pasteurized

266.9
Beverage, instant breakfast powder, chocolate, sugar-free, not reconstituted

263.4
Egg, duck, whole, fresh, raw


Choline (mg)
Foods to avoid in TMAU low-choline diet (100 g)

263.4
Egg, goose, whole, fresh, raw

263.4
Egg, quail, whole, fresh, raw

257.7
Caribou, shoulder meat, dried (Alaska Native)

255.9
Braunschweiger (a liver sausage), pork

255.7
Eggs, scrambled, frozen mixture

247.6
Egg, whole, cooked, omelet

247.5
Fish, whitefish, eggs (Alaska Native)

234.1
Egg, whole, cooked, poached

231.2
Fish, salmon, chum, dried (Alaska Native)

228.8
Pate, chicken liver, canned

228.8
Beef, variety meats and by-products, heart, cooked, simmered

225.0
Whey, acid, dried

225.0
Whey, sweet, dried

223.8
Salmon, red (sockeye), filets with skin, smoked (Alaska Native)

221.8
Turkey, liver, all classes, raw

221.0
Egg, whole, cooked, scrambled

220.2
Turkey, liver, all classes, cooked, simmered

209.3
Veal, variety meats and by-products, thymus, cooked, braised

205.6
Fish, whitefish, dried (Alaska Native)

202.7
Caribou, rump meat, half dried (Alaska Native)

201.7
Mushrooms, shiitake, dried

194.8
Pork, fresh, variety meats and by-products, stomach, raw

194.8
Beef, variety meats and by-products, tripe, raw

194.4
Chicken, liver, all classes, raw

191.7
Soy flour, low-fat

191.7
Soy flour, defatted, crude protein basis (N x 6.25)

190.9
Soy protein isolate

190.6
Soy flour, full-fat, raw

180.6
Fast foods, egg, scrambled

178.6
Cereals ready-to-eat, wheat germ, toasted, plain

178.1
Chicken, broilers or fryers, giblets, cooked, simmered

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