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Genetic and Rare Diseases Information Center (GARD)

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Other Names for this Disease
  • Fish malodor syndrome
  • Fish odor syndrome
  • Stale fish syndrome
  • TMAU
  • TMAuria
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How might trimethylaminuria be treated?

Although there is no cure for trimethylaminuria, the following are some ways to reduce symptoms of odor:[1][2]


  • Avoiding foods containing trimethylamine and its precursors (choline and trimethylamine N-oxide). Trimethylamine is present in high levels in milk obtained from wheat-fed cows. Choline is present in high amounts in: eggs, liver, kidney, peas, beans, peanuts, soy products, brussel sprouts, broccoli, cabbage, and cauliflower, lecithin, and lecithin-containing fish oil supplements. Trimethylamine N-oxide is present in seafood. Freshwater fish have lower levels of trimethylamine N-oxide than fish from the ocean.
  • Taking low doses of antibiotics to reduce the amount of bacteria in the gut. This decreases the amount of trimethylamine that is made by bacteria.
  • Taking laxatives can decrease the amount of time trimethylamine stays in the intestines and reduce the amount of trimethylamine made in the gut.
  • Taking certain nutritional supplements to decrease the concentration of trimethylamine in the urine.
  • Activated charcoal taken at a dose of 750mg twice daily for ten days. Copper chlorophyllin taken at a dose of 60mg three times a day after meals for three weeks.
  • Using soaps with a moderate pH, between 5.5 and 6.5. Trimethylamine is a strong base (pH 9.8), thus soaps with pH closer to that of normal skin help remove the secreted trimethylamine.
  • Taking riboflavin (vitamin B2) supplements to enhance any existing FMO3 enzyme activity (which breaks down trimethylamine). Recommended intake is 30-40mg taken 3-5 times per day with food.
  • Avoiding factors that promote sweating, such as exercise, stress, and emotional upsets.

NOTE: Individuals should follow the treatment advice of their healthcare provider and should not attempt to self-administer these treatment approaches. Medications and supplements can have unintended interactions, and dietary restrictions can result in nutritional deficits.

Choline is essential for nerve and brain development in fetuses and infants, therefore, pregnant and breast-feeding women should consult with their health care provider before restricting their dietary choline.[1]

People with trimethylaminuria may also find the following to be helpful:[1]  

  • Behavioral counseling to help with depression and other psychological symptoms.
  • Genetic counseling to better understand how they developed the condition and to be aware of the risks of passing this disease on to their children. Visit the Healthcare Services section to find a list of online resources that can assist you in finding a genetics clinic near you.
Last updated: 1/27/2014

  1. Learning about Trimethylaminuria. National Human Genome Research Institute Web site. July 20, 2011; Accessed 1/27/2014.
  2. Phillips IR, Shephard EA. Trimethylaminuria. GeneReviews. April 19, 2011; Accessed 1/27/2014.

Management Guidelines

  • GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions. Click on the link to view the article on this topic.
  • The United States Department of Agriculture has a document that lists the choline content of common foods. Click on the link above to view this document.

Clinical Trials & Research for this Disease

  • The U.S. National Institutes of Health, through the National Library of Medicine, developed to provide patients, family members, and members of the public with current information on clinical research studies. There is a study titled Studies of Children with Metabolic or Other Genetic Disorders which may be of interest to you. To find this trial, click on the link above.