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Blog Archive

Thursday, August 4, 2011

New TMAU paper : L-Carnitine treatment and fish odor syndrome: An unwanted adverse effect.

This is a new 'case study' trimethylaminuria paper by a group in France. There is very little to read in the abstract,  but it implies that a patient on Levocarnitine treatment was probably smelling (of fish ?) and they were tested and found to be positive for TMAU. This problem with levocarnitine has been mentioned before in pubmed. It has to be remembered that TMA can be produced from carnitine by gut bacteria.

They use concise terms that in effect describe TMAU1 and the most common form  of TMAU2 (bacterial overgrowth):
TMAU1 :  enzyme deficiency (FMO3)
TMAU2 from bacterial overgrowth :  enzyme saturation

Presumably the paper title should say "unwanted" rather than "unwaited"

[L-Carnitine treatment and fish odor syndrome: An unwaited adverse effect.]
[Article in French]
Rocher F, Caruba C, Broly F, Lebrun C.
Source
Centre régional de pharmacovigilance (CRPV) de Nice, CHU de Nice, hôpital Cimiez, 4, avenue Victoria, BP 1179, 06003 Nice cedex 1, France.
Abstract

INTRODUCTION:
Levocarnitine treatment is usually well tolerated, with essentially dose-dependent diarrhea as the main induced adverse effect.


CASE REPORT:
We report a case of fish odor syndrome during levocarnitine treatment which resolved after levocarnitine discontinuation.


CONCLUSION:
This adverse effect seems to be correlated with excedent carnitine intake and might be expressed when the elimination pathway becomes saturated or in a situation of deficiency enzymatic metabolism.
http://www.ncbi.nlm.nih.gov/pubmed/21481905

So it should be remembered that the TMAU diet probably involves reducing carnitine as well as choline.
wikipedia entry for carnitine

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