It raises the questions :
1. If a human with TMAU1 or TMAU2 (before diagnosis) is prone to develop long-term choline deficiency due to TMA bacteria 'eating' the choline.
2. If someone then follows the low choline diet protocol is choline deficient, or even moreso.
Choline plasma testing should be part of a TMAU 'profile' test, but it seems choline blood testing is a very difficult test to find from a health testing service, if at all.
It was only recently upgraded to an 'essential' nutrient, but still seems to be largely ignored despite known to be crucial for pregnant women, but probably still underestimated for everyone.
Some roles choline plays :
1. It is a main 'lipotropic' factor for the liver, in essence being a fat decongestant. Perhaps someday it will be regarded a factor in 'non-alcoholic fatty liver', or perhaps TMAU people are prone to NAFLD.
2. It is a main methyl donor.
3. It has an important role in the brain.
What the study did :
The study seemed to put 'gut-sterile' mice in 2 groups. 1 group was given tma-producing bacteria. Group 2 was given the same bacteria that had been genetically altered to not 'cleave' choline into tma.
It seems group 1 developed choline deficiency symptoms, while Group 2 did not.
Human TMAU - Choline dilemma :
There must be some thought that this might be true for TMAU humans too.
Only a choline blood test could probably confirm this, but is currently difficult to access.
Any form of choline less suitable for gut bacteria ?
The ordinary form of choline seems to be ideal for tma-bacteria.
There has been some 'talk' that perhaps choline in the form phosphatidylcholine (PPC) is harder for some types of gut bacteria to break down, but nothing can be confirmed of this.
Lecithin is mainly PPC (and less expensive than pure PPC), but lecithin contains other things (perhaps normal choline ?).
IN THE END, THIS ALL MAY BE POINTLESS OR MAKE THINGS WORSE, THE BESAT OPTION WOULD BE A CHOLINE BLOOD TEST.
Choline testing campaign :
Ultimately probably the best option would be a campaign to access the choline blood/plasma test. Since none of the main test labs seem to test for it, it's hard to know where to look.
One common test that may be of some use is a liver untrasound. This may show some signs of FLD. But it seems FLD may be common in Westerners due to the diet etc (just that for most it won't get so bad as to give symptoms).
It would be interesting to see if non/symptomatic NAFLD was a pattern in TMAU.
Interventions to stop gut-flora altering choline :
In the paper they use sterile mice and give group 2 a bacteria modified to not have the choline-tma enzyme.
In humans probably the best option will be Hazen/Cleveland/P&G microbe tma-blocker that is currently being researched (release date unknown) as this will simply block the formation of tma in the gut.
wikipedia :
Choline
Lecithin
Phosphatidaylcholine
Pauling Institute : Choline
Choline, Its Potential Role in Nonalcoholic Fatty Liver Disease, and the Case for Human and Bacterial Genes1,2
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