"Rotten fish odor disease", scientifically known as Trimethylaminuria, is a rare disorder that causes the body to emit a foul odor similar to that of rotting fish. People with this disease have difficulty breaking down the compound trimethylamine (TMA), which leads to its accumulation in the body and its exit through sweat, urine, and exhalation. Although this disease does not pose a threat to physical health, it causes major social and psychological problems. In this article, we will review Dalili Medical the most important information about rotten fish odor disease, including its causes, symptoms, and methods of treatment.

What is rotten fish odor syndrome?

 

Rotten fish odor syndrome is a psychological condition that affects the person suffering from it, as it leads to the emergence of a foul odor similar to the smell of rotting fish. This syndrome is often the result of a person being exposed to severe stress or severe depression, which makes individuals who suffer from it face embarrassing situations in society.

How common is rotten fish odor syndrome?

 

The incidence of this condition ranges from 1 in 200,000 to 1 in 1 million people worldwide, and women are more affected than men due to the influence of hormones.

Types of rotten fish syndrome:

1. **Primary syndrome**: It occurs as a result of a genetic mutation inherited from the parents, which leads to a defect in the FMO3 enzyme.

2. **Secondary syndrome**: It results from diseases or health conditions such as liver failure or intestinal disorders. It can also occur as a result of taking certain nutritional supplements such as choline or carnitine.

**Causes of fish odor syndrome:**

1. **Genetic cause:** This syndrome is transmitted through recessive genes, where an individual needs to inherit a defective copy of the FMO3 gene from both parents to develop the disease.

2. **Dietary factors:**   Eating foods rich in trimethylamine or its precursors can worsen the condition, including:

- Seafood

- Eggs

- Liver and organ meats

- Legumes

3. **Hormonal factors:**

Symptoms may worsen in some cases due to hormonal changes, such as:

- Menstrual periods

- Pregnancy

- Puberty

4. **Liver and kidney diseases:** In rare cases, liver or kidney problems may be the cause, as the body is unable to get rid of the compounds properly.

**Medical conditions:** These include some diseases such as viral hepatitis or an imbalance of gut microbes.

**Taking nutritional supplements:** Such as fish oil or choline and carnitine supplements.

**Imbalance in some body functions:** Liver or kidney dysfunction can lead to fish odor syndrome.

**Diet:**Fish odor syndrome can occur in some people who consume large amounts of proteins in their daily diet, such as seafood, foods rich in choline, and eggs.

What are the complications of rotten fish syndrome?

 

- Psychological effects include anxiety, depression, and low self-esteem.

- Social isolation due to fear of embarrassment.

- In rare cases, it may lead to suicidal thoughts.

When should you see a doctor?

 

If symptoms persist despite modifying your diet.

For additional treatment options or psychological support.

Rotten fish syndrome is a chronic condition, but it does not cause physical pain. However, it can have significant psychological and social effects. If you suffer from this condition, it is recommended to see a healthcare provider to develop a comprehensive treatment plan aimed at improving your quality of life.

**Fish odor syndrome symptoms**

The symptoms and severity of trimethylaminuria vary greatly between individuals, possibly due to the presence of different types of mutations in the FMO3 gene. However, a strong fishy smell remains a common symptom among everyone. This smell affects urine and sweat, and causes bad breath. In some cases, symptoms may begin from birth, while in other cases they may be delayed until after puberty.

There are also some factors that may increase the severity of the symptoms of fish odor syndrome. For example, the fishy smell is more pronounced in girls than in boys, without any clear reasons for this yet. Female hormones, such as estrogen and progesterone, may be responsible for the exacerbation of these smells, and the smell may become more severe at certain times, such as:

- Just before menstruation.

- During menstruation.

- After taking oral contraceptives.

- When approaching menopause.

Other factors that may contribute to the increase in the symptoms of fish odor syndrome include:

- Excessive sweating.

- Stress.

- Eating certain foods, such as fish, eggs, and legumes.

How to detect and diagnose affected cases?

 

Because of its rarity, diagnosing fish odor syndrome can sometimes be a challenge for doctors, especially when it is confused with other hygiene or health problems. Diagnosis is based on:

- Collecting a medical history by asking questions about symptoms and how often they occur.

- Performing urine tests to measure the level of trimethylamine, which is high in those affected.

- Performing genetic tests to detect mutations in the FMO3 gene, which confirms the condition.

Diagnosing fish odor syndrome?

 

1. Medical and family history:

- Ask about similar cases in the family.

2. Urine test:

- The level of trimethylamine and its derivatives is measured in the urine after eating a meal containing the causative foods.

3. Genetic tests:

- Genes are analyzed to detect mutations in the FMO3 gene.

Social and psychological effects of the disease:

Individuals with fish odor syndrome suffer from significant social challenges, such as:

- Bullying: They may be subjected to negative comments because of the smell.

- Social avoidance: as a result of feeling embarrassed when interacting with others.

**Low self-confidence: as a result of negative views from society.**

**Tips to reduce the severity of fish odor syndrome:**

1. **MaintainPersonal hygiene:**

- Bathe regularly using special products.

2. **Avoid embarrassing situations:**

- Avoid eating stimulating foods before social events.

3. **Seek support:**

- Join support groups dedicated to fish odor syndrome patients. 

- Consult psychological specialists to get the necessary support.

4. **Awareness:**

- Educating people around you about the nature of the disease to avoid misunderstanding or bullying.

5. **Avoid some foods:**

- Do not consume milk from cows fed wheat or wheat, because it contains trimethylamine in large quantities. 

- Avoid foods that contain trimethylamine, such as legumes.

6. **Use nutritional supplements:**

- Take supplements that help reduce trimethylamine and facilitate its excretion in the urine.

7. **Use charcoal tablets:**

- Take charcoal tablets twice a day to help get rid of annoying bloating.

8. **Taking laxatives:**

- Using laxatives or laxatives after eating foods that contain methylamine.

**Treatment of fish odor syndrome**

There are currently no comprehensive treatments for trimethylamine syndrome, so treatment focuses on effectively relieving and controlling symptoms. Patients can reduce the odor of trimethylamine by avoiding foods that promote its secretion or increase its levels in the body, such as lecithin and choline. For example, some fish oil supplements contain a high percentage of lecithin.

**Following a special diet:** Foods rich in trimethylamine should be avoided, such as animal proteins, seafood, and some vegetables such as broccoli and cabbage.

**Using certain medications:** Antibiotics can be used in specific doses to reduce the intestinal bacteria responsible for producing the compound, in addition to activated charcoal medications.

**Personal hygiene:** It is important to use medical preparations specifically designed to help reduce the unwanted odor.

**Psychological support:** It is necessary to treat the anxiety and depression resulting from the condition, through the use of anti-anxiety medications or behavioral therapy sessions.

Foods rich in choline include:

- Eggs

- Liver

- Kidneys

- Legumes such as beans, peas, and soy products

- Peanuts

- Cruciferous vegetables such as cabbage, cauliflower, broccoli, and Brussels sprouts

Wheat-fed cow's milk is also considered a rich source of trimethylamine, as well as seafood such as fish, shellfish, and crustaceans. Smaller amounts of choline can be found in freshwater fish.

In addition to reducing the intake of foods that may worsen symptoms of fish odor syndrome, there are some other ways to relieve these symptoms, including:

- Taking low doses of antibiotics, as they can help reduce bacteria in the intestines and thus reduce the production of trimethylamine.

- Using a laxative to reduce the time food passes through the digestive system, which helps reduce the production of trimethylamine.

- Avoiding situations or activities that lead to increased sweating, such as strenuous exercise or psychological stress.

- Taking certain nutritional supplements that may help reduce trimethylamine levels.

Take 750 mg of activated charcoal twice daily for ten days.

Take 60 mg of copper chlorophyllin after meals three times daily for three weeks.

Riboflavin (vitamin B2) can be taken at a dose of 30 to 40 mg three to five times daily with meals, as this may help enhance FMO3 activity.

Individuals should also avoid using alkaline soaps and highly acidic products, and preferably use products with a mild acidity of pH 5.5 to 6.5 to improve the removal of trimethylamine from the skin.

If there is a negative psychological or social impact as a result of trimethylamine syndrome, it is advisable to talk to a doctor, and family or relationship counseling may also be helpful.