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 Choline is a conditionally-essential nutrient.  For growing children, over-restriction of dietary choline may negatively affect health and well-being.

A. Folate Supplementation

Folate supplementation is suggested when following a choline-restricted diet.  Contact your physician or dietitian regarding how much folate is

required.  US Dietary Reference Intakes are noted in Table 1.

B. Tyramine Containing Foods

Individuals with severe TMA resulting from a defect in flavin mono-oxygenase may be advised to avoid or limit tyramine-containing foods in addition to a choline-restricted diet.

Foods high in tyramine are:

C. Dietary Supplements

Avoid lecithin (phosphatidyl-choline) and fish oil supplements. Avoid liquid supplements that may contain emulsifiers. Avoid carnitine supplements.

D. Label Reading

 For processed, packaged foods, look for ingredients that are known to be high in choline. Examples include: egg, egg yolk, soy lecithin, peanuts. These are to be avoided or eaten in moderation.

Processed foods with soy lecithin or emulsifiers may be consumed depending on the order in which it appears in the ingredient list.  For example,on a similar weight basis, a based product listing soy lecithin as fourth on the ingredient list will have more phosphatidylcholine than a similar product listing soy lecithin as seventh on the list of ingredients.  Talk with your dietitian if you have questions regarding this matter.

E. Indoles-Containing Foods

Individuals with severe TMA may need to limit or avoid indole-containing foods. These foods have been found to increase urinary TMA excretion (Cashman et al 1999).  Talk with your physician or dietitian whether you need to limit these foods.

 Foods containing high indole concentrations are:

F. Choline-Containing Foods

The following foods should be avoided in the choline-restricted diet:

G. Feeding Habits

Eating small amounts of choline means that eventually there will be a build up of Choline in the gut. When consuming choline containing foods, it may be beneficial to eat small frequent meals to help ensure choline absorption.  Unabsorbed choline is degraded to methylamines by bacteria in lower intestine.

H. Miscellaneous Notes about Foods

1. Lean fish contains less choline than fatty fish (Lied E, Braekkan OR: Tidsskrift fur Hermetikindustri 1974;60:200-203.

2. Whole wheat flour contains more choline than milled, processed commercial flour (Wilson JE, Lorene K: Lebensmittal Wissenschaft und Technologie 1979;12(2):72-75.


HIGH CHOLINE FOODS TO AVOID OR EAT ON A LIMITED BASIS : Choline Content 150mg  or more 

GUIDELINES: Based on Anecdotal Evidence From Clinical Experience.


The body needs healthy meals in order to function properly and starving oneself only leads to more malodors and a gradual deterioration of strength and wellness. A great way to get the additional servings of veggies and fruit is to make nutritious soups and smoothies.   


If your health insurance company allows it and if you need help with creating healthy meal plans, it is advised that you use the professional services of a nutritionist or dietitian for help with preparing nutritious and healthy meals that are low in choline, for help in reviewing and discussing meds you are taking and the interactions of the vitamins and supplements you plan to try - before mixing it all up yourself.  Foods are powerful and drug interaction is a serious matter.


The Low Choline Food Guide is not a diet to lose or gain weight and is a healthy way of eating.  It will not lead to weight loss nor weight gain unless you were eating dramatically different foods, and/or significantly increasing or decreasing the amount your consume and/or portion sizes. In addition, for every high-choline item you eliminate there are substitutions readily available to allow you to continue to enjoy a wide variety of meals. If you lived in a major city, chances are you have more varieties of fruits and veggies than you’ve tasted so don’t be afraid to experiment an start eating  healthy meals.


When living with a condition like TMAU, it is important to consider one’s entire medical and health history, get a diagnosis (as soon as possible), and consult with a medical professional before changing one’s diet.

It is certainly important to treat and stabilize life-threatening medical conditions (if any) before focusing on malodor symptoms.  

It is also advisable to seek care for seasonal allergies, emotional pain, et al. to improve the overall quality of one’s life.  


Be creative, be proactive, be healthy.

ALL OTHER FOOD ARE OK TO EAT

All veggies, fruits, poultry should be combined in preparing balanced, healthy meals. To the extent that you can, avoid foods and drinks that have a strong smell because if it smells going in, it will smell coming out. Foods such aromatic coffees, fresh garlic, onions, strong seasonings, alcohol and  especially those with high yeast and sugar content. 

 

Dairy foods from the organs of cows and goats; aged cheeses are stronger smelling and should be avoided. (Exception:  Crumbly white cheeses may be tolerated, such as Greek Feta cheese and similar.)


 High content tyramine foods: aged cheeses, meat extracts, yeast extracts, Red Wine.


 Added refined sugar to food and drink, in all forms: high fructose and sugary drinks. (Low-sugar content drinks or bottled water with added vitamins are good sometime substitutes for water but these may be high in sodium.)


          Some Food Substitutions


 Almond milk /  Yucca milk / Rice milk (is tolerable to some but for others, it is starchy and sticky and causes G.I. production)

 Lactaid milk  (for those who are just lactose intolerant)

 Coconut milk in liquid and powder forms


But, for some, it is problematic to have any kind of milk or diary products.


The objective is not to eat no-choline as that is not possible nor desirable. The objective is not to overload on choline by eating foods with low-choline content, limiting or avoiding foods with high content choline.  

 

1. Egg whole and egg yolk.

 

2. All organ meat: beef heart, liver and kidneys; chicken heart, liver and kidneys; Turkey heart, liver, kidneys, Veal liver and kidneys; pork ham, liver, kidneys and spleen; lamb shoulder, liver, kidneys; duck liver and pate products; brain and sweetbreads.

 

3. Peanut butter

 

4. Cruciferous veggies: Cauliflower, broccoli, cabbage; a few brussel sprouts (less choline content) may be tolerated if you are not bothered by gas after eating cabbage products. 


5. Most Fish: Eel (freshwater), Herring (dark muscle), Mackerel (female type and dark muscle), Tuna (dark muscle), Squid. Foods from fish - Fish oil and fish oil supplements.

 

6. Grains:  whole grain barley, rice bran, cooked brown rice, whole grain rye, durum Wheat, Wheatena cereal.  

 

7.  Legumes:  Soy beans, Blackeyed peas, Cowpeas aka Chickpeas, Garbanzo aka Ceci beans, Lentils, Mung beans, Waxbeans, Snapbeans, Red Beans   

 

8. All soy products. See above. Soy lecithin (phosphatidyl-choline);L-carnitine supplements, and items with a high level of emulsifiers made from these ingredients.