Rebuild your Health

There is increasing evidence that intestinal microbial dysbiosis has a role in the pathogenesis of systemic malodor conditions and other metabolic disorders. The most studied non-syndromic malodor condition Trimethylaminuria is usually inherited in an autosomal recessive fashion, which means that two mutations from both parents, both affecting abilities of FMO3 enzyme to catalyze the N-oxidation of trimethylamine into trimethylamine (eg, [Glu158Lys (rs2266782) and Glu308Gly (rs2266780)]), may be needed for a person to have symptoms. Yet genotype is not always predictive of phenotype, not even in this case.

Illustration by Monica Garwood

Studies have shown that the symptoms of metabolic inefficiencies, food intolerance and even allergies can be relieved by changing the composition of intestinal microbes and adjusting dietary components feeding these microbes - to encourage growth of microorganisms properly digesting problem ingredients. Lactose-digesting bacteria Lactobacillus acidophilus, Lactobacillus bulgaricus and Streptococcus thermophilus, for example, can help to digest lactose into useful compounds, instead of offensive gas. On the other hand, the low-FODMAP diet reduces gastrointestinal symptoms by reducing the food that bacteria ferment. For lactose-intolerance, however,  the "O" in FODMAPs - oligosacharides - can be beneficial as Galacto-oligosaccharides (GOS) are useful prebiotics promoting the growth of the right microorganisms. 

Rebuilding the network of microorganisms on and inside our bodies can help to improve the volatiles in the surrounding air, aka body and breath odor. Microbes associated with unpleasant odors include Anaerococcus, Corynebacterium, Campylobacter, and Propionibacterium [1], Gardnerella, Alloprevotella, Sutterella, and species of Candida. Microbes associated with improvements in odors include archaebiotic Methanomassiliicoccus luminyensis, Lactobacillus pentosus KCA1, and Lactobacillus salivarius, but there are more, working together and relying on each other. Our studies (see protocols of microbiome [2] and volatilome [3] trials published on Medrxiv)  identified several microbial strains and volatile compounds associated with improvement of malodor symptoms. We are currently summarizing our results and plan to publish it. Development of personalized protocols and defining the right compositions of probiotics and prebiotics is a long-term research endeavor. Meanwhile, be your own best medical researcher and take control of your wellbeing: 

Step 1: Pull out your fitness journal and create an action plan

• Analyze your diet, everyday activities, exercise and sleep patterns to make initial guesses about things that could be triggering your flareups or making you feel better. Write out a list of these things. 
• Break your goal into small steps and milestones. For example: if you have fructose as a potential trigger on your list, go fructose free for a week. An earlier survey of about 100 body odor and halitosis sufferers indicated stress (34%), food (25%) and environment, including the weather and perfumed products (15%) as main triggers of odors or PATM. Make sure you are not missing something in your diet - like Zinc, Vitamin C, or Vitamin D - insufficient amounts of these vitamins and minerals could also contribute to PATM. 
• Develop metrics for evaluating progress. Some people can't objectively evaluate their malodor or PATM condition. Try to find a trust buddy or take note of how the people around you react when you’re in close proximity. For example, pay attention to the space people leave between you and themselves (assuming COVID-19 is behind us and the 6-feet rule no longer applies!)

Step 2: Change your diet, physical activity and behavior

• Intestinal lining is regenerating every five to seven days, so you need to stick to your diet for at least a week to notice improvements in your symptoms. Most elimination diets are actually recommended for about 3–6 weeks, to allow the antibodies (negatively reacting to problem food components) dissipate. So if your diet seems to be helping, extend it to 3 or 6 weeks. 
• If it is not helping, try the next thing on your list. It should not be just diet - one study showed that bad breath was associated with abnormal sleep patterns. Perhaps you need to reevaluate your clothing material, temperature an humidity or mycotoxins in the environment? Are you getting enough sunlight ? Does your home have a healthy microbiome? Try to eliminate the triggers one at a time. No need to reduce your overall food intake, many people observe malodor or PATM flareups when they are hungry & undernourished. Try to train your body to digest more fiber - but start adding them to your diet little at a time, on weekends when you can safely experiment.   

Step 3: Let go of past hurts

• Stop dwelling on the past. You have the power to change your future. Learn how to express confidence with your body language. Pretend you are comfortable in presence of other people and they will learn to be comfortable in yours. 

RFRERENCES

1. Gabashvili IS. Cutaneous Bacteria in the Gut Microbiome as Biomarkers of Systemic Malodor and People Are Allergic to Me (PATM) Conditions: Insights From a Virtually Conducted Clinical Trial. JMIR Dermatology. 2020 Nov 4;3(1):e10508.

2. Gabashvili I.S. Dynamics of the Gut Microbiota in MEBO and PATM conditions: Protocol of a fully remote clinical study. medRxiv. 2020 Aug.24. medRxiv 2020.08.21.20179242; doi: https://doi.org/10.1101/2020.08.21.20179242

3. Gabashvili I.S. Effects of diet, activities, environmental exposures and trimethylamine metabolism on alveolar breath compounds: protocol for a retrospective case-cohort observational study medRxiv 2021, Jan. 26 2021.01.25.21250101; doi: https://doi.org/10.1101/2021.01.25.21250101

How do you feed your microbiome?

As we are gearing up for final stage of our clinical study NCT03582826, we are looking at different subgroups of our participants, to find more precise, personalized and powerful solutions for everyone. 

We know, that genes and environment always combine to make us who we are. We already talked about some of those seemingly less important genes - such as ABO blood group. The environmental factors include diet, exercise, social environments (such as social support), varying conditions and situations.   

According to descriptions of diets and lifestyle submitted by our participants, about 25% of them are taking commercial probiotic products, about the same number as those who had chicken as the main staple of their kitchen (see word cloud depiction of diet keywords on the right). About 2% take commercial prebiotics, but many more eat prebiotic foods (such as oats/oatmeal, bananas, apples and nuts shown in green). 4% eats onions and about the same percentage actively avoids it.  Milk, Rice, Bread and Pasta were among the most popular foods, after chicken. 

The world is eating less meat overall, and a few years ago, among the meat eaters, the scale tipped from greater consumption of beef to greater consumption of chicken.
This is even more pronounced in MEBO population. 

Half of MEBO population takes vitamins and  supplements.  The most popular among them is Zinc closely followed by Magnesium and Enzymes. Also popular are multivitamins, Calcium,  Resveratol, Vitamin B12, Charcoal, Chlorophyll, Ashwagandha, Biotin, Primrose oil, Omega 3 and Livercare. Blood pressure drugs are among the most used medications.

This information will be useful in understanding differences in microbiomes of subjects with similar symptoms. We might already be observing interesting trends. Certain supplements, for example, seem to benefit some blood group more than others. Same about foods naturally rich in certain minerals and vitamins.

We'll talk about this next time.

I Know What You Ate This Summer

Despite active foodstagramming and foodteresting, and eagerness to show pictures of meals and diet reports to friends on social media, we don't really want others to know everything we eat. But they might know anyway.

Why worry about NSA, when Google, Facebook, Amazon and many others know what we might be eating. Cameras record our ways to groceries and restaurants, credit cards record our purchases, food chains know our weaknesses, clothes shops know how, as a result, our pant sizes change over time. One day phones will know what we ate too.  As both short- and long-term diets change our breath-prints - creating signature metabolites in exhaled breath.

A recent Dutch study actually looked at what gluten-free eating does to our breath. Just 4 week of dieting lead to remarkable - though reversible -  differences. (As detected in 20 healthy individuals by gas chromatography coupled with mass spectrometry (TD-GC-tof-MS) in combination with chemometric analysis ). A set of twelve volatile compounds that distinguish gluten-free eaters along with information from Aurametrix knowledgebase is listed in the table below.

Compound	Odor	Notes
2-butanol	strong alcoholic	1-Butanol smells like permanent marker (Sharpie)
octane	Gasoline-like, car exhaust	octyl chloride smells faintly of oranges
2-propyl-1 pentanol	green banana	1-Pentanol smells like paint thinner
nonanal	strong fruity or floral	attracts mosquitoes
dihydro-4-methyl-2(3H)-furanone	strong coconut aroma	5-butyl-4-methyloxolan-2-one is known as "whisky lactone"
nonanoic acid	rancid beer, old cooking oil	armpits of males over 30
dodecanal	Soapy, waxy, aldehydic, citrus, orange rindy with floral nuances	Pure, synthetic qualities of this fatty aldehyde are used in traces in perfumery for "fresh laundry"-like effects.

Reference

Baranska A, Tigchelaar E, Smolinska A, Dallinga JW, Moonen EJ, Dekens JA, Wijmenga C, Zhernakova A, & van Schooten FJ (2013). Profile of volatile organic compounds in exhaled breath changes as a result of gluten-free diet. Journal of breath research, 7 (3) PMID: 23774130

Studying body odor: one step at a time

Unpleasant body odors could be a sign of a disease. But even when the cause of the disease is known - an example is trimethylaminuria or TMAU - there are no one-size-fits-all solutions. Elimination of choline and other essential nutrients from diet can be harmful and unhelpful.  Everyone has their own unique needs, with individual combinations of foods, activities and optimal environmental conditions.

An earlier survey of about 100 body odor and halitosis sufferers indicated stress (34%), food (25%) and environment, including the weather and perfumed products (15%) as main triggers of odors. 23% of sufferers did not know what the trigger was.

Our study seems to have less unknowns. As you see from the picture, 60% of participants have both body odor and halitosis. Only 22% of participants were diagnosed with TMAU, one third has IBS, one third has environmental sensitivities (mostly pollen and mold allergies, but some have dust mite and pet allergies and chemical sensitivities). Over 60% of participants reported sensitivities to specific foods. Most frequent was lactose sensitivity.

It is known that a specific diet, infections and diseases have major impact on variations in human body odor.  Some of our early results on fatty and ammonia types of odors identified a few food ingredients and their maldigestion as potential causes. Our next posts on musty and smoky odors, as well as unpleasant odors in general will tell more.

e-mail to

 for more information

And stay tuned for results!

REFERENCES
Jan Havlicek, & Pavlina Lenochova (2008). Environmental effects on human body odour Chemical Signals in Vertebrates DOI: 10.1007/978-0-387-73945-8_19

Havlicek, J., & Lenochova, P. (2006). The Effect of Meat Consumption on Body Odor Attractiveness Chemical Senses, 31 (8), 747-752 DOI: 10.1093/chemse/bjl017

Moshkin M, Litvinova N, Litvinova EA, Bedareva A, Lutsyuk A, Gerlinskaya L. Scent Recognition of Infected Status in Humans. J Sex Med. 2011 Dec 6. doi: 10.1111/j.1743-6109.2011.02562.x.

What's that fatty odor?

Body odor is closely associated with diet. Deciphering the chemistry of human odor is not an easy task - only about 5% of odorous molecules are usually recovered from collection containers, and not all of the molecules are identified in complex spectra. Volatile fatty acids, alcohols, and aromatic ring compounds comprise a substantial fraction of smelly molecules, yet very little is known about the origin and factors controlling their production in humans. Fortunately for some (and not so fortunately for others), the human nose can capture and discriminate many smell signatures. Could this discrimination be used to connect the dots between diet and body odor? MEBO Research has just started an anonymous study using the Aurametrix health analysis tool to find out.

Aurametrix's knowledge base provides a wide selection of foods and symptoms, including different types of odors recognizable by the human nose. Participants in the study have been recording some of their food intake and activities on days when their symptoms are better or worse than average, entering items they suspect might be contributing to or alleviating their body odor on those days. The tool's analysis engine then lets them explore all the possible cause-effect relationships. In addition, Aurametrix performs automated analyses across the entire user community and displays cumulative results as "aggregate correlations." The figure on the right is an excerpt from these results.

Although the study has only just begun, the preliminary results already look very interesting. One example is fatty odor. Aurametrix linked several dietary chemicals to unpleasant "fatty odor" emanating from skin based on Aura entries of several participants. The top chemicals so far are:  Vitamin K1 (phylloquinone), Octadecanoic acid, FODMAPs, Beta-carotene,  Carbohydrates and Monosaccharides. Another interesting result (although there were fewer observations) is that Vitamin B12 obtained from diet seemed to help prevent fatty body odor.

• Could Vitamin K1 really contribute to "fatty" odor?  Could 6 observations derived from different users' Auras be just a coincidence? Vitamin K is proposed to increase production of alkaline phosphatase in intestines. This enzyme produces a number of different substances, some of which have a peculiar sweetish smell.  Chlorophyll, usually recommended to combat body odor and supposedly makes odor "sweeter," is an excellent source of vitamin K1. And so is Asparagus that gives urine a disagreeable odor.
• Octadecanoic (Stearic) acid was also linked to fatty odor in 6 observations. This saturated fatty acid is most abundant in animal fats and cocoa butter, and also in nuts and seeds (peanuts, flax), cheese, cookies and candies. Its smell is fairly mild, yet can be detected by the human nose (Bolton and Halpern, 2010). Besides, it slowly converts in the liver to heart-healthy oleic acid which has a faintly fatty odor with a hint of dead insects. It could also metabolize into other compounds and incorporate into liver lipids or follow alternative routes.
• FODMAPs, highly fermentable but poorly absorbed short-chain carbohydrates and polyols, were found to be an important dietary factor contributing to gastrointestinal symptoms. Perhaps FODMAPs, carbohydrates and monosacharides in particular could also contribute to odor in the absence of GI discomfort?
• Beta-carotene is another heart-healthy chemical with anticancerous properties important in human nutrition as a source of Vitamin A. Tobacco, tea, many spices and flowers owe their flavors to chemicals metabolized from beta-carotene. One of such chemicals is warm and woody beta-Ionone that smells of blackberry at lower concentrations and fatty-cheesy at higher concentrations.

The chemistry of odors and their origins is undoubtedly very complex. Yet, these preliminary results show that together we may find the answers to many health-related questions. With more participants, we'll soon connect the dots between diet and body odor. Want to participate? Write to:

References

Bolton B, & Halpern BP (2010). Orthonasal and retronasal but not oral-cavity-only discrimination of vapor-phase fatty acids. Chemical senses, 35 (3), 229-38 PMID: 20100787

Dunkel M, Schmidt U, Struck S, Berger L, Gruening B, Hossbach J, Jaeger IS, Effmert U, Piechulla B, Eriksson R, Knudsen J, & Preissner R (2009). SuperScent--a database of flavors and scents. Nucleic acids research, 37 (Database issue) PMID: 18931377