TMAU Trimethylaminuria Explored Explained Understood?
One may term this as hiding from the truth as we all appear to do - when mysterious illness strikes?
This Paper is as much of what is reasonable to consider - as it is a matter of fact...
It is also a compilation of two papers - one Wikipedia and from another professional self-help style source.
Therefore it may contain a number of repeats - perhaps this particular set of mysterious and distressing symptoms, demands such scrutiny.
Moreover, for a Medically qualified Person considered as. Anecdotal - a posh word for storytelling.
If in reading this paper my writing appears to be like a foreign language or even rambling.
Consider reading this paper - not as a book; take some time to comprehend the contents.
Where I would like to think and feel sure, it will make sense?
So often we read or hear in detail "What" (description or symptoms) of an illness - but rarely if ever does anyone take the time to truly explain.
"WHY," or how it is really caused...
...this paper is designed to answer many of the questions - we are so often left with.
Where many times we have the questions and no answers - or the answers and not the questions.
If I have unwittingly left anything out or not satisfactorily answered, please email (address at the end of this page) and I will include it in this Paper at the earliest opportunity.
Please include item number or a copy and paste if possible - of the item that is not clear.
Did we not all struggle as a Child to learn many things we now through the experience of life - are now extremely competent with.
No apology if offered if discussions are repeated within this paper.
The understanding for this, is nothing is more repeating than illness that is there every day of one's life and - despite treatments does not get better or have a satisfactory explanation/understanding or when Medical Science writes Scientifically Proven Papers about illness; in a confusing or repeating manner that confuses everyone - even themselves!
The first thing in the process of answering this is, for any one suffering, it is clear...
"...New understandings are required about illness..."
...as it appears the existing education is the same worldwide?..
If on reading this or any of Talking Cures understanding of illness one gets the impression I am angry - then please believe it; because in 2016 People are not only not recovering from any illness - so often the treatments make them worse and no one knows why or it appears cares.
From Talking Cures point of view and therapeutic practice - names of illness especially Medically Diagnosed recognised and Scientifically proven, are of no real value in the understanding and treatment of any illness - the only Name we should use or symptom we may label is...
"A Person is unable to achieve a Healthy and satisfactory lifestyle...”
...Or never allowed to become the Person they should have...
Thus requires. “Specialised assistance,” in order to make sense of the presenting symptoms, the cause and reason for them - enabling automatic resolution via the Persons own immune systems and Body replication process - referred to as, the entire body chemistry.
...Surely if a Person cannot be in control of self-repair when can they be in control!
To a trained Medical Mind these questions and answer updates may well appear or feel patronising - it is hoped not, as their structure is at the very. "Heart" of the success of Talking Cures as a therapeutic application and may well be a serious asset and improvement in Medical Treatment outcome success.
In order to fully appreciate this, it is helpful to consider and accept;
All of the information as to why a Person became ill in the first place and as a consequence - all of the information required for them to automatically create immune response repair is - not only contained within the confines of their Mind - it is the only information required to bring about the required Automatic Cure using their own immune systems and Body replication processes. As designed by the Mind and Body.
By creating very cleverly constructed questions - knowing the Person is able to answer them with their own knowledge of themselves of which they are a Master and if they are unable to with my interpretations, accepted as re-education of their own information, that continues/completes on an ongoing bases; the process either returning to well-health or well-health for the very first time in their lives.
These explanations are from a collection of Scientifically Proven papers in the public domain and discussion forums and are in a Question and Answer forum style.
It is important to accept I am both the Questioner, on behalf of interested Person's as well as the Person supplying the Answers..,
...thus in many ways - my own best critic.
Leaving one to choose the Questions and Answers that are important for a better or individual understanding of this seemingly mysterious illness.
Courtesy of Wikipedia, the free encyclopedia:
This article is about making 2016 sense of the disorder.
Regarding Person's having TMAU and interrelated symptoms all with unknown cause and no known cure.
Trimethylamine Classification and external resources
4835 Gene Reviews
Trimethylaminuria - No data has been found on Wikidata.
TMAU Trimethylaminuria .
A. As there is so little information relating to this simple to understand disorder - may we accept this is a brief outline of the history of the disorder - opening up the way for further discussion.
B. Trimethylaminuria, has been around for centuries, but has only gained scientific recognition and support in the past 46 years.
C. The first clinical case of TMAU was described in 1970.
D. Trimethylaminuria is a rare disorder in which the Body's metabolic processes fail to alter the chemical trimethylamine.
E. Trimethylaminuria is a metabolic condition in which an individual is not able to convert trimethylamine into a compound called trimethylamine N-oxide.
F. Trimethylamine N-oxide does not smell.
G. Trimethylamine is notable for its unpleasant smell.
H. It is the chemical that gives rotten fish a bad smell.
I. When the normal metabolic process fails, trimethylamine accumulates in the Body and its odour is detected in the Person's sweat, urine and breath.
J. The consequences of emitting a foul odour can be socially and psychologically damaging among adolescents and adults.
K. The genetic or primary form of this disorder is transmitted as an autosomal recessive trait.
L. The metabolic deficiency occurs as a result of a failure in the cell to make a specific protein, in this case the enzyme flavin-containing monooxygenase 3.
M. Enzymes are nature's catalysts and act to speed up biochemical processes.
N. Without this enzyme, foods containing carnitine, choline and/or trimethylamine N-oxide are processed to trimethylamine and no further, causing a strong fishy odour.
O. A secondary form of Trimethylaminuria may result from the side effects of treatment with large doses of the amino-acid derivative L-carnitine (levocarnitine) or choline.
P. This secondary form of the disorder is a result of an overload of trimethylamine.
Q. In this case, there is not enough of the enzyme to get rid of the excess trimethylamine.
Question. 1: As there is so little information relating to this disorder - may we explore what there is, starting with the so called Signs and Symptoms?
Signs and Symptoms.
Answer. 1: The fish-odour smell is the obvious symptom, otherwise affected individuals appear normal and healthy.
A. Trimethylamine builds up in the Body of Patients with Trimethylaminuria.
B. The trimethylamine is released in the Person's sweat, urine, reproductive fluids and breath, giving off a strong fishy odour.
C. Some suggest it seems to be more common in Women than Men, but scientists do not know why.
D. Scientists suspect that Female sex hormones, such as progesterone and/or oestrogen, aggravate symptoms.
E. There are several reports that the condition worsens around puberty.
F. In Women, symptoms can worsen just before and during menstrual periods, after taking oral contraceptives and around menopause.
G. Moreover with Trimethylaminuria have a strong odour all the time, but most have a moderate smell that varies in intensity over time.
H. Other than the strong fishy odour, individuals with this condition typically appear healthy.
Question. 2: Is that it?
Answer. 2: It appears so - makes one wonder why it takes a Professor to make this diagnoses.
Question. 3: May we now look at what is suggested is the cause?
A. Trimethylaminuria is a rare metabolic disorder that is inherited as an autosomal recessive genetic trait or primary.
B. It is suggested People with Trimethylaminuria have an impaired version of the enzyme flavin-containing monooxygenase 3 (FMO3.
C. This is the enzyme that converts trimethylamine to trimethylamine N-oxide.
D. FMO3 is produced by the liver and is a member of a family of similar enzymes responsible for metabolizing compounds that contain nitrogen, sulphur, or phosphorous.
E. The enzyme is coded for by the FMO3 gene.
F. Trimethylaminuria may be caused by a variety of genetic changes to the FMO3 gene.
G. Not all of the functions of the FMO3 enzyme are known, so physicians do not know what other symptoms besides odour may be associated with Trimethylaminuria.
H. Or occurs as the result of treatment with large doses of dietary precursors of the offending chemical - secondary.
I. Symptoms develop when the ability of the liver enzyme - flavin-containing monooxygenase 3 to break down - metabolize, trimethylamine is inhibited.
J. The responsible gene, designated as FMO3, has been tracked to gene map locus 1q24.3.
K. Although humans have several FMO genes, changes in only one of these, FMO3, causes Trimethylaminuria.
L. For reasons that are unclear, many different changes - mutations) of the FMO3 gene exist.
M. Carry the genetic information for each individual.
O. Human Body cells normally have 46 chromosomes.
P. Pairs of Human chromosomes are numbered from 1 through 22 and the sex chromosomes are designated X and Y.
Q. Males have one X and one Y chromosome and Females have two X chromosomes.
R. Each chromosome has a short arm designated “p” and a long arm designated “q.”
S. Chromosomes are further sub-divided into many bands that are numbered.
T. For example, “chromosome 1q24.3” refers to a region on the long arm of chromosome 1, within the band 24.
U. The numbered bands specify the location of the thousands of genes that are present on each chromosome.
V. Genetic diseases are determined by the combination of genes for a particular trait that are on the chromosomes received from the Father and the Mother.
W. Recessive genetic disorders occur when an individual inherits the same abnormal gene for the same trait from each Parent.
X. If an individual receives one normal gene and one gene for the disease, the Person will be a carrier for the disease, but usually will not show symptoms.
Y. The risk for two carrier Parents to both pass the defective gene and, therefore, have an affected Child is 25% with each pregnancy.
Z. The risk of having a Child who is a carrier like the Parents is 50% with each pregnancy.
1. The chance for a Child to receive normal genes from both Parents and be genetically normal for that particular trait is 25%.
2. The risk is the same for Males and Females.
3. All individuals carry a few abnormal genes.
4. Parents who are close relatives - consanguineous, have a higher chance than unrelated Parents of both carrying the same abnormal gene, which increases the risk of having Children with a recessive genetic disorder.
Question. 4: What does this tell us?
Answer. 4: Above under "Causes" I have marked four items in Red and here I have re written them to make a little more sense and for further discussion...
"...For reasons that are unclear, physicians do not know if or why large doses of dietary precursors create other symptoms and what it means when they suggest the nucleus of Human cells carry the genetic information for each individual."
Question. 5: Who are in the main are affected?
A. Trimethylaminuria is a rare metabolic disorder. More than 100 cases have been reported in the medical literature.
B. Some clinicians believe that the disorder is under-diagnosed since many People with mild symptoms do not seek help.
C. However, some physicians do not recognize the symptoms of Trimethylaminuria when a Person with Body Odour seeks a diagnosis.
A. Why is it Doctors believe the disorder is underdiagnosed.
B. Is there a Diagnostic Formula?
A. There is a sadness here for all of the careers of our dedicated front line clinicians they have been forced to believe; we humans do not have a Mind only a Biological Brain - thus can be medicated.
B. In pursuit of this - have adopted various protections, when their scientifically proven treatments fail to achieve the desired or promised outcome. EG: "Its all in your Head." is the one required here.
C. Therefore when a Person has any disorder let alone one as personal as TMAU - knowing deep in their Mind it was caused by their Parents and exacerbated by their closets family and Friends, the very last thing they desire is to be further ridiculed by a Person in their professional capacity, considered - tantamount to a Priest.
D. Thus are in perpetual Fear of attending their Doctors or any professional - whether they have secure knowledge or not about the condition.
A. The presence of the rotten-fish odour is indicative, especially in severe cases.
B. However, diagnosis based on smell is unreliable because the odour is often episodic and not everyone can detect the smell of trimethylamine.
C. In addition, on the basis of smell, Trimethylaminuria can be difficult to distinguish from other conditions that give rise to an unpleasant Body Odour.
D. Diagnosis is based on urinary analysis of trimethylamine and trimethylamine N-oxide, which can distinguish between severe and mild cases.
E. Urine analysis after the administration of large doses of trimethylamine can distinguish carriers of the condition from unaffected individuals.
F. Testing can be done by giving choline by mouth followed by urine collection a certain number of times over a 24 hour period.
G. Urine testing should be performed on two separate occasions when the individual is on a non-restricted diet.
H. The test measures the ratio of trimethylamine to trimethylamine N-oxide present in the urine.
I. Genetic testing is available to distinguish between primary genetic Trimethylaminuria, which will result in severe symptoms, from secondary, non-genetic forms of the disorder.
Question. 7: How may we interpret the Diagnoses information?
Answer. 7: We do not - it is just information a Person would be able to supply, if one asked the correct questions.
Question. 8: Better explanation please?
Answer. 8: This is no more than a relief of the attending teams own Anxiety demonstrated by a Person being delighted for a brief moment in time at the confirmation their problem is biological not. "All in their Head."
Question. 9: Are there currently any therapies offered?
Standard Therapies and Treatments.
A. The following are some ways a Person with Trimethylaminuria can lower symptoms of odour: It is suggested. In mild cases, symptoms are relieved when foods containing choline and lecithin are restricted.
B. Some severe cases may require the administration of a gut-sterilizing antibiotic such as metronidazole.
C. This treatment reduces the number of intestinal bacteria that break down choline and trimethylamine N-oxide into trimethylamine.
D. Avoiding foods containing trimethylamine and its precursors (choline, lecithin and trimethylamine N-oxide).
E. Trimethylamine is present in high levels in milk obtained from wheat-fed cows Choline is present in high amounts in: Eggs. Liver. Kidney. Peas. Beans. Peanuts. Soy products. Brassicas - Brussels sprouts, broccoli, cabbage and cauliflower. Lecithin and lecithin-containing fish oil supplements
F. In the case of mutations that do not completely abolish FMO3 activity, supplements of riboflavin might help maximize residual enzyme activity.
G. Dietary supplements such as activated charcoal and copper chlorophyllin Activated charcoal taken at a dose of 750mg twice daily for ten days.
H. Copper chlorophyllin taken at a dose of 60mg three times a day after meals for three weeks can bind trimethylamine in the gut and hence reduce the amount available for absorption.
I. Taking low doses of antibiotics to reduce the amount of bacteria in the gut. This suppresses the production of trimethylamine. Taking riboflavin (vitamin B2) supplements to enhance any residual FMO3 enzyme activity. Recommended intake is 30-40mg taken 3-5 times per day with food.
J. Taking laxatives can decrease intestinal transit time and reduce the amount of trimethylamine produced in the gut.
K. Taking supplements to decrease the concentration of free trimethylamine in the urine.
L. The use of slightly acidic soaps and Body lotions can convert trimethylamine on the skin into a less volatile form that can be removed by washing.
M. If the disorder is acquired due to excessive doses of L-carnitine, choline or lecithin, symptoms disappear with reduction of dosage.
N. It is important that a person who has Trimethylaminuria follow the treatment advice of their health care provider.
O. They should not attempt to self-administer these treatment approaches.
P. Medications and supplements can have unintended interactions, and dietary restrictions can result in nutritional deficits.
Q. Choline is essential for nerve and brain development in fetuses and infants, therefore, pregnant and breast-feeding Women should consult with their health care provider before restricting their dietary choline.
R. Trimethylamine N-oxide is present in seafood - fish, cephalopods, crustaceans.
S. Freshwater fish have lower levels of trimethylamine N-oxide.
T. Using soaps with a moderate pH, between 5.5 and 6.5.
U. Trimethylamine is a strong base (pH 9.8), thus soaps with pH closer to that of normal skin help retain the secreted trimethylamine in a less volatile form that can be removed by washing.
V. Avoiding factors that promote sweating, such as exercise, stress and emotional upsets.
W. Behavioural counseling to help with depression and other psychological symptoms.
X. Genetic counseling may be of benefit for Patients and their Families.
Y. Genetic counseling to better understand how they developed the condition and to be aware of the risks of passing this disorder on to the next generation of Children.
Z. However, research suggests it is possible for People with this condition to live normal, healthy lives.
Question. 10: Can Trimethylaminuria be cured by replacing the enzyme FMO3?
Answer. 10: Unfortunately at this time, enzyme replacement therapy with the enzyme FMO3, which when absent, is believed to cause the condition, is not an option in the management of Trimethylaminuria.
Question. 11: Is there a value in Human Bio molecular Research?
Answer. 11: It appears there is Research being carried out into Human Bio molecular characteristics of TMAU. It appears the recommendation is working with a medical or genetics professional to contact the laboratories for further information.
A. Trimethylaminuria can be very upsetting, potentially affecting a personal life and career.
B. Depression and social isolation are common.
C. Counseling may help you cope with any depression and other psychological symptoms.
D. As the researcher also suspect that stress and diet play a role in triggering symptoms.
Question. 12: Are there any points of interest in this section?
Answer. 12: Forgive me for repeating. This is no more than a relief of the attending teams own Anxiety demonstrated by a Person being delighted for a brief moment in time at the confirmation their problem is biological not. "All in their Head."
Question. 13: Expand this please?
Answer. 13: Accepted there are perhaps only 100 cases world wide making study very expensive; is it really acceptable after some Forty Six years so little is understood about the condition - when one considers Man and indeed Woman have experienced Body Odour's for as long as mankind has occupied this planet.
In addition any clinician that has to consider the Family in any treatment application is surely to be considered - out of their brain and has and will never have any comprehension of this very sensitive disorder.
Question. 14: What if any investigation are being conducted into other therapies?
Answer. 14: It appears there are a number of investigations being conducted.
A. Whilst not exhaustive it was not easily - other that Wikipedia to source any information that expanded on the knowledge and treatment of this disorder.
B. Further searching confirmed...
1. To date there has been no systematic appraisal of suggested treatments in this condition.
2. Moreover it seems clear the various options have not been universally successful particularly in severely affected individuals.
C. At the very least, Patients may benefit from being warned that the symptom may be exacerbated by febrile fit or febrile convulsion - is a seizure associated with a high Body temperature, without any serious underlying health issue. including infections and during the pre menstrual period.
D. Some People with Trimethylaminuria experience depression and social isolation as a result of this condition.
E. It appears to me this is a far as investigations will ever go with this most distressing of disorders - more than ever medical advances are driven by the requirement of big profits - thus this as many will disappear into the history book of Novel but of No Scientific Value.
Question. 15. May we examine the Genetics implicated in the Understanding of this disorder? And is it inherited?
Is Trimethylaminuria inherited?
A. Research suggests. Trimethylaminuria is usually inherited in an autosomal recessive fashion, which means that two non-functioning FMO3 genes are usually needed for a Person to have symptoms.
B. Both Parents of an individual with Trimethylaminuria, are "carriers" of the condition, in other words, they both carry one copy of an altered gene for FMO3.
C. Since this condition usually requires two altered genes to cause symptoms, typically neither Parent of an individual with Trimethylaminuria has any symptoms.
D. Sometimes, "carriers" of one copy of an FMO3 mutation may have mild symptoms of Trimethylaminuria or have temporary episodes of fish-like odour.
E. Due to the variability of symptoms People with Trimethylaminuria experience, researchers think that different genetic mutations in FMO3 can influence the symptoms of the disease, affecting time of onset and how strong the odour is.
F. A carrier of this condition can be identified by the. "TMA challenge" or a "TMA load" test.
G. This involves giving an individual a 600 dmg pill of trimethylamine (TMA).
H. Carriers of Trimethylaminuria excrete 20-30 percent of total trimethylamine as the free unmetabolized amine and the rest as trimethylamine N-oxide.
I. Non-carriers excrete less than 13% of the dose as trimethylamine.
J. Gene testing called gene sequencing can be used to look for mutations in the FMO3 gene.
K. Note: One may be advised to consider Gene testing is currently available only through research laboratories thus may have a long waiting list and not accept direct contact from Patients.
Question. 16: Loads of nice interesting information collated from sources that deem to know about the disorder having studied it - through from Genetic to Symptom presentation and on to clinician and self management; presented in a logical format?
But has it or does it give any hope in the true understanding for a Person with the disorder and if I have to - include the many People surrounding such a Person?
Answer. 16: My initial response including watching a professor consulting with young Woman with the disorder on National UK Television - is not a chance.
Question. 17: Leads one to request you explain your observations and perhaps interaction if any with anyone from the medical profession or even Persons with the disorder?
Answer. 17. May we start with my interactions with others.
As far back as 2007 following a television program I wrote to many - copied below, significant People; who all are implicated in - so they say, finding the cause and an effective treatment or cure.
Of course I have to recognise I am not medical qualified - but with any mysterious disorder that is scientifically proven to not know the cause and have no known cures...
...I have to wonder the value in being medically qualified and why my opinion is not even worthy of a polite - thank you, but no thank you.
107 Victoria Road
Southend on Sea
Essex SS1 2TF
Telephone-Fax - 01702 60 30 30
25th September 2007.
Dr Robin Lachmann
University College London
Dear Dr Robin Lachmann
Re: “Help I smell of Fish” BBC Three.
Re: Fish Odour Syndrome.
Please receive the enclosed letter for forwarding on at your discretion to - any Person with this mysterious symptom - Rachel the 32 Year Old Lady who appeared on the above mentioned TV Program with you, as well as in your surgery at the UCL.
Whilst I have no previous knowledge of you there is no doubt in my mind like all Medical Staff whether within our NHS or private you are a fine and dedicated Doctor who would always wish to adhere to the Doctors premise of. “First do no harm” and in consideration of what I am about to request you do, this must come to your mind, it certainly does mine.
If I was a Doctor I would take great stock in saying to my Patient. “I have done some research and found a Therapist that may be able to help you.”
You are invited to take the credit in this case.
In consideration of the Fact in your own words; “there is no cure” for the above syndrome.
I would request first you talk to me - or at the very least forward the enclosed letter to Miss Rachel as an representative of the Three Hundred or so Sufferers in the UK left in the wilderness of no Scientific Evidence to help them, or better still under the guise of Scientific Research - refer her to my practice instead of leaving her to the ravages that could be reasonably expected to continue to destroy her life.
For this statement; whilst from a Scientific point of view may be true, for Talking Cures the same consideration is most certainly not true.
One could and should consider what harm can talking do, surely it is not in the same league as administering Drugs: thereby no side effects, Inserting Needles, no inadvertent infection or some form of Manual Manipulation, twisting a Body until it clicks in the belief the louder the click the more beneficial.
Talking Cures are a powerful stand alone treatment regime that does not rely on any form of instructions - relying on the Patients response to a very clever conversational technique based on secure techniques and understandings - Diet or Life style changes, as was the case with Mrs. Carol Sexton who was also featured on the program.
Such changes imposed upon a Person as a therapeutic application with a mystery disease as this, will only create an illness with the possibility of the new illness being, just, if not more mysterious and by definition even less curable.
This is not to be seen as a derogatory statement about the Psychologist Mrs. Sexton visited.
Being able to be fresh of the Body is a Right not a Gift, much the same a sleeping soundly; knowing one has done ones best in any given or prevailing situation!
It would be reasonable to expect, Rachel to be delighted to know there is at least One Person interested in her plight, with the belief her condition can be cured.
Your response is awaited
CC: Mr Robin Lachmann UCL London WC1E 6BT
CC: UCL Director. Professor Roger Lemon, BSc, MA, PhD, FMedSci
CC: Medical Research Council.
CC: General Medical Council.
CC: BBC 3 Television.
Treatment for: Sports injuries. HIV. Backpain. Accident Injuries. Whiplash. Muscle Aches. Allergies. Obsessive-Compulsive Disorder. Repetitive Strain Injury. Stress. Tiredness. Attention Deficit Disorder. Emotional Pain. Asthma. Fibromyalgia, Substance Abuse. Family Counseling. Fears. Phobias. Anxiety. Feminine Concerns. Infertility. Any discomfort of the Mind and Body where the degree of comfort desired has not been achieved.
Available for talks-demonstrations.
Telephone Treatments by request.
TMAU Trimethylaminuria .
Answer. 17: Continued.
To: All members of TMAU Group
Subject: Channel4 - Still looking for TMAU volunteer
Date: Wed, 6 July. 2011 12:34:05 +0100
The following is an e-mail sent to you by an administrator of. "TMAU Forum
Message sent to you follows:
Please see below email requesting a volunteer for channel 4 documentary.
Another opportunity for media exposure, includes help from Dr Lachmann.
Main criteria is newly diagnosed & who has not had any dietary intervention.
I believe some of you have already been discussing this program in the forums.
Please keep us updated in the forums if you are going to appear!!
On a separate matter please see latest posts from Malory in the forum: Board index - latest news and announcements.
Thanks to Malory - keep up the good work!
I am working with Vicki Cooper - who I know contacted you last year regarding Embarrassing Bodies and covering TMAU and you were extremely helpful putting out the word for her to find a contributor.
I wonder if you might be able to help again?
Vicki and I are now working on a specialist factual series for C4 called. 'Food Hospital.'
The series is looking at how specific diets impact and in some cases cure, certain conditions.
We are interested in metabolic diseases and would very much like to feature TMAU in order to raise awareness of the condition.
Once again we have Robin Lachmann on board to offer his expert support.
Would you be able to put up a Media Request?
We are looking for a contributor with newly diagnosed TMAU - confirmed through urine test and yet to start any dietary intervention.
We would like to find someone as soon as possible - preferably in the next 2 weeks.
The contributor would come to the Food Hospital and see our expert team and Robin Lachmann to receive the best dietary advise and support in order to, treat their odour.
If you have any queries or require any further information please do not hesitate to contact me.
Sue Edwards assistant producer Betty - firstname.lastname@example.org
020 7907 0870
Conclusion - As no encouraging response was received - it is reasonable to consider the very last thing especially the Medical and Media personal desire, is someone to come along and burst their bubble of Fifteen Minutes of fame.
If I had to think is such a manner I would most seriously have to consider my sanity of being such a Psychotic Control freak as to only desire a Person I work with to be deserved - if only but for the very first time in their life; the Fundamental Right to be educated in such a way as to be better in Mind and Body Health - than their Tutor-therapist. Myself.
TMAU Trimethylaminuria .
Question, 18: Where can we go to now?
Answer. 18: They may be the possibility of late breaking information we are able to use - however whilst we await its arrival may we explore although not in any particular order, some fragments gathered during my collection of information relating to this disorder and in so doing start my appraisal of the disorder.
A. May we start in a manner we intend to carry on:
B. May we dispel the name and all of its descriptions and any Diet that could cure or even long-term manage as all they are in reality information for the relief of the clinicians anxiety only and nothing to do with the Patient at all.
Question. 19: Trimethylamine is normally formed by bacterial action in the intestine on choline - found in foods such as soya, liver, kidneys, wheat germ, brewer’s yeast and egg yolk? What does this mean?
Answer. 19: This is nonsense - confirmed by - If one has no knowledge as to the chemical activity in the Body as instructed by the Mind.
A. And, if we accept - Trimethylamine is indeed formed by bacterial Action on another chemical Choline, then surely we must see this is only part of a long-chain of chemical events created by negative thoughts in the Mind, perhaps many years prior to the onset of symptoms this chemical activity is supposed to implicated; in the extreme Body odour secreted.
Question. 20: Where or why is this implicated in the disorder? Trimethylamine N-oxide - as found in salt water fish.
Answer. 20: One could with good reason consider it does not. As the trimethylamine is then carried to the liver where it is converted to trimethylamine N-oxide, a metabolic product that has no odour.
Question. 21: When secondary Trimethylaminuria develops as a result of large oral doses of L-carnitine, choline or lecithin, the symptoms disappear as the dosage is lowered.
Answer. 21: Strikes me this is a most serious attempt to ensure the disorder is of biological creation and of not even Novel let alone Scientific Value.
Question. 22: L-carnitine is used in the treatment of carnitine-deficiency syndromes and is sometimes used by athletes who believe it enhances physical strength.
Answer. 22: A confirmation of answer 21. Body odour and athletes physical strength are only related if one does not have a clue what one is doing and indeed understands the negative implication on a Patient this stupidity occasions.
Question. 23: It has been said - Choline is used in the treatment of Huntington disease and Alzheimer's disease. Does this have implications in the treatment of. TMAU?
Answer. 23: Sure does like all treatments for the two disorders you mention they only end in failure - thus as they say all Roads lead to Rome.
Question. 24: Choline and lecithin are present in certain food supplements and ‘health’ foods.
Answer. 24: One may be pushed to ask. "What has this to do with the price of Fish."
Surely if one has to turn to so-called Health Foods it is an admittance Scientific Medicine has not been successful in the resolution of earlier presented symptoms - so how can this. As explained in question and answer 19.
Question. 25: Trimethylaminuria - TMAU, as defined by the consortium of endocrinology disorders as fish odour syndrome or fish malodor syndrome, is a rare metabolic disorder that causes a defect in the normal production of an enzyme named flavin-containing monooxygenase 3 - FMO3.
Answer. 25: It is only rare because Medical Science is the only profession never once in real-terms to have improved its product outcome of illness treatments - using the very latest and best scientifically proven treatments.
Question. 26: When FMO3 is not working correctly or if not enough enzyme is produced, the Body loses the ability to properly convert trimethylamine (TMA) from precursor compounds in food digestion into trimethylamine oxide (TMAO), through a process called N-oxygenation. What does this to equate to?
Answer. 26: Nothing it is just a short section of the chain I spoke of in answer 19 paragraph A. The clue is in the term. N-oxygenation.
Question. 27: Please explain the clue?
Answer. 27: If the Body and the Blood is not properly naturally Oxygenated - then as nothing will burn without Oxygen then the Body is unable to burn its Fuel-Food in a manner to allow comfortable Mind and Body activity. Thus something is stopping this process and it is nothing to do with the Diet.
Question. 28: How does that work when - The Trimethylamine builds up and is released in the Person's sweat, urine and breath, giving off a strong fishy odour or strong body odour.
Answer. 28: A variant of TMAU - secondary TMAU or TMAU2 exists where there is no genetic cause, yet excessive TMA is secreted, possibly due to intestinal dysbiosis, altered metabolism, or hormonal reasons.
Question. 29: Tells me about it? Does not answer the question?
Answer. 29: If one takes into consideration the items marked in Red it is clear to see there is a lot of guesswork going on - thus cannot be of any real value in understanding the cause and in so doing create a cure for this most distressing disorder.
Question. 30: But - Trimethylamine builds up in the Body of Patients with Trimethylaminuria? Surely that is sufficient to understand the disorder is real and not imagined or in some ones HEAD?
Answer. 30: The trimethylamine is released in the Person's sweat, urine, reproductive fluids and breath, giving off a strong fishy or Body odour.
But then so is Co2.
A. Carbon dioxide (CO2) is produced by all aerobic organisms when they metabolize carbohydrate and lipids to produce energy by respiration.
B. It is returned to water via the gills of fish and to the air via the lungs of air-breathing land animals, including humans.
C. Carbon dioxide is produced during the processes of decay of organic materials and the fermentation of sugars in bread, beer and wine making.
D. It is produced by combustion of wood, carbohydrates and fossil fuels such as coal, peat, petroleum and natural gas.
F. Demonstrating why - Some People with Trimethylaminuria have a strong odour all the time, but most have a moderate smell that varies in intensity over time.
Question. 31: Why is it? The condition seems to be more common in Women than Men?
Answer. 31: Once again in true Scientific jargon the say with scientific confidence "For unknown reasons." Science suspects that female sex hormones, such as progesterone and oestrogen, aggravate symptoms.
Question. 32: Are there any indications as to what age a Child would be when first presenting the symptoms?
Answer. 32: There are several reports that the condition worsens around puberty, thereby indicating it may have been what they call Sub-Clinical for a long time.
A. Confirmed by there are a few reports of it being noticed in extremely young Children.
Question. 33: What are the longer term implications as to its progression or getting worse?
Answer. 33: In Women it is reported, symptoms can worsen just before and during menstrual periods, after taking oral contraceptives and around menopause.
Question. 34: What are the real implications indicated in the symptoms become worse "after taking oral contraceptives and around menopause."
Answer. 34: Whilst in this instance we have no knowledge as to the age a Woman might be on entering or completing cessation of menstruation.
A. May we for this instance accept the Woman is far too young to complete this necessary process for all of her Body functions to sustain through aging - a natural vibrancy.
B. Then we are able to see for much if not all of her lifetime of menstruating her ability to sustain a natural or even as a result of traumatic incidents in her life entire Body Chemistry Balance.
C. And then ask; "how much of this process is implicated in the worsening of the unpleasant Body odour symptoms.
Question. 35: What if anything are we able to make of; This odour varies depending on many known factors, including diet, hormonal changes, stress level, amount of sweat, other odour's in the space and individual sense of smell.
Answer. 35: We the Clinical Teams are running out of ideas in order for us to maintain the Moral and Scientific high ground of knowing something of value - so we are preparing for the final subliminal shove out of the door - and pay on the way out please.
Question. 36: Justify that harsh statement please?
Answer. 36: Of course a necessity if we are to improve the knowledge base of this simple to understand multifaceted and ever changing symptom presentation disorder.
A. Once this is stated; "stress level," "in the space and individual sense of smell." It is now out of the available Medical Science where Stress level is to close to the Mind so has to be ignored and In the space and Individual Sense of Smell." Is a subliminal suggestion of "It is all in your Head."
B. Leaving the Patient no option but to somewhat angrily stomp out of the surgery and the clinician content it was not their fault - it was the Patient who become angry and so was uncooperative.
Question. 37: Is there a value in a Diagnosis of TMAU?
Answer. 37: Only if one is Scientifically Nose Blind - other than that any Person Scientifically Qualified or not would be able to detect - Extreme body odour politely or impolitely referred to as. BO.
Question. 38: What if anything is the real value in testing - TMAU Symptoms?
Answer. 38: Measurement of urine for the ratio of trimethylamine to trimethylamine oxide is the standard screening test.
A blood test is available to provide genetic analysis.
The prominent enzyme responsible for TMA N-oxygenation is coded by the FMO3 gene.
False positives can occur in the following conditions, where elevated TMA can be present in the urine without any underlying TMAU.
Therefore in the Medical Professions own words. "False Positives," how can anything be truly be determined if these words are in one's therapeutic vocabulary after so many years of study.
Question. 39: What about Urinary tract infections?
Answer. 39: I would have to wonder if this term is used something is seriously missing or there - as a result of lack of satisfactory knowledge, a personal requirement to avoid certain areas of the Female Body.
Question. 40: Are you able to be more specific than this?
Answer. 40: Yes of course for Thirty Four plus years my number one specialty in the treatment of People has been of Feminine Concerns.
A. Far too many times - although this appears to be changing. Females have explained to me. "Why is it my Doctor even Female do not discuss as easily as you regarding the delicate areas of my Body."
B. If treatment of any presenting symptom is unable to at least incorporate this area into the discussions - then the treatment will never be as successful as desired.
Question. 41: How can this be demonstrated and are you able to bring this into the understanding required of TMAU?
Answer. 41: Yes I can and very willing to do so.
A. Bacterial Vaginosis is a common yet poorly understood condition, in which the balance of bacteria inside the vagina becomes disrupted.
B. BV doesn't usually cause any vaginal soreness or itching, but often causes unusual vaginal discharge.
C. Surely it must be seen if any Woman has these symptoms with or not TMAU - then how can she adopt her rightful and comfortable place in society.
Question. 42: Accepted and I feel sure you will make more sense of this later? Are there any other implications in this area of a Woman's Body we should consider?
Answer. 42: Yes and this explains my comment in answer. 40 B.
A. Cervical Cancer.
B. Advanced liver Disease.
C. Kidney Disease.
E. As the cause is not know and there is no known cure or effective treatment for the TMAU; as with any illness treated by symptom management only - will result in not only those listed but many other mysterious no known cause and no cure symptoms.
Question. 43: Is that last line what is referred to as. Tough Love?
Answer. 43: That is not so much as my intention more to educate before the medical Profession collapses under it own failures.
Question. 44: Does this in a hidden manner confirm your stance?
A. The metabolic and clinical manifestations of TMAU are generally regarded as benign, as there is no associated organ dysfunction?
Answer. 44: This designation is confirmed by the fact the condition is often unrecognised by Doctors, thus can have important ramifications including missed or delayed diagnosis.
A. Or is the truth of it Doctors know this is a Mind created disorder and are under strict instructions from their Masters to ignore the Mind as there is no Profit to be made in treating a disorder that cannot be seen and as the knowledge of the Mind in 2016 is verily non existent.
B. They would not know if the treatment they have long-term prescribed have created side-effects requiring - more profit making medications.
Question. 45: Where then do you stand on this statement? "Trimethylaminuria - fish malodour syndrome is a “benign,” genetic condition with major psychosocial sequelae?"
Answer. 45: It is Scientifically Proven NONSENSE, for these reasons:
A. Sequelae is a pathological condition resulting from a disease, injury, therapy, or other trauma.
B. Typically, a sequelae is, in medical language, a chronic condition that is a complication of an acute condition that begins during that acute condition.
C. In ordinary language; it may be described as a further condition that is different from, but a consequence of the first condition.
D. In timing a sequelae contrasts with a late effect, where there is a period, sometimes as long as several decades, between the resolution of the initial condition and the appearance of the late effect.
Question. 46: Love the last part - there we have it in Medical Science own words they make People through lack of secure knowledge as to how the Mind and Body interrelate in illness are making People more ill by their efforts.
Answer. 46: Sadly is the truth of it.
Question. 47: Is there any public information emanating for respected Medical Journals?
Answer. 47: It appears there is albeit very aged and very repetitive of what has always been not known and still today is no different.
A. One Medical Journal as far back as October 2008 appears to confirm and in part contradict others aged information.
B. Affected individuals experience shame and embarrassment, fail to maintain relationships, avoid contact with People who comment on their condition and are obsessive about masking the odour with hygiene products and even smoking.
C. The malodorous aspect can have serious and destructive effects on schooling, personal life, career and relationships, resulting in social isolation, low self-esteem, depression, paranoid behaviour and suicide.
D. Psychosocial problems resulting from delayed diagnosis, body odour and the lack of cure are considerable, making this far from a “benign” disorder.
E. When the condition is suspected or known to occur in a family, genetic testing can be helpful in identifying the specific individuals who have or carry the disorder.
F. "Trimethylaminuria - fish malodour syndrome: a “benign” genetic condition with major psychosocial sequelae."
G. Sequelae is a pathological condition resulting from a disease, injury, therapy, or other trauma.
H. Typically, a sequelae is, in medical language, a chronic condition that is a complication of an acute condition that begins during that acute condition.
I. In ordinary language it may be described as a further condition that is different from, but a consequence of, the first condition.
J. In timing - a sequelae contrasts with a late effect, where there is a period, sometimes as long as several decades, between the resolution of the initial condition and the appearance of the late effect.
K. Ways of reducing the fishy odour may include:
1. Avoiding foods such as egg yolks, legumes, red meats, fish, beans and other foods that contain choline, carnitine, nitrogen, sulphur and lecithin.
2. Taking low doses of antibiotics such as neomycin and metronidazole in order to reduce the amount of bacteria in the gut.
3. Using slightly acidic detergent with a pH between 5.5 and 6.5
L. Additionally, at least one study has suggested that daily intake of the supplements activated charcoal and copper chlorophyllin may improve the quality of life of individuals afflicted with TMAU by helping their bodies to oxidize and convert TMA to the odourless N-oxide (TMAO) metabolite.
1. Study participants experienced subjective reduction in odour as well as objective reduction in TMA and increase in TMAO concentration measured in their urine.
1. Objective. Pertaining to or characteristic of an individual; Personal; Individual: a subjective evaluation.
2. Subjective. Is explained as -Existing in the Mind; belonging to the thinking subject rather than to the object of thought.
3. Talking Cures demonstrates. Very few Humans are able to be Objective and Subjective at the same time - although this as a Fundamental Right is activated or returned as a result of effective; cause resolving therapy.
4. The study found that: 85% of test participants experienced complete loss of detectable "fishy" odour, 10% experienced some reduction in detectable odour. And 5% did not experience any detectable odour reduction.
5. Talking Cures observed; It appears no explanation was sought or demonstrated as to why this disparity occurred.
Question. 48: Is there a value of revisiting the Genetic aspect of this disorder?
Answer. 48: Good point I do have a collection of Genetic information which is only a repeat of information we have already questioned - however that is how medical science is so often presented; having said that let us say it anyway to ensure we have at least explored all the information which is of a world wide limited nature.
1. Trimethylaminuria has an autosomal recessive pattern of inheritance.
2. Most cases of Trimethylaminuria appear to be inherited in an autosomal recessive pattern, which means two copies of the gene in each cell are altered.
3. The Parents of an individual with an autosomal recessive disorder are carriers of one copy of the altered gene.
4. Carriers may have mild symptoms of Trimethylaminuria or experience temporary episodes of fish-like body odour.
5. Mutations in the FMO3 gene, which is found on the long arm of chromosome 1, cause Trimethylaminuria.
6. The FMO3 gene makes an enzyme that breaks down nitrogen-containing compounds from the diet, including trimethylamine.
7. These compounds are produced by bacteria in the intestine as they digest proteins from eggs, meat, soy, and other foods.
8. Normally, the FMO3 enzyme converts fishy-smelling trimethylamine into trimethylamine N-oxide which has no odour.
9. If the enzyme is missing or its activity is reduced because of a mutation in the FMO3 gene, trimethylamine is not broken down and instead builds up in the Body.
10. As the compound is released in a Person's sweat, urine and breath, it causes the strong odour characteristic of Trimethylaminuria.
11. There are more than 40 known mutations associated with TMAU.
12. Loss-of-function mutations, nonsense mutations and missense mutations are three of the most common.
13. Missense mutation is a point mutation in which a single nucleotide change results in a codon which is a sequence of three DNA or RNA nucleotides that corresponds with a specific amino acid or stop signal during protein synthesis. that codes for a different amino acid.
14. It is a type of nonsynonymous substitution.
15. Nonsynonymous mutations have a much greater affect on an individual than a synonymous mutation.
16. In a nonsynonymous mutation, there is usually an insertion or deletion of a single nucleotide in the sequence during transcription when the messenger RNA is copying the DNA.
17. This single missing or added nucleotide causes a frame shift mutation which throws off the entire reading frame of the amino acid sequence and mixes up the codons.
18. This usually does affect the amino acids that are coded for and change the resulting protein that is expressed.
19. The severity of this kind of mutation depends on how early in the amino acid sequence it happens.
20. If it happens near the beginning and the entire protein is changed, this could become a lethal mutation.
21. Another way a nonsynonymous mutation can occur is if the point mutation changes the single nucleotide into a codon that does not translate into the same amino acid.
22. A lot of times, the single amino acid change does not affect the protein very much and is still viable.
23. However, if it happens early in the sequence and the codon is changed to translate into a stop signal, then the protein will not be made and it could cause serious consequences. Sometimes nonsynonymous mutations are actually positive changes.
24. Natural selection may favour this new expression of the gene and the individual may have developed a favorable adaptation from the mutation.
25. If that mutation occurs in the gametes, this adaptation will be passed down to the next generation of offspring.
26. Nonsynonymous mutations increase the diversity in the gene pool for natural selection to work on and drive evolution on a microevolutionary level.
27. Nonsense and missense mutations cause the most severe phenotypes.
28. Although FMO3 mutations account for most known cases of Trimethylaminuria, some cases are caused by other factors.
29. A fish-like body odour could result from an excess of certain proteins in the diet or from an increase in bacteria in the digestive system.
30. A few cases of the disorder have been identified in adults with liver damage caused by hepatitis.
31. In 2007 the evolution of the FMO3 gene was studied, including the evolution of some mutations associated with TMAU.
Question. 49: Having observed the contradictions and in their own word and making much missense within question 48 subsections 1.31. In simple terms are you able to make some sense of it all?
Answer. 49: Yes it clearly Nonsense made clear by; Researchers believe that stress and diet also play a role in triggering symptoms.
And; Individuals with this condition who do not have any physical symptoms - typically appear healthy.
A Scientifically proven dismissal if ever there is one.
Question. 50: You spoke earlier in your answer 18 of late breaking information is this transpired or are we still waiting.
Answer. 50: Sadly nothing yet. I was hoping we would have a collaborator to make the discussion more of a confirmation of opinions rather than a discussion between just Medical Science and myself.
Question. 51: Is that a suggestion of a Person with the disorder collaborating with their input.
Answer. 51: Yes indeed.
Question. 52: Whilst we wait may we have your opinion as to the true cause of this disorder?
Answer. 52: Opinion is correct when we consider. Re: 18. B. May we dispel the name and all of its descriptions and any Diet that could cure or even long-term manage - as all they are in reality information for the relief of the clinicians anxiety only and nothing to do with the Patient at all.
Based on the secure Scientific understanding of the disorder; If Scientifically the cause is not known and there is no known cure, has one earned the right to give it a name.
Question, 53: Where you to be given the opportunity of giving this disorder a name - what if anything would you call it?
Answer, 53: Good question. The same as any disorder or condition of course recognising we have to have a reference point to work with.
1. Un natural Body Odour, would seem to suffice.
2. That if nothing else would put those around the Person with the disorder on notice to just respect the Person is experiencing difficult time and requires all the support they themselves may desire if they had concerns - that defy the understanding of Medical Science.
Question. 54: Nice - not sure where - 53.2 came from but is worthy of anyone's support?
A. Are we ready to explain the aetiology - posh word for real cause, of this disorder now?
TMAU Trimethylaminuria the cause.
Answer. 54: Statistics from the world appear to demonstrate there are some 7 billion People in the world.
A. Medical Science through its extensive Genetic studies - demonstrate every one of us is unique even siblings born of the same Parents.
B. There are we are also informed small number of exceptions to this - with, identical twins.
May we create in the fashion we started with a numbered order from creation to symptoms with no known cause and no known cure.
Ref. 1. From answer 54, A and B. It is clear why Medial Science is unable to make sense of the symptom presentation - as it is unique to each Person; so diagnosed.
Ref. 2. Not to be considered the absolute cause - However the Entire Body Chemistry of the affected Person's Parents - based on their negative emotional history are a very serious contributor.
A. Parents do not have to have or ever had the presenting symptoms, to comply with this.
Ref. 3: The Child's perception to a traumatic incident whilst within the womb, is a serious contender but not a guarantee.
Ref. 4. The same applies during the birthing process.
Ref. 5. From birth any one or all of these place a Child in Fear.
Ref. 6. This brings the Child into the world with a sensitive disposition.
Ref. 7. The sensitivity is not a concern indeed it can lead a Child to great life achievements if left to its own devices.
Ref. 8. However if at anytime during the Child's formative years - up to the age of Twenty one or When the Child leaves the Parental Home what ever came first - traumas could make what may well have been a positive sensitivity - into being negative.
Ref. 9. This irreversibly alters the Entire Body Chemistry and is not biologically changeable.
Ref. 10. This process places a Person on a life-long quest to gather understanding for the original - sensitivity creating cause.
A. Initially from the People deemed responsible; not ever to be considered guilty.
Ref. 11. If we may call item 10 a seed - given time and the correct negative nurturing and any or many, ever changing mysterious symptoms will evolve.
Ref. 12. In order to bring this into an understandable situation - we are all aware of the scent spraying/marking of an animal marking out its territory in order to protect its family and feeding ground.
A. With this to hand it is somewhat easier to consider - when a Person is unable to keep themselves fresh as a fundamental right, not a gift.
B. It is a deep seated subconscious Mind desire as a protection to maintain a position of safety.
C. Demonstrated by - as People so often find. NO-One will come near them or desire to form a relationship with them because they Smell Fishy.
D. Or is it the other way around.
Ref. 13. Of course as we started there are as many causes as there are People with or not the disorder in question.
A. Are we able to accept as painful as it must surely be - with this in Mind perhaps comes the explanation why no amount of Biological Testing or Management Treatments will offer long-term resolution of the ever-changing symptoms; if the originating cause is not - or has not been resolved.
Kindest regards and best wishes.
Peter Smith Talking Cures.
Question. 55. Are we to understand the collaborator we spoke of in question 51 has not and is not able to do so?
Answer. 55. Sadly this is so, of course we must respect the Person's situation as well as it is a fundament right not a gift to have the choice and not be forced into a compromising situation.
This being the very process that gave the Person the concern in the very first instance - leaving an unknown driving force of.
"Do not take my illness away from me I will not know what to do without it - nor be able to Protect myself from those well wishers that only do me harm."
This is my truth now tell me yours - change someone's Mind.
...In illness - The Mind/Brain/Body is not in the slightest doing something wrong, it is desperately trying to right a serious and terrible wrong?
"No apologies are made if this paper is seen as repeating or simplistic, for too long Scientific Medical Papers have been written in a manner no one truly understands, if this were not so, cures would have long since been found making this paper and Talking Cures unnecessary or redundant.
Whilst it must be recognised, the framework - part of the content, for this paper is in the public domain and credit given to the authors;
Peter Smith Talking Cures asserts the right to be recognised as author and Intellectual
©Copyright holder of his contribution to this document."
"TMAU Trimethylaminuria Explored Understood Explained." Author Peter Smith Talking Cures Copyright 26th April 2016.
Thus, in keeping with the generosity of many contributors - this document is free to use as an Education or Patient led assistance - in its entirety.
Talking Cures is a Twenty First Century Medicine...
...able to treat multiple symptoms of Mind and Body in a Person.
Via Telephone 01702 603030 or Skype. Talking.Cures
Criticisms and comments however harsh are welcomed and warmly responded too and seen as an accolade far greater than a United Kingdom Knighthood or Noble Prize.
Please feel invited to mail with questions or comments about this web site
Peter Smith Talking Cures asserts the right to be recognised as author and Intellectual ©Copyright holder - unless specifically stated - of all documents on this website.
These Articles may be printed and distributed at will but published in original form only with the consent of the copyright owner with the necessary authors contact details added.
email@example.com Peter E Smith Talking Cures Is available for Talks and Presentations to Groups of any Size or interest.
107 Victoria Road Southend on Sea Essex SS1 2TF United Kingdom. 01702 603030
Talking Cures is on the register of the Information Commissioner under the Data Protection Act and takes data protection and confidentiality very seriously and can confirm not at any time now or in the future will this site use any form of web site searching techniques to collect information of visitors to this site and if a person decided to email Talking Cures for further information, never will email or other contact information be sold, shown, loaned, or given to third parties. Registration Number Z214793X