Currently Sheffield is (was) the only lab in the UK running this test – the alternatives are labs in the US or Netherlands but I have no idea of prices and whether a GP would fund. 

The below is kindly reproduced with the permission of Nigel Manning, Sheffield Children's Hospital;  

Sheffield Children's NHS
Department of Clinical Chemistry
Western BankSheffield
S10 2TH


Arranging the TMAU test.  

Option 1. GP referral. The following metabolic specialists are recommended in the UK. 


Dr Robin Lachmann 

Charles Dent Metabolic Unit 

National Hospital for Neurology and Neurosurgery 

Queen Square 

London WC1N 3BG 


Dr Chris Hendriksz 

Adult Inherited Metabolic Disorders Clinic 

Salford Royal NHS Foundation Trust 

Stott Lane 

Salford M6 8HD 


Dr Tarekegn Hiwot 

Consultant in Inherited Metabolic Disorders 

IMD Department 

Queen Elizabeth Hospital Birmingham


Birmingham B15 2WB


Dr Helena Kemp 

Dept. of Clinical Biochemistry 

Southmead Hospital 

North Bristol NHS Trust 

Westbury on Trym 

Bristol BS10 5NB


Dr Yusof Rahman/Dr Radha Ramachandram, Consultants in Inherited Metabolic Disease

Department of Inherited Metabolic Disease

Evelina London Children's Hospital

3rd Floor, Becket House

Lambeth Palace Road

London SE1 7EU 

The adult metabolic public e-mail address for GP referrals is:
This email address is being protected from spambots. You need JavaScript enabled to view it.


Dr. Peter Galloway

NHS Greater Glasgow and Clyde Medical Consultant Biochemist

Glasgow Royal Infirmary

Tel. 0141 354 9034
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Option 2. GP organises the test sample. 
To test for Trimethylaminuria (TMAU) we require a 20ml urine sample and a referral letter or request form 
from a GP or local hospital. 
TMAU is associated with ingestion of certain foods so it is important to collect this sample at the time of the 
odour. For this we recommend a dietary ‘Choline Load’ before sample collection using foods known to 
produce the odour eg beans, eggs, liver. 
EITHER - '24 hour' urine collection - during a prolonged period urine is collected into a 2.5 litre container 
with approximately 10ml of ‘5M’ hydrochloric acid (available from general hospital laboratories) to acidify the 
sample and stabilise the trimethylamine. (This is the same sample collection as for a urine Calcium test) 
OR - (for convenience) a single 20ml sample with a small amount of hydrochloric acid (1ml of 1M HCl) to 
acidify the sample. 
SUGGESTED PROCEDURE: at 13:00 and 19:00 a high choline meal containing (eg 2 eggs + 400g baked 
beans / soya beans). 
1. Start ’24 hour’ urine collection the day after the choline load and collect urine until the end of the day 
or 2. collect a single 20ml sample the morning after the choline load. 
Send 10 – 20ml urine to Sheffield Childrens Hospital to measure: 
Trimethylamine and Trimethylamine-oxide. 
The acidified urine should be sent to the address below by 1st class post at room temperature. We should be 
able to return the results with interpretation within 4 weeks of receipt of the sample. The test costs £134 if 
GP requires the patient to pay for the test. Most GPs are funded for this test by the NHS so the test is free. 
Option 3. Testing via a private company called Smart Nutrition who can start the process without a GP 
They work with a company called Biolab Medical Unit who would send the patient the necessary kit to 
collect a single 20ml urine sample which is then sent to us. This costs approximately £190 and the report and 
advice would be dispatched in approximately 4 weeks.  
Nigel Manning 
Principal Clinical Scientist 
Dept. Clinical Chemistry 
Sheffield Children's Hospital 
Sheffield S10 2TH 
 © 2016, Not to be reproduced without permission.