Among other things, TMAU is mainly a build up problem. It wasn’t until I framed the problem in this way that things started to get better. And they are better. Probiotics, diet, antibiotics, and the endless supps all helped in varying degrees but they only helped in addressing the effects of the built up TM, none were enough to alter the build up itself. Low choline diet was probably the most effective of all but as we all know, it’s not a sustainable way of life. This is what helped me: a purgative laxative. I grossly underestimated this when first reading about it here. I use an herbal purgative (not bulk forming) laxative called triphala. I take 2 heaping whole teaspoons with about 3 pints of water in the morning. The taste is not for the faint of heart. It’s important not to eat anything before (taken first thing in morning) for 3-4 hours after taking it and no GI meds (like a mesalimine for Crohn’s). After about 2 hours I’m on the toilet and stay on for up to 30 minutes until I can feel I’m completely empty. It takes time. I’m back on if I feel the need. It’s foul what’ll come out of you but that’s the point. I think it’s likely people dealing with this may have a motility or bowel emptying disorder. This was the key for me. Triphala is an herbal so maybe less risky for dependency if taken long term. Think I’ll take 2 weeks off every few months just in case. Again, the key is to stay on the toilet (squatting potty also helps align the body to move bowels efficiently) until you feel completely empty. When you are, trust me, you’ll know it. Neomycin and rifaximin are low absorption antibiotics that helped me as well. I’d recommend pressing your doc for a 14 day course of Rifaximin to sanitize the gut. I have diagnosed Crohn’s but chances are you have some sort of IBS that could justify the course. Rifaximin is low risk because it’s designed not to be absorbed, hence low risk side effect profile. I also take 2 grapefruit seed extract caps with the triphala as well. Doubt this is doing much if anything though. Possible it’s weakening the strength of bad biofilms for the triphala to wash away but again cant be sure. Eating whatever I want. Skeptical probiotics might be compounding poor motility if taken long term. Again, the focus is on purging the gut not balancing it. Only way I finally gained ground. I’d say the smell (bouquet of fecal, garbage, stale, bad breathy) is 90% improved. Sometimes if I’m really moving around at work I’ll detect something but doesn’t compare to what I detected before or the onslaught of sneezes I’d get from people. Would probably disappear completely if I went on low precursor diet. Think I have TMAU 2 because this set in when hormones really changed in late teens/early 20s. Think I’d probably come up negative for genetic TMAU 1 test. Hope this helps someone. Do not underestimate laxatives like I did for years. Still fragile but I have my life back. I never would’ve known dependence on the Lord the way I do now without this disease. I credit and praise him for the clarity and ability to endure it.