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You also have the risk of getting nonalcoholic fatty liver disease if you are deficient in choline

Mutations in FMO3 can prevent TMA from being converted into TMAO, with excessive TMA excreted through urine, sweat, and breathing, emitting a fishy smell, which is clinically called fishy smell syndrome ( TMAO's Impact on AS In recent years, TMAO has been found to be associated with heart failure ( Controversially, a study on Apoe / mice revealed that choline supplementation promotes increased TMAO levels (increase to 20 M on chow diet and 9 M on Western diet) in CONV-R mice but does not affect aortic lesion size, whether on chow or HFD ( / mice and HFD-fed CONV-R Ldlr / mice ( Some clinical studies have also suggested that TMAO has a positive role in atherosclerotic disease

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(2009): Carnitine Insufficiency Caused by Aging and Overnutrition Compromises Mitochondrial Performance and Metabolic Control

doi:10.1007/s00430-010-0159-9