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Fish odour symptoms have been linked to the consumption of more than 12 grams of betaine daily, suggesting that regular supplementation may convert some betaine to TMA [9,15]

These mechanisms affect synaptic plasticity, energy metabolism, and the integrity of the gutbrain barrier

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Acknowledgements The authors acknowledge the efforts of Prof Omnia ElRashidy one of the founders of the Pediatric Ketoclinic and Prof Ehab Khairy Emam the Head of the Pediatric Gastroenterology, Hepatology and Clinical Nutrition Unit, at the children`s Hospital, Faculty of Medicine, Ain shams University, for their support