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Also, Escherichia coli , Citrobacter , Klebsiella pneaumoniae , and Shigella , Achromobacter from the strain of Betaproteobacteria , Sporosarcina from Firmicutes , and Actinobacteria have enzymes that can lead to the conversion of all food compounds including choline, betaine, lecithin, gamma-butyrobetaine, ergothioneine and L-carnitine into TMA

This can make it difficult to identify this symptom as a sign of cauda equina syndrome

Neuroscience 23(3):981989 Kim C-H, Leung A, Huh YH, Yang E, Kim D-J, Leblanc P, Ryu H, Kim K, Kim D-W, Garland EM (2011) Norepinephrine deficiency is caused by combined abnormal mRNA processing and defective protein trafficking of dopamine -hydroxylase

That percentage improves further when participants engage in structured exercise

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