Fish odor syndrome starts when an enzyme pathway in the gut called CntA/B produces TMA
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Primary research comprised structured interviews with 85+ industry stakeholders in 2025, including German endocrinologists and diabetologists from major centers (Charite Berlin, University Hospital Munich, Heidelberg University Hospital), GKV insurance fund (AOK, Techniker Krankenkasse) formulary and reimbursement executives, pharmaceutical company Germany market access directors, and hospital pharmacy directors across Germany's 1,900+ hospital network
Non-digested lactose ends up in the colon where it feeds the gut microbiota