The use of total volatile basic nitrogen (TVB‐N) as a quality parameter for fish is rapidly growing to include other types of meat. Investigations of meat quality have recently focused on TVB‐N as an index of freshness, but little is known on the biochemical pathways involved in its generation. Furthermore, TVB‐N and methylated amines have been reported to exert deterimental health effects, but the relationship between these compounds and human health has not been critically reviewed. Here, literature on the formative pathways of TVB‐N has been reviewed in depth. The association of methylated amines and human health has been critically evaluated. Interventions to mitigate the effects of TVB‐N on human health are discussed. TVB‐N levels in meat can be influenced by the diet of an animal, which calls for careful consideration when using TVB‐N thresholds for regulatory purposes. Bacterial contamination and temperature abuse contribute to significant levels of post‐mortem TVB‐N increases. Therefore, controlling spoilage factors through a good level of hygiene during processing and preservation techniques may contribute to a substantial reduction of TVB‐N. Trimethylamine (TMA) constitutes a significant part of TVB‐N. TMA and trimethylamine oxide (TMA‐N‐O) have been related to the pathogenesis of noncommunicable diseases, including atherosclerosis, cancers, and diabetes. Proposed methods for mitigation of TMA and TMA‐N‐O accumulation are discussed, which include a reduction in their daily dietary intake, control of internal production pathways by targeting gut microbiota, and inhibition of flavin monooxygenase 3 enzymes. The levels of TMA and TMA‐N‐O have significant health effects, and this should, therefore, be considered when evaluating meat quality and acceptability. Agreed international values for TVB‐N and TMA in meat products are required. The role of feed, gut microbiota, and translocation of methylated amines to muscles in farmed animals requires further investigation.