Smell and taste loss…how to cope
Imagine a life without being able to smell your favourite food or “taste” the delicious flavours in your favourite dish. How would that affect the quality of your life?
Sadly, smell loss (and to a lesser extent, taste loss) is quite common after any type of brain injury. The more serious the brain injury, the more a person’s sense of smell tends to be affected. “Olfactory dysfunction” (defined as a reduced or absent sense of smell) is reported in 20-44% of “mild” brain injuries, 37-68% of “moderate” brain injuries and 33-61% of “severe” brain injuries.1 This “dysfunction” can be a result of direct trauma to the olfactory region (e.g. facial fractures), tearing of the nerve filaments and/or damage to the olfactory region of the brain.2 In contrast, a reduced sense of taste has only been found in 0.4% of clients with head injuries.3
While it’s generally a person’s sense of smell which has been affected, what most people will say is “food has no taste” or “food doesn’t taste like it used to.” This is because most people have difficulty distinguishing between the sensory information transmitted by their tongue and the information transmitted by their nose. Taste buds only tell us whether a food is sweet, salty, sour, bitter or has a meaty (umami) flavour…nothing else. Determining whether a sweet taste comes from a strawberry or a peach is completely down to your sense of smell. This is because when you chew, the smell molecules in that food travel up the back of your throat into your nasal passage where the olfactory nerves are. Once these nerves are stimulated, they transmit information to the olfactory bulb in the brain which then recognises a particular flavour. The best way to test this out yourself is by pinching your nose closed while you eat something that has an aroma to it. Notice what flavours you can detect while your nose is pinched closed and then release your nose to see how the experience becomes very different.
If you suspect a client has an altered sense of smell or taste, what should you do?
1. Ensure that any changes to smell and taste are thoroughly investigated.
While a reduced or absent sense of smell can be caused by a brain injury (or COVID), it can also be due to treatable conditions such as: medication, swelling (e.g. due to facial trauma), upper respiratory tract infections, allergies, rhinosinusitis and/or a nasal obstruction.2
A reduced or absent sense of taste on the other hand, can be due to: medication, a zinc deficiency, low thyroid function or liver or kidney disorders.4
There are nine clinics in the UK which specialise in assessing and treating smell and taste disorders. These specialists can determine whether anything can be done to treat the problem.
- James Paget University Hospital in Norfolk
- Queen Elizabeth Hospital in Birmingham
- Gloucestershire Royal Hospital in Gloucester
- Freeman Hospital in Newcastle
- Aintree hospital in Liverpool
- Royal Surrey County Hospital
- Guys Hospital in London
- Imperial College Healthcare in London
- Royal London Hospital Joint Nasal Clinic
- For international clinic locations go to the Fifth Sense website
2. Encourage clients to join the charities Fifth Sense or Abscent.
Fifth Sense and Abscent are charities dedicated to helping people who suffer with smell and taste disorders. They stay abreast of all the current research in this area and hold regular educational events throughout the country.
3. Suggest ways that food can be altered to compensate.
Eating is a multi-sensory experience. That means if one sense (e.g. smell) has been reduced, it is important to dial up the other senses (e.g. taste, visual appeal) so the person still gets some level of stimulation and enjoyment from their food. Unfortunately, most people try to compensate for their altered sense of smell or taste by adding more salt or sugar to their food. This can lead to long term health problems such as high blood pressure or diabetes. Healthier compensation strategies include the following:
- Visual appeal – serve nicely presented and colourful food on beautiful plates and table wear.
- Temperature contrast – include hot, room temperature, cold or freezing food and drink at the same meal, or alternated between temperatures during the eating process.
- Different textures – recipes can be altered so that every mouthful includes multiple textures – smooth, crunchy, crisp and chewy (e.g. chopped apple and raisins can be added to porridge). This provides much more sensory stimulation and makes the meal more enjoyable.
- Tongue tingling – ingredients and condiments can be added to food that make the tongue “tingle” – such as mustard, vinegar, horseradish, hot chillis, or menthol.
- Carbonation – sometimes “bubbles” can make a drink more appealing. Encourage sparkling water instead of still water or fizzy drinks.
- Taste – dial up the taste by adding more vinegar/lemon juice (sour), marmite/Worcestershire sauce (umami) or rocket/tonic water (bitter) which will stimulate the person’s taste buds without excessive salt or sugar.
For a free digital recipe book dedicated to smell and taste loss, go to Life Kitchen Taste & Flavour Book.
4. Encourage clients to eat mindfully.
Eating in front of the TV or while otherwise distracted, means people are much less able to register the sensory information that they are still getting from their food. Family members and support workers can help clients really focus on the appearance, taste, temperature, texture and tingling sensation of food by having conversations about these topics at mealtimes.
5. Conduct risk assessments.
A reduced sense of smell means clients are at very high risk of injury from not being able to detect smoke, volatile agents/gases or even spoiled food.1 It can also have a huge impact on personal hygiene and home hygiene. Risk assessments and care plans need to be put in place to mitigate these risks. For safety information go to the Fifth Sense website or read our article on Safety Tips for Smell Loss.
6. Consider smell training.
Smell training is an evidence-based practice found to improve a person’s sense of smell in certain situations. It involves smelling four different odours twice daily for 4-6 months — a bit like “physio for the nose.” For more information on smell training go to:
Assessing for smell and taste loss is a routine part of our dietetic assessments for people after a brain injury. To make a referral, contact Specialist Nutrition Rehab at 0121 384 7087 or info@specialistnutritionrehab.co.uk.
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