Following a brain injury many people report that their senses of taste and/or smell have been affected. This may be as a consequence of injury to the nasal passages, damage to the nerves in the nose and mouth, or to areas of the brain itself loss or changes to smell and taste are particularly common after severe brain injury or stroke and, if the effects are due to damage to the brain itself, recovery is rare. The effects are also often reported after minor head injuries and recovery does occur, it is usually within a few months of the injury and recovery after more than two years is rare.

The two senses can both be affected in a number of different ways and some definitions of the terms for the different conditions are provided below. The two senses are connected and much of the sensation of taste is due to smell, so if the sense of smell is lost than the ability to detect flavour will be greatly affected. Therefore, a disorder of smell will usually occur together with a disorder of taste.

Sadly, there are no treatments available for loss of taste and smell, so this information is designed to provide practical suggestions on how you can compensate.

Disorders of smell

Anosmia: total loss of sense of smell
Hyposmia: partial loss of sense of smell
Hyperosmia: enhanced sensitivity to odours
Phantosmia:/parosmia: false smells
Dysosmia: distortion of odour perception

Disorder of taste

Ageusia: total loss of sense of taste
Dysgeusia: distortion or decrease in taste
Parageusia: perceiving a bad taste in the mouth
Dysgensia: persistent abnormal taste
Loss of taste and smell after brain injury

Health, safety and hygiene issues

Fire/smoke: fit a smoke alarm, have electrical regularly serviced, remove plugs when not in use and use an alarm to remind you of food cooking in the oven.

Gas leaks: have gas appliances regularly serviced and fit a gas detector. You might want to consider an electric cooker and fire.

Out-of-date food: always eat or throw our food by it’s used by date. If in doubt, throw it out! Clear out the fridge and cupboards regularly.

Identifying products: try to keep products such as drinks, bleach, cleaning products and solvents in their original containers. Make sure they are clearly labelled.

Home hygiene: ask friends/family/carers to help empty rubbish bins and keep toilets and kitchen clean to avoid health risks.

Personal hygiene: be aware of the need to wash yourself, your clothes and bed linen regularly. Use an antiperspirant deodorant and perhaps a shoe deodorant too. Ask a close friend of family member to advice in this area.

Mouth care: it is important to keep your mouth clean and to brush teeth regularly and thoroughly, including brushing your tongue as well. Using mouthwash and dental floss helps. Visit dentist regularly.

Toxic fumes: take precautions and follow manufacturer’s advice when using products such as paint, cleaning products and solvents. Wear protective mask, ensure rooms are well ventilated and don’t smoke.

Tips for a healthy, balanced diet

Changes to taste and smell can affect appetite and eating in a number of ways:

The smell of food stimulates the appetite, so loss of smell can lead to a reduced appetite and lack of interest in food. Loss of smell can also lead to a reduction in saliva production, therefore dry foods, such as biscuits and crackers, may be more difficult to eat.

The choice of foods may be limited to those with provide flavour, which can lead to a diet that doesn’t provide a balanced variety of nutrients.

Making meals more interesting

Be imaginative. Use varied colours and textures.

Under cook vegetables so that they are crunchy, have a crunchy base and smooth topping.

Try using seeds, nuts, wholegrain cereals, fresh fruit and vegetables, beans and pulses to add texture.

Adding bacon bits or grated strong cheese, such as parmesan, can add flavour to a meal.

Experiment with using different herbs and spices.

Grate onions, carrots, apples or other suitable fruits and vegetables to add texture.

Serve hot and cold foods together. Try ice-cream with hot sauce/stewed fruit or lasagne with salad.

Make meals a social time with friends and family.

Establish a regular routine for times to eat breakfast, lunch, evening meals and snacks each day.

Use a cookbook and try new and interesting recipes.

It is important to note that some of these suggestions may not be suitable if you are experiencing difficulty with chewing, swallowing or choking and have been advised to eat a softer diet. Consult your GP, dietician or speech therapist for further advice.

Loss of enjoyment of food can lead to avoiding eating altogether

Altered taste can make certain foods, such as meat, taste unpleasant and lead to those foods being avoided. Any of these problems may affect your choice of food and lead to an inadequate diet. It is very important to maintain a healthy, balanced diet and below is some suggestions to help you do this.

A balanced diet

This is essential for good health. All that is really required is to eat sensibly, choosing a range of foods in the correct proportions. Below are some suggestions to help you do this:

Try to base your meals on starchy foods such as bread, cereals, potatoes, rice or pasta. Aim to include at least one food from this group in each meal.

Try to eat as great a variety of foods as you can, have at least five portions of fruit and vegetables a day. Try to drink the equivalent of about a pint of milk a day. This includes milk used in tea and coffee. Try to use reduced fat milk and be very careful that the milk hasn’t gone off, especially in hot weather.

Limit foods containing a lot of fat and sugar

If you avoid certain foods because they taste unpleasant look for alternative sources of protein and nutrients. For example, if you cannot eat meat replace it with fish, beans, eggs or milk.

If you continue to experience difficulty adjusting your diet or have any other dietary concern, such as diabetes or Coeliac disease, that make it difficult to vary foods that you eat, discuss with your GP.

Avoiding too much salt

Loss of sense of taste may make people likely to add too much salt or other flavouring, such as garlic or chillies. Avoid too much salt by:

Following a recipe or routine to avoid oversalting foods during cooking.

Trying to add less salt in cooking and not to add salt to the table.

Vegetables that are steamed, baked, roasted or cooked in the microwave retain their natural flavour better than when they are boiled. This reduces the need to add extra salt in cooking.

To add flavour to foods try different herbs and spices, mustards, lemon juice, vinegar, pickles and success – follow directions for using additional flavourings and try not to add extra, as over-seasoning foods can cause indigestion.

Drinking and alcohol

Loss of taste and smell can also affect the amount of fluids you drink, which may result in dehydration. It is also possible to have too much caffeine or sugar in hot drinks to try to make up for an impaired sense of taste.

Try to drink eight glasses (totalling about 1.5-2.5 litres) of fluid a day. This includes all drinks such as water, juice, tea, coffee etc, but not alcoholic drinks, as alcohol dehydrates the body. If exercising heavily you will need to drink more than this.

Avoid very strong tea and coffee or try decaffeinated varieties.

Avoid excess sugar to tea and coffee.

Energy drinks often contain a large amount of caffeine and should be drunk in moderation.

Drinking plenty of liquid can help remove unpleasant tastes from the mouth.

Alcohol

You may have been advised to avoid alcohol because of your brain injury or any medications you are taking. If you are unsure, ask your GP. Tolerance to alcohol can be reduced following brain injury and stroke. Try to drink in moderation or not at all. Remember that alcohol will have the same effect on you even if you can’t taste it, and make sure that you know what is in the drinks bought for you. Try drinking low alcohol or alcohol free beers as an alternative.

This story was first seen in the Synapse bridge magazine, and was reproduced with the permission of Headway.org.uk.