Loss of taste is loss of weight

Abstract

Morbid obesity is an important health issue in more-developed countries. Therapeutic attempts by pharmaceutical agents, psychotherapy, and abdominal surgery are of only limited success.1Coelho JC Campos AC Surgical treatment of morbid obesity.Curr Opin Clin Nutr Metab Care. 2001; 4: 201-206Crossref PubMed Scopus (9) Google Scholar A further possibility for treatment might be modulation of taste. A man aged 53 years underwent resection of a vocal-cord polyp. During surgery, emergency intubation was necessary because of sudden apnoea. Intubation was complicated, lengthy, and induced massive bleeding. Immediately after surgery, the patient noticed loss of taste. He was taking no drug known to alter taste perception.2Henkin RI Drug-induced taste and smell disorders: incidence, mechanisms and management related primarily to treatment of sensory receptor dysfunction.Drug Saf. 1994; 11: 318-377Crossref PubMed Scopus (177) Google Scholar Smelling was slightly impaired. Gustatory tests revealed that taste was greatly impaired on the tip of his tongue, and that taste perception was absent for sour, salt, bitter, and severely reduced for sweet. 20 months later, the patient started tasting again, beginning on the tip of the tongue and with sweet taste. After 36 months, ageusia had completely disappeared. Immediately after surgery, the patient was slightly obese with a weight of 74 kg. He had repeatedly tried to lose weight, but none of his attempts was successful. Surprisingly, during the period of ageusia he lost 20 kg. He simply noticed decreased appetite and ate less. Decline in smell and taste can decrease appetite and lead to anorexia.3Poothullil JM Maintenance of weight loss using taste and smell sensations.J Womens Health. 1999; 8: 109-113Crossref PubMed Scopus (9) Google Scholar, 4Chapman-Novakofski K Brewer MS Riskowski J Burkowski C Winter L Alterations in taste thresholds in men with chronic obstructive pulmonary disease.J Am Diet Assoc. 1999; 99: 1536-1541Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 5Erkurt E Erkisi M Tunali C Supportive treatment in weight-losing cancer patients due to the additive adverse effects of radiation treatment and/or chemotherapy.J Exp Clin Cancer Res. 2000; 19: 431-439PubMed Google Scholar There are several possibilities for the pathogenesis of ageusia in our patient. First, ageusia occurred because of bilateral pressure palsy of the afferent sensory pathways, especially the chorda tympani, by lengthy laryngoscopic manipulation. Second, the central gustatory pathways might have been affected by an anaesthetic, any other medication given during surgery, or by cerebral hypoxia during emergency intubation. Third, gustatory receptors on the tongue were directly disturbed by difficult intubation. Most probably, the enforced manipulations with the blade of the laryngoscope led—directly or indirectly by haematoma—to bilateral local pressure of peripheral nervous structures, resulting in pressure palsy of the gustatory pathways and, consequently, to ageusia. Iatrogenic ageusia, like in the presented case, could be a therapeutic option for patients with morbid obesity. Possible interventions to induce ageusia could be drugs with ageusia as a side-effect,2Henkin RI Drug-induced taste and smell disorders: incidence, mechanisms and management related primarily to treatment of sensory receptor dysfunction.Drug Saf. 1994; 11: 318-377Crossref PubMed Scopus (177) Google Scholar thalamic stereotactic interventions, and interruptions of the centripetal gustatory projections on the peripheral or the central side.