Parosmia and malnutrition

Parosmia – a less familiar consequence of COVID

I’m guessing that you are now familiar with anosmia, or loss of smell, even if you didn’t previously know of this once rare condition, which can be a symptom of COVID.

But how about parosmia? It was new to me! Sometimes it follows an episode of anosmia, and it involves distortion of smell, with everyday scents such as onion, coffee or garlic, triggering disgusting smells like vomit or sewage.

Perhaps unsurprisingly, people with this condition have a greater risk of experiencing serious diet and nutrition issues including malnutrition.

Recent research has concluded that:

“the ways in which ‘smell loss symptoms’ are currently framed in the literature do not accurately present the extent of potential dietary complications in terms of nutritional compromise, weight loss and weight gain…”

Research conducted amongst Covid-19 Smell and Taste Loss support group members

Smell loss has a major impact on appetite, enjoyment, fullness and satiety.

One person said: “All food tastes/smells just too disgusting to eat. Only yoghurt is ok. So, I lose weight instead of gaining it.”

These are some key findings of the research into parosmia

• Food became bland and unappetising resulting in a reduced desire to eat, cook or participate in food-related activities

• Parosmia and phantosmia (olfactory hallucinations) had even more harrowing effects on food and eating

• People with parosmia tend to remove themselves from social and familial meal occasions. Where a partner cooks a meal, this can be revolting to a person with parosmia. Likewise socialising with friends in a pub, restaurant or coffee bar can also make people feel physically sick

• Unpleasant smells are constant and fluctuate, one person reports: “burning sort of taste and smell” then, later that month, an “awful metallic taste”

• Some people lose appetite, becoming unable to eat and therefore losing weight

• Others may unexpectedly gain weight as they eat more to try to recapture lost food satisfaction

• People struggled with overwhelming and often pervasively unpleasant parosmic smells. They were described with words that included: sewer, cat food, spicy, pungent, strong herbs, sickly metallic, dirty fish tank, off milk or yoghurt, sweet and grassy, dog food, curry, garlic, sickly sweet metallic, kippers, chemicals and fruity sewage.

• People alter their cooking, for instance: “I’m trying to focus on some other aspects of the ingesting experience like temperature and texture. I am relying a lot on the comforting aspect of soup, the surprising aspects of salads and crunchy snacks.”

• After time people make adjustments: “I’ve adjusted to foods I can eat and can’t eat now. Some things I just ploughed through and tried to get used to the adjusted taste. Some things still make me feel sick, like washing up liquid and perfume, but most things I can cope with.”
 

Dr Duika Burges Watson of Newcastle University is lead author on the research:

“Some people are struggling with malnutrition, and they are getting little understanding or support. We’ve been led to believe that impacts of smell loss are mild, or a trivial inconvenience but this is far from the experience of those people who are experiencing malnutrition.”

Chrissi Kelly, Founder of the charity, AbScent, said:

“We have a concern for individuals that may already have acute nutrition issues for instance, pregnant women experiencing morning sickness, those with existing eating disorders, those following specific diets, (e.g. vegans, coeliacs), or people undergoing medical treatment and of course young people.”

Professor Barry Smith, Director of the Centre for the Study of the Senses at the University of London said:

“When it comes to eating, it’s flavour first. We know what we should eat for better health and nutrition, but it’s how the food tastes that encourages us to eat it. Foods lack flavour for those with anosmia, and for people with parosmia many familiar foods taste distorted and disgusting, which means that the range of acceptable and nutritious food is drastically restricted.”

AbScent – the charity for smell disorders

The research has been published in the peer-reviewed journal PloS One with AbScent’s Covid-19 Smell and Taste Loss moderated Facebook support group from, which had 9000 members at the time of research.

AbScent is a charity registered in England and Wales since 2019 and has created an unrivalled resource of trusted information supported by a distinguished advisory board and working with the latest scientific and clinical evidence.

AbScent advocates to increase understanding and raise awareness of the conditions and their impacts supporting research into smell conditions.

You can find out more from AbScent’s website https://abscent.org (external link will open in a new browser tab or window)

 

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Further reading and resources

Taste can be a predictor of COVID outcomes

Our nutrition expert, Mary Farmer, on the role of smell in taste

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