A noticeable change in body odor, including breath that smells like nail polish remover, can be an early indicator of serious, even life-threatening, diseases, medical professionals are warning. These distinct smells are caused by chemical changes within the body that are excreted through breath, sweat, or urine.
Alice Dogruyol, a 49-year-old publicist from London, experienced such a change when her boyfriend remarked that her breath smelled like nail varnish remover. Initially mortified and attributing it to poor oral hygiene, she engaged in obsessive teeth brushing and increased water intake, but the peculiar odor persisted and caused her significant distress. This symptom, along with recurrent fungal infections and rapid weight loss, ultimately led to her diagnosis of type 1 diabetes.
The condition, known as diabetic ketoacidosis, occurs when the body, lacking sufficient insulin, begins to rapidly break down fat for energy. This process produces ketones, chemicals with a distinct acetone or pear-drop smell, which are then emitted through breath and sweat. Without prompt medical intervention, diabetic ketoacidosis can lead to unconsciousness, coma, and death.
Dogruyol’s journey to diagnosis was complicated by a prior misdiagnosis of type 2 diabetes in 2019. Unlike type 1 diabetes, where the body produces little to no insulin, type 2 diabetes involves the body's inefficient use of insulin, often manageable with diet, exercise, and medication. Her correct diagnosis of type 1 diabetes in January 2021 led to the start of insulin treatment and the disappearance of the distinctive breath odor. By the time of her diagnosis, doctors indicated she was close to a coma.
A study from the University of Exeter revealed that a significant percentage of adults diagnosed with type 1 diabetes after age 30 were initially treated for type 2, potentially delaying essential insulin treatment. This highlights a critical distinction, as type 1 diabetes can develop at any age, with nearly half of all cases now diagnosed in adulthood.
Dr. Dean Eggitt, a general practitioner, explained that diseases alter the body’s chemical composition, producing unique smells that are naturally expelled. While common issues like hygiene, food, dental problems, or infections are frequent causes of bad breath, Dr. Eggitt stressed that a new, unusual smell accompanying other symptoms in an unwell individual should be considered a red flag.
Other conditions can also manifest with distinct odors. Advanced liver failure, or cirrhosis, can cause a musty, sweet, or sulfur-like body odor due to the liver’s impaired ability to filter toxins. Similarly, chronic kidney disease can lead to an ammonia-like smell on the breath, known as uraemic breath, when kidneys struggle to remove waste products from the blood.
In some cases, medical conditions can alter body odor in ways that are too subtle for most people to detect. For instance, a rare condition called hyperosmia, which enhances the sense of smell, allowed one individual to detect the musty odor associated with Parkinson's disease years before diagnosis. Researchers are exploring these smell-based biomarkers, developing technologies like an 'electronic nose' to detect specific chemicals in clinical settings for early disease detection.
Medical professionals emphasize that while changes in smell can provide a clue, they are rarely used in isolation for diagnosis. A comprehensive clinical assessment, including symptoms, medical history, examination, and tests, is crucial for accurate diagnosis. Dogruyol advises others to take such warnings seriously, stating that had she recognized the strong signal her altered breath provided, she might have sought diagnosis sooner.