A distinctive smell on a person's breath or body can sometimes be an early indicator of serious health conditions, according to medical professionals. While often overlooked, these olfactory clues can manifest in various diseases, including diabetes, liver failure, and kidney disease.
Alice Dogruyol, a publicist from London, experienced such a symptom when her breath began to smell like nail polish remover. Initially mortified and attributing it to poor oral hygiene, she engaged in obsessive teeth brushing and frequent use of breath sprays. However, the persistent odor, coupled with other symptoms like recurrent fungal infections and rapid weight loss, eventually led to a diagnosis of type 1 diabetes. This condition, known as diabetic ketoacidosis, occurs when the body, lacking sufficient insulin, begins to burn fat for energy, producing ketones that emit a distinct acetone or pear-drop smell through breath and sweat. Without prompt treatment, diabetic ketoacidosis can lead to coma and death.
Dogruyol’s case was complicated by a prior misdiagnosis of type 2 diabetes in 2019, which delayed her access to necessary insulin treatment. Type 1 diabetes, in which the body produces little or no insulin, requires daily injections for survival. Type 2 diabetes, conversely, involves the body's difficulty in using insulin effectively, often manageable initially with diet, exercise, and medication.
A study from the University of Exeter revealed that 38% of adults diagnosed with type 1 diabetes after age 30 were initially treated for type 2, without receiving essential insulin therapy. Dogruyol recalled feeling critically ill, with doctors indicating she was only a week away from a coma.
Dr. Dean Eggitt, a general practitioner, explained that diseases can alter the body's chemical composition, leading to distinct smells excreted through bodily functions. He cautioned that while bad breath is frequently caused by mundane factors like hygiene, diet, or infections, a new or unusual smell accompanying other symptoms in an unwell individual should be considered a red flag.
Other conditions can also present with characteristic odors. Advanced liver failure, or cirrhosis, can cause a musty, sweet, or sulfur-like body odor as the liver loses its ability to filter toxins, allowing sulfurous compounds to build up and be exhaled. Chronic kidney disease can result in an ammonia-like smell, known as uraemic breath, when failing kidneys cannot effectively filter waste products, leading to their accumulation in blood and saliva.
While some conditions cause noticeable odors, others are detectable only by individuals with heightened senses. Joy Milne, a retired nurse with hyperosmia, gained attention for her ability to detect the distinct musty odor associated with Parkinson's disease even before diagnosis, inspiring research into a potential skin swab test for the condition.
Medical professionals emphasize that while changes in body odor or breath can offer clinical clues, they are rarely used in isolation for diagnosis. A comprehensive assessment, including symptoms, medical history, physical examination, and tests, is crucial for accurate diagnosis. Dogruyol advises taking such persistent warning signs seriously, suggesting that earlier recognition could have expedited her diagnosis and treatment.