Bariatric Surgery Success podcast

#72 Does Keto Breath Smell Like Nail Polish Remover?

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You know the smell of nail polish remover? That familiar smell is very similar to keto breath. Along with that smell might come a metallic taste in your mouth. Keto breath…yes, it’s a thing. Let’s talk about what keto breath is and what you can do about it if you have it.

Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 72. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening.

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Have you recently had bariatric surgery and now you have a terrible metallic taste in my mouth? Does brushing your teeth help for a little while and then the bad taste returns? Does your breath smell like nail polish remover? You may have keto breath.

The good news right up front is that it will go away.

Here’s what you need to know now about keto breath.

The most common causes of bad breath are dehydration, ketosis from rapid weight loss, dental issues, and food not emptying your pouch well. 

Let’s start with dehydration as it’s a big factor in bad breath. It's easy to cut back on fluids after surgery when you don’t mean to because you’re having to take smaller sips and there’s less fluid in your mouth keeping it fresh. So for many reasons, and bad breath being just one, take note of how much water and other fluids you drink each day. Just as a reminder, you’ll slowly be working your way up to 8-12 cups/day or two to almost three liters of water and other liquids. You’ll start with small sips every 15 minutes as tolerated and build from there. Did you know that dehydration is the main reason for re-hospitalization after bariatric surgery? That’s why fluids are so important to start your journey off right and keep it on the right track. Sometimes bad breath can be resolved just by making sure you drink enough.

If you think there’s any chance you might have tooth decay, gum disease, or any other dental issues, visit your dentist to rule it out. These types of issues can be an underlying cause of bad breath. Try to brush and even floss after each meal or snack whether it’s liquid or solid. Even brush your tongue as bacteria and food particles can build up on the surface and cause bad breath.

Now let’s get to keto breath as a cause of bad breath. What is keto breath?

Basically when you reduce carbohydrates to a very low level, the lack of carbs fueling your cell metabolism [meaning there’s a lack of energy to your cells], your body will turn to stored fat as an energy source and break it down it. When your body breaks down fat for energy instead of carbs, it converts the fatty acids into chemicals called ketones. The body has numerous self-regulating processes whose goal is to maintain a balance of it’s internal environment. With the increased production of ketones, the body gets rid of the them through both your breath/respiration and urine. One type of ketone, acetone, is an ingredient in some nail polish removers, which is why your breath may smell like it. So when you hear the words, keto breath, they refer to the release of ketones, which is the breakdown of stored fat in your body when there is a lack of carbohydrate for fuel. It also can give you a metallic taste in your mouth.

Keto breath can happen to anyone who loses weight, but is more noticeable after weight loss surgery because of how fast the weight comes off. How do you get rid of it? As you move along your journey and start to add more carbs back to your food intake, keto breath should go away. Speak to your bariatric dietitian about it. Sometimes adding back as few as 5 grams of carbs can make a difference. Eating foods that increase saliva production, like parsley, celery and lemon or grapefruit can help a little too with bad breath.

A less common problem but one I want to mention is that bad breath after lap band or gastric sleeve surgery can be caused by food that isn’t emptying the stomach pouch as it should. The result is likely a build-up of digestive fluids such as acid in the stomach pouch. This build up can put you at an increased risk for acid reflux, which often shows up as heartburn or regurgitation. The main reasons that food becomes stuck in the pouch is eating foods that are not recommended after weight loss surgery or eating too quickly. If you’re drinking plenty of fluids every day, have good oral hygiene and slowly adding carbs as allowed to diminish keto breath and you still have bad breath issues, talk to your health care team.

I hear you. Keto breath is not fun to deal with when you’re trying to make many other changes after surgery. But it will go away. Remember that it’s the very low carb diet that causes it so as you start to add even small amounts of carbs back to your diet, it should correct itself. Take care of yourself and be good to you…you’re worth it.

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