Taste and Smell Changes

Many people with cancer develop changes in taste and smell during or after treatment. These changes can lead to food aversions. Food aversions are strong dislikes for certain foods that make you avoid them.

Taste and smell changes can make it harder to eat and can lead to weight loss without trying.  Not getting enough to eat and drink can make it harder for your body to heal and recover from your cancer treatment.

What causes taste and smell changes in people with cancer?

Many of the same things cause both taste and smell changes. Certain types of cancer and cancer treatment can change your senses of taste and smell. Common causes include:

• Cancers in the head and neck area.
• Some cancer treatments, such as radiation to the head and neck area; surgery to the sinuses or nearby structures in the head; and some kinds of chemotherapy and targeted drug therapy.
• Side effects of cancer treatment, such as mouth sores or dryness.  
• Some medicines that help with side effects of treatment, such as antibiotics and some pain medicines.

Taste and smell changes can also be caused by things not related to cancer, such as:

• Problems with your teeth or gums
• Smoking
• Medicines to treat other health problems, such as high blood pressure, heart disease, diabetes, and low thyroid levels.

What are the symptoms of taste and smell change?

Taste changes can be different for each person. Some of the most common complaints are:

• Foods not tasting the same as they used to, such as bitter, sweet, or salty foods.
• Food may taste bland (little flavor).
• All foods taste the same.
• Food tasting too salty or sweet.
• A bitter or metallic taste in the mouth, especially after eating meat or other high-protein foods.

Foods may smell different than they used to. People report that they:

• Can’t smell things they used to, or these things don’t smell as strong.
• Can’t smell things that other people can.
• Notice things smell different or certain smells are stronger.
• Can’t handle some smells they used to like.

These changes most often go away after treatment ends. But for some people, these changes in taste and smell can last a long time.

Treating taste and smell changes

• See a dentist to make sure that your taste and smell changes aren’t caused by tooth or mouth problems. Ask about the best way to keep your mouth clean and if a special mouthwash might help.
• Ask to meet with a registered dietitian nutritionist (RDN) or registered dietitian (RD). They can help you figure out what to eat and the best way to prepare your meals.
• Ask your cancer care team if there are medicines that might help. Some people find zinc sulfate supplements helpful. There are other medicines that are being studied that might help with taste changes, such as dronabinol and megestrol.
• If you use any tobacco products, quitting might help improve your senses of taste and smell. Talk with your care team (cancer or primary care) about a good plan for you to quit.

Tips to manage taste and smell changes

The first step is to figure what tastes and smells good or bad to you. This can help you make choices about what to eat and ways to make your food taste better. It might help to keep a food diary to keep track of what food and drinks work and don’t work for you.

If your treatment causes you to have nausea and vomiting, it is best to not eat 1 to 2 hours before and about 3 hours after chemotherapy. This might help prevent food aversions to foods you eat during that time.

If you have a metallic taste in your mouth

• Try using plastic forks, spoons, and knives and glass cups and plates.
• Cook your food in glass pots and pans instead of metal ones.
• Try sugar-free gum or hard candies in flavors like mint, lemon, or orange. These flavors can help mask a bitter or metallic taste in your mouth.
• Try fresh or frozen fruits and vegetables instead of canned.

If your food has no taste or doesn’t taste good to you

• Flavor foods with herbs, spices, sugar, or tart flavors. Try lemon wedges, lemonade, citrus fruits, vinegar, and pickled foods.
• Try flavoring foods with new sauces, herbs or spices .
• Counter a salty or bitter taste by adding sweeteners. A sweet taste can be offset by adding lemon juice and salt.
• Keeping your mouth clean and brushing your teeth to help ease bad tastes.
• Rinse your mouth with a baking soda, salt, and water mouthwash before eating to help foods taste better. (Mix 1 teaspoon salt and 1 teaspoon baking soda in 4 cups of water. Shake well before swishing and spitting.)
• Serve foods cold or at room temperature. This can decrease food tastes and smells, making them easier to tolerate.
• Freeze fruits like cantaloupe, grapes, oranges, and watermelon, and eat them as frozen treats.
• Eat fresh vegetables. They may be more tempting than canned or frozen ones.
• Try marinating meats in fruit juices, sweet wines, salad dressings or other sauces
• If red meats taste strange, try other protein-rich foods like chicken, fish, peanut butter, beans or peas, tofu, nuts, seeds, eggs, or cheese.
• Blend fresh fruits into shakes, ice cream, or yogurt. 

If some food smells bad to you

• Eat foods that don’t need to be cooked
• Serve foods cold or at room temperature
• Keep foods covered and lift lid away from you
• Use cups with lids (such as travel mugs)
• Drink through a straw
• Decrease indoor cooking smells by cooking outdoors or using a kitchen fan when cooking
• Avoid eating in rooms that are stuffy or too warm.

Talking with your cancer care team

Let your cancer care team know if: 

• You notice that your taste and smell have changed
• You are having trouble eating or drinking

It might help to keep a list of foods and drinks that you are having trouble eating because of taste and smell changes. Also keep track of any smells that you are having trouble dealing with. Sharing these details with your cancer care team can help them come up with a plan to help you.