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How Your Sense of Smell Predicts Your Overall Health - BBC Future
How Your Sense of Smell Predicts Your Overall Health - BBC Future
How Your Sense of Smell Predicts Your Overall Health - BBC Future
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MEDICINE
The effect that disease can have on our sense of smell has been thrown under the
spotlight by Covid-19, but what else can we learn about our health from our
noses?
B before he was given his diagnosis, he developed a very strange and permanent
symptom. One day he detected "a strong smoky smell, like burning wires", he
says. Since then, he has never smelt anything again. At the time, flummoxed,
Smith's doctor attributed the loss of his sense of smell to his scuba diving, as deep diving is
known to sometimes cause smell impairments.
Smell loss can have sinister origins beyond scuba diving, and in Smith's case, that proved to
be true. In today's world, most would automatically attribute the loss of smell to Covid-19,
but it is also a common symptom of neurodegenerative diseases, including Multiple
Sclerosis, Parkinson's disease and Alzheimer's disease. Research has found that up to 38%
of those suffering from Multiple Sclerosis while almost half of older adults diagnosed with
dementia showed signs of smell loss five years earlier. In Parkinson's disease 45-96% of
patients show smell impairment.
For years, smell loss – or anosmia as it is also known – has been largely ignored as a marker
for diseases such as Parkinson's, but now some scientists believe using it as a tool of
diagnosis could come with big advantages.
The pathology of diseases such as Parkinson’s is present in the olfactory area of the brain
long before other areas, and this is thought to be the reason why Smith lost his sense of
smell 18 years before his first tremor. An accurate smell test might have identified his
disease almost two decades before his official diagnosis, and that could potentially have
given him much more time to slow the disease’s progression.
Several initiatives are now developing tests which could use smell to help diagnose
neurodegenerative diseases.
One study in older adults found a link between a person's ability to smell and their life expectancy
(Credit: Fabrice/ Getty Images)
Predict-PD is one such initiative. According to Alastair Noyce, a clinical senior lecturer at
Queen Mary University of London, who leads the project, it has developed a smell test
called Scratch and Sniff. This is a quick test that presents six smells to the patient that we
commonly encounter throughout the day, based off a larger roster of 40 odours.
The hope is the data they collect could be used to predict who is going to develop
Parkinson's, which might lead to new early treatments that could prevent the disease from
progressing or slow it down. And with up to 0.45-3.4% of individuals (depending on the
test) apparently unaware of their own smell loss, tools such as Predict-PD could help people
to identify it.
The catch is that such tests are currently expensive. "The standard smell test costs on
average £25 [$34.88] to undertake but only a few pence to produce," says Noyce. Whilst
cost may not be a barrier for the many private clinics that are using smell tests as a tool for
diagnosis, it would limit its usefulness for public healthcare systems with limited resources.
A study from 2016 found that men (but not women) with symptoms of depression also
tended to have a poor sense of smell, while those who felt lonely were generally less good
at identifying different smells. Other research has linked a defective sense of smell to
increased mortality, suggesting it could be a "bellweather" for aging or illness. One study of
more than 2,200 people aged 71-82 years old finding that those with a poor sense of smell
had a 46% higher risk of dying within a ten year period than those with an ordinary sense
of smell.
But how is it that smell can have such a powerful link to our health?
Carl Philpott, professor of rhinology and olfactology at the University of East Anglia,
believes there could be a link to what we eat. According to his research, "one-third of
patients with smell loss overconsume and another one-third of patients under-consume", he
says. Since a healthy diet is one of the pillars of good health, it is easy to see why this would
lead to increased mortality.
"Smell plays an important part in a patient lives many lose the enjoyment from activities
that are a core part of their daily routine," she says, explaining that she oen finds that
those close to her patients with smell loss say they have changed their behaviour, becoming
more inward-looking, angry or withdrawn.
The Predict-PD smell test involves six everyday smells, and can help to identify people at risk of
developing Parkinson's disease (Credit: Predict-PD).
If you have a sense of smell, just think about those times you have found yourself walking
alongside a road when you smell particularly repugnant car fumes, hurrying up as a result.
In this situation, the person lacking the ability to smell would continue to inhale the toxic
fumes. Smith describes how he had once been sitting in his room for hours which had been
full of smoke from his neighbours' wood fire, but had not noticed until his wife came in.
The good news is that the areas of the brain which shrink due to smell loss can regrow,
should the person regain their sense of smell. When this happens, the olfactory bulb,
piriform cortices, anterior cingulate cortex and limbic system would all expand, and the
person's diet would also improve. This means that smell restoration therapies can be a very
effective technique. There are currently researchers who are designing techniques that
would enable them to do this.
Thomas Hummel, who leads the Smell and Taste Clinic at the University of Dresden,
invented one such technique called "smell training". The technique involves patients sniffing
an approximation of smells that combine scents from four odour categories, usually rose,
clove, eucalyptus and lemon. The patient is required to smell the approximations for 10
minutes, twice a day for a three-month period. While the technique does not work on
everyone, it has been shown to be effective in improving the smell abilities of 40% of
patients.
Therapies such as Hummel's are for people who have a lose or weakening in their smell
because of a range of conditions, whether Covid-19 or neurodegenerative diseases. There
are also drugs available for restoring a person's smell, but these are not commonly as drugs
may have side effects and smell training doesn’t. However, new therapies are needed for the
60% of patients who are unresponsive to smell training.
Smell loss can lead to significant changes in the structure of the brain (Credit: Gabrielle Lurie/
Getty Images)
There are other therapies being developed for those who have lost their sense of smell. One
of these is electrical stimulation: stimulating a particular area of the brain via electrodes
either placed on the surface or implanted during surgery. These electrodes lead to changes
in brain activity, which in turn can improve a patient's sense of smell.
For example, electrical stimulation in the nose has been shown to increase proliferation of
olfactory receptor cells, these being the cells responsible for smell. While stimulating the
regions of the brain involved in smell could lead to improved smell as this is one of the ways
smell training is thought to be effective, by increasing the activity within the smell regions
of the brain.
In the meantime, perhaps this long-overlooked sense deserves a little more appreciation.
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