After a stroke, you might have changes to your senses of taste and smell. This guide can help you understand why this happens, and how to get help if you need it. Plus practical tips for stroke survivors, family and friends.

A new, sudden loss of taste and smell is also one of the signs of coronavirus (COVID-19). The NHS website has more information about COVID-19 including a symptom checker.

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On this page: 

What are taste and smell? 
The impact of taste and smell changes
What causes changes to taste and smell after a stroke?
Types of change to taste and smell
Diagnosing and treating problems with taste and smell 
Practical tips for eating and drinking 
Tips for looking after your mouth and teeth (oral hygiene) 

What are taste and smell?

The senses of taste and smell work together. Your tongue can detect five basic tastes (salty, sweet, bitter, sour and ‘umami’ or savoury). Flavour is different from taste, because it depends mainly on your sense of smell. That’s why food has no flavour if you have a blocked nose.

Smell, taste and flavour

This is how your nose, tongue and brain work together to detect smells, tastes and flavours:

1. When something gives off a smell, such as coffee, it means that millions of smell particles are rising from the coffee into the air. When you breathe, the particles hit the smell receptor cells at the back of your nose. Taste works in the same way: when you eat or drink, particles hit the taste receptors on your tongue.  

2. The taste and smell receptors send information through nerves into the brain. The brain interprets the information as smells and tastes.

3. Inside the brain, taste and smell information are combined to let you identify flavours.

Areas of the brain dealing with memory, learning and emotion are also involved in taste and smell. So smells and tastes can be linked to feelings and memories.

Other sensations from food

The nose and tongue are part of our chemosensory system. This system allows us to understand the world through molecules (chemicals) that come from the objects and materials around us. 

The impact of taste and smell changes

Although taste and smell problems after a stroke can have a big impact on your life, they aren’t always discussed as part of medical treatment. It may affect up to 30% of people soon after a stroke, but changes to taste and smell can and do improve. There may be some things you can do to help your recovery.

People often tell us that problems with taste and smell affect their quality of life or stop them from eating a healthy diet. It can also have an impact on your physical and emotional well-being, and can even affect your recovery. So if you’re having difficulties, contact your GP or stroke nurse and ask for help.

Emotional impact

We may not think about taste and smell very much, but they play a part in our feelings and memories.

Smell can trigger powerful emotions such as disgust caused by the bad smell of a dirty bin, or joy from a scented flower. Smell can be part of attraction, such as your partner’s perfume. Smells can give you information, such as the smell of coffee telling you that you are near a cafe. They can bring back memories, such as the smell of seaweed making you think of a holiday by the sea.

Losing the ability to smell can make you feel cut off from some experiences, or give you a feeling of missing out. It can also be upsetting if your sense of taste and smell are distorted and you experience bad smells or tastes.

Taste also has an emotional and social impact. The pleasure you get from eating adds to your enjoyment of life. If you stop liking your favourite food and drink, this can make you feel sad or upset. On top of that, eating with other people can be an important social activity. Some people say they feel isolated if they aren’t able to enjoy their food with everyone else

Impact on your health and stroke recovery

  • Reduced appetite

The taste and smell of food give you an appetite and help you enjoy what you’re eating. If you can’t taste or smell properly, it can reduce your appetite and you might end up eating and drinking less than you need to. This can lead to losing weight, or not getting the nutrients you need. If you don’t drink enough you could become dehydrated.

Being undernourished or dehydrated can make you feel tired and low, and have trouble concentrating. Infections can be more likely, and injuries can take longer to heal.

  • Eating too much

Some people may over-eat, perhaps because they are seeking to get more satisfaction from food when it’s lacking in flavour. This can lead to weight gain, which can raise the risk of another stroke.

  • Seeking out certain tastes

Some people start to seek out foods with a certain taste and avoid others, perhaps because some things are very bland, or tastes are distorted. This can stop you from having a balanced diet, and can lead to more health problems. For example, having more sweet food and drink can lead to weight gain and tooth decay, and having a lot of salty food can raise your blood pressure.

  • Safety and hygiene

If you can’t smell, you might miss some important danger warning smells such as the smell of smoke, gas, or chemicals in the air. We also use our sense of taste and smell to help us avoid food that’s gone off. You might not notice your own body odour or bad smells in the kitchen, which would normally prompt you to wash or clean the room. 

What causes changes to taste and smell after a stroke?

Stroke damage in the brain

A stroke happens when the blood supply to part of your brain is cut off, killing brain cells. A stroke can cause changes to any of your senses, including vision, hearing, touch, taste and smell. If a stroke damages the parts of the brain that interpret information about taste and smell from your nose and tongue, it causes changes to your senses of taste and smell.

Your stroke is unique to you, so the exact effect depends on how big the area of damage is, and where it is in your brain. 

Like many effects of stroke, taste and smell changes can recover in the first few weeks and months after a stroke. If you have longer-lasting changes, there are treatments and practical steps that may help.

What else could be causing my problems with taste and smell?

It’s a good idea to speak to your GP or stroke nurse to find out if something else could be causing or contributing to your problems with taste and smell. Other causes include:

  • Medications

Some common medications can cause a bad taste, loss of smell or dry mouth. They include some medications that are often used after a stroke, such as blood pressure, cholesterol and muscle relaxant medications. Some antibiotics, diabetes medication, antidepressants and anti-inflammatories can also do this.

  • Infections

Infections in your nose or sinuses can cause a bad taste in the mouth or loss of taste and smell. Infections of the mouth and teeth can also have this effect, so good oral hygiene is important.

  • Swallowing problems

Swallowing problems after a stroke can give you a dry mouth which may lead to a bad taste, as well as making an infection more likely. A speech and language therapist can assess you and give treatment for swallowing problems. For more information visit stroke.org.uk/swallowing-problems or call our Helpline for print copies.

  • Other brain conditions

Other conditions affecting the brain, such as dementia, cancer, and Parkinson’s disease can affect taste and smell.

  • Diabetes

Diabetes is linked to a loss of taste and smell, and some diabetes medications can cause a metallic taste in the mouth.

  • Migraines and seizures

Some migraines and seizures can be preceded by taste or smell disturbances.

  • Age

Our sense of taste and smell decreases naturally with age. 

Types of change to taste and smell

Taste changes

There are different types of problems with taste, including:

  • Ageusia: not being able to taste anything.
  • Burning mouth syndrome: a burning or scalding sensation most often affecting the tongue. It can happen alongside other types of taste change.
  • Dysgeusia (also known as parageusia): food and drink have a distorted taste. For example, something might taste bitter or metallic.
  • Hypogeusia: a reduced ability to taste, so things can taste bland.
  • Phantogeusia: having a taste in your mouth when you’re not eating or drinking. This could be any taste from metallic to sweet.

Smell changes

There are different types of smell problems including:

  • Anosmia: being unable to smell anything.
  • Dysosmia – a distorted sense of smell. This has two forms:
  • Parosmia (also called troposmia): smells are distorted, and can seem different or unpleasant.
  • Phantosmia: smelling something that isn’t there.
  • Hyperosmia: being oversensitive to smell.
  • Hyposmia: a reduced ability to smell.

Diagnosing and treating problems with taste and smell

The first thing is to find out what is causing the changes to your sense of taste and smell. If it’s due to something apart from stroke, such as medication side effects or an infection, it may be possible to improve things by treating the underlying cause.

Contact your GP or stroke nurse. They can give advice and treatment or can make appointments with other professionals. These can include:

  • Specialist in ear, nose and throat, known as an otorhinolaryngologist or ear nose and throat specialist (ENT).
  • Dietitian to give you advice about food and eating.
  • Speech and language therapist to help with swallowing problems and eating.
  • A medication review by your pharmacist or GP can check if medications are causing the problem, and if anything can be done to help.

Taste and smell tests

A taste assessment might include tasting different liquids or dissolving taste strips on your tongue.
A smell test involves being given a range of common odours to sniff.
These tests aim to find out if you can identify a taste or smell, and how strongly you can smell or taste.

Looking after your mouth and teeth (oral hygiene)

Some problems with taste and smell can be helped by treating the underlying cause. Tooth and gum infections can cause taste changes, so it’s important to keep your mouth and teeth clean.

Practical changes to how you eat and drink

If you have longer-lasting problems, there are things you can do to help you enjoy your food. Over time, you may find that things improve and you start being able to identify more tastes, or regain more of the ability to smell. Read our practical tips for eating and drinking below.

Smell training

Smell training is based on the idea that you can relearn smell by practising with familiar scents. Smell training involves short daily sessions where you focus on smelling a small number of different scents. You record your responses each time to monitor any changes or improvements in what you can smell.

Find out more about smell training

Fifth Sense is a charity dedicated to people with anosmia (loss of smell). Visit the Fifth Sense website to learn more about smell training, and find free downloadable resources to help you test your sense of smell, and do the training at home.

Practical tips for eating and drinking

There are some things you can try to make your food more tasty and appetising without eating too much salt and sugar.

If you have any swallowing problems, always ask your speech and language therapist for advice before changing your diet.

Ideas to improve your appetite

  • Tempt your appetite by making your food look bright and fresh. Add colourful veg, such as adding some peas to your macaroni cheese. Drizzle some olive oil on cooked veg, or add some natural yoghurt on top of curry.
  • Vary the texture to make things more interesting to eat. Add crunch with raw vegetables like red pepper and cucumber, and have contrasting textures like a handful of tortilla chips alongside a bowl of veggie chilli and rice.
  • Arrange the food on your plate so it looks appealing to you.
  • Try eating food cold or at room temperature, rather than hot. Cooling can reduce strong or sweet flavours.
  • If you have a bad taste in your mouth, drink plenty of fluids such as water, low-sugar drinks, tea and coffee.
  • Dilute sweet drinks like squash or juice with water or soda.
  • Chewing sweets such as mints or boiled sweets can help to refresh your mouth. Try sugar-free varieties.

Ideas to flavour food

  • Use aromatic herbs and spices to add more flavour. Try herbs like tarragon, rosemary and mint, or spices like cumin, curry powder and chilli.
  • Try adding toasted nuts, seeds or a squeeze of lemon to vegetables.
  • Use pickles, chutneys or relishes. Try making them at home to reduce the salt you eat.
  • When you’re cooking, use flavour boosters like low-salt stock cubes, mustard, a dash of Thai fish sauce or Worcestershire sauce to add a savoury taste without too much salt.
  • Olives, garlic or pesto are great with pasta dishes.

If food tastes too sweet

  • Choose sharp-tasting fruits such as gooseberries, blackcurrants, grapefruit or stewed rhubarb in pies or tarts.
  • Add spices to puddings, for example, nutmeg to rice pudding or custard, or ginger to stewed fruit or fresh melon.

If food tastes bitter

  • Adding some sweetness such as small amounts of honey, or sweet spices like cinnamon may hide bitter tastes. If you have diabetes, check with your GP first.
  • If tea or coffee tastes bitter, try alternatives like lemon or herbal tea, hot chocolate or fruit juices.

Tips for looking after your mouth and teeth (oral hygiene)

One reason for taste changes is an infection inside your mouth. Tooth decay, gum infections, and thrush (a fungal infection) can cause a bad taste, as well as making it harder to eat. 

Looking after your mouth and teeth can help with taste changes. It can also help you stay healthy by reducing your chance of infections, and enable you to eat a healthy diet.

To find out what you need to know and get practical tips, visit our guide to oral hygiene after a stroke.

If you have swallowing problems, ask your stroke nurse or speech and language therapist for individual advice about how to keep your mouth and teeth clean.

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