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By the way, doctor: Is loss of taste or smell a side effect of blood pressure medications?

By the way, doctor

Is loss of taste or smell a side effect of blood pressure medications?

Q. I know someone who lost her sense of taste after years of heavy prescriptions for high blood pressure. Is this a side effect you have to accept, or should my friend’s doctor try prescribing a different medication? Is the loss of taste reversible?

A. Our ability to fully enjoy food requires stimulation of many nerve endings in the mouth and nose. The strict definition of taste is the mouth’s ability to identify what is salty, sweet, sour, or bitter. There’s also a fifth, savory taste called umami (from the Japanese for delicious) that is triggered by monosodium glutamate (MSG).

But what we commonly refer to as the taste of food is actually its flavor. And flavor is determined more by the food’s aroma, which is a function of our sense of smell, than by pure taste.

Tongue taste zones

Some loss of smell and taste almost always occurs as we get older, usually starting after about age 60. But before attributing the loss of taste to age, it’s worth considering reasons for losing the ability to smell that aren’t related to getting older. Topping the list is nasal obstruction, which might be caused by allergies, secondhand smoke or other irritants, a persistent sinus infection, or polyps. Sometimes people develop anosmia (medicalese for loss of smell) after an upper respiratory tract infection. It’s not clear why this happens. Head injuries, diabetes, liver disorders, kidney disease, Parkinson’s disease and, rarely, nutrient deficiencies (zinc and niacin) may also be causes.

People with high blood pressure appear to be prone to the loss of taste and smell. Whether this is related to high blood pressure itself or to the medicines used to treat it remains unclear. Types of high blood pressure medications commonly reported to cause taste loss include diuretics (water pills) such as hydrochlorothiazide, and ACE inhibitors such as captopril (Capoten), enalapril (Vasotec), and lisinopril (Prinivil, Zestril).

If your friend’s problem is related to her blood pressure medications, it’s probably reversible. But she should not stop taking them before reviewing the situation with her doctor. Together, they may decide to switch to a different class of medications or take other steps to help her regain some taste. For example, if her mouth is dry from diuretics, she might try sipping water between bites. The moisture can sometimes help make food more flavorful.

It’s quite possible, though, that switching medications won’t help. And the loss of flavor may not be readily explained by a medical condition or something like a polyp that is blocking the nasal passages. In fact, pinpointing the reason someone has lost his or her sense of taste and smell can be difficult. Sometimes the best that doctors can do is make an educated guess.

But your friend shouldn’t be discouraged. There are some things she can try. For example, a multiple vitamin with minerals to provide a little extra niacin and zinc has a small chance of helping. There’s little, if any, solid scientific proof that this will make a difference, but it is safe. This may seem a little obvious, but people often overlook that herbs and spices add a lot of flavor to food, although I realize that spicy food can be a problem for people with sensitive stomachs. MSG is worth trying, but it’s very high in sodium. Because of her high blood pressure, that’s probably not a good choice for your friend.

Other tips include varying food textures by, for example, adding croutons to salads and eating small servings of sherbet between courses. Some people — in fact, probably most! — find that something sweet at the end of the meal stimulates their taste buds. If calorie control is an issue, the flavor can come from artificial sweeteners instead of sugar.

— Howard LeWine, M.D. Chief Medical Editor of Internet Publishing, Harvard Health Publications

Last updated:	August 21, 2006