In the initial months following bariatric surgery, bad breath or halitosis is a common side effect that many patients experience. Bad breath is normal during aggressive weight loss. It could also result from dehydration or the stomach not emptying well. Gastric bypass patients complain of bad breath more than gastric sleeve patients.

Fortunately, this common side effect is only temporary and lasts up to a few weeks. In this article, we will explore the causes of stinky breath after bariatric surgery and tell you how to get rid of it.

Why Do I Have Bad Breath After Bariatric Surgery?

It is ironic, but having bad breath after a bariatric weight loss operation is good. That means you are losing weight rapidly. In the beginning stages, weight loss surgery can change your senses, like taste or smell.

“As a person eats less, the taste sense is deprived of stimulation, making the sense of smell more acute. Like hearing, it can become more acute when a person can’t see.” Jen, Bariatric-Specialized Surgeon Liaison.

Although this can occur after weight loss procedures, such as sleeve gastrectomy, it is more severe with malabsorptive procedures like roux-en-y gastric bypass, mini bypass, and duodenal switch surgery.

What Causes Halitosis After Bariatric Surgery

Having foul-smelling breath post-operation is mainly caused by fast-paced weight loss and the body’s reaction to a new diet. A dry or sticky mouth usually accompanies this.

“Weight loss surgery is also a metabolic surgery so hormone changes from losing weight fast can explain the bad breath.” Bariatric Surgeon, Dr. Christian Rodriguez Lopez.

Six common causes of rotten breath:

  1. Rapid weight loss: When you are not eating enough calories, your body enters Ketosis. This occurs when your body is using fat for energy instead of glucose from food intake.
  2. Dehydration: If you are not hitting your clear liquid goal of 64oz daily, you may develop a dry mouth. The Journal of Metabolic Surgery and Allied Care states that decreased saliva production from having a dry mouth is a major health problem in obese patients and can lead to a foul scent of breath.
  3. Delayed gastric emptying: After surgery, food digests slower, allowing stomach acids to accumulate. This indigestion triggers bad breath due to the stasis of food fermenting within the stomach.
  4. Bleeding gums: Vitamin C deficiency is a common side effect of malabsorptive bariatric procedures. This can lead to bleeding gums or gum disease, which, if not treated, may release an unpleasant-smelling gas.
  5. Protein-rich pre- and postoperative diet: The pre- and post-op regimen requires high protein and low carbohydrate
  6. Ketosis: The body burns off the stored fat instead of carbohydrates for energy

Other factors that can contribute to the occurrence of halitosis are,

  • Acid reflux and too much acid in the stomach
  • Tongue coating index (white aphthae)
  • Oral Health
  • Plaque index
  • Salivary flow rate

If bad breath is due to food getting trapped in the candy cane portion of the intestine in gastric bypass patients, it requires reoperation to correct it.

What is Ketosis?

Immediately after surgery, patients are put on a restrictive diet. Due to the lack of carbohydrate intake, your body is forced to use fat for energy, which puts you in ketosis. Your liver secretes ketones to break down fats, causing higher levels of ketones in the blood. One side effect of ketone production is a high level of acetone, which is accountable for extra-oral odour. Bariatric patients often describe this taste as metallic or fruity.

A study conducted by the College of Dentistry involving 39 gastric sleeve patients revealed that rapid weight loss within one month led to high acetone levels and a notable increase in extraoral halitosis among the patients.

While your body is still adjusting to the new diet, additional symptoms can occur, including body odor, flatulence, and constipation.

5 Steps of Ketosis-Mexico Bariatric Center

How do you get rid of bad breath after bariatric surgery?

Approximately five weeks after surgery, you will gradually reintroduce soft, solid foods into your diet. The natural carbohydrates found in vegetables should help you alleviate the issue of bad breath. If you are still experiencing a sweet-smelling odor when you exhale, you can try these tips:

  • Stay hydrated by drinking plenty of water
  • Brush teeth and tongue, and floss after every meal
  • Use a water pick
  • Eat a sugar-free mint or Aspira
  • Use a breath spray or Listerine strips
  • Maintain oral health
  • Visit a dentist to rule out gum disease or tooth decay
  • Take a stomach protector like Gaviscon

6 Ways to Stop Bad Breath After Bariatric Surgery

Wrapping Up

The good news is that bad breath side effects will not last long. As patients gradually transition to a more diverse diet and incorporate good oral hygiene practices, they can alleviate bad breath.

While getting used to the lifestyle changes after surgery may take time, understanding your body can help you successfully navigate your weight loss journey. The key is being consistent with the dietary guidelines provided by your nutritionist and not getting discouraged if changes take time.

By sticking to the post-op diet and developing mindful eating habits, bariatric patients can reap the full benefits of their procedure and feel confident in the long run.

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