I was given metformin for diabetes in early 2016, but due to side effects, I switched to linagliptin. After two months, I lost my sense of smell and taste.
I was sent to a specialist who said I might never get it back – it was a side effect of linagliptin. I'm so unhappy because I can only taste lemon juice and spices. Do you have any advice?
V. A. Simmonds, Finchfield, West Mids.
The loss of taste and smell is more burdensome than most of us can imagine. The two senses are interconnected because the smell and taste messages converge in the same areas of the brain.
While our taste buds can recognize some flavors: sweet, sour, salty, bitter and umami (spicy), these are secondary to the sense of smell. In fact, around 80 percent of the aromas we taste come from smells.
Fact: Studies from the 1960s describe the possible harmful effects of diabetes on the sense of smell
The fact that you no longer recognize the aroma of eating or drinking is the reason why your taste is so bad. I researched this area for you and found two possible explanations for your sense of smell.
First, research from the 1960s describes the possible harmful effects of diabetes on the sense of smell, though this is certainly not a common complication.
Why this happens is not known, but one way of thinking is that the nerves that run from the high-nostrils of the olfactory receptors to the brain are somehow damaged, possibly as a result of increased blood sugar.
It may therefore be that the odor and taste loss is a feature of your diabetes and is not related to your medication.
The other possibility is that the damage was caused by the linagliptin. This medicine belongs to a group of medicines called DPP-4 inhibitors (dipeptidyl peptidase 4).
The side effects of linagliptin include nasal congestion and nasal streaming – recognition of the fact that the drug may be associated with inflammation of the nasal mucosa. That alone could be responsible for the loss of the sense of smell.
It is possible that the linagliptin has triggered inflammation in the nose, where the receptors for the smell are, and then persists.
Side effect: It is possible that the linagliptin has triggered an inflammation high in your nose, where the receptors for the smell are, and this persists then
A study of steroid nasal drops administered twice a day for at least one month may be helpful in suppressing inflammation and reducing swelling.
The drop – betamethasone, which is available by prescription, is best suited – must be introduced head-down and forward, and you must remain in that position for one minute after putting the drops into each nostril.
To take this position, kneel forwards with your head on the floor.
I admit that this is far from easy, but do not make the mistake of using the drops lying on your back, with your head tilted backwards, as the medication will not reach the right place.
Talk to your doctor about trying the drops – I sincerely hope that this is an effective remedy.
I have small, red swellings on several fingers that are sore and tender, extending from the base of my fingernails to my knuckles.
My family doctor diagnosed chilblains, but I still had complaints during the warm weather this summer, and, as I understand it, these are due to bad weather. I know that there is no cure, but will they disappear soon?
Name and address specified.
Chilblains usually appear as small, itchy swellings shortly after cold – we think they are due to damage to the blood vessels.
As you rightly point out, they usually resolve in warmer weather – but not yours. For this reason, I ask the diagnosis of your family doctor.
So what could be the true cause of your sore fingers? Without a physical examination it is difficult to come to a final conclusion – but from the information you have given me, I have two options.
Low-Down: Garrods pads are usually not painful and harmless. Although sometimes confused with arthritis, they do not deserve treatment
The first is Garrods pads, calluses that appear over the interphalangeal joints of the fingers – the joints closest to the palms.
The pads appear on the back of the hand and not on the palm.
Sometimes, the pads occur at the distal interphalangeal joints, at the joints closest to the nails, and are caused by thickening of the tissue, often as a result of trauma or recurrence injury.
Garrods pads are usually not painful and harmless. Although sometimes confused with arthritis, they do not deserve treatment. The second option is a condition called Chilblain lupus erythematosus.
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Although rare, this typically affects middle-aged women who appear at the onset of cold weather due to inflammation in the tissues of the finger skin.
They look remarkably similar and cause symptoms similar to chilblains.
The difference is that, in contrast to classic chilblains, they do not dissolve in warm weather.
Less than 10 percent of cases involve systemic lupus erythematosus, an autoimmune disease that causes swelling throughout the body.
For this reason, you should talk to your doctor and explain that the symptoms have not improved in the summer. A blood test may be needed to test for this other condition.
The recommended treatment for Frostbite Lupus Erythematosus is a steroid ointment or cream for which you need a prescription.
A patient I saw in this unusual condition was treated by her specialist with a steroid injection in each of the red bumps – quite painful, but it triggered the full resolution.
Hopefully your problem will improve without this being necessary.
In my view, we have to feed our brains
We pay attention to the right nutrition for our body – but should we think about how we can feed our minds?
The brain consumes about 20 percent of our calorie needs, but it's the type and quality of foods that I think more doctors need to pay attention to, especially when treating patients with a mood disorder like depression or anxiety.
About 60 percent of the dry weight of the brain (much of it is water) consists of fat (it is the fattest organ in the body) – or in particular essential fatty acids.
However, we are unable to synthesize them in the body. Therefore, the only way to preserve these vital materials is through the food we eat.
An important review of the data from 19 studies involving more than 1,200 people on essential omega-3 essential fatty acid supplements showed that dietary supplements produce "statistically significant" improvements compared to placebo effects.
The oils help to form part of the brain membrane and this can reduce inflammation and affect the way neurotransmitters – brain chemicals – signal each other.
The study has limitations: it was small and participants took the supplements in different doses for different lengths of time.
Further research is underway, but these observations should be enough to make health experts think.
I do not suggest that doctors prescribe fish oil capsules to all of their mental patients – after all, the same oils are contained in a can of sardines that you can eat on toast once or twice a week. However, as we know, antidepressants do not work for everyone – so this study is definitely a food for thought.