LOSS OF SMELL CAN WRECK ELDERLY APPETITES.

Byline: Steven Pratt Chicago Tribune

Kids soon discover that if they hold their noses, they won't taste the peas their parents make them eat.

But for older people, losing the sense of smell can have serious health consequences.

The ability to identify and appreciate flavors comes from the olfactory organ behind the nose.

If people had to rely solely on their tongues for tasting, about all they could distinguish would be salty, sweet, sour, bitter and perhaps a fifth ``brothy'' taste the Japanese call umani.

``It is smelling through the mouth that allows us to identify what we eat,'' says Valerie Duffy, a professor of dietetics at the University of Connecticut School of Allied Health Sciences, in Storrs.

The primary taste sensations - mostly from the tongue - remain fairly constant and robust throughout life, but our sensory perception through our nose, called olfaction, often weakens with age, Duffy says. She and other researchers estimate that half of the people 65 and older have major olfactory impairment.

This can be downright dangerous: Such people can't detect a gas leak, a chemical spill or something burning in the next room. That's why smoke and gas detectors are important in buildings where older people reside, she says.

Olfactory impairment also makes older people lose cues for appetite, such as the aromas a restaurant produces or the smell of fresh bread from the supermarket bakery. More important, it causes food to lose its flavor and become less enjoyable or interesting. People with diminished sense of smell detect fewer spices, less intensity and less subtlety in what they eat.

So they change what they eat and the way they eat, often not for the better, says Duffy. For instance, many tend to eat the same foods and lose variety and balance in their diet.

A recent study of 80 older women conducted by Duffy and other researchers concluded that those with olfactory dysfunction have a higher risk of chronic diseases. Women who need to control their diets find the task more difficult if their sense of smell is impaired, according to a study published in the Journal of the American Dietetic Association last year.

``The women with olfactory dysfunction liked fruits and vegetables less,'' she says. ``That may be because a grapefruit or lime or a piece of cabbage would have only the primary sour or bitter taste to them, not the characteristic grapefruit flavor.''

On the other hand, the impaired women in the study ate more sweets and high-fat desserts, she says. This tendency is supported by anecdotal reports from nursing homes, where very sweet and fatty desserts always are popular.

Though her study didn't support it, a central theme of other research is that people with impaired olfactory senses tend to be overweight, not underweight. ``Many report they are hoping the next bite will taste better,'' Duffy says.

Other factors, such as how vigorously a person chews, existing illnesses or the kinds of medications a person takes, can affect taste as well.

``When you chew food, it releases the flavor and pumps it up to the olfactor bulb behind the bridge of the nose,'' Duffy says. ``But older people who don't chew much or have bad dentures, even if they have the normal sense of smell, can lose some flavor perception.''

Sinus disease and immune system disorders can damage or dull the receptors, which can lead to poorer diets and more illness, says Susan Schiffman, professor and taste researcher at Duke University Medical Center, in Durham, N.C.

``Cancer patients on chemotherapy or patients recovering from major surgery, for example, are prone to this cycle,'' Schiffman says.

In what she calls the ``true bitterness of old age,'' Schiffman says the average person 65 and older takes three or more different drugs. Drugs generally are bitter, and that bitterness affects the taste of food.

Although the women with impaired smell in Duffy's study were less interested in food, in cooking for themselves or in eating a variety of foods, they reported no difference in appetite or the perception of how much they were eating, Duffy says.

What was evident, however, was that they were less discriminating in what they were eating and tended to eat more total fat and more saturated fats.

Though there's not much hope for restoring olfaction, there are several ways to compensate for its loss.

Because sweetness is a preferred taste, choosing fruits and vegetables packed in syrup, such as peaches and plums, can help make them more attractive, Duffy says. Also, unfortunately, adding salt helps make food less bland, but the extra sodium may raise blood pressure.

Schiffman says that spices and herbs don't seem to make much difference, but she has found that spiking foods with a little glutamate, the amino acid responsible for the umani taste, has improved appetites. Glutamate is available in its salt form, monosodium glutamate or MSG.

Peppery additions might work for some, Duffy says, but the women in her study did not dump on the hot sauce, horseradish or black pepper. ``Perhaps the pain is not as enjoyable without the other flavors of the ingredients.''

Lastly, because we eat with all our senses, Duffy suggests we pay attention to a meal's texture, temperature, color and variety. That can make food more appetizing to everyone, not just those who have difficulty sensing flavor.

Seniors' food quiz

If you are an older American, this checklist lets you see whether you are at nutritional risk. The list was developed by the American Academy of Family Physicians, the American Dietetic Association and the National Council on Aging.

Add the points after each statement that rings true.

1. I have an illness or condition that made me change the amount or kind of food I eat. (2)

2. I eat fewer than two meals a day. (3)

3. I eat few fruits or vegetables or milk products. (2)

4. I have three or more drinks of beer, liquor or wine every day. (2)

5. I have tooth or mouth problems that make it hard for me to eat. (2)

6. I don't always have enough money to buy the food I need. (4)

7. I eat alone most of the time. (1)

8. I take three or more different prescribed or over-the-counter drugs a day. (1)

9. Without wanting to, I have lost or gained 10 pounds in the last six months. (2)

10. I am not always physically able to shop, cook or feed myself. (2)

Scoring:

0 to 2 points: Good. Check again in six months.

3 to 5 points: You may be at moderate nutritional risk. See what can be done to improve your eating habits and lifestyle. Recheck in six months.

6 or more points: High nutritional risk. Take this checklist to your doctor, dietitian or other health professional the next time you visit. Ask for help to improve your nutrition.

Rejuvenating a taste for food

If you are having trouble tasting and smelling, here are some tips from Janet Lepke, a dietitian writing in Environmental Nutrition Newsletter:

Ask your doctor about potential side effects any newly prescribed drug might have on your senses of smell and taste.

Avoid overexposing your taste buds to any one sensation, such as the bitterness of coffee, which can temporarily deaden sensitivity.

Wait 10 or 15 minutes after brushing your teeth before you eat. Lauryl sulfate, a compound in most toothpastes, can inhibit taste sensitivity.

Avoid food that is very hot or very cold. Flavors are less intense at temperature extremes.

Stop smoking. It masks the flavor of foods and contributes to other health problems.

Eat slowly to savor the flavors and aromas of foods.

Alternate foods from one bite to the next to keep from being desensitized to flavors.

Jazz up your meals with extra herbs and spices, varieties of color and different textures.

CAPTION(S):

Photo, 2 Boxes

Photo: (Color) The sense of smell often dulls with age, causing food to lose its flavor - and thus its interest and appeal.

Bob Fila/Chicago Tribune

Box: (1) Seniors' food quiz

(2) Rejuvenating a taste for food