Dolittle

Gooner · Post by **Gooner** » Fri Apr 27, 2012 11:29 pm

I may be going blind but has your 'Halitology Consult' thread been deleted? Im interested to know how your tonsillectomy has gone since your last post...

halitosisux · Post by **halitosisux** » Sat Apr 28, 2012 6:43 am

Yeah looks like the thread has been deleted. No idea why. There were some good discussions in there.

Gooner · Post by **Gooner** » Sat Apr 28, 2012 5:45 pm

Hopefully he will see this and post an update, his insights and medical background are good to have on the forum.

dolittle · Post by **dolittle** » Sun Apr 29, 2012 4:34 pm

Yeah, I got paranoid that I had given too much personal info out on that thread.

surgery I think partial success. It may have reduced my breath issue, but I was still getting strong reactions. I am not sure if this is now just my "IBS"/SIBO issue left or not. My urine, sweat, breath, genitals and feet sometimes smell v bad still. Testing for TMAU now, and going to have some surgery that aims to increase the "seal" of my back passage. Not to go into gruesome detail, but if you are interested in that kind of thing http://www.solestainfo.com/hcp/administ ... lesta.aspx Just frustrating how most GI docs will not even want to see you if you have been labeled with IBS... so don't ever get the investigations and treatment that might solve things (e.g. hydrogen breath test for SIBO, followed by Neomycin). Just another marker of how society in general treats people with these problems. I think now my odor symptoms will return to the 2-3 week relapsing/remitting intermittent pattern that was present for about 3 years, then I think in the last year, the tonsil issue made things constant. Certainly some days I was getting less reactions than others after the tonsillectomy. Compared to before the surgery, when most days I was getting strong reactions.

I've become pretty knowledgeable about the diagnosis and management of halitosis by this point, so I started writing several scientific papers, hoping to get them published. Only one is finished atm...I'll post the link for you guys to read when/if it get accepted to be published in a journal. The first paper is about a new metabolic condition that causes halitosis, and follows the work of these researchers in 2007 http://www.ncbi.nlm.nih.gov/pubmed/17716310 . This new condition looks like it is the most common cause of blood borne halitosis.

They take a long time to write because everything you say has to be backed up with evidence and referenced, but s its a great way of getting your head around the evidence base. When read together, I intend these papers to cover the whole topic of halitology. I'm amazed that no1 seems to have written an "ENT causes of halitosis" paper before, so this is the second paper I am working on now. Obviously there are all the other aspects like lower respoiratory tract, psuedohalitosis, gastrointestinal, blood borne haltiosis, etc. Who knows maybe I run a part time clinic devoted to diagnosis and treatment of this clinical problem in the future. Definitely seems to be a untapped market in UK compared to US, and I think I could do a better job (i.e more ethical) than many of them because of research covering extraoral halitosis (causes outside the mouth), including metabolic blood borne causes of bad breath, and not just tongue coating and gum disease (although these are the 2 most common causes). I would also like to learn how to scope the nose, sinuses and throat, and get a breath sulfide detector (OralChroma), hoping that I could get a grant for this, then I could use it research too.

emotional rescue · Post by **emotional rescue** » Sun Apr 29, 2012 5:40 pm

dolittle wrote: They take a long time to write because everything you say has to be backed up with evidence and referenced, but s its a great way of getting your head around the evidence base. When read together, I intend these papers to cover the whole topic of halitology. I'm amazed that no1 seems to have written an "ENT causes of halitosis" paper before, so this is the second paper I am working on now. Obviously there are all the other aspects like lower respoiratory tract, psuedohalitosis, gastrointestinal, blood borne haltiosis, etc. Who knows maybe I run a part time clinic devoted to diagnosis and treatment of this clinical problem in the future. Definitely seems to be a untapped market in UK compared to US, and I think I could do a better job (i.e more ethical) than many of them because of research covering extraoral halitosis (causes outside the mouth), including metabolic blood borne causes of bad breath, and not just tongue coating and gum disease (although these are the 2 most common causes). I would also like to learn how to scope the nose, sinuses and throat, and get a breath sulfide detector (OralChroma), hoping that I could get a grant for this, then I could use it research too.

Sounds great!
I hope that you can make it happen.

Good luck!

Gooner · Post by **Gooner** » Sun Apr 29, 2012 7:08 pm

Just reading that link you posted. I had the oral chroma test twice and both times hydrogen sulphide (H(2)S) and methyl mercaptan (CH(3)SH) registered a 0 whereas Dimethyl Suphide CH(3)SCH(3) registered on both occasions. The first time it was above the 'cognative threshold' and the second time it registered but just below the threshold but still had a reading.

At the time I got no explanation to differentiate between the 3 gases other than that Dimethyl Sulphide suggested the odour was from the throat rather than the mouth.

I have read another publication by Tangerman and Winkel which states:

Extra-oral halitosis can be subdivided into non-blood-borne halitosis, such as halitosis from the upper respiratory tract including the nose and from the lower respiratory tract, and blood-borne halitosis. The majority of patients with extra-oral halitosis have blood-borne halitosis. Blood-borne halitosis is also frequently caused by odorous VSCs, in particular dimethyl sulfide (CH3SCH3). Extra-oral halitosis, covering about 5–10% of all cases of halitosis, might be a manifestation of a serious disease for which treatment is much more complicated than for intra-oral halitosis.

So based on this I can conclude that I have blood borne halitosis ie TMAU or a respiratory problem?

Gooner · Post by **Gooner** » Sun Apr 29, 2012 7:56 pm

I am thinking of going back to my GP with a printout of this article:

http://www.ncbi.nlm.nih.gov/pubmed/11488130

dolittle · Post by **dolittle** » Sun Apr 29, 2012 9:02 pm

Hi G

I've read both papers, along with almost 200 other references to the paper I have finished

Its difficult to answer your Qs. From your oralchroma results, you don't seem to have any intra oral halitosis. Dimethylsulfide (DMS) is normally almost undetectable on breath analysis, so this to me is very relevant in the setting of your symptom. It is also worth remembering that although DMS is mainly attributed to extraoral halitosis, it can be synthesized from Methyl mercaptan, so if you have MM from intraoral halitosis, you will likely have a tiny amount of DMS which can be mistaken for an indication of extraoral halitosis.

Unfortunately, DMS can be raised for many reasons. From my paper:

Table 3: Dimethylsulfidemia: differential diagnosis

Metabolic:
Hypermethioninemias, including isolated persistent hypermethioninemia

Systemic:
Fetor hepaticus

Medications:
Dimethylsulfoxide
cysteamine

Suspected (unproven) causes:
new metabolic condition resulting in DMSE and related blood borne halitosis
Supulast tosillate therapy
? FMO3 dysfunction/overload

TMA in the urine is a marker for the deficiency or overload of a liver enzyme, FMO3. However, FMO3 deals with 1000's of substrates. DMS is one such substrate. The hypothesis is that "TMAU" is really a subtype of a larger family of blood borne malodor conditions caused by presence of volatiles that FMO3 would normally convert to the non volatile state. Utter speculation at this point, but it would explain why many patients with TMAU smell of many things, but rarely fish. Also, it could explain why so many test negatively for TMAU, but still have malodor symptoms. Maybe we need to eb testing for a profile of volatiles, not just TMA. I want to run DMS urinalysis on a cohort of TMAU +ve patients, and I think this would give me evidence for this theory.

To complicate things, elevated breath DMS has also been correlated with several other factors: Old age, female gender, HDL cholesterol, history of colon polyps, asthma or even Male pattern baldness.

Its all very intellectually stimulating, BUT what about the poor patients who have DMS on their breath... If you dont have any of the factors i list initially, then no-one really knows how to treat this. I would guess: reduce dietary sulfur and thiols (but not going below RDA of essential sulfur nutrients). And vigorous exercise to try and "sweat out" the DMS from the blood.

You can see how much knowledge is lacking in the topic of blood borne halitosis. I look forward to a time when we will know how to diagnose and treat extraoral halitosis, especially blood borne, just as well as we can intraoral halitosis.

Gooner · Post by **Gooner** » Mon Apr 30, 2012 7:09 pm

Thanks for your reply.

I am guessing that in my case the DMS readings aren't due to the gas being synthesized from MM as that came up as 0 on both tests. I dunno, I would think I would still get some reading of MM wouldnt you?

Researching all forms of extra oral halitosis is a real minefield, I dont know where to start. Ive got this 2nd laser tonsillectomy tomorrow which now seems a bit pointless.

On a positive note, ive had a good BB day today and yesterday as a result of one of the following:

Lufenuron
Enforced mouth breathing during sleep (I have blocked my nose for 2 nights running and have noticed a real change in nasal BB)
GSE & Psyllium Husk tablets I started 2 days ago

I am starting to wonder if my issue is respiratory, ive realised since doing the forced mouth breathing how I dont take full intakes of air usually. Now im doing it my BB is reducing and ive not go the fecal/garbage nasal BB that has been crippling me for ages. It seems a bit of a coincidence that ive been altering my breathing and suddenly my nasal BB has improved so much.

halitosisux · Post by **halitosisux** » Wed May 02, 2012 1:24 pm

dolittle, good to hear from you again.
I have a few questions if I may..
Can dimethylsulphide in the bloodstream find it's way into the mouth via the saliva or mucus? (or by any other secretory means?) or is the dimethylsulphide in the bloodstream only released via the lungs?

I've read somewhere that tonsil stones (the smelly components of the stones) are made from the condensed gases from the smelly chemicals responsible for bad breath. If this is true, and a person happens to have nasal anatomy which allows these gases to condense within certain crevices or cavities such as the sinuses, could they then end up smelling badly like the tonsil crypts can?

Thinking about it, it makes sense that if tonsils can absolutely reek, even though there's no sign of infection or much abnormality. The same thing could be happening in the sinuses in some people, and why ENTs tend to find nothing wrong within the nasal cavity for most people on here when they are inspected.

I'm really fascinated by some of the things you've said in this thread. I've read many times that the chemical trimethylamine can have a bizarre range of different odours at low concentrations. But what you've said (something which I've always wondered and believed could be the case) is that there could potentially be 1000's(?) of other smelly chemicals produced within the body (such as dimethylsulphide) which a "fault" within a person's FMO3 makes it unable to convert into the oxidized(?) form.

Is dimethylsulphide produced by gut microorganisms?

@Gooner, your enforced mouthbreathing experiements and findings correlate with what I've said about condensed gases breathed out collecting in the nasal cavities. Reducing the airflow through the nasal passages would reduce the amount of gas which could be condensing and building up there (if this really were happening.)

Phantasist · Post by **Phantasist** » Wed May 02, 2012 2:52 pm

Can a gas really be "condensing" in the nasal cavity? Doesn't it take a drop in temperature to cause condensation of a gas? Wouldn't normal body temperature prevent condensation?

halitosisux · Post by **halitosisux** » Wed May 02, 2012 6:49 pm

It depends on the chemical involved - every chemical has unique melting point/Boiling point etc which determine their thermal characteristics. We need a scientist to answer such stuff really.

When I blow my nose, or "snort" inwards to try to clear any mucus from my sinuses, sometimes the snot feels ice cold.

One of the roles of the nasal cavity is to add moisture to the air we breathe in and to try to regulate the humidity and temperature of the air before it goes into our lungs. So it's quite feasible that these foul smelling gases from the throat or mouth can end up condensing up there and building up to cause stench when we breathe outwards if the lining of the nasal cavities have become cold from warming the cold air coming in, the warm air going out could in theory condense onto these cold nasal membranes.

dolittle · Post by **dolittle** » Wed May 02, 2012 7:16 pm

I'll be in a better position to answer ENT questions after i finish the 2nd paper I am writing, essentially on the ENT causes of halitosis. I'm gathering a lot of info on these conditions. Its someway done already, but need to keep it short for publication.

I would encourage to concentrate on intraoral halitosis (oral malodor) management, as this is what the research shows in by far most common form (around 90%). For the around 10% of cases that are extraoral; dimethyl sulfide seems to be the most common cause, and this probably will turn out to be a new metabolic condition. We will have to wait for the researchers to publish their latest findings. If you have had an oralchroma test showing that you have elevated DMS on the breath, then currently I would advise low sulfur + thiol diet (not reducing essential sulfur containing nutrients below the RDA). Yes DMS can be synthesized by gut bacteria.
http://www.ncbi.nlm.nih.gov/pubmed/21386205
http://www.ncbi.nlm.nih.gov/pubmed/17716310

Having said that, ENT causes are obviously still a spanner in the works
http://www.ncbi.nlm.nih.gov/pubmed/21386160

Not sure where you are going with this condensing gas topic (do you have a link I could read up on this?) It is volatile sulfur gasses released from the putrefaction of sulfur containing proteins by anaerobic, proteolytic bacteria. Only if the gasses are liberated into the air are they perceptible as malodorous by others. If they stay insolution (e.g. in sinonasal secretions or saliva), then they don't smell. Thats why we have to smell tongue debris or used floss as it dries - so as to detect the VSCs as they evaporate.Tonsils stones do not smell I think because of the calcified/mineralized material itself, but rather the microcolony of halitogenic bacteria that it houses, and the halitogenic local dysbiosis that lead to its formation. The structure resembles dental calculus, i.e. living and non living components, which is together very bad smelling (part of the reason why gum disease smells)
http://www.ncbi.nlm.nih.gov/pubmed/19716006

Even when the stones are removed, if the anatomy of the tonsillar crypt system is still predisposed toward stasis, i.e. impaired drainage of secretions and collection of fungi, bacteria, dead cells, food debris, etc...then there will still be malodor even when the stone is gone. If the local anatomical retentive factors that lead to the formation of the stone are not corrected, then it is highly likely to reform, especially since tonsilloliths tend to pathologically enlarge the part of tonsilliar crypt system they are growing in.

dolittle · Post by **dolittle** » Wed May 02, 2012 7:26 pm

Also, wanted to quote this (from my paper, one of the closing comments):

"It is also interesting to note the evolution of a commercial industry revolving around the theory that a “candidosis syndrome” is widely prevalent, giving many symptoms, including a musty, mousy or yeast-like halitosis and/or body odor. These particular odor descriptions are reminiscent of the descriptions of fetor hepaticus, which as discussed previously, has been shown to be largely caused by DMS related blood borne halitosis."

Not to deliberately aggravate the "followers" of the candida religion, but I've always been a bit sceptical about candida causing odor. I studied Oral candidiasis in detail, ok its different environment from gut and perhaps a different aeitopathogenesis from "fungal type dysbiosis", but candidosis in the mouth doesn't smell, unless there is dry mouth, which caused the candida to overgrow because of lack of mechanical and immunological action of saliva. Dry mouth causes populations of bacteria to increase, it is this that causes the halitosis associated with xerostomia. So dry mouth can cause candida, and dry mouth can cause halitosis, but candiosis can not cause haltiosis.... if that makes sense.

deebo · Post by **deebo** » Wed May 02, 2012 9:24 pm

Thank you Bro for bringing some much needed critical thinking to the 'candida' topic . I almost want to delete some of the posts on it as spam because ppl seem so averse to doing some actual research of their own .

btw , I'm still catching up on old skype post reading . =/
we should get on voice if youre around friday .

jo hanson on FB & Hopemovo.com odor dating and support network

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