by Alicia Potee
Bad breath is embarrassing—no doubt about it. But it is more than an indicator of your last meal. Bad breath can also be a warning sign of serious health issues.
That’s because your breath doubles as a barometer for your health where several key systems are concerned. And chronic halitosis is a lesser-known calling card of at least four potentially serious illnesses.
If you’re dealing with any of these disorders, more mouthwash isn’t the solution. Each of them warrants a visit to your doctor.
So let’s start at the bottom and work our way up.
Culprit #1: Small Intestinal Bacterial Overgrowth
Small intestinal bacterial overgrowth (SIBO) is exactly what it sounds like. Bacteria—both good and bad—are plentiful all along your digestive tract. Most of these (around one billion bacteria per mL of fluid) are concentrated in your colon.
Your small bowel—which connects your stomach and your large intestine—contains far less bacteria. (Only around 10,000 bacteria per mL of fluid.)
In the case of SIBO, the bacteria in your small intestine multiply abnormally. This can be caused by bowel obstruction or any other form of reduced gut motility—a common complication of celiac disease, diabetes, low stomach acid (naturally occurring or caused by acid-reducing medication) and other conditions that impact intestinal health.1
As a result, your small intestine’s bacterial population more closely resembles the bacteria in your colon. These bacteria eat up sugar and carbohydrates, producing excessive gas—including foul-smelling hydrogen sulfide.
And this gas can eventually make its way north and out through your mouth.
But bad breath isn’t the only risk SIBO poses. In fact, it’s probably the least of your concerns. Other complications of small intestinal bacterial overgrowth include bloating, diarrhea, poor nutrient absorption and malnutrition. 2
Luckily, your doctor can identify this with a non-invasive breath test. Even without smelly “sulfur burps”, the presence of hydrogen in your breath is a tip off of excess bacteria in your small intestine.
This is important, since SIBO is often mistaken for irritable bowel syndrome. This can lead to a lack of effective antibiotic treatment. And, if left undiagnosed, bacterial overgrowth could eventually move outside the intestine—causing sepsis and organ failure.
The test itself is easy. Your doctor administers 50 to 75 grams of a non-digestible sugar called lactulose. If hydrogen expiration exceeds a certain level (usually 10 to 20 parts per million) in response, small intestinal bacterial overgrowth is the likely cause. It’s that simple. 3
Culprit #2: H. Pylori Infection
SIBO isn’t the only condition in which rogue gut bacteria can hijack your breath. Helicobactor pylori (H. pylori)—the common bacteria linked to ulcers and stomach cancer—can cause halitosis too.
As part of a 2006 study, Japanese researchers analyzed the saliva of 326 subjects. Of these, 251 had bad breath and 75 didn’t. None of them showed signs of any gastrointestinal illness.
Along with other bacteria that cause halitosis, just over six percent of the subjects also harbored H. pylori in their saliva. These same subjects showed higher levels of gum disease markers, including bleeding, tooth mobility and methyl mercaptan (a gas that causes bad breath).
Additionally, among the 102 subjects with periodontal disease, approximately 16 percent also had oral H. pylori colonization. The study authors’ conclusion: H. pylori may not cause bad breath—but it’s definitely associated with both halitosis and gum disease. 4
The link between H. pylori infection in the mouth and the stomach has yet to be determined. But studies have already shown that mouth bacteria can lead to heart inflammation. 5
These latest findings suggest that chronic bad breath might be a good reason to look for H. pylori in your GI tract before the bacteria create future problems that are far more serious than halitosis.
On the bright side, H. pylori is fairly easy to diagnose. Blood and stool tests are two possible methods. But a breath test is an accurate non-invasive option.
For this test, you simply swallow a tablet containing urea (a chemical formed from nitrogen and carbon). The amount of carbon dioxide you exhale afterward will reveal the presence of H. pylori. 6
Culprit #3: Sinus Infection
Not surprisingly, your respiratory tract could also be harboring the real cause of halitosis. And one of the most common manifestations of this is the dreaded sinus infection.
Sinus inflammation and swelling (acute sinusitis) is usually the result of a cold or virus irritating your nasal passages. That’s why you end up with that miserable stuffy nose and pressure.
These symptoms will usually disappear once the viral infection runs its course. But sometimes—especially if the mucus builds up too much to circulate—bacteria can begin to take hold. And that, in turn, can cause a case of bad breath. 7
In addition to halitosis, thick yellow or green nasal discharge that doesn’t go away is a good indication that your stuffy nose has become a sinus infection.
Earache, pressure, sore throat and facial tenderness are other telltale signs.
Minor viral cases of sinusitis will often resolve themselves. But if you still can’t shake symptoms after seven to 10 days—especially if they’re accompanied by a fever—it might be time to make a call to your doctor. 8
Usually, he or she will be able to identify a bacterial sinus infection with a physical examination of your face. Additionally, some sinus infections can be caused by fungus. Your doctor can do a culture to determine the correct cause.
Culprit #4: Ketoacidosis
If it seems like bacteria is always behind a case of bad breath, that’s because, well… it usually is. But not always.
There is one case where a bacterial infection isn’t to blame. And that’s a condition called ketoacidosis.
Ketones are compounds your body generates when it begins to break down fat for energy in your liver. The process is called ketosis—and it happens when your body’s glycogen (or carbohydrate) stores are depleted.
Ketosis isn’t necessarily a bad thing. In fact, it’s a fat-burning state that many low-carb diets aim for. But when ketone production becomes uncontrolled—usually as a result of diabetes, when your body can’t use the sugar in your blood for energy—it can be dangerous.
This is called ketoacidosis. It’s marked by an extreme drop in blood pH, as well as other symptoms like flushing, nausea and stomach pain. And it definitely calls for a trip to your doctor. 9
Unlike the “rotten egg” smell that comes with sulfur gas, ketoacidosis leaves a fruity, acetone odor on your breath. Unfortunately, this condition isn’t identifiable through a breath test. In order to identify ketoacidosis, your doctor will perform a battery of blood tests, including a ketone and a glucose test.
In this case, timely diagnosis is critical, as untreated diabetes kills.
Beyond Breath Mints
The bottom line on chronic bad breath? If your mouth offends, despite good oral hygiene habits, make an appointment with your doctor today.
There could be a larger problem at play. And a swift diagnosis could save you from more than an awkward social situation. It could also save you a trip to the hospital.
1. Marks, Jay, M.D. “Small intestinal bacterial overgrowth (SIBO).” www.medicinenet.com.
2. Bures J, et al. World J Gastroenterol. 2010 June 28;16(24): 2978-90.
3. World Journal of Gastroenterology. “Breath Test Can Discriminate Between A Bacterial Overgrowth And IBS.” ScienceDaily, 20 Dec. 2007.
4. Society for General Microbiology. “Stomach Ulcer Bug Causes Bad Breath.” ScienceDaily, 29 Nov. 2008.
5. “Bacteria From Mouth Can Lead to Heart Inflammation: Study” 26 Mar 2012. http://health.usnews.com/health-news/news/articles/2012/03/26/bacteria-from-mouth-can-lead-to-heart-inflammation-study.
6. “The urea breath test and H. pylori.” http://www.webmd.com/digestive-disorders/urea-breath-test.
7. Connelly, Thomas D.D.S. “The Different Kinds of Bad Breath, Part 3: Sinus Breath.” 11 Apr 2012.
8. Mayo Clinic Fact Sheet. “Acute Sinusitis.” http://www.mayoclinic.com/health/acute-sinusitis/DS00170/DSECTION=causes.
9. Medline Plus Fact Sheet. “Diabetic ketoacidosis.”