Can weight loss medications cause halitosis?

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Can your oral health be affected while taking GLP-1 medications? Aleksandar Georgiev/Getty Images
  • People can experience a range of side effects while taking GLP-1 medications such as Ozempic and Wegovy.
  • A growing number of people report experiencing “Ozempic breath,” or foul-smelling breath that they believe stems from using GLP-1 weight loss medications.
  • Health experts say there are a number of factors that can contribute to oral health problems while taking weight loss medications.

Ozempic and similar drugs, including Wegovy, Monjouro and Zepbound, are being hailed as breakthrough weight loss medications in qualified patients.

Patients lost one average 15% of their body weight in clinical trials of semaglutide (Weogvy and Ozempic) and about 21% on tirzepatide (Monjouro and Zepbound).

Side effects, mainly gastrointestinal complaints, have also been reported. Some, however, have adopted buzzy terms – “Ozempic face,” “Ozempic butt,” and now “Ozempic breath.”

“Ozempic breath refers to a fishy odor with belching or bad breath,” says Neha Lalani, MD.

It is not a clinical diagnosis, nor is it discussed with the same frequency as gastrointestinal complaints. Still, the two can be intertwined, and doctors and dentists agree that it’s important to understand all the possible side effects of taking a GLP-1 drug.

“All medications have side effects, and anti-obesity medications are no exception,” says Christopher McGowan, MD, gastroenterologist, obesity medicine specialist and founder of True You Weight Loss. “Bad breath, or halitosis, almost universally stems from oral hygiene. That is why it is crucial to differentiate where odors arise so that they can be addressed at the source.”

In particular, halitosis, or bad breath, is not listed as a side effect of Ozempic, Wegovy, Monjouro or Zepbound.

Furthermore, there is no peer-reviewed data on whether these medications cause bad breath and why they might do so.

“People are studying it, though,” says Fatima Khan, DMD, a dentist and co-founder of Riven Oral Care. And that’s important, as Khan emphasizes, because it’s essential to collect more long-term data before drawing any conclusions about why people may experience oral hygiene problems like bad breath while taking these medications.

However, Khan pointed out that clinical studies found that “belching” (or burping) was a side effect that participants experienced, which is often called “Ozempic burp.”

In a Novo Nordisk study, almost 9% of people taking semaglutide reported belching. Again, more research is needed before linking foul-smelling breath (or a bad taste in a person’s mouth) to GLP-1 medications. However, experts say it’s likely that belching is a possible reason GLP-1 drugs can cause mouth odor – keyword: one.

“The three most common causes of GLP-1-related mouth odor are belching, bad breath (halitosis) and ketosis,” says McGowan.

Burping-related mouth odor is not bad breath, although it can feel like one and lead to mental health side effects.

“This is stomach odor flowing through the mouth,” says McGowan. “Patients report that these odors can ‘clean up a room’ and be a source of anxiety in social situations.”

“This is a direct result of the mechanism of action of GLP-1 drugs,” McGowan explains. “All medications within this drug class cause a delay in gastric emptying, meaning it takes significantly longer for food to leave the stomach. This is one way the medications help with portion control.”

The downside is that food can break down and ferment in the stomach.

“The stomach is normally designed to be emptied within four hours of eating,” says McGowan. “However, GLP-1 drugs such as Ozempic ensure that food remains in the stomach for many hours, even days. At that point, your stomach is functionally a compost bin, and if you burp, it won’t be pleasant.

McGowan adds that patients who experience GI-related side effects, such as vomiting and diarrhea, may become dehydrated and develop dry mouth, a common cause of bad breath.

Finally, the drug’s ability to reduce food noise is a benefit, but in rare cases can cause severely reduced nutritional intake leading to ketosis.

“Ketosis occurs when the body burns fat for energy, which usually leads to a sweet, acetone-like odor on the breath,” says McGowan. “Maintaining a balanced diet, full of all macronutrients, will prevent this.”

In addition to the possibility of oral odor, Khan says people taking GLP-1 medications may experience:

Khan notes that people with gastroesophageal ulcer disease (GERD) can often experience heartburn, as well as a bitter and sour taste in their GERD. Vomiting, a possible side effect, can erode the enamel.

“Enamel… is the hard and mineralized outer layer of your tooth,” says Khan. “Tooth erosion is the result of the dissolution of enamel by acidic substances. GERD further worsens erosion.”

Khan says this erosion can have a ripple effect, leading to oral sensitivity, discolored teeth, and teeth that look smaller.

Khan adds that dry mouth also increases the risk of tooth decay, and people with diabetes are more likely to develop dental disease.

“The good news is that most of these symptoms will improve over time as the body adjusts to the medication,” says McGowan.

However, there are a few steps you can take in the meantime. The first are common-sense measures recommended for people regardless of what medications they take, such as brushing and flossing daily and seeing a dentist at least twice a year, McGowan says.

Other tips include staying hydrated (especially if you experience dry mouth, nausea, or vomiting) and eating a well-balanced diet.

“Fatty, greasy, and heavier foods are digested more slowly and leave the stomach, leading to increased belching and odor,” says McGowan. “Stick to lean proteins, fruits and vegetables, and healthy fats in moderation. Fast food, saturated fats, cheeses and fatty meats should be limited.”

The time of day you eat can also help.

“Finish your last meal three to four hours before bedtime,” says Lalani.

Finally, if you’re still experiencing poor oral health, experts recommend talking to your team.

Registered dietitians can help guide food choices, and a dentist can provide insight into oral health issues and advice.

Ozempic breath is not a clinical diagnosis, but people experience bad mouth odor while taking GLP-1 medications.

Experts say this can be due to burping (and therefore no bad breath), halitosis or ketosis.

In addition, side effects of GLP-1 medications can cause nausea and vomiting, dehydration (and dry mouth), enamel erosion, tooth sensitivity, and discoloration.

Following general guidelines about brushing and flossing and visiting a dentist can help prevent these side effects, which usually go away over time.

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