Has anyone experienced continuous bad breath since the surgery? I cannot seem to freshen up no matter how much I brush and use my tongue scraper. I use mouthwash but it soon wears off. I've never had breath like this before.

I think a bit of that might be down to the initial ELEVATED PROTEIN RATIO in your post op diet.

After surgery your body can be thrown into ketosis. Ketosis is a normal metabolic process. When the body does not have enough glucose for energy, it burns stored fats instead; this results in a build-up of acids called ketones within the body. According to the internet:

The most typical source of energy used by the body is glucose. This is typically derived from carbohydrates, where the digestive system breaks down complex sugars into simple glucose molecules.

On very low carb diets, however, the body is unable to utilize such a fuel. Instead, the liver utilizes the fat present in the body as an energy source, producing “ketones” in the process(2). This is known as “ketosis” – and is the process from where keto diets get their unusual name.

These ketone bodies come in three common forms; acetoacetate, beta-hydroxybutyrate and acetone(3). In large quantities they are removed from the body in the urine or through exhalation.

Ketones can have quite a characteristic smell; they often make the dieter’s breath smell quite sweet and fruity, quite distinct from typical halitosis.

Excessive volumes of acetone, however, can smell rather different. Acetone on the breath is most commonly likened to the smell of nail varnish remover(4).

Protein Excess

A second possible cause of ketosis breath isn’t directly linked to the breakdown of fat as a fuel source.

Instead, it is a side issue caused by typical changes to the diet. As those on keto diets try to minimize the consumption of carbohydrates, so the diet is often filled with other constituents; most typically fat and protein.

A diet that is high in protein can have two impacts on breath. Firstly, the breakdown of protein in the body produces ammonia; this can lead to urine or breath smelling particularly strongly. If your breath has started to smell like a cat litter tray while on a ketosis diet then this may well be your culprit!

Standard bad breath is most commonly caused by bacteria in the mouth. This bacteria breaks down its food, producing volatile sulphur compounds (“VSCs”).

It is interesting to note that studies suggest that the most common source of VSC production is the breakdown specifically of protein, as opposed to other food sources. Higher protein diets, especially in the absence of suitable oral hygiene, can also therefore impact one’s breath.

Some advise to normalize this condition are:

Drink plenty of water.

Rinse your mouth with an anti-bacterial oral rinse.

Consider the use of calorie-free and carb-free mints or gum, or use a flavoured oral preparation such as a mint-flavoured breath spray or mouthwash.

One of the other suggestion it seems you are already doing. Studies suggest that cleaning the tongue is almost twice as effective as brushing alone at removing bad breath. As a result, investing in a tongue scraper can be a worthwhile exercise.

Ketosis often causes increased urination. This diuretic effect is due in part to your glycogen stores being emptied. Also known as “water weight,” one gram of glycogen necessitates around 3 to 4 grams of water in storage. This mass exodus of surplus fluids (aka pee) can cause dry mouth, and increased sensations of thirst. One of the other conditions that I encountered after weight loss surgery was dry mouth. I found that Biotène® Dry Mouth Oral Rinse helped with this condition.

Thank you!! That's very helpful.

Or...you know...ask your doctor. The extreme dry mouth after surgery can sometimes get a thrush infection going and you might need a little medicated mouthwash to slay it. Also wouldn't hurt to get in to see the dentist....the scarce nutrition right after the procedure can cause an underlying dental issue to worsen...so getting a fresh cleaning and staying on top of any problems would also be a great idea. Don't forget to floss those back teeth regularly, since any trapped food back there is a common culprit of halitosis and you're not working it loose by chewing daily.

James covered it all. My breath was better after about 7 months

I saw my PA today for my one week and asked her about it. She noticed my tongue color (which is kind of pale, sort of white, so duh...) and an ulcer on my tongue I hadn't noticed and diagnosed it as probable thrush. She thinks it's probably from the antibiotics. So, I get nystatin swish and swallow. The thought of it makes me nauseous, though I'm already nauseous most of the time anyway. Thank you all for your input, I appreciate it!