Bad breath may not be bad at all

DEAR DR. ROACH: Could the cause of chronic bad breath be due to having a tortuous esophagus? I've always had a horrible taste in my mouth 10 to 20 minutes after eating — sometimes worse than others, depending on what I've eaten. I was diagnosed with GERD 10 years ago. I tried eliminating certain foods, had my tonsils removed in my late 20s and have brought it up with doctors a few times, to no avail.

I have regular cleanings every three months with a dental hygienist, and I floss regularly, gargle and brush my teeth two or three times a day. I do not enjoy going to social events or participating in group activities. I am too embarrassed to discuss this with anyone, including my gastroenterologist, who discovered this type of esophagus during my endoscopy. A TV doctor said there are millions of people out there who can't find a cure for their bad breath. Please help me! – S.H.

ANSWER: There are indeed millions of people with bad breath, and many of them are unaware of it. On the other hand, millions of people who think they have bad breath do not, when examined objectively by professionals. This is largely because it is very difficult to judge what our own breath smells like. This is common enough that it has a name: halitophobia.

Approximately 80 percent to 90 percent of bad breath comes from the oral cavity; the nasal passages, tonsils and sinuses are the causes in nearly all the others. Bad breath almost never arises from the esophagus or stomach, so I don't think your tortuous (a term meaning that the esophagus is twisted somewhat and doesn't go straight down) esophagus is the cause.

A bad taste in your mouth certainly can come from having GERD. Many people think that the bad taste means their breath smells bad when, in fact, it doesn't. I think you need to have an evaluation by an expert. Some ENT doctors have particular expertise in this area.

The booklet on heartburn explains GERD and acid reflux. Readers can obtain a copy by writing: Dr. Roach, No. 501W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: I'm a 76-year-old woman who enjoys a 6-ounce glass of ruby-red grapefruit juice every morning before my breakfast of cereal, half a banana and coffee. My husband has been trying to convince me that I should stop having my morning juice, as it is a real "sugar bomb." Is he correct in his thinking? – P.W.

ANSWER: A 6-ounce glass of grapefruit juice is a perfectly reasonable serving size. Six ounces would contain about 16 grams of sugar. That's less than half of what's in a can of soda, and although it's a good chunk of your daily sugar intake, if that's where you want to have it, that's fine. Your husband should lighten up. I see people drinking 64 ounces of juice or soda. Those are sugar bombs.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]. To view and order health pamphlets, visit rbmamall.com, or write to P.O. Box 536475, Orlando, FL 32853-6475. (c) 2015 North America Synd. Inc. All Rights Reserved