Ewwww: Body odor can have serious causes

Gyms smell like sweat, as they should! But most of us draw the line when people smell like old socks. Some folks don’t change their gym clothes for days— or weeks.

I used to belong to a pretty nice gym (if you define nice gym as dues costing as much as a mortgage). Most people donned their little designer workout clothes with fresh sneakers to support their arches. However, one dude always entered the gym as Clark Kent and then turned into PooperMan by putting on dirty workout clothes and shoes. He reeked during his workouts!

What do you do when someone has body odor?

I have patients who smell like medieval warriors on a hot summer day. Years ago, people didn’t bathe because they thought it would kill them. So perfumes and colognes became very popular to hide the natural human body smell.

However, in our culture, body odor is no longer the norm: it's as welcome as Winona Ryder at Target. When I have a patient with body odor, I have concerns that are medically related. First, does this person lack resources for proper hygiene? Maybe he can’t do his ADLs (activities of daily living) because of physical limitations. Perhaps mental illness is responsible for the lack of self-care.

Broaching the topic of body odor is never fun, but I’ve gotten used to it. I try to deliver a message that is nonjudgmental and compassionate. I bring up the problem and state my concern: the patient is at risk of infection. Odor often springs from bacteria gone haywire. And bacteria loves sweat.

So if a diabetic person doesn’t wash his feet, doesn’t wear clean socks and good shoes, and doesn’t check his feet for lesions, then he’s at risk of infection that can lead to amputation of the toes, foot, or even leg.

It can be quite embarrassing for the patient to hear about the odor, but I concentrate on the risk of infection and how to improve the situation. For people with overlapping skin (e.g. pendulous breasts that press on the abdomen, abdominal folds, especially over the pelvis) fungal infections– called intertrigo– can release an odor. Ulcers can form in these intertriginous regions and form abscesses.

One of my college suite-mates never used deodorant, and his armpits smelled like death. Washing the armpits– perhaps shaving the hair– and using deodorant can reduce body odor.

From odors I've been able to diagnose fecal or urinary incontinence in patients too embarrassed to admit they have these problems. Depending on the cause, both of these conditions can be treated. There are also undergarments to help control odor from accidents.

I didn’t get to read the actual study done by Monell Chemical Senses Center in Philadelphia on a biological cause of B.O., but it reported that about 33 percent of participants with unexplained body odor had trimethylaminuria (TMAU). In this genetic disorder, trimethylamine cannot be metabolized, leading to a fishy body odor. This problem is linked to food high in choline, which is found in eggs, wheat germ, organ meats, saltwater fish, and certain beans.

There are enough other causes of body odor to keep a bloodhound happy for years, but I'm out of room. Do you wonder what happened with Mr. Stinky at the gym? Managers said they couldn’t do anything about it.

So I did what any logical person would do: I sprayed disinfectant everywhere he went, like I was Felix Unger. He got the message.
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Dr. Hook cracks a joke or two, but he’s a respected physician with an interesting website, drjohnhong.com. Email him with your questions!