Dr Justus Apffelstaedt: Is your medication changing the way wine tastes?

The taste of wine is complex neurophysiological phenomenon: Chemical compounds in the wine interact with smell receptors in the nose and taste receptors in the mouth; these generate signals that are carried via nerves to the brain where integration of the different signals to a coherent, memorable and conscious smell and taste perception takes place. Such a complex sensory experience is subject to multiple modifiers. It is commonplace, that on your vacation in Spain a particular wine tasted so much better as a sunset drink in the beach restaurant in Alicante than at the dinner table in Midrand. Moods, surroundings, company and situations all shape the perception of smell and taste in general and wine in particular. Furthermore, physiological changes greatly influence taste perception. Ever noticed, that you smell by about three orders of magnitude better when you are very hungry than after a good meal? As another example, taste perception in women varies with menstrual periods. Note, that for simplicity’s sake smell and taste are referred to hereunder as simply taste.

From age 40 onward, the majority of patients in our practice are on some medication, be it for hypertension, high cholesterol or – the newest fashion – on weight loss medication and still many more. In younger female patients, hormonal contraception is common. It therefore makes sense to examine what is known about the potential interaction between your medication and sense of taste. Note, that in South Africa alone more than 40 000 different medications are on the market. It therefore is impossible to accurately research how each medication will change the perception of the taste of wine.

As protective mechanism, humans evolved to perceive poisonous and thus potentially harmful compounds as tasting repellently metallic or bitter. Active ingredients in medication are mostly synthesized chemical compounds that do not occur naturally. Therefore they are recognized subconsciously as potentially harmful leading to a perceived bitter or metallic taste sensation. Active ingredients are only a small part of oral medications with fillers, manufacturing aids (e. g. pills shouldn’t stick to the pill pressing machine), stabilizers and coatings making up the rest; these are tweaked to make medication palatable. On the other hand the active ingredients can directly alter smell and taste in a number of ways: They can actively change receptors in nose and tongue, modify signal transmission to the brain and also change ultimate signal processing in the brain leading to a changed taste perception. To add complexity to the picture, a number of diseases also change taste perception. A good example was the recent CoViD 19 epidemic that left many with a loss of smell and taste for a prolonged time. But also other common and chronic diseases such as high blood pressure, diabetes or neurologic diseases change taste perception, making it difficult to differentiate between changes due to disease or treatment.

For these reasons, scientific data on changes of taste perception due to medication are thin, but solid data exist for common medications: On the list are anti-biotics such as Amoxicillin and Ciprofloxacin; pain medications such as Aspirin, Diclophenac and Tramadol; hypertension medications such as Diltiazem, Lisinopril, Furosemide; virtually all of the common statins (cholesterol medications); anti-diabetics such as Metformin and also the newer GLP1 agonists (also known as “slimming drugs”) which started out as anti-diabetics; antacids such as Omeprazole; not unexpectedly psychoactive drugs such as many anti-depressants, tranquilizers and sleeping medications such as Sertraline, Diazepam and Venlafaxine; chemotherapeutics and lastly, contraceptives. Note, that this list is by no means exhaustive. Furthermore, even less data are available on “alternative” medications and supplements, but what data are available suggests that these also can influence taste perception. As example of a widely used supplement, vitamin D preparations can do so.  

Changes in smell and taste perception are described and classified as decreased up to total loss, altered (most often substances then smell and taste bitter or metallic) and hypersensitivity.  It is highly unpredictable for the individual, in which way the perception will be changed with the introduction of a new medication if at all. Luckily, for the majority of individuals, changes are only minor and do not bother. But if you suspect, that bottle variation may not be the cause of the sudden change in taste of your favorite cabernet but rather the newly prescribed statin you are taking, read the package insert. If changes to taste perception are a known side effects of your medication, discuss the availability of alternative medications with your doctor. On the other hand, individuals who need an acute sense of small and taste for their profession as for example sommeliers, winemakers or wine judges must be extra-careful. These individuals should proactively discuss potential changes to smell and taste perception for new medications with their prescribing doctors.

• Dr. Justus Apffelstaedt is a specialist in breast and thyroid health, leading Apffelstaedt & Associates in Cape Town and Windhoek. A surgeon, oncologist, and researcher, he was Associate Professor of Surgery at Stellenbosch University (1994–2017) and Head of Surgical Oncology, managing 1,000-plus cancer cases annually. He has more than 50 publications, shaped South Africa’s breast cancer screening policy, and co-founded Breast Surgery International. A sought-after speaker, he has given over 100 international lectures. He also holds an MBA and a Diploma in Wine. Through Apffelstaedt & Associates, he continues to advance specialized, patient-centered care in Southern Africa.