Diabetes poop: Is sweet-smelling poop a sign of diabetes?

 Key takeaways

• Sweet-smelling poop isn't a recognized symptom of diabetes (a condition characterized by high glucose), and there are no particular features to describe what the stool of people with diabetes smells or looks like.
• Medications and diet are some factors that may cause sweet-smelling poop. Also, sweet-smelling stool is one of the symptoms of Clostridioides difficile infection.
• While diabetes may not affect a person’s poop, the smell, appearance, and consistency of your poop can still be a pointer to an underlying health condition. It's best to see a doctor if you notice anything unusual.

Poop is definitely not a pleasantly discussed topic. However, it's important because everything in the human body can tell something about one's state of health.

To begin with, every person's poop has a unique smell, which may be termed ‘normal.’ Stool smell typically results from the action of gut bacteria and enzymes, which act on consumed food. Also, the type of food you eat contributes to the characteristic smell of poop. Moreso, some doctors opine that a healthy poop should have some level of unpleasant smell. Therefore, having your poop stink shouldn't get you worried.

When poop has a ‘too pleasant’ or ‘fruity’ smell, it is often referred to as ’sweet smelling.’ This is not usually a feature to describe human stool; however, it can occur in certain cases, such as a Clostridioides infection, which is a bacterial infection. Several other factors can cause a person’s poop to have a sweet smell, e.g., food and medications. Because anything “sweet” or “sugary” is usually linked to diabetes mellitus (DM), you may wonder if a sweet-smelling poop is one of the signs of diabetes mellitus.

 Is sweet-smelling poop a sign of diabetes?

“Sweet-smelling poop is not a recognized symptom of diabetes mellitus,” says Dr. Palmer Dennis, (MBBS), an endocrinologist at the Federal Teaching Hospital, Lokoja, Kogi State, Nigeria. 

Sweet-smelling stool can be caused by some other disease conditions, but not diabetes mellitus. The most common symptoms that can suggest diabetes mellitus are polyuria (the passage of large amounts of urine), polydipsia (an increased thirst for water), and weight loss.

 The distinct smells associated with diabetes

“The distinct smell associated with diabetes mellitus is mostly the fruity breath smell, which is linked to acetone in the breath and is mostly seen in patients who have an emergency of DM called diabetic ketoacidosis ( DKA),” says Dr. Palmer, adding that in this condition, the body is unable to utilize glucose for energy, and this results in the body using ketone bodies. 

Acetone is a ketone body and is excreted both in the breath as exhaled air and in the urine. It has a typical sweet, fruity, and sickening smell.

Another smell that may be associated with diabetes mellitus is the putrid smell of a diabetic foot ulcer. Severe or untreated diabetes can cause blockage or damage to the blood vessels supplying blood to the leg and foot, leading to ulceration, infection, destruction, or death of deep tissues in those parts of the body. The decaying tissues can cause an unpleasant smell.

 What diabetic poop may look like

According to Palmer, “There is no particular characteristic to describe poop in diabetes mellitus.” But he explains that diabetes can cause both diarrhea and constipation. For people with diabetes who have diarrhea, the poop is loose and watery, while for those with constipation, the stool is hard. 

The diarrhea and constipation linked to diabetes are often the result of diabetic neuropathy affecting the gastrointestinal tract. Diabetic neuropathy is a situation where the nerves supplying a particular area of the body are damaged. Although it commonly affects the legs and feet, it can also occur in other organs or parts of the body.

Notably, diabetes mellitus can affect several tissues and organs in the body, causing different symptoms or complications.

 Signs and symptoms of diabetes

Some signs and symptoms of diabetes include:

• Polyuria (excessive urination)
• Polydipsia (excessive thirst)
• Increased hunger
• Unexplained weight loss
• Fatigue
• Slow healing of wounds
• Blurred vision
• Numbness/tingling of hands/feet
• Ketone in urine on laboratory investigation
• Increased blood sugar level

 Causes: Why you may have a sweet-smelling poop

Certain factors may cause one to have sweet-smelling poop. They include:

 Clostridioides infection

“Clostridioides infection, formerly called Clostridium infection, is one of the commonest causes of sweet-smelling poop,” Palmer notes. This is often a result of excessive antibiotic intake, which alters the normal gut microbiota and causes the growth of the bacterium, Clostridioides difficile (C. difficile). This may result in one's poop having a sweet smell. 

Nevertheless, sweet-smelling poop alone cannot suggest or confirm a person has Clostridioides infections because the infection usually comes with other symptoms like fever, abdominal pain, nausea and vomiting, and diarrhea. There are also tests for diagnosing this infection, such as stool tests and blood tests. 

 Medications

Certain drugs can cause sweet-smelling poop; e.g., a 2020 study opined that metformin, a diabetes medication, causes the excretion of sugar in the stool, resulting in one's poop having a sweet smell.

 Diet

Certain foods, e.g., the keto diet, can cause sweet-smelling poop. A keto diet is a type of diet that restricts carbohydrate consumption while encouraging the consumption of high-fat foods. While it's popular for inducing weight loss, a keto diet can lead to a high level of ketones, which may be excreted through poop, causing the fruity, pleasant smell of poop.

In addition to the above causes, the sweet smell you perceive might be that of urine. Because urine is excreted with poop in most cases, the sweet smell might be coming from your urine. Therefore, it is important to visit the hospital for a proper check-up if you notice any unusual smell of poop. 

 Causes of foul-smelling poop

Factors that can contribute to the foul smell of poop may include:

• Diet: Sulfuric (e.g., garlic), leguminous (e.g., beans), fatty foods, and a high-protein diet can make your poop have a more stinky smell than usual. Also, sugary/processed foods can contribute to this.
• Excessive alcohol intake: Alcohol contains some amount of sulfates. So if consumed in excess, it can alter the smell of poop, causing it to have a more unpleasant odor than usual.
• Lactose intolerance: Lactose intolerance is a condition where the body has little or no lactase (an enzyme that digests lactose-containing foods), making it difficult or impossible to digest the lactose sugar found in abundance in milk. This may cause indigestion and further lead to the passage of foul-smelling poop.
• Dehydration: Dehydration means the body doesn't have enough water to function well. This can slow down bowel movement and cause the formation of dry, hard stool, which may get stuck in the rectum. The longer fecal matter stays in the gut, the more unpleasant the smell becomes.

Other causes of foul-smelling poop may include:

• Medications
• Malabsorption syndrome
• Infection 

 Should you be concerned about the smell of your poop?

The smell of poop might seem insignificant when it comes to health. However, along with the appearance and consistency of your poop, it can be a great pointer to an underlying health condition.

Therefore, it's best to pay attention to any deviation from normal in your poop smell, appearance, and consistency.

 When to see a doctor

When your poop begins to have a fruity or too pleasant smell or a foul smell than usual, consider consulting a doctor for a proper examination or investigation, especially if this happens persistently. 

Also, consider visiting the hospital if you notice that the appearance and consistency of your poop have begun to change, e.g., poop becomes tarry or black or has blood stains. This might be a sign of gastrointestinal bleeding and will need proper medical treatment.