tastes to the receptor and protection of the taste receptor. typical clinical investigations involve sialometry and sialochemistry. studies have shown that electron micrographs of taste receptors obtained from saliva samples indicate pathological changes in the taste buds of patients with dysgeusia and other gustatory disorders. treatments artificial saliva and pilocarpine because medications have been linked to approximately 22% to 28% of all cases of dysgeusia, researching a treatment for this particular cause has been important. xerostomia, or a decrease in saliva flow, can be a side effect of many drugs, which, in turn, can lead to the development of taste disturbances such as dysgeusia. patients can lessen the effects of xerostomia with breath mints, sugarless gum, or lozenges, or physicians can increase saliva flow with artificial saliva or oral pilocarpine. artificial saliva mimics the characteristics of natural saliva by lubricating and protecting the mouth but does not provide any digestive or enzymatic benefits. pilocarpine is a cholinergic drug meaning it has the same effects as the neurotransmitter acetylcholine. acetylcholine has the function of stimulating the salivary glands to actively produce saliva. the increase in saliva flow is effective in improving the movement of tastants to the taste buds. zinc supplementation zinc gluconate. approximately one half of drug-related taste distortions are caused by a zinc deficiency. many medications are known to chelate, or bind, zinc, preventing the element from functioning properly. due to the causal relationship of insufficient zinc levels to taste disorders, research has been conducted to test the efficacy of zinc supplementation as a possible treatment for dysgeusia. in a randomized clinical trial, fifty patients with idiopathic dysgeusia were given either zinc or a lactose placebo. the patients prescribed the zinc reported experiencing improved taste function and less severe symptoms compared to the control group, suggesting that zinc may be a beneficial treatment. the efficacy of zinc, however, has been ambiguous in the past. in a second study, 94% of patients who were provided with zinc supplementation did not experience any improvement in their condition. this ambiguity is most likely due to small sample sizes and the wide range of causes of dysgeusia. a recommended daily oral dose of 25–100 mg, as zinc gluconate, appears to be an effective treatment for taste dysfunction provided that there are low levels of zinc in the blood serum. there is not a sufficient amount of evidence to determine whether or not zinc supplementation is able to treat dysgeusia when low zinc concentrations are not detected in the blood. a cochrane review in 2017 assessed the effects of different interventions for the management of taste disturbances. there was very low-quality evidence to support the role of zinc supplementation in the improvement of taste acuity and taste discrimination in patients with zinc deficiency or idiopathic taste disorders. further research is required to improve the quality of evidence for zinc supplementation as an effective intervention for the management of dysgeusia. zinc infusion in chemotherapy it has been reported that approximately 68% of cancer patients undergoing chemotherapy experience disturbances in sensory perception such as dysgeusia. in a pilot study involving twelve lung cancer patients, chemotherapy drugs were infused with zinc in order to test its potential as a treatment. the results indicated that, after two weeks, no taste disturbances were reported by the patients who received the zinc-supplemented treatment while most of the patients in the control group who did not receive the zinc reported taste alterations. a multi-institutional study involving a larger sample size of 169 patients, however, indicated that zinc-infused chemotherapy did not have an effect on the development of taste disorders in cancer patients. an excess amount of zinc in the body can have negative effects on the immune system, and physicians must use caution when administering zinc to immunocompromised cancer patients. because taste disorders can have detrimental effects on a patient's quality of life, more research needs to be conducted concerning possible treatments such as zinc supplementation. altering drug therapy eprosartan. the effects of drug-related dysgeusia can often be reversed by stopping the patient's regimen of the taste altering medication. in one case, a forty-eight-year-old woman who had hypertension was being treated with valsartan. due to this drug's inability to treat her condition, she began taking a regimen of eprosartan, an angiotensin ii receptor antagonist. within three weeks, she began experiencing a metallic taste and a burning sensation in her mouth that ceased when she stopped taking the medication. when she began taking eprosartan on a second occasion, her dysgeusia returned. in a second case, a fifty-nine-year-old man was prescribed amlodipine in order to treat his hypertension. after eight years of taking the drug, he developed a loss of taste sensation and numbness in his tongue. when he ran out of his medication, he decided not to obtain a refill and stopped taking amlodipine. following this self-removal, he reported experiencing a return of his taste sensation. once he refilled his prescription and began taking amlodipine a second time, his taste disturbance reoccurred. these two cases suggest that there is an association between these drugs and taste disorders. this link is supported by the "de-challenge" and "re-challenge" that took place in both instances. it appears that drug-induced dysgeusia can be alleviated by reducing the drug's dose or by substituting a second drug from the same class. alpha lipoic acid alpha lipoic acid alpha lipoic acid (ala) is an antioxidant that is made naturally by human cells. it can also be administered in capsules or can be found in foods such as red meat, organ meats, and yeast. like other antioxidants, it functions by ridding the body of harmful free radicals that can cause damage to tissues and organs. it has an important role in the krebs cycle as a coenzyme leading to the production of antioxidants, intracellular glutathione, and nerve-growth factors. animal research has also uncovered the ability of ala to improve nerve conduction velocity. because flavors are perceived by differences in electric potential through specific nerves innervating the tongue, idiopathic dysgeusia may be a form of a neuropathy. ala has proven to be an effective treatment for burning mouth syndrome spurring studies in its potential to treat dysgeusia. in a study of forty-four patients diagnosed with the disorder, one half was treated with the drug for two months while the other half, the control group, was given a placebo for two months followed by a two-month treatment of ala. the results reported show that 91% of the group initially treated with ala reported an improvement in their condition compared to only 36% of the control group. after the control group was treated with ala, 72% reported an improvement. this study suggests that ala may be a potential treatment for patients and supports that full double blind randomized studies should be performed. managing dysgeusia in addition to the aforementioned treatments, there are also many management approaches that can alleviate the symptoms of dysgeusia. these include using non-metallic silverware, avoiding metallic or bitter tasting foods, increasing the consumption of foods high in protein, flavoring foods with spices and seasonings, serving foods cold in order to reduce any unpleasant taste or odor, frequently brushing one's teeth and utilizing mouthwash, or using sialogogues such as chewing sugar-free gum or sour-tasting drops that stimulate the productivity of saliva. when taste is impeded, the food experience can be improved through means other than taste, such as texture, aroma, temperature, and color. psychological impacts people with dysgeusia are also forced to manage the impact that the disorder has on their quality of life. an altered taste has effects on food choice and intake and can lead to weight loss, malnutrition, impaired immunity, and a decline in health. patients diagnosed with dysgeusia must use caution when adding sugar and salt to food and must be sure not to overcompensate for their lack of taste with excess amounts. since the elderly are often on multiple medications, they are at risk for taste disturbances increasing the chances of developing depression, loss of appetite, and extreme weight loss. this is cause for an evaluation and management of their dysgeusia. in patients undergoing chemotherapy, taste distortions can often be severe and make compliance with cancer treatment difficult. other problems that may arise include anorexia and behavioral changes that can be misinterpreted as psychiatric delusions regarding food. symptoms including paranoia, amnesia, cerebellar malfunction, and lethargy can also manifest when undergoing histidine treatment. future research every year, more than 200,000 individuals see their physicians concerning chemosensory problems, and many more taste disturbances are never reported. due to the large number of persons affected by taste disorders, basic and clinical research are receiving support at different institutions and chemosensory research centers across the country. these taste and smell clinics are focusing their research on better understanding the mechanisms involved in gustatory function and taste disorders such as dysgeusia. for example, the national institute on deafness and other communication disorders is looking into the mechanisms underlying the key receptors on taste cells and applying this knowledge to the future of medications and artificial food products. meanwhile, the taste and smell clinic at the university of connecticut health center is integrating behavioral, neurophysiological, and genetic studies involving stimulus concentrations and intensities in order to better understand taste function.