Did you know that having a deviated septum can lead to weight gain? No? Well it can! If you are asking yourself what a deviated septum is, let me explain it to you. The septum is a cartilaginous divider between the right and left halves of the nose. When the septum is straight, it provides laminar, or smooth, airflow equally to the nasal passageways and sinuses. When there is a bend or distortion of the normally straight septum, then airflow becomes turbulent, leading to all kinds of problems. The picture below shows a young man who has a significant septal deviation before and after correction.
Deviated septum can be caused by many things. Some people born with significant facial asymmetries tend to have deviated septa. Also, deviated septa can be caused by nasal and mid-facial trauma. In fact, after any nasal or mid-facial trauma, it is important to evaluate the nasal septum to confirm that it is intact. A missed hematoma (blood clot) of the septum can lead to septal perforation (hole in the septum) and weakening of the septal integrity and nasal collapse.
So, what is the mechanism of action by which a deviated septum causes weight gain? Well, it is multi-factorial. The first thing that a patient with a deviated septum notices, while awake, is difficulty breathing through the nose, especially when trying to exercise, making cardio more difficult to perform without mouth breathing. With advanced deviation, they may feel this restricted nasal breathing at rest. With reduced airflow comes reduced exercise capacity. This can lead to weight gain.
As intranasal airflow stays turbulent, specialized structures known as the turbinates are affected causing them to enlarge. This further blocks airflow, especially on the more open side of the nose. This is known as compensatory hypertrophy. The reason this occurs is that feedback loops inside the nose and sinuses are trying to compensate for asymmetric airflow, drying, and particulate matter exposure. In the end, the nose is trying to re-equalize airflow.
Another thing that most patients with deviated septa experience is snoring when asleep. The mechanism for this has to do with the fact that turbulent nasal airflow due to a bent septum forces people to breath with their mouths open when asleep. While asleep the tongue relaxes and falls to the back of the throat vibrating off the soft palate, making the distinctive snoring noise.
As this combination of effects adds up, excess fat that is gained is partially gained around the airway, narrowing it a bit and making the effect of a relaxed tongue with sleep more powerful. Eventually snoring leads to disordered sleep for the patient and often for their bed partners. In advanced cases, patients can develop sleep apnea which is a potentially life threatening obstructive breathing problem.
It is well-known that folks that have trouble sleeping develop certain types of hormone imbalances in substances like insulin, ghrelin, and leptin. This can lead to increased hunger, especially for carbohydrates, and disordered insulin function. High carbohydrate diets have been associated with significant weight gain. Another hormone that increases with poor sleep is cortisol. Cortisol is a stress hormone that in excessive amounts further deranges insulin function and carbohydrate metabolism, causing further weight gain. This cycle continues causing further sleep disturbances, weight gain, and more snoring. If you aren’t already convinced that getting good sleep is of the utmost importance, check out this article on the long-term effects of sleep deprivation.
The diagram below shows the basic cycle of problems caused by septal deviation:
If you happen to have a deviated septum and suffer from weight gain, you may want to consider being seen by a nasal surgery specialist for an evaluation. It may even help to get a sleep study to see how advanced your sleep deprivation is and to determine if you have sleep apnea. While a septoplasty procedure can help correct septal airway deformities, a diagnosis of sleep apnea requires a multi-pronged approach for management. Dr. Manish Shah is a Denver, Colorado area nasal surgery and rhinoplasty specialist who has a greater than 98% breathing reconstruction success rate. In fact, Dr. Shah had a septoplasty procedure as a teenager, and is currently the father of 3 high school students, so he intimately understands the importance of getting a good night’s sleep.