Ending Vertigo Today

Foods, supplements and vertigo: Part 1

If you do an AI search on foods to embrace or avoid for vertigo, you will get a long list of suggestions. We are told to stay hydrated, avoid salt, take calcium, magnesium or vitamin D, and to avoid caffeine and alcohol, just for starters. Some lists have dozens of do’s and don’ts. Have people with vertigo been creating their own problem by eating the wrong foods or not taking the right supplements?

There are two problems with these kind of lists. First, vertigo encompasses many completely different disorders, but these lists lump all kinds of vertigo together. If you carefully avoid the “bad” foods for a disease you don’t have, you have wasted your time for no reason. Secondly, medical websites in general tend to give diet more importance than it actually has compared to other disease causes like genetic deficiencies, aging, or trauma. That’s because changing the diet is “easy”. Restricting the diet is seen as having minimal side effects and it gives people the feeling they are doing something for themselves. This may be just an illusion if the problem they are treating is not really responsive to these foods.

Let’s start with water and salt intake. Vertigo advice often includes increasing water and decreasing salt. Dehydration makes people dizzy, but this is not the vertigo-type dizziness with the room spinning. If you are dehydrated, you might feel faint or woozy if you stand up quickly or exercise, but the world does not usually spin. Often this will come on when you’ve been exercising in the heat and not drinking enough fluids. Heavy sweating makes it more likely.

The treatment for dehydration is to drink plenty of fluids. Plain water is fine if it’s just a hot day and you are not working out, but if heavy sweating is involved you will need to have some salts too (like sodium and potassium), so sports drinks, teas and fruit juices are more useful.

Unfortunately, young people take the advice to drink fluids for dizziness even when they aren’t dehydrated. They’ll carry around bottles of water and sip constantly. Drinking too much water that does not contain salt can cause headaches, faintness and dizziness also, called water intoxication. Most people can avoid being dehydrated by simply drinking something (not necessarily only water) when they feel thirsty. There is no benefit to forcing water intake.

Most vertigo advice also recommends avoiding salt, which of course conflicts directly with advice for dehydration, when salts are needed. Restricting salt has been used for many years to treat Meniere’s disease. This disorder causes progressive deafness, usually in just one ear, and ringing in the ear, with spectacular vertigo spells lasting hours with the room spinning. If you don’t have all these symptoms, cutting salt out of your diet has no benefit. Salt in the diet helps maintain normal blood pressure, but can cause high blood pressure if too much is taken, so being moderate in your intake is the best course.

In the next post we will deal with vitamins and minerals for vertigo.

Vertigo, headaches and palpitations

A reader writes in with a group of puzzling symptoms: After a lifetime of excellent balance, she experienced slight dizziness and instability that gradually worsened over a few weeks. There was also a low, deeply vibratory sound in the right ear. This was followed by severe vertigo for which weeks were spent in bed. She felt a constant internal spinning sensation even without any head movement, although she did not see the room spinning.

She also noticed pulsing vertigo in the right ear and increased sound sensitivity in that ear. Hearing felt “under water” and the ear felt full on and off. She could sometimes have brief vertigo when rolling over in bed.

She was diagnosed with a few different dizziness disorders including BPPV and Meniere’s disease. She was also diagnosed with migraine-associated dizziness since she had had migraines for many years. Then more new symptoms arose: irregular heartbeats and blood pressure spikes. A workup found an AV fistula on the right side of the brain inside the skull, although no connection was made with her Meniere problem.

This reader has the classic triad of Meniere’s disease with a low-pitched tinnitus, vertigo, and hearing loss in the right ear. Hearing tests usually remain normal at first except during flareups, but over time a permanent hearing loss will develop in the affected ear. Balance function also gradually declines over time, often immediately after a bad spell. BPPV (positional vertigo caused by rolling over in bed) often complicates the picture and this more minor symptom can be controlled with maneuvers.

Meniere’s has long been connected to endolymphatic hydrops, a dilation of the inner ear with build-up of fluid. In my articles I have shown that this condition by itself is not enough to cause the symptoms of Meniere’s disease . A second hit is needed. That second problem is vascular disease. The inner ear has a sensitive system to keep blood flowing smoothly called autoregulation, and this is lost in people who have hydrops. This means that any additional fluctuations in blood flow near the ear can result in sluggish perfusion of the inner ear itself. Low perfusion can shut off or impair hearing and balance in the ear during spells and eventually destroys the ear.

The most common vascular disease in Meniere patients is sleep apnea. This causes snoring or gasping during sleep, frequent awakenings, elevated blood pressure and palpitations. Migraines are also associated with sleep apnea. Migraine itself is known to cause vasospasm—constrictions in blood vessels that can slow blood flow. Because sleep apnea is so prevalent in Meniere’s patients, every person with this disorder should have a formal sleep study. If sleep apnea is the main vascular problem, using a CPAP machine can greatly slow the progression of the disease.

There is another potential problem here, an AV (arteriovenous) fistula. Normally arteries and veins are separated by a capillary bed, where cells receive oxygen and nutrients before passing on the depleted blood to veins. Arteries have high pressure blood flow, while veins are low pressure, allowing the blood for easily flow “downhill” from a pressure standpoint. A fistula exposes the veins to pressure that is too high and slows blood flow. These can cause headaches and pulsing tinnitus, just as she describes.

If a fistula is located in the skull near an inner ear, the pressure that is too high in the veins can lead to back pressure in the ear itself. If there is also hydrops in the ear, the loss of autoregulation combined with back pressure is enough to cause Meniere’s disease. We don’t have information about where the fistula is in this case. If the fistula is near the ear it may increase the blood flow problem in the ear. These leaks can be blocked by embolization, a type of surgery that is done from inside the vessels. Some fistulas can also be resolved from outside the head by a focused beam of radiation (radiosurgery).

Rocking vertigo and PMDD

A reader writes: I have a general sensation that I am on a boat. It is the worst in the morning and I am finding that I have difficulty walking straight and really have to concentrate on keeping my balance during the first hour of the day.

Rocking vertigo is a feeling of continuous up-and-down, boat-like rocking. Usually this sensation is inside your head and there is no visual appearance of motion. It can occur spontaneously or can arise immediately after travel in a boat or airplane.

Most people with this sensation have experienced migraine headaches or auras in the past, suggesting that it may be a form of migraine-associated vestibulopathy. Usually vestibular testing is normal, although some people show a low-grade positional nystagmus. The disorder does not worsen over time, causes no permanent damage to the ears, and tends to spontaneously disappear.

It is common to experience a rocking sensation for a few hours after returning to land from a boat trip. This sensation tends to increase when lying down with the eyes closed and can cause nausea similar to seasickness. A French term, Mal De Debarquement, is often used to refer to this normal sensation.

In some people the symptom can drag on for weeks, months or even years after travel, and is relieved by going back on a boat. This has been named Persistent Mal De Debarquement, or PMDD. It is also sometimes called Disembarkation Syndrome. The cause of this disorder is not known. The vestibular system is able to adapt to the rocking motion of the boat, part of the process that reduces motion sickness as one acquires “sea legs” on a voyage. PMDD likely results from a difficulty in shutting off this adaptation when returning to land. This sensation can also occur after turbulent airplane flights or other long-term exposure to rhythmic motion.

Part of this syndrome is is that you may become permanently programmed to the rocking feeling. This programming can be helpful in some ways; if you travel by boat often, you will adapt more quickly to the motion than most people do. Even after your symptoms resolve you might go into a room that triggers the memory months later, causing the rocking to instantly reappear.

There is a connection between OCD (obsessive compulsive disorder) and rocking vertigo. Once the rocking subsides, it is best to stop checking in your head for little signs of the feeling. It is better to distract yourself with other movement and not to pay close attention to it. Treatment with Paroxetine, a medication that affects serotonin in the brain, is one of the more effective drugs for this condition. Typically a remission develops gradually, with a day free of symptoms followed by a recurrence of the rocking, with more and more normal days over the next few weeks until the condition disappears. Activities that involve a great deal of head motion are also helpful, but rhythmic vertical movement should be avoided (tennis is a better choice, for example, than jogging). Vestibular rehabilitation is often useful when combined with medication. Since the rocking feeling is a vertical motion, you can counteract this by rotating your head side to side in the same rhythm as the rocking you feel. This helps override the programming.