Ending Vertigo Today

Vitamins, minerals, and vertigo

It has long been known that diet can affect some vertigo disorders. Vitamins and minerals can help in some conditions but may not do much in other dizziness disorders. This article will break down some of the key categories of dizziness and how they respond to dietary treatments.

BPPV (Benign paroxysmal positional vertigo) is the most common cause of vertigo and causes brief spells of vertigo brought on by arising from bed, rolling over, or lying down quickly. It is caused by calcium crystals that become displaced from the gravity sensors and enter the spinning sensors of the inner ear. While it is simply treated with maneuvers, it has a tendency to recur. There is good evidence that vitamin D supplements can help reduce recurrences if you are deficient in this vitamin. Vitamin D insufficiency is a frequent problem in people and worsens with age.

BPPV is more common in older women, and these women also often have osteoporosis, a loss of calcium in the bones, and this responds to vitamin D supplementation. This has raised the possibility that BPPV indicates a problem in calcium metabolism similar to osteoporosis. However, treatment of osteoporosis using estrogen, calcium, or medications to restore bone density has not yet been shown to have a major effect on BPPV.

Meniere’s disease is a damaging inner ear disorder that results in violent spells of vertigo lasting hours associated with ringing in the affected ear and hearing loss that gradually becomes permanent. Vitamin D supplements do not seem to be able to prevent these spells. No simple supplements have been shown to control this disorder, although it can respond to sodium restriction as noted in the previous post.

Vestibular neuritis is a viral infection of the balance nerve in one ear. It causes severe vertigo for several days, without hearing loss and can take weeks for recovery. Since it is an infection, it is not surprising that no simple vitamin or mineral supplement can prevent it or hasten recovery.

Migraine associated dizziness is a low-grade form of dizziness in people who also have frequent severe headaches, often on one side of the head. Taking magnesium supplements has been shown to help reduce the headaches and can help manage the dizziness.

Multisensory imbalance is responsible for the decline in balance with aging. It results from gradual declines in inner ear balance combined with visual impairments and loss of sensation in the legs and feet. Vitamins are often given for visual impairments such as macular degeneration, and B vitamins are important to maintain sensation in the limbs. Having a complete examination by a provider is important to guide decisions on supplements for these connected conditions.

In summary, then, you will benefit most from seeing a provider to look at your nutritional status, particularly vitamin D, and taking any supplements needed to help correct these deficiencies. If you have BPPV and are low in vitamin D, this will often help reduce your vertigo. There isn’t a magic supplement that can reliably control most vertigo disorders. If you have a concern about nutrition and your vertigo, a daily multivitamin may be enough to reduce the risk of deficiencies.

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).