Dietary triggers of Ménière's (which aren't salt)

While the true causes of Ménière's are still unknown, research shows that triggers are many and can vary by individual. As a Nutritional Therapist with Ménière's myself, I feel it is my duty to give you the latest research in the hope that it can improve your symptoms, even just a little. 

It takes on average 17 years for the latest scientific knowledge to filter down into mainstream medicine. This glacial pace of adoption, combined with the fact that nutrition isn’t part of conventional medical training, means that your doctor may not be providing you with the latest advice. I’m not here to replace your doctor – just to try to plug that specialist knowledge gap.

MÉNIÈRE’S IS AN AUTOIMMUNE DISEASE

The latest research suggests that Ménière's is on the autoimmune spectrum, in which case a similar dietary approach would be beneficial. As with Ménière’s, the causes of autoimmunity are many and vary by individual. 

An autoimmune disease is where the body mounts an inflammatory attack against a foreign invader, usually a food, virus or toxin. Then the antibodies dispatched to destroy it also attack the harmless cells of the labyrinth (the inner ear) causing damage and increased fluid known as endolymph. Your immune system is attacking your nervous system. Autoimmune diseases are western diseases, meaning they stem from a western diet and lifestyle. Three foods commonly trigger this mechanism:- Sugar, Gluten, and Dairy.


1. SUGAR

Refined sugar is one of the most inflammatory foods we can eat. Eight times more addictive than cocaine, it sends your blood sugar flying up, only to come crashing back down again, like a kind of blood sugar rollercoaster. The hunger and shakiness which follow make us reach for yet more sugar, which sets the rollercoaster in motion again.

The International Tinnitus Journal believes that high blood sugar may be one of the main causes of Ménière’s Disease. In 2014 the American Journal of Otology & Neurotology found that hearing loss in Ménière's fluctuates with insulin levels (insulin is the hormone released when we consume too much sugar). The higher the insulin, the worse the hearing loss. In fact 94.2% of Ménière's sufferers had abnormal blood sugar results when tested. But once put on a ‘Low carb (this means low sugar, as all carbs are broken down into sugar by the body), high protein’ diet to stabilise blood sugar, 92% of patients achieved control of their vertigo.

You’ll know if you have problems with blood sugar as you’ll crave sweet or carby foods, have energy slumps after eating and may also have fat around your middle, as excess sugar is converted to tummy fat. If you develop Ménière's symptoms late morning, late afternoon or in the middle of the night, then a blood sugar crash may be the problem, as these are the times when blood sugar is at its lowest.


LAURA’S LOW SUGAR RECOMMENDATIONS

  • Gradually reduce refined sugar (chocolate, cakes, cereal etc) to an occasional treat.

  • Reduce refined carbohydrates (cereal, bread & pasta) to 1/4 of your plate. All carbohydrates are converted to sugar by the body. In fact a slice of wholemeal bread spikes blood sugar more than a snickers bar! 

  • Eat a palm sized portion of protein (meat, fish, nuts, seeds, yoghurt, pulses etc) at every meal or snack, as protein helps stabilize blood sugar. This is the reason a Snickers spikes blood sugar less than bread - it contains nuts.

  • Eat every 4 hours as going longer without food will cause you blood sugar to fall and could trigger an attack.


LOW SUGAR ALTERNATIVES

  • Switch to 70% dark chocolate. Place a small square under your tongue and let it melt to get a big chocolate hit without the bloody sugar rollercoaster. 

  • Switch your toast, or cereal to scrambled eggs or an omelette.

  • Keep a bag of almonds and an apple in your bag for a blood sugar friendly snack

  • Artificial Sweeteners also spike blood sugar.

2. GLUTEN

Gluten is the protein in wheat, barley and rye, commonly found in flour, bread, pasta and most processed foods. It is hard to digest so many people are sensitive to gluten. This sensitivity to gluten is believed to trigger inflammation which is the gateway to autoimmune diseases, including Ménière's. 


GLUTEN SENSITIVITY IN MÉNIÈRE’S


You are 6 times more likely to be sensitive to gluten if you have Ménière’s. Ménière's symptoms may indeed be the only symptoms that manifest. This means you may not have digestive issues which are commonly associated with gluten sensitivity, such as bloating, gas, constipation or diarrhea. Gluten sensitivity can also cause brain fog, fatigue, poor memory, joint pain, headaches and anxiety. 

In 2013 the American Journal of Otolaryngology proved that a gluten free diet can improve Ménière’s symptoms, with symptoms reappearing again with the reintroduction of gluten containing foods. Dr Datis Kharrazian, a Functional Medicine doctor has also seen that strategies to manage autoimmunity, such as removing gluten, benefit those with Menieres.

LAURA’S GLUTEN FREE RECOMMENDATIONS

  • Eliminate gluten from your diet for 3 weeks - This is the best way to see if gluten is an issue for you. Then reintroduce gluten and see how you feel. If you feel worse you’ll know that gluten is causing inflammation in your body and you should avoid it from now on.  

There are tests a nutritional therapist can do to see if your immune system is reacting to gluten, however an elimination diet is more reliable and far cheaper. I believe everyone with Ménière's should rule out gluten sensitivity before taking more drastic measures. 

NB: Gluten must be consumed for 6 weeks prior to a celiac test, so make sure to get tested for celiac before removing gluten for good.

GLUTEN FREE ALTERNATIVES

  • Look for healthy alternatives which are naturally gluten free such as brown rice, quinoa, gluten free oats, oat cakes, rice cakes, sweet potatoes, rice noodles, rice wraps, buckwheat bread, buckwheat pasta and buckwheat crackers. 

  • Try to avoid the gluten free aisle as these foods tend to be highly processed and full of sugar and other highly processed inflammatory nasties. 

  • For baking use almond flour,  coconut flour, buckwheat flour or chickpea flour.

  • Eat more veg - it’s anti-inflammatory! Aim to eat for 5 different coloured veg daily.

3. DAIRY

The protein in cow’s milk is eight times the size of protein in human breast milk, so many people find it hard to digest. In fact 75% of the population are dairy intolerant. As with gluten, this means dairy can lead to inflammation, autoimmune and inflammatory conditions such as Ménière’s.  In 2018 The American College of Nutrition found that Ménière’s symptoms were relieved with a milk free diet and reappeared with its reintroduction.

Other signs you may have a sensitivity to dairy are IBS, joint pain, headaches, migraine, acne, congestion, sinusitis, postnasal drip, ear infections, bloating and gas. Dairy containing foods (cheese, milk, yoghurt or ice cream) may also be your comfort food of choice, as the foods we are exposed too most often are the ones we tend to develop sensitivities too.

LAURA’S DAIRY FREE RECOMMENDATION

  • Eliminate dairy for 3 weeks, then reintroduce it noting any symptoms as described above. Both gluten and dairy can be removed at the same time, but make sure to reintroduce them at least 3 days apart so it’s obvious which food caused symptoms.


    DAIRY ALTERNATIVES

  • Switch cow’s milk to hemp, rice, almond or coconut milk.

  • Switch yoghurt or ice cream to coconut, cashew or GM free soy.

  • Instead of butter use olive oil, coconut oil or ghee for cooking (ghee is safe as the undigestible proteins have been removed.)

  • Eat plenty of greens such as brocolli and kale, as well as nuts and seeds. Calcium is far more abundant in these anti-inflammatory foods than in dairy, contrary to popular belief. 


START A FOOD DIARY

It would be far too much to expect anyone to remove all three foods at once. Life with Ménière’s is overwhelming enough!  Keeping a food and symptom diary can help you see which of these foods you’re eating most often and if any are triggering symptoms. Symptoms can take up to 3 days to appear so this is why a diary is invaluable. This will help you work out what to focus on first. You may need to do it for a few weeks to notice a pattern. For information or help on how to do this then do get in touch. 

CONCLUSION

Sugar, gluten and dairy are the most common foods to set up the inflammation which leads to Ménière’s disease in susceptible individuals. Foods we are sensitive too trigger inflammation, the gateway to autoimmune disease and Ménière’s. 

The science is clear: once inflammation is reduced by removing these foods, you can stop and eventually reverse the damage of most autoimmune diseases, if you catch them early before permanent damage has been done. Unfortunately, if you don’t tackle the root cause the unchecked inflammation may also lead to further autoimmune conditions. That’s why uncovering your own root cause is so important.

This article originally appeared in the September 2018 edition of Spin magazine

REFERENCES

The American Autoimmune Related Diseases Association: https://www.aarda.org/diseaseinfo/menieres-disease/

Bellioni-Businco et al. Allergenicity of Goats Milk in Children with Cow’s Milk Allergy. Journal of Allergy and Clinical immunology 103, no 6. (Jun 1999): 1191-94. 

Carroccio A et al. High Proportions of People with Non-Celiac Wheat sensitivity Have Autoimmune disease or Antinuclear Antibodies. American Journal of Gastroenterology 149, no 3 (Sep 2015): 596-603 

Carraccio A et al. Non-Celiac Wheat Sensitivity Diagnosed by Double Blind Placebo-Controlled Challenge: Exploring a New Clinical Entity. American Journal of Gastroenterology 107, no 12 (Dec 2012): 1898-906. 

D’Avila C, Lavinsky L. Glucose and Insulin Profiles and Their Correlation in Ménière’s Disease. International Tinnitus Journal. Vol 11, No 2, 170-176 (2005)

Di Berardino F, Cesarani A. Gluten Sensitivity in Ménière’s disease. The Laryngoscope. 2012 Vol 122, Issue 3.

Di Berardino F, Filipponi E, Alpini D, O’Bryan T, Soi D, Cesarani A. Ménière’s disease and gluten sensitivity: recovery after a gluten-free diet. American Journal of Otolaryngol. 2013 34(4):355-6

Di Berardino F., Zanetti D.  Delayed Immunomodulatory Effect of Cow Milk-Free Diet in Ménière's Disease. Journal of The American College of Nutrition. 2018 Feb;37(2):149-153. doi: 10.1080/07315724.2017.1364181. Epub 2017 Oct 31.

Feuerstein J. Reversal of premature ovarian failure in a patient with Sjögren syndrome using an elimination diet protocol. Journal of Alternative and Complementary Medicine.  2010 Jul;16(7):807-9. doi: 10.1089/acm. 2010.0022.

Finkel A, Yerry J, Mann J. Dietary Considerations in Migraine Management. Does a consistent diet improve migraine? Current Pain and Headache Reports 17. no 11 (Nov 2013): 373. doi:1007/s11916-0130373-4 

Gaby A. Integrative Approaches to Ménière’sMénière’s Disease. Vol 8, No 2 Integrative Medicine. Apr/May 2009. 
Gazquez I, Soto-Varela A, Aran I, Santos S, Batuecas A, Trinidad G, Perez-Garrigues H, Gonzalez-Oller C, Acosta L, Lopez-Escamez J. High Prevalence of Systemic Autoimmune Diseases in Patients with Ménière’sMénière’s Disease. PLoS One. 2011; 6(10) e26759

Hadjivassiliou M, Grünewald R, Kandler R, Chattopadhyay A, Jarratt J, Sanders D, Sharrack B, Wharton B, and Davies‐Jones G. Neuropathy associated with gluten sensitivity. Journal of Neurology, Neurosurgery & Psychiatry. 2006 Nov; 77(11): 1262–1266. 

Kharrazian D. Why Isnt My Brain Working? Elephant Press LP, USA. 2013 

Lavinsky J, Wolff M, Trasel A, Valerio M, Lavinsky L. Effect of hyperinsulinism on sensorineural hearing impairment in Ménière's disease: a cohort study. The American Journal of Otology & Neurotology. 2014 Jan;35(1):155-61. doi: 10.1097/MAO.0b013e3182976f5f. 

Riente L, Bongiorni F, Nacci A, Migliorini P, Segnini G, Delle Sedie A, Ursino F, Tommasi S, Fattori B. Antibodies to inner ear antigens in Ménière’sMénière’s disease. Clin Exp Immunol. 2004 Jan; 135(1):159-163.

Yoo TJ, Shea J Jr, Ge X et al. Presence of autoantibodies in the sera of Ménière’s disease. Ann Otol Rhinol Laryngol 2001; 110:425–9.

Ménière's and Vitamin D

Are you taking vitamin D to help your Ménière's? A recent study which came out last month by the 'Medical Hypothesis Journal' found that Vitamin D supplementation may help improve the symptoms of Ménière's.

This is because Vitamin D helps regulate the immune system, reduce inflammation and heal a leaky gut (the root cause of autoimmune conditions). 

The benefit of Vitamin D in autoimmune conditions has been widely researched, but this is the first study specifically looking at the benefit of Vitamin D in Ménière's.

Vitamin D is one of the most common deficiencies in the UK, due to our lack of sun and increased use of suncream. This deficiency is also believed to partly explain why autoimmune conditions (and I believe Ménière's symptoms too) are worse during the winter months for some.

What to take? 

I'd recommend the BetterYou DLux spray. This peppermint flavored spray is absorbed directly into your bloodstream. It comes in 3000 IU and 1000 IUs.
You can buy it in Holland and Barrett, Waitrose or Ocado. Spray it under your tongue or onto the inside of your cheek.

How much vitamin D should I take?

If you have never had your vitamin D levels checked I'd recommend taking 3000 IU per day. However people with Ménière's may need up to 4000 IU per day initially, but I'd only recommend taking this much if your vitamin D levels have been tested first. For a maintenance dose, I'd then recommend 2000 IU per day.
 

How to get tested?

Your GP will sometimes test vitamin D levels for free, BetterYou offer vitamin D tests here, or you can be tested by your Nutritional Therapist.

Sleep hygeine tips for Meniere's and autoimmunity

Getting enough sleep is crucial when you have Ménière's disease. The immune system only works properly when we sleep, so healing and regeneration of the inner ear won’t happen if we aren’t getting enough quality sleep. 

Sleep deprivation and the stress it puts on the body can trigger attacks and exacerbate symptoms. Poor sleep also increases our stress hormones, spikes blood sugar and increases inflammation (believed to be the root cause of Ménière's and autoimmunity).  

It comes as no surprise then, that sleep disorders are much more common in those with Ménière's (ref). Certainly in clinic, most clients I see struggle with sleeping well to some extent. If you have Ménière's, or another autoimmune condition you should aim for 8-9 hours of quality sleep a night. But you may need more initially if you are severely sleep deprived. 

Sleep hygiene is the first step towards recovery from Ménière's. Here are 5 ways to achieve it:-

5 sleep hygiene tips

1. Total darkness

Light and dark determine our circadian rhythm, the bodies internal body clock which tells us when to sleep. For this reason, our bodies are incredibly sensitive to light, particularly at night.

For total darkness try using a sleep mask or ideally fit blackout blinds or thick curtains. Use velcro if necessary to ensure blinds are fitted close to the wall.

2. No devices 90 minutes before bed

Looking at your phone, iPad or laptop before bed is the equivalent to looking at the sun. This is because the blue light they emit sends a message to the pineal gland in the brain telling it to stop making melatonin, the sleep hormone. 

Ideally, switch your device off 90 minutes before bed and leave it downstairs when you go to bed. Most smartphones now also have a ‘night shift’ function which allows you to shift the colour spectrum away from blue light towards warmer red tones which have less of an effect on melatonin. 

TV also emits blue light, but this is less damaging as we sit further away. Ideally turn the TV off 30 minutes before bed.

3. Caffeine before noon

Caffeine reduces the time we sleep, our quality of sleep and increases the time it takes to fall asleep. It can also cause us to wake up at night needing the toilet. Caffeine reduction is also beneficial in Ménière's as caffeine can affect the endolymph and increase stress and anxiety which can also trigger Ménière's attacks.  Ideally, keep caffeine to before noon.

4. Create a bedtime routine 

Adults are no different to children. Having a bedtime routine that you use most nights helps the body wind down naturally for sleep. For example:

  • Noon - Stop drinking caffeine 
  • 9.30 pm - Devices off
  • 10.30 pm - TV off and do something relaxing - stretching, meditation, bath or shower, read next to a dim light. 
  • 11 pm - Lights out - Try setting an alarm to remind you to go to bed

Going to bed and waking up at the same time each day also helps re-set our circadian rhythm. For this reason, if you need to catch up on sleep it’s far better to have a quick nap later in the day, rather than sleeping late in the morning.

5. Contain worries

It’s easy to find yourself worrying when you have Ménière's. Anxiety can also cause attacks and disrupt sleep so take steps to reduce worries before bed. 

For example, avoid the evening news or difficult conversations at night. Instead, a relaxing book, bath or shower, deep breathing or short meditation before bed can do the trick. Research shows practicing gratitude each night can help us feel less anxious, making sleep easier to come by. Simply write down 5 things that you are grateful for before going to bed each night. 

 

References:

Bruderer, Bodmer, Stohler, Jick,  Meier. Population-Based Study on the Epidemiology of Ménière's Disease. Audiology & Neurotology. 2017;22(2):74-82.

Kim, Jeon, Hong. Relationship between sleep quality and dizziness. 2018. PloS One2018 Mar 7;13(3):e0192705. 

Sharon, Trevino, Schubert, Carey. Treatment of Menière's Disease. Current Treatment options in neurology. 2015 Apr;17(4):341

Yeo, White, Ronan, Whinney, Curnow, Tyrrell. Stress and Unusual Events Exacerbate Symptoms in Menière's Disease: A Longitudinal Study. 2018

COULD DIET BE ONE OF THE CAUSES OF MÉNIÈRES?

This article was originally published in SPIN magazine, May 2018.

Four years ago, I began suffering frequent debilitating bouts of tinnitus, deafness and vertigo, and was eventually diagnosed with Ménière’s disease. As a Nutritional Therapist, I have been naturally drawn to researching the links between diet and Ménière’s. We all know that salt can be a trigger for Ménière’s, but I wanted to know what, if any, other dietary triggers existed.

Through this research, I have found that various types of food can play a significant role in the occurrence of Ménière’s symptoms. I have since made a number of dietary changes that have transformed my quality of life. For example, since excluding gluten from my diet, I’ve noticed that if I accidentally eat any, an attack follows within a few hours. Whilst the changes I’ve made are far from being a cure for Ménière’s, I can happily say that I’ve been largely symptom-free for over twelve months.

In the course of my investigation, the relationship between Ménière’s and gluten was among the most significant that I discovered. So, I’m excited to share my findings today, in the hope that I may help others with their own Ménière’s symptoms.

WHAT IS GLUTEN?

Gluten is a protein found in common grains such as wheat, barley and rye. These grains are contained in bread, pasta, cereal, cake and most processed foods. Wheat, in

particular, is a staple of the modern western diet. It is eaten in some form at almost every meal, making it the most consumed grain on the planet.

Given this ubiquity, it’s easy to imagine that we’ve been eating gluten forever. The reality is very different. In evolutionary terms, gluten is a very recent addition to the human diet. It was first introduced ten generations ago, when farming replaced hunter-gathering and humans progressed to a predominantly wheat-based diet. Whilst ten generations sounds a long time to us, it’s not long enough for the human digestive system to adapt to such a fundamental dietary shift.

Moreover, around fifty years ago all commercial wheat was genetically modified in order to increase yield. This had the unfortunate side-effect of making wheat even harder for our bodies to digest.

So what evidence is there that removing gluten from your diet could help with Ménière’s?

1. GLUTEN SENSITIVITY IS MORE COMMON IN PEOPLE WITH MÉNIÈRE’S

You are six times more likely to have a sensitivity to gluten if you have Ménière’s. In a 2012 study by US journal The Laryngoscope, 56.9% of the Ménière’s community had gluten sensitivity. Moreover, the same study found that many people with Ménière’s suffer from digestive symptoms that seem to correlate with episodes of vertigo.

Gluten sensitivity can also cause symptoms beyond the digestive system (only one in eight gluten-sensitive people suffer digestive issues). The inflammation gluten sensitivity causes throughout the body can lead to headaches, memory loss, joint pain, swelling, brain fog, ear infections, vertigo, tinnitus and hearing loss.

2. IF YOU HAVE MÉNIÈRE’S YOU ALMOST CERTAINLY HAVE LEAKY GUT

In a 2017 study by the American Journal of Otolaryngology, 100% of symptomatic Ménière’s sufferers had a leaky gut. Leaky gut is when holes appear between the cells of the gut wall, allowing undigested food, toxins and microbes into the body via the bloodstream.

Once in the bloodstream, the undigested gluten is seen as a foreign invader. This triggers an immune response, which over the long term may lead to Ménière’s in susceptible individuals.

3. MÉNIÈRE’S SYMPTOMS MAY BE CAUSED BY GLUTEN-BASED VITAMIN DEFICIENCIES

A study in 2010 found that leaky gut caused by gluten sensitivity can also hinder nutrient absorption, leading to multiple vitamin deficiencies which may exacerbate Ménière’s

symptoms. In particular, deficiencies in vitamin B12, B6 and vitamin D were found in gluten sensitive people. These deficiencies have been linked with anxiety, tinnitus, dizziness, nausea, and vertigo.

4. MÉNIÈRE’S IS LIKELY TO BE AN AUTOIMMUNE DISEASE

A growing weight of opinion believes that Ménière’s is actually a type of autoimmune disease. A systematic review in 2011 found that autoimmune diseases are far more prevalent in the Ménière’s population. Autoimmune-antibodies have also been discovered in Ménière’s sufferers, suggesting a role for autoimmunity in the development of Ménière’s Disease.

An autoimmune disease is where the body detects a foreign invader and the antibodies dispatched to destroy it also attack harmless tissues and organs by mistake. The American Journal of Gastroenterology has shown that gluten sensitivity, and its effect on the gut, is a primary cause of many autoimmune diseases.

5. LOSS OF BALANCE AND HEARING CAN BE TRIGGERED BY GLUTEN

Tinnitus, vertigo and hearing loss can also be triggered by gluten sensitivity. Gluten sensitivity has been shown to cause the body’s immune system to attack its own brain tissue.

In 2012, A Professor of Neurology at Sheffield Teaching Hospitals NHS Trust discovered that gluten antibodies can attack the cerebellum, the part of the brain responsible for balance, causing vertigo and nausea. Gluten antibodies can also attack the temporal lobe, the part of the brain responsible for hearing, causing tinnitus and hearing loss.

SUMMARY

Studies show that Ménière’s sufferers seem to be predisposed to gluten sensitivity. Gluten sensitivity can trigger the immune system to attack its own tissues, which in turn can trigger Ménière’s symptoms.

In my opinion, ruling out gluten sensitivity as a trigger for symptoms is a must for everyone with Ménière’s. Unfortunately, there is no reliable test for gluten sensitivity, so the best way to do this is to eliminate gluten from your diet for three weeks and then reintroduce it to see if symptoms return.

That said, we are all individuals, so Ménière’s triggers will vary from person to person. Therefore I strongly recommend you work with a health professional to develop a personalised plan before removing gluten from your diet, or making any other dietary changes.

Laura is a Registered Nutritional Therapist DipION MBANT CNHC and runs a nutritional therapy clinic focusing on Autoimmunity including Ménière’s. She offers complimentary support which works alongside conventional medicine. For more information or to contact her visit www.laurafishernutrition.com.

 

REFERENCES

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