As a Nutritional Therapist with Ménière’s I use food and lifestyle to manage my own and my clients’ symptoms. I am constantly asked about the low sodium diet guidelines. I can see how a low sodium diet can be helpful for people when first diagnosed, but clients often come to me as they are frustrated with the restrictive nature of this approach.
Standard guidelines for Ménière’s management are to keep sodium levels between 1500 and 2000mg of sodium per day. This is about half what the average person consumes. It is widely believed that salt restriction works by reducing fluid balance, thus stabilizing the endolymph in the inner ear, as an increase in endolymph is believed to be the main cause of Ménière’s. However, the latest research suggests that this is only half the story.
I believe this approach can work in the short term, but anecdotally some clients find sodium restriction stressful and restrictive in the long run. Much like calorie counting, counting sodium can take over your life. It can stop you enjoying food. It can make eating out stressful at best, or impossible at worst, and can make following recipes difficult. One of my core beliefs is that food should be enjoyable and not stressful. As stress is also considered a major trigger for Ménière’s and its reduction essential for the management of the condition, any guidelines which add to stress levels are not helpful.
Focusing purely on low sodium foods can also mean we restrict healthy foods and instead turn to unhealthy processed foods marketed as ‘low sodium’ options. Processed foods also come with an ingredients list that includes sodium content, which makes them an attractive option if you’re counting sodium. I see many clients scared to eat natural, nutritious, anti-inflammatory foods like fish or olives who instead turn to ‘low sodium’ potato chips, deli meat, cheese, instant mash or french fries, thinking they are better for them. This approach can lead to people avoiding anti-inflammatory foods which could help manage symptoms better and replacing them with foods that are inflammatory, devoid of nutrition and that could actually worsen their condition.
The latest research shows that Ménière’s Disease is actually an immune mediated condition. All immune mediated conditions, including Ménière’s, are driven by the same underlying factor: inflammation. This inflammation can lead to changes in the endolymph and eventually damage to the ear in people susceptible to Ménière’s. This means that thousands of studies linking inflammatory foods with autoimmune conditions can now be applied to Ménière’s too. Salt in itself has been found to be inflammatory, but inflammation can be caused by many other foods, infections and lifestyle factors. To successfully manage the condition it is important that we remove the underlying trigger of the inflammation causing the condition. It is clear that salt removal alone does not do this.
The Western diet is now believed to be inflammatory, high in processed and prepackaged food, and devoid of nutritious fibre, healthy fats and nutrients. These have been replaced with cheap sugar, salt, and artificial ingredients. As the Western diet is adopted in more and more countries, a rise in immune mediated diseases follow. This is why immune meditated conditions and Ménière’s are now considered to be Western diseases. If you don’t eat a Western diet, you’re a lot less likely to get an immune mediated condition.
Manufacturers add salt because it is a cheap way to make food taste good and to make us eat more and therefore buy more. Not surprisingly, processed food accounts for 75% of sodium intake in the Western diet. So what’s the solution?
A WHOLE FOODS APPROACH
A whole foods diet is naturally low in salt, and also naturally anti-inflammatory. But what exactly is a whole food? A whole food is a single ingredient, so no ingredients list is required. For example, plant based foods such as broccoli, almonds and oats, or animal based foods like salmon, eggs and chicken, are all whole foods. They have not been manufactured in a factory which means they are unprocessed and free of additives, artificial ingredients, sugar, gluten and of course salt.
I believe focusing on eating whole foods is a far more positive approach than focusing on salt restriction. It is much more positive to focus on what you can eat rather than what you can’t – it puts the focus on health rather than on disease. As a real world approach, it is much less stressful and easier to stick to. For example, in a restaurant it’s much easier to order a meal of fish and vegetables, or a chicken salad than to estimate the sodium content of every dish on the menu.
Eating an unprocessed diet is nutritionally better for us for many reasons. Not only is it higher in nutrients, fibre, protein, and healthy fats but an unprocessed diet cuts all manner of Ménière’s triggers - MSG, gluten, sugar, dairy, salt - in one fell swoop.
Unprocessed foods are also the richest sources of potassium, the nutrient that balances out sodium in the body. So eating an unprocessed diet gives the body the ratio of nutrients it needs naturally. More importantly, an anti-inflammatory diet can help reduce some of the inflammation triggering Ménière’s much more effectively than focusing on low salt alone.
A whole foods diet also re-educates your taste buds – so fruit tastes sweet, and the tiniest amount of salt tastes salty. This makes it increasingly easy to stick to as your taste buds change and you begin to crave natural foods over processed foods, which increasingly taste manufactured and unnatural.
For context, the average person consumes 3500mg of sodium per day. Significantly, processed food accounts for approximately 75% of our sodium intake. It therefore follows that if you eliminated processed food from your diet completely you would instantly knock 2625mg off your daily sodium intake, reducing it to 875mg per day – way below the aforementioned 1500-2000mg guidelines for Ménière’s.
Obviously eliminating all processed food from your diet is a drastic step, and as we’ve shown would actually be overkill in terms of meeting the Ménière’s Guidelines for sodium. It’s possible to meet these guidelines with smaller and more achievable methods. Aiming to eat whole foods 80% of the time and keeping processed food for an occasional treat should get your sodium levels down to the safe range. If you cut out most of the processed food in your diet, you get to stop counting salt – so you may still even be able to get the salt mill out occasionally!
If your existing approach of counting salt is working for you then please don't change it. But if you find it stressful and restrictive then try following the following recommendations:
Cook from scratch with whole foods 80% of the time, so you can remove the stress of obsessively counting sodium
Continue to avoid very salty foods such as salted nuts, crisps and bacon
Make processed food an occasional treat
Focus on quality foods without ingredients lists (and therefore salt)
Avoid foods with ‘low sodium’ claims. They’re likely to be highly processed and inflammatory.
Once symptoms reduce you may need to occasionally add a little salt to food. In which case use a mineral rich unrefined pink himalayan salt.
Ensure you drink adequate water as dehydration can also affect fluid balance. Aim for 0.033 liters of filtered water per kg of body weight per day.
Following an anti-inflammatory diet will naturally reduce salt, without the hassle of counting sodium.
Reducing salt can help manage the symptoms of Ménière’s for some people. However I believe that salt reduction is one small part of a much bigger picture. I feel that the guidance is too narrow and could be reframed in a more positive and beneficial way. Also, the guidelines have been in place since 1931 and don’t take the latest research on Ménière’s into consideration.
Counting sodium levels can be stressful for people in their daily lives, and as stress is a major factor in Ménière’s this is not helpful. Not only that, but a focus purely on low salt can actually push us towards eating inflammatory foods which while being marketed as ‘low sodium’ may actually worsen our condition. In choosing processed, inflammatory foods, you’re by default neglecting to eat anti-inflammatory foods which could in fact help manage the condition far better.
I believe a focus on whole foods, as opposed to salt restriction is a more positive, relaxed and pleasurable approach, putting the emphasis back on health rather than disease and on what we can eat, rather than what we can’t. Whole foods reduce salt in a natural and healthy way, improve nutrition and reduce inflammation immeasurably. A whole foods diet is increasingly easy to stick to, both when eating out and cooking at home. A low salt diet alone will not significantly solve the root cause of Ménière’s, that being reduction of the inflammation that’s driving the increase in endolymph in the ear. Whereas eating an anti-inflammatory diet can help manage the symptoms and potentially even the root cause of Ménière’s over the long term.
To remove the need to obsessively count your salt intake, you simply need to cook from scratch 80% of the time. This means using ingredients without ingredients lists as much as possible, and focusing on quality not quantity. Cooking from scratch doesn’t need to take long either, despite what food companies would have us believe. It takes seconds to scramble an egg or make a stir fry, and minutes to cook a piece of salmon or chicken. Keep processed foods for special occasions and when you do choose some try to avoid products that contain ingredients that are unfamiliar, unpronounceable or are five or more in number. Remember that a processed diet is inflammatory, whereas a natural whole foods diet is anti-inflammatory.
Only once symptoms have reduced permanently can a small amount of high quality salt be occasionally added to your food. The key is to listen to your body.
When I was experiencing Ménière’s symptoms, there was something I called the ‘danger zone’. This was when my tinnitus was constant and at its loudest and I was generally feeling dreadful and exhausted. I knew that feeling like this meant it was not the moment to take any risks with my diet. But now that I haven’t experienced symptoms for a long time, I know that I’m out of the danger zone, and can allow myself to add the odd bit of salt to my food from time to time. For you, being out of the danger zone could mean that your tinnitus is low or barely perceptible and you feel energetic and positive again.
Unfortunately there is no one trigger for Meniere’s. Diet is one of several factors which can increase inflammation. Diet, infections, medications, lifestyle and genetic factors can all play their part. We are all individuals after all, and Meniere’s is complex so each person will have a different mix of triggers. This is why diet is not a cure, but can be a safe approach to try to see if it works for you too.
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