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.
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.
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
Caulley L, Quimby A, Karsh J, Ahrari A, Tse D, Kontorinis G. Autoimmune arthritis in Ménière's disease: A systematic review of the literature. Seminars in Arthritis and Rheumitism. 2017 Nov 29. pii: S0049-0172(17)30691-1.
Daulatzai M. Non Celiac Gluten Sensitivity Triggers Gut Dysbiosis, Neuroinflammation, GutTBrain Axis Dysfunction. CNS & Neurological Disorders Drug Targets. 2015;14(1):110-31.
Di Berardino F, Cesarani A. Gluten Sensitivity in Meniere’s disease. The Laryngoscope. 2012 Vol 122, Issue 3.
Di Berardino F, Filipponi E, Alpini D, O’Bryan T, Soi D, Cesarani A. Ménière disease and gluten sensitivity: recovery after a gluten-free diet. American Journal of Otolaryngol. 2013 34(4):355-6
Di Berardino F, Zanetti D, Ciusani E, Caccia C, Leoni V, De Grazia U, Filipponi E, Elli L et al. Intestinal permeability and Meniere’s disease. American Journal of Otolaryngol. 2017 Dec 5
Fasano A. Physiological, pathological, and therapeutic implications of zonulin-mediated intestinal barrier modulation: living life on the edge of the wall. American Journal of Pathology. 2008;173(5):1243–1252.
Fattori B, Nacci A, Dardano A, Dallan I, Grosso M, Traino C, Mancini V, Ursino F, Monzani F. Possible association between thyroid autoimmunity and Menière's disease. Clinical and Experimental Immunology. 2008 Apr;152(1):28-32. doi:
Frasano A. Zonulin, regulation of tight junctions, and autoimmune diseases. Annals of the New York Academy of Sciences. 2012 Jul: 1258(1):25-33
Frejo L, Martin-Sanz R, Teggi R, Trinidad G, Soto-Varela A, Santos-Perez S et al. 2012 et al. Extended phenotype and clinical subgroups in unilateral Meniere’s disease: A cross-sectional study with cluster analysis. Clin Otolaryngol. 2017 Feb 6
Frejo L, Requena T, Okawa S, Gallego-Martinez A, Martinez-Bueno m et al. Regulation of Fn14 Receptor and NF-κB Underlies Inflammation in Meniere’s Disease. Front Immunology. 2017. 13 December 2017
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 Meniere’s Disease. PLoS One. 2011; 6(10) e26759
Greco A, Gallo A, Fusconi M, Marinelli C, Macri G, Vincentiis M. 2012. Meniere's disease might be an autoimmune condition? Autoimmunity Reviews. January 2012
Hollon J, Puppa E, Greenwald B, Goldberg B, Guerrerio A, Fasono A. Effect of gliadin on permeability of intestinal biopsy explants from celiac disease patients and patients with non-celiac gluten sensitivity. 2015 Nutrients
Hadjivassiliou M, Boscolo S, Davies-Jones G, Grunewalk R, Not T, Sanders D, Simpson J, Tongiorgi E, Williamson C, Woodroofe N. The humoral response in the gut pathogenesis of gluten ataxi. Neurologu. 2002 Apr 23;58(8):1221-6
Hadjivassiliou M, Sanders D, Grunewald R, Woodroofe N, Boscolo S, Aeschlimann D. Gluten sensitivity: from gut to brain. Lancet Neurology. 2010 Mar;9(3):318-30.
Hadjivassiliou M. Immune mediated acquired ataxia. Handb Clin Neurol. 2012; 103:189-99
Infantino M, Meacci F, Grossi V, Macchia D, Manfredi M. Anti-gliadin antibodies in non-celiac gluten sensitivity. Minerva Gastroenterologica e Dietologica. 2017 Mar;63(1):1-4.
Kim S, Kim J, Lee H, Gi M, Kim G, Choi J. Autoimmunity as a candidate for the etiopathogenesis of Meniere's disease: detection of autoimmune reactions and diagnostic biomarker candidate. PLoS One. 2014 Oct 17;9(10):e111039.
Leggio L, Cadoni G, D’Angelo C, Mirijello A, Scipione S, Ferrulli A, Agostini S, Paludetti G, Gasbarrini G, Addolorato G. Coeliac Disease and hearing loss: Preliminary data on a new possible association. Scandinavian Journal of Gastroenterology. 2007 Oct;42(10):1209-13.
Lerner A, Shoenfeld Y, Matthias T. Adverse effects of gluten ingestion and advantages of gluten withdrawal in nonceliac autoimmune disease. Nutrition Reviews. 2017 Dec 1;75(12):1046-1058.
Punder K, Priumboom L. The Dietary Intake of Wheat and other Cereal Grains and Their role in Inflammation. Nutrients 2013, 5, 771-787.
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 Meniere’s disease. Clin Exp Immunol. 2004 Jan; 135(1):159-163.
Saturni L. The gluten-free diet: safety and nutritional quality. Nutrients, 2010;2:16-34.
Solmaz F, Unal F, Apuhan T. Celiac disease and sensorineural hearing loss in children. Acta Otolaryngol. 2012 Feb; 132(2):146-51
Sun Y, Zhang D, Sun G, Ly Y, Li Y, Li X, Song Y, Li J, Fan Z, Wang H. RNA-sequencing study of peripheral blood mononuclear cells in sporadic Ménière's disease patients: possible contribution of immunologic dysfunction to the development of this disorder. Clinical and Experimental Immunology. 2017 Nov 22. doi: 10.1111/cei.13083.
Van Heel D., West J, Recent Advances in Coeliac Disease, Gut 2006;55:1037–1046
Visser J, Rozing J, Sapone A, Lammers K, Fasono A. Tight junctions, intestinal permeability, and autoimmunity: celiac disease and type 1 diabetes paradigms. Annals of the New York Academy of Sciences. 2009 May;1165:195-205.
Wu S, Hui J. Treat your bug right. Frontiers in Physiology. 2011;2, article 9
Yoo TJ, Shea J Jr, Ge X et al. Presence of autoantibodies in the sera of Meniere’s disease. Ann Otol Rhinol Laryngol 2001; 110:425–9.