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