A Cause of Dizziness - Meniere’s Disease

There are many causes of room-spinning dizziness, so it’s important to identify other symptoms to be able to correctly diagnose the cause. Meniere’s disease (you may hear it called endolymphatic hydrops) is characterized by room-spinning dizziness provoked with head position change and can last hours to days. It can also be accompanied with hearing loss, a sense of fullness in the ears, and ringing in the ears.

This is caused by an excessive amount of endolymph; the lymphatic fluid that flows through the inner ear. The exact cause is unknown, but it’s a condition of “too much”. The normal production or reabsorption of fluid has been altered. Some theories as to why this occurs are an abnormal immune response, viral infection, or a genetic predisposition. 

Another interesting finding is that there is a strong correlation between Meniere’s disease onset occurring with changes in carbohydrate consumption. After a meal, insulin is released to usher carbohydrates out of the bloodstream and into muscle cells and into the liver. Under normal circumstances, insulin has a dilating effect on blood vessels. However, with a diet that is chronically high in carbohydrates, one will develop insulin resistance. Now the cells stop responding to insulin and it has an opposite effect on the blood vessels; it constricts them. That is the association between diabetes mellitus (insulin resistance) and high blood pressure. Meniere’s disease is basically a high pressure system (I think of it like a traffic jam, too many cars, not enough highway). In 2005, D’Avila and Lavinsky found that in a sample of 64 patients with Meniere’s, 72% had hyperinsulinemia (when one is insulin resistant, the pancreas secretes more insulin - this is hyperinsulinemia). 

The current conservative recommendations is avoidance of salt, caffeine, and alcohol, and increased hydration in an attempt to restore normal pressure. However, there is not high levels of evidence as of yet demonstrating the effectiveness. If that doesn’t work, oftentimes medicines such as meclizine or diazepam are administered to dampen the symptoms. Some patients are given gentamicin, an antibiotic. This is a known ototoxic drug and can damage the hair cells of the inner ear. So you may be swapping an intermittent problem with an irreversible one. 

I hope to see randomized control trials looking at low carbohydrate diets as a way to address Meniere’s disease. There is plenty of case studies and anecdotal evidence for it, however we just don’t have the evidence as of yet. It would seem to make sense that treating the underlying issue of a high pressure problem would be superior to treating the symptoms. 

Regardless, many patients are left with some balance problems and sometimes a disturbance in the vestibular ocular reflex; the reflex that allows you to keep your gaze stable. These problems are both easily treatable with physical therapy. If this sounds like you, let’s get on a free call to see if we can determine the cause. 

Reference:

D'Avila, C., & Lavinsky, L. (2005). Glucose and insulin profiles and their correlations in Ménière's disease. https://pubmed.ncbi.nlm.nih.gov/16639918/.