Dietary Causes of Vertigo (BPPV)
Benign paroxysmal positional vertigo, or BPPV for short, is a debilitating condition that causes severe room-spinning dizziness with changes of head position. If you’ve heard of ‘crystals being loose in the ear’, this is BPPV. It is usually called ‘idiopathic BPPV’, which simply means we don’t know the cause. Head trauma can cause it, but for many patients that deal with this, they haven’t had any trauma. Some recent research has proposed that there is likely a dietary component of this condition in the form of changes in carbohydrate metabolism.
First, a quick overview on the inner ear. You have 3 semicircular canals in your inner ear. They are full of two layers of fluids, the endolymph and perilymph. The endolymph contains more potassium ions, and the perilymph contains more sodium ions. This gradient differential creates a potential to conduct nerve impulses. One suggestion of a possible dietary cause is as simple as an electrolyte imbalance, particularly sodium, as it may interfere with the nerve impulse.
At the base of the semicircular canals, there is an organ called the utricle which has otoconia (the crystals) and hair cells attached to it. In BPPV, the otoconia degenerate and make their way into the canals, causing severe room-spinning dizziness. Degeneration has been linked to a number of causes, including vitamin D deficiency (Talaat et al. 2016).
There also has been studies that show a correlation between dysfunctions in carbohydrate metabolism and BPPV. It is well known that chronically high levels of insulin can affect the cardiovascular system and cause hypertension. The endolymphatic sac has a high level of insulin receptors (Bittar et al. 2004). So it would follow that any problems with insulin, such as diabetes, would have an effect on inner ear function. The research supports this idea and in a Brazilian study conducted in 2015 (Webster et al.), followed a group of 72 patients that had BPPV, and followed them for 4 years. They found that recurrence of BPPV with patients that had hyperinsulinemia to be 4.6 times greater than those without, and recurrence of patients with hyperglycemia to be 2.47 times greater than the general population. Also, hyperinsulinemia has been associated with endolymphatic hydrops (a different form of dizziness) and there have been studies that have suggested endolymphatic hydrops may cause BPPV (Tanimoto et al., 2008). So perhaps hyperinsulinemia may be a common underlying cause.
Lastly, pH levels also appear to have an influence on the crystals. An acidic diet can cause erosion of the crystals. During sleep, shallow breathing can cause respiratory acidosis, and low blood pH. It is common for BPPV to happen first thing in the morning. Additionally, diabetes and gout can decrease blood pH, leading to BPPV (Han & Kim., 2020).
Alas, more evidence that a high carbohydrate diet is probably not the best for everybody. The research is not conclusive, but there is a pretty strong signal.
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References:
(PDF) vestibular impairment secondary to Glucose Metabolic ... (n.d.). Retrieved September 15, 2021, from https://www.researchgate.net/publication/262483036_Vestibular_impairment_secondary_to_glucose_metabolic_disorders_reality_or_myth.
Han, D.-G., & Kim, D.-J. (2020). The evolutionary hypothesis of benign paroxysmal positional vertigo. Medical Hypotheses, 134, 109445. https://doi.org/10.1016/j.mehy.2019.109445
Talaat, H. S., Kabel, A.-M. H., Khaliel, L. H., Abuhadied, G., El-Naga, H. A., & Talaat, A. S. (2016). Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin d deficiency. Auris Nasus Larynx, 43(3), 237–241. https://doi.org/10.1016/j.anl.2015.08.009
Tanimoto H, Doi K, Nishikawa T, Nibu K. Risk factors for recurrence of benign paroxysmal positional vertigo. J Otolaryngol Head Neck Surg. 2008 Dec;37(6):832-5. PMID: 19128712.
Webster, G., Sens, P. M., Salmito, M. C., Cavalcante, J. D., dos Santos, P. R., da Silva, A. L., & de Souza, É. C. (2015). Hyperinsulinemia and HYPERGLYCEMIA: Risk factors for recurrence of benign paroxysmal positional vertigo. Brazilian Journal of Otorhinolaryngology, 81(4), 347–351. https://doi.org/10.1016/j.bjorl.2014.09.008