The Meniere’s Disease Diet

With many health disorders, there is an associated diet.  With Meniere’s disease, the most common eating guideline is to lower your sodium intake.  I’ve spent a lot of time here talking about lowering your sodium. I’ve also touched on avoiding caffeine, alcohol, and tobacco–which is often also suggested by doctors.

In your quest to manage Meniere’s disease, there are other diet considerations.

  • Something often cited as a trigger to vertigo attacks with Meniere’s disease sufferers is allergies.  For this reason, it is a good idea to get tested for allergies to know if you are allergic to certain foods.  The Food Allergy and Anaphlaxis Network states that eight different foods account for 90% of all allergic reactions.  The eight foods are egg, milk, peanuts, fish, shellfish, tree nuts, soy and wheat.
  • Other things that have been cited as causing vertigo attacks among those with Meniere’s disease include sugar, chocolate, MSG, and aspirin products.
  • There was an article published in the August 2006 issue of The Laryngoscope titled Water May Cure Patients with Meniere’s Disease.  The study had 18 people with Meniere’s disease drink 35 mL/kg per day.  At the end of two years, they had lessened symptoms of vertigo and improved hearing.

One thing I have learned over the years is that you can be your own best doctor.  You are in charge of what works best for you.  As you ponder some of these concepts, you need to assess if avoiding some of the foods mentioned improve your health or if increasing your water intake lessens your Meniere’s symptoms.   These kind of things take time to determine.  Don’t be too hasty in your assessment.  This will take some time.  You will need to be objective over a long period. If your new food strategy reduces your attacks, it is reasonable to maintain that strategy.  However, an attack that occurs immediately after eating a specific food should not be attributed to that food unless, it occurs several times.

Bon appetit!

 

The Sodium Content of Foods

Most processed foods will be higher in sodium than their raw counterparts because of the role sodium plays in processing and preserving. In general, aside from fresh fruits and vegetables, the more “convenient” a food is to eat, the higher the sodium content. Frozen prepared meals are high in sodium. Fast foods are even more sodium-filled. It is a good idea to take note of any nutritional information available at places you often eat. You may be quite surprised at the eye-popping levels of sodium served up daily. Snack foods like potato chips, crackers, nuts, popcorn and pretzels lead the pack in sodium content.

Here are some examples of the sodium content of different foods:

 

Food portion Sodium (mg)
Apple juice 1 cup 7
Banana 1 banana 1
Egg Bagel 4” bagel 449
Canned beef stew 1 cup 947
Raw blueberries 1 cup 1
Lemon-lime soda 12 fluid oz. 40
catsup 1 Tablespoon 167
Cheddar chees 1 ounce 176
Hard-boiled egg 1 large 62
McDonald’s Quarterpounder w/cheese 1 burger 1190
honey 1 Tablespoon 1
Vanilla ice cream ½ cup 53
Lemon juice From 1 lemon 0
1% low-fat milk 1 cup 107
almonds 1 ounce 0
Raw onion 1 whole 3
papaya 1 cup 4
Dill pickle 1 pickle 833
Pizza Hut pepperoni pizza 1 slice medium pan 590
raisins 1 cup 16

For more information, click here for the sodium content of foods.

The average consumer can reduce his or her sodium consumption by 30 percent by doing a few simple things. You can stop salting your food. You can reduce the amount of salt used when cooking. When cooking in our house, we don’t include salt even if it’s calls for in recipes. We have not noticed a difference in taste or satisfaction. This includes our kids who are very picky eaters. Avoid high sodium foods. If you are crazy about pizza (which has a high sodium content) and cannot live without it, eat it less frequently and eat fewer slices. Eat pizza for dinner but plan ahead and go sodium free at breakfast and lunch that day.

Despite all attempts in our house to create a good tasting low sodium pizza, we have repeatedly failed. We have accepted the fact that pizza is a salty food and we try to eat less of it overall. You will find that when you do reduce the consumption of a favorite food, you appreciate it even more when the occasion comes to eat it.

 

Lowering Your Sodium Intake in the Kitchen

While preparing your own meals, keep the following items in mind to help keep your sodium levels low:

  • Instead of adding salt, season with vinegar or lemon juice for zest.
  • While you may start with a plate low in sodium, be careful of the condiments, sauces and dressings you add. Soy sauce is a big offender, weighing in at 1,500 milligrams of sodium per tablespoon. Innocent salad dressings can be exposed as not-so-innocent after a careful inspection of sodium levels.
  • Pure oils are typically low in sodium. Use olive oil or vegetable oil instead of butter or margarine when you can.
  • Salted butter has about 45 milligrams of sodium per tablespoon, while unsalted versions are closer to one or two milligrams.
  • Soft drinks can vary from a couple of milligrams to 100 milligrams of sodium per can.
  • Use frozen vegetables instead of canned vegetables.
  • Make your own condiments, dressings and sauces rather than using the high-sodium versions from the store.
  • Create your own season blends. Italian: basil, oregano, rosemary, sage, savory, and thyme or Barbeque: cumin, garlic, hot pepper, and oregano.
  • Use “Mrs. Dash” brand seasonings. They provide a variety of options, all without salt or MSG.
  • Season foods with herbs and spices instead of salt. On the foods in the table below, try the suggested seasonings in place of salt.

 

Food to season Seasonings
Eggs garlic, parsley, pepper, basil, dill, oregano
Fish basil, French tarragon, lemon, thyme, parsley, oregano
Poultry lovage, marjoram, sage
Salads basil, lovage, parsley, French tarragon
Vegetables basil, parsley, savory

 

In the rare case where you are given the amount of salt in a food item and you want to convert to the equivalent amount of sodium, just multiply by 0.4.

It is all very easy to determine sodium levels when you have a label on the side of what you are about to eat. What about foods without labels, like an apple or a 1/2 cup of cooked broccoli? What do you do then? The easiest thing to do is to consult the USDA web site for their table of sodium content in food.

Generally, if food comes in a can, bag or box, the sodium levels will be much higher than something you pick up from the produce aisle of your grocery store. Frozen and fresh fruit and fruit juices are low in sodium. Most of them have less than 16 milligrams per one cup serving. Fresh or frozen vegetables have around 35 milligrams of sodium or less. Grains are naturally very low in sodium.

 

Studying Food Labels (part 2)

The FDA has defined the following low salt terms:

 

term Definition
Unsalted no salt added
Without added salt no salt added
Sodium free less than 5 milligram per portion
Very low sodium less than 35 milligrams per portion
Low sodium Less than 140 milligrams per portion
These next two are defined relative to the manufacturer’s normal offering
Reduced sodium Contains 25% less sodium than the original food item
Light in sodium Contains 50% less sodium than the original food item

 

Although products may have “low sodium” labels, you still need to do your homework. Compute the amount of sodium per serving. Remember that manufacturers may not be as interested in your good health as they are in selling more product. Always do your due diligence.

In those rare cases where the labels do not show the amount of sodium per serving, you will need to study the list of ingredients. Ingredients are listed in the order of their weight. If salt is the second ingredient listed, it is the second heaviest ingredient in the product and you will likely want to avoid that food item.

You will also need to look for other sodium products on the label like baking soda (commonly known as sodium bicarbonate), brine, garlic salt, onion salt and sodium citrate.

Let’s take a look at this label from a can of Uncle Salty’s Lizard Gizzards:

 

INGREDIENTS: Lizard gizzards, vegetable oil, salt, onion salt, monosodium glutamate, sodium citrate, sodium caseinate, trisodium phosphate, sodium ascorbate, sodium stearoyl lactylate, artificial flavors, red 99, white 66, blue 33

 

 

While salt is the third ingredient, there are eight sodium ingredients making this product very high in sodium. You will need to remove this item from your diet.

As a last resort, if you cannot deduce the sodium amount from a label, you may need to write to the manufacturer directly. They are usually pretty good about sharing nutritional information. Some manufacturers will even publish this data on the internet. For example, McDonald’s and Pizza Hut make this information available on their respective websites.

 

Study Food Labels to Help Lower Your Sodium Intake

Study food labels to learn about the sodium content of the products you consume. If you judge sodium content based on taste alone, you will still be taking high amounts of sodium into your body. The most obvious high-salt foods to avoid include bacon and other cured meat products, canned soup, salted nuts, potato chips, lunch meats, etc.

Sodium also hides in certain foods you might not suspect. These include canned vegetables, tomato juice and tuna fish. Foods can have high sodium content but not taste very salty. Many sauces and seasonings are high in sodium. These include soy sauce, barbeque sauce, catsup, mustard, Worcestershire sauce, relishes and salad dressings. While ninety percent of our sodium intake comes by way of salt, there are other additives we need to watch out for. Baking additives such as baking powder, baking soda and monosodium glutamate (also known as MSG, it’s used by some restaurants and in many barbeque flavored potato chips and sauces) contain sodium. Sodium is naturally present in most foods, thereby making it almost impossible to eat a sodium-free diet.

What is the relationship between sodium and table salt? Table salt is sodium chloride, 40 percent sodium and 60 percent chloride. You will have two domains in which to track sodium: recipes and food labels. Since sodium is a component of salt and recipes call for salt, you will need to do a little conversion. Use the following table as a guide to convert from salt to the equivalent amounts of sodium.

 

Amount of Salt Amount of Sodium
¼ teaspoon 500 milligrams
½ teaspoon 1000 milligrams
¾ teaspoon 1500 milligrams
1 teaspoon 2000 milligrams

 

Most of the time, food labels will provide the sodium levels for that food. The catch is that the amount of sodium indicated on the label corresponds to a single “serving size” determined by the manufacturer. So if manufacturers do not want their bag of super salty nuts to appear too unhealthy, they may declare that the serving size is 14 grams (or 1/2 ounce). This is a fraction of a handful and would not really satiate anyone’s appetite for a snack. In fact, that amount would do little more than leave you wanting more. But the sodium level reported on the label may be more palatable for someone looking to keep their sodium level down. What an ultra-informed consumer needs to do is consider what thier actual serving size would be. It may be more or less than what the manufacturer prints as the suggested serving size. Then you need to calculate just how much sodium will be in your specific serving size.

This “serving size” tweaking can go the other direction, too. If a manufacturer would like their super sugary chewy fruit snacks to appear more nutritious than they really are, they could print a suggested serving size of 16 ounces in order to crank up the percentage of vitamin C contained in each serving.  Be aware of these tricks and determine your own serving size.

 

Applying the Low Sodium Diet

The 2010 Dietary guidelines for Americans recommends that we limit our daily sodium intake to 1500 mg sodium per day. This is a decrease from 2300 mg per day in the 2005 guidelines.

Adhering to a low-sodium diet is probably the first thing your doctor will suggest you do. Some Meniere’s patients have found the change effective and studies have proven that these diets help, so it is certainly worth a try. A low-sodium diet is one of the most challenging diets because most foods have sodium in them and almost all processed foods have high amounts of sodium. The easiest way to go “low sodium” is to slowly ramp down to the intake level your doctor has targeted for you. This may not be the way your doctor would like you to do it, but if you remove all salty items from your diet immediately and replace those items with their low-sodium equivalents, you will find that everything has suddenly lost its savory appeal. I know because that is what I did. After a few weeks, your taste buds acclimate to the lower sodium level and the flavor comes back to foods in a new way; when you taste foods with regular sodium content, they taste too salty.

It will take time to unlearn your salt preferences. Research shows that reductions in salt content at 10 percent a year are not noticeable to one’s taste buds. Going from a high sodium diet to below 1500 milligrams a day overnight can be very discouraging.

To help you reduce your sodium intake, here are some strategies for you saltshaker lovers:

  • Cover half your plate with a piece of paper. Salt the plate as you normally do. Remove the paper and see if the unsalted half really tastes that much worse than the salted half.
  • Take an empty plate and salt it as though it were a regular plate of food. Collect that salt and measure it. 1/8 of a teaspoon of salt contains 250 milligrams of sodium.
  • If you just cannot break the habit of shaking salt over your food before you eat, employ the help of a loved one. Over time and without your knowledge, this person can slowly cover the holes in the shaker with a piece of tape on the inside of the shaker lid. If they really love you, they will just cover all the holes on the first day.

The majority of sodium that typical Americans eat comes from restaurants and processed foods. If you eat out, avoid typical high sodium foods and do not add any additional salt from the saltshaker. Ask for salad dressings and sauces on the side so you control how much you consume.

 

Meniere’s and the Low Sodium Diet (part 2)

Low-sodium diets are often recommended by doctors to patients with Meniere’s disease. A  low-sodium diet was the first thing suggested to me during my first round with the disease. I was very diligent in consuming less than 1500 milligrams of sodium per day as my doctor suggested. The low-sodium diet did not seem to help alleviate any of the more serious symptoms of the disease, though I did notice that when I consumed a high-sodium food, the tinnitus in my ear increased. I could keep the ringing down by eating less sodium, but I could not eliminate the dizziness and vertigo. Still, the more I studied the benefits of a low-sodium diet, the more I was sold on its value. Although a low-sodium diet did little to help with Meniere’s disease during this first round.  I maintained that diet to improve my health in other areas.

The basic idea behind the low-sodium diet is that reducing sodium reduces the volume of endolymphatic fluid in the ear. This reduces endolymphatic hydrops and the symptoms associated with it. That hypothesis has not been fully proven, but the low-sodium diet does seem to help some Meniere’s disease sufferers.

High sodium intake leads to high blood pressure. High blood pressure is a major cause of stroke and heart disease. Since the 1970s, sodium consumption has increased greatly. The Center for Disease Control and Prevention has determined that the average sodium intake for Americans over the age of two is over 3400 milligrams per day. This is high, as I will show you a little later.

Lowering sodium intake is important even for those who do not have high blood pressure. The lower your blood pressure, the lower your risk for stroke and heart disease. That is the fact that really wins me over.  Everyone, not just those with Meniere’s disease, should commit to consuming lower amounts of sodium.

Meniere’s Disease and the Low Sodium Diet

When I was first diagnosed with Meniere’s disease, my doctor put me on a low sodium diet.  I was so motivated at that time to rid myself of the disease that I took the low sodium diet to new lows and ate almost a no sodium diet for several months.  When the Meniere’s symptoms did not disappear, I disappointingly wrote off the low sodium diet, convinced that it couldn’t help me.

What I did not realize at that time was that the stresses in my life were destroying my health at such a rate that the low sodium diet could not compete with such strong negative forces.  Since then, I have learned that the low sodium diet helps but may not always be able to stand on its own to help you manage your Meniere’s disease symptoms if you have much greater negative forces affecting your health.

In the next few weeks, I will be talking about a low sodium diet.  In the meantime,  check out the Daily Dish, which is run by Christy Ellingsworth who herself suffers from Meniere’s disease.  That site has plenty of low sodium recipes that take a departure from the typically bland low sodium recipe books you may have experienced.

 

Managing Meniere’s Disease: CATS and SPADE

When I was first diagnosed with Meniere’s disease, my doctor told me to avoid CATS.  This is common advice to Meniere’s sufferers.  CATS stands for caffeine, alcohol, tobacco, and stress.  I felt pretty good about this advice because I could monitor and eliminate the input of the first three things on the list and I incorrectly assumed that stress was not a problem in my life.  It wasn’t until a good doctor had a serious discussion with me about stress that I realized that I had a lot of stress in my life and that started me on my journey towards understanding how to manage my Meniere’s disease symptoms.   I feel that controlling your stress is important in handling any illness.  I have written plenty on that subject.

While reading the book, “Tinnitus, Turning the Volume Down,” I learned of another acronym.  That is SPADE and it stands for Stress, Panic disorder, Anxiety, Depression, and Emotional challenges.  In the book, Kevin Hogan the author, states that research into tinnitus suffering shows that the “ingredients” of SPADE tend to predispose people to tinnitus.

Since my initial diagnosis of Meniere’s disease, I have heard of CATS being defined another way: caffeine, alcohol, tobacco, and sodium.  I like this definition better especially when used together with the SPADE acronym defined above.  You can think of this definition of CATS as guidelines covering what to not take into your body and of SPADE as the emotional states to avoid.

Together, CATS and SPADE, provide simple yet sound guidelines in helping to manage your Meniere’s disease symptoms.