When I received my Ménière's diagnosis years ago, doctors introduced me to several basic treatments they said would be available to me during my journey with Ménière's —
Lifestyle Changes
Medication
Medical Devices
Physical Therapy (Vestibular Rehabilitation)
Counseling
Alternative Therapies
Hearing Aids
Surgery
As we saw in the last part of our series, these and other treatments are recommended by medical specialists in countries across the world.
I’d like to begin by looking at one of the easiest things each of us can do — change the way we live our life. By that, I mean changes in our ‘lifestyle’ in ways that may help us deal more effectively with our illness.
Lifestyle Changes
I like to say — “Change what you can, pray for what you can’t.” As I’ve moved through my Ménière's journey, I’ve found that making changes (sometimes ‘tweaks', sometimes major shifts) in the way I live my life have usually had a positive impact on me. I’ll share several with you during the next few newsletters and support them with information from the medical community.
Water
Let’s begin with drinking water (hydration). We’ve all heard that adults should drink 6-8 glasses of water a day. Some water glasses hold about 8-10 ounces, while others are 12 ounces or more. Many water bottles hold about 16-18 ounces of water. Some of the ones I have hold 20 or 28 ounces.
The U.S. National Academies of Sciences, Engineering, and Medicine recommends about 3.7 liters a day for men, and 2.7 liters a day for women.
“This report refers to total water, which includes the water contained in beverages and the moisture in foods, to avoid confusion with drinking water only … About 80 percent of people's total water comes from drinking water and beverages -- including caffeinated beverages -- and the other 20 percent is derived from food.”
The Cleveland Clinic recommends considering the National Academies’ numbers as a starting point —
“Your size, metabolism, location, diet, physical activity and health all factor into how much water you need,” says preventive medicine specialist Roxanne B. Sukol, MD.
Let’s do a little math to see what the National Academies recommendations mean for adults. 3.7 liters equals about 125 fluid ounces. 2.7 liters equals about 91 fluid ounces. You can divide those numbers by how many ounces your glass or water bottle holds. The glass I use at home holds about 12 ounces of water. After subtracting the 20% of water that comes from food, it’s about 8 12-ounce glasses a day for men and 6 12-ounce glasses a day for women. Thus the well-known recommendation of drinking 6-8 glasses of water a day would hold true in that case.
Here’s a recommendation from the Mayo Clinic —
You've probably heard the advice to drink eight glasses of water a day. That's easy to remember, and it's a reasonable goal.
Most healthy people can stay hydrated by drinking water and other fluids whenever they feel thirsty. For some people, fewer than eight glasses a day might be enough. But other people might need more.
Mayo went on to say that the amount of water a person should drink each day may also depend on things like exercise, environment, overall health, pregnancy, and breastfeeding.
Here are some thoughts from Harvard Health —
While the daily four-to-six cup rule is for generally healthy people, that amount differs based on how much water they take in from other beverages and food sources. Also, certain health conditions, medications, activity level, and ambient temperature influence total daily water intake.
For healthy individuals, the average daily water for men is about 15.5 cups and for women about 11.5 cups. That might mean you need only four to six cups of plain water, depending on other fluid sources such as coffee, tea, juice, fruits, and vegetables.
What About Ménière's Patients?
The National Library of Medicine recommends “abundant water intake” for people with Ménière's. Here’s the reasoning —
Naganuma et al [49] proposed time-series study with historical control regarding the water intake therapy for patients with MD that demonstrates that water intake therapy could improve and prevent hearing loss compared to other conventional therapies.
Hearing ability and relieved vertigo are improved in these patients by the increased drinking water and decrease of plasma ADH level.
A group leaded by Kitahara [50] confirmed that abundant water intake (35 mL/Kg/day as specified by Naganuma) can be a feasible treatment in Meniere’s disease.
A Japanese clinical trial done in the 1990s found that —
Deliberate modulation of the intake of water may be the simplest and most cost-effective medical treatment for patients with MD.
The control group that led to the above conclusion drank 35 mL/kg of water per day for two years. The other control group, at the same hospital, was treated with conventional dietary and diuretic therapy for more than two years. The number of Ménière's patients involved in the trial was small, so that’s important to note. You can read the details of the trial here.
I’ve read recommendations from many Ménière's groups that also encourage MD patients drink plenty of water each day. Some of the medical research I’ve seen recommends drinking water at about the same time period each day. Here are some recommendations from various sources —
Drink adequate amounts of fluid daily. Fluids can include water, milk, and low-sugar fruit juices but not coffee, caffeinated tea, alcohol, or soft drinks. If possible, extra fluids should be drunk before and during exercise and in hot weather. It is important to make sure that you drink at least 5 or more glasses of water over the course of the day. You should not have all your fluid intake a one time. Vestibular.org
Drink adequate amounts of fluid daily. This should include water and low-sugar fruit juices (for example cranberry). Try to anticipate fluid loss which will occur with exercise or heat, and replace these fluids before they are lost. University Hospitals Sussex
On the day itself try to keep to the same times for any medication you take and do not take any medication that you have not taken previously. Keep some water handy so that you do not become dehydrated, particularly on summer days. For a summer wedding, if you are in the main bridal party, arrange for water to be in the wedding cars, in the church vestry, and available on arriving at the hotel to save having to carry a water bottle. Coping with Vertigo on Special Occasions, Menieres.org.uk
** Let me add a note of caution here. It is possible to drink too much water in a day (known as water intoxication), so find what works well and safely for you. Ask your doctors for recommendations about how much water you should drink as a Ménière's sufferer. Your doctors know you and your health history, so they should be in a good position to guide you.
Diet
Next, let’s look at our diet (nutrition). That’s something else we can control. Some of the news areas I covered during my years as a journalist were health. I also worked for a natural health food company for 14 years after retiring from television news. We used to say that everyone is a laboratory of one — meaning that each person is unique and should be treated uniquely. What works well for one person may not work as well for you, and vice versa.
Some people living in Western countries eat too much food and/or too many "bad" foods. By that I mean foods that are bad in themselves or are prepared in ways that are bad for the human body (e.g. fried foods, over-salted foods, etc). Eat less of the foods that are bad for you, more of the foods that are good for you, and prepare them in healthy ways.
I’ve long been guided by something many know as the ‘Biblical Diet.’ It combines what we read in Genesis 1 & 2, Leviticus 11, and Daniel 1. Some people refer to them individually as —
The Genesis Diet (Herbs, Seeds, Vegetables, Fruits)
The Levitical Diet (Clean Meats)
The Daniel Diet (Vegetables and Water)
When you put the three diets together, you get a great balance of healthy foods (e.g. with macro and micro nutrients) that your body will appreciate. People who are vegetarians or vegans can still use portions of these diets to fulfill their body’s nutritional needs.
One key is eating plenty of “raw” food each day (e.g. raw vegetables, fruits, nuts, seeds, etc). Another key is eating food that is nutrient dense and calorically low. Some people refer to it as the CRON Diet (Caloric Restriction with Optimal Nutrition). I slowly changed my eating habits toward the CRON diet more than 20 years ago and found it impacted me in many positive ways. It’s worth a look.
While the Bible refers to using salt to ‘season’ and ‘preserve’ food, there’s no mention about how much salt a person should have every day. The American Heart Association and other health organizations report that Americans eat too much salt, which can lead to heart disease and failure.
Sodium is a mineral that we all need. It plays a role in the healthy function of nerves and muscles and helps keep your body’s fluid levels in proper balance.
But that fluid balance is delicate. “Too much sodium can cause fluid retention, which can increase blood pressure,” says Dr. Laffin. And high blood pressure is a major risk factor for heart attack, stroke and heart failure.
So keep tabs on your sodium, especially if you have high blood pressure or heart disease or are at risk of developing them. Cleveland Clinic
Salt can be a ‘trigger’ for some Ménière's patients, so it’s good to take control of how much salt you ingest each day if that affects you. Some doctors recommend a maximum of 1,200 - 1,500 mg of sodium per day, spreading that amount across the day (not eating it at one sitting). Other doctors recommend 2,000 mg of sodium per day as the maximum.
Here’s why the medical community makes this recommendation —
Cutting back on salt will help keep the inner ear fluid low and help prevent vertigo. For most patients, 2000 mg of sodium a day is the target value. When symptoms are severe, 1500 mg a day is advisable. A low-salt diet consists of: not adding salt to food, avoiding prepared foods, and tallying the sodium intake by reading food labels. Ménière's Disease Treatment NYC/Mt. Sinai
2,000 mg sodium limit can help alleviate symptoms, but some people need to limit their sodium intake to 1500 mg. If this limit does not help, please consult your doctor. Read nutrition labels. Know how much sodium is in your foods. Medical University of South Carolina
I also know some people with Ménière's who have no problem with the amount of salt they use in a day. Others use Himalayan Pink salt and report that works well for them. You can check with your doctors to see what they recommend for you.
Here are a some other recommendations about diet for Ménière's patients —
Distribute food and fluid intake evenly throughout the day and from day to day. This includes consuming approximately the same amount of food at each meal, not skipping meals, and eating snacks, if needed, at regular intervals. Evenly spacing food and fluid intake helps with inner-ear fluid stability; hypoglycemia (low blood sugar) can trigger migraine attacks. Having breakfast soon after rising can help stabilize your system for the day.
Avoid foods and beverages that have a high salt or sugar content. In general, a diet high in fresh fruits, vegetables, and whole grains and low in canned, processed frozen food, and other processed foods helps control salt and sugar intake. Be careful of drinking fruit juices as they may have a very high sugar content. Vestibular.org
Dietary modification includes a low sodium diet, a reduction in daily alcohol and caffeine intake, a gluten-free diet, and a new dietary approach to specially processed grains, all of which are first-line treatments. National Library of Science
Many dietary changes have been suggested to benefit patients with Ménière's disease. Salt restriction has been suggested to be of benefit for many years, with dietary intake of sodium usually recommended to be less than 2000 mg per day (Sharon 2015). A survey of UK‐based ENT surgeons found that restriction of salt was the second most common 'medical intervention' recommended to patients with Ménière's disease, after betahistine (Smith 2005). Restriction of caffeine and alcohol has also been said to benefit individuals with Ménière's disease, although there does not appear to be a consensus on the level of intake that is acceptable. National Library of Medicine
Eliminating caffeine, chocolate, alcohol, and salt may reduce the frequency and intensity of symptoms. Johns Hopkins Medicine
Menieres.org also has a good article about what NOT to eat here.
Herbs, Spices, and Vitamins
Some ENTs and Ménière's organizations recommend eating herbs and spices and taking vitamins as part of a patient’s nutrition. Depending on what medical or Ménière's group you contact, you may find various views on whether these really help us or not. I checked with several doctors I know and they said it couldn't hurt, and might even help.
Here are some of the herbs, spices, and vitamins I’ve found recommended (in no particular order). As a journalist I am only reporting what I’ve found doctors, herbalists, nutritionists, and others recommend. I cannot independently verify the efficacy of any of these recommendations for every Ménière's patient. I suggest you talk with your medical providers to see what they think about these and other food options. If I’ve left out something you’ve found helpful, please add it in the Comment section below —
Vitamin D3
Calcium
Alfalfa
Ginkgo Biloba
Vitamin B12
Vitamin C
Ginger
Wheatgrass
CoQ10
Echinacea
Ginseng
Lavender
Manganese
Lysine
Vitamin B3 (niacin)
Dandelion Tea
Vitamin B2 (riboflavin)
Lemon Riboflavin
Turmeric
Zinc
Peppermint Tea
Grape seed extract
Lipo Flavonoid
Vitamin B6
Glycerol
Feverfew
St. John’s Wart
Lecithin
The Traditional Chinese Medicine doctors I’ve seen through the years also recommended several herbal remedies (for example — Ban Xia Bai Zhu Tian Ma Tang). The TCM doctors either had the remedies available for sale in their office, made their own, or sent me to a Chinese pharmacist with a ‘prescription’ for the herbal combination. I’ll share more about TCM and Ménière's when we look at ‘alternative’ treatments in future articles.
We’ll look at other Lifestyle Changes in the next Managing Ménière's Disease newsletter.
“… rejoicing in hope, patient in tribulation, continuing steadfastly in prayer.” Romans 12:12
Here’s to hope!
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