Increase your awareness of dietary triggers

Some people find specific foods or ingredients trigger attacks of dizziness including those brought on by vestibular migraine and Ménière’s disease. Avoiding things you are sensitive to can often help improve symptoms. You may find it helpful to experiment with minimizing or eliminating your intake of the following ingredients:

• Sodium (salt)
  Our bodies need a small amount of salt to stay healthy, however most Canadians take in more than twice the amount needed. As well as helping lower blood pressure, there is some evidence that a lower sodium diet can help with Ménière’s disease and secondary endolymphatic hydrops (SEH).
  It may be even more important to maintain a consistent level of sodium intake. If your sodium intake is already low, for example, and one day you consume even less, your condition may act up.
  Heath Canada guidelines recommend consuming less than 1500 mg (just over 1/2 teaspoon) of sodium per day. This is called the adequate intake (AI). The recommended maximum daily sodium intake is 2300 mg (1 ½ teaspoons).
  It is usually easier to lower your sodium intake if you mainly eat whole foods and prepare your own meals.
  Watch for foods high in sodium. These include: canned or packaged soups, cereal, vegetables, and vegetable juices; convenience items such as seasoned pasta and rice mixes, stews, spaghetti sauce, seasoning mixes, frozen dinners, and muffins; foods preserved with salt such as pickles, relish, olives, and sauerkraut; sauces and seasonings such as ketchup, mustard, relish, soy sauce, teriyaki sauce, and salad dressing; deli meats, bacon, hot dogs, and sausages; processed cheese and cheese spreads; salty snack foods such as chips, pretzels, crackers, popcorn, trail mix, nuts, and energy bars.
  Pay close attention to product labels – remember to note the amount of sodium by serving size to decide how much of a given food might be suitable. A good guide to follow is 5% DV (daily value) or less in a serving is a little salt; 15% DV or more is a lot. Food products in Canada considered “sodium-free” must contain less than 5 mg of sodium per serving. A label of “less sodium” indicates 25% less sodium than the regular product.
  Although not a food, be aware that some antacids are high in sodium.
• Foods rich in tyramine
  Tyramine is an amino acid (building block of protein) that helps regulate blood pressure. Eating foods containing tyramine triggers vestibular migraine in some people.Aged and fermented foods are particularly high in tyramine. These include strong or aged cheeses; smoked, processed or cured meats and fish; Asian-style sauces such as soy sauce, fish sauce, miso, and teriyaki sauce; dried or overripe fruits; meat tenderizers; Marmite^® and brewer’s yeast; yogurt; sourdough bread; red wine; and some beers. Other sources include soybeans, snow peas, broad beans, and nuts.
• Foods containing nitrates and nitrites
  Some people may have higher levels of microbes in their guts that turn foods containing nitrates into nitric oxide by-products. These by-products may trigger vestibular migraine. Foods containing nitrites may have a similar effect. Foods rich in nitrates/nitrites include chocolate, wine, and cured meats.
• Caffeine and alcohol
  Some people with dizziness and balance problems find caffeine and alcohol trigger or worsen their symptoms. If you think they may be triggers, try avoiding caffeine and alcohol and see if your symptoms improve. While caffeinated beverages may have a mild diuretic effect (meaning you may need to pee more often), they do not appear to increase the risk of dehydration. Caffeine, however, can contribute to stress levels by more than doubling levels of cortisol (a stress hormone).
  Avoid caffeine if you are recovering from ​concussion.
  In addition to coffee, caffeine is found in tea, chocolate, yerba mate, and may be added to soft drinks flavoured with kola or guarana.
  Alcohol can have a negative impact on the inner ear by altering the volume and composition of its fluid.
• Gluten
  Autonomic neuropathy in 25% of people with celiac disease may lead to episodic vertigo (spinning sensation), fainting (syncope) and nausea. Research suggests a potential relationship between vestibular migraine and gluten sensitivity. There is limited evidence to suggest a gluten-free diet reduces imbalance in people with  Ménière’s disease.Gluten-containing foods and ingredients include barley, bulgar, couscous, durum, einkorn, emmer, faro, kamut, malt, rye, semolina, spelt, triticale, wheat, wheat bran, wheat germ, and wheat starch.Be aware that most commercially available oats contain small amounts of wheat or barley. Many prepared foods contain gluten – read labels carefully.
• Aspartame
  The artificial sweetener aspartame has an adverse effect on the inner ear in some individuals, causing symptoms including nausea, headache, vertigo (spinning sensation), tinnitus, and hearing loss. The symptoms are reversible when aspartame is no longer consumed. In Canada, aspartame is marketed under the brand names Equal^® and Nutrasweet^®.
• Monosodium glutamate (MSG)
  Some people have headaches and dizziness after eating food that has the flavour enhancer MSG added as an ingredient. It is used in many canned foods – read labels if you are sensitive. MSG is also stereotypically associated with food in Asian restaurants.

Vitamins and minerals – their affect on dizziness and imbalance

There is a connection between intake of some vitamins and minerals and increased dizziness and falls risk.

• Vitamin B6
  Vitamin B6 is a water-soluble vitamin that helps your body maintain proper blood sugar levels. A sudden drop can lead to dizzy spells. Deficiency is uncommon. Sources rich in vitamin B6 include: fortified cereals; fish; beef liver and other organ meats; potatoes and other starchy vegetables; and non-citrus fruit.
• Vitamin B12
  Over time, nerve cells can be damaged and poor balance may result if you do not get enough vitamin B12. Vitamin B12 deficiency affects about 20% of the elderly population. Those over 80 are particularly at risk.Vitamin B12 deficiency can be caused by insufficient production of intrinsic factor (IF), a protein produced in the stomach. Your body needs IF to absorb vitamin B12. A routine blood test will show if your B12 levels are low. Low B12 levels are sometimes corrected with an injection.Food sources rich in vitamin B12 include eggs, meat, poultry, shellfish, milk, and milk products.
• Calcium
  Calcium is important to ensure strong healthy bones. It also helps nerves and muscles work properly. ​Vitamin D​ helps you absorb calcium.The recommended daily intake of calcium varies by age and gender. Health Canada recommends 1000 mg/day for females 19-50 years and males 19-70 years, and 1200 mg/day for females over 50 and males over 70. If you find it hard to get the recommended amount of calcium through food, talk to your doctor. A supplement may be suggested.Foods high in calcium include milk, yogurt, cheese, calcium-enriched orange juice, rice beverages, and soy beverages.
• Vitamin D
  Vitamin D deficiency may lead to bone loss, impaired muscle function, and an increased risk of falls and fractures in older people. Additionally, vitamin D deficiency may be a risk factor for a seasonal form of BPPV.There is no conclusive evidence that vitamin D supplementation increases bone mineral density (BMD). Exercise regularly to keep your bones as strong as possible.On sunny days, plenty of vitamin D is synthesized through your skin. On cloudy days in Canada, particularly between October and March, you may need to take vitamin D supplements. The recommended intake of vitamin D for Canadians varies by province. Health Canada recommends a daily intake of 600 International Units (IU) for adults up to age 70 and 800 IU over 70. The Fraser Health Authority in British Columbia implemented the first protocol in Canada recommending that everyone who is 65 and older living in residential care get 20,000 IU of vitamin D per week (about 3000 IU per day).Foods high in vitamin D include salmon, tuna and eggs. Choose beverages with added vitamin D, such as milk, rice, and soy drinks.
• Potassium
  Most Canadians do not get enough potassium. Being deficient may contribute to low blood pressure and feelings of dizziness or faintness that can result in a fall. The recommended daily intake for Canadians is 4700 mg.Potassium-rich foods include fortified cereals, leafy green vegetables, white beans, avocados, potatoes, acorn squash, milk, mushrooms, bananas, and cooked tomatoes.
• Iron
  A diet deficient in iron-rich foods can lead to anemia. If you are anemic, you have a shortage of red blood cells resulting in an insufficient supply of oxygen to the body. One symptom of anemia is dizziness.Foods rich in iron include green leafy vegetables, meat, fish, poultry, beans, mushroom, nuts, and seeds.

Nutrient overdose (hypervitaminosis)

Our bodies strive for a delicate nutrient balance – just because something is good for you does not mean more is better. If you take mega-doses of supplements, it is possible to reach a toxic level of intake quite quickly. For example, one orange (about 0.7 gram of vitamin C) a day normally prevents scurvy. Taking 2 grams of vitamin C a day is not going to help you. And it is not true that a large dose of a water-soluble vitamin such as vitamin C will be simply eliminated in your pee problem-free. There is still some negative effect on the body.

• Vitamin A is a fat-soluble vitamin that is particularly toxic. Early polar explorers learned the hard way not to eat too much polar bear liver. It is so high in vitamin A that just a few ounces can be deadly. Be careful – too much vitamin A can cause dizziness and balance problems.

Follow a balanced diet

Although nutritional science suggests that it is impossible to identify a single best way to eat, all responsible global experts agree that a better diet leads to better health.

Increase nutrient density

Eat nutrient-dense fruits and vegetables, either raw or cooked. There is a wonderful synergy that increases the nutritional content of many of these foods when they are cooked. For example, the lycopene content in raw tomatoes is much lower than in cooked tomatoes. If you eat cooked tomatoes, perhaps in spaghetti sauce, the lycopene content increases exponentially.

Manage your intake of food and liquids

• drink water before you feel thirsty (pre-hydrate) or are physically active
• monitor the colour of your pee – usually a very pale yellow colour is a sign of good hydration

Our thirst response, however, declines as we age because the part of the brain that tells we are thirsty becomes less active. People over 65 are not as able to determine accurately their level of dehydration because of this decline.

Eat protein for healthy muscles

Protein is a key part of a balanced diet. It is very effective in preserving muscle mass. Good muscle mass keeps you strong and mobile. Research indicates that those over 40 years of age need more protein than previously recommended.

The Canadian recommended daily intake of protein is 0.8 grams per kilogram of body weight per day.

It is not difficult to get enough protein through regular food intake. It is best to balance your protein intake across all 3 meals. If you usually just have tea and toast in the morning, for example, try adding an egg, a piece of cheese, yogurt, or whey protein powder. Whey protein powder is a complete protein, breaks down very quickly, and is well absorbed by the body.

To minimize the adverse effects of too much animal protein, eat plant proteins such as brown rice, legumes, nuts, and lentils.

Keep an eye on carbs

Managing carbohydrate (sugar) intake can have a positive impact on managing balance and dizziness disorders. It helps to choose food that are nutrient-dense and naturally lower in carbohydrates such as beans, legumes, most vegetables and berries, as well as most nuts and seeds. Watch how many you are eating at one time.

The optimal amount of carbohydrates varies by individual as everyone has a unique response to carbohydrates. 30 grams would be very low and likely result in excellent blood sugar control. More moderate carb restriction of 70-90 grams of total carbs, or 20% of calories from carbs, is also effective. Most people need about 45 to 60 grams of carbohydrates per main meals and about 15 to 30 grams for each snack.

Canadian food labels do not distinguish between naturally occurring sugars from added sugars and syrups.

More resources

The following can offer more help and support for affected individuals and their families.

Online

Big Life Sodium Calculator
An online quiz to help you determine how much sodium you consume each day.

Canada’s Food Guide
The 2019 guide replaces the old rainbow with photos of real food. It is wider in scope, giving an overview of not just what Canadians should eat but also how we should eat. In addition, it offers an online suite of resources including actionable advice, videos and recipes.

Diabetes Canada: Diet & Nutrition
These resources can help you learn more about portion control, meal planning, fats and other facts about diet and nutrition.

Heart & Stroke: Healthy Eating
This section of the Heart & Stroke website includes a wide variety healthy eating information, tips and low-sodium recipes.

UnlockFood.ca - Find a Dietician
A guide to dietician services in Canada, including a list of provincial call centres where you can speak with a dietician at no cost and without a referral.

Books