Eating in the Zone: My new Menieres Diet

I’ve gotten a lot of requests for more information since Twittering about the new diet my vestibular specialist has put me on, so I thought I’d try to summarize it here for everyone who is interested.

My particular vestibular disorder, Menieres Disease (aka endolymphatic hydrops) is caused by excess fluid in the inner ear’s hearing and balance structures. Normally these structures are independent of the body’s fluid system, but in Menieres Disease the independent fluid control is lost, causing fluctuating fluid volumes and concentrations in the inner ear, which in turn causes pressure, tinnitus, dizziness/imbalance, and loss of hearing.

For years, people with Menieres have been told to go on low sodium diets. Increased sodium means increased fluid retention, as we all learned in high school biology. But in nursing school physiology I learned that the body regulates sodium balance in the kidneys, so I knew that although eating too much salt would definitely cause increased volumes, eating less salt would, at least to some extent, just mean my body would excrete less of it in order to keep things balanced. Nevertheless, once I had cut back on sodium, I could cause instant symptoms of dizziness and vertigo just by eating something that was too salty, so I could definitely tell it had an effect. As a result, I have spent the last 10 years or so carefully avoiding foods I knew have more sodium than I can tolerate.

Last month, I started seeing a new vestibular specialist. My symptoms have been pretty well controlled, but my previous specialist retired about 3 years ago, and I figured it was probably about time to have a checkup. My new doctor explained to me that the fluid volumes in my inner ear are governed by the overall chemical / hormonal / electrolyte balance of the body fluids as a whole. The driving factor behind that overall balance is not sodium, but insulin.

The key to symptom management, as well as minimizing the permanent damage being done to the inner ear and even trying to restore some function, is managing the level of insulin in the blood and trying to keep it as steady as possible. The more consistent my insulin levels are, the less fluctuation there will be in the fluid volumes in my inner ears.

The diet he wants me to follow (and this is the sobering part: FOR THE REST OF MY LIFE!) is based on the Zone Diet. Where the Zone Diet uses 3 meals and 2 snacks per day, however, this version uses 6 equal small meals evenly distributed throughout the each day. The first one is to be eaten within an hour of waking up, and the last one before bedtime is the most important one, because of the long gap before the next meal.

Each meal consists of the same proportions of protein, carbohydrates, and fats. Carbohydrates, as probably everybody knows, increase the level of glucose in the bloodstream, which causes a corresponding rise in insulin levels. Protein causes the release of glucagon, which regulates insulin levels. And fats control various hormones that also work to keep insulin levels controlled. So the whole point is to balance intake in order to keep insulin at a relatively steady level.

At the Zone website there are lists of “Zone food blocks.” There are three types: a protein block contains 7 grams of protein; a carbohydrate block contains 9 grams of carbs (not counting fiber), and a fat block contains 3 grams of fat. There is also a “body fat calculator” that tells you how many “blocks” per day you should consume. I’m supposed to eat 12 blocks per day of each of the 3 types, so with 6 meals, that’s 2 blocks of each type per meal. I’m to eat every 2-3 hours, never going more than 5 hours between meals during the daytime.

The approach that the nurse recommended to me is to make lists of the foods I’m interested in in each of the 3 lists, stockpile those foods, and as much as possible, have them pre-prepared in block-sized portions. Then I can just mix and match for each meal. For the first 4 weeks, I’m not supposed to eat from the “less favorable carbohydrates” list, so that means the only grain I’m allowed to have right now is steel cut oats. Fortunately, that’s my favorite breakfast. :)

I’m also supposed to carry “emergency food.” One stick of string cheese is one protein block, and they don’t have to be refrigerated. One apple is two carbohydrate blocks; you can get your hands on an apple just about anywhere. Applesauce also comes in single-serving containers, and one of those is one block. Fat is easy – three almonds is one block. There are also Zone Balance bars and another brand called Balance Bare that have the right proportions and amounts for one 2:2:2 meal. And 6 ounces of 2% milk is a perfect 1:1:1 food, so in a pinch I can drink a half glass of milk and go a little longer before my next meal.

Besides the protein : carb : fat ratios, there are some other things that I have to monitor in my diet. Splenda and stevia are the only sweeteners I can use — all of the others can affect glucose levels. Caffeine increases insulin secretion, so ideally I should avoid it, although for people who just have to have a cup of coffee in the morning, my doctor says to do it consistently — the same amount at the same time every day. MSG is also to be avoided, as are aspirin and all other non-steroidal anti-inflammatory drugs. (I will have to ask again what the reason is, because I’ve already forgotten, but they do something that affects fluid balance in the inner ears.) And I’m supposed to drink a minimum of 64 ounces of water per day, evenly spaced throughout the day.

As for sodium, it’s to be avoided in large amounts. Like everything else, my meals should contain similar amounts of sodium — but the plan is to titrate me back up to within the ADA recommended 2000-3000 mg daily consumption range. Oh, and I’m supposed to eat a 1:1:1 snack 20 minutes before exercising.

It’s actually been kind of fun creating my meals, since I’m not cooking for a family any more, which means they can be as weird as I want. I’ve loaded the freezer with frozen protein servings (turkey sausage, chicken breasts, etc.) and frozen fruits, stocked the fridge with boiled eggs, tofu, apples, oranges, kiwi, and Mozzarella cheese, and stashed single-serving containers of salmon, tuna, sardines, and different flavors of applesauce in the pantry.

For breakfast today I ate 2 links of turkey sausage, and 2/3 cup of steel-cut oats with Splenda and 2/3 tsp of butter. I could have had 1/3 cup of oatmeal and mixed in 1/2 cup of blueberries instead — maybe I’ll do that tomorrow. I had a Balance Bare bar for one of my meals, and it was actually quite tasty. My latest meal was 3 oz. of canned salmon, 1/4 cup hummus, 1 kiwi, and 6 almonds.

I’m also expected to keep a diary of the foods I eat every day, what time I ate them, what time I noticed feeling hungry, my fluid intake, and my symptoms. That way, over time we’ll be able to fine-tune my diet to my needs. My diary is also supposed to show the barometric pressure each day — that’s the wildcard in the equation; it’s the one thing that can’t be controlled. (I still have to go buy a barometer.)

I’m the least-regimented person on the fact of the planet, but I’m determined to make this work. Wish me luck! Better yet, join me; then we can share ideas for making it painless and fun!

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59 Responses to Eating in the Zone: My new Menieres Diet

  1. Shar says:

    I was just diagnosed with MD although I believe I have had it for years. I would love if you could recommend a good doctor that has a vast knowledge of this condition as I don’t particularly trust mine. Have you still been able to control yours?

  2. Surfer Mike says:

    Ugghh I just suffered a vertigo attack this past weekend after 3 years of not having one, I’m so distraught! I had a feeling it would hit me sooner or later though as I have not watched my diet, am out of shape, and have been drinking my fair share of alcohol lately. My ear has been full and ringing out of control for the past 3 weeks so I guess that was my warning. My ENT can’t get me in until Dec 30th. Any recommendations out there on how to ease the symptoms which include severe ringing and dizziness? I assume I should cut out sodium, drink as much water as possible and stay hydrated. I am 38 and can’t imagine living with this illness my entire life! : (

  3. Katrina says:

    Ruth,

    Thank you for sharing your experience and insights! Love the blogs too♥. Also very thankful that the thread continues to be current!

    As a diabetic with Menieres that has resulted in severe hearing loss where I miss a large portion of conversations, I find this information so valuable particularly the explanation of how regulation of insulin is key. Just wonder how diabetics would do on this diet? Would love to hear more about the diabetic aspect of this and how it or if it contributes to the Menieres disease process. I had Minieres prior to being diagnosised as a diabetic, though I was pre-diabetic for a few year.

    Any thoughts?

    Thank you!

  4. Jennifer says:

    Please let us know how this diet did–or did not–work for you. It makes a lot of sense!

  5. nospin says:

    I too am on a lower salt diet. It helps. The only thing that stopped the vertigo for me were gentamicin shots. A little tough at first; but so worth it. I have not had an attack in over 3 years.

  6. Davi says:

    Hello, I am a little confused on something. This zone diet appears to be a brand name, and you have to buy these products. I mean, I’m not opposed to purchasing products, but is this what you are doing instead of making up meals from a chart, or am I missing something?
    I’ve been recently diagnosed with MD, and My earlier bouts were mostly just hearing loss and very minor vertigo, but I had days and even weeks of relief. Now I’m having daily changes, and in some cases it has been severe vertigo keeping me at home for days, having vertigo bouts at sporadic intervals
    I’d also like to know if you or anyone else got the impression that this started out in their stomach/intenstinal tract? I remember months ago that I started having bowel trouble first, and at the time the MD was primarily just a little plugged up feeling in the ear. the one consistent thing aside from the usual MD symptoms has been irregularity, gas, acidy stools, and loose stools…or constipation, and at times of the worst vertigo, the stomach gurgles and even hurts, as well as muscular movement in that area. I eat fairly well, but I still may have overeaten given my physiology
    and one last question if you will: I went through a few week period recently where the vertigo was more dominant than the hearing loss, and the attacks were accompanied by tenseness in the neck muscles to the point you could hear the bones cracking when turning your head, and when the attacks stopped (say 1 hour or 2) the back of my head got a tingling feeling like you get when circulation returns. It’s as though the muscles were strangling the blood vessels. I’ve not read this anywhere as a general symptom, but then again, I never read about the hypoglycemia link until today either
    Thanks,

    Davi

  7. Bill says:

    Thank you for this interesting information. I have had Menieres for about 12 years, with several severe episodes resulting in an ambulance ride to the emergency room. I maintain a reasonable diet, take a diuretic each day and have fortunately been free from any vertigo episodes for about 3 years(although being superstitious, I’m always reluctant to say I have had no symptoms). The diuretic has really been the most effective means of control for me. Good luck to everyone!
    Bill

  8. Suzanne Meka says:

    Hi, I have meniere disease since age 13 and I m on low sodium diet. I avoid coffee and alcohol. I’m plan to do the mud race in April 13, 2014. I want to get into good shape before the race. I just hired a personal trainer. She gave me a recipe for smoothie with protein power. I just bought Natural Whey Protein Power from Wegman’s grocery store. I was wondering if protein power can effect my inner ear? Please advise. What do you recommend?

    Thank you,
    Suzi

  9. moldyrocks says:

    I have MD in both ears. I have a lot that I would love to share, but not enough time right now. However, I really want to share something that has helped me immensely. I use earplugs to help regulate / negate the pain in my inner ears from the barometric pressure and internal pressures as a result of increased blood flow.

    I hope that this helps.

    Cheers,
    Moldyrocks

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