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!