How to reduce your salt intake

Have you ever had the misfortune of being hit over the head from behind? That’s what it felt like when I had my first serious vertigo attack. The surprising jolt when it hits has you grabbing onto the nearest object so you don’t fall over. Unfortunately, for me it wasn’t a one-off and started happening more regularly. You can never accurately pick its arrival and you never know where it’s going to take place. But after it hits, you need to wait out hour upon hour of everything spinning madly around you. You try to sit motionless and attempt to focus intently on a fixed object in front of you because any eye or head movement results in the worst nausea and vomiting you’ll experience. I wouldn’t wish it on anybody.

In early 1997, I’d started suffering some minor dizziness after noticing some tinnitus (buzzing sound) in my left ear. Some increasingly longer dizzy spells at work led me to get some tests, including an MRI to check whether I had any tumours. It was concluded that there was nothing wrong and it might just be an inner ear infection or a virus. But a few weeks later came the sledgehammer hit!

I was at a restaurant with my wife and some friends, enjoying a beautiful mushroom risotto (the significance of this very salty meal will become clear later) when suddenly my head jerked forward and I grabbed the table so I wouldn’t fall off my chair. It was then my world started spinning out of control. I’d never really vomited before, but that night I certainly made up for it, filling several buckets in the doctor’s surgery I ended up at. Anyone who has suffered from vertigo can understand its debilitating nature, but when it lasts hour upon hour, you really do feel desperate and helpless, thinking the rest of your life might be spent in a world that constantly spins.

It actually took another six months of weekly vertigo attacks, nausea, misdiagnosis with ear, nose and throat specialists and feelings of confusion and depression before I got to the bottom of what I had. Luckily, I married into a supportive family of health professionals who asked enough questions and undertook enough research to find out there was a specialist centre at Royal Prince Alfred Hospital in Sydney that might diagnose and help to treat my problem.

Meniere’s disease

Once I got an appointment with Dr Michael Halmalgyi and his team at RPAH, they were able to diagnose that I had something called Meniere’s disease. It’s defined as “idiopathic syndrome of endolymphatic hydrops” or, in easier-to-understand terms, “episodic vertigo associated with hearing loss, aural fullness and tinnitus”. Although several other disorders can involve episodic vertigo, it is the tinnitus or aural fullness (or both) that must be present and tested on the affected side to formally diagnose Meniere’s.

An uncomfortable testing procedure that included an electronic device and a series of balance and aural fullness tests confirmed I had the disease. The diagnosis was something of a relief because I now knew what I had and what I could do about it. In fact, after they diagnosed me as having “classic” Meniere’s, I initially felt a weird sense of triumph in how special I must be to be diagnosed with “classic” Meniere’s.

This smugness soon left me when they told me there was no known cause and no magical cure. “So, do I have to put up with these vicious vertigo attacks for the rest of my life?” I asked? “It really does depend on how you move forward from here,” was the response from the doctor. “There are several stages to Meniere’s and you will have periods of vertigo attacks, associated nausea and constant tinnitus in the ear, but if managed well, their severity might be a lot less.” He added, “Although there are no guarantees, many Meniere’s sufferers have responded positively to a very low-salt diet with the help of diuretics now and then, and staying as fit and healthy as possible.”

Beyond vertigo

The team at RPAH gave me some dietary information on what a low-salt diet meant and details of a support group available to assist in providing more information on Meniere’s and how to best control it. “OK, a glimmer of hope that I can do something about this thing,” I remember thinking at the time.

Twelve years after being initially diagnosed, there have been many bumps on the road, bouts of confusion and a few frustrating twists and turns. I still get the odd bout of vertigo — maybe once every six months — and, when I do, it usually lasts a couple of seconds with the nausea almost gone. As any partner of a Meniere’s sufferer will attest, you develop a very structured lifestyle to manage the disease, including always sleeping on the affected side (many of my earlier vertigo attacks occurred in bed after turning quickly); adopting a very regimented diet and eating regime (I have frustrated many a chef!); and avoiding activities such as swimming and some sports that might involve rapid head movement.

I can now safely say I have managed my Meniere’s well, the common denominator being the strict adherence to a low-salt diet. Yes, I have constant tinnitus and, yes, when it is at its worst I can hardly hear out of the effected ear, but my ability to reduce the incidence and severity of vertigo attacks and nausea has enabled me to lead a relatively normal life.

In fact, in a roundabout way, having Meniere’s has taught me much about my body, my health and my approach to life. This is why I want to tell people about my positive experience in managing this awful disease and to proclaim the benefits of having a low-salt diet, not just because it helps with Meniere’s but because it can help with your overall health, especially in managing the risks associated with blood pressure and heart disease.

I do need to provide you with a disclaimer, though. The research shows that not all Meniere’s treatments, which range from dietary and lifestyle changes to medications and surgery, work for everyone. Each Meniere’s sufferer needs to work with their specialist, monitor changes to figure out what might be a potential trigger for each Meniere’s-related episode (this can lead to a lot of second guessing, but diarising your daily food intake can help as you can trace what you had in the lead-up to an attack), and to try different treatments to find out what works best for them. It appears most sufferers are able to manage their symptoms reasonably well by finding the regime that works best for them. For me, it’s mainly the low-salt diet.

Living a low-salt life

So why does low-salt living work well for Meniere’s sufferers? Sodium, a primary component of salt (also known as sodium chloride), increases fluid retention in the body. The build-up of the potassium-rich inner ear fluid I mentioned earlier can be alleviated by reducing overall fluid in the body and therefore lowering sodium levels, which in turn reduces the amount of fluid in the inner ear. Diuretics are also prescribed to further reduce bodily fluids.

It’s not only Meniere’s sufferers who benefit from lower salt levels in their diet. Those with high blood pressure will particularly benefit, with research also showing that a low-salt diet reduces the incidence of strokes, heart failure, kidney problems, gastric cancer, migraine headaches and osteoporosis. In fact, Australia’s high incidence of these particular health problems has resulted in a major campaign by health departments to lower people’s salt intake.

The National Health and Medical Research Centre suggests the average Australian consumes eight to nine times more salt than necessary. It suggests that the recommended daily intake should be around 1600 milligrams of sodium (or four grams or one teaspoon of salt). For Meniere’s sufferers, it’s recommended that you go much lower than this. How much lower you go is the trial and error you will go through to find what works best for you.

I decided after months of experimenting with different levels that I should eat only low-salt food, which would ensure I stayed well under 800 milligrams per day. A low-salt product is defined as any item that has a sodium content under 120 milligrams per 100 grams of weight. Thankfully, Australia’s food labelling system has helped me enormously — every packaged food product has a nutritional information label, which includes the amount of sodium in each product.

Low salt — high enjoyment

Low-salt eaters should drink plenty of water every day to maintain good levels of hydration. This can be important as dehydration has led me to have some uncomfortable dizzy spells — one reason why alcohol and caffeine, which can dehydrate, can be problematic for Meniere’s suffers. Continue to monitor your body’s health through regular testing with your health practitioner, but once you get started on a low-salt diet you won’t want to turn back. There are two main reasons for this:

• You will start tasting the natural flavours of food once again and begin to recoil from food that is heavily salted — your palate just won’t accept these foods any more.
• You’ll notice you begin to eat much more healthily and your body feels so much better. You’ll soon realise that many of the salty foods you have started cutting out are also high in fats.