The low-salt diet
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.
The shape of low-salt
So what does a well-balanced, healthy, yet very low-salt diet look like? It took me a long while to figure it out because initially I was so focused on sodium content that I forgot about the importance of nutrition. I became quite addicted to sweet foods and dairy products because they were relatively low in sodium. Unfortunately, this meant my body was being starved of protein while stocking up on fats and carbohydrates. It became obvious after a while why I started to put on some weight, even though I was doing some exercise. Over time, I began to balance my body’s needs and developed a diet that is very low in salt, low in saturated fats and high in protein.
The table provides an example of what constitutes a very low-salt diet of under 800mg per day. The protein component is gained from having servings of tinned salmon, nuts and chicken and every meal is low in saturated fat. My sweet tooth is satisfied by some small glasses of juice and a flavoured ice block (really just a treat), which are much lower in sugar content than candy bars. I also drink several litres of water a day.
| Time of day | Food/ingredients | Serving size | Sodium ratio | Sodium amount | |
|---|---|---|---|---|---|
| Breakfast | 2 Uncle Toby’s Oats flavoured sachets with Sanitarium So Good Vanilla soy milk
and/or 2 slices of Moore’s Low-Salt Bread toast with 1 cup of black coffee |
2 x 30g ½ cup 2 x 31g |
25mg per 100g 45mg per 100ml 110mg per 100g 0mg per 100g |
16mg 45mg 75mg 0mg |
|
| Lunch | 2 large Sniders Matzos Crackers with 1 tin of Coles No Added Salt Pink Salmon with half avocado with 1 roma tomato 1 piece of fruit (eg mandarin) |
2 x 32g 84g |
6mg per 100g 80mg per 100g |
4mg 70mg 2mg 8mg 2mg |
|
| Afternoon Tea | 1 Be Natural Nut Bar
1 cup of black coffee |
40g | 50mg per 100g | 20mg
0mg |
|
| Dinner | Chicken stirfry over rice containing: 2 pieces chopped chicken thigh ½ chopped carrot 4 florets broccoli ½ small white onion 4 large button mushrooms 2 chopped chillies 1 tsp cumin 1 tsp cardamom 1 tsp ginger 2 tsp olive oil 1 cup boiled rice 1 small glass of juice 1 Nestlé Life Savers Ice Confection |
2 x 125g | 75mg per 100g | 190mg 20mg 10mg 5mg 32mg 6mg 5mg 5mg 1mg 0mg 0mg 0mg 0mg |
Once you start to research all the food out there that is low in salt, you’ll quickly realise there is quite a lot of choice available to you if you are willing to cook for yourself, avoid fast-food restaurants and eat healthy, fresh, unprocessed foods. Below are some examples of the range of other low-salt foods available to you:
Naturally low-sodium foods
- Any fresh fruit or vegetable
- Most fresh red and white meats (not sausages or sautéed meats.
- Plain tofu, lentils and beans
- Most fresh fish (not calamari, shellfish, crab, prawns, mussels or oysters)
My favourite specially made, no-added salt foods
- Naked Foods Traditional Basil and Tomato Pasta Sauce — 0mg sodium (available from the healthfood section of Coles) — great for pasta and other dishes requiring sauces.
- Leggos No Added Salt Tomato Paste — 68mg per 70gram tub (available in most supermarkets) — great as a base for homemade curries and sauces.
- Heinz No Added Salt Baked Beans — 46mg per 420gram tin (available in most supermarkets) — great on Moore’s low-salt bread toast.
- Eden Organic range of beans (including kidney, adzuki and chickpeas — available at Macro Wholefood Stores in Sydney and Melbourne) — great in a homemade nachos mixed with pasta sauce and ground chilli on top of some low-salt Mr Chipman Corn Chips (available at most supermarket healthfood sections) .
My favourite dinner ideas
- Grilled Atlantic salmon topped with cumin, basil, chopped onion and chopped chillies on a small bed of rice.
- Homemade chicken curry (made with low-fat European-style yoghurt, tomato paste, cumin, cardamom, garam masala, chillies and water).
- Lasagne made with ground beef or Planet Organic’s textured vegetable protein mixed with pasta sauce, pepper, basil and caramelised mushrooms and onion, layered with Pantalica Smooth Ricotta Cheese (100mg per 100g.)
- Beef, chicken or tofu burgers using Moore’s Low-Salt Bread, caramelised mushrooms and onion, tomatoes, rocket and Fountain No Added Salt Tomato Sauce (20mg per 100g).
Foods to avoid at all costs
- Most tinned products (unless it has a No Added Salt label), which are processed, preserved and flavoured using large quantities of salt.
- All commercial-brand breads and pastries.
- Flavoured or salted potato crisps.
- Biscuits, crackers and some confectionary.
- Commercially made sauces, dressings and other condiments.
- For further information and links on Meniere’s disease, including Australian and international support groups: www.menieresinfo.com
- Some great information on where to find low-salt food in Australia: www.findlowsaltfood.info
- Health advantages of a low-salt diet: www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Salt?Open
- Links to labelling, nutritional guidelines and listing of food components: www.foodstandards.gov.au
Here are some great websites available to find out more about Meniere’s disease and low-salt living:
