Treatments for Meniere’s disease: Fact, Fiction or Biological Plausibility? Part III

Salt – What’s the connection?

A couple of weeks ago, my lovely wife and I celebrated our 19th anniversary. Being the kind and generous type, she surprised me with a new subscription to the Sunday New York Times. I sat down with my crisp paper, hoping for an hour of relaxation, and what do I come across on the front page of the Sunday Review? An article titled, “Salt –Reconsidered.”{{1}}[[1]]Salt –Reconsidered  Gary Taubes, Sunday New York Times, June 3, 2012[[1]]

There goes my mental mini-vacation!

I was intrigued by the term “Biological Plausibility” used to describe medical advice that makes sense, seems reasonable, and can be explained in scientific terms. But does that make it true? The author, Gary Taubes, makes the point that biological plausibility is a hypothesis, and researchers do studies to try and prove their hypothesis. Has a low salt diet for Meniere’s disease undergone this type of rigorous study? Is there proven benefit to a salt restricted diet?

Theoretically, a Meniere’s episode is triggered by a build-up of inner ear fluid known as endolymph. Because this is essentially an issue of fluid retention within the inner ear, many believe that it correlates to overall fluid retention within the body. Salt consumption (as well as hormonal fluctuations) has been shown to increase fluid retention.

Let me say that I believe there is a correlation between salt intake and Meniere’s attacks. I have seen too many people over the years reporting attacks after a salty meal to dismiss the connection. Some very old studies showed some mild benefit to a reduced salt diet, and demonstrated an inducement of a Meniere’s attack from salt loading. An excerpt from a recent review article  from the International Journal of Clinical Practice sums it up nicely:

There is low level evidence … which suggests that salt loading induces attacks in Meniere’s disease patients and that salt reduction to urinary sodium levels of less than 50 mmol per day reduces the frequency of vertigo attacks in these patients. These studies{{2}}[[2]]Furstenberg AC, Lashmet FH, Lathrop F. Ménière’s symptom complex: medical treatment. Ann Otol Rhinol Laryngol 1934; 43: 1035–46.

Boles R, Rice DH, Hybels R, Work WP. Conservative management of Ménière’s disease: Furstenberg regimen revisited. Ann Otol 1975; 84: 513–7.[[2]]also involved the use of diuretic therapy and there are no high quality randomised trials that investigate the role of dietary salt restriction in isolation. It is worth explaining to the patient that a low sodium diet may be beneficial. However, they should be made aware of the limited evidence for dietary salt restriction as such an endeavour can impinge upon a patient’s quality of life. Severe salt restriction should not be recommended in patients on diuretic therapy as this can result in significant electrolyte imbalance.

More on this next week.

 

 

 

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.