Benign paroxysmal positional vertigo (BPPV) is commonly described as a mechanical based issue of the inner ear involving our rotational and linear sensory organs. Repositioning techniques are used to treat this condition and are specific based upon the involvement of the structures within the inner ear. Individuals will often report vertigo, which is typically described as spinning or a sense of motion, with changes in head movements or positions. Most individuals who experience these symptoms respond well to repositioning techniques and report a decrease or resolution in their symptoms. Unfortunately, many people are not informed that these symptoms can return.
It is not uncommon for individuals who have had BPPV to experience it more than once. It is estimated that six months after experiencing these symptoms more than one quarter of people will have a relapse and will require treatment again. Based upon this information, we should do a better job in educating people in their expectations and also in the management of their symptoms. There are times where BPPV will reoccur without any explanation and it is important that people realize that it can be insidious. Yet, there are times that individuals may increase their risk of recurrence and this is where education is key.
There are some factors for recurrence that are out of one’s control, such as age and gender. As we age our bodies undergo a cascade of events that results in many physiological changes including changes in hormones, gut biome, and neuro-musculoskeletal system. Also, it is known that females are more likely to have these symptoms occur after a successful response to previous treatment. It is hypothesized that changes in estrogen levels can be a factor in women who have a recurrence of symptoms.
Given that we are unable to control some factors as to whether or not BPPV returns, it is also important to recognize that there are some steps that may help decrease one’s risk. Here are just a few in which you should be aware:
- Metabolic changes
Elevated blood glucose levels over increased periods of time are known to have detrimental effects on various parts of our body including our cardiovascular and nervous systems. It is known that heightened blood glucose levels can damage the blood vessels that supply the nerves and ultimately result in decreased oxygen being transported to these nerves. Without the necessary supply of oxygen these nerves can become damaged and depending on the severity and/or length of time the nerves can be destroyed. In addition to glucose levels, it is known that heightened insulin levels due to resistance can also have a detrimental effect on our body, including the vestibular system.
- Vascular concerns
Diseases associated with cardiovascular health such as hypertension (high blood pressure) may have an influence on recurrent BPPV. Hypertension results in damage to the walls of blood vessels and can increase the risk of blockages as well. If you have decreased blood flow there will ultimately be decreased oxygen transportation to a specified region. It is possible that these changes can have a direct influence on the structural health of the inner ear.
- Bone Health Factors
When asked what is necessary for bone health, most people are able to recognize the need of calcium. In addition to calcium, our body’s need vitamin D. Vitamin D helps with the absorption of calcium and is a necessary nutrient. You may be wondering what bone health has to do with symptoms related to BPPV. Studies have shown that lower levels of vitamin D have been noted in individuals who have recurrent BPPV.
After reading through this, you may be wondering what steps you can take to help decrease the risk of BPPV from recurring. A great place to start is with your diet. Eating a balanced diet is a great place to start.
Research has shown that there is a correlation between hyperglycemia and insulin, which can lead to elevated levels of insulin presence. Yes, carbohydrates are our main source of energy and the body breaks these compounds down to glucose for fuel. However, particularly with the American diet, the types of carbohydrates being consumed are poor in nutritional value. In addition to one’s glucose consumption, awareness of consumption of sodium and fats are key as well. Sodium, high cholesterol based foods, and fatty foods directly influence our vascular structures. Paying attention to these substances in your diet can be a key factor. Learning to read and understand the nutritional labels on foods can offer some initial guidance. Also, avoidance of too many processed foods will greatly cut down on sodium and unhealthy fats.
A great place to start with adjusting your diet is by speaking to your medical provider, a dietician, or a nutritionist. If you have a history of BPPV and also possess one of the factors mentioned above, you could be at increased risk for recurrence symptoms. You may not be able to control all factors such as your age or gender, but you can take charge of the controllable factors, such as diet.
Also, please note that if your BPPV does recur, it does not mean that you have caused it to occur. Sometimes it just happens and we do not have a clear understanding of the cause. Yet, if you can decrease your risk by making some simple dietary adjustments, it could be well worth it.
*This information is not meant to serve as medical advice. It is simply information to help you become better informed. It is advised that you speak with your medical team/providers prior to attempting any changes on your own.
References
Sfakianaki I, Binos P, Karkos P, Dimas GG, Psillas G. Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review. J Clin Med. 2021 Sep 24;10(19):4372. doi: 10.3390/jcm10194372. PMID: 34640391; PMCID: PMC8509726.
Talaat HS, Abuhadied G, Talaat AS, Abdelaal MS. Low bone mineral density and vitamin D deficiency in patients with benign positional paroxysmal vertigo. Eur Arch Otorhinolaryngol. 2015 Sep;272(9):2249-53. doi: 10.1007/s00405-014-3175-3. Epub 2014 Jun 29. PMID: 24973969.
Wang, Weia; Lin, Penga; Han, Xia; Mao, Xianga; Li, Shanshana; Wen, Chaoa; Liu, Qianga; Ni, Guangjian; Chen, Taishenga. New views on benign paroxysmal positional vertigo. Journal of Bio-X Research: June 2020 – Volume 3 – Issue 2 – p 78-82
doi: 10.1097/JBR.0000000000000069
You P, Instrum R, Parnes L. Benign paroxysmal positional vertigo. Laryngoscope Investig Otolaryngol. 2018 Dec 14;4(1):116-123. doi: 10.1002/lio2.230. PMID: 30828628; PMCID: PMC6383320.