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Hydrops and Hydrops Diet

Timothy C. Hain, MD Page last modified: April 9, 2014

A one-page version of the hydrops diet is found here

Normal membranous labyrinth

Dilated membranous labyrinth in Meniere's disease (Hydrops)

Hydrops means that the pressure in the inner ear is elevated. All persons with Meniere's disease have hydrops. There are also persons who have hydrops (usually documented with the ECochG test), who do not meet the diagnostic criteria for Meniere's disease. These people are simply diagnosed as having "hydrops"

Hydrops Diet

The fluid-filled hearing and balance structures of the inner ear normally function independent of the body's overall fluid/blood system. In a normal inner ear, the fluid is maintained at a constant volume and contains specific concentrations of sodium, potassium, chloride and other electrolytes. This fluid bathes the sensory cells of the inner ear and allows them to function normally.

With injury or degeneration of the inner ear structures, independent control is lost, and the volume and concentration of the inner ear fluid fluctuates with changes in the body's fluid/blood. This fluctuation causes the symptoms of hydrops--pressure or fullness in the ears, tinnitus (ringing in the ears), hearing loss, dizziness and imbalance.

Note that it is not the overall level of sodium that is important, but whether or not it fluctuates. It is not necessary or wise to lower your salt intake to amounts barely able to sustain life. We do not encourage use of 1 gram sodium diets. Rather the goal is to keep sodium levels from fluctuation, and also on the low side of normal. A 2 gram sodium diet is usually possible. Note, we are not suggesting a 2 gram "salt" diet -- but rather a 2 gram "sodium" diet. Salt has both sodium and chloride. We are only trying to control the sodium part.

History:

An early version of the hydrops diet was proposed by Furstenberg (1934). He suggested that protein and calories need not be restricted, but that salt should be "low". Dr. Furstenberg provided an elaborate list of foods to be taken daily or avoided. He did not restrict caffeine at all, and did not mention sugar, alcohol, or nicotine. Dr. Furstenberg advocated use of "acid producing salts" such as Ammonium chloride. Thus it can be seen that the Furstenberg diet is not synonymous with the "hydrops" diet, and in fact, does not even set the amount of sodium.

How does what I eat affect my dizziness?

Your inner ear fluid is influenced by certain substances in your blood and other body fluids. For instance, when you eat foods that are high in salt or sugar, your blood level concentration of salt or sugar increases, and this, in turn, will affect the concentration of substances in your inner ear.

People with certain balance disorders must control the amount of salt and sugar that is added to food. You must also become aware of the hidden salts and sugars that foods contain. Limiting or eliminating your use of caffeine and alcohol will also help to reduce symptoms of dizziness and ringing in the ears.

Dietary goals

The goal of treatment is to provide stable body fluid/blood levels so that secondary fluctuations in the inner ear fluid can be avoided.

  1. Distribute your food and fluid intake evenly throughout the day and from day to day. Eat approximately the same amount of food at each meal and do not skip meals. If you eat snacks, have them at regular times.
  2. Avoid eating foods or fluids which have a high salt content. High salt intake results in fluctuations in the inner ear fluid pressure and may increase your symptoms. Aim for a diet high in fresh fruits, vegetables and whole grains, and low in canned, frozen or processed foods. A 2-gram sodium intake diet is usually what we recommend. One teaspoon of table salt has about 2 grams of sodium. Note that sodium (one of the two elements in table salt) is not exactly the same as sodium chloride (salt). A 2 gram "salt" diet is not what is intended. This web site: http://www.myfitnesspal.com, has a diet diary program that can be configured to track sodium.
  3. Drink adequate amounts of fluid daily. This should include water, milk and low-sugar fruit juices (for example, cranberry or cranapple). Try to anticipate fluid loss which will occur with exercise or heat, and replace these fluids before they are lost. Be cautious about the milk intake -- some individuals have food allergy and get symptoms from milk products.
  4. Avoid caffeine-containing fluids and foods (such as coffee, tea and chocolate). Caffeine has stimulant properties that may make your symptoms worse. Caffeine also may make tinnitus louder. Large amounts of caffeine may trigger migraine (migraine can be difficult diagnostically to separate from Meniere's disease). Chocolate is also a migraine trigger.
  5. Limit your alcohol intake to one glass of beer or wine each day. Alcohol may trigger migraine associated vertigo.
  6. Avoid foods containing MSG (monosodium glutamate). This is often present in pre-packaged food products and in Chinese food. It may increase symptoms in some patients, possibly because of the link to migraine associated vertigo, and also because it contains sodium.

Drug Considerations

  1. Avoid aspirin and medications that contain aspirin. Aspirin can cause tinnitus (abnormal noise in the ear). Nonsteroidal anti-inflammatory agents such as ibuprofen or naproxen should also be avoided when practical.
  2. Avoid caffeine-containing medications. Caffeine can increase tinnitus as well as have the problems mentioned above under foods.
  3. Pay attention to the content of all over-the-counter medications as well as drugs prescribed by other physicians. Some medications may increase your symptoms.

Where can I get additional help in modifying my diet?

Dietitians can help you work out a nutritional program which meets your special needs. They can also suggest ways to prepare your favorite foods for a restricted-salt or low-sugar diet. With their assistance, you'll find that modifying your eating habits can help you control the symptoms of your balance disorder.

Most grocery stores carry pamphlets that list the amounts of sodium in common foods.

More information:

Self-help groups.

Other Links

  • The Meniere's network
  • Review article: www.bmj.com/cgi/content/full/316/7128/368
  • Written By: Timothy C. Hain, MD of Chicago Dizziness and Hearing.

     

    Copyright April 9, 2014 , Timothy C. Hain, M.D. All rights reserved. Last saved on April 9, 2014