Underlying Causes of Vertigo and How Nutrition Helps - Ask a Nutritionist

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Transcript

Caroline: Welcome to this week's “Ask a Nutritionist”, our weekly mini episode of Dishing Up Nutrition. I'm Caroline Wilcox, Registered and Licensed Dietitian Nutritionist with Nutritional Weight & Wellness. Have you ever rolled over in bed and suddenly felt like the entire room was spinning? Or maybe you stood up and felt dizzy, unsteady, or like you needed to grab onto something.

That sensation can be incredibly unsettling, and it's surprisingly common. Millions of Americans experience spinning or dizziness, and the likelihood increases as we age. By around age sixty-five and up, dizziness and balance problems are among the more common reasons people seek medical care. And I'll explain why the condition vertigo tends to affect women more than men.

Why can vertigo occur?

So today, we're talking about vertigo, but we're going to look beyond the symptom itself and ask the question: Why is it happening in the first place? Because vertigo isn't really a diagnosis by itself. Rather, it's a symptom. And while some causes of vertigo are mechanical problems in the inner ear, there may also be underlying factors worth investigating, including nutrient deficiencies, blood sugar fluctuations, and hormonal changes.

What is vertigo?

So let's unpack what we know. First, what is vertigo? There's an important distinction between dizziness and vertigo. Dizziness is a broad term where you might feel lightheaded, faint, woozy, or off-balance. Vertigo is more specific. It's the false sensation that either you are moving or the environment around you is moving, often described as a spinning feeling.

The most common cause affecting close to half of all cases is called benign paroxysmal positional vertigo, or BPPV for short. Inside our inner ear are tiny calcium carbonate crystals. Normally, they're located where they should belong and help our brain detect movement and gravity.

With BPPV, some of these crystals become displaced and enter the canals of the inner ear where they don't belong. When you change the position of your head, maybe you roll over in bed, you look upward, bend down to pick something up, or sit up, the displaced crystals move and send confusing information to your brain.

Suddenly, the room spins. This is why BPPV is typically treated with a repositioning technique called the Epley maneuver, which essentially just moves those crystals back to where they belong. In the case of crystals being displaced, nutrition isn't going to physically move them back into place.

Possible nutritional connections to vertigo

#1: vitamin D

However, we can ask another question: Why might someone be more susceptible to developing or repeatedly experiencing vertigo? That's where things get interesting. One of the strongest nutritional connections we're seeing in research involves vitamin D and BPPV.

A 2024 systematic review and meta-analysis found that people with BPPV had lower vitamin D levels on average than people without. A larger 2025 meta-analysis involving more than sixteen thousand participants also found lower vitamin D levels among people with BPPV and reported that vitamin D supplementation was associated with fewer reoccurrences.

So why would vitamin D have anything to do with your inner ear? Remember those little crystals we were talking about? Well, they're made primarily from calcium carbonate, so calcium. Vitamin D plays a huge role in calcium metabolism and bone mineralization.

So vitamin D helps your body absorb calcium, so it transports calcium from the bloodstream into the bones and teeth where it belongs. Researchers have proposed that a lack of adequate vitamin D could influence the formation of those inner ear crystals.

That's why, particularly in someone experiencing reoccurrence BPPV, it would be worth getting your vitamin D levels tested and supplementing if needed. We can get small amounts of vitamin D in food sources like fatty fish such as salmon and sardines, free-range eggs, and vitamin D fortified foods.

But vitamin D is difficult to obtain through food alone, particularly for people living in northern climates or getting limited sun exposure, especially as we age. So I usually recommend supplementing.

Other vitamin & mineral deficiencies to consider (B12, iron & magnesium)

So what about other vitamin and mineral deficiencies? Well, vitamin D currently has the, stronger correlation to BPPV than most other nutrients. However, if someone is repeatedly experiencing dizziness, imbalance, or neurological symptoms, I'd want to look at their overall nutrition status, specifically B12 and iron.

For example, vitamin B12 deficiency can affect the nervous system and may contribute to balance problems, numbness, tingling, weakness, or difficulty walking.

Iron deficiency or anemia can cause dizziness, fatigue, weakness, shortness of breath, and lightheadedness. That's not necessarily true spinning vertigo, but people commonly use the word dizziness to describe both sensations.

And then there's magnesium. Magnesium is essential for normal nerve and muscle function and has an important role in migraine physiology. That's particularly interesting because some people who think they have an inner ear problem actually have what's called vestibular migraine.

So if a migraine is part of the picture, magnesium status becomes more relevant. So as a dietitian, I would ask, what are a person's symptoms? What is their diet? What medications are they taking? And what is their whole health history telling us? And is there a deficiency we can identify and correct?

Hormonal changes can impact vertigo

Now let's talk about something that doesn't always get enough attention, hormonal changes. At the beginning of this episode, I mentioned that women are more likely than men to experience vertigo, and it can become particularly noticeable around perimenopause and menopause.

During perimenopause, estrogen doesn't simply decline in a nice straight line. It can fluctuate dramatically before eventually settling at lower levels. Here's something interesting. Scientists have found specifically estrogen and progesterone receptors directly inside the inner ear structures.

That's so fascinating. So fluctuations in estrogen and progesterone directly affect the inner ear and central balance pathways. Researchers have been investigating whether changing estrogen levels may influence inner ear function and BPPV risk. There may also be an indirect connection. As estrogen declines, women experience accelerated bone loss, specifically in those five years following menopause.

Because BPPV involves calcium carbonate structures in the inner ear, researchers have explored connections among menopause, osteoporosis, vitamin D status, and BPPV. That doesn't mean low estrogen automatically causes vertigo.

But imagine a woman in her late forty or fifty who suddenly starts experiencing dizziness or reoccurring BPPV, along with hot flashes, sleep problems, headaches, menstrual changes, and other perimenopausal symptoms. As a dietitian, I'm looking at the whole hormonal picture rather than treating each symptom as completely unrelated.

Also, hormonal fluctuations are a well-known migraine trigger, and vestibular type of migraine can produce vertigo even without a classic migraine headache. So if dizziness seems to fluctuate with the menstrual cycle or begins during perimenopause, that's useful information

Thyroid function/disorders can affect vertigo

Another area worth investigating is thyroid function. Your thyroid hormones influence metabolism throughout the body, including the cardiovascular and nervous systems. Both too much and too little thyroid hormone can produce symptoms people may describe as dizziness, weakness, heart racing, or feeling unsteady.

There has also been research looking specifically at thyroid disease and BPPV. A systematic review and meta-analysis found a possible association between Hashimoto's thyroiditis and BPPV. We don't want to say you have vertigo, therefore you have a thyroid problem. But if someone has recurrent vertigo, plus fatigue, plus constipation, plus unexplained weight changes and feeling unusually cold or hot, hair changes, heart palpitations, or other thyroid-related symptoms, it may be appropriate to get your thyroid tested.

Something important to consider is that we're looking for a full thyroid panel. It's common to get just TSH, T3, and T4 tested. A full panel gives us much more detailed picture of your thyroid function.

The diet connection to vertigo (think blood sugar balance, hydration & possibly high histamine foods)

Now let's get into the diet connection to vertigo. As a dietitian, one of the foundations I work on with every single client is blood sugar balance. Are you eating a balanced amount of protein, fat, and carbohydrates consistently throughout the day?

Blood sugar fluctuations don't necessarily cause vertigo, but low blood glucose can make you feel shaky, weak, lightheaded, dizzy, which can just make an existing balance problem feel considerably worse. So we want to build meals around high-quality protein, healthy fats, and fiber-rich whole food carbohydrates.

For breakfast, that might be free-range eggs sautéed with vegetables and avocado. Lunch could be chicken over a big salad with some quinoa and olive oil dressing. And dinner might be salmon with roasted broccoli and sweet potato, all roasted in avocado oil.

Instead of having coffee and a high carbohydrate breakfast, skipping lunch, and then wondering why you feel shaky at three p.m. in the afternoon, give your brain and nervous system consistent fuel.

And don't forget hydration. We never want to forget hydration. This is a simple yet commonly overlooked thing that can contribute to dizziness. If your blood volume drops because you're dehydrated, your blood pressure can fall, particularly when you stand up.

Again, that's technically different from classic spinning vertigo, but people often describe both as dizziness. Drink water consistently throughout the day, and remember that electrolytes matter too. Sodium, potassium, and magnesium are electrolytes involved in fluid balance and normal nerve and muscle function.

The appropriate amount of sodium is highly individual. However, particularly for someone with high blood pressure, kidney disease, heart disease, or Meniere's disease, where it is typically recommended to limit sodium intake, the good news is, is that eating a real whole foods diet and avoiding ultra-processed foods and restaurant foods will naturally eliminate most sources of sodium.

So to answer the big question, what foods should you eat for vertigo? Well, there isn't one magical vertigo diet. Instead, think about supporting the systems involved in balance, circulation, bone health, and neurological function. We want to build meals around high-quality protein. This is animal proteins, eggs, fish, poultry, beef, and other minimally processed sources.

It's incorporating healthy fats at every meal from foods like olive oil, avocado, nuts, seeds, and grass-fed butter, as well as eating lots of colorful vegetables for potassium, magnesium, antioxidants, and other vitamins and minerals, and it's drinking adequate water throughout the day. Generally, we recommend half your body weight in ounces per day.

As a side note, for some people with migraine-associated vertigo, high-histamine foods may be worth investigating as an individual trigger. If you think this may be the case, it's best to work with a knowledgeable dietitian, as a low-histamine diet can be pretty tricky to navigate alone.

Keep a food & symptom journal

In the meantime, I like to advise keeping a food and symptom journal to see whether there's a connection. Write down questions like, when did the episode happen? What had you eaten? Had you skipped a meal? How much water had I consumed that day? Had you been drinking alcohol? How much caffeine did you have and when? How did you sleep? If you're a woman in perimenopause, where were you in your menstrual cycle?

Did you have a headache or sensitivity to light or sound? All of these patterns can provide much more useful information than simply eliminating dozens of foods.

Putting it all together

Now, let's put this all together. If someone came to me saying, "I keep getting vertigo, what should I eat?" I'd want to know what kind of vertigo you're dealing with. Is it BPPV? Is it a vestibular migraine? Is it Ménière's disease? A medication side effect? Low blood pressure? Possibly blood sugar fluctuations? Or could it be a nutritional deficiency?

Then we can evaluate the bigger picture. Are you eating enough protein and nutrient-dense foods? Could you be deficient in vitamin D3, B12, or iron? Are you adequately hydrated? Are you experiencing migraines? Are you entering perimenopause or menopause?

Do your symptoms suggest that your thyroid should be evaluated? And are you sleeping and eating consistently and managing stress? We want to examine all the potential underlying contributors. You don't have to simply accept that you're a dizzy person. Get curious about what's driving it. Start with the diagnosis and then look at the bigger picture, your vitamin D and nutrient status, hormones, thyroid, blood sugar, hydration, migraines, and overall diet.

Thanks for listening today. If you found this episode helpful, the best way you can support our podcast is to share with someone who could benefit. And to find out more about working with me or any other wonderful dietitian at Nutritional Weight & Wellness, give us a call at 651-699-3438 or visit us at weightandwellness.com. I'll talk with you next time. Have a great rest of your day.

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