Nutritional Support for Vestibular Disorders

Tom Schnorr, RPh, CCN.

Dietary Manipulations :

Low salt (low sodium) diet +/- (<1000mg per day)

Water intake +++(1/2 body wt in ounces [eg.1/2 x 200lbs=100oz (~3 qts)])

Caffeine restriction ++

Chocolate restriction +

Alcohol restriction +/-

Avoid Ansaids +/- (ibuprofen,naprosyn,celebrex)

Diuretics (Water pills)

Dyazide; Maxzide (HCTZ), Diamox , (avoid Lasix, Bumex, Edecrin, Demedex)

Anti-emetic, Anti-nausea and Anti-vertigo drugs

Meclizine , Phenergan, Promethazine, Dramamine, Compazine, Scopolamine patches and gels ,

Vistaril, Torecan, Ginger, Zofran, Reglan, Tigan, Kytril,

Betahistine ( compounded medication) Betahistine is also reported to increase cochlear blood flow,

***(Special price for ALL members of the 360 Balance Support Group $65/#100, $45/#60caps)

Anti-anxiety drugs( Vestibular Sedatives) (GABA Blockers)

Valium (diazepam) low dose topical compounded, Ativan (lorazepam), Thorazine (chlorpromazine)

Steroids (anti-inflamatory), and Immunosuppressant)

Prednisone, Cortisone, Dexamethasone, Methotrexate, Enbrel,

Local Anesthetics

Lidocaine nasal spray (compounded med)

Anti-histamines

Claritin, Allegra, Zyrtec

Calcium channel blockers and Vasoactive drugs (some Sodium Channel blockers,(Dilantin)

Lotrel , Norvasc, Caduet, nifedipine, Calan, Cardizem, Niacin

Osmotic Agents

Glycerol, Urea, Isosorbide

Antiviral Drugs

Acyclovir, Famvir, Valtrex.

**OTOTOXIC DRUGS (See attached list)

Gentamicin, Streptomycin, Tobramycin, Clindamycin, some diuretics, Hg, Environmental exposure, Antibiotics:amikacin (Amikin),streptomycin,neomycin, gentamicin (Garamycin), erythromycin (E-Mycin,), kanamycin (Kantrex), tobramycin (Nebcin), netilmycin (Netromycin), vancomycin (Vancocin), Anti-cancer drugs: cisplatin (Platinol AQ), bleomycin (Blenoxane), vincristine (Oncovin), Diuretics:acetazolamide (Diamox), furosemide (Lasix), bumetanide (Bumex),ethacrynic acid (Edecrine)

Nutritional supplements in the literature

Ginkgo biloba (80mg 2-3 x day) Ginger (3 x day) Lipoflavinoids (+/-),

Anecdotal experiences:

Vinpocetine (20-40mg/day but will usually stop working after 3-4weeks, give rest and return)

D-Hist -1-2cap every 4-8 hrs)

Vit B2 – 500mg 2 x day x 2-3 months

Vit B6 – 500mg-1000mg 2 x day x 2-3 months

NAC 600mg 2 x day x 1 month then daily

Bromelain/ Quercetin

Vit C 2000-4000mg /day

Enzyme therapies, digestive and proteolytic.

Cucurmin, Tumeric, Garlic,

Adaptagenic Chinese mushrooms and herbs.

VertigoHEEL, Homeopathetic 2-3 tabs daily.(Cocculus Compostium)

Finally ,a list of the Nutraceuticals that have shown promise in promoting healing and supporting optimal health.

Co Q10 100-600mg

Vit E (mixed Nat) 200-400 IU

Vit C 1000-2000mg

Chromium 600-1000mcg

Zinc 30-60mg

Vanadium 5-15mg

EFA’s (Omega3’s) 500-1500mg

B1 (Thiamine) 50-100mg

Vit B3 Niacin 500-2000mg

B6 100-500mg

B12 500-2000mcg

Cinnamon 1/8tsp 2 x day

Gymnema Sylvestre 250-400mg

Inositol 700-1500mg

Lipoic Acid 200-600mg

Biotin 3-5mg

Mg Glycinate 200-600mg

L Argenine 500- 1500mg

Folic Acid 1mg

Li Orotate 5mg

DMAE 50-100mg

αGPC or PPCholine 1000mg

Copper 2mg

Selenium 200mcg

Digestive Enzymes varies

L Carnitine 500-100mg

Fiber ( Ground Flax) 2 tablespoons

Acidophyllis/Bifodophllis varies

Chlorella/Spirolena varies

Bioflavoids 500- 1000mg

Niacin Inositol 1000mg

The above products are available in multiple mixed packaging; furthermore, the list is never complete and is constantly changing as we learn more about the body and the world we live in.

If you have any questions please call me at the store. I am available for consults at the store during the lunch hour 1pm to 2pm and after the store closes at 6:30pm. I invite you to bring your prescriptions, nutritional supplements and pertinent labs for a tune-up. My rates are $60/hr in 30 min blocks.

Ototoxicity

Ototoxicity ("ear poisoning") is due to drugs or chemicals that damage the inner ear or the vestibulo-cochlear nerve, which sends balance and hearing information from the inner ear to the brain. Ototoxicity can result in temporary or permanent disturbances of hearing, balance, or both.

Many chemicals have ototoxic potential, including over-the-counter drugs, prescription medications, and environmental chemicals. If you are taking any drugs on the advice of your physician, do not stop taking them just because you see them listed below. Speak with your doctor or other health care advisor about your concerns.

Substances that may cause ototoxicity include:

Aminoglycoside antibiotics, including gentamicin, streptomycin, kanamycin, tobramycin, neomycin, amikacin, netilmicin, dihydrostreptomycin, and ribostamycin. All members of this family are well known for their potential to cause permanent ototoxicity. They can enter the inner ear through the blood system, through inhalation, or via diffusion from the middle ear into the inner ear. They enter the blood stream in largest amounts when given intravenously (by IV).

Anti-neoplastics (anti-cancer drugs). Cisplatin is well known to cause hearing loss that is many times massive and permanent. Carboplatin has been implicated as well.

Environmental chemicals, including butyl nitrite, mercury, carbon disulfide, styrene, carbon monoxide, tin, hexane, toluene, lead, trichloroethylene, manganese, and xylene. Most are associated with hearing disturbances that may be permanent; mercury has also been linked to permanent balance problems.

Loop diuretics, including bumetanide (Bumex), ethacrynic acid (Edecrin), furosemide (Lasix), and torsemide (Demadex). These drugs cause ringing in the ears or decreased hearing that reverses when the drug is stopped. Note: Hydrochlorothiazide (HCTZ) and Maxide, diuretics commonly prescribed to people with Meniere's disease or other forms of endolymphatic hydrops, are not loop diuretics.

Aspirin and quinine products. These may cause temporary ototoxicity, particularly tinnitus, but may also reduce hearing.

Symptoms of ototoxicity vary considerably from drug to drug and person to person. They range from mild imbalance to total incapacitation, and from tinnitus to total hearing loss.

A bilateral (two-sided) vestibular loss usually doesn't produce intense vertigo, vomiting, and nystagmus but instead a headache, a feeling of ear fullness, imbalance to the point of being unable to walk, and a bouncing and blurring of vision (oscillopsia). It also produces inability to tolerate head movement, a wide-based gait (walking with the legs farther apart than usual), difficulty walking in the dark, a feeling of unsteadiness and actual unsteadiness while moving, lightheadedness, and severe fatigue. If the damage is severe, symptoms such as oscillopsia and problems with walking in the dark or with the eyes closed are not going to go away.

The diagnosis of ototoxicity is based upon the patient's history, symptoms, and test results. There is no specific test; this makes a positive history for ototoxin exposure crucial to the diagnosis.

At present, there are no treatments that can reverse the damage. Currently available treatments are aimed at reducing the effect of the damage and rehabilitating function. Individuals with hearing loss may be helped with hearing aids, and those with profound bilateral losses have benefited from cochlear implants. In the case of lost balance function, physical therapy is of great value for many individuals. The aim is to help the brain become accustomed to the changed information from the inner ear and to assist the individual in developing other ways to maintain balance.

From VEDA publication F-19, Ototoxicity