How I manage Meniere's symptoms with a low-sodium diet
Excessive sodium is a common symptom trigger for many chronic conditions—including Meniere’s disease and tinnitus—and it’s a hard one to avoid because salt is so prevalent in the average Western diet.
Most people have no idea of how much sodium they consume on a daily basis. Even if you never add salt to anything, there is still sodium in just about everything you eat, and it adds up fast. Why does this matter? Salt makes the body retain water, increasing the pressure in your ears.
When I was diagnosed with Meniere’s disease, it quickly became clear that salt was affecting my symptoms. After high-sodium meals, my tinnitus volume would spike, and I would start to feel dizzy. Some of my worst vertigo attacks immediately followed salt-heavy meals.
If sodium is a trigger for you (or if you suspect it might be), the good news is that adopting a low-sodium diet can make a meaningful difference in the severity of your symptoms.
It’s a hard switch to make, but after years of living a low-sodium lifestyle, I’ve learned a lot of helpful and effective strategies to make it as easy as possible.
How much sodium is too much?
Unfortunately, implementing a low-sodium diet isn’t an exact science. The upper limit on how much sodium you should consume daily is going to vary greatly from person to person.
It’s important to discuss this with your doctor before you make the change. Even when salt is a one of your major symptom triggers, you still need some sodium in your diet to sustain life.
But the American Heart Association’s guidelines are a good starting point: “No more than 2,300 milligrams (mg) a day and moving toward an ideal limit of no more than 1,500 mg per day for most adults.”
The problem is that the average American unknowingly consumes more than 3,400 mg of sodium per day. Most people simply have no concept of how much sodium they take in on a daily basis or even the ability to accurately estimate their consumption.
How to keep track of sodium intake
So when switching to a low-sodium diet, it’s important to keep track of what you eat, at least for the first while.
(Click here to get my free tinnitus trigger journal worksheet, which allows you to track your diet—including sodium—and many other lifestyle and environmental factors to help you discover your tinnitus triggers.)
It’s also important to spread out your sodium consumption as evenly as possible over the course of a single day. Often, one sodium-heavy meal is enough to trigger my symptoms, even if I’ve kept my overall consumption under my daily limit.
The important variable here is sodium concentration in the body. By spreading out your sodium intake, you can avoid major spikes in sodium concentration at any one time and reduce the overall impact on your symptoms.
Strategies for grocery shopping
Your first line of defense when grocery shopping for a low-sodium diet are FDA nutrition labels. There is sodium in almost everything we eat, but you won’t know if you don’t check the sodium content on the label.
Almost always, one brand will have less–sometimes a lot less–sodium than others when considering a specific food item. Sometimes, all you need to do is switch brands to maintain a lower sodium diet.
'Low sodium' labels can be misleading
It’s also important to know that marketing slogans like “Low Sodium” and “Reduced Sodium” can be deceiving, and often only signify that there is less sodium than the original. Get in the habit of checking and comparing labels on everything you purchase.
When you go grocery shopping, keep in mind that the majority of packaged products are processed foods and very high in sodium. Always double-check the labels on anything that comes in a can, box, or bag, has a long list of ingredients, or is frozen or dehydrated.
Sauces, dressings, marinades, dry rubs and condiments are often high in sodium. As are many breads, cheeses, yogurts, soups, canned meats, tuna fish, cold cut deli meats, crackers, cookies, chips and cereals.
If it sounds like you have to worry about almost everything in the grocery store, you’re right. But the type of grocery store you shop at can make a difference. In my experience, premium grocery stores like Whole Foods, Sprouts, and Fresh Market have far more low-sodium options, especially when it comes to snacks.
Planning low-salt meals and snacks
When planning meals, it’s important to understand that every component of the meal has some amount of sodium, and it all adds up.
For example, let’s take a look at the sodium content in a simple turkey sandwich that you might eat for lunch. The average slice of bread has 125-250 mg of sodium, so before we add anything else, we’re already at 250-500 mg.
Next up is the turkey. Unless you are cooking and slicing it yourself, deli meats are loaded with sodium–even the reduced-sodium options. At a local grocery store, turkey deli meats have around 670-800 mg sodium per serving. Even the reduced sodium turkey breast deli meats have 360 mg per serving.
A single slice of provolone cheese adds another 250 mg sodium, and if we add mustard, depending on the brand, it’s another 60-120 mg per teaspoon.
Assuming you are following the recommended serving size of each component, which is unlikely, this plain turkey sandwich can add up to more than 1,540 mg per serving.
And that’s just one simple example–most of your meals will be more complicated. You have to take the whole meal into account and it’s a lot to think about, but it does get easier over time.
Salty food preference is actually an acquired taste
One of the biggest obstacles to adopting a low-sodium diet is your sense of taste, especially if you’re used to a high-sodium diet.
If you just take out the salt, meals will taste pretty bland. You will likely experience salt cravings as well, which doesn’t make it any easier.
But a preference for salty food is actually an acquired taste and can be unlearned. So if you struggle with the low-sodium diet at first, know that after a little bit of time, the cravings will dissipate and the higher sodium foods you used to enjoy will start to taste terrible.
After a while, you will develop a new appreciation for the foods you enjoy. The flavors of the actual ingredients become more important and much more prominent.
Tips for cooking with less salt
In the meantime, however, you don’t have to sacrifice flavor when you cut out the salt. Many other spices and ingredients can pick up the slack.
Salt has an acidic taste, so finding and using other acidic ingredients, like lemon, is a great strategy. Both fresh lemon and lemon zest can add a savory flavor to a meal that is somewhat similar to salt.
Some other good spices and ingredients to explore are cumin, rosemary, lemongrass, star anise, thyme, cilantro, coriander, gomasio (made from ground and dry roasted sesame seeds), basil, garlic powder, black pepper, onion powder, cayenne and tarragon.
There are many sodium-free spice blends you can try well. For example, Mrs. Dash Seasonings, which have zero sodium, can be found at most grocery stores in many different flavors. And it’s not the only brand–many smaller artisan companies produce gourmet, sodium-free spice blends, marinades, and sauces as well.
What about low-sodium snacks?
Snacking is another challenge because snack foods are often processed foods that tend to be higher in sodium.
When I first changed my diet, I struggled with snacking more than anything else. I just didn’t know what to eat other than fruits and vegetables. But when I finally found snacks that I didn’t have to worry about, regardless of the serving size, it made the whole diet a lot more manageable.
A good strategy here is to find snacks that have 50-80 mg of sodium per serving or less. But it’s especially worth the effort to find enjoyable snacks with 20 mg or less.
Serving sizes are almost always smaller than you think, and it’s tough when you want more but have to stop after one serving because of sodium content.
If you can find tasty snacks that have 20 mg of sodium or less, you won’t have to worry about sodium at all. Even if you eat five servings, you won’t be making much of a dent in your daily allowance.
Premium grocery stores are going to be your best bet to find these ultra-low-sodium snacks and tend to have a better selection.
Just to give you an idea, some of my favorite low-sodium snacks (that I’ve found at the local Whole Foods) are unsalted potato chips, unsalted trail mix, 85% dark chocolate bars, and banana chips.
Take the time to find the low-sodium snacks you enjoy. It can make a huge difference in your mindset and help you to maintain the diet long-term.
Going out to eat on a low-sodium diet
Eating out on a low-sodium diet brings a whole a new set of challenges into the equation. But with a little bit of planning, you can still go out and have a good time.
Most restaurants are happy to accommodate dietary restrictions, but you have to be assertive with your server. Chefs love to cook with salt and tend to season with a heavy hand, so simply asking for less salt isn’t a good strategy–it still might be too much.
Instead, you need to be specific in your request and ask if a specific dish and its sides can be prepared without salt. Let them know that you have a medical condition so they understand that it’s not just a preference, that you actually need it without salt. Servers know people have dietary restrictions and will not be upset with the request.
You can ask for recommendations, too. Your server likely has a good idea of what can be ordered without salt.
Some restaurants will have fewer low-sodium options than others, but don’t let that hold you back from eating out with family or friends. I’ve never been to a restaurant that didn’t have at least something I could order.
Fish is often a good choice because it’s usually cooked to order and can be made without salt, even when all the other meats have been pre-seasoned.
But when all else fails, you can always just order a salad and have your server bring you oil and vinegar for dressing. If they can add an unsalted grilled chicken breast or some other protein, even better.
Lastly, when your food arrives, make sure to double check with the server that it was in fact prepared without salt. If they aren’t sure, or if it tastes salty, send it back.
I always feel bad when I have to send my food back, and in the past, I didn’t always speak up. But it’s never worth triggering your symptoms over such an easy-to-fix mistake.
Your server won’t be upset, either–the money doesn’t come out of their pocket and they want to make you happy to earn better tips.
Traveling on a low-salt diet
When I first went low-sodium, vacations were difficult. Between the junk food at the airport and going out to eat for every meal, my first few vacations were a disaster. Even when I managed to keep it together, my symptoms were through the roof by the end of the trip.
Luckily, I’ve learned to make traveling on a low-sodium diet a lot easier.
First and foremost, one of the simplest strategies is to bring food with you. You can’t bring liquids through TSA checkpoints, but you can bring food. I generally eat a meal before I head to the airport and pack a bunch of snacks in my carry-on bag.
If they are serving meals on your flight, call the airline ahead of time and ask for a low-sodium meal. Airlines will always accommodate dietary restrictions, and often the replacement meal is higher quality than the standard fare.
Once you arrive at your destination, it’s helpful to stop by a local grocery store to pick up additional low-sodium snacks and fresh foods. Otherwise, you may be left with the minibar, hotel gift shop, or whatever food your hosts have on hand.
Lastly, and arguably most importantly, it’s a good strategy to spend time researching menus. I know it’s not always fun to have all your meals planned out, but nothing ruins my vacation faster than a terrible tinnitus spike or Meniere’s flare up.
At the very least, identify and make reservations at the restaurants with the best low-sodium options ahead of time.
Final thoughts on Meniere's and salt
In the early days of my Meniere’s diagnosis, salt was one of my biggest triggers. Yet it still took a while for me to get serious with the diet.
It was hard at first and I really struggled for a few weeks. I didn’t have much guidance and I was making a lot of other difficult lifestyle changes at the same time. But my symptoms continued to improve, and that was all the motivation I needed to keep going.
After a month or two, it just became a part of my life. My taste buds adapted, my preferences changed, and in the end, it was worth the initial struggle.
It’s important to remember that a low-sodium diet is by no means the end all be all of managing a chronic condition like tinnitus or Meniere’s disease. I do a lot on an ongoing basis to keep my symptoms in check.
But if sodium makes your symptoms worse, I encourage you to give the diet and these suggestions a try. Even if it only raises your quality of life slightly, every little bit counts.
Tackling Tinnitus: Read more of Glenn Schweitzer's columns
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