Saturday, November 18th, 2017

Life Style


appleWhat can you do to help yourself? Good question! Modify your habits and diet to lower stress, caffeine, alcohol, tobacco and salt. A low salt diet will reduce your body fluids, in turn resulting in less ear pressure, not to mention the benefits for your circulatory system. But low salt diets might be harder to achieve than you think. Unfortunately, prepared foods and eating out may become a thing of the past. Here are some helpful hints:

  • “Normal” salt diet … … 1100 – 3300 mg/day
  • “High” salt diet … … 4000 – 6000 mg/day
  • “Low” salt diet … … 400 – 1000 mg/day

Physicians may initially suggest a partially reduced salt level, in the range of 1000 – 2000 mg/day, to see if symptoms can be alleviated. Maintaining a sodium intake below 2000 mg/day requires considerable effort. Eating in restaurants causes difficulty as the majority of restaurant food is salted. To maintain a low sodium diet, you need to scrutinize the “Nutritional Information” boxes on food cartons. The amount of salt is listed as “sodium”. Choose those products which would give you the least sodium, based on the amount of product you eat. Note that many “high salt” products (ketchup, salad dressing, corn chips) show relatively low sodium values based on very small serving portions (who eats only 12 corn chips at a sitting??). What is important is the total amount of sodium you are eating each day. As shown in the list below, fresh fruits and vegetables have low sodium content, but avoid adding salt to vegetables during preparation. The following advice may help maintain a low salt intake.

  • Do not use salt at the table
  • Reduce the salt used in food preparation. Try 1/2 teaspoon when recipes call for 1 teaspoon. Many cakes and desserts can be prepared without adding salt.
  • Use herbs and spices for flavoring meats and vegetables instead of salt.
  • Avoid salty foods such as processed meat and fish, pickles, soy sauce, salted nuts, chips and other snack foods.
  • Check every “Nutritional Information” label before you buy or use a product. Note sodium and portion size information.
  • A cautionary note:The body possesses exquisite systems which accurately regulate body sodium. The goal of a low sodium diet is to “push” this regulation system toward one end of its range,without pushing it to the limit when body sodium starts falling. Although a low-salt diet if difficult to achieve, be aware that the low-salt diet can be “overdone” with possible adverse consequences. For this reason, if your vestibular symptoms persist, do not keep decreasing your salt intake. The level of sodium intake should be decided in consultation with your physician or nutritionist. Lower levels require more rigorous monitoring by your physician. You should also be aware that your body can lose sodium by a number of routes other than in the urine. Sweating, vomiting and diarrhea can all produce significant sodium loss. In addition, other diseases, such as those which impair kidney function, may result in greater than normal sodium losses. In the event of adverse symptoms, you should contact your physician.

    Maintaining a low-sodium diet is more difficult if you use some types of “softened water”.

    To understand the problem you need to know a little about how water softeners work. They usually contain a chamber filled with beads or a chemical matrix called zeolite. This is an ion-exchanger and acts by replacing the chemicals in the water that make it hard (calcium and magnesium) with another ion, usually sodium. When the beads are “full” of calcium and magnesium, they are regenerated by passing a high level of sodium chloride through the exchanger, which displaces the calcium and magnesium and replaces it with sodium. Now, when the beads are exposed to hard water again, they continue to do their job of swapping calcium and magnesium for sodium.

    For most individuals, the amount of sodium present in softened water is not a health problem. If however, you are trying to maintain a low sodium diet, this can add to your difficulties.

    The amount of sodium in softened water can vary. According to a paper by Yarows et al., (Sodium concentration from water softeners, Arch Intern Med. 1997 Jan 27;157(2):218-22) the sodium concentration of softened well water averaged 278 mg/L but the variation was very large. Levels from 46 to 1219 mg/L were observed. 17% of households had sodium levels above 400 mg/L. The amount of sodium that gets added depends on how hard the water is to start with. If the water is very hard then the sodium level will be higher, as shown in the table below.

    Initial Hardness
    (Grains CaCO3/gallon)

    Na added
    mg/liter

    10 75
    20 150
    30 225

    The above figures are the amount that is in addition to the sodium content before the water is softened. If you are trying to limit your sodium intake to 1500 mg/day, then drinking 2 liters of water with 400 mg/L sodium over the course of a day will represent more than half your daily limit! In the same study, the mean sodium concentration of municipal, non-softened water was 110 mg/L (range 0 – 253 mg/L).

    There are types of water softeners that do not add sodium to the water. Alternatively, if the ion-exchanger type of water softener is regenerated using potassium chloride, instead of sodium chloride, then potassium would be added to the water instead of sodium as the water was softened. However, in some patients with renal or cardiac disease, diabetes or high blood pressure, there can also be complications due to increased potassium intake so this should only be performed in consultation with your physician.

    Finally, drinking LESS water is NOT a solution to this problem. In order to clear sodium from the body effectively, the kidneys need water. Higher rates of urine production allow greater amounts of sodium to be cleared, which is why diuretics are commonly prescribed to Meniere’s patients. Ideally, you should follow the widely recommended guideline of drinking 8 glasses of water, each of 8 oz, per day.

    Buying distilled water or using reverse-osmosis purification of your water for drinking may be an option.

    I would be interested in hearing from patients who have previously dealt with this problem. I’m particularly interested in whether your symptoms changed after installing or removing a water softener and whether water softeners have any impact on the management of Meniere’s disease.

    Page generated by: Alec N. Salt, Ph.D.,
    Cochlear Fluids Research Laboratory,
    Washington University, St. Louis

    Sodium Content of Common Foods

    All values are given in mg of sodium for a 100 g (3.5 oz) food portion. These values are a guide. More accurate values are given in the Nutritional Information on the package of most products, in the form of mg of sodium per serving.

    • Apple, raw unpeeled 1
    • Apple juice, bottled 1
    • Applesauce, sweetened 2
    • Asparagus, cooked 1 (regular canned 236)
    • Avocado 4
    • Bacon, cooked 1021
    • Bacon, Canadian 2500
    • Baking powder 11,000
    • Banana 1
    • Barley, pearled 3
    • Beans, Lima 1 (regular canned 236)
    • Beans, snap green, cooked 4 (regular canned 236)
    • Beans, white common, cooked 7
    • Beans, canned with pork and tomato sauce 463
    • Bean sprouts, cooked 4
    • Beef, roasted broiled or stewed 60
    • Beef, corned 1,740
    • Beef hash, canned 540
    • Beef, dried 4,300
    • Beef hamburger 47
    • Beef pie or stew, commercial 400
    • Beets, cooked 43 (regular canned 236)
    • Beverages, beer 7
    • Beverages, liquor 1 (avoid Margarita’s with salt!)
    • Beverages, wine 5
    • Beverage, soda 0 to 100 (check can)
    • Beverage, fruit drink 0
    • Beverage, water 0
    • Biscuits 630
    • Blackberries 1
    • Bluefish, cooked 104
    • Bouillon cubes 24,000
    • Bread 300 to 500
    • Broccoli, cooked 10
    • Brussel sprouts, cooked 10
    • Butter, salted 826 (unsalted – less than 10)
    • Cabbage 20
    • Cakes 100 to 300
    • Candy, caramels, fudge 200
    • Candy, hard, marshmallow, peanut brittle 30
    • Cantaloupe 12
    • Carrots 40 (regular canned 236)
    • Cashews, unsalted 15
    • Cauliflower 10
    • Celery, raw 126 (cooked 88)
    • Cereals bran, wheat, crude 9
    • Cereals, commercial 700 to 1100
    • Cereal, Corn grits 1
    • Cereal, Cornmeal 1
    • Cereal, Farina, dry 2 (cooked salted or instant 160)
    • Cereal, Oatmeal, dry 2 (cooked salted 218)
    • Cereal, Rice flakes 987
    • Cereal, wheat flakes 1000
    • Cereal, wheat, puffed 4
    • Cereal, wheat, shredded 3
    • Cheese, cheddar 620
    • Cheese, processed 1189
    • Cheese, cottage 406
    • Cheese, cream 296
    • Cheese, Mozzarella 373
    • Cheese, Parmesan 1,862
    • Cheese, Swiss 260
    • Cherries, Raw 2
    • Chicken, cooked, without skin 60 to 80
    • Chicken pot pie, commercial 411
    • Chickpeas, dry 8
    • Chicory 7
    • Chili con carne, canned with beans 531
    • Chili powder with seasonings 1574
    • Chocolate, plain 4
    • Chocolate syrup 52
    • Clams, raw soft 36
    • Clams, hard, round 205
    • Cocoa, dry 6
    • Cocoa, processed 717
    • Coconut, fresh 23
    • Coffee, instant, dry 72
    • Coffee, beverage, 1
    • Collards, cooked 25
    • Cookies, Fig bars 252
    • Cookies, oatmeal 170
    • Cookies , plain 365
    • Corn, sweet, cooked 0 (regular canned 236)
    • Cowpeas, dry, cooked 8
    • Crabmeat, canned 1000
    • Crackers, Graham 670
    • Crackers, saltines 1,100
    • Cranberry juice or sauce 1
    • Cream 40
    • Cucumber 6
    • Dates 1
    • Doughnuts 500
    • Duck 74
    • Eggplant, cooked 1
    • Egg, whole, raw 74 (whites 152, yolk 49)
    • Endive, curly 14
    • Figs 2
    • Flounder 78
    • Flour 2
    • Fruit cocktail 5
    • Gelatin, dry 0 (sweetened, ready-to eat 51)
    • Grapefruit, fresh, canned or juice 1
    • Grapes 3
    • Haddock, raw 61 (battered 177)
    • Heart, beef 86
    • Herring 74
    • Honey 5
    • Honeydew melon 12
    • Ice cream, vanilla 87
    • Jams and preserves 12
    • Jellies 17
    • Kale, cooked 43
    • Lamb, lean 70
    • Lard 0
    • Lasagna 490
    • Lemon, juice or fresh 1
    • Lettuce 9
    • Lime, fresh or juice 1
    • Liver, beef 184
    • Liver, pork 111
    • Lobster 210
    • Macaroni, dry 2 (commercial with cheese 543)
    • Margarine 987
    • Milk 50
    • Milk, buttermilk 130
    • Milk, evaporated 106
    • Milk, dried 549
    • Molasses, light 15 (Dark 96)
    • Muffins, plain 441
    • Mushrooms 14 (canned 400)
    • Mustard, prepared yellow 1,252
    • Mustard greens 18
    • Nectarine 6
    • Noodles, dry 5
    • Nuts, in shell 1 (processed nuts may contain high amounts of salt)
    • Oil, corn 0
    • Okra, 2
    • Olives, green 2,400
    • Onions, green 5 (mature 10)
    • Orange peeled, juice, canned or juice 1
    • Oysters, raw 73
    • Pancakes 425
    • Papayas, raw 3
    • Parsley 45
    • Parsnips, cooked 8
    • Peaches 2
    • Peanuts, roasted 5 (salted 418)
    • Peanut butter 607
    • Pears 2
    • Peas, cooked 2 (regular canned 236)
    • Peas, dried 40
    • Pecans, shelled 0
    • Peppers, green 13
    • Perch 79
    • Pickles, dill 1,428
    • Pickles, relish, sweet 712
    • Pie 250 to 450
    • Pie crust, baked 617
    • Pike, walleye 51
    • Pineapple, raw or canned 1
    • Pizza, cheese 702
    • Plums 2
    • Popcorn, salted with oil 1,940
    • Pork 65
    • Pork, cured ham 930
    • Pork canned ham 1,100
    • Potatoes, baked or French fried, 2 to 6
    • Potatoes, mashed salted 331
    • Potato chips, up to 1000
    • Pretzels 1680
    • Prunes 4
    • Pumpkin, canned 2
    • Radishes 18
    • Raisins, dried 27
    • Raspberries 1
    • Rhubarb 2
    • Rice, dry 5 (cooked salted 374)
    • Rolls, bread or sweet 400 to 550
    • Rutabagas 4
    • Rye wafers 882
    • Salad dressing 700 to 1300
    • Salmon 64 (canned 387)
    • Sardines, canned 400
    • Sauerkraut 747
    • Sausage, pork 958
    • Sausage, Frankfurter 1,100
    • Sausage, Bologna 1,300
    • Scallops, 265
    • Shrimp 150
    • Soup, canned 350 to 450
    • Spaghetti, dry 2
    • Spaghetti with meatballs, canned 488
    • Spinach, raw 71 (cooked 50)
    • Squash 1
    • Strawberries 1
    • Sugar, white 1 (brown 30)
    • Sunflower seeds 30
    • Sweet potatoes 12
    • Syrup 68
    • Tapioca, dry 3
    • Tomato 3 (canned 130)
    • Tomato ketchup 1,042
    • Tomato juice, canned 200
    • Tongue, beef 61
    • Tuna in oil 800
    • Turkey, 82
    • Turnips 34
    • Veal 80
    • Vinegar 1
    • Waffles 475
    • Walnuts 3
    • Watermelon 1
    • Wheat germ 827
    • Yeast, compressed 16 (dry , active 52)
    • Yogurt 46