Dizziness and Vertigo

Health and Fitness [1405.17]

Dizziness and Vertigo

Disclaimer: if you are experiencing dizziness or vertigo, contact your health care provider! Come back after you're feeling better.

As I mentioned in part 3 of the low carb diet series, during the first month of keto-adaptation I experienced some dehydration and cramping, which are typical symptoms if you do not sufficiently increase both fluid and salt comsumption to compensate for the extra water and sodium excreted by the kidneys when in nutritional ketosis. Other symptoms, which I also experienced to some extent, include dizziness, weakness, fatigue, headaches, and hypotension (low blood pressure). All these are exacerbated by physical exertion or heat stress. I was unaware of the heat aspect, and as a result ended up feeling like I was on the verge of heat stroke a couple of times during those first 4 weeks (July-August 2012).

The Art and Science of Low Carbohydrate Living explains how sodium depletion can lead to reduction of plasma volume, and eventually to potassium excretion (transcription found on this low carb forum):

Sodium is the positively charged ion that the body uses in its circulating fluid (serum and extracellular fluid) to balance the concentration of positive charges from potassium that is concentrated inside cells. The membrane enzyme sodium-potassium ATPase is the ion pump that keeps both of these cations separated and in the right place. For nerves, muscles, and other cellular functions to work right, neither of these ion concentrations can deviate much from that of the other. With severe sodium restriction (like 1.3 grams per day, combined with the natriuretic effects of carbohydrate restriction), the body responds first by mobilizing any excess extracellular fluid (which is why bloating disappears) and then by contracting its circulating volume. It is this contracted circulating volume that causes dizziness, headache, and ease of fatigue.

At some point, when confronted with this low sodium intake plus carbohydrate restriction, most people’s defense mechanisms can’t maintain normal mineral balances. So the body’s next level of defense is for the adrenal gland to secrete the hormone aldosterone, which makes kidney tubular cells excrete potassium in order to conserve sodium. That is, the body wastes some of its intracellula potassium in order to cling to whatever sodium it can. However unless there is copious potassium coming in from the diet, this excess urinary potassium comes from the body’s potassium pool inside cells. Two things then happen. First, nerve and muscle cells don’t work well, leading to cardiac dysrhythmias and muscle cramps. Second, because potassium is an obligate component of lean tissue, the body starts losing muscle even if there’s plenty of protein in the diet.

Yikes! Fortunately, according to the authors, all this can be easily avoided by taking an extra 1-2 grams of sodium per day (they recommend consuming a couple of cups of bouillon daily, including a cup 30 minutes before exercise or heat stress).

Recently, I experienced some vertigo after starting a strength training program. I was also feeling dehydrated, so my first instinct was to up my fluid and sodium intake. However, after a few days, it was clear that sodium depletion wasn't the problem (and in retrospect it doesn't really make sense that it would be).

My friend, Ted, from kendo mentioned seeing a program on Japanese television demonstrating physical therapy to cure the type of vertigo involving grains of "sand" in the inner ear. I could not believe my problem was this type of vertigo, since the only new thing in my life was the strength training (and it was a very moderate program at that). However, applying google-fu, I eventually found the following:

benign paroxysmal positional vertigo (BPPV) is the name of this type of vertigo
according to the Hallpike test, I had BPPV in my right ear
note: this explained why it was worst when I got up (I roll out of bed to the right)
the Epley maneuver has a very high success rate, and in fact did the trick for me
here is a video demonstrating both the Hallpike test and the Epley maneuver
(apply your own google-fu to find many others)
"Doctor and invention outlast jeers and threats" is the astonishing story of Dr. John Epley and his procedure

Apparently, perhaps half of all BPPV cases are "idiopathic" (occur for no known reason). My best guess is mine may have been triggered when I laid back on a weight bench to work with some light dumbbells.

Remember my disclaimer!