Vitamin deficiency vertigo. Vitamin D Supplementation for Benign Paroxysmal Positional Vertigo: A Comprehensive Analysis

28.07.202308.07.2023 by alexxlab

How does vitamin D supplementation affect benign paroxysmal positional vertigo. What are the key findings of the longitudinal clinical study on vitamin D and BPPV. How can vitamin D deficiency impact vertigo symptoms and recurrence rates. What is the relationship between vitamin D levels and vestibular function in older adults. How effective are vitamin D supplements in improving muscle strength and balance in BPPV patients.

Содержание

Understanding Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV) is a common vestibular disorder characterized by brief episodes of vertigo triggered by changes in head position. This condition can significantly impact an individual’s quality of life and daily functioning. To better understand BPPV, it’s essential to explore its underlying mechanisms and potential contributing factors.

What causes BPPV? The condition results from the displacement of otoconia (calcium carbonate crystals) within the semicircular canals of the inner ear. These displaced crystals disrupt the normal fluid movement in the canals, leading to false signals of motion being sent to the brain. This miscommunication results in the characteristic spinning sensation experienced by BPPV patients.

Prevalence and Impact of BPPV

BPPV is particularly prevalent among older adults, with its incidence increasing with age. A study by Silva et al. (2015) reviewed 101 cases of BPPV, highlighting its significant impact on patients’ daily lives. The condition can lead to:

Increased risk of falls
Reduced mobility
Anxiety and depression
Decreased overall quality of life

These findings underscore the importance of effective management strategies for BPPV, including the exploration of potential contributing factors such as vitamin D deficiency.

The Role of Vitamin D in Vestibular Function

Vitamin D, often referred to as the “sunshine vitamin,” plays a crucial role in various physiological processes, including bone metabolism, muscle function, and immune regulation. Recent research has shed light on its potential involvement in vestibular health and the development of BPPV.

How does vitamin D influence vestibular function? Vitamin D receptors are present in the vestibular system, suggesting a direct role in maintaining its proper function. Additionally, vitamin D is essential for calcium metabolism, which is critical for the formation and maintenance of otoconia in the inner ear.

Vitamin D Deficiency and BPPV Risk

Several studies have explored the relationship between vitamin D deficiency and BPPV. Jeong et al. (2013) found that patients with idiopathic BPPV had significantly lower serum vitamin D levels compared to healthy controls. This association raises an important question: Does vitamin D deficiency contribute to the development or recurrence of BPPV?

The potential mechanisms by which vitamin D deficiency may increase BPPV risk include:

Impaired calcium metabolism affecting otoconia formation
Reduced muscle strength and balance control
Altered immune function in the inner ear

These findings highlight the need for further investigation into the role of vitamin D in vestibular health and BPPV management.

Longitudinal Clinical Study: Vitamin D Supplementation and BPPV

The featured longitudinal clinical study aimed to investigate the influence of supplemental vitamin D on the intensity of BPPV. This research provides valuable insights into the potential therapeutic role of vitamin D in managing this common vestibular disorder.

What were the key findings of the study? The research demonstrated that vitamin D supplementation in BPPV patients with vitamin D deficiency led to:

Reduced intensity of vertigo symptoms
Decreased frequency of BPPV recurrence
Improved overall vestibular function

These results suggest that addressing vitamin D deficiency may be an important adjunctive treatment strategy for BPPV patients.

Study Design and Methodology

The longitudinal study followed BPPV patients over an extended period, allowing for the assessment of long-term outcomes. Participants were divided into groups receiving vitamin D supplementation or placebo, with regular assessments of vertigo symptoms, vitamin D levels, and vestibular function.

How was the effectiveness of vitamin D supplementation measured? The researchers utilized various outcome measures, including:

Dix-Hallpike test results
Vertigo Symptom Scale scores
Serum vitamin D levels
Recurrence rates of BPPV episodes

This comprehensive approach provided a robust evaluation of the impact of vitamin D supplementation on BPPV symptoms and recurrence.

Vitamin D and Muscle Function in BPPV Patients

Beyond its direct effects on vestibular function, vitamin D plays a crucial role in maintaining muscle strength and balance. These factors are particularly relevant for BPPV patients, who often experience increased fall risk and reduced mobility.

How does vitamin D affect muscle function in BPPV patients? Research by Rejnmark (2011) and Muir et al. (2011) has demonstrated that vitamin D supplementation can lead to:

Improved muscle strength, particularly in the lower limbs
Enhanced balance and postural control
Reduced risk of falls in older adults

These benefits are especially significant for BPPV patients, as they may help mitigate the functional limitations associated with the condition.

Vitamin D and Fall Prevention in Older Adults

The relationship between vitamin D status and fall risk has been extensively studied in older populations. A meta-analysis by Bischoff-Ferrari et al. (2009) found that vitamin D supplementation significantly reduced the risk of falls in elderly individuals.

What are the potential mechanisms behind vitamin D’s fall-prevention effects? The vitamin’s impact on fall risk may be attributed to:

Improved muscle strength and power
Enhanced neuromuscular coordination
Increased bone density and skeletal integrity

These findings highlight the importance of maintaining adequate vitamin D levels in older adults, particularly those with vestibular disorders like BPPV.

Seasonal Variations in Vitamin D Levels and BPPV Incidence

An interesting aspect of vitamin D metabolism is its seasonal variability, primarily due to changes in sunlight exposure. Heidari et al. (2012) investigated seasonal variations in serum vitamin D levels, finding significant fluctuations throughout the year.

How do seasonal changes in vitamin D levels relate to BPPV incidence? Some studies have observed a higher incidence of BPPV during winter months when vitamin D levels tend to be lower. This correlation raises questions about the potential role of seasonal vitamin D deficiency in BPPV development and recurrence.

Implications for BPPV Management

Understanding the seasonal patterns of vitamin D levels and BPPV incidence may have important implications for patient care. Healthcare providers may consider:

Increased vigilance for BPPV symptoms during winter months
Seasonal vitamin D supplementation strategies
Patient education on maintaining adequate vitamin D levels year-round

These approaches could potentially help reduce the seasonal burden of BPPV and improve overall patient outcomes.

Combining Vitamin D Supplementation with Traditional BPPV Treatments

While vitamin D supplementation shows promise in managing BPPV, it is essential to consider its role in conjunction with established treatment modalities. The Epley maneuver and other canalith repositioning techniques remain the primary interventions for BPPV.

How can vitamin D supplementation complement traditional BPPV treatments? Integrating vitamin D therapy with standard care may offer several advantages:

Enhanced effectiveness of repositioning maneuvers
Reduced recurrence rates following successful treatment
Improved long-term outcomes and quality of life for patients

Future research should focus on optimizing combination therapies to maximize the benefits for BPPV patients.

Patient-Specific Considerations

When incorporating vitamin D supplementation into BPPV management, it is crucial to consider individual patient factors. These may include:

Baseline vitamin D status
Age and overall health status
Presence of comorbidities
Medication interactions

Tailoring the approach to each patient’s unique circumstances can help ensure safe and effective implementation of vitamin D therapy in BPPV care.

Future Directions in Vitamin D and BPPV Research

The findings of the longitudinal clinical study and related research open up exciting avenues for future investigation in the field of vitamin D and BPPV. Several key areas warrant further exploration to advance our understanding and improve patient care.

What are the priority areas for future research on vitamin D and BPPV? Some promising directions include:

Large-scale, multicenter clinical trials to confirm the efficacy of vitamin D supplementation
Investigation of optimal vitamin D dosing regimens for BPPV prevention and treatment
Exploration of potential synergistic effects between vitamin D and other micronutrients in vestibular health
Development of personalized treatment algorithms incorporating vitamin D status and other risk factors

Addressing these research questions could lead to significant advancements in BPPV management and prevention strategies.

Translating Research into Clinical Practice

As evidence accumulates supporting the role of vitamin D in BPPV management, it is essential to consider how these findings can be effectively translated into clinical practice. This process may involve:

Updating clinical guidelines to include vitamin D assessment and supplementation recommendations
Developing standardized protocols for vitamin D testing and monitoring in BPPV patients
Implementing educational programs for healthcare providers on the importance of vitamin D in vestibular health
Engaging in patient education initiatives to promote awareness of the vitamin D-BPPV connection

By bridging the gap between research and practice, we can work towards improving outcomes for individuals affected by BPPV and related vestibular disorders.

Influence of supplemental vitamin D on intensity of benign paroxysmal positional vertigo: A longitudinal clinical study

1. Heidari B, Heidari P, Samari E, Jalali MR. Frequency of vitamin D deficiency in common musculoskeletal conditions. J Babol Univ Med Sci. 2014;16:7–15. [in Persian] [Google Scholar]

2. Heidari B, Heidari P, Hajian-Tilaki K. High prevalence of vitamin D deficiency in women presenting to rheumatology clinic in north of Iran: An inverse relation with age. J Women’s Health Care. 2013;2:123. [Google Scholar]

3. Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Intern Med. 2011;2:205–12. [PMC free article] [PubMed] [Google Scholar]

4. Heidari B. Muscle strength, vitamin D deficiency and knee osteoarthritis. J Babol Univ Med Sci. 2012;14:84–91. [Google Scholar]

5. Heidari B. Knee osteoarthritis diagnosis, treatment and associated factors of progression: Part II. Casp J Intern Med. 2011;2:249–55. [PMC free article] [PubMed] [Google Scholar]

6. Heidari B, Heidari P, Tilaki KH. Relationship between unexplained arthralgia and vitamin D deficiency: a case control study. Acta Med Iran. 2014;52:400–5. [PubMed] [Google Scholar]

7. Heidari B, Javadian Y, Babaei M, Yousef Ghahari B. Restorative effect of vitamin D deficiency on knee pain and quadriceps muscle strength in knee osteoarthritis. Acta Med Iran. 2015;53:460–70. [PubMed] [Google Scholar]

8. Heidari B, Monadi M, Asgharpour M, et al. Efficiency of supplemental vitamin D in patients with chronic obstructive pulmonary disease. Br J Med Med Res. 2014;4:3031–41. [Google Scholar]

9. Silva C, Amorim AM, Paiva A. Benign paroxysmal positional vertigo–a review of 101 cases. Acta Otorrinolaringol Esp. 2015;66:205–9. [PubMed] [Google Scholar]

10. Lopez-Escamez JA, Gamiz MJ, Fernandez-Perez A, Gomez-Fiñana M. Long-term outcome and health-related quality of life in benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol. 2005;262:507–11. [PubMed] [Google Scholar]

11. Iwasaki S, Yamasoba T. Dizziness and Imbalance in the Elderly: Age-related Decline in the Vestibular System. Aging Dis. 2014;6:38–47. [PMC free article] [PubMed] [Google Scholar]

12. Rejnmark L. Effects of vitamin D on muscle function and performance: a review of evidence from randomized controlled trials. Ther Adv Chronic Dis. 2011;2:25–37. [PMC free article] [PubMed] [Google Scholar]

13. Muir SW, Montero-Odasso M. Effect of vitamin D supplementation on muscle strength, gait and balance in older adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2011;59:2291–300. [PubMed] [Google Scholar]

14. Hilton M, Pinder D. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev. 2004;2:CD003162. [PubMed] [Google Scholar]

15. Nunez RA, Cass SP, Furman JM. Short- and long-termoutcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2000;122:647–52. [PubMed] [Google Scholar]

16. West N, Hansen S, Møller MN, Bloch SL, Klokker M. Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome. Eur Arch Otorhinolaryngol. 2015 Mar 7; [Epub ahead of print] [PubMed] [Google Scholar]

17. Heidari B, Haji Mirghassemi MB. Seasonal variations in serum vitamin D according to age and sex. Caspian J Intern Med. 2012;3:535–40. [PMC free article] [PubMed] [Google Scholar]

18. Talaat HS, Kabel AH, Khaliel LH, Abuhadied G, El-Naga HA, Talaat AS. Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency. Auris Nasus Larynx. 2015 Sep 16; pii: S0385-8146(15)00203-5. doi: 10.1016/j.anl.2015.08.009. [Epub ahead of print] [PubMed] [Google Scholar]

19. Jeong SH, Kim JS, Shin JW, et al. Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol. 2013;260:832–8. [PubMed] [Google Scholar]

20. Suzuki T. Frontiers in vitamin D; basic research and clinical application Vitamin D and falls. Clin Calcium. 2011;21:71–9. [PubMed] [Google Scholar]

21. Mastaglia SR, Seijo M, Muzio D, et al. Effect of vitamin D nutritional status on muscle function and strength in healthy women aged over sixty-five years. J Nutr Health Aging. 2011;15:349–54. [PubMed] [Google Scholar]

22. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, et al. Fall prevention with supplemental and active forms of vitamin D: A meta-analysis of randomised controlled trials. BMJ. 2009;339:b3692. [PMC free article] [PubMed] [Google Scholar]

23. Boersma D, Demontiero O, Mohtasham Amiri Z, et al. Vitamin D status in relation to postural stability in the elderly. J Nutr Health Aging. 2012;16:270–5. [PubMed] [Google Scholar]

24. Cangussu LM, Nahas-Neto J, Orsatti CL, et al. Effect of isolated vitamin D supplementation on the rate of falls and postural balance in postmenopausal women fallers: a randomized, double-blind, placebo-controlled trial. Menopause. 2015 Nov 2; [Epub ahead of print] [PubMed] [Google Scholar]

25. Parham K, Leonard G, Feinn RS, et al. Prospective clinical investigation of the relationship between idiopathic benign paroxysmal positional vertigo and bone turnover: a pilot study. Laryngoscope. 2013;123:2834–9. [PubMed] [Google Scholar]

26. Talaat HS, Abuhadied G, Talaat AS, Abdelaal MS. Low bone mineral density and vitamin D deficiency in patients with benign positional paroxysmal vertigo. Eur Arch Otorhinolaryngol. 2015;272:2249–53. [PubMed] [Google Scholar]

27. Yu S, Liu F, Cheng Z, Wang Q. Association between osteoporosis and benign paroxysmal positional vertigo: a systematic review. BMC Neurol. 2014;14:110. [PMC free article] [PubMed] [Google Scholar]

28. Heidari B, Heidari P, Nourooddini HG, Hajian-Tilaki KO. Relationship between parity and bone mass in postmenopausal women according to number of parities and age. J Reprod Med. 2013;58:389–94. [PubMed] [Google Scholar]

29. Heidari B, Hoshmand S, Hajian K, Heidari P. Comparing bone mineral density in postmenopausal women with and without vertebral fracture and its value in recognizing high-risk individuals. East Mediterr Health J. 2010;16:868–73. [PubMed] [Google Scholar]

30. Heidari B, Javadian Y, Monadi M, Dankob Y, Firouzjahi A. Vitamin D status and distribution in patients with chronic obstructive pulmonary disease versus healthy controls. Caspian J Intern Med. 2015;6:93–7. [PMC free article] [PubMed] [Google Scholar]

31. Hajian-Tilaki K, Heidari B, Firouzjahi A, et al. Prevalence of metabolic syndrome and the association with socio-demographic characteristics and physical activity in urban population of Iranian adults: a population-based study. Diabetes Metab Syndr. 2014;8:170–6. [PubMed] [Google Scholar]

32. Prasad P, Kochhar A. Interplay of vitamin D and metabolic syndrome: A review. Diabetes Metab Syndr. 2015 Mar 6; pii: S1871-4021(15)00027-2. doi: 10.1016/j.dsx.2015 .02.014. [Epub ahead of print] [PubMed] [Google Scholar]

33. Hajian-Tilaki K, Heidari B. Prevalence of obesity, central obesity and the associated factors in urban population aged 20-70 years, in the north of Iran: a population-based study and regression approach. Obes Rev. 2007;8:3–10. [PubMed] [Google Scholar]

34. Hajian-Tilaki K, Heidari B. Childhood obesity, overweight, sociodemographic and life style determinants among preschool children in Babol, Northern Iran. Iran Public Health. 2013;42:1283–91. [PMC free article] [PubMed] [Google Scholar]

35. Hajian-Tilaki K, Heidari B. Prevalence of overweight and obesity and their association with physical activity pattern among Iranian adolescents aged 12-17 years. Public Health Nutr. 2012;15:2246–52. [PMC free article] [PubMed] [Google Scholar]

36. Waringhoff JC, Bayer O, Ferrari U, Straube A. Co-morbidities of vertiginous disease. BMC Neurol. 2009;9:29. [PMC free article] [PubMed] [Google Scholar]

37. Yamanka T, Fukuda T, Shirota S, et al. The prevalence and characteristics of metabolic syndrome in patients with vertigo. Plos One. 2013;8:e80176. [PMC free article] [PubMed] [Google Scholar]

Two Common Nutrients Might Keep Vertigo at Bay

WEDNESDAY, Aug. 5, 2020 (HealthDay News) — Taking in extra vitamin D plus calcium might cut your odds of getting a debilitating form of vertigo, new research shows.

The Korean study focused on benign paroxysmal positional vertigo (BPPV), a sudden spinning sensation that’s commonly triggered by changing your head position. According to the study authors, about 86% of people who have this type of vertigo find that it affects their life, even resulting in missed days at work.

Often, the condition can be remedied by undergoing a specific type of head movement under a doctor’s supervision, according to researcher Dr. Ji-Soo Kim, of Seoul National University College of Medicine.

But the new findings now suggest that for folks with BPPV, “taking a supplement of vitamin D and calcium is a simple, low-risk way to prevent vertigo from recurring,” he said in a news release from the American Academy of Neurology.

Kim added that the treatment “is especially effective if you have low vitamin D levels to begin with.”

One U.S. expert said the study adds to prior data supporting the therapy.

The study “represents the best evidence to date that a simple over-the-counter treatment of this common condition affecting adults over the age of 50 is safe and effective,” said Dr. Anthony Geraci. He directs neuromuscular medicine for Northwell Health in Great Neck, N.Y.

In their study, Kim’s team recruited more than 900 people with BPPV. Participants were divided into two groups. In the first group, those with low vitamin D levels (below 20 nanograms per milliliter) were given supplements with 400 international units of vitamin D and 500 milligrams of calcium, twice daily, while those with healthier vitamin D levels (equal to or greater than 20 ng/mL) were not given supplements.

The second group was not given supplements regardless of their vitamin D levels.

The result: People taking the supplements experienced a 24% reduction in their rate of vertigo compared with those not taking supplements, the researchers found.

The greatest benefit was seen in those who were more deficient in vitamin D to begin with. People whose vitamin D levels were lower than 10 ng/mL saw a 45% reduction in vertigo recurrence, while those with vitamin D levels of 10 to 20 ng/mL saw only a 14% reduction, the researchers found.

In all, 38% of people who took vitamin D/calcium experienced another episode of vertigo, compared with 47% of those who weren’t taking them.

“Our results are exciting because, so far, going to the doctor to have them perform head movements has been the main way we treat benign paroxysmal positional vertigo,” Kim said. “Our study suggests an inexpensive, low-risk treatment like vitamin D and calcium tablets may be effective at preventing this common, and commonly recurring, disorder.”

Geraci noted there are already good reasons to get more vitamin D and calcium into your diet.

“The beneficial effects of vitamin D and calcium supplementation have previously been shown to improve cardiovascular health, bone health and reduction in fractures due to falls in the elderly,” he noted.

Dr. Sami Saba is a neurologist at Lenox Hill Hospital in Great Neck, N.Y. He said that “the standard treatment for BPPV is a repositioning maneuver that puts the crystals in the inner ear that have been displaced back where they belong.”

However, Saba added, “the symptoms often recur after such a maneuver, and until now there hasn’t been any proven treatment to prevent recurrence.”

Vitamin D plus calcium might change all that, Saba said — and there’s logic behind the treatment.

“The inner ear crystals, or otoconia, are partially made of calcium carbonate, and vitamin D is essential for calcium metabolism, so the mechanism of the treatment makes sense,” he said.

The report was published online Aug. 5 in the journal Neurology.

More information

For more on vertigo, head to the U.S. National Library of Medicine.

SOURCES: AnthonyGeraci, MD, director, neuromuscular medicine, Northwell Health, Great Neck, N.Y.; Sami Saba, MD, neurologist, Lenox Hill Hospital, New York City; American Academy of Neurology, news release, Aug. 5, 2020

Vitamin D deficiency can cause dizziness attacks

Health

To find out, Egyptian scientists conducted a study on 40 patients diagnosed with benign paroxysmal positional vertigo. Translated into human – dizzy with a sharp change in posture.

August 24, 2021

Source:: iStock/Getty Images

About 20 percent of adults complain of dizziness. Many of them are not due to problems with neurology, but with disorders in the vestibular apparatus. Calcium carbonate crystals (otoconia) enter the semicircular canals and cause benign paroxysmal positional vertigo (BPPV). It occurs most often due to a change in the position of the head, tilting, turning when you get out of bed or lie down in it. Therefore, the disease has another name – positional vertigo. It can be accompanied by mild nausea, even vomiting, and does not last long – a few minutes. Scientists have suggested that the process may be affected by a lack of vitamin D.

“We set out to evaluate the association between recurrent BPPV attacks and vitamin D deficiency,” Aida Ahmed Abdelmaqsoud, co-author of the ENT department at the University of the South Valley School of Medicine, Egypt, explained the purpose of the study in the journal Nature.

Vitamin D and benign paroxysmal positional vertigo

PUBLICATIONS

Relevance

Benign paroxysmal positional vertigo (BPPV) is one of the most common diseases of the peripheral part of the vestibular analyzer. The main clinical manifestation of BPPV is intermittent short-term attacks of dizziness when the head position changes. It is believed that BPPV is the most common cause of dizziness (18-25% of all cases of dizziness).

Despite the benign nature of the disease, the presence of BPPV is associated with a decrease in the quality of life. However, there are no effective methods to prevent BPPV. Several observational studies have found that BPPV patients are more likely than the general population to have vitamin D deficiency and decreased bone mineral density. In this connection, the purpose of the study under discussion was to evaluate the effectiveness of vitamin D in the prevention of BPPV.

Methods

The randomized trial was performed in 8 hospitals in South Korea between December 2013 and May 2017.

Its participants were patients with BPPV. All of them were randomized into two groups: vitamin D therapy 400 IU in combination with 500 mg calcium carbonate twice a day (if the concentration of vitamin D was less than 20 ng/ml) and standard observation.

The primary end point was the annual recurrence rate. The mean follow-up period for participants was 1 year.

Results

The study participants were 1050 patients with BPPV.
It was found that, on average, during the study period, relapses of dizziness were observed with a frequency of 0.83 cases per year in the vitamin D group and 1.1 cases per year in the standard observation group (hazard ratio 0.76; 95% confidence interval 0.66-0.87; p<0.001. In addition , in the active therapy group, BPPV relapses were reported in fewer patients (37.8% vs. 46.7%; p=0.005).
The estimated number of patients who needed to be treated with vitamin D to prevent recurrence of BPPV was 3.7 (95% CI 2.5-7.14).

Conclusion

Thus, the results of the present study demonstrate that in patients with BPPV, vitamin D and calcium supplementation reduces the frequency of relapses.