I have come across a few published articles that cover the high incidence of systemic autoimmune diseases in patient's with Menière's Disease, for example [1, 2], but I always wondered if the other way around could also be a possibility. I mean, one of the health disturbing aspects I have seen reported in Sjogren's patients has to do with events of labyrinthitis (inflammation of part of the inner ear) or pressure put in the inner ear by a very inflamed parotid gland that can trigger vestibular disturbance (i.e., related to the inner ear and sense of balance). However, since Sjogren's is so intrinsically related to metabolism and diet, I have also learned of the nefarious effects caused by certain foods and beverages in a patient's balance, vestibular 'equilibrium' and an impaired digestive tract.
It is easy to establish a chain of consequences that is potentially triggered at any point of the affected physiological system, one that in a healthy person can be counteracted and re-established to normality, but that in an autoimmune one will have to be compensated with potential biological actions that can, on their own, eventually initiate particular imbalances elsewhere in the system.
However, autoimmunity (where Sjogren's sits as a syndrome) appears to be quite associated with Menière's disease (a pathophysiology marked by vertigo, tinnitus, high pressure felt at the inner ear, and in grave cases even resulting in hearing impairment) [1]. Menière's can play episodically through events usually marked by inflammation at an associated contiguous point, even resulting in potential bilateral vestibular hypofunction (in the worst scenarios). But just as Sjogren's syndrome, also Menière's disease is a chronic condition, hence persistent and recurrent, where the associated vertigo episodes can last from a only a few minutes to excruciating long hours. Now imagine the impact on the performing of regular activities such as driving, operating machinery, walking, etc.
Where some doctors might immediately resort to prescribing prochlorperazine maleate or any other typical phenothiazine indicated for severe nausea, from a personal perspective a patient must also learn how to identify the triggers that typically promote the onset of such vestibular disturbance. In different examples to me presented, I had the chance to read that this can be very closely associated to dietary options alongside the typical promoters, such as stress, anxiety, opportunistic viral infections that take advantage of structurally-compromised tissues, and the consumption of desiccants (such as alcohol, spicy foods, etc.).
Add to all this the still quite abstract concept of leaky gut, a disorder that has not yet been fully clinically accepted and medically characterised, but one that it is thought to involve cracks in the intestinal tissue that will allow the passage of unexpected macromolecules to the blood stream... molecules that due to their size, composition and complexity were not supposed to be allowed in the circulatory system, and that will, therefore, promote physiological disturbance. It is extremely difficult to find literature to support the idea of a leaky gut, but the same people who have been blaming gluten for several metabolic and physiological ailments have now turned (no personal judgement here at all!) to the idea of a leaky gut - as the portal to disarray. From within a list of supposed complications one can identify the multifactorial Menière's disease [3]. And considering what the authors also debate, i.e., "that patients often complain of aspecific gastrointestinal symptoms associated with autonomic dysregulation, frequently outweighed by the otological manifestations", a recurrent cycle of afflictions is theoretically hereby established.
In a way, and as suggested in the image that I have edited and enclosed in the post, the metabolic dietary stressors will trigger a reinforced imbalanced immune response, that is already appanage of an autoimmune disease patient. However, in association with a debilitated gastrointestinal mucosa, be it in the stomach (as it occurs typically with reflux or H. pylori infections, for example) or at the intestinal tissue, the molecules unexpectedly absorbed into the bloodstream will add to the inflammatory dynamics and this will potentially increase the implications of ongoing inflammation at the vestibular domain. Ergo, making the vestibular tissues even more vulnerable to opportunistic viral infections, and affecting the profile of the naturally-occurring crystals in the inner ear's liquids (the endolymph and perilymph), consequently affecting the audiovestibular moiety, adding to the incidence and seriousness of the reported "dizziness, generalised, imbalance, ataxia, motion intolerance, positional vertigo, oscillopsia, and episodic vertigo" [2].
In that sense, it is my personal belief that dietary changes need to account for the supposed 'leakiness' of the gut, and might be able to help reduce (not cure!!!) the episodic occurrence of inflammation that affects equilibrium in an autoimmune patient. What do you have to say about it? Does it sound feasible?
[1] Gazquez, I., Soto-Varela, A., Aran, I. et al (2011). "High Prevalence of Systemic Autoimmune Diseases in Patients with Menière's Disease". PLoS One, 6(10): e26759.
[2] Girasoli, L., Cazzador, D., Padoan, R et al. (2018). "Autoimmunity and Otolaryngology Diseases - Update on Vertigo in Autoimmune Disorders, from Diagnosis to Treatment". Journal of Immunology Research, pp. 1-16.
[3] Berardino, F., Zanetti, D., Ciusani, E. et al (2018). "Intestinal permeability and Ménière's disease". Am J Otolaryngol, 39(2), pp. 153-156.
Original post photo by Omid Armin on Unsplash
