Wake up, drink coffee, go to work. That’s how most people start the day, many even prioritizing coffee over breakfast! But what happens if your doctor says that coffee, specifically caffeine, is problematic for you?
For those with vestibular disorders this is incredibly common. Caffeine is amongst the many triggers for dizziness, headache, and lightheadedness. Therefore, one of the first changes after being diagnosed with a vestibular condition are dietary restrictions. A Migraine or Ménière’s Disease Diet is not always easy, but good replacements can improve your day to day! There is alcohol-free beer & 0% ABV spirits that can be replacements for happy hour, and there is Swiss Water Process decaf coffee for continuity in your morning routine. Those with Vestibular Migraine, Secondary Endolymphatic Hydrops, and Ménière’s Disease will benefit most from dietary changes, especially those who are frequently or chronically dizzy. Caffeine and dizziness are partners in crime. Any small amount of caffeine, even a sip or two, can cause a dizzy-attack.
Caffeine is the ingredient that makes coffee dangerous for those with vestibular dysfunction. So, it would seem like decaf is a great alternative if you’re in need of caffeine-free-coffee. However the vestibular system is highly sensitive to caffeine, including in tea, chocolate, and the small amount in decaf coffee. The decaffeination process removes approximately 97% of all caffeine in a cup of coffee, which still leaves about 7mg per 8-ounce cup of coffee. Unfortunately, this small amount of caffeine is enough to cause you to have a dizzy episode.
In order to avoid even the 7mg of caffeine in decaf coffee, Swiss Water Processed coffee is the safest option. Additionally it avoids the use of Ethyl Acetate, the chemical used to take the caffeine out of the beans before they are roasted. Instead the Swiss Water Decaffeination process uses just hot water and time to keep the flavor of coffee, while ridding the beans of caffeine!
No matter how you make coffee, whether it’s a Nespresso or Keurig machine, a French Press, or drip coffee, there are options for you! The list below compiles the best coffee you can buy for a Vestibular Migraine Diet, Ménière’s Disease Diet, or if you’re avoiding caffeine for any other reason!
This decaf coffee is excellent for those who need K-cup compatible decaf coffee. These pods are compostable, and are 99.99% caffeine free. Simply pop the pod into your Keurig Machine and you will have a fresh cup of coffee your brain and the environment will thank you for!
This cup of jo will have you convinced you’re drinking caffeinated coffee! Stone Street Coffee is roasted locally in Brooklyn, NY, but can be shipped anywhere you’d like! They sell through Amazon, their website, and have a tasting room in Brooklyn. Each batch of beans is sourced through fair trade from small family farms in Africa. Then, it is carefully processed and roasted for a consistent taste and tone! This Swiss Water Processed Coffee company sets itself apart with its excellent flavor and quality.
Living true to its mission and slogan, this coffee will help you wake up, and kick ass. It is free of caffeine, herbicides, and pesticides. It is sustainable, organic, and fair trade. They hold themselves to the highest standards when it comes to recycling, composting and being sustainable. In fact, Kicking Horse is so sustainable, they will not sell single-serve coffee in a pod as it is not sustainable, however they do provide ground and whole bean options. Kicking Horse Coffee is determined to make you feel good about yourself while drinking excellent coffee, and their mission is maintained through their Swiss Water Decaf Coffee.
Offered in whole beans and ground coffee, this Swiss Water Processed Decaf Coffee can be found anywhere you shop, and has a fantastic medium roast. Verena Street sources its beans sustainably through Rainforest Alliance Certified farms to insure the highest quality of beans that support local, family owned farms.
If you like a dark roasted coffee that is also sweet and smooth, Allegro’s Swiss Water Decaf Coffee is the one for you! It is one of the only companies that produces Swiss Water Processed Decaf Coffee in multiple roasts. It comes in French Roast, Italian Roast, and Sumatra. Additionally, it is also one of the most affordable brands of decaffeinated coffee, making it easier on your pocket to order more than one bag!
For those of us who can’t get enough Trader Joe’s, you can add another win to the list of things you love about it! According to FAQ’s pages, their decaf coffee is Swiss water processed, making it ideal for a caffeine-dizziness problem! Trader Joe’s Decaf Coffee is a staple for many as it is easy to drink, affordable, and free of pesticides! It is easier to purchase in stores, as most Trader Joe’s items are, but is available on Amazon as well.
All information regarding how Swiss Water Process Decaf Coffee is made:
Best Decaffeinated Coffee: The Process. (2019, August 14). Retrieved January 05, 2021, from https://www.swisswater.com/our-process/
Restarting your exercise routine can be difficult, and whether you do it inside a gym, or at your house, you may be in need of some new products. Below, I have listed my top 10 favorite exercise products. Some are for balance, others are for strengthening or stability. Any and all of them would be great additions to a home gym, or as something to bring to your gym with you depending on what you have access to!
These kettlebells are coated in rubber, which is a nice feature for protecting your floor, and making them quieter to place down! I love kettlebells, they’re one of the most versatile pieces of equipment; you can do kettlebell swings, single leg deadlifts, or overhead presses with them. A quick Google Search of “kettlebell workout” will get you millions of web results and workout options!
Hand weights are other great pieces of equipment! In my opinion, these can always be put to god use, and if you don’t have any, here’s an option from Amazon that has many different weights to choose from. Be sure to get a weight that seems challenging for one hand, but nothing so heavy you can’t lift it up!
One of my FAVORITE exercises to give to people are step ups. They challenge dynamic balance, use single leg stance, and can functionally strengthen your legs! This Reebok Step is adjustable, so you can always make it higher if you so choose. It is a great options for step ups, elevated lunges, supported single leg stance, and toe taps!
Challenging your balance every day is incredibly important to reduce risk of falls. Balance exercises are frequently overlooked in exercise routines. Challenge your balance by standing on a balance board at your desk during the day, or use it just for workouts. Balance pads and balance boards challenge different balance systems, but are both really useful.
Loop bands are great for around your ankles during lateral crab walks, or around your knees when you’re doing squats to challenge your gluteus muscles! There are endless possibilities for loop bands, and I use them for both my vestibular and orthopedic patients all the time.
An addition, or an alternative, to looped bands are resistance bands. These can be hung from doorways or used independently to strengthen your core, arms, and legs, or added to balance exercises for an extra challenge.
A staple in any home workout area, or to bring to your gym, is a yoga mat. They provide a more comfortable option to workout than the floor, and make clean up after easier. This mat has two different options for thickness and colors!
A thicker yoga mat could also be very beneficial. Here’s a link to a more comfortable one.
A yoga ball is popular for improving your posture while sitting at a desk. However it can also be used for working out. You can do sit ups on it for a dynamic challenge, lifted dynamic bridges, or ab roll outs!
Staying hydrated is so IMPORTANT! Everyone knows this, but many people forget to bring water with them. This water bottle will remind you to drink water, and is insulated, so it will keep your tea hot, and your water cold!
Rest and recovery is just as important as exercising! You should stretch and roll out your muscles after your workout, and on your recovery days. This foam roller is small enough to fit in your apartment, and firm enough to help your muscles recover and leave you feeling refreshed.
Meal prep is the concept of preparing your meals ahead of time to save you time in the future. Most people meal prep one or two days a week. Although it will take up some time, it saves time, energy, and so much thinking, in the long run.
If you have specific dietary needs, or if you find you don’t have time to cook meals during the week, this is a fantastic way to keep a healthy diet, save money, and save time.
Personally, I like to meal prep on Sundays and Wednesdays. That way, I can keep my meals fresh and I don’t have to eat the same thing all week (which is a common complaint I hear).
You can plan to prep parts of your meals to put together later, or full meals all at once. Personally, I like to do both. I chop some of my vegetables (think greens, potatoes, peppers, and onions) to be used later in easy egg scrambles. Then, I prepare my snacks by separately boxing and bagging foods like carrots, hummus, gluten free pretzels, and trail mix. Lastly, I boil pasta or rice, or roast a squash that I can use with one or multiple meals. Some of these I keep in separate containers, and others I put together to form a meal.
I always go into the week with a game plan. This begins with thinking of breakfast, lunches, and dinners and prepping a menu. I like to start with breakfast; my favorites are overnight oats, or egg muffins. I think of the ingredients I need for these, and I add them to my list. Next, I think of what I would like for lunch: usually a big salad with vegetables, protein, and my favorite low-sodium dressing. Lastly, think of a few dinners you may want, and repeat.
An important factor is to consider how many times you eat out during the week. Don’t lie to yourself about this, because you’ll end up wasting food and spending extra money.
Additionally, invest in good cooking equipment, and quality storage containers. I always recommend stainless steel or glass instead of plastic to avoid chemicals leaching into your foods. And great nonstick pans, sharp knives, and a crockpot or slow cooker are always amazing additions to your kitchen.
Any grocery store is a great choice, something familiar is always helpful. Personally, I get my produce delivered via Imperfect Foods. I use this service to deliver me discounted food that would have normally been thrown away, which is great for me and for the environment! I do my in person shopping at Trader Joes, Safeway, or H-E-B.
Regardless of if you use a grocery delivery service, go to the grocery store yourself, or do a combination you will need a list. You will probably find that you already have a lot of what you need at home in your pantry, like the staples that you buy in bulk. Be sure to look and see what you already have before making a list and shopping!
When you’ve written your list head to the grocery store to shop for your groceries.
Many people decide on a singular day of the week to meal prep, while others do it twice a week in order to ensure freshness and to decrease food boredom. This totally depends on you, and both options are perfect. It all depends on you, your habits, and your schedule. Even if you prep more than once a week, you can absolutely only go to the store one time if you choose.
Regardless of the option you choose, you should be sure that it is consistent every week. If you choose Sunday and Wednesday, make sure you stick to this so that you consistently have food every day. However, if you find one plan isn’t working for you, try changing it up, there is no wrong way to do this. Also, if you choose the twice a week option, this does not mean you need to shop more than once a week – buy everything in one fell swoop!
When you are at the grocery store, be sure you are looking at the labels. Reading a nutrition label may be new for you, and that is totally fine! Because you may be new to eating a low or controlled sodium diet, what you need to look for is the section that says “Sodium”. Sometimes it is on the front of the package, and other times it is only on the back.
Once you locate the label, find the word “Sodium”, and look at how many milligrams are in each serving. This can be anywhere from 0mg to thousands. A good way to figure out if something is high or low, is to look at the “%DV”, or Percent of Daily Value. Anything higher than 20% is considered high for your daily value in one serving. But, just because something may be high, doesn’t mean you can’t use or purchase the item. Be wary that you can use part of a serving, or combine it with something lower in sodium, to prepare a meal with a normal or lower amount of sodium.
Once you finish making your list, checking your cabinets, and grocery shopping, you are ready to start cooking!
You can do the cooking all at once, or in steps, but regardless of how you’re going to do it preparing, portioning, and storing your food is important.
Once you’ve prepared your food, portion and place the meals into containers and reusable snack bags, you are ready for the week!
Maybe you’ve done this for one meal, maybe you’ve done it for all 3. The important thing about meal prepping is consistency, cooking foods you actually like, and adhering to your personal dietary needs. If you need low sodium, don’t add salt, and season your foods with sodium-free seasonings!
Comment below what’s on your menu this week!
There are many ways to train your balance, but to truly focus on your vestibular system you need two big factors. The first factor is decreased or eliminated vision, and the second is an uneven surface. Your vestibular system processes your spatial orientation and balance constantly; it works with your proprioception and vision to keep you upright. If you have tested your balance and you have difficulty depending on your vestibular system, it’s time to do some vestibular balance training.
To do this, you’re going to need a balance pad. There are many options to choose from when you’re searching for the perfect surface to do balance training. The most important factor is that you are standing on an unstable surface.
Personally, my favorite balance pad is the Airex balance pad. It’s one of those staples in any good PT clinic and it’s a consistently good product. It has just enough stability that it doesn’t break with overuse, and unstable enough that you won’t be able to feel the floor when you use it. Not being able to feel the floor when practicing balance training is incredibly important.In my opinion, the Airex a fantastic option, however it is pricier than other balance pad options that are pretty comparable.
This balance pad, the Yes4All has different sizes and colors to choose from, and I have used it in my practice many times. This balance pad has a little less give to it, it feels a little more like the floor. For those who are looking for more give and a greater challenge that you would find in the clinic, the Airex is right for you! However, if you have a much harder time balancing, or you’re worried your balance on uneven surfaces, it may actually be a better choice for you!
If you are going to be testing your balance and practicing your balance in the future, it’s a great idea to invest in a balance pad like the ones above! Challenging your balance in a variety of ways, especially with uneven surfaces, helps your overall balance, increases confidence in your ability to get around, and will decrease your risk for falling!
Balance is the system our body uses to keep us upright, helps us catch ourselves when we trip, and lets us walk, dance, and run without falling over. Our balance system is constantly being used, even when we are sitting down! There are three systems that make up our balance system. The first is proprioception, the second is vision, and the last is our vestibular system. All three are intricate and purposeful and they all help us with our daily activities.
Proprioception is our internal awareness of where we are in space and how we are moving. Proprioception is used consciously and unconsciously so that we know the angles of our joints, how much force to produce with movement, to sense how and where we are moving, and to sense a change in our velocity. We use proprioception to help us balance constantly, it specifically is helpful when we are on uneven surfaces. Our brain uses constant input from our joints, especially our ankles, knees, and hips in order to keep us upright. When we are on an even surface, like a hardwood floor or smooth concrete, our brain has an easy time keeping us standing up. Our peripheral nervous system (nerves outside the brain and spinal cord) sends signals to our central nervous system (the spinal cord and brain) to tell us where our joints are, and if we need to make adjustments to our posture. When you are on an uneven surface, your joints and peripheral nervous system send signals to your central nervous system to make chronic adjustments so that you don’t trip on the surface. If your brain begins to process this information too slowly or if you receive poor signals for any reason you will have a harder time balancing. If you practice balancing on uneven surfaces your brain will relearn how to balance on all surfaces and you will have an easier time walking on surfaces like carpet, grass, and gravel.
Being able to see is another important variable in your balance. You may notice that when your eyes are closed or if it’s dark outside you have more trouble standing or walking around. Your visual system provides extra information to your vestibular and proprioception systems to process the information being provided to them. Something as simple as putting on your glasses or turning on the light can drastically improve your balance. Vision is the most relied upon system in our bodies; it is important that we can use vision if we have the option. Going to the optometrist or ophthalmologist is vital if you have visual dysfunction! However, over-relying on your vision can also be dangerous. When we are over-reliant on our vision we don’t utilize the other systems that are important for keeping us upright, our proprioceptive and vestibular systems.
Your vestibular system is an essential part of your balance. Your vestibular system is your inner ear system responsible for balance when you can’t see, can’t feel the floor well, or both! Your vestibular system has its biggest job if you’re walking on grass at night. This system will help your balance, and processing information from the other two systems to adjust your body in space. In practice, we often find that there are many people whose brains have unlearned this system.
Impairment of any of these three systems can lead to poor balance, falls, and the feeling of general unsteadiness. Additionally, some patients with vestibular dysfunction report nausea, dizziness, and swaying when they are still. Many of my patients say that they assume that falling and balance dysfunction is “just a part of aging” and that they should “just get used to it”. On the contrary, balance dysfunction should NOT be a part of aging, and it should NOT be something you just get used to. There are so many ways you can work on your balance, independently or with a physical therapist.
In the clinic there are numerous tests we can use to test your balance. However, in order to differentiate which of your balance systems are not functioning correctly we most often use the M-CTSIB, the Modified Clinical Test of Sensory Interaction in Balance (1). This test measures your balance on 2 surfaces with your eyes both open and closed. In the unmodified version (CTSIB), there is a dome used to provide a visual conflict; this shows whether or not you can intentionally override your vision and use your vestibular system intentionally. However, for most purposes, and ours here, using the modified version is great. Let’s go through how to test yourself if, and when, you find it necessary. Remember to always be as safe as possible when performing this test. I would recommend doing this test with another person nearby and to do it near your countertop or a sturdy chair.
To perform this test you will need a solid surface to stand on, like hardwood or tile floor, and an uneven surface, like balance foam or a couch cushion. You must stand with your feet touching (as close as you can get them) and your arms at your sides, throughout the duration of the test periods.
There are 4 conditions:
For each of the four conditions, you may have three attempts. The time begins when you are set in position, and ends when you complete 30 consecutive seconds or make a mistake. Mistakes include: opening your eyes in a closed condition, taking a step, moving your arms from your sides, or needing assistance to prevent a fall (1). If you, the testee, are able to complete the first round without a mistake, move to the next condition and do not repeat all 3 attempts.
Some sway at the ankles and/or hips, called ankle strategy or hip strategy, respectively, is normal. But, this test shows us which is most difficult for you; the condition that is most difficult is the condition you should work on most in PT. Let’s work through what your test results mean when you finish the test.
Condition 1) while standing in this position, all of your systems are available for balance, but your base of support (BOS) is significantly smaller than you would usually stand. BOS consists of the parts of your body touching the floor beneath you; when it is larger, it is easier to stand, and the smaller it is the more difficult it is to stand (2).
Condition 2) you are able to use your proprioceptive and vestibular systems in this condition. However, you are unable to use your visual system. This tells us that you are very dependent on your vision, and without it you are at an increased risk for falling in situations when you have decreased light, or no vision at all.
Condition 3) in this condition, you are able to use vision and your vestibular system, but it challenges your proprioception significantly. If you have trouble here, it is a sign to work on proprioceptive and dynamic balance in physical therapy.
Condition 4) here, you are mainly able to use your vestibular system to balance. Individuals have most difficulty in this position if they have vestibular dysfunction, and this is frequently something we treat in vestibular therapy.
Fortunately, almost all of the reasons you are experiencing imbalance can be treated in physical therapy. Finding what is difficult for you, and then slowly working on it will improve your balance, reduce your risk of falling, and improve your confidence with your balance!
Sources:
(1) Wrisley, D. (n.d.). Clinical Test of Sensory Interaction on Balance. Retrieved September 07, 2020, from https://www.sralab.org/rehabilitation-measures/clinical-test-sensory-interaction-balance-vedge
(2) Physiopedia. (n.d.). Base of Support. Retrieved September 07, 2020, from https://www.physio-pedia.com/Base_of_Support
The inner ear, which is deep inside of your skull can seem abstract and strange. We all know we use our ears for hearing, however it actually has a much bigger job than just hearing. We use it to keep us balanced, to help us walk in the dark, for spatial orientation, head position, and eye stability. All of this comes from a tiny, curly-shaped, organ in our skulls. Luckily, it actually can be simplified down to a few parts, so let’s break it down!
The ear, where the vestibular system is housed, is separated into three distinct parts. The outer ear (the spot we stick a Q-tip even though we know we shouldn’t), the middle ear (the part that pops on an airplane) and the inner ear (or the vestibular system, which helps us with everything balance and hearing related). You can see all of these parts in this picture below:
Each of these parts plays a vital role in hearing, balance, and daily function. Let’s review the three main parts.
The outer ear begins at the part you can see, the pinna, and ends at the eardrum, or tympanic membrane. The purpose of this structure is to collect sound waves and direct them to the eardrum, which helps to conduct sound to your cochlea in the inner ear. This structure is important to hearing, but less so for balance.
The middle ear sits between your eardrum and your eustachian tube. It houses the 3 ossicle bones that conduct vibrations to your inner ear so you can hear, and connects to your eustachian tube which is the part of your ear that pops when you climb elevation on an airplane. The job of your eustachian tube is to equalize pressure between your ear and the back of your throat. It is typically closed, but when you have a rapid change in pressure for any reason, it rapidly opens to equalize the pressure in your ears. When this doesn’t happen, it becomes quite uncomfortable and we can either intentionally equalize the pressure (frequently called popping your ears), or it may lead to a feeling of dizziness or lightheadedness. Because of the closeness in proximity, the middle ear directly impacts the inner ear, which is why dizziness and lightheadedness are so entwined with symptoms of your middle ear.
The inner ear is the innermost portion of your ear system. It is your vestibular system, it controls most of your balance, whether or not you feel dizzy, spatial orientation and many other functions. It consists of two distinct parts: the vestibular system and the cochlea. The cochlea is your hearing portion, and the vestibular system is your balance portion. Within the vestibular system you have semicircular canals and the vestibule. The signals from these systems are sent to your brain via your vestibulocochlear nerve. This nerve fires constantly at a consistent rate when you’re looking forward. If you look in another direction, the nerve signal is altered, so you always know where your head is in space. For instance, if you look to the right, the right vestibulocochlear nerve fires more than the left, and vise versa, until you look forward again.
The vestibule houses the utricle and the saccule, these two have tiny calcium-carbonate crystals, or otoconia, that react to linear movement. The otoconia are located on a gelatin layer; when you’re upright so are the crystals, and when you tilt your head forward, the crystals move forward with gravity. The same thing happens when you tilt your head backwards, the crystals slide backward. That same signal that is sent to your brain via the vestibulocochlear nerve tells your brain where your head is in space.
Lastly, there are the three semicircular canals: anterior, posterior, and horizontal. Each of these structures is positioned to detect angular motion, are filled with fluid called endolymph, and have a structure called the ampulla at the end. The anterior canal detects motion around the lateral axis of your head, like you’re nodding yes. The posterior canal detects motion around the antero-posterior axis of your head, which is the motion when you tip your head to the side or do a cartwheel. The horizontal canal detects motion around your vertical axis, the motion used when you say no. As you move at an angle, the endolymph moves, this causes the fluid to move toward or away from the ampulla and distort a structure inside, called the cupula. The movement of the cupula sends the final signal through your vestibulocochlear nerve to help you orient your head in space.
The inner ear is incredibly complex and it can be difficult to understand why this tiny structure is making you so dizzy. Now that you have a clearer understanding of the anatomy and physiology of your ears, hopefully you can gain some clarity about why your symptoms are occurring and begin to work toward diagnosis and treatment.