A recent clinical trial suggests that vitamin D supplementation may help patients manage benign paroxysmal positional vertigo (BPPV).
BPPV occurs when small calcium carbonate crystals become dislodged from their normal location on the utricle, one of the inner ear sensory organs. The crystals migrate into the semicircular canals, the parts of the ear that are responsible for sensing the rotation of the head. Once the crystals begin to accumulate in one of the canals, they interfere with normal fluid movement that the canals use to sense head motion. This leads to a false sensation of spinning, otherwise known as vertigo.
BPPV is the most common cause of vertigo. It can affect people of all ages, although it’s most prevalent in individuals above the age of 60. This condition can negatively impact quality of life and result in impaired daily activities. BPPV is especially harmful in the elderly, potentially leading to falls and fractures.
A common physical therapy maneuver used to treat BPPV is called Epley’s maneuver. The therapy works by using gravity to relocate the calcium crystals back into the utricle. Epley’s maneuver has been shown to be safe and effective; though, BPPV recurs in approximately 12-36% of individuals who undergo the treatment. If this method fails, doctors may use a surgical procedure.
In recent years, vitamin D supplementation has posed a promising adjunct therapy for patients with BPPV. Researchers became interested in the relationship between vitamin D and BPPV due to the presence of vitamin D receptors within calcium channel transport systems in the inner ear and vitamin D’s ability to help regulate calcium. A past study discovered that treating vitamin D deficiency reduced the recurrence rate of BPPV. The most recent study on the topic was conducted to determine whether treating vitamin D deficiency reduces the severity of BPPV.
Eighty-one patients entered to the study. Vitamin D deficient [25(OH)D < 20 ng/ml] patients were grouped into a vitamin D (50,000 IU per week, then 50,000 IU/month) treatment group, which also received Epley’s maneuver. The second group, also vitamin D deficient, was treated by Epley’s maneuver alone. Patients in the third group had sufficient vitamin D [25(OH)D > 30 ng/ml] and were also treated with Epley’s maneuver alone.
At baseline, the researchers measured the intensity of BPPV in patients with the Visual Analogue Scale (VAS). The VAS uses a scoring of 1-10 to assess various symptoms and characteristics with a higher score indicating a greater intensity.
After two months of treatment with vitamin D, vitamin D status significantly increased from 11.4 ng/ml to 34.2 ng/ml (p = 0.001) in the vitamin D treatment group. Vitamin D status remained the same in the non-treated and control groups. The intensity of BPPV decreased significantly in all three study groups compared to initially (p = 0.001).
Vitamin D supplementation was reduced to 50,000 IU/month but the study continued for a total of six months. Over the study period, the intensity of BPPV regressed to the baseline value in the vitamin D non-treated group (p = 0.001). The intensity of BPPV remained stable and unchanged over the six-month period in the treated group and the control group in comparison to the vitamin D deficient non-treated group (p = 0.001).
The researchers concluded,
“The results of this study demonstrated a significant decrease in the intensity of BPPV two months after treatment in all groups irrespective to serum 25-OHD status. Thereafter, improvement persisted in vitamin D sufficient and vitamin D treated groups but regressed to baseline value in vitamin D deficient group.”
“Based on the results of this study, Epley’s therapy is effective in the treatment of BPPV for a short time period but persistent of improvement requires normalization of serum vitamin D in those who have vitamin D deficiency.”
The findings suggest that treating vitamin D deficiency may play a crucial role in the path of recovery for patients with BPPV. By using vitamin D deficient individuals, researchers could evaluate the benefits derived from achieving a healthy vitamin D status. However, one must note that this study did not follow a randomized controlled trial design. While the study was still able to prove causation, since it was a clinical trial, it also was more prone to bias. The patients were not randomly allocated into each group and the treatment was not blinded. Therefore, randomized controlled trials should investigate this topic further.
For more information on BPPV, check out Vestibular Disorders Assocation’s website. The VDA provides education and support to those affected by Vestibular Disorders.
Tovey, A & Cannell, JJ. Recent clinical trial discovers vitamin D supplementation may improve non-alcoholic fatty liver disease. The Vitamin D Council Blog & Newsletter, 2016.