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Vertigo and salicylates

A neighbour said recently: “there’s an epidemic of vertigo happening here”.  There can be many causes of vertigo. Most people don’t realise that vertigo – or dizziness – can be related to drugs and foods.

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Key points

  • Vertigo can be a side effect of many drugs
  • Aspirin can be associated with reversible hearing loss, tinnitus (ringing in the ears), and vertigo
  • People who have problems with salicylates in drugs can also have problems with salicylates in foods

Many drugs

If you develop vertigo soon after starting a new prescription or over-the-counter drug, ask your pharmacist or doctor if vertigo is listed as a side effect. Or see this Consumer Report on drugs that can make you dizzy

Vertigo could also be related to salicylates in:

  • aspirin (methyl salicylate)
  • drugs that interact with aspirin – e.g. anti-inflammatories such as ibuprofen or nurofen, and many others
  • herbal medications such oil of wintergreen or white willow bark (see story below), and any medications containing salicylates or with a warning for asthmatics in the Consumer Medicine Information sheet. Salicylate containing skin creams or ointments can include arthritis creams, sports creams like Dencorub, Vicks Vaporub, teething gel and oral gels like Bonjela and Ora-Sed, wart removers, acne cleansers and some insect repellents.

“I’ve been using Ibuprofen regularly for my chronic back pain …  I switched to white willow bark and have had vertigo for 2 weeks. I stopped taking all my herbal medicines and the vertigo subsided but came back today after taking white willow bark and then a light bulb came on (when I saw your salicylates factsheet!)”  - Ramesh, UK, [1458]

Doctors don’t necessarily know

In Europe, the vertigo- salicylate effect seems well known (see French, German and Swiss papers below).  However, it seems that salicylates as a cause of vertigo are now commonly overlooked in English-speaking countries - as you can see in the list of vertigo-causing drugs above that doesn’t include aspirin.

The following story comes from a 48 year old now-failsafer  who had an allergic reaction to aspirin, developed vertigo while taking pasugrel (known to interact with aspirin), and later developed a life-threatening  reaction after eating large amounts of wild blackberry jam while taking anti-inflammatories.

“Later that day I found virtually all my arms and neck covered in hives and rashes, I had difficulty breathing and was taken to Accident & Emergency in an ambulance ...  My partner discovered that blackberries are very high in salicylates which is also the reason that people have an allergic reaction to aspirin. When I mentioned this at A&E they seemed totally unaware of this link, and carried on treating me for a suspected heart attack …Why was it not obvious to trained medical staff that if you have an allergic reaction to aspirin, it is quite likely that it is because of salicylates and that care should then be taken when prescribing further medicines?” – Tony, UK [1386]

If you are sensitive to salicylates in drugs, you may also be sensitive to salicylates in foods

Here are a mother and daughter who are both suffer from aspirin-induced vertigo and other salicylate-related health issues:

“My mother and I have known for years that we are allergic to aspirin. We both react with ringing in the ears, nausea, vertigo, lethargy, and I even lost consciousness once … My mother and I both have had doctors mystified for years with strange and debilitating health issues …  None of my doctors have ever mentioned that salicylates are in foods.

After coming across this information I realised that almost every diet change recommended to me by the doctors has caused my salicylate intake to be astronomical. It's no wonder I've been in and out of emergency rooms.

Everyone made fun of me calling me a "health nut" because of the supposedly ultra-healthy diet I was on … on a low salicylate diet my mother and I have both been improving so drastically that everyone is asking us what is going on.”  [559]

References

Our salicylate factsheet

Our tinnitus story collection

Cuffel C, Guyot JP. [Aspirin ototoxicity: a rare situation today]. [article in French] Rev Med Suisse. 2013;9(400):1785-8. From the abstract: We report a case of acute aspirin intoxication resulting in a transitory hearing loss, tinnitus, and vertigo. https://www.ncbi.nlm.nih.gov/pubmed/24187753

Fleck C, [Vertigo drug therapy--merely drug vertigo? Vertigo from the pharmacologic viewpoint]. [Article in German] Arztl Fortbild Qualitatssich, 2000;94(6):501-7. From the abstract: The variety of drugs responsible for vertigo consists in relatively harmless substances like aspirin up to substances used in vertigo drug therapy! https://www.ncbi.nlm.nih.gov/pubmed/10996941

Venna N, Dizziness, falling, and fainting: differential diagnosis in the aged (Part II), Geriatrics, 1986;41(7):31-3, 36-7, 41-5. From the abstract: Salicylates used for rheumatoid arthritis, or in inadvertently high dosages by patients themselves, often cause toxicity manifested by tinnitus, hearing impairment, and imbalance. Vestibulotoxic drugs should always be considered in older patients when the cause of imbalance is not apparent. https://www.ncbi.nlm.nih.gov/pubmed/3721202

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Food intolerance

Some of the many symptoms of food intolerance that can be helped by diet:

Airways: Asthma, Stuffy blocked or runny nose/ nasal polyps, Frequent nose bleeds, Catarrh, chronic throat-clearing, Sinusitis, Frequent ear infections, Frequent tonsillitis, Frequent colds and flu, symptoms of Samter's Triad, hayfever, allergic rhinitis Skin: Eczema, Urticaria (hives), Cradlecap, Other skin rashes, Angioedema (swollen lips, eyes, tongue), Geographic tongue, Pruritis (itching), Rosaceae, Allergic shiners (dark circles under eyes), Pallor (pale skin), Flushing, Excessive sweating, Body odour, Sore vagina in children, Alopecia (patchy baldness) Digestive system: Irritable bowel symptoms (IBS), Recurrent mouth ulcers, Indigestion, Nausea, Bad breath, Vomiting, Diarrhea, Stomach ache, Bloating, Reflux in babies, adults, Constipation, Colic in babies, adults, Sluggish bowel syndrome (feeling of "more to come"), Encopresis, Soiling (sneaky poos), Dairy intolerance, Gluten and wheat intolerance, Eating disorders (ed), anorexia nervosa, bulimia nervosa, binge eating disorder (BED)  Bladder: Bedwetting, Daytime incontinence, Urinary urgency, Recurrent inflammation (cystitis) Skeletal: Growing pains, Arthritis, joint pain, arthralgia Eyes: Nystagmus (involuntary movement), Blurred vision Muscles: Low muscle tone, Myalgia (muscle pain), Tics (involuntary movement), Tremor, Leg 'jiggling', Heart: Rapid heart beat, Heart palpitations, Cardiac arrhythmias, Pseudo heart attack (feeling of impending doom, chest pressure, pain down arm), Tachycardia (fast heart beat), Angina-type pain, HHT Central nervous system: Headaches or migraines, unexplained tiredness, Chronic fatigue, Feeling 'hung-over', Confusion, Dizziness, Agitation, Tinnitus (noises in ear), HyperacusisAuditory sensory processing disorder (ASPD), Paraesthesia (pins and needles), Dysaesthesia (numbness), Hypoglycemia, Salicylate-induced hypoglycemia, Epileptic seizures, Fits, Sensory symptoms of multiple sclerosis, Symptoms of lupus Anxiety: Panic attacks, Depression, Obsessive ruminations (repetitively focusing on bad feelings and experiences from the past), Self harm, Suicidal thoughts, actions, teeth grinding (bruxism) Impaired memory: Vague or forgetful, Unable to concentrate, Won't persevere, Unmotivated, Disorganised, Easily distracted, Difficulty reading and writing Speech: Loud voice (no volume control), Speech hard to understand, Speech delay, Selective mutism, Stuttering, Repetitive noises, Talks too much (empty chatter) Coordination: Poor handwriting, Poor coordination, Frequent accidents, Vertigo Sleep: Difficulty falling asleep, Restless legs syndrome (RLS), Persistent night waking, Insomnia, Nightmares/night terrors/sleepwalking, Sleep apnoea Mood: Brain snaps, Mood swings, Premenstrual tension, Grizzly or unhappy, Cries easily or often, Irritable, Uncooperative Oppositional defiance: ODD, Loses temper, Argumentative, Refuses requests, Defies rules, Deliberately annoys others, Blames others for own mistakes, Touchy, easily annoyed, Angry, resentful Other behaviour: ADHD, ADD, Autism, Aspergers, Inattentive, easily bored, unmotivated, 'Unable to entertain himself', Restless, fidgety or overactive, Head banging, Hyperactivity, Fights with siblings, Difficulty making friends, Destructive, aggressive, Unreasonable, Tantrums, Demanding, never satisfied, Disruptive, Discipline is ineffective, Pervasive Development Disorder

Some causes of food intolerance:

Food additives: Artificial colours: (food dyes, artificial colors) tartrazine 102 (E102, FD&C Yellow No.5), quinoline yellow 104 (E104), sunset yellow 110 (E110, FD&C Yellow No.6), azorubine, carmoisine 122 (E122), amaranth 123 (E123), ponceau, brilliant scarlet 124 (E124), erythrosine 127 (E127, FD&C Red No.3), allura red 129 (E129, FD&C Red No.40), indigotine, indigo carmine 132 (E132, FD&C Blue No.2), brilliant blue 133 (E133, FD&C Blue No.1), green S, food green, acid brilliant green 142 (E142), fast green FCF 143 (E143, FD&C Green No.3), brilliant black 151 (E151), brown, chocolate brown 155 (E155)  Natural colours: (colors) Annatto (annatto extracts, bixin, norbixin, 160b, E160b) Preservatives: Sorbates: (sorbic acid 200, E200, sodium sorbate 201, E201, potassium sorbate 202, E202, calcium sorbate 203, E203) Benzoates, hydroxybenzoates, parabens: (including benzoic acid 210, E210, sodium benzoate 211, E211, potassium benzoate 212, E212, calcium benzoate 213, E213, ethyl para-hydroxybenzoate 214, E214, sodium ethyl para-hydroxybenzoate 215, E215, propylparaben 216, E216, propyl 4 hydroxybenzoate 217, E217, methylparaben 218, E218) Sulfites, bisulfites, metabisulfites: (200-228, sulphites, sulphur dioxide, sulfur dioxide 220, E220, sodium sulphite 221, E221, sodium bisulphite 222, E222, sodium metabisulphite 223, E223, potassium metabisulphite 224, E224, potassium sulphite 225, E225, calcium sulphite 226, E226, calcium bisulfite 227, E227, potassium bisulphite 228, E228) Nitrates & nitrites: (249-252, potassium nitrite 249, E249, sodium nitrite 250, E250, sodium nitrate 251, E251, potassium nitrate 252, E252 Propionates: (bread preservative, mould inhibitor 280-283: propionic acid 280, E280, sodium propionate 281, E281, calcium propionate 282, E282, potassium propionate 283, E283, 'natural' preservatives in bread, cultured wheat, cultured dextrose, cultured whey) Synthetic antioxidants: Gallates 310, 311, 312 (E310, E311, E312), tBHQ 319, E319, BHA 320, E320, BHT 321, E321 Flavour enhancers: (flavor enhancers) glutamic acid and all glutamates, MSG monosodium glutamate 620-625, yeast extract, hydrolysed vegetable protein HVP, disodium guanylate 627 (E627, DSG, GMP), disodium inosinate 631 (E631, DSI, IMP), ribonucleotides 635 (E635, I&G, nucleotides)  Flavours: (flavors)  Natural food chemicals: Salicylates: salicylic acid, sodium salicylate, acetylsalicylic acid Biogenic amines: vasoactive amines (tyramine, phenylethylamine, histamine and others) Glutamates:  Natural foods: Dairy: milk, yoghurt, cheese, butter, lactose-free milks Wheat or Gluten: (wheat, rye, barley, oats) Soy: Sugar free sweeteners:Sugar free sweeteners: polyols, sorbitol, mannitol

On this website, failsafe refers to foods that are Free of Additives and Low in Salicylates, Amines and Flavour Enhancers. Note that copyright applies to the commercial use of the term "failsafe" in the food and health context so as to control inappropriate use by the food and health industries.