TürkçeVertigo patients should pay particular attention to their fluid intake and dietary routine during Ramadan. Prolonged hunger and dehydration during fasting may affect the balance system and trigger vertigo attacks. Therefore, suhoor and iftar meals should be planned in a balanced manner and should be free from excessive salt and caffeine.
To maintain fluid balance, an adequate amount of water should be consumed at suhoor. Dehydration lasting throughout the day may negatively affect the fluid balance in the inner ear. Consuming 2–2.5 liters of water between iftar and suhoor plays an important role in reducing vertigo symptoms.
Insufficient sleep may increase vertigo attacks. Changes in sleep patterns during Ramadan may intensify complaints such as dizziness and loss of balance. Therefore, it is recommended not to interrupt nighttime sleep and to compensate for sleep deficiency with short periods of rest during the day.
Salty and processed foods should be avoided. Such foods may cause fluid imbalance in the inner ear and trigger vertigo. Choosing fresh vegetables, healthy fats, and protein-rich foods in suhoor and iftar menus helps vertigo patients experience Ramadan more comfortably.
Why Do We Feel Dizzy While Fasting?
We can compare the balance system to a seesaw or a sensitive spirit level. For this system to remain balanced, it is not enough for only the inner ear to be healthy; the body’s overall metabolic balance must also be maintained. Prolonged hunger and dehydration during Ramadan cause some fundamental changes in the body’s biochemistry.
The brain and inner ear are among the areas of the body that consume the most energy and oxygen and also have the most sensitive blood supply. When the body cannot obtain enough fuel or fluid, it gives priority to vital organs. In this case, microscopic slowdowns may occur in the blood flow to areas such as the inner ear, which are supplied by very fine capillaries.
As the period of hunger becomes longer, the body switches to energy-saving mode. During this process, the brain may not process incoming balance signals as quickly as before. Delayed perception by the brain of the signal coming from the inner ear after head movement causes millisecond delays. These delays may appear as lightheadedness, a floating sensation, or a mild feeling of swaying.
This is not always a sign of illness; it is often the body’s natural warning meaning “my fuel is decreasing, slow down your movements.” However, in individuals with an existing vertigo disorder, this process may trigger an attack.
How Does Dehydration Affect Inner Ear Fluids?
Water is essentially the lifeblood of the balance system. Inside the semicircular canals located deep within the inner ear, there is a special fluid called “endolymph.” The density, fluidity, and electrolyte balance of this fluid (sodium-potassium ratio) are vital for preventing dizziness.
When dehydration begins in the body, the blood becomes more concentrated. This directly affects the fluid balance in the inner ear as well. Especially when Ramadan falls on long and hot days, fluid is continuously lost through sweating and breathing, but this loss cannot be replaced during the day. As a result, fluctuations may occur in the pressure of the inner ear fluid.
This situation is more critical for individuals with Meniere’s disease. As dehydration increases, worsening tinnitus is one of the first signs that the inner ear is under stress. Just as the flow of water changes in a dried riverbed, the dynamics of balance fluids are also disrupted in a dehydrated body.
The possible effects of dehydration on balance are as follows:
- Ear buzzing
- A feeling of fullness in the ear
- Difficulty concentrating
- Lightheadedness
- Headache
Can Low Blood Sugar Cause Loss of Balance?
The brain continuously needs glucose in order to function. While muscles can convert fats and proteins into energy, the brain’s primary fuel is sugar. As iftar approaches, blood sugar naturally falls. When hypoglycemia is approached, the brain creates a sense of “emergency,” and functions requiring high processing power, especially balance and coordination, become the first areas affected.
Dizziness caused by low blood sugar is generally different from the inner ear-related sensation of “the surroundings spinning.” It is more commonly described as “feeling as though one will faint,” “the ground slipping from under the feet,” or mental fog. However, in individuals with an existing balance problem, this condition may trigger a vertigo attack.
Symptoms that may occur with low blood sugar are as follows:
- Sweating
- Trembling
- Irritability
- Darkening of vision
- Loss of concentration
What Types of Dizziness May We Experience During Ramadan?
Not every episode of dizziness experienced during Ramadan means a vertigo attack. Correct classification from an audiological perspective prevents unnecessary medication use and ensures that the right precautions are taken. Some forms of dizziness originate not from the inner ear but from blood pressure or metabolic causes.
For example, sudden dimming of vision experienced when getting out of bed or rising from prostration during prayer is usually related to low blood pressure. Because prolonged hunger and dehydration reduce intravascular fluid volume, blood flow to the brain temporarily slows during sudden changes in position. This condition is called orthostatic hypotension and is different from the displacement of ear crystals.
The types of balance disorders frequently encountered during Ramadan are as follows:
- BPPV
- Meniere’s attack
- Presyncope
- Hypoglycemic lightheadedness
- Orthostatic hypotension
- Vestibular migraine
Can Audiological Tests Be Performed While Fasting?
Balance tests (VNG, vHIT, posturography, etc.) are not technically procedures that invalidate fasting. However, because some tests carry a risk of nausea and vomiting, they require careful planning in fasting patients. Caloric tests and positional tests in particular (if BPPV is present) may cause more intense discomfort in fasting patients with low blood sugar.
Therefore, audiologists may modify the choice of test according to the patient’s general condition. More comfortable tests such as vHIT may be preferred, or appointments may be scheduled for the early morning hours.
Tests considered safer while fasting are as follows:
- vHIT
- Dynamic posturography
- Audiometry
- Tympanometry
Does Salt Consumption at Iftar Trigger Vertigo?
Salt is an important trigger, especially for individuals diagnosed with Meniere’s disease and endolymphatic hydrops. Consuming excessively salty foods at iftar rapidly raises the sodium level in the blood. The body retains water to balance this sodium, and this may cause an increase in inner ear fluid pressure.
As a result, a severe vertigo attack, fullness in the ear, and fluctuations in hearing may occur a few hours after the meal. Therefore, the amount of salt on Ramadan tables should be kept to a minimum, and flavor should be provided with spices.
High-sodium foods that should be avoided:
- Pickles
- Brined olives
- Soy sauce
- Instant soups
- Turnip juice
- Chips
- Mineral water
How Should Caffeine and Sugar Consumption Be Balanced?
Caffeine is a strong diuretic and increases dehydration. It may also worsen tinnitus by stimulating the nervous system and may impair sleep quality.
Caffeine is not found only in coffee; it is also present in tea. The substance called “theine” in tea is chemically the same as caffeine. However, because caffeine in tea is bound to tannins, its absorption occurs more slowly and its effect lasts longer. Therefore, tea is also actually diuretic; it increases urine volume by reducing the reabsorption of sodium and water in the kidneys. This effect becomes particularly noticeable when consumed in high amounts.
Sugary and syrup-based desserts may trigger migrainous vertigo attacks by causing sudden fluctuations in blood sugar.
Items that should be limited:
- Strong tea
- Turkish coffee
- Energy drinks
- Baklava
- Cola
- Chocolate
What Should the Water-Drinking Strategy Be?
Instead of drinking a large amount of water in a short period at iftar, the most appropriate approach is to spread water consumption throughout the period between iftar and suhoor. In this way, inner ear fluid balance is maintained and the body uses water more efficiently.
Foods with high water content support hydration:
- Cucumber
- Watermelon
- Zucchini
- Lettuce
- Tomato
- Strawberry
- Yogurt
Should Balance Exercises Be Continued During Ramadan?
Vestibular rehabilitation exercises should not be discontinued during Ramadan, but their intensity may be reduced. Even if sessions in the clinical setting continue without interruption, the stimuli will be adjusted by your audiologist.
If you are performing home-based exercises, they should be planned for after iftar. The most suitable time is approximately 1–1.5 hours after iftar.
Recommended exercises:
- Eye-tracking movements
- Head stabilization exercises
- Balance exercises while sitting/standing
- Slow-paced walking
Vitamin Deficiencies and Supplements
Vitamin D, vitamin B12, and magnesium are critically important for the balance system. Their deficiencies may increase vertigo attacks. These supplements must be taken under a doctor’s supervision.
Supplements that support the balance system:
- Vitamin D
- Vitamin B12
- Magnesium
- Omega-3
- Zinc
For Which Symptoms Should We Break the Fast and Seek Emergency Care?
If dizziness is accompanied by the following symptoms, emergency medical assistance should be sought. These conditions may be life-threatening:
- Double vision
- Speech disorder
- Facial numbness
- Weakness in the arm or leg
- Difficulty swallowing
- Severe headache
- Confusion
Health is a prerequisite for worship. Paying attention to your body’s warnings is vitally important.
Frequently Asked Questions
Dr. Audiologist Emel Uğur was born in 1982 in Çanakkale. She specialized in Pediatric Audiology, Otologic Disorders, and Vestibular System Disorders, and served for 15 years at the Istanbul Training and Research Hospital. In 2015, she joined the Acıbadem Healthcare Group. She currently works as an Audiologist at the Acıbadem Altunizade Hospital and also serves as a faculty member and program director in the Acıbadem University Vocational School of Health Services Audiometry Program.
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