Vitamin D for Dizziness

Vitamin D plus calcium reduced BPPV recurrence in a randomised trial of people with low vitamin D — a specific, replicable finding.

Overview

Vitamin D plus calcium reduced BPPV recurrence in a randomised trial of people with low vitamin D — a specific, replicable finding.

Verdict

Mixed evidence

Reasonable for people with recurrent BPPV and low vitamin D. Not a treatment for an active attack, which needs the Epley manoeuvre.

How It Works

Otoconia are calcium carbonate crystals whose turnover depends on calcium handling in the inner ear. Low vitamin D disturbs calcium homeostasis and is proposed to make otoconia more prone to dislodging into the semicircular canals.

Dosing & Protocol

Typical dose

Recommended dose: 400 IU twice daily with 500mg calcium where 25-OH-D is below 20 ng/mL; retest after three months
Expected timeframe: Recurrence reduction assessed over 6-12 months, not days

Protocol

form: Vitamin D3 (cholecalciferol)
duration: 3-6 months, counting recurrence episodes
co factor: Take with the largest meal. Evidence is mixed but there is one genuinely interesting signal: a randomised trial in benign paroxysmal positional vertigo found that vitamin D plus calcium supplementation in people with low vitamin D reduced BPPV recurrence. That is specific to BPPV, not to dizziness in general, and vitamin D has not been shown to help vestibular migraine, orthostatic hypotension or other causes.
titration: Higher replacement doses only under medical guidance; target 75-125 nmol/L
starting dose: 1000-2000 IU (25-50 mcg) vitamin D3 daily with a fat-containing meal, ideally after testing 25-hydroxyvitamin D

Evidence

What the studies say

A 2020 multicentre randomised trial in Neurology gave vitamin D 400 IU twice daily plus 500mg calcium to people with BPPV and serum 25-OH-D below 20 ng/mL, and found recurrence fell from 1.10 to 0.83 episodes per person-year — around a 24% relative reduction. Several observational studies also report lower vitamin D in people with recurrent BPPV. The effect size is modest and limited to the deficient subgroup, which is why this sits at mixed rather than likely.

Prevention of benign paroxysmal positional vertigo with vitamin D supplementation: A randomized trial

Score: 8/10

2020

rct

n=957

Jeong SH, Kim JS, Kim HJ

Supplementation with vitamin D and calcium reduced the annual recurrence of benign paroxysmal positional vertigo in patients with low vitamin D.

View source

Safety

Caveats

Does not treat an active vertigo attack. Avoid added calcium in people with a history of calcium kidney stones or hypercalcaemia without medical advice.

Less likely to help if

People with vitamin D already in the normal range showed no recurrence benefit in the trial.

Medical Disclaimer

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Individual results may vary. The statements on this website have not been evaluated by the Food and Drug Administration. Products and information are not intended to diagnose, treat, cure, or prevent any disease.