Vertigo and Vitamin Deficiencies: What the Science Says and How to Fix It

Room spinning out of nowhere? You grab a wall, the bed, anything solid-because your brain swears the floor tilted. Vertigo can be caused by ear crystals, migraines, infections, even rare brain issues. Here’s the part most people miss: certain vitamin and mineral deficiencies can amplify vertigo or make it come back. They’re not the only cause, and supplements aren’t magic, but they’re one of the most fixable pieces of the puzzle.

• TL;DR: The strongest nutrition links are vitamin D with BPPV (position-triggered vertigo), B12 with balance/nerve issues, iron with lightheadedness (and sometimes vertigo), magnesium with migraine-related vertigo, and thiamine in severe deficiency.
• Don’t guess. Ask your GP for targeted labs and treat the cause, not just the symptom.
• Evidence snapshot: vitamin D supplementation reduced BPPV recurrences in a 2020 randomized trial (Neurology); low B12 and iron commonly present with dizziness; magnesium helps migraines for some.
• Safe fixes: right dose, right form, and checks at 8-12 weeks. Overdoing it can backfire.
• Pair nutrition with proven maneuvers (Epley for BPPV), hydration, and sleep. That combo works better than any single trick.

The science behind vertigo and nutrients (what matters, what doesn’t)

First, quick clarity. Vertigo is a spinning sensation, like the room moves when you turn your head. Dizziness is broader-lightheaded, woozy, unsteady. Vitamin problems can cause either, but the patterns differ. The big vertigo types you’ll hear about: BPPV (crystals in the inner ear), vestibular neuritis (often viral), Ménière’s (fluid pressure), and vestibular migraine. Nutrition most often intersects with BPPV and migraine; it can also worsen overall balance when nerves or blood oxygen run low.

Vitamin D: the best-studied link. Multiple observational studies since 2013 found people with recurrent BPPV had lower vitamin D levels. The standout: a 2020 randomized, open-label trial in Neurology showed that supplementing vitamin D (with calcium if needed) cut BPPV recurrences over a year, especially if baseline vitamin D was low. The likely mechanism? Vitamin D influences calcium metabolism in the inner ear’s otoconia (the “crystals”). Low vitamin D may make them more fragile, easier to dislodge, and more likely to misbehave when you roll over in bed.

Vitamin B12: the stealthy one. B12 deficiency damages nerves and can cause unsteady gait, numbness, and cognitive fog. Dizziness is common; for some, it feels like vertigo. Case series and cohort studies (for example, J Neurol Sci, 2014) link low B12 to balance problems that improved after repletion. If you’re vegan, take metformin, or have gut issues (like after gastric surgery), your risk is higher.

Iron: oxygen delivery matters. Iron-deficiency anemia can cause lightheadedness, fatigue, palpitations, and sometimes true vertigo, especially when you stand up quickly. Heavy periods, pregnancy, post-viral fatigue, and low iron intake set the stage. Correcting iron deficiency often settles the “floating” feeling and steadies the legs.

Magnesium: a migraine lever. Vestibular migraine (yes, migraines can be mostly vertigo) responds to the same upstream tools as classic migraine: steady sleep, trigger control, and sometimes magnesium. Clinical guidance from headache societies and meta-analyses in Nutrients (2021) suggest magnesium can reduce migraine frequency and intensity for some, with low downside when dosed sensibly. People who get spinning with bright lights, certain foods, periods, or poor sleep are classic candidates.

Thiamine (B1): rare but urgent. Severe deficiency-think heavy alcohol use, prolonged vomiting, or extreme dieting-can cause Wernicke’s encephalopathy with nystagmus, confusion, and unsteady gait. That’s hospital-level urgent and treated with high-dose thiamine. Most folks with day-to-day vertigo are not here, but it’s a life-saving rule-out.

What about folate, vitamin E, zinc? Folate walks with B12; low folate can elevate homocysteine and worsen anemia symptoms, but it’s a co-star, not the lead. Vitamin E and zinc have scattered data; nothing consistent enough to target for vertigo alone.

So where does that leave you? If episodes are brief, triggered by rolling in bed or looking up, think BPPV and vitamin D status. If dizziness pairs with tingling feet or a vegan diet, think B12. If you’re pale, exhausted, and breathless on stairs, think iron. If vertigo rides along with headaches, light sensitivity, or a menstrual pattern, think magnesium and migraine.

Test smarter, supplement safely, and eat in a way that steadies you

Guessing is slow. A simple lab panel can separate what’s fixable from what’s noise. In New Zealand and similar systems, ask your GP about:

• 25-hydroxy vitamin D (25[OH]D)
• Vitamin B12, methylmalonic acid (MMA) and/or homocysteine if B12 is borderline
• Full blood count, ferritin, and iron studies (TSAT) for iron status
• Magnesium (note: serum can be normal even if total body is low), and a migraine history screen
• Thiamine (B1) if at risk (alcohol use disorder, eating disorders, gastric surgery, prolonged vomiting)
• Thyroid-stimulating hormone (TSH) and fasting glucose if symptoms point that way

Target ranges vary by lab. Here are practical targets many clinicians use and how they connect to symptoms. Use this as a conversation starter with your doctor, not a DIY diagnosis.

How to supplement without drama:

• Vitamin D: Start 1,000-2,000 IU/day with food. If your level is under 50 nmol/L, your doctor may push to 2,000-4,000 IU/day short-term. Retest in 8-12 weeks.
• B12: If low or borderline with high MMA, 1,000 mcg/day methylcobalamin or cyanocobalamin works for most. If you’ve had gastric bypass, pernicious anemia, or severe deficiency, ask about injections.
• Iron: Choose a form you tolerate (ferrous fumarate or gluconate). Alternate-day dosing often absorbs better and causes fewer gut issues. Pair with vitamin C; avoid tea/coffee and calcium within 2 hours.
• Magnesium: Glycinate is gentle; citrate helps if you’re constipated. Start at 200 mg elemental at night and step up to 300-400 mg if needed.
• Thiamine: If you or someone you love has confusion, weird eye movements, or severe gait issues in the setting of alcohol misuse or prolonged vomiting-this is not a supplement-store moment. It’s A&E.

Food pattern that helps you stay steady:

• Protein at each meal to stabilise blood sugar (eggs at breakfast beat a muffin every time).
• Iron-smart combos: add kiwifruit or capsicum to lentil dishes; do red meat or mussels once or twice a week if you eat animal foods.
• Magnesium from a nightly handful of nuts/seeds and a big leafy salad most days.
• Vitamin D from oily fish twice a week, plus sensible midday sun in winter when UV is lower in Wellington-but never burn.
• Hydration matters. Dehydration can mimic vertigo, especially after a virus or intense training.

Quick decision guide (not a diagnosis):

• Spins last seconds, triggered by rolling over or looking up? Likely BPPV. Do an Epley maneuver and check vitamin D.
• Dizzy with tingling feet, memory slips, or vegan diet? Check B12 (and MMA).
• Woozy on standing, pale, heavy periods, breathless? Check ferritin, haemoglobin.
• Vertigo with light/sound sensitivity or headache? Think vestibular migraine; consider magnesium and migraine hygiene.
• Confusion + unsteady eyes/walk + heavy alcohol or severe vomiting? Urgent thiamine in hospital.

From spinning to steady: maneuvers, checklists, and what to do this week

If your vertigo is positional (BPPV), the Epley maneuver can be a game-changer while you sort your labs. It repositions the crystals back to where they belong. If you can, have a physio demonstrate; done right, relief can be immediate.

1. Sit on the bed with your head turned 45° toward the affected ear (the side that triggers spinning).
2. Quickly lie back with your head hanging slightly off the edge, still turned 45°. Wait for the spin to peak and settle (30-60 seconds).
3. Rotate your head 90° toward the other side without lifting it. Hold 30-60 seconds.
4. Roll onto your side in the same direction your head is now facing so you’re looking down at the floor. Hold 30-60 seconds.
5. Sit up slowly. Rest a few minutes.

Repeat up to three times if needed, once or twice a day for a few days. If symptoms swap ears or worsen, stop and see a clinician-there are variants (horizontal canal) that need different maneuvers.

Weekly plan to cover your bases:

• Day 1-2: Book your GP for labs (25[OH]D, B12 ± MMA, FBC, ferritin, iron studies, magnesium, and others as needed). Start a symptom diary: what triggers, how long, any headaches, period timing, or viral illness.
• Day 3-4: If BPPV likely, practice the Epley maneuver. Begin gentle hydration goals (urine pale yellow), regular meals with protein, and an earlier bedtime.
• Day 5-7: Based on diet history, start safe baseline supplements (e.g., vitamin D 1,000-2,000 IU/day in winter; magnesium 200 mg at night if you’re a migraine person). Wait for iron and B12 results before dosing high.
• Week 2-4: Adjust doses with your GP once labs are back. Keep a daily 1-10 dizziness score. If migraine patterns emerge, read your triggers (sleep, stress, certain wines/cheeses) and set a simple routine.
• Week 8-12: Retest labs if you were low. If BPPV recurs, recheck vitamin D; consider a vestibular physio for tailored maneuvers and balance training.

Safety checklist before you supplement:

• Don’t exceed 4,000 IU/day of vitamin D unless supervised; it can raise calcium.
• Iron can constipate and irritate the gut. If stools go tarry black with abdominal pain, call your doctor.
• Separate iron from calcium, coffee, and tea by at least two hours.
• Magnesium can loosen stools. Start low, go slow, and pick glycinate if your gut is touchy.
• Pregnancy or planning? Get individual advice-doses differ and some migraines behave oddly in pregnancy.

Evidence you can trust (no links, just the receipts):

• Neurology, 2020: Randomized trial showed vitamin D supplementation reduced BPPV recurrences, especially in those with low baseline levels.
• Journals across 2013-2016: Observational studies linking low vitamin D to BPPV and recurrence risk.
• Journal of Neurological Sciences, 2014: Cohort data connecting low B12 with balance impairment-improved with repletion.
• Nutrients, 2021: Meta-analyses support magnesium for migraine prevention in some patients.
• World Health Organization and haematology guidance: iron-deficiency anemia commonly causes dizziness and exercise intolerance; ferritin is the key early marker.

Pro tips from clinic floors:

• If you’re frequently outside in Wellington but always wear high-SPF sunscreen and work indoors, you can still be low in vitamin D by late winter. Testing beats guessing.
• Heavy periods? Consider iron checks twice a year. Small, steady doses beat heroic, nauseating ones.
• On metformin? Put B12 on your annual bloods; long-term use can deplete it.
• Vestibular migraine loves irregular sleep. Same bedtime, same wake time-a boring but potent tool.

Mini‑FAQ

• Can vitamins alone cure vertigo? Not usually. They can cut recurrences (vitamin D in BPPV), fix contributory problems (B12/iron), and reduce migraine frequency (magnesium), but maneuvers and lifestyle matter too.
• How fast will I feel better? Epley can help the same day. Iron and B12 take weeks for nerves and oxygen capacity to rebound. Vitamin D changes show up over months in recurrence patterns.
• Is a multivitamin enough? Often not for deficiency levels. Targeted doses work faster and safer than throwing a kitchen-sink multi at the problem.
• Could low blood sugar be my dizziness? Yes. If you skip meals or have diabetes medication adjustments, shaky/clammy wooziness can mimic vertigo. Eat regular protein and check with your GP.
• When should I worry it’s not vitamins? New severe headache, one-sided weakness, slurred speech, chest pain, or fainting-seek urgent care. Continuous vertigo with hearing loss or facial weakness also needs same-day assessment.

Troubleshooting different scenarios

• All my labs are normal, but I still spin: Ask for an ENT or vestibular physio referral. You may have a horizontal canal variant or vestibular migraine. A tailored rehab plan (gaze stabilization, balance drills) changes lives.
• Supplements upset my stomach: Shift iron to alternate days, take with vitamin C, and try a gentler salt (ferrous gluconate). Switch magnesium form (glycinate). Take vitamin D with your main meal.
• I’m vegetarian/vegan: Lock in a reliable B12 source (supplement or fortified foods) and plan iron with vitamin C at each meal. Consider a magnesium supplement if migraines are in the mix.
• I’m on lots of meds: Bring your list to your GP or pharmacist. Iron interacts with thyroid meds and some antibiotics; magnesium can affect some heart drugs.
• I had a virus and now I’m dizzy: Vestibular neuritis can drag on. Hydrate, sleep, and ask about a short course of vestibular rehab. Nutrition still supports recovery, but time and physio are key.

Bottom line: identifying and fixing vertigo and vitamin deficiencies won’t solve every wobble, but it can reduce attacks, speed recovery, and give you back some control. Get the right tests, correct what’s low, use maneuvers that work, and keep a simple routine. That’s how the spinning slows.