Grounded | The Vestibular Podcast

“Progesterone will hold up the mirror for you and show you about your habits. Estrogen is forgiving—progesterone is not.”

For so many women with vestibular disorders, symptoms get dramatically worse right before their period or around ovulation, and the answer they’re usually given is “take birth control” or “drink more water.” 

That, of course, is not enough. I brought in Dr. Saru Bala, Naturopathic Doctor and Women’s Hormonal Health Specialist, to break it all down. Get ready to nerd out on all things hormones!

In this episode, we’re talking about what hormones actually are, how your cycle phases impact your vestibular symptom, why your liver is way more important than you think, the estrogen-histamine-MCAS loop, and what bloodwork you should be asking for.

In this episode, we’ll dig into:

What are hormones

What to pay attention to with women’s hormones

The phases of your cycle

What progesterone is reflecting back about your habits 

The basics that impact your hormones the most

Bloodwork Dr. Saru recommends for her clients

Why you want to get a full thyroid panel

The liver’s role in hormone metabolism

How to support your liver

The estrogen-histamine loop

How MCAS plays a role here

Why gut & liver support are essential for histamine, MCAS, and hormone issues

Why women are taking much longer to feel better than even 5 years ago

If you take nothing else away from this, remember your hormones, liver, gut, and nervous system are all talking to each other. When you start supporting them, things are able to start changing.

Meet: Dr. Saru Bala

Dr. Saru Bala is a licensed Naturopathic Doctor with a degree from Bastyr University in Seattle, WA. Prior to attending medical school, she graduated from University of Texas at Austin where she received her bachelor’s degree in Neurobiology. She’s done extra training in women’s health and naturopathic endocrinology and wants to talk to you about all things women’s health.

Connect w/ Dr Saru Bala

Website: https://www.drsarubala.com/

Instagram: https://www.instagram.com/drsarubala

Facebook: https://www.facebook.com/periodpractice

Period Solutions Academy: https://www.drsarubala.com/periodsolutionsacademy

Links Mentioned:

Vestibular Group Fit (code GROUNDED at checkout for 15% off!): https://thevertigodoctor.com/vestibular-group-fit

Rise Centered Alarm Clock: https://risecentered.com?sca_ref=7113075.4mnDvPsCZ8H

Free Resources:

⁠The 4 Steps to Managing Vestibular Migraine: https://thevertigodoctor.myflodesk.com/cb5js0y78n

⁠The PPPD Management Masterclass⁠: https://thevertigodoctor.myflodesk.com/new-pppd

⁠What your Partner Should Know About Living with Dizziness⁠: https://thevertigodoctor.myflodesk.com/partnership

⁠The FREE Mini VGFit Workout⁠: https://thevertigodoctor.myflodesk.com/minifit

⁠The FREE POTS – safe Workouts⁠: https://thevertigodoctor.myflodesk.com/pots

Connect with Dr. Madison (@TheVertigoDoctor): https://instagram.com/thevertigodoctor

Work with Dr. Madison:

For 1:1 Vestibular Rehabilitation Therapy, email madison@thevertigodoctor.com

Otherwise, I’ll see ya in Vestibular Group Fit!

Connect with Dr. Jenna (@dizzy.rehab.therapist): https://www.instagram.com/dizzy.rehab.therapist/

Learn about the Oak Method: http://thevertigodoctor.com/why-vestibular-group-fit

Love what you heard?
Consider leaving a review on your favorite podcast platform to help us reach more vestibular warriors like you!

This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

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Having a list or “menu” of ideas for what to do on those higher symptom days can be helpful to have before you actually need it.

This could be a time when you’re riding out an attack and looking for things to do that are gentle but stimulating to help pass the time. 

Of course, what will be the best fit will depend on the person and the symptoms on a given day.

Save this episode to come back to because I’m walking through a whole list of low-demand activities that can be enjoyable on higher symptom days.

In this episode, we’ll dig into:

Why you need a go-to activity list before a high symptom day hits

A reminder to always reach for your toolkit first on harder days

A variety of gentle indoor and outdoor activities to note

An upcoming MCAS webinar you won’t want to miss

Having a list of things your brain already trusts on a hard day isn’t just self care, it’s part of your toolkit.

Links Mentioned:

Vestibular Group Fit (code GROUNDED at checkout for 15% off!): https://thevertigodoctor.com/vestibular-group-fit

MCAS Webinar (August 14, 2026): https://resolvinghistamine.heysummit.com/

Seek App: https://www.inaturalist.org/pages/seek_app

Petals and Profanity coloring book: https://amzn.to/49VMBTC

The 15 Puzzle (slider game): https://amzn.to/4vjoZ40

Sagrada board game: https://amzn.to/4fMGN2l

Carcassonne board game: https://amzn.to/4ejqbgk

Flip 7 card game: https://amzn.to/4vHK5su

Five Crowns card game: https://amzn.to/44bNuUw

Free Resources:

⁠The 4 Steps to Managing Vestibular Migraine: https://thevertigodoctor.myflodesk.com/cb5js0y78n

⁠The PPPD Management Masterclass⁠: https://thevertigodoctor.myflodesk.com/new-pppd

⁠What your Partner Should Know About Living with Dizziness⁠: https://thevertigodoctor.myflodesk.com/partnership

⁠The FREE Mini VGFit Workout⁠: https://thevertigodoctor.myflodesk.com/minifit

⁠The FREE POTS – safe Workouts⁠: https://thevertigodoctor.myflodesk.com/pots

Connect with Dr. Madison (@TheVertigoDoctor): https://instagram.com/thevertigodoctor

Work with Dr. Madison:

For 1:1 Vestibular Rehabilitation Therapy, email madison@thevertigodoctor.com

Otherwise, I’ll see ya in Vestibular Group Fit!

Connect with Dr. Jenna (@dizzy.rehab.therapist): https://www.instagram.com/dizzy.rehab.therapist/

Learn about the Oak Method: http://thevertigodoctor.com/why-vestibular-group-fit

Love what you heard?
Consider leaving a review on your favorite podcast platform to help us reach more vestibular warriors like you!

This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

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Vestibular disorders (particularly vestibular migraine) and POTS are often talked about in our practice and in Vestibular Group Fit as they overlap quite a bit.

In this episode, I’m digging into one of the most common co-occurring conditions I see in my practice alongside vestibular migraine: POTS (Postural Orthostatic Tachycardia Syndrome).

I’m also introducing something called the pentad super syndrome (almost every single person I see in my clinic has all five). You’ll learn what it is and what I believe is missing from the list.

Discover everything from how POTS is diagnosed, to helpful resources, and why your basics matter more than ever when you’re managing both POTS and vestibular disorders at the same time.

In this episode, we’ll dig into:

What POTS is

The diagnostic criteria for POTS

Why there is overlap between POTS and vestibular 

What the pentad super syndrome is

Why histamine and MCAS are a huge piece of the puzzle

The tilt table test vs. active stand test

What conditions can sometimes mimic POTS

What the CHOP POTS protocol is

Why heat is a major POTS and MCAS trigger

What tools to keep in your toolkit for heat

Lifestyle changes that are beneficial for POTS and vestibular conditions

How VGF members apply the threshold and bucket theory to manage both conditions

The good news is that the toolkit for your vestibular disorder and your POTS have a LOT of overlap, which means you’re already building the right foundation.

Related Episodes:

Build Your Migraine Threshold: https://thevertigodoctor.com/podcast/74-build-your-migraine-threshold-to-reduce-vestibular-migraine-attacks/

Links Mentioned:

Vestibular Group Fit (code GROUNDED at checkout for 15% off!): https://thevertigodoctor.com/vestibular-group-fit

Standing Up to POTS podcast: https://www.standinguptopots.org/podcast

dysautonomiaproject.org 

Santosha Spirit on YouTube (Rachel): https://www.youtube.com/channel/UC0ROkm_8Bjk0qOQ13XYOebg

Compression socks: https://sockwellusa.com/

NEWZILL Calf Compression Sleeve: https://www.amazon.com/NEWZILL-Calf-Compression-Sleeve-Footless/dp/B0DRYS7KBD/

Doc Miller Calf Compression Sleeves: https://www.amazon.com/Doc-Miller-Compression-20-30mmHg-Fashionable/dp/B012E1B5P6/

LMNT electrolytes: https://www.amazon.com/LMNT-Zero-Sugar-Electrolytes/dp/B084HQ4DYQ/

Free Resources:

⁠The 4 Steps to Managing Vestibular Migraine: https://thevertigodoctor.myflodesk.com/cb5js0y78n

⁠The PPPD Management Masterclass⁠: https://thevertigodoctor.myflodesk.com/new-pppd

⁠What your Partner Should Know About Living with Dizziness⁠: https://thevertigodoctor.myflodesk.com/partnership

⁠The FREE Mini VGFit Workout⁠: https://thevertigodoctor.myflodesk.com/minifit

⁠The FREE POTS – safe Workouts⁠: https://thevertigodoctor.myflodesk.com/pots

Connect with Dr. Madison (@TheVertigoDoctor): https://instagram.com/thevertigodoctor

Work with Dr. Madison:

For 1:1 Vestibular Rehabilitation Therapy, email madison@thevertigodoctor.com

Otherwise, I’ll see ya in Vestibular Group Fit!

Connect with Dr. Jenna (@dizzy.rehab.therapist): https://www.instagram.com/dizzy.rehab.therapist/

Learn about the Oak Method: http://thevertigodoctor.com/why-vestibular-group-fit

Love what you heard?
Consider leaving a review on your favorite podcast platform to help us reach more vestibular warriors like you!

This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

Citations

“Research Summary: Postural Orthostatic Tachycardia Syndrome (POTS)….” American Headache Society, 2022, americanheadachesociety.org/research/library/research-summary-postural-orthostatic-tachycardia-syndrome-pots-and-migraine-a-narrative-review.

Cleveland Clinic. “Postural Orthostatic Tachycardia Syndrome (POTS).” Cleveland Clinic, 9 Sept. 2022, my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots.

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You’ve probably heard the words ‘biofeedback’ and ‘neurofeedback’ floating around the internet. And you’re also probably wondering what they mean and if they’re worth your time and money when you have a vestibular disorder.

I’m answering all of that in this episode!

Biofeedback is a type of mind-body technique to control some of the body’s function. And neurofeedback is a type of biofeedback that measures and records brainwaves. As always, I’ve got research and scenarios for us to talk through to help this really land.

They’re probably not the first thing you want to invest in and there are even less expensive options that are equally or more effective which I share more about in the episode.

Buckle up and let’s get a little nerdy with this one!

In this episode, we’ll dig into:

What biofeedback is and how it works

What the main types of biofeedback are

What neurofeedback is and how it relates to biofeedback

The difference between active and passive neurofeedback

The two main models of biofeedback that exist

What to expect in a biofeedback session

What biofeedback is considered effective for

Types of neurofeedback and biofeedback sessions, devices, and apps available

How to find a qualified biofeedback provider

What questions to ask before committing to either option

If you want to go even deeper with what you heard in this episode, we have coaching calls specifically about biofeedback and neurofeedback available in Vestibular Group Fit.

Biofeedback is a tool, not a cure. But if you’re curious, informed, and financially comfortable exploring it, it absolutely can have a place in your vestibular toolkit.

Links Mentioned:

Vestibular Group Fit (code GROUNDED at checkout for 15% off!): https://thevertigodoctor.com/vestibular-group-fit

Certification from the Association for Applied Psychophysiology and Biofeedback (AAPB) site has an option to find a practitioner: https://aapb.org/Find_a_Practitioner 

Hearthmath: https://www.heartmath.com/ 

Resperate (FDA approved for blood pressure and stress): https://resperate.com 

Leva (FDA approved for pelvic floor): https://levacares.com/ 

Prism (FDA approved for PTSD): https://www.graymatters-health.com/prism-for-ptsd 

Finding a provider

International society for neuroregulation and research: https://isnr.org/

Biofeedback certification international alliance: https://www.bcia.org/

Free Resources:

⁠The 4 Steps to Managing Vestibular Migraine: https://thevertigodoctor.myflodesk.com/cb5js0y78n

⁠The PPPD Management Masterclass⁠: https://thevertigodoctor.myflodesk.com/new-pppd

⁠What your Partner Should Know About Living with Dizziness⁠: https://thevertigodoctor.myflodesk.com/partnership

⁠The FREE Mini VGFit Workout⁠: https://thevertigodoctor.myflodesk.com/minifit

⁠The FREE POTS – safe Workouts⁠: https://thevertigodoctor.myflodesk.com/pots

Connect with Dr. Madison (@TheVertigoDoctor): https://instagram.com/thevertigodoctor

Work with Dr. Madison:

For 1:1 Vestibular Rehabilitation Therapy, email madison@thevertigodoctor.com

Otherwise, I’ll see ya in Vestibular Group Fit!

Connect with Dr. Jenna (@dizzy.rehab.therapist): https://www.instagram.com/dizzy.rehab.therapist/

Learn about the Oak Method: http://thevertigodoctor.com/why-vestibular-group-fit

Love what you heard?
Consider leaving a review on your favorite podcast platform to help us reach more vestibular warriors like you!

This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

Citations

Frank, D. L., Khorshid, L., Kiffer, J. F., Moravec, C. S., & McKee, M. G. (2010). Biofeedback in medicine: who, when, why and how?. Mental health in family medicine, 7(2), 85–91.

Mayo Clinic. “Biofeedback – Mayo Clinic.” Mayoclinic.org, 18 Mar. 2023, www.mayoclinic.org/tests-procedures/biofeedback/about/pac-20384664.

Marzbani, H., Marateb, H. R., & Mansourian, M. (2016). Neurofeedback: A Comprehensive Review on System Design, Methodology and Clinical Applications. Basic and clinical neuroscience, 7(2), 143–158. https://doi.org/10.15412/J.BCN.03070208

Bazzana, F., Finzi, S., Di Fini, G., & Veglia, F. (2022). Infra-Low Frequency Neurofeedback: A Systematic Mixed Studies Review. Frontiers in human neuroscience, 16, 920659. https://doi.org/10.3389/fnhum.2022.920659

Duke, G., Yotter, C. N., Sharifian, B., Duke, G., & Petersen, S. (2024). The effectiveness of microcurrent neurofeedback on depression, anxiety, post-traumatic stress disorder, and quality of life. Journal of the American Association of Nurse Practitioners, 36(2), 100–109. https://doi.org/10.1097/JXX.0000000000000945

Cleveland Clinic. “Biofeedback: What Is It & Procedure Details.” Cleveland Clinic, 21 Dec. 2020, my.clevelandclinic.org/health/treatments/13354-biofeedback.

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One thing that a lot of people with vestibular disorders notice is how fatiguing or challenging different tasks become over time. 

What’s happening is your brain is trying to process multiple inputs (or even tasks) at the same time. 

For those with vestibular disorders, it becomes more difficult because your body is trying to process more information—and it’s also now having to work double time to keep you upright.

Multitasking and task switching are a part of daily life, but it comes with costs. And those with vestibular disorders often notice this more but aren’t quite sure how to make it go away.

But this episode is here to help!

In this episode, we’ll dig into:

Why tasks feel manageable alone but become overwhelming when combined

How multitasking and task switching are similar and different

What the “switch cost” is and how it adds up over time for those with vestibular disorders

What percentage of people with vestibular conditions experience cognitive symptoms like brain fog

How the central nervous system and cerebral cortices matter for cognitive symptoms

Why spatial awareness demands extra resources when you have a vestibular disorder

How balance exercises in VRT are designed to gradually scale up task demands

Why errors are actually part of healing with a vestibular condition

Why rest and recovery are essential when you’re adding in more cognitive or physical tasks

Task switching and multitasking are hard for everyone! A vestibular disorder just adds an extra layer—it doesn’t mean things can’t improve, but it does take time, space, and grace.

You’re doing more things than you think and certainly doing more than you take credit for.

Links Mentioned:

Vestibular Group Fit (code GROUNDED at checkout for 15% off!): https://thevertigodoctor.com/vestibular-group-fit

Free Resources:

⁠The 4 Steps to Managing Vestibular Migraine: https://thevertigodoctor.myflodesk.com/cb5js0y78n

⁠The PPPD Management Masterclass⁠: https://thevertigodoctor.myflodesk.com/new-pppd

⁠What your Partner Should Know About Living with Dizziness⁠: https://thevertigodoctor.myflodesk.com/partnership

⁠The FREE Mini VGFit Workout⁠: https://thevertigodoctor.myflodesk.com/minifit

⁠The FREE POTS – safe Workouts⁠: https://thevertigodoctor.myflodesk.com/pots

Connect with Dr. Madison (@TheVertigoDoctor): https://instagram.com/thevertigodoctor

Work with Dr. Madison:

For 1:1 Vestibular Rehabilitation Therapy, email madison@thevertigodoctor.com

Otherwise, I’ll see ya in Vestibular Group Fit!

Connect with Dr. Jenna (@dizzy.rehab.therapist): https://www.instagram.com/dizzy.rehab.therapist/

Learn about the Oak Method: http://thevertigodoctor.com/why-vestibular-group-fit

Love what you heard?
Consider leaving a review on your favorite podcast platform to help us reach more vestibular warriors like you!

This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

Citations 

McGrath, Kim. “The “Switch Cost” of Multitasking.” Wake Forest News, 16 Apr. 2024, news.wfu.edu/2024/04/16/the-switch-cost-of-multitasking/.

Asuako, P. A. G., Stojan, R., Bock, O., Mack, M., & Voelcker-Rehage, C. (2025). Multitasking: does task-switching add to the effect of dual-tasking on everyday-like driving behavior?. Cognitive research: principles and implications, 10(1), 5. https://doi.org/10.1186/s41235-025-00611-y

Smith, L. J., Wilkinson, D., Bodani, M., & Surenthiran, S. S. (2024). Cognition in vestibular disorders: state of the field, challenges, and priorities for the future. Frontiers in neurology, 15, 1159174. https://doi.org/10.3389/fneur.2024.1159174

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