The ringing in the ears just…won’t…stop. It is a constant companion; both during the day and at night. It is especially burdensome at night when the noise of the day dies down, and you are left to your thoughts—and the incessant ringing. I am talking about tinnitus.
Tinnitus is the perception of sound when no external sound is present. It can be characterized as a ringing, buzzing, hissing, or roaring noise. The sound can be in one ear, both ear, and can also feel like it is inside the head. Roughly one out of every seven adults globally will experience tinnitus in their lifetime.[1]
Causes of Tinnitus
Tinnitus is often the result of hearing loss caused by damage to the hair cells in the cochlea that vibrate in the inner ear. This vibration causes a neural signaling response in the brain that is reproduced as an auditory signal.[2] Frequent and prolonged noise exposure like concerts, gunfire, motorcycles, machinery, and headphones at high volumes can increase hearing loss and risk of tinnitus.
Blockages in the middle ear can increase risk of experiencing tinnitus. Common causes include buildup of earwax, middle ear infections, and fluid accumulation. Use and overuse of medications, like high-dose aspirin, antibiotics, chemotherapeutic drugs, and diuretics can both cause tinnitus and make it worse. Abnormalities in blood vessels, head and neck injuries, and temporomandibular joint (TMJ) disorders are also known tinnitus triggers. Other cases of tinnitus are idiopathic--meaning the cause is not one of those listed above and is unknown.[3]
Tinnitus: Biological Pathways
Tinnitus is not a disease in and of itself but is the result of an imbalance in different biological pathways.[4] Noise trauma can produce reactive oxygen species (ROS) like superoxide, peroxynitrite, and hydroxyl radicals that damage cochlear cells and can cause hearing loss. These ROS molecules can overwhelm the cells in the ear if the antioxidant pathways in the body—such as NRF2, glutathione, and superoxide dismutase—are not working in tip-top shape due to lifestyle factors such as poor diet, a sedentary lifestyle, and lack of sleep.
Inflammation in both the cochlea and brainstem, known as neuroinflammation, can cause tinnitus by overactivation of the NFKB gene pathway, increased microglial production, and release of inflammatory molecules called cytokines.[5] Imbalance in calcium signaling is also a common culprit of why tinnitus can occur.[6]
Molecular Solutions for Tinnitus
The body is molecular, meaning it consists of molecules. The biological mechanisms of action that cause tinnitus are molecular. Therefore, it makes sense that there are molecules that could help with tinnitus that significantly diminishes quality of life for so many. Here are a few molecules from natural sources that can help to keep tinnitus at bay.
Ginkgo biloba leaves
Ginkgo biloba is a tree native to China that now grows throughout Asia. The leaves contain a powerful class of molecules called ginkgolides that can help with tinnitus. The most common dosage shown to be effective in clinical studies was 120 milligrams twice a day (morning and night).[7] The most effective ginkgo material to use for helping with tinnitus contains 24% flavone glycosides and 6% terpene lactones. This is a common ratio that can be found in many ginkgo supplements.
Choose a ginkgo supplement from a brand that is trusted, conducts third party testing, and is standardized to specific bioactive molecules.
Alpha-lipoic acid (ALA)
ALA is one of the best antioxidants found on this beautiful planet. It is especially good at protecting the cells in the inner ear from being damaged. Clinical studies have shown that taking 600 milligrams of ALA per day for two months can reduce the frequency of tinnitus. Spinach, broccoli, and tomatoes are good food sources of ALA. [8]
Magnesium
Magnesium can help with tinnitus by protecting the hair cells from noise-induced damage.[9] It is best to get magnesium from foods because the absorption of this critical mineral is higher than in a traditional nutritional supplement. Highest food sources of magnesium include pumpkin seeds, almonds, spinach, black beans, and dark chocolate.
Zinc
Zinc is an essential mineral that improves health of many aspects of the body, including tinnitus.[10] Oysters have the highest amount of zinc of any food. Other foods high in zinc include beef, chickpeas, lentils, and pumpkin seeds. Eating a palm-full of pumpkin seeds gets you good amounts of both zinc and magnesium and puts you well on your way to balancing several of the biological pathways responsible for reducing tinnitus.
Curcumin
Curcumin, abundant in the turmeric root (curcuma longa), can help reduce tinnitus by downregulating the NF-KB epigenetic pathway that is a master driver of inflammation.[11] Use curcumin in your curries, meat rubs, and other recipes. Curcumin is also a nice addition to yogurts and protein shakes. Taking one teaspoon of curcumin three times per week can be helpful for tinnitus.
Overcoming tinnitus might seem like a futile endeavor. There is hope! Molecules are the answer!
The molecules and minerals mentioned above could be the key to improving quality of life for yourself if your struggle with tinnitus or with a loved one.
Please share this newsletter with someone who could be interested and encourage them to sign up for the Molecular Brief below.
To learn more about how molecules can heal our bodies, please listen each week to the Molecules Matter with Dr. Dan podcast here:
I appreciate you and I am grateful to be with you on this molecular journey to greater health and happiness!
Be well,
Dr. Dan
[1] Jarach, Carlotta M et al. “Global Prevalence and Incidence of Tinnitus: A Systematic Review and Meta-analysis.” JAMA neurology vol. 79,9 (2022): 888-900. doi:10.1001/jamaneurol.2022.2189
[2] Han, Byung In et al. “Tinnitus: characteristics, causes, mechanisms, and treatments.” Journal of clinical neurology (Seoul, Korea) vol. 5,1 (2009): 11-9. doi:10.3988/jcn.2009.5.1.11
[3] Langguth, Berthold et al. “Tinnitus: causes and clinical management.” The Lancet. Neurology vol. 12,9 (2013): 920-930. doi:10.1016/S1474-4422(13)70160-1
[4] Simonetti, Patricia, and Jeanne Oiticica. “Tinnitus Neural Mechanisms and Structural Changes in the Brain: The Contribution of Neuroimaging Research.” International archives of otorhinolaryngology vol. 19,3 (2015): 259-65. doi:10.1055/s-0035-1548671
[5] Shulman, Abraham et al. “Neuroinflammation and Tinnitus.” Current topics in behavioral neurosciencesvol. 51 (2021): 161-174. doi:10.1007/7854_2021_238
[6] Sziklai, István. “The significance of the calcium signal in the outer hair cells and its possible role in tinnitus of cochlear origin.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery vol. 261,10 (2004): 517-25. doi:10.1007/s00405-004-0745-9
[7] Morgenstern, C, and E Biermann. “The efficacy of Ginkgo special extract EGb 761 in patients with tinnitus.” International journal of clinical pharmacology and therapeutics vol. 40,5 (2002): 188-97. doi:10.5414/cpp40188
[8] Sacchetto, Luca et al. “The Effect of Alpha-Lipoic Acid in the Treatment of Chronic Subjective Tinnitus through the Tinnitus Handicap Inventory Scores.” Audiology research vol. 13,4 484-494. 7 Jul. 2023, doi:10.3390/audiolres13040043
[9] Cevette, Michael J et al. “Phase 2 study examining magnesium-dependent tinnitus.” The international tinnitus journal vol. 16,2 (2011): 168-73.
[10] Arda, H Nedim et al. “The role of zinc in the treatment of tinnitus.” Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology vol. 24,1 (2003): 86-9. doi:10.1097/00129492-200301000-00018
[11] Li, Ning et al. “Curcumin protects against the age-related hearing loss by attenuating apoptosis and senescence via activating Nrf2 signaling in cochlear hair cells.” Biochemical pharmacology vol. 212 (2023): 115575. doi:10.1016/j.bcp.2023.115575
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