Tinnitus, characterized by the perception of noise or ringing in the ears without an external sound source, affects a significant portion of the global population. While there is no definitive cure, emerging research suggests that diet and lifestyle factors may play a role in tinnitus management. This comprehensive review explores the relationship between diet, lifestyle, and tinnitus, examining the existing evidence and potential mechanisms.
Understanding Tinnitus
Tinnitus manifests as the perception of noise or ringing in the ears without any external sound source. Its manifestations vary widely, from occasional buzzing to constant ringing, impacting various aspects of daily life such as concentration and sleep quality. Studies estimate that about 10-15% of people worldwide experience some degrees of tinnitus, with 1-2% enduring severe and persistent symptoms.
Tinnitus presents as a multifaceted symptom with diverse potential causes and mechanisms. It can stem from cochlear dysfunction, such as impairment to the outer hair cells in the inner ear, resulting in aberrant neural synchrony and alterations in tonotopic representation. However, tinnitus can also emanate from various relevant anatomical structures along the central auditory pathways, with ample evidence indicating that many tinnitus forms arise from intricate interactions between peripheral and central mechanisms. Beyond cochlear dysfunction, various factors may induce tinnitus, including exposure to loud noises, hearing impairment, emotional distress, and somatosensory influences.
Conceptually, tinnitus can be viewed as a pathology rooted in neural plasticity, with both molecular and systemic components. It encompasses a cochlear component linked to its onset phase and a central aspect tied to its long-term maintenance. Insights from animal models of tinnitus have been instrumental in identifying the location and characteristics of underlying defects, revealing heightened spontaneous activity in regions like the dorsal cochlear nucleus, inferior colliculus, and primary auditory cortex, alongside increased neural synchrony and bursting activity along the auditory pathway. Spontaneous otoacoustic emissions (SOAEs) represent one potential source of tinnitus, termed cochlear mechanical tinnitus. They are typically mild occurrences, often encountered in individuals with normal hearing and those affected by middle-ear ailments.
Tinnitus encompasses various types, with subjective and objective tinnitus being the primary classifications. Subjective tinnitus comprises approximately 99% of cases and is audible solely to the individual experiencing it. It can arise from diverse factors such as sudden exposure to loud noises, aging, hearing impairment, or conditions like Ménière's disease. In contrast, objective tinnitus, a rare occurrence affecting only about 1% of tinnitus sufferers, can be heard by the affected person and others, including medical professionals employing a stethoscope. Typically, objective tinnitus stems from vascular anomalies, neurological disorders affecting facial muscles, or patulous eustachian tubes, a condition characterized by the persistent opening of these tubes.
Read also: The Hoxsey Diet
Additional varieties of tinnitus include somatic tinnitus, associated with movements or tactile sensations, often triggered by muscle spasms, neck misalignments, or dental issues. Pulsatile tinnitus, exhibiting a rhythmic pattern synchronized with the heart's beats, indicates alterations in blood flow near the ear. Low-frequency tinnitus, affecting individuals profoundly with tones corresponding to the lowest octaves on a piano, manifests as humming, murmuring, rumbling, or deep droning sounds. Musical tinnitus, also known as musical hallucinations or auditory imagery, is a less common type characterized by the perception of simple tones or layered melodies, prevalent among individuals with prolonged hearing loss and tinnitus history.
Impact on Quality of Life
Tinnitus profoundly impacts individuals' quality of life, affecting diverse facets such as psychological well-being, emotional stability, sleep patterns, auditory functions, and overall health-related quality of life (HRQoL). Its presence often correlates with lower HRQoL due to associated factors like hearing loss, ototoxicity, head injury, and depression, presenting a formidable challenge to individuals' overall well-being. Studies underscore the emotional toll of tinnitus, revealing a spectrum of reactions including difficulty concentrating, frustration, anger, and even depression, all of which significantly disrupt daily functioning and emotional equilibrium.
The adverse effects of tinnitus extend beyond the auditory realm, encompassing psychological and emotional distress, sleep disturbances, and broader health repercussions. Moreover, tinnitus can prove debilitating, impeding individuals' ability to focus, sleep, and participate in routine activities, consequently diminishing their overall quality of life.
The Role of Diet
Diet may affect susceptibility of the inner ear to noise and age-related effects that lead to tinnitus and hearing loss. Tinnitus was based on report of ringing or buzzing in one or both ears that lasts more than five minutes at a time and is currently experienced at least some of the time. Identification of a hearing problem was based on self-reported difficulties with hearing. Encouragingly, there is evidence that both hearing loss and tinnitus may be associated with modifiable lifestyle factors including noise exposure, smoking, alcohol consumption, exercise, and diet, offering possibilities for prevention. The role of diet in tinnitus has been identified as a research priority by both patients and clinicians. There is anecdotal evidence for certain foods, single nutrients, and dietary supplements exacerbating or reducing tinnitus in individuals; however, there is little or no research evidence for a role of any particular dietary factor in contributing to tinnitus. Taken together, these studies suggest a small but significant impact of diet on tinnitus in the general population.
Macronutrients and Micronutrients
Micronutrients, comprising vitamins and minerals, are indispensable for the body despite being needed in minute quantities. They fulfill various functions, facilitating enzyme and hormone production essential for normal growth and development. Water-soluble vitamins, such as vitamins B and C, dissolve in water and necessitate daily replenishment as they are not stored in the body. In contrast, fat-soluble vitamins like A, D, E, and K dissolve in fat and can be stored for later use. Microminerals such as calcium, magnesium, sodium, and potassium are crucial for muscle and bone health and contribute to blood pressure regulation. Trace minerals like iron, manganese, copper, zinc, and selenium play pivotal roles in muscle health, nervous system function, and cell repair.
Read also: Walnut Keto Guide
Carbohydrates serve as the primary energy source for the body, vital for various physiological functions including central nervous system, brain, kidney, and muscle function. They can be stored for later use and play a key role in intestinal health and waste elimination. Carbohydrate sources encompass simple sugars in honey and fruits and complex starches in grains, potatoes, and starchy vegetables. Proteins, essential for growth, tissue repair, and maintaining lean body mass, are composed of amino acids, some of which must be acquired through diet. Protein-rich foods include animal products like meat, poultry, fish, dairy, and plant-based sources like beans, lentils, nuts, seeds, and soy. Fats are vital for energy storage, organ cushioning, hormone synthesis, vitamin absorption, and cell membrane integrity. While trans fats should be limited, unsaturated fats in olive oil, avocados, and nuts benefit heart health.
Dietary Patterns and Tinnitus
Research on dietary patterns and tinnitus aims to uncover potential relationships between them. While evidence linking specific foods or drinks to tinnitus severity remains inconsistent, some studies suggest dietary factors may influence conditions like Ménière’s disease, affecting the inner ear. However, conclusive links are lacking for other types of tinnitus, with research presenting contradictory findings. For instance, a 2018 study found associations between persistent tinnitus and higher intake of fruits, vegetables, bread, fish, and eggs, while dairy and caffeinated coffee intake were linked to reduced odds of persistent tinnitus. Additionally, higher caffeine intake was associated with a lower risk of incident tinnitus in women.
In a multivariate model, higher intake of vitamin B12 was associated with reduced odds of tinnitus, while higher intakes of calcium, iron, and fat were associated with increased odds (B12, odds ratio [OR] 0.85, 95% confidence interval [CI] 0.75 to 0.97; Calcium, OR 1.20, 95% CI 1.08 to 1.34; Iron, OR 1.20, 95% CI 1.05 to 1.37; Fat, OR 1.33, 95% CI 1.09 to 1.62, respectively, for quintile 5 versus quintile 1). A dietary pattern characterised by high protein intake was associated with reduced odds of tinnitus (OR 0.90, 95% CI 0.82 to 0.99 for quintile 5 versus quintile 1).
Potential Dietary Triggers
Potential dietary triggers of tinnitus encompass caffeine, sodium, salicylates, aspartame, sugar, and unhealthy fats. Caffeine, prevalent in beverages like coffee, tea, hot chocolate, and energy drinks, can exacerbate tinnitus symptoms by elevating blood pressure and stimulating nerve cell activity. Sodium, commonly found in processed and fast foods and snack items, can constrict blood vessels and elevate blood pressure, worsening tinnitus symptoms. Salicylates, natural compounds in fruits, vegetables, nuts, and oils, may accumulate in the body and provoke adverse reactions, potentially exacerbating tinnitus symptoms in sensitive individuals. Aspartame, an artificial sweetener, is suspected to be linked to tinnitus due to its potential toxicity to the brain and inner ear, particularly under conditions of heat exposure or prolonged storage. Problems with sugar metabolism, such as hyperinsulinemia, may also contribute to tinnitus symptoms, and adherence to a diabetic diet could alleviate symptoms for some individuals. Unhealthy fats, including saturated and trans fats, can impede circulation and diminish blood flow, potentially intensifying tinnitus severity.
Hydration
Hydration is pivotal in managing tinnitus, as dehydration can worsen symptoms and contribute to conditions that trigger tinnitus, such as high blood pressure, compromised hearing health, and ear infections. Ensuring adequate hydration is essential for sustaining healthy hearing, as the ears rely on fluid for optimal function. Studies have indicated that decreased vitamins B2, B3, water, and protein intake may correlate with tinnitus and related discomfort. Moreover, research conducted in Korea revealed a significant association between water intake and tinnitus, with individuals experiencing tinnitus displaying lower water consumption. This finding underscores the significance of maintaining adequate hydration, particularly during middle age when many individuals are engaged in active careers.
Read also: Weight Loss with Low-FODMAP
Foods to Consider
Some foods and drinks may make tinnitus worse, while others can help improve your ear health. Certain foods can increase blood pressure, affect blood flow to your ears, or cause fluid buildup. This can make tinnitus louder or more noticeable.
Foods and drinks that may worsen tinnitus:
- Caffeine: Many people rely on coffee, tea, or soda to stay awake, but caffeine can make tinnitus worse for some individuals. Caffeine can stimulate your nervous system, which might increase the ringing or buzzing in your ears.
- Salt: Eating too much salt can raise your blood pressure and affect your blood flow, including to your ears. This might make tinnitus louder.
- Sugar: Foods high in sugar, like candy, cookies, and sugary drinks, can spike blood sugar levels. These spikes can affect your ears and make tinnitus worse.
- Alcohol: Drinking alcohol can expand blood vessels and increase the flow of blood to your inner ear, which can make tinnitus more noticeable.
- Aspartame: Some researchers suspect aspartame might have a connection to tinnitus. Though a definitive link between the two has yet to be proven, the reason aspartame is considered suspect is that some components of it may be toxic to the brain and the inner ear - two organs that are particularly sensitive to neurotoxins.
- Salicylates: Salicylates are naturally occurring chemicals that protect plants against bacteria, pests and disease. People with salicylate sensitivity can have adverse reactions to the accumulation of salicylates in their body. People with tinnitus can experience a worsening of their symptoms when exposed to salicylates, according to the Journal of Neurosciences. Foods that contain salicylates include fruits such as dried fruit, blackberries, blueberries, boysenberry, oranges, pineapples, raisins, raspberries, strawberries and tangerines. Vegetables with salicylates include peppers, tomatoes, and canned green olives.
- Beverages: Red wine, grain-based spirits such as rum and beer, cider, sherry and brandy all contain high to very high levels of salicylates. Beverages that contain caffeine such as coffee, tea, hot chocolate and energy drinks also exacerbate tinnitus, according to American Tinnitus Association.
- Fats: Foods with saturated and trans fats contribute to poor circulation and reduce blood flow. A diet high in these unhealthy fats increases bad cholesterol and decreases good cholesterol, affecting long-term heart health and potentially heightening the severity of ringing in the ears.
Foods and drinks that may improve ear health:
- Fruits and Vegetables: Packed with vitamins and minerals, fruits and vegetables help keep your entire body healthy, including your ears.
- Fish: Fish like salmon and tuna are rich in omega-3 fatty acids, which are good for reducing inflammation in your body.
- Whole Grains: Eating whole grains like brown rice and oats is good for your blood circulation.
- Nuts and Seeds: Almonds, flaxseeds, and chia seeds are full of healthy fats and magnesium.
- Water: Drinking plenty of water is important for your body and your ears. Dehydration can affect fluid levels in your inner ear, which might make tinnitus worse.
The Migraine Connection
Over the last 10 years, my team at the University of California, Irvine has published scores of papers on the phenomenon called “otologic migraine”. We used to think that migraine is a headache phenomenon, but headaches are only one manifestation of the migraine reaction in the brain. Instead, migraine describes a reaction in the brain that can affect multiple sensory systems, including hearing. We now believe tinnitus is a form of atypical migraine. The first feature of migraine is that some trigger, whether internal or external, causes inflammation in the nervous system. This is not inflammation like with an infection. Instead, it's a sterile inflammation that is caused by the release of certain chemical messengers (cytokines) released by the nerves themselves. The second feature of migraine is that the neurogenic inflammation leads to sensory nerve hypersensitivity.
The hardest thing for my tinnitus patients to accept is that you can have a migraine without a headache. Almost everyone with chronic tinnitus has triggers. Interestingly, the things that make tinnitus worse are the same things that make migraines worse. Controlling these factors is called “trigger management“. This means the tinnitus diet is not about weight loss or addressing high blood pressure. It does not necessarily follow the healthy eating index. It isn't even a long term diet. This does not mean that there are not diets that tend to be better for tinnitus.
Elimination Diet
An elimination diet involves systematically removing specific foods or food groups from one's diet to identify which are causing the problem. The good news is that elimination diets are temporary. We generally recommend avoiding foods in the following categories. Glutamate is a neurotransmitter in the brain involved in signal transmission between neurons and plays a crucial role in various brain functions. Glutamate is the “G” in MSG. It is used in processed foods as a preservative and flavor enhancer. Certain foods sometimes hide MSG under different names like autolyzed yeast powder. Tyramine is a compound found in certain foods (such as fermented foods) where there is breakdown of the amino acid tyrosine. It is known to trigger the migraine reaction in the brain due to its ability to cause blood vessels to constrict and then expand, leading to changes in blood flow. Histamine is a compound involved in various physiological processes, including immune response and neurotransmission. In the context of tinnitus, histamine act as a vasodilator, promoting blood vessel dilation and potentially contributing to the migraine reaction.
Diet Types
- Ketogenic (Keto): May helpful in reducing tinnitus by decreasing inflammation and stabilizing blood sugar levels, which can mitigate triggers for the migraine reaction.
- Mediterranean: May help with people with tinnitus due to its emphasis on anti-inflammatory foods rich in antioxidants, healthy fats, and omega-3 fatty acids, potentially reducing inflammation and oxidative stress associated with migraine onset.
- Diabetic (Low Gl): May aid in tinnitus management by promoting stable blood sugar levels and reducing fluctuations. “Low GI” stands for low glycemic index.
- Anti-neuroinflammatory (ANI): May assist with tinnitus by incorporating foods rich in antioxidant and anti-inflammatory compounds. These can help reduce inflammation in the brain and potentially alleviate the migraine reaction that drives tinnitus.
- Antioxidant-rich: May benefit tinnitus sufferers by reducing oxidative stress and inflammation in the body, potentially decreasing the frequency and severity of tinnitus attacks. This diet is also good for hearing health and may protect against toxic noise exposure.
The best tinnitus diet is usual one or a combination of these. Most dietary supplements that helps with migraine will also help with tinnitus. Antioxidant supplements are great natural remedies for tinnitus and for hearing health. For instance, they can help prevent the progressive sensorineural hearing loss seen with aging or mitigate noise induced hearing loss.
Lifestyle Factors
Stress Management
Effective stress management techniques can significantly ameliorate tinnitus symptoms and alleviate the associated distress. Tinnitus and stress share a close relationship, with stress often exacerbating tinnitus symptoms, while the condition itself can induce stress and anxiety. The research underscores stress as a trigger for tinnitus or a factor in worsening existing symptoms, creating a cyclic interplay between stress and tinnitus. An array of stress management strategies can be implemented to disrupt this cycle. Relaxation techniques, such as deep breathing exercises, visualization, and self-hypnosis, have effectively reduced stress levels and tinnitus symptoms. Mindfulness-based tinnitus stress reduction programs, which emphasize deep breathing, yoga, relaxation, and meditation, offer promise in tinnitus management. Additionally, mitigating stress through exercise, problem-solving, engaging in enjoyable activities, and socializing can contribute to tinnitus management. Activities that reduce overall stress levels may positively impact tinnitus perception and reactions, given the interconnectedness of stress and tinnitus. Cognitive-behavioral therapy (CBT) serves as another valuable tool in tinnitus management by assisting individuals in identifying and reframing negative thoughts regarding tinnitus into more constructive ones. Often utilized alongside mindfulness programs, CBT has demonstrated efficacy in reducing depression and anxiety, enhancing social functioning, and improving overall mental well-being. Furthermore, adopting a daily exercise regimen, learning to regulate stress responses, and seeking support from healthcare professionals or tinnitus support groups are valuable components of stress and tinnitus management.
Physical Activity and Exercise
The influence of physical activity and exercise on tinnitus is a multifaceted issue characterized by both positive and negative ramifications. On one hand, regular physical activity has demonstrated notable benefits in enhancing health-related and overall quality of life while concurrently diminishing levels of tinnitus distress. A study revealed a significant association between higher physical activity levels and improved health-related and global quality of life, coupled with reduced tinnitus distress. Furthermore, physical activity emerged as a significant factor contributing to variations in tinnitus severity, indicating its potential as a management strategy for affected individuals. Conversely, certain forms of exercise can precipitate or exacerbate tinnitus symptoms. High-impact aerobics, such as running, basketball, football, and soccer, can potentially dislodge otoconia and calcium crystals within the ears, leading to inner ear issues and tinnitus exacerbations. Additionally, exerting strain while lifting weights or engaging in heavy exertions can elevate intracranial pressure, exerting pressure on the ears and potentially resulting in perilymph fistula, which is a tear in the membrane separating the middle and inner ear, manifesting as dizziness, tinnitus, and heightened hearing sensitivity. Hence, it is imperative to recognize the potential impact of exercise on tinnitus and seek medical guidance if experiencing ringing or buzzing in the ears following physical activity.
Additional Strategies
- Noise management: Some find it helpful to use background noise, such as white noise machines or calming music, to mask the tinnitus sounds and make them less noticeable.
- Hearing protection: It may help to protect the ears from loud sounds. People can ask their doctor for advice on the best ear protection for concerts, events, or their workplace.
- Social activities and hobbies: Isolation can negatively impact mental health, and may cause a person to focus more on their tinnitus. Social experiences and hobbies may provide something positive to focus on.
- Mindfulness: A therapy that emphasizes “mindfulness” - a deliberate and non-judgemental awareness of one’s physical sensations, sensory perceptions, emotional reactions, and cognitive processes.
- Acceptance and Commitment Therapy (ACT): Emphasizes the need to reduce experiential avoidance of tinnitus. Patients are taught to fully experience thoughts, perceptions, and emotions in a direct, non-judgemental way.
- Biofeedback: Is relaxation technique that teaches patients to control certain autonomic body functions, such as pulse, muscle tension, and skin temperature. The goal of biofeedback is to help people manage stress and anxiety by changing the body’s reaction to these negative influences.
- Hypnotherapy: Has been shown to promote relaxation and reduce anxiety. It may also alter neural connections between areas of the brain.
Practical Recommendations
The key findings highlight the influence of dietary patterns, hydration, stress management, physical activity, and sleep hygiene on tinnitus severity and frequency.
For Healthcare Professionals:
Encourage healthcare professionals to integrate discussions about diet and lifestyle into tinnitus management protocols, while individuals affected by tinnitus are urged to adopt healthy habits and actively participate in their care. It is important for clinicians to communicate that it is beyond question that a healthy diet has many beneficial effects on the body, which may lessen the impact of tinnitus.
For Individuals with Tinnitus:
Consider keeping a symptom log to monitor dietary choices, perceived stress levels, and tinnitus symptoms to identify patterns. You can monitor their tinnitus by documenting the date, time, and perceived severity of their symptoms, as well as factors that might influence these symptoms, such as stress levels, or transitions from loud to quiet environments. People can implement a straightforward rating system to gauge the severity of tinnitus symptoms. For instance, they could rate the symptoms on a scale from 1 (mild) to 10 (severe). After consistently recording symptoms and dietary preferences, review the diary entries for recurring patterns or trends. Seek professional guidance if they identify potential links between tinnitus symptoms and specific foods or triggers. These experts can provide guidance, conduct further assessments, and assist in creating a personalized plan to manage tinnitus effectively.
tags: #tinnitus #and #diet #connection