Author: Siddarth Goel

Tinnitus, often characterized as the perception of sound without any external acoustic stimuli, is a prevalent condition that can significantly impact an individual’s quality of life. While brief episodes of tinnitus are common, its chronic manifestation can lead to poor sleep, psychological distress, and diminished overall well-being.

The complex pathophysiology of tinnitus remains inadequately elucidated within conventional medical frameworks. However, by adopting a functional medicine perspective, we can begin to uncover potential underlying factors contributing to this condition, often involving oxidative damage. This article explores various common contributors to tinnitus and highlights evidence-based strategies for its management.

Understanding the Underlying Factors of Tinnitus

1. Inflammation and Oxidative Damage: Invariably, inflammation and oxidative damage are implicated in the deterioration of the delicate inner ear structures. These two conditions are recurring elements in the context of chronic ailments and necessitate a deeper investigation to identify and address their root causes.

2. Noise-Induced Hearing Loss: Exposure to excessively loud sounds, such as attending concerts or prolonged use of headphones at high volumes, can result in inner ear damage leading to tinnitus.

3. Structural Issues: Anatomical problems within the ear or surrounding regions, including temporomandibular joint (TMJ) disorders and cervical spine issues, may exert pressure on the inner ear, potentially causing tinnitus.

4. Chronic Ear or Sinus Infections: Often overlooked, ear or sinus infections and associated congestion can be a common, easily treatable cause of tinnitus.

5. Infections: Viral infections, notably the impact of viral overload, can provoke inner ear inflammation and subsequent damage, contributing to tinnitus. Recent research has also indicated a connection between COVID-19 infections and exacerbation of pre-existing tinnitus in a substantial proportion of cases.

6. Mold Toxicity: Mold toxins, recognized for their potent inflammatory properties, can damage nerves in the inner ear and give rise to tinnitus, an often underestimated etiological factor in various chronic health conditions.

7. Osteosclerosis: Elderly individuals and those with certain chronic ailments may experience stiffening of the bones in the middle ear, which can be linked to tinnitus.

8. Age-Related Hearing Loss: Neuronal degeneration, vascular changes, medication usage, and chronic stress can all contribute to hearing impairment and, consequently, tinnitus in the aging population.

9. Meniere’s Disease: This condition can lead to fluid accumulation within the inner ear, causing pressure and structural damage, often accompanied by tinnitus, along with symptoms like vertigo, nausea, vomiting, dizziness, and hearing loss.

10. Prescription Medications: Prolonged use of specific drugs, including Aminoglycoside Antibiotics, loop diuretics, NSAIDs, and chemotherapy medications, can result in tinnitus as an adverse effect.

11. Psychological Factors: Anxiety and depression can influence the development of tinnitus through various pathways, highlighting the intricate interplay between mental health and auditory perception.

12. Blood Vessel Disorders: Conditions such as high blood pressure and atherosclerosis, which impede proper blood supply to the inner ear, can also contribute to the onset of tinnitus.

Oxidative Damage and Hearing Loss

Emerging evidence suggests that oxidative damage to delicate auditory tissues may underlie the hearing loss associated with tinnitus. This damage can lead to specific alterations in the brain’s processing of sound, prompting some researchers to speculate that tinnitus may be the brain’s way of compensating for missing sound frequencies.

Given the prevalent presence of oxidative stress in tinnitus cases, interventions aimed at enhancing antioxidant function through dietary modifications and targeted supplements have yielded favorable outcomes.

Dietary Strategies for Managing Tinnitus

To mitigate oxidative stress, transitioning to a low-glycemic, anti-inflammatory diet is advisable. Increasing the consumption of colorful vegetables, herbs, spices, berries, and wild fish, or supplementing with algae or fish oil to ensure sufficient omega-3 essential fat intake, can be beneficial.

Supplements for Tinnitus Management

Several supplements have demonstrated potential in tinnitus management:

1. Zinc: Supplementation with zinc may be beneficial, particularly for individuals with low zinc levels and those experiencing noise-induced hearing loss-associated tinnitus.

2. Coenzyme Q10 (CoQ10): CoQ10, an essential antioxidant involved in mitochondrial energy generation, has shown promise in reducing tinnitus symptoms when supplemented.

3. Taurine: Taurine plays a role in hearing, and animal studies have indicated its potential to reverse tinnitus when administered as a supplement.

4. Vitamin B12: Individuals with tinnitus often exhibit low vitamin B12 levels, and supplementation has demonstrated benefits. B12 deficiency can contribute to neuropathic degeneration in the inner ear, potentially exacerbating tinnitus.

5. Ginkgo Biloba: Studies have reported positive outcomes with ginkgo biloba supplementation for tinnitus management. This herb possesses antioxidant and neuroprotective properties and enhances circulation.

6. Melatonin: Research suggests that melatonin, with its anti-inflammatory, antioxidant, and neuroprotective properties, may protect nerve cells and mitigate auditory system damage.

7. Other Supplements: Supporting optimal glutathione synthesis, B2/B9/B12 vitamins for methylation, B6 for transsulfuration, and supplements such as glycine and NAC can also help reduce oxidative stress.

Complementary Therapies

Complementary therapies like yoga and acupuncture may provide additional relief for tinnitus. Addressing underlying anatomical issues, such as TMJ dysfunction or dental grinding, should also be considered in a comprehensive approach to managing tinnitus.

In conclusion, tinnitus is a multifaceted condition with various contributing factors. Taking a functional medicine perspective, addressing oxidative damage, adopting a suitable diet, and considering targeted supplements can offer valuable strategies for managing tinnitus and improving overall well-being. Additionally, complementary therapies and addressing anatomical issues can complement these approaches for more comprehensive care.

Reference:

• A Comprehensive Study of Oxidative Stress in Tinnitus Patients – Mustafa Celik and İsmail Koyuncu – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224822/
• Changes in Tinnitus Experiences During the COVID-19 Pandemic – Eldré W. Beukes, David M. Baguley – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676491/
• The Effect of Antioxidant Supplementation in Patients with Tinnitus- Anna I. Petridou,1 Eleftheria T. Zagora,2 Petros Petridis et al – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950042/
• Effects of serum zinc level on tinnitus- Güler Berkiten et al – https://pubmed.ncbi.nlm.nih.gov/25554004/
• Effects of oral zinc supplementation on patients with noise-induced hearing loss associated tinnitus: A clinical trial – Chun-Wei Yeh et al – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6468114/
• A pilot clinical trial of the effects of coenzyme Q10 on chronic tinnitus aurium- Martin Khan, Johann Gross– https://pubmed.ncbi.nlm.nih.gov/17210337/
• Therapeutic role of Vitamin B12 in patients of chronic tinnitus: A pilot study – Charu Singh, Rahul Kawatra, Jaya Gupta, Vishnu Awasthi,1 and Homnath Dungana – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918681/

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Kidney stones are a common and one of the most painful problems. It often leads to pretty expensive treatment options. What makes it much worse is that for a majority of people the stones recur every few years. This is simply because they fail to understand and address the underlying root causes.

Prevalent treatments for kidney stones include shockwave therapy, laparoscopic surgery and ureteroscopy. Certain medicines are used to relax the muscles of the ureter, helping the stone pass out more easily.

So let us understand why kidney stones happen? What causes them? And what can we do to avoid as well as get rid of them?

DEHYDRATION – Before we start delving into this topic, let us remember that the single most important reason for kidney stones is dehydration. Due to low water consumption, the volume of urine decreases, making it more concentrated. This obviously increases the chances of stones getting precipitated. For those with a tendency to get kidney stones, drinking 2-3 litres of water per day is a must. This figure needs to be adapted for lifestyle factors like ambient temperature, job profile etc. For example, a person who is into sales and has to spend a lot of time daily commuting between meetings requires a much higher water intake compared to someone else whose job involves working on a computer in an airconditioned environment.

About 80% of kidney stones are of the calcium oxalate variety. So we need to pay attention to factors affecting the metabolism of these two constituents. Here are some of the important factors that impact calcium and oxalate levels.

MAGNESIUM – Sufficient magnesium is critical for ensuring proper utilization of calcium. Magnesium is also one of the most common deficiencies found in our population today.

It is helpful to take a magnesium supplement while consciously increasing the consumption of foods that are rich in magnesium (e.g. pumpkin seeds, cashews, green leafy vegetables, organic peanuts, etc.).

If taking supplements, target to keep the levels in the upper third of the reference range. It is best to use chelated forms as they are better absorbed. If constipation is also present, consider using the citrate form (it can also be in combination with another well-absorbed form such as magnesium glycinate).

POTASSIUM – Potassium supplementation is quite useful for patients with uric acid based stones. (Potassium should be avoided by people on certain medications like certain diuretics prescribed for hypertension). Potassium citrate is one of the more useful forms of potassium as the citrate is also useful in this condition. 200 mg can be taken daily.

VITAMIN K2 – K2 is critical to ensure that calcium from food/supplements is taken up into bones instead of ending up in circulation and being excreted from the kidneys. If calcium remains in blood circulation there are higher chances of it reacting and forming stones. Vitamin K2 prevents this from happening. For prevention, up to 90 mcg of vitamin K2 of the MK-7 variety can be taken daily. Dosage can be increased in the case of active stones. (people on blood thinners should avoid taking K2).

B VITAMINS, B6 – Adequate levels of all B vitamins is very important. Of special note is B6 as it is key for glutathione synthesis, oxalate metabolism and nerve health. These vitamins should be the ‘active’ type as not everyone’s body is good at converting them to active forms. E.g. for B6 the correct form is P5P and not pyridoxine. It is important to note that we need all the B vitamins to be in the upper third of the reference range. It is not good enough to have them just above the bottom of the reference range. (This is generally applicable for most nutrients).

VITAMIN D – People with a tendency to get kidney stones should be careful while taking vitamin D supplements as it increases the absorption of calcium into the body. It also uses up the magnesium present in the body so less is available to ensure proper utilization of calcium.

AVOID BLACK TEA – It is very important to avoid all black teas as they are a rich source of oxalates. As we saw earlier, nearly 80% of the stones are of the oxalate variety. Hence drinking black tea can aggravate the problem significantly.

AVOID OXALATE RICH FOODS – Foods like spinach, beets, almonds, groundnuts, chocolates, etc. have a good amount of oxalates and should be avoided or consumed in moderation by people susceptible to kidney stones.

AVOID PURINE RICH FOODS – Another common food ingredient that can cause kidney stones is purine. This is generally connected with the uric acid variety of stones. Some foods high in purines are red and a few other types of meat, some seafood varieties, all alcoholic beverages, mushrooms, green peas, cauliflower, etc.

Fresh LEMON JUICE is one of the simplest tools to both prevent the recurrence of stones as also to get rid of active stones. The juice of half a lemon can be taken twice a day to prevent a recurrence. While for existing stones one can consume the juice of 4 lemons per day. The high citric acid content binds with extra calcium and prevents it from precipitating in the form of stones.

INSULIN RESISTANCE & INFLAMMATION – Insulin resistance and chronic inflammation often play a key role in this dynamic and must be addressed for any long-lasting solution. Very often insulin resistance and prediabetes are present to an appreciable extent in kidney stone patients. The most important and easiest steps are to eliminate all sugars and refined carbohydrates.

It is well known that diabetics are at a higher risk for kidney stones because elevated blood sugar is highly oxidising in nature and damages the kidneys.

LIVER & BILE – Overall liver health and quality of bile also have an impact on kidney stones. Sluggish bile flow is also a common contributor to stone formation. Also individuals whose gallbladders have been removed are at a higher risk. These dynamics ensure that enough bile is not available for fat digestion. This unabsorbed fat readily binds with calcium in the gut. Hence calcium is not available for binding with oxalates, which then readily get absorbed by the gut.

YEAST – Certain yeast species (such as candida aspergillus) produce oxalates as part of their metabolic processes. So people with yeast overgrowths can struggle with excessive oxalate levels (also causing issues with the urinary/vaginal tract and elsewhere in the body).

OXALOBACTER – Oxalobacter formigenes is a commensal bacteria (found in a healthy gut). It metabolises oxalates thereby reducing the amount in the body. If this is low in numbers or activity then oxalates can build up in the system.

I hope this article gives some useful insight into the various causes and solutions for kidney stones.

Please leave your thoughts in the comments section below.

REFERENCES

Trinchieri, A., Esposito, N., & Castelnuovo, C. (2009). Dissolution of radiolucent renal stones by oral alkalinization with potassium citrate/potassium bicarbonate. Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica, 81(3), 188–191.
Reddy, S. K., Shaik, A. B., & Bokkisam, S. (2014). Effect of Potassium Magnesium Citrate and Vitamin B-6 Prophylaxis for Recurrent and Multiple Calcium Oxalate and Phosphate Urolithiasis. Korean Journal of Urology, 55(6), 411. https://doi.org/10.4111/kju.2014.55.6.411
di Tommaso, L., Tolomelli, B., Mezzini, R., Marchetti, M., Cenacchi, G., Foschini, M., & Mancini, A. (2002b). Renal calcium phosphate and oxalate deposition in prolonged vitamin B6 deficiency: studies on a rat model of urolithiasis. BJU International, 89(6), 571–575. https://doi.org/10.1046/j.1464-410x.2002.02670.x
Marickar Y. M. (2009). Calcium oxalate stone and gout. Urological research, 37(6), 345–347. https://doi.org/10.1007/s00240-009-0218-0
Einollahi, B., Naghii, M. R., & Sepandi, M. (2013). Association of nonalcoholic fatty liver disease (NAFLD) with urolithiasis. Endocrine regulations, 47(1), 27–32. https://doi.org/10.4149/endo_2013_01_27

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