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Reardonmetal

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 #1 
Dr. Nagler,

I find a lot of sites for tinnitus with people suggesting different supplements, drugs, diets, etc. for tinnitus. Some of these things are:

(1)probably harmless (e.g. Arches tinnitus, Ginko Biloba),
(2)almost for certain don't work.

If they're cheap and unlikely to hurt anyone, then I generally keep my mouth shut. Who am I to tell someone to not do something that might even have a placebo effect for them?

There are other things (typically drugs) that are:

(1) almost for certain harmful,
(2) almost for certain don't work.

These I feel the need to speak up and at least suggest that the person goes to a doctor before trying. Lastly, there has lately been people on another board (one in particular) where someone suggests a diet (ketogenic). He says that tinnitus is often caused by metabolic disease (such as inability to metabolize glucose, etc)... I've seen a few medical journals (that I am ill-equipped to judge their quality) that have come to what seems like some statistically valid conclusion that this is true. And that a diet lower in fats, sugars, alcohol, etc., will cause improvement in your tinnitus. Now, ever fiber of my being tells me that if this were true, it'd be on the front page of the New York Times, and we'd all be eating better to gain relief from our tinnitus. But there at least seems some work done by scientific journals to back this up. Is there anything to this research, or is it just nonsense?

Thanks,

Eric
Dr. Nagler

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 #2 
Wow, Eric. Talk about a minefield!!!

Let me work on giving you an unbiased response, which will take a bit of doing - since I have such a strong bias in the above regard.

Please check back in a day or two. This will take some thought.

Dr. Stephen Nagler
Atlanta Tinnitus Consultants, LLC

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Dr. Nagler

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 #3 
OK, Eric. I'm going to try to break your post up into parts to try to address some of the very good points you raise.

Quote:
I find a lot of sites for tinnitus with people suggesting different supplements, drugs, diets, etc. for tinnitus. Some of these things are:

(1)probably harmless (e.g. Arches tinnitus, Ginko Biloba),
(2)almost for certain don't work.

If they're cheap and unlikely to hurt anyone, then I generally keep my mouth shut. Who am I to tell someone to not do something that might even have a placebo effect for them?

Let's first look at your statement (2) to the effect that they "almost for certain don't work." What that really means is that they almost for certain have no pharmacological efficacy against tinnitus - because if they did, as I see it, they would no longer be considered "alternative." Pharmacological efficacy is very easy to establish by virtue of reliable and verifiable double-blind randomized prospective studies. And none of these drugs have met that standard. Their manufacturers will give you all sorts of excuses - but when it gets right down to it, if they had pharmacological efficacy the stockholders in those companies would immediately become gazillioinaires. So when these drugs do "work," it is the taking of the drug
rather than any pharmacological action that results in the improvement. That phenomenon is what you have referred to in your post as "placebo effect."

Which gets us back to the "probably harmless" part of your post ...

While the active ingredient is in many cases harmless, all too often the impurities are not. You see, the supplement industry (in the US, anyway) is entirely self-regulated, which is to say that it is not regulated at all. The pharmaceutical industry is tightly controlled by the FDA; not so with the supplement industry. So when you purchase some "1000u Supplement A" pills, (1) you have no assurance that you are purchasing Supplement A at all, (2) you have no assurance that each pull contains 1000u, and (3) you have no idea what else might be in the pills.

So I have a big problem with your "probably harmless" assumption. A year or so ago I read a terrific book that I would strongly recommend to anybody who is considering taking supplements for any reason other than a documented deficiency. The book is Do You Believe in Magic?: Vitamins, Supplements, and All Things Natural by Paul A. Offit. Given that Offit is a medical doctor with the same sorts of biases that I have, the book is incredibly well-balanced. Definitely worth a read.

Quote:
There are other things (typically drugs) that are:

(1) almost for certain harmful,
(2) almost for certain don't work.

These I feel the need to speak up and at least suggest that the person goes to a doctor before trying.

That goes without saying. The only question is whether anybody will listen to you ... or for that matter to me! People hear what they want to hear. Remember Stringplayer's Second Law: "The degree to which a person will apply common sense and logic in search of relief from a malady is inversely proportional to the square of that person's misery and desperation." 

Quote:
Lastly, there has lately been people on another board (one in particular) where someone suggests a diet (ketogenic). He says that tinnitus is often caused by metabolic disease (such as inability to metabolize glucose, etc)... I've seen a few medical journals (that I am ill-equipped to judge their quality) that have come to what seems like some statistically valid conclusion that this is true.

You are way ahead of the game in that you understand that just because something is published in a journal is no assurance that the conclusion is reliable and verifiable. You have to know the journal, and you have to understand how to read the literature. Bottom line: Tinnitus is not a metabolic disorder.

And as far as what you might read on that one board in particular to which you refer above, please let's not go there. The sheer volume of incredibly bad information and misleading (if not downright dangerous) postings on that site absolutely defies description.

Quote:
And that a diet lower in fats, sugars, alcohol, etc., will cause improvement in your tinnitus. Now, ever fiber of my being tells me that if this were true, it'd be on the front page of the New York Times, and we'd all be eating better to gain relief from our tinnitus. But there at least seems some work done by scientific journals to back this up. Is there anything to this research, or is it just nonsense?

The latter.

Hope this helps more than frustrates.

Dr. Stephen Nagler
Atlanta Tinnitus Consultants, LLC



__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Reardonmetal

Member
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Posts: 6
 #4 

Dr. Nagler,

Thanks.  I'll give that book a look.

Eric
 

Dr. Nagler

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Registered:
Posts: 1,764
 #5 
Quote:
Originally Posted by Eric
Thanks.  I'll give that book a look.

You are welcome, Eric. I'm sure you'll find the book to be informative.

By the way, In my post above I referred to "Stringplayer's Second Law." You can find all three of Stringplayer's Laws HERE.

Dr. Stephen Nagler

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
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Dr. Nagler's Tinnitus Corner is provided for education and information only. It is not intended for the purpose of providing medical care and should in no way substitute for appropriate in-person consultations with qualified healthcare professionals. By using this site, participants agree to hold Dr. Nagler and Atlanta Tinnitus Consultants, LLC harmless with respect to any loss, injury, claim, liability, or damage arising from following the postings herein.