Video summary
The video explores the vast landscape of over-the-counter dietary supplements marketed as cures for tinnitus, highlighting how these unproven remedies reflect the high demand among patients despite US guidelines advising against their use. Commonly promoted ingredients include ginkgo biloba, lipoflavonoid, vitamin B12, zinc, magnesium, and melatonin, yet users frequently report adverse effects such as stomach pain, diarrhea, nausea, dizziness, headaches, bleeding, chest pain, and palpitations. The discussion emphasizes that while these supplements are lightly regulated and lucrative, their efficacy is often overstated by marketers, leading many individuals to take risks without proven clinical benefits.
Ginkgo biloba is examined in detail as a frequently used supplement, with studies showing mixed results regarding its impact on Tinnitus Handicap Inventory (THI) scores. While some trials suggested an impressive percentage decrease in THI scores when ginkgo was combined with antioxidants like vitamin E, selenium, and beta-carotene, the actual point reduction was minimal and not clinically significant compared to the placebo effect. Furthermore, the addition of antioxidants such as vitamin E raises concerns due to associations with increased mortality risk and higher prostate cancer rates in men, contradicting claims that European and American guidelines support their use; in reality, these guidelines specifically recommend against them due to a lack of proven efficacy and potential harm.
Other supplements like acai, melatonin, and Korean red ginseng have also been tested without yielding clinically meaningful effects over control groups. The video presents a nuanced case for vitamin B12, noting that while general supplementation showed no distinctive effect in reducing tinnitus severity for the average population, correcting a deficiency caused by pernicious anemia can lead to complete resolution of symptoms in specific cases. This distinction underscores that restoring normal levels of nutrients like B12 may help only those who are actually deficient, rather than serving as a universal cure for all tinnitus sufferers.
Ultimately, the transcript warns against relying on published reports from randomized control trials that often suffer from poor reporting practices which distort results and mislead readers by being overly optimistic. Given the subjective nature of tinnitus and the strong likelihood of a placebo response, viewers are encouraged to approach newly published trials with skepticism, ensuring that randomization and blinding are of the highest quality before accepting any claims about supplement efficacy. The conclusion reinforces that while some individuals may find relief through correcting specific deficiencies like B12, most dietary supplements lack robust evidence to support their use as a primary treatment for tinnitus.
Read the full video transcript
[music]
Our journey through the tinitus universe
would not be complete without reviewing
the plethora of over-the-counter
so-called tinitus cures. Do any of the
marketer's promises ring true? The wide
array of unproven over-the-counter
tinitus remedies indicates just how high
the demand is on the part of tenitus
patients.
And dietary supplements are lightly
regulated and highly lucrative. In a
survey of the effectiveness of dietary
supplements to treat tenitus, the most
used were gaoaloba, lipoplavonoid,
vitamin B12, zinc, magnesium, and
melatonin. Despite US guidelines
recommending against herbals,
neutrauticals, and supplements for
tinitus management, tinitus supplement
users reported adverse effects including
all sorts of symptoms. Stomach pain,
diarrhea, nausea, dizziness, headache,
bleeding, chest pain, and palpitations.
A common supplement used for tenitus is
ginkoaloba.
At the time this Cochran review was
written, the two studies of ginkoaloba
that made the cut had little to no
effect on THI scores compared to
placebo. Since then, I could find one
additional placeboc control trial with
ginkoaloba.
Treatment groups received 60 milligs of
ginkoa twice a day, either by itself or
in combination with antioxidants,
a mix of betaarotene, vitamin C, vitamin
E, and selenium.
After 14 weeks, the THI scores had
decreased 18% in the GKOalla group and
36% in the GKOalla plus antioxidants
group. While those sound impressive as
percentages, the GKOba group only
decreased their THI score by six points,
not a clinically significant amount,
about the amount expected from the
placebo effect alone. And somewhat
oddly, we actually see no placebo effect
in the placebo group in the GKOalla
study.
Okay, but what about the ginkoa plus
antioxidants group? They had an
impressive 11point drop.
But should we really be taking
supplements with additional antioxidants
like vitamin E, which has been
associated with a small but significant
increase in mortality risk and higher
prostate cancer risk in men. While the
study authors conveniently claim
European and American guidelines
recommend ginkoaloba, if you actually
look at the guidelines, they
specifically recommend against their
use, citing no proven efficacy and
potential harm. Other supplements have
been put to the test with no clinically
meaningful effect over control found for
acai melatonin and Korean red ginsing.
In 1979, a woman presented to the clinic
with tinitus in both ears. She had no
history of ear infections, trauma,
hearing loss, or other risk factors. But
she did have pernicious anemia, likely
due to very low vitamin B12 levels. Once
her B12 deficiency was corrected, her
tenitus completely resolved.
Could this be the case for other people
with tenitus? In a double blind clinical
trial, one month of vitamin B12
treatment led to no distinctive effect
on reducing tinitus severity. However,
in another trial of B12 supplementation,
it did improve tinitus severity among
people with B12 deficiency by about
eight points. So for someone who is
deficient, restoring B12 to normal
levels could help with their tinitus
symptoms. Published reports of tenitus
randomized control trials often include
spin, a reporting practice that distorts
results and misleads readers by being
more optimistic than the results
justify.
When encountering a newly published
trial, keep in mind that randomization
and blinding should be of the highest
quality given the subjective nature of
tinitus and the strong likelihood of a
placebo response.