MD Review of Tinnitus Food Triggers

Here, I introduce some important information about tinnitus and diet, with a particular focus on tinnitus food triggers. This is not a weight loss diet, it’s a diet to help you avoid tinnitus trigger foods. Here’s what I cover:

• What factors make tinnitus worse?
• What is a tinnitus diet?
• What are the foods that trigger tinnitus symptoms?
• What diet is good for tinnitus?
• What are the best dietary supplements for tinnitus?

What causes tinnitus?

Most people will tell you that hearing loss causes tinnitus. While it’s true that typically some kind of hearing loss precedes tinnitus, the cause of tinnitus loudness and severity is found in the brain, not the ears.

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. Tinnitus is a migraine-related phenomenon.

What is migraine?

Migraine is not just about headaches. 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.

There are two fundamental features of the migraine reaction:

Neurogenic Inflammation in 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. This is called neurogenic inflammation. 

Sensory Hypersensitivity in Migraine

The second feature of migraine is that the neurogenic inflammation leads to sensory nerve hypersensitivity. Now if the sensory nerve affected is the one that supplies sensation to the brain lining (the trigeminal nerve), you get a headache. If it affects the balance nerve, you get vertigo (called vestibular migraine). And if it affects the hearing nerve, you get tinnitus.

The hardest thing for my tinnitus patients to accept is that you can have a migraine without a headache. For some people, tinnitus is the only symptom of migraine.

What triggers tinnitus?

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“. The list of possible migraine triggers is large and includes both external and internal triggers:

External Migraine Triggers

• Bright or flickering lights
• Strong smells or odors
• Loud noises or noise pollution
• Changes in weather or barometric pressure
• Certain foods or dietary habits
• Stressful events or emotional triggers
• Hormonal changes (e.g., menstruation, menopause)
• Intense physical activity or exertion

Internal Migraine Triggers

• Hormonal fluctuations (e.g., estrogen levels)
• Sleep disturbances or irregular sleep patterns
• Medication side effects or overuse (e.g., rebound headaches)
• Muscle tension or poor posture
• Allergies or sensitivities to certain substances
• Stress (both psychological and physiological)

As you’ll see below, the foods that trigger migraine are also the foods that trigger tinnitus.

What is a tinnitus diet?

Clinical trials at my university has shown that for many otologic migraine conditions respond well to migraine prophylaxis via dietary trigger elimination (that is, cutting out the foods that trigger tinnitus).

This means the tinnitus diet is not about weight loss or addressing high blood pressure. It does not follow the healthy eating index. It isn’t even a long term diet. Instead, it’s about identifying and temporarily eliminating the foods that trigger tinnitus.

What is an elimination diet?

An elimination diet involves systematically removing specific foods or food groups from one’s diet to identify which are causing the problem. You need to investigate whether certain foods are triggering your tinnitus symptoms, and the only way to do that is to cut them out and then retry them to see what happens.

The good news is that elimination diets are temporary. After you identify the foods that trigger tinnitus symptoms, you can resume a balanced and healthy diet.

What are the foods that trigger tinnitus symptoms?

We generally recommend avoiding foods in the following categories. These foods are notorious migraine trigger foods, so they should also be avoided in people with tinnitus.

Glutamate and Tinnitus

Glutamate is a neurotransmitter in the brain involved in signal transmission between neurons and plays a crucial role in various brain functions. In the context of tinnitus, excessive glutamate activity has been implicated in the generation and maintenance of tinnitus symptoms.

Here are some foods high in glutamate:

• Tomatoes
• Parmesan cheese
• Soy sauce and other Asian sauces
• Mushrooms
• Seaweed
• Anchovies
• Miso
• Bone broth

Monosodium Glutamate (MSG) and Tinnitus

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. MSG should be avoided by people with tinnitus whenever possible.

Tyramine and Tinnitus

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. A diet high in tyramine can exacerbate ringing.

Here are some foods high in tyramine:

• Aged cheeses (e.g., cheddar, blue cheese, Parmesan)
• Cured meats (e.g., salami, pepperoni)
• Fermented soy products (e.g., soy sauce, tofu)
• Pickled or fermented foods (e.g., sauerkraut, pickles)
• Certain alcoholic beverages (e.g., red wine, beer)

Histamine and Tinnitus

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. Additionally, histamine release is implicated in neurogenic inflammation, which as we noted above, is the trigger for sensory hypersensitivity, and thus, increased tinnitus symptoms.

Here are some foods high in histamine:

• Aged cheeses (e.g., blue cheese, cheddar)
• Fermented foods (e.g., sauerkraut, kimchi)
• Processed meats (e.g., salami, pepperoni)
• Fermented alcoholic beverages (e.g., wine, beer)
• Cured meats (e.g., bacon, ham)
• Sour foods (e.g., vinegar, sour cream)
• Smoked fish or seafood
• Some fruits (e.g., avocados, bananas)
• Some vegetables (e.g., tomatoes, spinach)
• Certain nuts (e.g., walnuts, cashews)

While citrus fruits like lemons, limes, and oranges themselves are not inherently high in histamine, consuming them can stimulate the release of histamine within your body.

But some of these are healthy foods, right?

Yes, many of these items are actually really good for your health (like avocados or citrus). However, remember that the point of the tinnitus diet is to identify your triggers. Once this is accomplished you can resume a healthier diet that includes many of the items listed above.

Can coffee cause tinnitus?

Caffeine is a natural stimulant found in coffee, tea, chocolate, energy drinks, and some medications. Higher caffeine intake can often exacerbate tinnitus symptoms. It can also disrupt sleep, which itself can trigger the migraine reaction in the brain. Unfortunately, this makes it one of the notorious foods that trigger tinnitus.

Some studies show caffeine intake may help tinnitus. How does this make sense, when we know it’s on the bad list? The reason is that your brain becomes addicted to caffeine. When you don’t have it, you get symptoms like headache or tinnitus. Then when you drink it, the headache or tinnitus goes away, but it was the caffeine withdrawal that lead to the problem in the first place.

Can alcohol cause tinnitus?

The effect of alcohol consumption on tinnitus usually depends on the form it comes in. Beer and wine frequently trigger the migraine reaction in the brain, worsening tinnitus. This is because fermented products are foods that trigger tinnitus.

The good news (for drinkers) is that distilled alcohol, like vodka, tends to not have the same effect.

Does fat intake affect tinnitus?

Fatty foods do not necessarily trigger tinnitus, but a dietary pattern high in fat can make tinnitus worse due to its effect on blood vessels and inner ear circulation. A high fat diet or one that raises bad cholesterol (like red meat intake) can lead to arterial disease, which reduces blood flow to the inner ear. It’s best to stick to fats like olive oil that can actually increase your good cholesterol.

Trans fats, such as seen in fried foods, can trigger an inflammatory reaction in the body. Inflammation in general is one of the risk factors for triggering the migraine reaction. This means that trans fats are among the foods that trigger tinnitus and should be avoided.

Can aspartame cause tinnitus?

Artificial sweeteners like aspartame should be avoided by tinnitus patients. Aspartame can trigger the migraine reaction by altering neurotransmitter levels in the brain. It is also considered an excitotoxin, in that it stimulates glutamate receptors, leading to sensory hypersensitivity and ultimately, loud tinnitus.

Does salt intake affect tinnitus?

Excessive salt intake (sodium chloride) can lead to fluid retention, electrolyte imbalances, and increased blood pressure, all of which are potential tinnitus triggers.

It’s interesting that a low salt diet was recommended as a primary treatment for Meniere’s disease for many years. The effects may have not been ear specific, but rather from a mitigation of the migraine process in the brain.

Avoiding high salt intake does not just mean avoiding regular table salt. You have to look at labels of processed or canned goods, because these can often contain a high salt content.

Can dehydration cause tinnitus?

Dehydration can contribute to tinnitus in a number of ways. For instance, dehydration can directly affect the fluid filled structures of the inner ear. Dehydration reduces blood flow, leading to poor blood circulation to the inner ear. Maintaining adequate hydration by drinking water regularly is crucial for preventing and managing tinnitus.

Can skipping meals trigger tinnitus?

Just as with migraine headaches, skipping meals can trigger the migraine reaction and lead to bothersome tinnitus. Skipping meals leads to fluctuations in blood sugar levels, changes in neurotransmitter levels, and alterations in hormone levels.

When your blood sugar levels drop, it can trigger a cascade of events, including the release of stress hormones like adrenaline and cortisol, which can increase blood pressure and cause blood vessels in the brain to constrict and dilate, triggering tinnitus.

To avoid triggering tinnitus, you want to keep your dietary pattern stable and your eating habits on a regular schedule.

What diet is good for tinnitus?

The diets good for migraine are going to be good for tinnitus. Various diets show benefit in terms of reducing the migraine process in the brain.

Diet Type	Description
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.

What dietary supplements help with tinnitus symptoms?

Most dietary supplements that helps with migraine will also help with tinnitus. Some supplements may have only weak evidence in the tinnitus literature, but they’ve been extensively studied for migraine in rigorous clinical trials.

The British Tinnitus Association has a good list of tinnitus supplement scams, but their ratings on certain dietary supplements are dated do not factor in new research on tinnitus and migraine.

The best dietary supplements for tinnitus symptoms include vitamin B2 (riboflavin), vitamin D, magnesium, melatonin, and coenzyme Q10. In randomized controlled trial studies, these have each independently been shown to help mitigate the migraine reaction in the brain.

There is some research evidence that deficiency in certain vitamins can be a risk factor for tinnitus. These include folic acid, magnesium, vitamin D, and zinc.

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. However, there is no hard evidence that they “cure” tinnitus or hearing difficulties.

Conclusion: Avoid Foods that Trigger Tinnitus!

This information is typically overwhelming for my tinnitus patients when they hear it. However, I always emphasize that the tinnitus diet is not a “forever” diet, but instead a method of investigation to find the foods that trigger tinnitus. Having reduced odds of persistent tinnitus through short-term dietary sacrifices is worth it.

Now some people will say they can’t live without certain foods, like avocados, a glass of wine, or caffeinated coffee. For these people, I tell them that as long as they know that the incident tinnitus is caused by these certain foods, it will be OK. They can rest assured that the tinnitus loudness will subside in a matter of hours. This takes away the anxiety component of tinnitus, making it much more manageable.

Some adjustments here should be adopted as part of a healthy diet, not just to avoid tinnitus. This includes elimination of processed foods and trans fats. Incorporating a diet rich in antioxidants will help people with hearing difficulties preserve their hearing in the long run. And staying well hydrated is good for your whole body, not just tinnitus.

Of course, avoiding foods that trigger tinnitus is only one aspect of a comprehensive tinnitus rehabilitation program. At NeuroMed, this also includes prescription medications, sound therapy, CBT for tinnitus, and many more important components.