Omega-3s, Inflammation and Tinnitus: A Fish Story

By Barry Keate
Barry Keate, has lived with tinnitus over 40 years and has published 150+ research articles on numerous aspects of tinnitus. He is an expert on the condition and a well-known advocate for those with tinnitus.

Inflammation causes pain as well as a host of degenerative diseases and can have a significant effect on tinnitus. We have heard from many people who either developed tinnitus or who have had it worsen due to inflammatory conditions. Poor diet is the most common cause of chronic inflammation. Ear infections and illnesses such as a cold or flu as well as blows to the head can also cause inflammation and affect tinnitus.

Inflammation is the body’s response to damage and can be a very good thing. If you bang your thumb with a hammer, the immune system sends white blood cells and other, hormone-like substances to help start the healing process. As a result, your thumb swells. However, chronic inflammation can cause diseases such as arthritis, heart disease, Inflammatory Bowel disease, numerous neurodegenerative diseases, Alzheimer’s and Parkinson’s disease, asthma, and even cancer. It also causes inflammatory skin problems such as psoriasis and eczema. There are a growing number of researchers who also believe chronic inflammation can lead to depression and bipolar disorder.

OTC Remedies and Drugs
Most of the over-the-counter and prescription pain medications Americans use were developed to reduce inflammation, thereby reducing pain. These medications are known as Non-Steroidal Anti-Inflammatory Drugs (NSAID). This class of medications includes common remedies such as aspirin, ibuprofen, acetaminophen, and prescription drugs. Two prescription NSAIDs which have garnered a good deal of media attention are Vioxx and Celebrex, cited for causing increased rates of heart attacks. Vioxx has been taken off the market and Celebrex may soon follow. There are safe prescription NSAIDs and it is wise to consult one’s physician first. A complete list of both over-the-counter and prescription NSAIDs can be seen at the end of this article.

A Fish Story
Omega-3s, Inflammation and TinnitusThere are other methods to reduce inflammation besides medication. A balanced diet and the proper supplementation can be of great benefit. Omega-3 polyunsaturated fatty acids top the list for effective control of inflammation. These compounds are found in fish oils, especially in cold water fish such as salmon, sardine, lake trout, mackerel, albacore tuna and swordfish. They are termed Essential Fatty Acids (EFA’s) because the body must have them to survive but cannot make them on its own. They must be obtained from the diet. Key Omega-3 fatty acids include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Omega-6 fatty acids are also essential to health, however these are very plentiful. They are found in grains, most plant based oils, poultry and eggs. Americans receive much more Omega-6 fatty acids than they do Omega-3’s. The optimal balance between these two acids is 1:1. With the decrease in fish consumption in the western world over the past century, a typical diet has a ratio closer to 20 parts Omega-6 to 1 part Omega-3. Studies have shown that if the ratio of Omega-6 to Omega-3 exceeds 4:1, health problems are likely to occur.

Scientists made one of the first associations between Omega-3’s and human health while studying the Inuit people (Eskimo) of Greenland. As a group, the Inuit suffered far less from many diseases than their European counterparts even though their diet was high in fat from eating whale, seal and salmon. Eventually researchers realized that these foods were all rich in Omega-3 fatty acids, which provided real disease-countering benefits.

Studies suggest that Omega-3 can improve insulin sensitivity in those with Type 2 Diabetes. They work another way to reduce menstrual pain. Clinical studies have shown the use of Omega-3 fatty acids can reduce the need for pain medication for people with chronic arthritis. I read a story of a fellow with severe osteoarthritis in his right shoulder. He had been taking a prescription-strength anti-inflammatory medication but was concerned about the effects on his heart, liver and kidneys. He then shifted to over-the-counter ibuprofen but was still concerned about overloading his organs. His doctor finally recommended Omega-3 fatty acids as a way of reducing inflammation. It worked well and now he only takes ibuprofen on an as-needed basis instead of several times a day.

An overview of clinical studies published in the Journal of the American College of Nutrition in 2002 reveals how Omega-3’s are effective in the management of inflammatory and autoimmune diseases. The review states that coronary heart disease, depression, aging and cancer are characterized by an increased level of interleukin 1 (IL-1), a proinflammatory cytokine. Similarly, arthritis, Crohn’s disease, ulcerative colitis and lupus are autoimmune diseases also characterized by high levels of IL-1. The overview discusses a number of clinical trials conducted assessing the benefits of dietary supplementation with fish oils in several diseases in humans, including rheumatoid arthritis, Crohn’s disease, colitis, psoriasis, lupus, multiple sclerosis and migraine headaches. These studies reveal significant benefit, including decreased disease activity and a lowered use of pain medication.

There is significant scientific evidence that fish oil can be used as a treatment for depression and bi-polar disorder. In a clinical study conducted at the Harvard Medical School, patients with manic depression received either fish oil or olive oil (as a placebo) along with their standard medications. After four months, 65% of the fish oil recipients improved compared to only 19% of the olive oil group. The results were so impressive that the researchers halted the study early so that those in the placebo group could begin taking fish oil if they wished.

No one knows exactly how Omega-3 fatty acids regulate mood. One theory is that they work like lithium and dampen over-active communication channels in the brain. Research by the National Institute on Alcohol Abuse suggests that the increase in the number of people suffering from depression in the United States over the past few decades may be directly linked to the declining consumption of fish over the same time period.

Omega-3’s, which are lacking in diets in the US and other developed countries, are very abundant fats in the brain and are essential for normal brain function.

All this sounds very familiar to us. It is known that people with tinnitus have over-active communication channels in the auditory cortex which results in excessive electrical activity. Dr. Abraham Shulman at the Martha Entenmann Tinnitus Research Center in Brooklyn, NY is treating some of his tinnitus patients with a combination of Neurontin and Klonopin. The Neurontin activates GABA receptors in the brain and slows electrical activity.

A diet high in cold water, oily fish provides adequate amounts of Omega-3 fatty acids. Some individuals may be concerned about eating oily fish because of possible contaminates like mercury and other pollutants. The National Institute of Health has issued guidelines for how much oily fish can be safely consumed by children and pregnant women. Fish oil supplements can provide adequate amounts and most of them do not contain the pollutants found in the whole fish. Consumer Labs has tested many fish oil supplements and found none of them contained mercury

Normal dosages of fish oil for inflammatory conditions are one to three grams per day. In order to fight depression, research indicates a dosage of 3 to 10 grams daily is an effective dose. Fish oil can be purchased in capsule form or as natural oil. On a personal note I take a fish oil, which is in liquid oil form and is lemon flavored. Other than the oily feel, it is pleasant tasting. I take two teaspoons a day which provides me with 3,200 mg of combined EPA and DHA.

The ideal ratio of Omega-6 to Omega-3 is between 1 to 1 and 4 to 1. The typical American diet provides a ratio of between 10 and 25 Omega-6 to 1 Omega-3. This imbalance leads to many autoimmune and inflammatory conditions.

A recent article published in the July 9, 2010 issue of the American Journal of Clinical Nutrition found a protective effect for Omega-3 fatty acid against the development of age-related hearing loss (presbycusis).

Data evaluated from participants in the Blue Mountains Hearing Study of age-related hearing loss showed greater total Omega-3 intake upon enrollment was associated with a lower risk of hearing loss. Those who consumed higher amounts of Omega-3 during the study had a 42% lower risk of hearing loss at the five year follow up. Additionally, a reduced risk of hearing loss progression was observed in those who consumed higher amounts of Omega-3.

If you suffer from tinnitus and feel that inflammation is part of the blame, increasing your intake of Omega-3 fatty acid may be of help. As one’s general health is improved, a reduction in tinnitus may often follow.

List of NSAIDs
Aspirin (Anacin, Ascriptin, Bayer, Bufferin, Ecotrin, Excedrin)
Choline and magnesium salicylates (CMT, Tricosal, Trilisate)
Choline salicylate (Arthropan)
Celecoxib (Celebrex)
Diclofenac potassium (Cataflam)
Diclofenac sodium (Voltaren, Voltaren XR)
Diclofenac sodium with misoprostol (Arthrotec)
Diflunisal (Dolobid)
Etodolac (Lodine, Lodine XL)
Fenoprofen calcium (Nalfon)
Flurbiprofen (Ansaid)
Ibuprofen (Advil, Motrin, Motrin IB, Nuprin)
Indomethacin (Indocin, Indocin SR)
Ketoprofen (Actron, Orudis, Orudis KT, Oruvail)
Magnesium salicylate (Arthritab, Bayer Select, Doan’s Pills, Magan, Mobidin, Mobogesic)
Meclofenamate sodium (Meclomen)
Mefenamic acid (Ponstel)
Meloxicam (Mobic)
Nabumetone (Relafen)
Naproxen (Naprosyn, Naprelan)
Naproxen sodium (Aleve, Anaprox)
Oxaprozin (Daypro)
Piroxicam (Feldene)
Rofecoxib (Vioxx)
Salsalate (Amigesic, Anaflex 750, Disalcid, Marthritic, Mono-Gesic, Salflex, Salsitab)
Sodium salicylate (various generics)
Sulindac (Clinoril)
Tolmetin sodium (Tolectin)
Valdecoxib (Bextra)