Sugar Metabolism, Ketones and Tinnitus

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.

Author’s Note: First published in 2004, this article has been updated with important, new information about ketones as a dietary source of energy.

There has been discussion in the scientific community for several years about a connection between sugar metabolism disorders, such as hyperinsulinemia and diabetes, and tinnitus. A detailed study from the Federal University of Rio Grande School of Medicine, in Brazil, brought this dietary connection into sharp focus. It was initially published in the International Tinnitus Journal in 2004. (1)

A complete discussion of the metabolic disorders that lead to diabetes is beyond my expertise and is still being researched and debated by scientists. I have therefore simplified the study and distilled it into something useful for myself and, hopefully, the readers of this newsletter.

The inner ear, like the brain, is totally without energy reserves. Its metabolism depends directly on the supply of oxygen and sugar (glucose) from the blood supply. Alterations in glucose metabolism therefore have great potential for disturbing the workings of the inner ear. The researchers in this study referenced previous studies showing that between 84 and 92% of tinnitus patients were shown to have a metabolic disorder called hyperinsulinemia.

Hyperinsulinemia is an elevation of insulin levels in the bloodstream. It is a direct consequence of a metabolic disorder known as insulin resistance. This is characterized by a reduced biological response to insulin at the cellular level. Insulin becomes less effective in transferring glucose from the bloodstream to the cells. The pancreas then produces more insulin in order to lower blood glucose levels and insulin levels increase. Hyperinsulinemia is known to be related to hypoglycemia and, as it progresses, may eventually lead to type 2 diabetes.

There are three standard tests to determine hyperinsulinemia. They all involve having the patient drink 100 mg of pure glucose in a water solution then monitoring blood insulin levels over a period of time. The first test is fasting insulinemia, the second is a two-hour test and the third is a five-hour test which measures and averages insulin levels every hour. The fasting insulinemia test has been shown to only have an accuracy of 10% for diagnosing hyperinsulinemia. The two-hour test has an accuracy of 89% and the five-hour test has an accuracy of 99% in diagnosing this metabolic disorder.

Hyperinsulinemia and type 2 diabetes can most often be controlled through diet and exercise. This fact led the researchers to embark on a clinical trial to find if dietary control of hyperinsulinemia would have an effect on the patient’s tinnitus.

They enrolled 80 tinnitus patients who were also diagnosed with hyperinsulinemia into the study. They placed the 80 patients on a minimum 2-year diet designed to restore insulin to normal levels. Patients were asked to eat every three hours to prevent hypoglycemia; to avoid refined sugar and simple carbohydrates; to restrict their intake of fatty foods, especially saturated or hydrogenated fats; to take no more than 2 cups of coffee per day, limit intake of alcoholic beverages and drink four to six glasses of water per day.

The end results of this study are quite remarkable. The researches found that, of the 80 patients enrolled, 59 had followed the diet for the minimum of two years and 21 had not. In the patients who followed the diet, improvement of tinnitus was 5 times greater than in those who did not follow it. Specifically, of those who adhered to the diet, 24% had no improvement, 22% had some improvement, 39% had significant improvement and 15% had resolution of their tinnitus; it completely disappeared. Over 50% of the patients who adhered to the diet had significant improvement or complete resolution.

Of those who did not adhere to the diet, 86% had no improvement, 0% had some improvement, 14% had significant improvement and 0% had resolution. Overall, of those who adhered to the diet, 76% had improvement ranging from moderate to complete elimination, while in those who did not adhere, 14% had improvement.

The researchers continued to state that sugar metabolism disorders are one of the probable causes of Meniere’s disease as well as tinnitus. They said that while tinnitus can be managed with diet and exercise, dizziness is the symptom that diminishes the most with metabolic control.

They conclude by urging physicians who treat tinnitus patients to give them a thorough investigation for metabolic disorders, using the 5 hour glycemic and insulinemic curves, and to urge their patients who have these disorders to adjust their diet and lifestyles to manage insulin levels, thereby reducing tinnitus and Meniere’s disease symptoms.

Michael Seidman, MD, noted tinnitus authority, has long advocated regular exercise and diet restrictions for those with tinnitus. Dr. Seidman states, “It is imperative that people with tinnitus adhere to an excellent diet based on all food groups and that they reduce or eliminate their use of caffeine, nicotine, alcohol, fatty foods, salt and simple sugars (such as refined carbohydrates)”.

Diet and Ketones

Much of the information in this next section comes from the groundbreaking book by Mary Newport, MD, called “Alzheimer’s Disease: What if There Was a Cure? The Story of Ketones” (2)

We stated earlier that the metabolism of the brain and inner ear depend entirely on oxygen and glucose for their energy supply. This is not entirely true, as we are about to find out.

When we eat something that contains carbohydrate (sugar), it is broken down into smaller glucose molecules and this signals the pancreas to release the hormone insulin. Insulin must attach to the insulin receptor on the cell to allow the glucose to pass through the cell membrane. Once inside the cell, the glucose proceeds to the mitochondria where it is converted to the energy molecule adenosine tri-phosphate (ATP). This is the molecule used by the entire body for its source of energy.

But what happens when we go for long periods of time without food? Our bodies are only able to store enough glucose in the liver to last about 48 hours. After that it begins to convert muscle into glucose. This process can last for up to 40 days but after about two weeks we would consume so much muscle that survival would no longer be possible.

What happens is that the body begins to use its store of fat for fuel. Triglycerides are the storage form of fats. These are converted into fatty acids and then into what is known as ketone bodies (molecules). Ketones can be used as fuel for the cells, replacing glucose, and have the further advantage that they do not need insulin to pass through the cell membranes. Ketones can be used by the brain, the heart and the muscles and help people stay alive during periods of starvation.

The tremendous advantage of using ketones over glucose as fuel for the body is they bypass the need for insulin and restore blood glucose to healthy low levels without overtaxing the pancreas!

As we fast overnight when sleeping, a small amount of ketones are made, but as soon as we eat a typical breakfast, they disappear. If we continue to fast for two or more days, the levels of ketones are increased significantly.

Ketones can be produced in the body by exercise and diet. The Ketone Diet is the most fascinating area of nutritional research being conducted in medicine today.* It has therapeutic possibilities in a wide variety of neurological diseases, including Alzheimer’s disease, epilepsy, headache, Parkinson’s disease, brain cancer, autism and multiple sclerosis. (3)

As Dr. Newport points out in her book, Alzheimer’s disease is increasing becoming known as a metabolic condition of poor sugar metabolism in the brain. Insulin is needed in the brain to allow glucose to cross into the cells to produce ATP. However insulin cannot cross the blood-brain barrier to get into the brain.

Until 2005, it was commonly thought that insulin was only produced in the pancreas. Then it was discovered that the brain makes its own insulin. A new body of thought is developing that insulin resistance or a deficiency of insulin in the brain are responsible for cognitive impairment and Alzheimer’s disease. Researchers are now commonly referring to Alzheimer’s as “type 3 diabetes.” As such, the Ketone Diet is a promising therapy to reduce insulin resistance in the brain and prevent deterioration from the disease.

Dr. Dominic D’Agostino is a leading researcher into the uses of the Ketone Diet for disease conditions. He discusses how all cells are fueled by glucose. When glucose is not available, the cells have the ability to switch over to the alternate fuel, ketones. Except for cancer cells. They have a defect that does not allow them to shift over. So, by using the Ketone Diet, cancer cells are selectively starved and die. “It just absolutely amazes me that medical science is just now finding this out,” he said. (4)

And, to get back to the origins of this article, a Ketone Diet has been shown to be effective in improving sugar metabolism and reducing the need for medications in patients with type 2 diabetes. (5)

Ketone Diet Restrictions

The pure Ketone Diet is very restrictive and difficult to follow. It mandates that 80% of calories must come from healthy, medium chain fatty acids, such as those found in coconut oil and palm kernel oil. Only 20% of calories can come from combined carbohydrates and protein. This diet will lead to a dramatic increase in ketone bodies and a decrease in glucose and insulin.

When a person eats foods that contain medium chain fatty acids, they are absorbed from the small intestine and transported directly to the liver, where they are partially converted to ketones and released into the blood stream.

The oils normally consumed in the US, such as soybean, olive, canola, corn, peanut and sesame, do not contain any medium chain fatty acids. Some foods that do contain these acids are goat’s milk, whole cow’s milk, butter, heavy cream and goat and feta cheese. These do not have nearly the concentrations found in coconut and palm oils, which contain about 55 to 60% medium chain fatty acids.

These are saturated fats but do not behave the same way in the body as long chain saturated fats that doctors worry about. They are much healthier than long chain saturated fats and hydrogenated fats.

The Atkins Diet and the South Beach Diet are both offshoots of the Ketone Diet that are not as rigorous and are easier to follow. The Atkins Diet allows for unlimited amounts of protein, however, and this somewhat defeats the purpose as protein can be converted to glucose.

The South Beach Diet allows for more carbohydrates but tries to concentrate on the good carbohydrates, that take longer to digest, and not use simple carbohydrates. Either of these diets can produce ketones in lower amounts but are still helpful for many sugar metabolism disorders.

A word about ketosis: When doctors worry about the possible dangers of raising ketone levels, they are thinking about diabetic ketoacidosis, a potentially life threatening condition that happens to some people with type 1 diabetes. The levels of ketones become dangerously high, as much as 5 to 10 times higher than the situation of starvation or the classic Ketone Diet. The levels of ketones are 50 times higher in diabetic ketoacidosis than after consuming a large quantity (20 grams) of medium chain triglyceride (MCT) oil.

There are many Ketone Diet cookbooks available on the web. Coconut oil and MCT oil are available online and in most health food stores.

So, put away the pastries, limit white bread, forego the ice cream and go for a walk. Eat more vegetables and fruits and avoid as much as possible processed foods, which are often high in saturated fat and salt. If you have a particularly disturbing case of tinnitus, consult with your doctor about possible metabolic disturbances and investigate whether a Ketone Diet can help. And remember Arches Tinnitus Formulas have been clinically proven to reduce tinnitus for most people and can significantly reduce neurological and cardiovascular damage caused by diabetes-related metabolic disorders.

* Please note: The Ketone Diet discussed here has nothing to do with Raspberry Ketone weight loss products that are widely advertised.



1 – Lavinsky L, Oliveira MW, Bassanesi HJ, D’Avila C. Lavinsky M. “Hyperinsulinemia and tinnitus: a historical cohort.” Int. Tinnitus J. 2004;10(1):24-30.

2 – Mary Newport, MD. “Alzheimer’s Disease: What if There Was a Cure? The Story of Ketones.” Copyright 2011. Basic Health Publications, Inc. Laguna Beach, CA

3 – Stafstrom CE, Rho JM. “The Ketogenic Diet as a Treatment Paradigm for Divers Neurological Disorders.” Front Pharmacol. 2012, 3:59.

4 – Friday, June 21, 2013.

5 – Yancy YS Jr, Foy M, et. al. “A low-carbohydrate, ketogenic diet to treat type 2 diabetes.” Nutr. Metab. (Lond). 2005; 2:34.