CBT for tinnitus

The most evidence-supported intervention overall. Cochrane review confirms benefit for distress and quality of life.

Sound therapy / TRT

Tinnitus Retraining Therapy combines counseling with broadband noise. Multiple RCTs support efficacy.

Notched sound therapy

Frequency-filtered music targeting the tinnitus pitch. Emerging evidence from German university trials.

Acupuncture

Mixed evidence. Some trials show benefit; systematic reviews are inconclusive.

Perception of ringing, buzzing, or other sounds without an external source. Affects ~15% of adults globally.

Tinnitus

CBT for insomnia (CBT-I)

First-line treatment per AASM guidelines. More effective than medication long-term. Multiple large RCTs.

Sleep hygiene optimization

Temperature, light, timing, and stimulus control. Foundational but insufficient alone for clinical insomnia.

Blue light filtering

Evening blue light reduction supports melatonin production. Some RCTs support benefit; effect size debated.

Sleep disruption including insomnia, poor sleep quality, and difficulty with sleep onset or maintenance.

Sleep

Mediterranean diet

Strongest dietary evidence for metabolic syndrome reversal. Multiple large RCTs including PREDIMED.

Resistance training

Improves insulin sensitivity independent of weight loss. Strong RCT evidence for glucose and lipid management.

Time-restricted eating

Emerging evidence for metabolic markers. Multiple small RCTs show benefit; long-term data still building.

Cluster of conditions — elevated blood sugar, abnormal cholesterol, high blood pressure, excess abdominal fat — that increase heart disease and diabetes risk.

Metabolic syndrome

Aerobic exercise

Strongest modifiable factor for cognitive preservation. Meta-analyses show significant benefit for memory and executive function.

Cognitive training

Targeted brain training shows transfer to real-world function in some trials. ACTIVE trial showed lasting benefits.

Social engagement

Strong epidemiological evidence linking social activity to reduced dementia risk. Interventional data still limited.

Age-related decline in memory, processing speed, and executive function. Ranges from normal aging to MCI to dementia.

Cognitive decline

Hearing protection

Prevention is the strongest intervention. Custom earplugs and noise monitoring prevent noise-induced damage.

Hearing aids

Gold standard for management. Modern devices significantly improve quality of life and may slow cognitive decline.

Noise-induced, age-related, or other forms of sensorineural or conductive hearing loss.

Hearing loss

Anti-VEGF injections

Standard of care for wet AMD. Dramatically changed outcomes for neovascular disease.

Smoking cessation

Smoking doubles AMD risk. Cessation is the single most impactful modifiable factor.

Age-related macular degeneration (AMD). Progressive vision loss affecting the central visual field.

Macular degeneration

30+ minutes most days reduces cardiovascular mortality by 30-50%. Strongest lifestyle intervention.

PREDIMED trial showed 30% reduction in cardiovascular events. Strong evidence base.

Stress management

Chronic stress contributes to hypertension and inflammation. Meditation and mindfulness show modest benefits in trials.

Cardiovascular disease including atherosclerosis, hypertension, heart failure, and elevated lipids.

Heart disease

Weight loss (5-10%)

Most effective intervention for NAFLD. Even modest weight loss significantly reduces liver fat and inflammation.

Coffee consumption

3-4 cups/day associated with reduced liver fibrosis, cirrhosis, and hepatocellular carcinoma risk across multiple meta-analyses.

Liver conditions including NAFLD/MASLD, fatty liver, elevated enzymes, and general hepatoprotection.

Liver disease

Blood pressure control

Most important modifiable factor for CKD progression. ACE inhibitors/ARBs have specific renal protective effects.

Adequate hydration

Maintaining hydration supports kidney function. Evidence strongest for kidney stone prevention.

Kidney health including CKD support, urinary tract health, and renal protection.

Kidney disease

Endogenous hormone regulating circadian rhythm. Specifically studied for tinnitus-related sleep disruption, with some evidence for reducing tinnitus perception itself. One of the most evidence-backed sleep supplements.

Melatonin

The most bioavailable form of magnesium for sleep and relaxation. Glycine itself has calming properties. US Army studies showed magnesium reduced noise-induced hearing damage. Addresses widespread deficiency — estimated 50% of Americans are magnesium deficient.

Magnesium glycinate

Essential trace mineral involved in over 300 enzymatic reactions. Zinc deficiency is linked to tinnitus in multiple studies. Also critical for immune function, wound healing, and retinal health.

Zinc

Essential for nerve function, DNA synthesis, and red blood cell formation. B12 deficiency is associated with tinnitus, hearing loss, and cognitive decline. Methylcobalamin form preferred for neurological applications.

Vitamin B12

The most-studied supplement specifically for tinnitus. Improves cochlear blood flow. Cochrane review found mixed evidence, but European trials show benefit with standardized EGb 761 extract. Widely prescribed in France and Germany.

Ginkgo biloba

Heavily marketed specifically for tinnitus. Contains bioflavonoids and B vitamins. Despite ubiquitous advertising, clinical evidence for tinnitus relief is minimal. One small, older trial cited by the manufacturer; no independent replication.

Lipo-Flavonoid

Amino acid found naturally in green tea. Promotes alpha brain wave activity associated with calm alertness. Reduces anxiety without sedation. May help tinnitus via stress/anxiety reduction pathway.

L-Theanine

The brain's primary inhibitory neurotransmitter. Oral supplementation is controversial — debate over whether it crosses the blood-brain barrier. Some evidence for stress reduction and sleep onset.

GABA

Conditionally essential amino acid abundant in brain, heart, and muscle. 2023 Science paper showed lifespan extension across multiple species. Supports GABA-ergic signaling and cardiovascular function.

Taurine

The simplest amino acid. Building block for collagen, glutathione, creatine, and inhibitory neurotransmitters. At 3g bedtime doses, lowers core body temperature and promotes NREM sleep quality.

Glycine

One of the oldest herbal sleep remedies, used since ancient Greece. Acts on GABA receptors. Evidence is mixed — some meta-analyses find modest benefit while others find no significant effect vs. placebo.

Valerian

Traditional calming herb used for centuries as tea. Contains apigenin, which binds GABA receptors. Most evidence is from chamomile extract capsules rather than tea.

Chamomile

Mint-family herb traditionally used for calming and sleep. Inhibits GABA transaminase, increasing GABA availability. Often combined with valerian in European herbal preparations.

Lemon balm

Traditional anxiolytic and sleep herb. One head-to-head trial showed comparable efficacy to oxazepam for anxiety with fewer side effects. Mechanism involves GABA modulation.

Passionflower

Oral lavender oil preparation (Silexan/Lavela) is one of the best-studied herbal anxiolytics. Multiple RCTs show efficacy comparable to low-dose benzodiazepines for generalized anxiety, with secondary sleep benefits.

Lavender (oral)

Adaptogenic herb from Ayurvedic medicine. Reduces cortisol, supports sleep, and may improve metabolic markers. KSM-66 and Sensoril are the most-studied standardized extracts.

Ashwagandha

Non-psychoactive cannabinoid from hemp. Interacts with endocannabinoid system. Popular for sleep and anxiety but clinical evidence is still catching up to consumer adoption. Legal status varies.

Direct precursor to serotonin, which converts to melatonin. Derived from Griffonia simplicifolia seeds. Raises serotonin levels more directly than tryptophan.

5-HTP

Essential amino acid and precursor to serotonin and melatonin. The original 'turkey drowsiness' molecule. Supplementation raises serotonin more gradually than 5-HTP.

Tryptophan

A carbocyclic sugar involved in insulin signaling and neurotransmitter function. Strong evidence for PCOS and metabolic markers. Also used for anxiety and sleep at higher doses.

Myo-inositol

A stereoisomer of inositol involved in insulin signaling. Often used alongside myo-inositol in a 40:1 ratio for PCOS and metabolic support.

D-Chiro-Inositol

Alkaloid from goldenseal and barberry. Activates AMPK, same pathway as metformin. Strong evidence for blood sugar and lipid management. Sometimes called 'nature's metformin.'

Berberine

Common spice with blood sugar-lowering properties. Ceylon (true) cinnamon preferred over cassia due to lower coumarin content. Modest evidence for fasting glucose reduction.

Cinnamon

Trace mineral involved in insulin signaling. Once heavily promoted for blood sugar control. More recent evidence suggests benefits are modest and mainly in deficient individuals.

Chromium

Potent antioxidant that works in both water and fat-soluble environments. R-form is the biologically active isomer. Evidence for diabetic neuropathy and blood sugar support.

Alpha-lipoic acid

Essential fatty acids the body cannot produce. EPA and DHA support cardiovascular health, reduce triglycerides, and have anti-inflammatory effects. One of the most studied supplements in existence.

Fish oil

Plant-based source of DHA and EPA from microalgae — the same source fish get their omega-3s from. Suitable for vegetarians/vegans. Equivalent bioavailability to fish oil.

Algal DHA/EPA

Soluble fiber from Plantago ovata seeds. One of the most evidence-backed supplements for cholesterol and blood sugar management. FDA-approved health claim for heart disease risk reduction.

Psyllium husk

Water-soluble fiber from konjac root. Absorbs enormous amounts of water, promoting satiety. EU-approved weight loss claim at 3g/day. Also lowers cholesterol and blood sugar.

Glucomannan

Soluble fiber found in oats, barley, and yeast. Oat beta-glucan has an FDA-approved health claim for cholesterol reduction. Also modulates immune function.

Beta-glucan

Concentrated polyphenol from green tea. EGCG is the primary active catechin. Supports metabolic rate, fat oxidation, and has neuroprotective properties. Liver safety concerns at high doses.

Green tea extract

Active compound in turmeric with broad anti-inflammatory and antioxidant effects. Poor bioavailability requires enhanced formulations (piperine, phytosome, nanoparticle). One of the most researched natural compounds.

Curcumin

Polyphenol found in red wine, grape skins, and Japanese knotweed. Activates SIRT1 and AMPK pathways. Dramatic longevity effects in animal models have not clearly translated to humans.

Resveratrol

Flavonoid found in onions, apples, and berries with anti-inflammatory and senolytic properties. When combined with dasatinib, selectively clears senescent cells. Phytosome form improves poor bioavailability.

Quercetin

Most potent natural activator of Nrf2 pathway — the body's master antioxidant defense system. Derived from broccoli sprouts. Upregulates hundreds of protective genes.

Sulforaphane

One of the oldest medicinal plants. Allicin is the primary active compound formed when garlic is crushed. Evidence for modest blood pressure and cholesterol reduction.

Garlic

Garlic aged for 20 months, converting allicin to S-allyl cysteine and other stable compounds. Better tolerated than raw garlic. Kyolic brand is the most studied. Some evidence for arterial calcification reduction.

Aged garlic extract

Essential coenzyme in mitochondrial energy production. Levels decline with age and are depleted by statins. Ubiquinol is the active reduced form with better bioavailability.

CoQ10

Naturally occurring compounds in plants that block cholesterol absorption. FDA-approved health claim for heart disease risk reduction. One of the most evidence-backed supplements for LDL.

Plant sterols

Fermented rice containing monacolin K, which is chemically identical to lovastatin. Effective for cholesterol but controversial due to variable monacolin content and regulatory concerns.

Red yeast rice

Vitamin B3 in its nicotinic acid form. Most effective supplement for raising HDL. Fell out of favor after AIM-HIGH and HPS2-THRIVE trials questioned cardiovascular outcomes despite lipid improvement.

Niacin

Fat-soluble vitamin functioning like a hormone, affecting 1,000+ genes. Widespread deficiency (40% of US adults). Critical for bone, immune, and cardiovascular health.

Vitamin D3

Directs calcium to bones and away from arteries. Works synergistically with D3. MK-7 form has longest half-life.

Vitamin K2

Essential mineral for bone health. Controversial for cardiovascular safety — some meta-analyses suggest increased MI risk with supplements (not dietary calcium). Citrate form better absorbed.

Calcium

Essential trace mineral with antioxidant properties. Necessary for thyroid function and glutathione production. Excess can be toxic — narrow therapeutic window.

Selenium

Essential for thyroid hormone production. Deficiency affects cognitive development and metabolic rate. Most people in developed countries get adequate iodine from iodized salt.

Iodine

Essential mineral for oxygen transport and energy production. Deficiency is common (especially in women) and causes fatigue, cognitive impairment, and hearing issues. Do NOT supplement without confirmed deficiency.

Iron

Essential B vitamin critical for DNA synthesis, methylation, and homocysteine metabolism. Methylfolate (5-MTHF) is the active form, preferred over folic acid especially for MTHFR variants.

Folate

Combination of all eight B vitamins. Supports energy metabolism, nerve function, and methylation. Often used as a baseline supplement. Quality varies significantly between brands.

B-Complex

Active form (P5P) is involved in neurotransmitter synthesis and over 100 enzyme reactions. Deficiency affects nerve function. High doses of pyridoxine (not P5P) can cause neuropathy.

Vitamin B6

Essential for energy metabolism and nerve function. Deficiency causes Wernicke-Korsakoff syndrome. Benfotiamine is a fat-soluble form with better tissue penetration.

Thiamine

Essential for energy production and antioxidant function. Best known for migraine prevention at high doses. Some evidence linking deficiency to hearing issues.

Riboflavin

Essential antioxidant vitamin. Included in AREDS2 formula for AMD. Supports immune function, collagen synthesis, and iron absorption. Megadose claims are largely unsupported.

Vitamin C

Fat-soluble antioxidant. Part of AREDS2 formula for AMD. SELECT trial raised concerns about prostate cancer risk at high doses. Mixed tocopherols may be safer than alpha-tocopherol alone.

Vitamin E

Essential fat-soluble vitamin for vision, immune function, and cell growth. Preformed vitamin A (retinol) has toxicity risk. Beta-carotene is the safer provitamin A form.

Vitamin A

Provitamin A carotenoid. Was included in original AREDS formula for AMD but removed in AREDS2 due to increased lung cancer risk in smokers. Replaced by lutein/zeaxanthin.

Beta-carotene

Carotenoid pigments forming macular pigment that filters blue light and protects photoreceptors. The only carotenoids found in the human lens and retina. AREDS2 validated their role.

Lutein & Zeaxanthin

Essential trace mineral. Included in AREDS2 formula to offset copper depletion from high-dose zinc. Most people get adequate copper from diet.

Copper

Specific combination of vitamin C (500mg), vitamin E (400 IU), lutein (10mg), zeaxanthin (2mg), zinc (80mg), and copper (2mg) validated by the NIH-funded AREDS2 trial for slowing AMD progression.

AREDS2 formula

European relative of blueberry. Rich in anthocyanins. WWII-era claims about RAF pilots' night vision drove popularity. Modern evidence is modest for eye health.

Bilberry

Expensive spice with surprisingly strong evidence for depression and emerging evidence for AMD. Crocin and safranal are the active compounds. Multiple well-designed RCTs.

Saffron

Carotenoid from microalgae — gives salmon and flamingos their color. Estimated 6,000x stronger than vitamin C in singlet oxygen quenching. Crosses blood-brain and blood-retinal barriers.

Astaxanthin

Precursor to glutathione, the body's master antioxidant. Originally a mucolytic drug, now used for liver protection (acetaminophen overdose antidote), respiratory health, and cochlear protection. One of the most versatile supplements.

Most widely used liver-protective herb. Silymarin is the active flavonolignan complex. Used historically for mushroom poisoning. Strong mechanistic evidence for hepatoprotection.

Milk thistle

Traditional Mediterranean remedy for liver and digestive health. Contains cynarin and chlorogenic acid. Evidence for cholesterol reduction and liver enzyme improvement.

Artichoke extract

Traditional herbal remedy for liver and kidney support. Root is used for liver/digestion; leaf as a natural diuretic. Limited but growing clinical evidence.

Dandelion

Traditional anti-nausea and anti-inflammatory remedy with modern clinical validation. Gingerols and shogaols are the active compounds. Evidence for nausea, pain, and metabolic markers.

Ginger

Live beneficial bacteria. Effects are highly strain-specific — different strains do different things. Gut microbiome influences virtually every organ system. Quality and strain selection matter enormously.

Probiotics

Non-digestible fibers that feed beneficial gut bacteria. Inulin and FOS are the most common. Support gut microbiome diversity and short-chain fatty acid production.

Prebiotics

Combination of probiotics and prebiotics in a single product. The prebiotic component feeds the probiotic strains, theoretically improving colonization and efficacy.

Supplements for Hearing loss

Ginkgo biloba

Zinc

Bilberry

Iron

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Beyond supplements