Vertigo

I. Vertigo is defined as a condition of dizziness of feeling of spinning, or swaying when one is stationary. Dizziness is a general, non-specific term to indicate a sense of disorientation. Some researchers suggested that vertigo is a subtype of dizziness and refers to an erroneous perception of self- or object-motion or an unpleasant distortion of static gravitational orientation that is a result of a mismatch between vestibular, visual, and somatosensory systems, affecting approximately 20-30% of the general population(1) and about two to three times higher in women than in men.

II. Symptoms
A. Eidelman D. in the study of "Fatigue on rest" and associated symptoms (headache, vertigo, blurred vision, nausea, tension and irritability) due to locally asymptomatic, unerupted, impacted teeth" showed that
1. "Fatigue on Rest",
2. headache,  
3. vertigo and the feeling of loss of balance,
4. blurred vision,
5. nausea,
6. tension and
7.  irritability
were found to be prevalent amongst patients who had  locally asymptomatic, unerupted impacted teeth. A comparative pressure sign was developed, which, when positive, confirmed the relationship between the impacted teeth and the medical symptoms. Removal of the impactions resulted in the alleviation of the symptoms. Stress and psychogenic factors are considered as trigger mechanisms, rather than as basic causes of the symptoms(2).

B. Other symptoms
Other researchers indicated that Destructive lesions of labyrinth, or of vestibular tracks, partial or complete.-Heterogeneous stimulations of the paired intact vestibular-end organs.-The hypersensitive labyrinth.-Clinical manifestations of vertigo, associated with nausea, headache, 
8. visual disturbances,
9. nystagmus, 
10. diplopia, 
11. staggering gait,
12. vasomotor and cardio-vascular symptoms, 
13. pallor, flushing,  
14. sweating, 
15. dyspnoea, 
16. fainting, 
17. vomiting and 
18. diarrhoea.
19. Etc.(3)


III. Causes and Risk Factors
 A. Causes
1. DR. Karatas M. at the Baskent University, Medical School, Adana Research Center in a study of Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes indicated that central causes are responsible for almost one-fourth of the dizziness experience by patients. The patient's history, neurologic examination, and imaging studies are usually the key to differentiation of peripheral and central causes of vertigo. The most common central causes of dizziness and vertigo are  
a. cerebrovascular disorders related to the vertebrobasilar circulation,  
b. migraine, 
c. multiple sclerosis, 
d. tumors of the posterior fossa, 
e. neurodegenerative disorders, 
f.  some drugs, and 
g. psychiatric disorders.(4)


2. Stroke
Stroke accounts for 3-7% among all causes of vertigo. The blood perfusion to the inner ear, brainstem, and cerebellum arise from the vertebrobasilar system. Vertigo, nausea, and vomiting, along with nystagmus, represent symptoms of stroke in posterior fossa due to arterial occlusion or rupture of the vertebrobasilar system. However, the spectrum of signs and symptoms as a manifestation of stroke associated with dizziness and vertigo may be variable depending on the affected vascular territories(1)

3. Meniere's disease
Meniere's disease is a clinical syndrome characterized by spontaneous episodes of recurrent vertigo, sensorineural hearing loss, tinnitus and aural fullness and familial Meniere's disease in around 10-20% of cases. An international collaborative effort to define the clinical phenotype and recruiting patients with migrainous vertigo and Meniere's disease is ongoing for genome-wide association studies(5).

4. Diabetes
Some researchers at the GENyO Pfizer-Universidad de Granada suggested that suggest that type 1 diabetes mellitus is associated with cupular and free-floating deposits in the semicircular canals. The patients with type 1 diabetes mellitus with a longer duration of disease have an increased probability of suffering from benign paroxysmal positional vertigo(6).

5. Head trauma
It is well known that head trauma may cause hearing loss, which can be either conductive or sensorineural. Benign paroxysmal positional vertigo and olfactory dysfunction due to head trauma are also well known(7).


6. Syphilis
Syphilis is a chronic, systemic and sexually transmitted infectious disease affecting most of the organs in the body. A young African man presented with vertigo, unsteadiness of gait and a skin rash suggestive of secondary syphilis. Diagnosis was confirmed on serology and was treated with two shots of long-acting penicillin, following which his symptoms settled(8).

7. Benign positional vertigo (BPV) 
Benign positional vertigo (BPV) is the most common cause of episodic vertigo. It results from activation of semicircular canal receptors by the movement of calcium carbonate particles (otoconia) which dislodge from the otolith membranes. During changes in head position, the otoconia either float freely within the semicircular canal duct (canalithiasis) or adhere to and move with the cupula of the canal (cupulolithiasis). BPV from canalithiasis evokes brief spells of vertigo lasting seconds and can be diagnosed at the bedside by provoking paroxysmal vertigo and nystagmus on tilting the head in the plane of the affected canal. The nystagmus has a unique rotational axis perpendicular to the affected canal(9)

B. Risk Factors
1. Endolymphatic hydrops 
In the study to assess the results of treatment for a first episode of benign paroxysmal positional vertigo (BPPV) and risk factors for recurrence at the Kobe University Graduate School of Medicine, showed that  endolymphatic hydrops is a risk factor for recurrence of BPPV and that prevention of recurrent BPPV is important for control of endolymphatic hydrops(10)

2. Vascular risk factors
Vascular risk factors predispose to vertebrobasilar ischemia. Cervical osteophytes can impinge on the vertebral artery causing mechanical occlusion during head turning. Presentation with vertigo in such instances is a common finding(11)


3. Otitis media history
Researchers found that having an otitis media history or eustachian tube dysfunction determined with the nine-step inflation/deflation tympanometric test before diving, or difficulty in clearing ears during diving could be important risk factors for AV in sport SCUBA divers (p <.05)(12).

4. Gender
If you are women, you at  two to three times higher risk to develop Vertigo

5. Vestibular neuritis (VN) is a condition of an ear disorder that involves irritation and inflammation. The recurrence rate of vertigo due to any cause in patients with vestibular neuritis (VN) was about 26.0(13)

6. Heredity
Genetic loci and clinical features of familial episodic ataxias have been defined in linkage disequilibrium studies with mutations in neuronal genes KCNA1 and CACNA1A. Migrainous vertigo is a clinical disorder with a high comorbidity within families much more common in females with overlapping features with episodic ataxia and migraine. Bilateral vestibular hypofunction is a heterogeneous clinical group defined by episodes of vertigo leading to progressive loss of vestibular function which also can include migraine. Meniere's disease is a clinical syndrome characterized by spontaneous episodes of recurrent vertigo, sensorineural hearing loss, tinnitus and aural fullness and familial Meniere's disease in around 10-20% of cases.(14)

7. Etc.

IV. Diseases associated with Vertigo
In the study to the DISCUSSION ON VERTIGO, the team wrote that Vertigo associated with
1. acute, non-perforative otitis media, with
2. chronic otitis media, with 
3. labyrinthine fistula, with  
4. otosclerosis,
5. post-suppurative adhesions; with 
6. peripheral nerve deafness,
7. gun deafness;
8. with rhinitis,  
9. ethmoiditis, 
10. sinusitis, 
11. nasal polypi, 
12. postnasal catarrh and 
13. dental infections.-Influence of general health on recurrent vertigo and vice versa (3)


V. Diagnosis
Dr. Della-Morte D, Rundek T. at the University of Miami, indicated that differential diagnosis between vascular vertigo and other causes of vertigo can result in misclassification due to the overlapping of symptoms. Careful medical history, physical examination, neuroimaging and ear, nose, and throat studies may help to distinguish vascular vertigo from other causes.(1)
1. Positive Dix-Hallpike test.
In the study of Twelve patients from the derivation set and six patients from the validation set had DHT + BPPV. Binomial logistic regression analysis selected a "duration of dizziness ≤15 seconds" and "onset when turning over in bed" as independent predictors of DHT + BPPV with an odds ratio (95% confidence interval) of 4.36 (1.18-16.19) and 10.17 (2.49-41.63), respectively. Affirmative answers to both questions yielded a likelihood ratio of 6.81 (5.11-9.10) for diagnosis of DHT + BPPV, while negative answers to both had a likelihood ratio of 0.19 (0.08-0.47).(15)

2. Electronystagmography versus videonystagmography
In the study to assess the value of electronystagmography (ENG) and videonystagmography (VNG) for diagnosing vertigo of various origin, scientists at the Medical University of Łódź, showed that In all patients with vertigo due to vestibular neuritis, barotrauma and kinetosis, significant CP, the important sign of peripheral site of vestibular lesion was identified both in ENG and VNG. None of the patients with central origin disorders showed CP in VNG; in the majority of cases DP was observed. However, in ENG we found CP in 5 patients with central origin disorders. There were no essential differences between ENG and VNG in measurements of FRQ and SPV except for higher values in VNG in controls and patients with mixed vertigo(16)

3. CT scan
CT scan  if a brain injury is suspected to be the cause of vertigo or your doctor would like to rule out the tumors or cancer causes of vertigo.

4. Etc.


VI. Preventions
A. The Do's and Do not's list 
1. Unhealthy diet
Unhealthy diet with high in saturated and trans fat and less fruits and vegetables can increase the risk of cholesterol building up in the arteries and nutrients deficiency of that can lead to insufficient blood flow to the back of the brain.

2.  Avoid damage to the head
From a neurotologic perspective, approximately 21.9% of head injured workers were determined to have recognizable evidence of cochleovestibular dysfunction. Olfactory dysfunction as a physical finding post-head injury compares favourably with the presence of post-traumatic benign positional paroxysmal vertigo (BPPV) and its atypical variants in 11.2% of head injured workers(17)

3. Relaxation
In the study of VERTIGO AND PSYCHOLOGICAL DISTURBANCES  Timothy C. Hain, MD, showed that Psychological abnormalities are common in the general population, even more common in those who are ill, and are certainly also common in individuals with vertigo. In a recent study by Garcia et al in Portugal, out of 43 patients, a large number of psychological abnormalities were diagnosed by the SCL-90 (a standard psychological test) including
a. Somatization     41.9%
b. Hostility     20.9%
c. Interpersonal sensitivity     18.6%
d. Anxiety     23.3%
e. Phobic anxiety     20.9%
f. OCD (obsessive compulsive disorder)     53.5%
g. Depression     30.2%
h. Paranoid traits     11.6%
i. Psychotic traits     2.3%(18)

4. Fruits and vegetables
Fruits and vegetables contain high amount of antioxidants and overprotective nutrients of which can enhance the immune system in fighting against firming of free radicals causes of degenerative diseases and viral and bacteria causes of infection and inflammation and decrease the chronic diseases causes of vertigo.

5. Moderate exercise
Excessive exercise can decrease the immune function in fighting against disease, moderate exercise not only enhances the blood circulation to increase oxygen to the back of the brain but also promotes the immune function fighting against inflammation and weaken immune system causes of vertigo.

6. Smoking
Smoking can reduce the lung function in oxygen absorption, thus reducing the risk of oxygen deficiency causes of vertigo.

7. Excessive alcohol drinking
Alcoholism can weaken the immune system and increase the risk of inflammatory causes of vertigo.

8. Etc.

B. Diet
 against vertigo
1. Mushroom
Mushroom is a standard name of white button mushroom, the fleshy, spore-bearing fruiting body of a fungus produced above ground on soil or on its food source, It is a genus A. Muscaria and belong to the family Amanitaceae and has been cultivation in many cultures all over the world for foods and health benefits.
a. Immunologic effects
In the analyzing White button mushrooms (WBM) and its effect in immune response, found that WBM promote DC maturation and enhance their antigen-presenting function. This effect may have potential in enhancing both innate and T cell-mediated immunity leading to a more efficient surveillance and defense mechanism against microbial invasion and tumor development, according to "White button mushroom enhances maturation of bone marrow-derived dendritic cells and their antigen presenting function in mice" by Ren Z, Guo Z, Meydani SN, Wu D.(36)

b. Neurotrophic action
Found that the neurotrophic action of cobalamin (Cbl) in the central nervous system (CNS) of totally gastrectomized (TGX) rats is mediated by stimulation of the epidermal growth factor(EGF) synthesis in the CNS itself. It thus appears that Cbl inversely regulates the expression of EGF and TNF-alpha genes in the CNS of TGX rats, according to "Epidermal growth factor as a local mediator of the neurotrophic action of vitamin B(12) (cobalamin) in the rat central nervous system" by Scalabrino G, Nicolini G, Buccellato FR, Peracchi M, Tredici G, Manfridi A, Pravettoni G.(37)

c. Copper
Copper is best known for its function in regulating the proper growth, utilization of iron, it is also a strong antioxidant, aiding the antioxidant enzyme, superoxide dismutase, and preventing oxidation in the cell membrane, according to the article of antioxidant cancer and diseases, posted in(38) 

d. Cholesterol Levels
Since it contains high amount of fiber, it not only helps to bind the bad cholesterol (LDL) in the digestive track then expelling them through normal waste release, but also burns cholesterol when they are digested because of its high lean protein content., according to the study of "Fiber intake, serum cholesterol levels, and cardiovascular disease in European individuals with type 1 diabetes. EURODIAB IDDM Complications Study Group" by Toeller M, Buyken AE, Heitkamp G, de Pergola G, Giorgino F, Fuller JH., (39)

e. Immune system
Since it contain high amount of vitamin C, it not only helps to improve the immune system in fighting against the foreign invasion, such as virus and bacteria, but also helps to inhibits fatty acid synthase expression as a result of the presence linoleic acid, thus reducing the risk of tumors and breast, colon and prostate cancers, according to the study of "The 10t,12c isomer of conjugated linoleic acid inhibits fatty acid synthase expression and enzyme activity in human breast, colon, and prostate cancer cells" by Lau DS, Archer MC.,(40)

2. Cabbage is a spicies of Brassica oleracea belong to the family Brassicaceae (or Cruciferae), native to the Mediterranean region along the seacoast. It has a short stem of which is crowded a mass of leaves, usually green but in some varieties, it may be red or purplish.
a. Cardiovascular health
Cabbage in steam cooking and other vegetable such as collard greens, kale, mustard greens, broccoli, green bell pepper has exerted the ability in lowering the recirculation of bile acids results in utilization of cholesterol to synthesize bile acid and reduced fat absorption and may be beneficial in preventing cardiovascular disease, cancer and improve public health, according to the study of "Steam cooking significantly improves in vitro bile acid binding of collard greens, kale, mustard greens, broccoli, green bell pepper, and cabbage" by Kahlon TS, Chiu MC, Chapman MH.(41)

b.  Vitamin K
Degenerative diseases of ageing
Long-term vitamin K inadequacy may reduce the function of supporting the carboxylation of at least some of these Gla-protein that can lead the development of degenerative diseases of ageing including osteoporosis and atherosclerosis, according to the study of "Vitamin K, osteoporosis and degenerative diseases of ageing" by Cees Vermeer and Elke Theuwissen(42)


c. Omega 3 fatty acid
Cabbage reduces the risk of cardiovascular diseases by controlling the secretion of bad cholesterol, due to high amount of Omega 3 fatty acid, according to the study of "The Omega-3 Index as a risk factor for cardiovascular diseases' by von Schacky C.(43)


3. Kiwifruit also best hnown as kiwi or Chinese gooseberry, is a species of A. chinensis belong to the family Actinidia, subgroup of the flavonoids and native to Southern China.
a. Type 2 diabetes
In the investigation of six kinds of fruits tested were grapes, Asian pears, guavas, golden kiwifruit, lychees and bananas and their glycemic index found that there was no significant difference in glycemic index values between healthy and Type 2 diabetes subjects. There was also no significant difference in PII when comparing healthy subjects and subjects with Type 2 diabetes and concluded that glycemic index and peak incremental indices in healthy subjects can be approximately the same for Type 2 diabetes, according to "Glycemia and peak incremental indices of six popular fruits in Taiwan: healthy and Type 2 diabetes subjects compared" by Chen YY, Wu PC, Weng SF, Liu JF.(44)


b. Vitamin C
Besides is essential in preventing the breaking off small vein cause of hardening of the vessel wall, vitamin C also improves the digestive system in maximum absorption of vital nutrients. Overdoses can cause diarrhea, It also plays an important role in enhancing immune system fighting against the forming of free radicals that cause muscle damage, according to the study of "Does antioxidant vitamin supplementation protect against muscle damage?" by McGinley C, Shafat A, Donnelly AE.,(45)


c. Antioxidants
 Since kiwifruit contains high amount of Vitamin C, it helps to enhance the immune function in fighting against forming of free radicals, thus reducing the risk of irregular cell growth, such as tumor and cancer, according to the study of "High-dose vitamin C (ascorbic acid) therapy in the treatment of patients with advanced cancer" by Ohno S, Ohno Y, Suzuki N, Soma G, Inoue M.(46)


4.  Olive Oil
Olive is belongs to the the family Oleaceae, native to the coastal areas of the eastern Mediterranean Basin and south end of the Caspian Sea. Its fruit, is also called the olive and the source of olive oil.
a. Cardiovascular health
In the investigation of the olive oil of the primary source of fat used in Mediterranean diet, found that olive oil consumption could contribute to explaining the low rate of cardiovascular mortality found in southern European-Mediterranean countries, according to "Olive oil and cardiovascular health" by Covas MI, Konstantinidou V, Fitó M.(47)

b. Antioxidants and weight loss
In the analyzing the influence of a Mediterranean dietary pattern on plasma total antioxidant capacity (TAC) found that Mediterranean diet, especially rich in virgin olive oil, is associated with higher levels of plasma antioxidant capacity. Plasma TAC is related to a reduction in body weight after 3 years of intervention in a high cardiovascular risk population with a Mediterranean-style diet rich in virgin olive oil, according to "A 3 years follow-up of a Mediterranean diet rich in virgin olive oil is associated with high plasma antioxidant capacity and reduced body weight gain" by Razquin C, Martinez JA, Martinez-Gonzalez MA, Mitjavila MT, Estruch R, Marti A.(48)

c. Healthy effect of virgin olive oil
According to "International conference on the healthy effect of virgin olive oil" by

Perez-Jimenez F, Alvarez de Cienfuegos G, Badimon L, Barja G, Battino M, Blanco A, Bonanome A, Colomer R, Corella-Piquer D, Covas I, Chamorro-Quiros J, Escrich E, Gaforio JJ, Garcia Luna PP, Hidalgo L, Kafatos A, Kris-Etherton PM, Lairon D, Lamuela-Raventos R, Lopez-Miranda J, Lopez-Segura F, Martinez-Gonzalez MA, Mata P, Mataix J, Ordovas J, Osada J, Pacheco-Reyes R, Perucho M, Pineda-Priego M, Quiles JL, Ramirez-Tortosa MC, Ruiz-Gutierrez V, Sanchez-Rovira P, Solfrizzi V, Soriguer-Escofet F, de la Torre-Fornell R, Trichopoulos A, Villalba-Montoro JM, Villar-Ortiz JR, Visioli F. indicated that
c.1. Ageing represents a great concern in developed countries because the number of people involved and the pathologies related with it, like atherosclerosis, morbus Parkinson, Alzheimer's disease, vascular dementia, cognitive decline, diabetes and cancer.
c.2. Epidemiological studies suggest that a Mediterranean diet (which is rich in virgin olive oil) decreases the risk of cardiovascular disease.
c.3. The Mediterranean diet, rich in virgin olive oil, improves the major risk factors for cardiovascular disease, such as the lipoprotein profile, blood pressure, glucose metabolism and antithrombotic profile. Endothelial function, inflammation and oxidative stress are also positively modulated. Some of these effects are attributed to minor components of virgin olive oil. Therefore, the definition of the Mediterranean diet should include virgin olive oil.
c.4. Different observational studies conducted in humans have shown that the intake of monounsaturated fat may be protective against age-related cognitive decline and Alzheimer's disease.
c.5. Microconstituents from virgin olive oil are bioavailable in humans and have shown antioxidant properties and capacity to improve endothelial function. Furthermore they are also able to modify the haemostasis, showing antithrombotic properties.
c.6. In countries where the populations fulfilled a typical Mediterranean diet, such as Spain, Greece and Italy, where virgin olive oil is the principal source of fat, cancer incidence rates are lower than in northern European countries.
c.7. The protective effect of virgin olive oil can be most important in the first decades of life, which suggests that the dietetic benefit of virgin olive oil intake should be initiated before puberty, and maintained through life.
c.8. The more recent studies consistently support that the Mediterranean diet, based in virgin olive oil, is compatible with a healthier ageing and increased longevity. However, despite the significant advances of the recent years, the final proof about the specific mechanisms and contributing role of the different components of virgin olive oil to its beneficial effects requires further investigations.(49)

5. Lean beef are considered as animal fresh of which most fats are withdrawn before consuming to reduce the amount of sutured fat and cholesterol. Although some people insist that meats with fat are highly tasty, but the consequence of eating too much fat can damp the health of your body, leading to all kinds of diseases. Because of the use of growth hormone and selective breeding for commercial purposes, it is advised only eating lean meats from organic farm.

a. Nutrients
In the assessment of the nutrients in lean beef found that Total beef consumed among adults 19 to 50 and 51+ years was 49.3 +/- 1.4 g (1.74 oz/d) and 37.1 +/- 1.2 g (1.31 oz/d), respectively. In adults 19 to 50 and 51+ years, LB contributed 3.9% and 3.7% to total energy; 4.5% and 4.1% to total fat, 3.8% and 3.6% to saturated fatty acids; 13% and 11% to cholesterol intake; 15% and 14% to protein; 25% and 20% to vitamin B(12); 23% and 20% to zinc; and 8% and 7% to iron, respectively. Beef was also an important food source of many other nutrients, including niacin, vitamin B(6), phosphorus, and potassium. In addition, beef provided only 1% of total sodium intake and concluded that Consumption of beef contributed significantly to intake of protein and other key nutrients by US adults, according to "Lean beef contributes significant amounts of key nutrients to the diets of US adults: National Health and Nutrition Examination Survey 1999-2004" by Zanovec M, O'Neil CE, Keast DR, Fulgoni VL 3rd, Nicklas TA.(50)

b. Cardiovascular health
In the examination of the effects of dietary protein intake on energy restriction (ER)-induced changes in body mass and body composition found that overweight postmenopausal women can achieve significant weight loss and comparable short-term improvements in body composition and lipid-lipoprotein profile by consuming either a moderate-protein (25% of energy intake) poultry- or beef-containing diet or a lacto-ovo vegetarian protein (17% of energy intake) diet, according to "Protein intake during energy restriction: effects on body composition and markers of metabolic and cardiovascular health in postmenopausal women" by

Mahon AK, Flynn MG, Stewart LK, McFarlin BK, Iglay HB, Mattes RD, Lyle RM, Considine RV, Campbell WW.(51)

c. Diabetes
In random sequence, 50 g protein in the form of very lean beef or only water at 0800 h and studied over the subsequent 8 h found that the amount of glucose appearing in the circulation was only approximately 2 g. The peripheral plasma glucose concentration decreased by approximately 1 mM after ingestion of either protein or water, confirming that ingested protein does not result in a net increase in glucose concentration, and results in only a modest increase in the rate of glucose disappearance, according to "Effect of protein ingestion on the glucose appearance rate in people with type 2 diabetes" by Gannon MC, Nuttall JA, Damberg G, Gupta V, Nuttall FQ.(52)

d. Improve the nutrient transportation

The high levels of iron helps in maintaining high levels of energy and oxygen through the bloodstream as it enhances the function of blood in oxygen absorption, reduces the risk of iron deficiency anemia and improves the menstrual health for teenage girls and women in their child-bearing years, according to the study of "[Menstrual blood loss and iron nutritional status in female undergraduate students].[Article in Chinese]" by Li J, Gao Q, Tian S, Chen Y, Ma Y, Huang Z., posted in PubMed(53)

6. Sardines are several types of small, salt-water, soft-boned small oily fish in the family Clupeidae. There are as many as 21 species can be classified as sardines and their main food is plankton on the surface of the water. They are commercially fished for foods and variety of uses, including animal feed, sardine oil used in manufacture paint, varnish and linoleum.

a.  cardiovascular diseases
In the investigation of the nutritional benefits of fish consumption relate to the utilization of proteins of high biological value, as well as certain minerals and vitamins of fish found that The top 11 fish species [e.g., sardines, mackerel, herring (Atlantic and Pacific), lake trout, salmon (Chinook, Atlantic, and Sockeye), anchovy (European), sablefish, and bluefish] provide an adequate amount of omega-3 PUFAs (2.7-7.5g/meal) and appear to meet the nutritional recommendation of the American Heart Association, according to "Health benefits and potential risks related to consumption of fish or fish oil" by Sidhu KS.(54)

b. Cardiometabolic syndrome
In the research of Ogema 3 fatty acids (Found abundantly in sardine) and its effect in reducing cardiometabolic syndrome risk factors found that consumption of fish or fish oil containing omega-3 polyunsaturated fatty acids reduces the risk of coronary heart disease, decreases triglyceride, blood pressure, and inflammatory markers, improves endothelial function, prevents certain cardiac arrhythmias, reduces platelet aggregation (including reactivity and adhesion), reduces vasoconstriction, enhances fibrinolysis, reduces fibrin formation, and decreases the risk of microalbuminuria and sudden cardiac death. Thus, fish intake or fish oil supplement use is beneficial to reduce cardiometabolic risk factors, according to "Omega-3 fatty acids and the cardiometabolic syndrome" by Juturu V.(55)

c. Glucose tolerance
In the observation of an enzymatic hydrolysate of sardine protein (sardine peptide, SP) derived from sardine muscle possesses angiotensin I-converting enzyme (ACE) inhibitory activity, found that treatment with SP and captopril decreased ACE activity in the kidney, aorta, and mesentery. SP and captopril administration significantly suppressed the increase in blood glucose after glucose loading in the control SHRSPs, according to "Sardine peptide with angiotensin I-converting enzyme inhibitory activity improves glucose tolerance in stroke-prone spontaneously hypertensive rats" by Otani L, Ninomiya T, Murakami M, Osajima K, Kato H, Murakami T.(56)

d. Anti-Hyperleptinemia and anti- inflammation
In the exploring the effects of sardine protein on insulin resistance, plasma lipid profile, as well as oxidative and inflammatory status in rats with fructose-induced metabolic syndrome found that Sardine protein diets also prevented hyperleptinemia and reduced inflammatory status in comparison with rats fed casein diets, according to "Dietary sardine protein lowers insulin resistance, leptin and TNF-α and beneficially affects adipose tissue oxidative stress in rats with fructose-induced metabolic syndrome" by Madani Z, Louchami K, Sener A, Malaisse WJ, Ait Yahia D.(57)

7. Etc.

 

C. Antioxidants Against vertigo
1. Carotenoids
Carotenoids are organic pigments, occurring in the chloroplasts and chromoplasts of plants and some other photosynthetic organisms like algae, some bacteria.
a. Beta-carotene
Beta-Carotene, an organic compound and classified as a terpenoid, a strongly-coloured red-orange pigment in plants and fruits.
a.1. It is not toxic and stored in liver for the production of vitamin A that inhibits cancer cell in experiment. Beta-carotene also neutralize singlet oxygen before giving rise of free radicals which can damage of DNA, leading to improper cell DNA replication, causing cancers.
a.2. Cell communication
Researcher found that beta-carotene enhances the communication between cell can reduce the risk of cancer by making cells division more reliable.
a.3. Immune system
Beta-carotene promotes the immune system in identifying the foreign invasion such as virus and bacteria by increasing the quality of MHC2 protein in maintaining optimal function of white cells.
a.4. Polyunsaturated fat
Researchers found that beta-carotene also inhibits the oxidation of polyunsaturated fat and lipoprotein in the blood that reduce the risk of plaques build up onto the arterial walls, causing heart diseases and stroke.
a.5. There are more benefits of beta-carotene.

b. Alpha-carotene
Alpha-carotene, one of the most abundant carotenoids in the North American diet, is a form of carotene with a β-ring at one end and an ε-ring at the other. It is the second most common form of carotene which not only protects cells from the damaging effects of free radicals and enhances the immune system in fighting against bacteria and virus invasion, but also stimulates the communication between cells thus preventing irregular cell growth cause of cancers.

c. Beta-cryptoxanthin
Beta cryptoxanthin is an antioxidant, beside helping to prevent free radical damage to cells and DNA but also stimulates the repair of oxidative damage to DNA. it enhances the immune function infighting against inflammatory cause of polyarthritis, and irregular cell growth cause of cancer due to oxidation.

d. Lutein
Lutein is one of the most popular North American carotenoids. It is found in greens like kale and spinach as well as the yolk of eggs. Lutein is also found in the human eye. Getting enough lutein in your diet may help to fight off age related macular degeneration, an eye condition.
Researcher has shown that people who do not have enough lutein in their diet will not have enough lutein present in the muscular part of the eye. This is what likely leads to age related macular degeneration that can result in blindness.

e. Zeaxanthin
Zeaxanthin, a most common carotenoid alcohols found in nature, is one of the two primary xanthophyll carotenoids contained within the retina of the eye. Intake of foods providing zeaxanthin with lower incidence of age-related macular degeneration as a result of its function of reducing the risk oxidative stress.

f. Lycopene
Lycopene is a red carotene of the carotenoid group that can be found in tomatoes, watermelons, and grapefruits. This powerful antioxidant is believed to be a powerful fighter of prostate cancer. Lycopene has many anti-aging capabilities as well as one of the most powerful antioxidants in the carotenoid group.

2. Antioxidants and Atherosclerosis
a. Bioflavonoids or vitamin P
Discovered by Szent-Gyorgyi and his colleagues back in the 1930`s. In Laboratory tests, B
bioflavonoids help to reduce the fragility and “permeability” in capillaries and prevent the clotting up of arterial as a result of oxidation.

b. Vitamins C and E, beta-carotene
Recent research findings have suggested that antioxidants such as vitamin C, E and beta carotene play an important role in the prevention of atherosclerosis. Data from animal studies showed they are able to prevent oxidative modification of low density lipoproteins (LDL).

c. Alpha-tocopherol
Alpha-tocopherol, a antioxidant found abundant in vitamin E, helps to decrease lipid peroxidation and platelet aggregation, adhesion and inflammatory. Epidemiological studies suggest that low levels of antioxidants are associated with increased risk for cardiovascular disease.

d. Vitamin C and E
Studies showed in take of 500mg of vitamin C and 400 IU of vitamin E helps to retard the progression of coronary atherosclersis.

e. Chlorophyl
Antioxidant chorophyll in the green algae shows to inhibit the chemical cadmium of smoking, by preventing from oxidation that cause building up of plaque along the walls of arteries.

3. Antioxidants and Multiple sclerosis
Antioxidants can help protect the neural tissue from damage that reduce the risk of inflammation result in lessening the risk of oxidative stress.
a. TNFalpha
An imflammatory cytokine has been associated with MS is inhibited by antioxidants of green tea, and others such as curcumin, quercetin, etc.

b. Melatonin
Melatonin functions as an antioxidant and has the ability to protect neurons from free radicals cause of lipid peroxidation.

c Selenium
Some studied found that the levels of selenium in the blood of people with MS was lower than in that of people without MS.

d. Niacin
Niacin acts as antioxidant is a key to the successful treatment of multiple sclerosis, researchers at Harvard Medical School found that Niacin profoundly prevents the degeneration of demyelinated axons and improves the behavioral deficits.

e. Vitamin D
A study published in a recent issue of the journal Neurology, the group receiving the vitamin D demonstrated a remarkable 41 percent reduction in new MS events with no meaningful side effects.

f. Etc.

4. Antioxidants and diabetes
a. a. Alloxam
Invitro and vivo study found that hydroxyl radical scavengers, metal chelation and fat soluble antioxidants inhibit the damage caused by Alloxam.

b. Vitamin E
Study also found that vitamin E can prevent the development of Alloxam induced diabetes by administrating butylated hydroxyanisole, an antioxidant consisting of a mixture of two isomeric organic compounds, 2-tert-butyl-4-hydroxyanisole & 3-tert-butyl-4-hydroxyanisole.

c. Vitamin C
Depress levels of vitamin C is found in diabestic. as we know vitamin C compete with glucose in transported in the cell via insulin. low levels of vitamin C also elevates sorbitol, leading to diabetic complication.

d. Alpha-lipoic acid
Alpha-lipoic acid beside lower the levels of blood sugar, it also destroys free radicals that help to reduces symptoms and complication caused by diabetes, including peripheral neuropathy.

e. Etc.


5. Antioxidants and immune system
Enzyme antioxidants, superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase are best known to defense our body in fighting or scavenging against forming of free radicals by neutralizing them. Other antioxidants include
a. Zinc
Zinc, as a antioxidant is essential mineral in ading immune system by enhancing the peoper function of T cells which belong to a group of white blood cells known as lymphocytes, in fighting against damaging free radicals.

b. Selenium
Selenium is one of the powerful antioxidant. In the extracellular space, it helps to influence immune processes by proliferating the response to mitogen, and macrophages, leukotriene.

c. Vitamin A
vitamin A plays an essential roles in enhancing a broad range of immune processes, including lymphocyte activation and proliferation, T-helper-cell differentiation, the production of specific antibody isotypes and regulation of the immune response.

d. Vitamin C
Researchers found that vitamin C raised the concentration in the blood of immunoglobulin A, M that promotes the ability of antibodies and phagocytic cells to clear pathogens.

e. Vitamin E
In aged mice study showed that Vitamin E beside increased both cell-dividing and IL-producing capacities of naive T cells it also enhances the immune functions in association with significant improvement in resistance to influenza infection.

f. Carotenoids
Carotenoids reduces oxidation damage to cells and protects LDL cholesterol from oxidation, thus reducing the risk of aging and chronic diseases caused by damaging free radicals.

g. Etc.

D. Phytochemicals against vertigo
1. Rutin also known as rutoside, quercetin-3-O-rutinoside and sophorin is a Flavonols, belong to Flavonoids (polyphenols) of Phenolic compounds found orange, grapefruit, lemon, lime, berries mulberry, cranberries, buckwheat etc.
a. Anti-inflammatory activity
In the investigation of Rutin, a natural flavone derivative and its anti inflammatory effect found that Oral administration of rutin reduced rat paw swelling starting 2 hours after lambda-carrageenan injection. Rutin reduced significantly (p < 0.05) and in a dose-dependant manner the polymorphonuclear neutrophils chemotaxis to fMet-Leu-Phe, according to the study of "Anti-inflammatory effect of rutin on rat paw oedema, and on neutrophils chemotaxis and degranulation" by Selloum L, Bouriche H, Tigrine C, Boudoukha C.(19)

b.  Diabetes-increased aging effect
In the observation of 1 g.kg-1.day-1 rutin, an aldose reductase inhibitor and irs effect on products from the advanced Maillard reaction which increase during aging and diabetes found that even though rutin prevent the accumulation of fluorescence are unknown, but these observations raise the question of whether they could be identical. If fluorescence is a marker for age-related pathologies and diabetic sequelae, aminoguanidine and rutin could have therapeutic effects in their prevention, according to "Prevention of diabetes-increased aging effect on rat collagen-linked fluorescence by aminoguanidine and rutin" by Odetti PR, Borgoglio A, De Pascale A, Rolandi R, Adezati L.(20)

c. Diabetes, Hyperglycemia and dyslipidemia
In the analyzing Dietary antioxidant compounds such as flavonoids and its protection against early-stage diabetes mellitus, found that Rutin (50 mg kg(-1)) reduced (p<0.05) blood glucose and improved the lipid profile in STZ-induced diabetic rats and concluded that that rutin can improve hyperglycemia and dyslipidemia while inhibiting the progression of liver and heart dysfunction in STZ-induced diabetic rats, acccording to "Influence of rutin treatment on biochemical alterations in experimental diabetes" by Fernandes AA, Novelli EL, Okoshi K, Okoshi MP, Di Muzio BP, Guimarães JF, Fernandes Junior A.(21)

d. Fatty liver disease
In evaluation of rutin, a common dietary flavonoid and the hypolipidemic effect of it on fatty liver disease found that rutin could attenuate lipid accumulation by decreasing lipogenesis and oxidative stress in hepatocyte, according to "Rutin inhibits oleic acid induced lipid accumulation via reducing lipogenesis and oxidative stress in hepatocarcinoma cells" by Wu CH, Lin MC, Wang HC, Yang MY, Jou MJ, Wang CJ.(22)

e. Cardiovascular health
In the testing the hypothesis of the consumption of a diet rich in flavonoids can be associated with a reduced risk for cardiovascular disease found that hamster fed with 2% cranberry concentrate powder (HFHC+CE); a HFHC with 0.1% rutin (HFHC+Rutin); and a HFHC with 30 mg/kg vitamin E (HFHC+Vit.E) diet for either 12 or 20 weeks, found that Ratios of plasma high-density lipoprotein cholesterol (HDL-C) to very-low-density lipoprotein cholesterol and of plasma HDL-C to low-density lipoprotein cholesterol were significantly higher in animals consuming HFHC+Vit.E, according to the strudy of "Effects of a flavonol-rich diet on select cardiovascular parameters in a Golden Syrian hamster model" by Kalgaonkar S, Gross HB, Yokoyama W, Keen CL.(23)

f.  Periodontal disease
In the study of isolation from the mouths of 2 healthy subjects, hydrolysed innocuous rutin, a flavonoid glycoside, to its genotoxic aglycon quercetin and its effect on local carcinogenic process found that a hypothesis for a novel role of the oral microflora in a disease process other than caries and periodontal disease, namely intra-oral cancer, is presented. The possibility of a bacterial liberation of the genotoxic quercetin in situ could be but one example of its involvement in the local carcinogenic process, according to "Activation of rutin by human oral bacterial isolates to the carcinogen-mutagen quercetin" by Parisis DM, Pritchard ET.(24)

2. Naringenin, a flavanone, belonging to the red, blue, purple pigments of Flavonoids (polyphenols) found predominantly in citrus fruits is considered as one of powerful antioxiant with many health benefits.
a. Antioxidant, radical scavenging and biomolecule activity
In the affirmation of the capacity of flavonoid naringenin and its glycoside naringin in the comparison of theirs antioxidant capacities, radical scavenging and biomolecule activities found that naringenin exhibited higher antioxidant capacity and hydroxyl and superoxide radical scavenger efficiency than naringin and both flavanones were equally effective in reducing DNA damage. However, they show no protective effect on oxidation of GSH, according to the study of "Antioxidant properties, radical scavenging activity and biomolecule protection capacity of flavonoid naringenin and its glycoside naringin: a comparative study" by Cavia-Saiz M, Busto MD, Pilar-Izquierdo MC, Ortega N, Perez-Mateos M, Muñiz P.(25)

c. Cholesterol-lowering activity
In the affirmation of naringenin and its Cholesterol-lowering effect found that naringenin lowers the plasma and hepatic cholesterol concentrations by suppressing HMG-CoA reductase and ACAT in rats fed a high-cholesterol diet, according to "Cholesterol-lowering activity of naringenin via inhibition of 3-hydroxy-3-methylglutaryl coenzyme A reductase and acyl coenzyme A:cholesterol acyltransferase in rats" by Lee SH, Park YB, Bae KH, Bok SH, Kwon YK, Lee ES, Choi MS.(26)

d. Anti-inflammatory effects
In the evaluation of the mechanisms of action of the effective compounds. Flavone, the isoflavones daidzein and genistein, the flavonols isorhamnetin, kaempferol and quercetin, the flavanone naringenin, and the anthocyanin pelargonidin amd theirs anti-inflammatory effects found that they inhibited iNOS protein and mRNA expression and also NO production in a dose-dependent manner, according to "Anti-inflammatory effects of flavonoids: genistein, kaempferol, quercetin, and daidzein inhibit STAT-1 and NF-kappaB activations, whereas flavone, isorhamnetin, naringenin, and pelargonidin inhibit only NF-kappaB activation along with their inhibitory effect on iNOS expression and NO production in activated macrophages" by Hämäläinen M, Nieminen R, Vuorela P, Heinonen M, Moilanen E.(27)

e. Immunity
In the unvestigation of Naringenin, a flavonoid in grapefruits and citrus fruits and its effec in immune system found that naringenin potently suppressed picryl chloride (PCl)-induced contact hypersensitivity by inhibiting the proliferation and activation of T lymphocytes. In vitro, both of the activated hapten-specific T cells and the T cells stimulated with anti-CD3/anti-CD28 showed growth arrest after naringenin treatment, according to "A novel regulatory mechanism of naringenin through inhibition of T lymphocyte function in contact hypersensitivity suppression" by Fang F, Tang Y, Gao Z, Xu Q.(28)

3. Catechin is phytochemical of Flavan-3-ols, in the group of Flavonoids (polyphenols), found abundantly in white tea, green tea, black tea, grapes, wine, apple juice, cocoa, lentils, etc.
a. Cholesterol
In a systematic review and meta-analysis of randomized controlled trials evaluating the relationship between GTCs and serum lipid levels, including total, low-density lipoprotein (LDL), high-density lipoprotein (HDL) cholesterol, and triglycerides, found that the consumption of GTCs is associated with a statistically significant reduction in total and LDL cholesterol levels; however, there was no significant effect on HDL cholesterol or triglyceride levels, according to " Green tea catechins decrease total and low-density lipoprotein cholesterol: a systematic review and meta-analysis" by Kim A, Chiu A, Barone MK, Avino D, Wang F, Coleman CI, Phung OJ.(29)

b. Antioxidant activity
In the research on polyphenolic compounds (included catechins) in the berries of edible honeysuckle and their biological effects, including recommended utilization, are reviewed found that These berries seem to be prospective sources of health-supporting phytochemicals that exhibit beneficial anti-adherence and chemo-protective activities, thus they may provide protection against a number of chronic conditions, e.g., cancer, diabetes mellitus, tumour growth or cardiovascular and neurodegenerative diseases, according to "Phenolic profile of edible honeysuckle berries (genus lonicera) and their biological effects" by Jurikova T, Rop O, Mlcek J, Sochor J, Balla S, Szekeres L, Hegedusova A, Hubalek J, Adam V, Kizek R.(30)

c. Severe dyslipidemia
In the observation of three-month old ATX mice were treated, or not, for 3 months with the polyphenol (+)-catechin (CAT, 30 mg/kg/day) and compared to wild-type (WT) controls,
found that cctive remodeling of the cerebrovascular wall in ATX mice was further suggested by the increase (P<0.05) in pro-metalloproteinase-9 activity, which was normalized by CAT. We conclude that by preserving the endothelial function, a chronic treatment with CAT prevents the deleterious effect of severe dyslipidemia on cerebral artery wall structure and biomechanical properties, contributing to preserving resting cerebral blood flow, according to "Catechin prevents severe dyslipidemia-associated changes in wall biomechanics of cerebral arteries in LDLr-/-:hApoB+/+ mice and improves cerebral blood flow" by Bolduc V, Baraghis E, Duquette N, Thorin-Trescases N, Lambert J, Lesage F, Thorin E.(31)

d. Anti-inflammatory effect
In the preparation of the gel of Chinese medicine catechu, and to observe the release mechanism in vitro and anti-inflammatory activity in rats, found that the optimum condition of extraction from catechu was as follows, the concentration of ethanol, ratio of raw material to solvent, ultrasonic time, and extraction temperature were 50% , 1: 12, 35 min and 60 degrees C, respectively. The formulation of catechu gel was carbomer-9 400.5 g, glycerol 5.0 g, the extracts of catechu 50.0 mL, and triethanomine 0.5 mL The gel was semitransparent and stable. The drugs released quickly. The catechu gel reduced the paw edema considerably in dose-dependent manner compared to carrageenan-induced rat, according to "[Preparation and pharmacodynamics studies on anti-inflammatory effect of catechu gel].[Article in Chinese]" by Zheng X, Zheng C.(32)

4. Flavanonols (with two "o"s aka 3-hydroxyflavanone or 2,3-dihydroflavonol) are a class of flavonoids that use the 3-hydroxy-2,3-dihydro-2-phenylchromen-4-one (IUPAC name) backbone(a), found in Japanese Raisin Tree, the wood of Pinus sibirica, Prunus domestica, brazilian green propolis, Black mulberry, etc.
 a. Antioxidant capacity
In the determination of the antioxidant of the polyphenolic constituents in some fruits, using the total oxidant scavenging capacity (TOSC) assay, found that cutite showed the highest antioxidant capacity followed by jambolão, araçá, and muruci and antioxidant turned out to be primarily good sources of hydrolyzable tannins and/or flavonols, according to "Phenolic constituents and antioxidant capacity of four underutilized fruits from the Amazon region"by Gordon A, Jungfer E, da Silva BA, Maia JG, Marx F.(33)

b. Anti viral effects
In testing several flavonoids effects on Moloney murine leukemia virus reverse transcriptase activity and studies of four groups of flavonoids, namely flavones, flavanones, flavonols, and flavanonols, found that flavonols and flavanonols were very active in this regard while flavones and flavanones displayed very low activity, according to "Inhibitory effects of flavonoids on Moloney murine leukemia virus reverse transcriptase activity" by Chu SC, Hsieh YS, Lin JY.(34)

c. Anti inflammatory effects
In the examination in a double-blind intervention study conducted with two groups of non-smoking, un-treated sarcoidosis patients, matched for age and gender. One group was given 4x500 mg quercetin (n = 12) orally within 24 h, the other one placebo (n = 6). Plasma malondialdehyde levels were used as marker of oxidative damage, plasma ratios of TNFα/IL-10 and IL-8/IL-10 as pro-inflammatory markers, found that Sarcoidosis patients might benefit from the use of antioxidants, such as quercetin in the group of Flavonols, to reduce the occurring oxidative stress as well as inflammation. The effects of long-term use of antioxidant supplementation in sarcoidosis, using e.g. quercetin, on improvement of lung function remain to be investigated, according to "Quercetin reduces markers of oxidative stress and inflammation in sarcoidosis" by Boots AW, Drent M, de Boer VC, Bast A, Haenen GR.(35)

d. Etc.

5. Etc.

V. Treatments
A. In conventional medicine perspective 
 1. Manoeuvres
The most common Epley maneuver is performed by a doctor, audiologist, physical therapist, or with a BPPV maneuver at home. Dr, and the research team at in the study of Diagnosis and treatment of 318 benign paroxysmal positional vertigo cases, suggested that 318 patients, 221 (69.5%) with posterior semicircular canal involvement, Epley repositioning maneuver was performed; 62 (19.5%) with horizontal semicircular canal involvement, Barbecue maneuver combined forced prolonged position maneuver were applied; 23 (7.2%) with anterior canal involvement were treated with Epley maneuver; 12 (3.8%) had the mixed type and were treated with corresponding repositioning maneuvers. After one week the total improvement rate was 82.1% (261/318) and 91.8% three months later (292/318)(58).

Some researchers suggested that Prevention begins by maintaining good hydration and avoiding rapid movements of the head can be helpful. Researchers at the Università degli Studi di Palermo, indicated that Gufoni's manoeuvre is effective in treating patients suffering from BPPV of LSC; it is simple to perform; there are not many movements to execute, it needs low time of positioning, and positions are comfortable to the patient(59). Others suggested that Vannucchi maneuver and Log Roll. For more information of the above. (60)

2. Postural restriction therapy
The treatment of benign paroxysmal positional vertigo (BPPV) consists of a repositioning maneuver in order to remove otoliths from the posterior semicircular canal and subsequent postural restrictions to prevent debris from reentering the canal.but researchers at Chonnam National University Medical School and other showed that Postural restriction therapy, practiced after the modified Epley repositioning maneuver, did not have a significant effect on the final outcomes of BPPV. Based on our results, we do not recommend this therapy since there was no significant benefit for the patients who utilized postural restrictions(61).

3. Vestibular training (VT)
In the  study on treatment effects of vestibular training (VT) for benign paroxysmal positional vertigo was performed. The VT was compared with courses of patients in three different groups: patients treated by medication, by VT, and by VT with medication during 8 weeks. Dr. Fujino A and the team of reserachers at Kitasato University found that  In the groups treated by VT, the effects were not influenced by time since onset of disease or by patient age. It is therefore assumed that VT can be used as a first-choice treatment in patients with benign paroxysmal positional vertigo, even in long-term cases or older patients(65).

3. Medication
Certain medication are used in treating vertigo depending to the underlying cause. Dr Hain TC, and Dr. Uddin M. at the , Northwestern University indicated that therapy of vertigo is optimised when the prescriber has detailed knowledge of the pharmacology of medications being administered as well as the precise actions being sought. There are four broad causes of vertigo, for which specific regimens of drug therapy can be tailored. Otological vertigo includes disorders of the inner ear such as Ménière's disease, vestibular neuritis, benign paroxysmal positional vertigo (BPPV) and bilateral vestibular paresis. In both Ménière's disease and vestibular neuritis, vestibular suppressants such as anticholinergics and benzodiazepines are used. In Ménière's disease, salt restriction and diuretics are used in an attempt to prevent flare-ups. In vestibular neuritis, only brief use of vestibular suppressants is now recommended. Drug treatments are not presently recommended for BPPV and bilateral vestibular paresis, but physical therapy treatment can be very useful in both. Central vertigo includes entities such as vertigo associated with migraine and certain strokes. Prophylactic agents (L-channel calcium channel antagonists, tricyclic antidepressants, beta-blockers) are the mainstay of treatment for migraine-associated vertigo. In individuals with stroke or other structural lesions of the brainstem or cerebellum, an eclectic approach incorporating trials of vestibular suppressants and physical therapy is recommended. Psychogenic vertigo occurs in association with disorders such as panic disorder, anxiety disorder and agoraphobia. Benzodiazepines are the most useful agents here(62).
 Other researchers suggested that treatment by medication together with two maneuvers-the particle repositioning maneuver (PRM) reported by Parnes and Price-Jones and the liberatory maneuver (LM) reported by Semont et al.-were compared with treatment by medication alone. The most important benefit of these maneuvers seemed to be the speedier recovery than with medication alone, as there was no significant difference in the late success rate after 3 months between the maneuvers and medication alone(63).
 
4. Surgery (Tenotomy)
In the study to compare the unique long-term results of tenotomy of the stapedius and tensor tympani muscles in definite Meniere's disease refractory to medical treatment and presents a hypothesis on why tenotomy seems effective, Dr. Loader B, and the research team at Medical University of Vienna showed that a statistically significant improvement of inner ear hearing levels postoperatively (p = 0.041) and a major reduction in vertigo attacks in all groups (p < 0.001) with complete absence of attacks in 26/30 patients was noted. Results remained constant up to 9 years postoperatively. Although tinnitus persisted, the intensity was lower overall (p = 0.013)(64)

5. Etc.

B. In herbal medicine perspective
The aim of herbal treatment is to stop the symptoms of dizziness by opening up sinus and enhancing the circulation to the central nervous system ginkgo, ginger, hawthorn, and
1. Ginkgo
Gingko biloba has been used for hundreds of years to treat various disorders such as asthma, vertigo, fatigue and, tinnitus or circulatory problems. Two of the main extracts are EGb761 and LI 1370. Most pharmacological, toxicological and clinical studies have focused on the neuroprotective value of these two main extracts. Neuroprotection is a rapidly expanding area of research. This area is of particular interest due to the fact that it represents a new avenue of therapy for a frustrating disease that may progress despite optimal treatment(66).

2. Ginger 
In the study of 78 cases were randomly divided into 2 groups, of whom 40 were treated with jinger moxibustion and 38 treated with acupuncture, showed that showed a cure rate of 72.5% with a total effective rate of 97.5% in the jinger moxibustion (Ginger moxibustion) group, while 44.7% and 73.7% respectively in the acupuncture group(67).

3. Hawthorn
a. Hypotensive effects
In the investigation of Hawthorn (Crataegus laevigata) leaves, flowers and berries used by herbal practitioners in the UK to treat hypertension in conjunction with prescribed drugs indicated that this is the first randomised controlled trial to demonstrate a hypotensive effect of hawthorn in patients with diabetes takin, according to "Hypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trial" by Walker AF, Marakis G, Simpson E, Hope JL, Robinson PA, Hassanein M, Simpson HC(68)

b. Cardiac effects
In the evaluation of the potential cardiac effects of two alcohol extracts of commercially available hawthorn found that the mechanism of cardiac activity of hawthorn is via the Na(+),K(+)-ATPase and intracellular calcium concentrations are influenced, according to "A comparison of the effects of commercially available hawthorn preparations on calcium transients of isolated cardiomyocytes" by Rodriguez ME, Poindexter BJ, Bick RJ, Dasgupta A.(69)

c. Cardiovascular disease
In the analyzing the effect of hawthorn in prevention and protection of cardiovascular disease indicated that these beneficial effects may in part be due to the presence of antioxidant flavonoid components. While a number of studies have been performed to evaluate the clinical efficacy of hawthorn, an international, multicenter, prospective clinical study including a large number of New York Heart Association (NYHA) class II/III heart failure patients is ongoing to test hawthorn's long-term therapeutic effects, according to "Hawthorn: potential roles in cardiovascular disease"by Chang WT, Dao J, Shao ZH.(70)

d. Hyperlipemia
in the determination of The Yishoujiangzhi (de-blood-lipid) tablets (composed of Radix Polygori Multiflori, Rhizoma Polygonati, Fructus Lycii, Crataegus Pinnatifida and Cassia Tora) and its effect on Hyperlipemia found that in the treatment of 130 cases of hyperlipemia, achieving an effective rate of 87.0% in lowering serum cholesterol and 80.8% in lowering triglyceride, according to 'Yishou jiangzhi (de-blood-lipid) tablets in the treatment of hyperlipemia" by Guan Y, Zhao S.(71)

4. Gotu kola
a. Hyperglycemia and hypertension
In the determination of the inhibitory potential of selected Malaysian plants, including pegaga (Centella asiatica) against key enzymes related to type 2 diabetes and hypertension, found that In alpha-amylase inhibition assay, the inhibitory potential was highest in pucuk ubi for both hexane (59.22%) and dichloromethane extract (54.15%). Hexane extract of pucuk ubi (95.01%) and dichloromethane extract of kacang botol (38.94%) showed the highest inhibitory potential against alpha-glucosidase, while in ACE inhibition assay, the inhibitory potential was highest in hexane extract of pegaga (48.45%) and dichloromethane extract of pucuk betik (59.77%), according to "In vitro inhibitory potential of selected Malaysian plants against key enzymes involved in hyperglycemia and hypertension" by Loh SP, Hadira O.(72)

b. Locomotor activity
In the investigation of the asiatic acid, a triterpenoids isolated from Centella asiatica and its inhibitory effect on acetylcholinesterase (AChE) properties, excitatory post synaptic potential (EPSP) and locomotor activity. found that asiatic acid having an effect on AChE, a selective GABA(B) receptor agonist and no sedative effect on locomotor, according to "Inhibitory effect of asiatic acid on acetylcholinesterase, excitatory post synapticpotential and locomotor activity" by Nasir MN, Abdullah J, Habsah M, Ghani RI, Rammes G.(73)

c. Cognitive effects
In the assessment of the role of "Brahmi" (Bocopa monnieri and Centella asiatica) and its effect on the loss of memory, cognitive deficits, impaired mental function found that both plants possess neuroprotective properties, have nootropic activity with therapeutic implications for patients with memory loss. The field has witnessed exciting patent activity with most inventions aiming at either (i) improving the methods of herbal extraction or (ii) enrichment and purification of novel compounds from brahmi or (iii) providing novel synergistic formulations for therapeutics in various human ailments, according to "Exploring the role of "Brahmi" (Bocopa monnieri and Centella asiatica) in brain function and therapy" by Shinomol GK, Muralidhara, Bharath MM.(74)

d. Antioxidant capacity
In the identification of antioxidant effects of C. asiatica was exposed to various fermentations: no fermentation (0 min), partial fermentation (120 min) and full fermentation (24 h). Total phenolic content (TPC) and ferric-reducing antioxidant power (FRAP) of C. asiatica, found that C. asiatica herbal teas should be prepared at 100 °C for 10 min to obtain the optimum antioxidant capacity. Multiple brewing steps in C. asiatica herbal tea are encouraged due to the certain amount of antioxidant obtained, according to "Antioxidant capacity and phenolic composition of fermented Centella asiatica herbal teas" by Ariffin F, Heong Chew S, Bhupinder K, Karim AA, Huda N.(75)

5. Erc.

C. In Traditional Chinese medicine perspective(76)
Traditional Chinese medicine (TCM) defines vertigo is a result of the imbalance of internal organs of that can lead to phlegm production and deficiency causes of poor blood circulation and insufficient blood supply to the brain.
1. Hyperactivity of kidney yang
a. As a result of liver qi stagnation of that lead to develop of liver fire which cause damage to the liver yin
b. TCM formula:Tian Ma Gou Teng Yin(77)
b.1. Tian Ma (Rhizoma Gastrodiae Elatae, Gastrodia Rhizome) - 9g.  -calms liver, clears wind
b.2. Gou Teng (Ramulus Cum Uncis Uncariae, Gambir Vine Stems, Gambir) - 12-15g.  -calms liver, clears wind
b.3. Shi Jue Ming (Concha Haliotidis, Abolone Shell) - 18-24g  -calms liver, clears wind
b.4. Zhi Zi (Fructus Gardeniae Jasminoidis, Cape Jasmine Fruit, Gardenia) - 9g.  -clear heat, drain fire  b.5. Huang Qin (Radix Scutellariae Baicalensis, Baical Skullcap Root, Scutellaria, Scute) - 9g.  -clear heat, drain fire
b.6. Yi Mu Cao (Herba Leonuri Heterophylli, Chinese Motherwort, Leonurus) - 9-12g.  -promote blood circulation, prevents rising of blood to the head with ascending yang
b.7. Chuan Niu Xi (RadixCyathulae Officinalis Sichuan Ox Knee) - 12g.  -promotes downward movement of blood
b.8. Du Zhong (Cortex Eucommiae Ulmoidis, Eucommia Bark) - 9-12g.  -nourish liver and kidneys
b.9. Sang Ji Sheng  (Ramulus Sangjisheng, Mulberry Mistletoe Stem, Loranthus) - 9-24g.  -nourish liver and kidneys
b.10. Ye Jiao Teng  (Caulis Polygoni Multiflori) - 9-30g.  -calms spirit  Fu Shen   (Sclerotium Poriae Cocos Pararadicis, Poria Spirit) - 9-15g.  -calms spirit

2. Retention of turbid phlegm in the middle burner
a. As a result of eating too much greasy and/or sweet foods, working too much, etc. that lead to impair the ability of spleen and stomach function
b. TCM formula: Ban Xia Bai Zhu Tian Ma Tang(78)
b.1. Ban Xia (Rhizoma Pinelliae Tematae, Pinellia Rhizome) - 4.5g.  -dries dampness, transform phlegm, direct Qi downwards
b.2. Tian Ma (Rhizoma Gastrodiae Elatae, Gastrodia Rhizome) - 3g.  -transforms phlegm, clears wind, eliminates headache and dizziness
b.3. Bai Zhu (Rhizoma Atractyloids Macrocephaelae, White Atractylodes Rhizome) - 9g.  -tonify spleen, dry dampness
b.4. Ju Hong (Pars Rubra Epicarpii Citri Erythocarpae, Red Part of the Tangerine Peel) - 3g.  -regulates Qi, transform phlegm
b.5. Fu Ling (Sclerotium Poriae Cocos,China Root, Poria, Hoelen) - 3g.  -tonify spleen, drains dampness
b.6. Gan Cao (Radix Glycyrrhizae Uralensis, Licorice Root) - 1.5g.  -harmonize herbs within formula, regulates middle jiao
b.7. Sheng Jiang (Rhizoma Zingiberis Officinalis Recens, Fresh Ginger Rhizome) - 1 slice  -harmonize stomach and spleen
b.8. Da Zao (Fructus Ziziphi Jujubae, Chinese Date, Jujube) - 2 pieces  -harmonize stomach and spleen

3. Deficiency of kidney essence (yin)
a. Most case of Deficiency of kidney essence are the result of congenital deficiency, aging, or excessive stress on the kidney system
b. TCM formula: Liu Wei Di Huang Wan(79)
b.1. Shu Di Huang (Rehmanniae Glutinosae Conquitae, Rehmannia (cooked)) - 240g.  -tonify kidney yin and essense
b.2. Shan Zhu Yu (Fructus Corni Officinalis, Asiatic Comelian Cherry Fruit, Cornus) - 120g.  -nourish liver, stops essence leakage
b.3. ShanYao (Radix Dioscoreae Oppositae, Chinese Yam, Dioscorea) - 120g.  -stabilizes essence, tonify spleen
b.4. Mu Dan Pi (Cortex Moutan Radicis, Cortex of the Tree Peony Root, Moutan) - 90g.  -clears liver fire
b.5. Fu Ling (Sclerotium Poriae Cocos, China-root, Poria, Hoelen) - 90g.  -drains dampness, tonify spleen
b.6. Ze Xie (Rhizoma Alismatis Orientalitis, Water Plantain Rhizome, Alisma) - 90g.  -clears and drains kidney fire


4. Deficiency of qi and blood(80)
a. Chronic illness, massive blood loss, or chronic deficiencies of spleen and stomach function can cause the deficiency of qi and blood
b. TCM formula Guipi Tang 
b.1. Huang Qi (Radix Astragali Membranaceus, Milk Vetch Root, Astragalus) - 9-12g.  -tonify spleen Qi, tonify blood
b.2. Ren Shen (Radix Ginseng, Ginseng) - 3-6g.  -tonify spleen Qi
b.3. Bai Zhu (Rhizoma Atractyloids Macrocephaeiae, Atractylodes (white) Rhizome) - 9-12g.  -tonify spleen Qi, dries dampness
b.4. Fu Shen (Sclerotium Porae Cocos Pararadicis, Poria Spirit) - 9-12g.  -calms spirit, tonify spleen  b.5. Dang Gui (Radix Angelicae Sinensis, Chinese Angelica Root, tang-kuei) - 6-9g.  -tonify blood, regulate menstruation
b.6. Mu Xiang (Radix Aucklandiae Lappae, Costus Root, Saussurea, Aucklandia) - 3-6g.  -regulates Qi  b.7. Long Yan Rou (Arillus Euphoriae Longanae, Flesh of the Longan Fruit, Longan) - 6-9g.  -tonify blood, calm spirit
b.8. Suan Zao Ren (Semen Zizyphi Spinosae, Sour Jujube Seed, Zizyphus) - 9-12g.  -calms spirit
b.9. Yuan Zhi (Radix Polygalae Tenuifoliae, Chinese Senega root, Polygala) - 3-6g.  -calms spirit, promotes heart Qi
b.10. Zhi Gan Cao (Radix Glycyrrhizae Uralensis, Licorice Root) - 3-6g.  -tonify spleen Qi
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