COVER STORY generation via the nitrate-nitrite-NO pathway (Sweazea et al, 2018). Besides the common beetroot, vegetables that are particularly rich in nitrates include green leafy vegetables such as spinach and lettuce, as well as fennel, radishes, Chinese cabbage and parsley (Sweazea et al., 2018). . Physical Activity: An important way to produce NO is physical exercise. Moderate-intensity aerobic exercise augments endothelium-dependent vasodilation in humans through the increased production of nitric oxide (Goto et al., 2003). Moderate intensity refers to approximately 50% of one’s VO2 max (Goto et al., 2003). It is in-teresting to note that Goto et al. (2013) suggests that high-intensity exercise, indicated as 75% of VO2 max, possibly increases oxidative stress. Walking is a low-cost activity that has shown benefits in blood pressure. In a Cochrane report by Lee et al. (2021), there is moderate evidence suggesting that walking reduces systolic blood pressure by 4.11mmHg on average in participants aged 40 and under. Nutraceuticals can be supplemental in supporting a healthy blood pressure. Magnesium : A meta-analysis by Dibaba et al. (2017) of 11 RCTs show that magnesium supplementation had significantly lowered blood pressure, both systolic and diastolic values. The RDA requirement for magnesium for adults aged 18 and over is approxi-mately 400mg (National Institutes of Health [NIH], 2022). Garlic: There are two trials that showed a mean reduction of systolic and diastolic blood pressure by 10-12mmHg and 6-9mmHg, respectively (Stabler et al., 2012). Garlic has been shown to be similarly as effective as first-line antihypertensive medications. The active compound in garlic is alli-cin, or S-allycysteine, which likely ex-hibits prostaglandin-like effects (Rashid & Khan, 1985). In a dose-re-sponse trial by Reid et al. (2013), A dose of 480mg of aged garlic extract containing 1.2mg S-allycysteine low-ered systolic blood pressure by 12mmHg in over 12 weeks. “Despite collaboration, screening for the basics has become overlooked” with several health care practitioners for various conditions. Despite the collaboration between professionals, screening for the basics has become overlooked. Just screening patients even 18 and over with blood pressure can make a difference. If blood pres-sure is not well maintained, there are many considerations to take. There is current research applying changes of the vasculature in the brain also reflecting in the eyes. A 2019 study in Ophthalmology Retina showed that there are small vessel changes in the retina of patients with later stages of dementia compared to healthy controls using Optical Coherence Tomography Angiography (Lee et al., 2020). Know-ing that there are changes in vascula-ture that compromises the brain, this could be a potential screening tool for dementia. Cardiovascular disease and dementia appear to have an intricate connection. Empowering patients to self-manage their blood pressure, along with other factors of cardiovascular health, can be a very powerful attempt in mitigating our risk for cognitive decline. pressure in individuals with insulin resistance, prediabetes, or noncommunicable chronic diseases: a meta-analysis of randomized controlled trials. The American journal of clinical nutrition, 106(3), 921–929. https://doi.org/10.3945/ ajcn.117.155291 Ding, J., et al. (2019). Antihypertensive medications and risk for incident dementia and Alzheimer’s disease: a meta-analysis of individual participant data from prospective cohort studies. Lancet Neurology. 2019;pii: S1474-4422(19)30393-X. doi: 10.1016/S1474-4422(19)30393-X. Eriksson, U. K., Bennet, A. M., Gatz, M., Dickman, P. W., & Pedersen, N. L. (2010). Nonstroke cardiovascular disease and risk of Alzheimer disease and dementia. Alzheimer disease and associated disorders, 24(3), 213–219. https://doi. org/10.1097/WAD.0b013e3181d1b99b Gelber, R. P., Launer, L. J., & White, L. R. (2012). The Honolulu-Asia Aging Study: epidemiologic and neuropathologic research on cognitive impairment. Current Alzheimer research, 9(6), 664–672. https://doi.org/10.2174/156720512801322618 Goto, C. et al. (2003). Effect of Different Intensities of Exercise on Endothelium-Dependent Vasodilation in Humans. Circulation; 108: 530-535. He, F. J. et al. (2013). Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. BMJ. doi: https://doi.org/10.1136/ bmj.f1325 O’Halloran, S. A., Grimes, C. A., Lacy, K. E., Campbell, K. J., & Nowson, C. A. (2016). Dietary Intake and Sources of Potassium and the Relationship to Dietary Sodium in a Sample of Australian Pre-School Children. Nutrients, 8(8), 496. https://doi. org/10.3390/nu8080496 Lanham-New, S. A., Lambert, H., & Frassetto, L. (2012). Potassium. Advances in nutrition (Bethesda, Md.), 3(6), 820– 821. https://doi.org/10.3945/an.112.003012 Lee, J. Y. et al. (2020). Optical coherence tomography angiogrpahy as a potential screening tool for cerebral small vessel diseases. Alzheimer’s Research & Therapy. https://doi. org/10.1186/s13195-020-00638-x Lee, L. L., et al. (2021). Walking for hypertension. Cochrane Database of Systematic Reviews. DOI: 10.1002/14651858. CD008823.pub2. National Institutes of Health. (2022). Magnesium. Retrieved from: https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/ Rashid, A., & Khan, H. H. (1985). The mechanism of hypotensive effect of garlic extract. JPMA. The Journal of the Pakistan Medical Association, 35(12), 357–362. Ried, K., Frank, O. R., & Stocks, N. P. (2013). Aged garlic extract reduces blood pressure in hypertensives: a dose-response trial. European journal of clinical nutrition, 67(1), 64–70. https://doi. org/10.1038/ejcn.2012.178 Stabler, S. N., et al. (2012). Garlic for the prevention of cardiovascular morbidity and mortality in hypertensive patients. Cochrane Database of Systematic Reviews. DOI: 10.1002/14651858.CD007653.pub2 World Health Organization [WHO]. (2021). Hypertension. Retrieved from: https://www.who.int/news-room/fact-sheets/ detail/hypertension REFERENCES Aburto, N. J. et al. (2013). Efefct of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ. doi: https://doi.org/10.1136/bmj.f1378 Alzheimer’s Association. (n.d.). Vascular dementia. Retrieved from: https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/vascular-dementia/ Alzheimer’s Society. (n.d.) What is vascular dementia? Retrieved from: https://www.alzheimers.org.uk/about-dementia/types-dementia/vascular-dementia Appel, L. J., Moore ,T. J., Obarzanek, E., Vollmer, W. M., Svetkey, L.P., Sacks, F.M., et al. (1997). A clinical trial of the effects of dietary patterns on blood pressure. New England Journal of Medicine 336(16):1117-24. Bensaaud, A. et al. (2020). Dietary Approaches to Stop Hypertension (DASH) for the primary and secondary prevention of cardiovascular diseases. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD013729 Centre for Disease Control [CDC]. (2022). Hypertension Statistics and Maps. Retrieved from: https://www.cdc.gov/bloodpressure/ statistics_maps.htm Dafny, N. (2020). Overview of the Nervous System. Retrieved from: https://nba.uth.tmc.edu/neuroscience/m/s2/chapter01. html Dibaba, D. T., Xun, P., Song, Y., Rosanoff, A., Shechter, M., & He, K. (2017). The effect of magnesium supplementation on blood Summary, implications in practice, and future considerations It is very common to see a patient work Sign-up for our newsletter to be sure you don’t miss out on any of our articles and case reports: cndoctor.ca/subscribe www.Cndoctor.ca 8 Chiropractic and Naturopathic Doctor September/October 2022
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