An Integrative and Comprehensive Approach to Transient Ischemic Attacks

Roughly 240,000 Americans experience a transient ischemic attack (TIA) annually. Nearly one in five of these people will experience a stroke within 90 days. Two in five people, when evaluated appropriately, will learn they actually had a stroke instead of a TIA. (25) 

The fortunate news is that stroke is preventable after experiencing a TIA. Stroke risk is highly associated with modifiable cardiovascular risk factors, such as hypertension, diabetes, and high cholesterol. These risk factors can be identified by seeking prompt medical attention after a TIA and undergoing a comprehensive health evaluation. With a functional medicine approach to treatment, heavily emphasizing lifestyle and dietary modifications, achieving the therapeutic goals of improving arterial health and circulation to prevent future TIA and stroke is possible. 

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What Are Transient Ischemic Attacks?

A transient ischemic attack (TIA), often called a "mini-stroke," is a temporary episode of neurological dysfunction caused by a temporary disruption of blood flow to a part of the brain. The key difference between a TIA and a stroke lies in the duration of symptoms and the absence of permanent damage associated with TIAs. The symptoms of a TIA typically last for a short period, usually a few minutes to an hour, and then resolve completely. This is in contrast to a stroke, where the symptoms can be more prolonged and may result in permanent brain damage. (28) 

It's important to note that even though the symptoms of a TIA are temporary, they should be taken seriously, as they indicate an increased risk of stroke. Timely medical intervention and lifestyle changes, such as managing blood pressure, cholesterol, and diabetes, can help reduce the risk of TIAs and strokes. (15) 

Transient Ischemic Attacks Signs & Symptoms

TIAs can cause sudden and temporary neurological deficits, depending on which part of the brain is affected by the disruption of blood flow. Common signs and symptoms of a TIA include:

• Sudden weakness or numbness that affects one side of the body
• Trouble speaking or understanding speech
• Blurred or double vision or sudden partial loss of vision in one or both eyes
• Dizziness and loss of balance that leads to difficulty walking
• Sudden, severe headache 
• Confusion
• Loss of coordination, resulting in uncontrolled movements, unsteady walking, and loss of fine motor skills

The symptoms of a TIA are temporary and typically resolve within a short period within an hour. However, there is no way to distinguish the symptoms from an acute stroke during an attack. Therefore, it is crucial not to ignore these symptoms and to seek urgent medical attention so that the cause of the TIA can be identified and appropriate therapy can be initiated to reduce the risk of future stroke. (26) 

What Are the Possible Causes of Transient Ischemic Attacks?

TIAs are caused by a temporary disruption of blood flow to a part of the brain (26). The underlying mechanisms are similar to those of ischemic strokes, where a blood clot or atherosclerotic plaque temporarily blocks a blood vessel and reduces blood flow to the brain (9).  

Atherosclerosis is a condition where fatty deposits (plaques) build up within the arteries, narrowing the blood vessels and potentially leading to blood clots. These plaques can partially block blood flow to the brain, causing a TIA. High blood pressure, diabetes, high cholesterol, and smoking damage the blood vessels, increasing the risk of atherosclerotic cardiovascular disease and clot formation (1).  

An embolism occurs when a blood clot or debris travels through the bloodstream and becomes lodged in a smaller blood vessel in the brain, temporarily blocking blood flow. Certain heart conditions, such as atrial fibrillation, can lead to the formation of blood clots that can travel to the brain and cause a TIA. (16) 

Many modifiable and non-modifiable factors are associated with increased risk for cardiovascular disease and major adverse cardiovascular events, including stroke and TIA. These include: 

• Age: Stroke rates double every ten years after age 55
• Male gender
• Family history of stroke or cardiovascular disease
• Personal history of TIA or stroke
• Obesity 
• Sedentary lifestyle
• Poor nutrition
• Excessive alcohol use

Functional Medicine Labs to Test for Root Cause of Transient Ischemic Attacks

TIAs are warning signs that a more serious stroke might occur in the future, so they should not be ignored. People who experience symptoms of a TIA should seek medical attention promptly to determine the underlying cause and to receive appropriate treatment to reduce the risk of a future stroke. Medical professionals will often conduct tests such as imaging (MRI, CT, and angiography), blood tests, and other diagnostic procedures to assess for risk factors and recommend preventive measures.

Cholesterol Panel

A basic lipid panel is a standard blood test used to assess an individual's lipid profile, which includes measurements of cholesterol levels (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides). While a basic lipid panel provides valuable information about a person's lipid levels, recent research suggests it offers an incomplete risk assessment for atherosclerotic cardiovascular disease (ASCVD). Instead, an advanced lipid profile includes additional markers that more accurately assess atherogenic lipid particles in circulation to predict ASCVD risk. (19) 

Once an individual's lipid levels have been measured, they can be input into the ASCVD Risk Calculator, along with other variables, to estimate a person's 10-year ASCVD risk and help make informed treatment decisions to reduce their risk. 

hs-CRP

High-sensitivity C-reactive protein (hs-CRP) is a sensitive marker of inflammation and tissue injury in the arterial walls. Elevated hs-CRP levels are a marker for cardiovascular and cerebrovascular disease. High hs-CRP has been identified as a strong independent predictor of acute ischemic stroke. (6) 

Homocysteine

Homocysteine is an amino acid that, when present in the blood in excess amounts, promotes atherosclerosis through increased oxidative stress, impaired endothelial function, and induction of blood clotting. Studies have revealed elevated homocysteine increases the risk of cardiovascular and cerebrovascular diseases by as much as twofold. (14) 

Diabetes Panel

Elevated blood sugar confers a greater risk of stroke occurrence and is associated with poorer clinical outcomes following ischemic stroke (7). A diabetes panel measures six biomarkers related to the pathogenesis, diagnosis, and management of diabetes. 

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Conventional Treatment for Transient Ischemic Attacks

The management of TIAs focuses on treating underlying pathologies to decrease the risk of subsequent TIA or stroke. Therapies should emphasize a combination of dietary modifications, exercise, and pharmacologic therapies. Medications prescribed often include antiplatelets, statins, and antihypertensives to reduce clotting risk and reduce cholesterol and blood pressure levels. Studies have shown that early interventions post-TIA mitigate the risk of future stroke by 80-90%. (23) 

Functional Medicine Treatment for Transient Ischemic Attacks

Because, in most cases, TIA is a consequence of atherosclerosis, appropriate treatment involves using various modalities that optimize cardiovascular health to prevent blood clotting and enhance blood and oxygen supply to the brain. Functional neurologists and cardiologists are trained in recognizing the multifaceted complexities involved in the development of cerebrovascular disease. By implementing holistic therapies, it is possible to prevent disease prevention and optimize cardiovascular and brain health and function.

Nutrition Considerations for Transient Ischemic Attacks

A heart-healthy diet is a dietary approach designed to promote cardiovascular health by emphasizing foods that can help manage and prevent conditions like TIAs and strokes by promoting vascular health. It typically includes a variety of nutrient-rich, whole foods such as fruits, vegetables, whole grains, lean proteins (like fish, poultry, and legumes), and healthy fats (such as those found in avocados, nuts, and olive oil). The cardiometabolic food plan, in particular, is a subset of a heart-healthy diet tailored to address cardiometabolic risk factors like high blood pressure, high cholesterol, and insulin resistance. This plan involves reducing the intake of processed foods, added sugars, and excessive sodium while prioritizing foods rich in fiber, antioxidants, and omega-3 fatty acids.

A heart-healthy diet is crucial in treating TIA and preventing strokes because it helps manage key risk factors. High blood pressure, high cholesterol levels, and insulin resistance significantly contribute to atherosclerosis and stroke risk. By focusing on nutrient-dense foods, the diet can help lower blood pressure, reduce LDL ("bad") cholesterol, improve insulin sensitivity, and maintain a healthy body weight. Additionally, the cardiometabolic food plan's emphasis on anti-inflammatory and antioxidant-rich foods can reduce inflammation in the arteries, lowering the risk of plaque formation and thrombosis. (3, 4) 

Using Supplements to Support the Treatment of Transient Ischemic Attacks

There is no shortage of natural dietary and herbal supplements that can promote heart health, support healing from TIAs, and prevent the risk of future stroke. Here are just several possibilities: 

Fish Oil

Low levels of omega-3 fatty acids (EPA and DHA) in blood and heart tissue are associated with increased arterial plaques at high risk for rupture and increased risk of total mortality. Conversely, high dietary intake and increased blood levels of omega-3s are associated with a lower prevalence of atherosclerotic plaque and plaque progression. The REDUCE-IT study demonstrated that adding icosapent ethyl (purified EPA) to statin therapy reduced the risk of major cardiovascular events, including stroke, in patients with elevated cardiovascular risk, particularly those with high triglyceride levels. (12) 

Ginkgo Biloba Extract 

Ginkgo biloba, an herbal supplement derived from the leaves of the ginkgo tree, has been explored for its potential benefits in treating TIAs and preventing strokes. Some studies suggest that ginkgo biloba improves blood circulation by dilating blood vessels and reducing platelet aggregation, which can help reduce the risk of clot formation. Additionally, it has antioxidant properties that may protect brain cells from damage caused by oxidative stress. (5) 

Aged Garlic Extract

As an herbal supplement in therapeutic doses, garlic has been shown to have many cardioprotective effects, including lowering total and LDL cholesterol levels, reducing blood clotting, and significantly lowering blood pressure (8).  

Complementary and Integrative Medicine for Transient Ischemic Attacks

The importance of a healthy lifestyle must be considered when discussing cardio- and cerebrovascular health. In addition to a heart-healthy, anti-inflammatory diet, nothing can replace regular exercise, sleep, and stress reduction for establishing a solid foundation for long-term cardiovascular health and brain function. 

Several studies have explored the effectiveness of cardiac rehabilitation programs in patients diagnosed with stroke or TIA. One study by Lennon et al. assessed a 10-week cardiac rehabilitation program's impact on non-acute ischemic stroke patients. They found that participants in the rehabilitation program experienced significant improvements in aerobic exercise capacity and a cardiac risk score, suggesting that regular participation in cardiac rehabilitation can enhance cardiovascular fitness and reduce cardiovascular disease risk in non-acute ischemic stroke patients. Tang et al. also supported this idea by demonstrating that six months of regular exercise participation improved aerobic capacity in individuals with mild to moderate stroke disability.

Everson-Rose et al. investigated the relationship between chronic psychological factors and the risk of stroke and TIA in participants from the Multi-Ethnic Study of Atherosclerosis (MESA). The researchers conducted a comprehensive analysis of data from the MESA study and concluded that individuals with higher levels of chronic stress, depressive symptoms, anger, and hostility had a modestly increased risk of stroke and TIA compared to those with lower levels, suggesting a potential connection between negative emotional states and cerebrovascular events. Mind-body interventions are effective in supporting psychological and emotional well-being. 2019 systematic review suggested that yoga and tai chi can positively impact the quality of life in stroke survivors by reducing psychological stressors, depression, and anxiety. 

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Summary

An integrative and comprehensive approach to TIAs is essential for effectively managing this critical cerebrovascular condition. Combining a thorough understanding of TIA risk factors, early diagnosis, prompt medical intervention, and holistic patient care encompassing lifestyle modifications, psychosocial support, and rehabilitation can significantly reduce the risk of recurrent TIAs and prevent their progression to debilitating strokes. Such an approach enhances the immediate health outcomes and quality of life for TIA patients; it underscores the importance of a patient-centered, multidisciplinary healthcare model in addressing complex neurological disorders. Continued research and clinical innovation in TIA management will further refine our strategies and ultimately improve the long-term prognosis and well-being of individuals at risk for or affected by TIAs.