Mini-strokes lead to major dementia risk

You might think of stroke as a major, impossible-to-ignore event. And, generally speaking, it is. But it’s also possible to have a stroke — or even a whole series of them — without ever realizing it.

In fact, a lot of people have what doctors refer to as “mini-strokes” (technically called transient ischemic attacks, or TIAs) with alarming frequency. But the medical community has always considered these mini-strokes to be benign. In most cases, they come and go without any fanfare, and the sufferer is none the wiser.

But emerging research shows that TIAs do have a lasting impact on the brain.

And considering the fact that a person may experience hundreds of thousands of mini-strokes in their lifetime, it’s important to learn more about them, what causes them — and how you can protect yourself from their damaging effects.

The real effects of mini-strokes

During a mini-stroke, blood flow to a part of the brain is blocked or reduced (because of a clot, for instance) for a period of time before it starts back up again. That’s the difference between a “mini-stroke” and the standard variety — in a regular stroke, the blood flow does not resume.

While TIAs resolve themselves in a matter of days without any intervention or major lasting effects, they do cause a part of the brain to die. And the part of the brain that is destroyed will never come back to life.

Until recently, though, we always assumed that mini-strokes only affect a very tiny part of the brain. And since there’s a lot of brain matter to go around, the consensus was that the brain bounces back after a mini-stroke, and life goes on without a hitch.

But a new study shows that the effects of mini-strokes may be far more significant than we previously thought.Now, I should preface this by saying that mini-strokes are incredibly hard to study. They’re so small that even with the best MRI available, it can be near impossible to measure the true impact they have on the brain. In humans, anyway…

So a team of researchers looked at the effects of mini-strokes in mice. What they found was surprising to many of us who have been following TIA research for a while.

According to the researchers, the TIAs observed affected an area at least 12 times greater in size than expected. What’s more, the function of the affected part of the brain suffered for 14 to 17 days after the mini stroke.

Even after three weeks, blood flow hadn’t gotten fully back to normal.

And on top of that, a person who suffers from mini-strokes is likely to keep having them during the recovery time. Which means that, over time, it’s possible for enough damage to accumulate in the brain to equal the impact of a much larger stroke — without the person even realizing what’s going on.

Ultimately, all of this damage significantly increases the risk of cognitive decline, dementia, and Alzheimer’s disease.

And a mini-stroke — a painless event you’re not even aware of as it’s happening — is the first tile to fall in this devastating domino effect.

So how do you protect yourself? Well, the first step is to determine if you’re at risk.

Causes of mini-stroke 

In general, the risk factors for mini-strokes will sound familiar:

  • Family history. Your risk may be greater if one of your family members has had a TIA or a stroke.
  • Age. Risk of mini-stroke increases as you get older, especially after age 55.
  • Race. African Americans are at greater risk, partly because of the higher prevalence of high blood pressure and diabetes among this ethnic group.

Speaking of diabetes and high blood pressure…a few specific conditions also increase the risk of mini-strokes, but many of them share a common thread.

I’ll get into that topic shortly, but first let’s discuss some of the conditions that may put you at risk for mini-strokes, starting with the two I just mentioned.

High blood pressure High blood pressure can cause mini-strokes to occur all the time without you ever knowing they’re happening. If you’ve ever had an MRI and the report comes back with “white matter changes,” that’s evidence of mini-strokes.

Diabetes I’ve written a lot in the past about how diabetes affects the brain. Tiny blood vessels and capillaries get destroyed in diabetes. And unfortunately, once the small vessels go, there is no getting them back. That’s the reason behind some of the hallmark side effects of diabetes, like numbness and tingling, loss of sensation, loss of erections, and eye disease. And it’s also what puts diabetics at increased risk of TIAs.

Peripheral artery disease (PAD) In a nutshell, PAD restricts the blood vessels leading to your limbs — blocking nutrient, oxygen, and blood flow.

High levels of homocysteine Elevated levels of this amino acid cause your arteries to thicken and scar, which makes them more susceptible to clots.

Sickle cell anemia People with this genetic disorder have abnormally shaped blood cells. The misshapen blood cells aren’t able to carry as much oxygen, and they also tend to get stuck in artery walls, which restricts blood flow to the brain — and increases risk of mini-stroke.

Excess weight A body mass index of 25 or higher and a waist circumference greater than 35 inches in women or 40 inches in men increases risk of mini stroke.

As I mentioned earlier, half of these conditions — high blood pressure, diabetes, and PAD — share one common feature: They’re directly related to the network of blood vessels and capillaries that carry oxygen and nutrients to all your body parts, including your brain.

A system known as microcirculation.

In fact, the blood brain barrier, which is essential for allowing critical nutrients into the brain while keeping harmful chemicals out, depends on healthy microcirculation. And addressing this little-known and often overlooked system is also the key to avoiding mini-strokes — and all of the devastating consequences that come along with them.

It’s never too late — or too early — to care for your microcirculation 

One way to strengthen your microcirculation is to reduce damaging inflammation in the body. And that starts by cutting out foods that promote inflammation — namely, sugar, white flour, and simple carbohydrates. Instead focus on anti-inflammatory foods like organic produce, lean protein, and healthy monounsaturated fats (MUFAs) — the basis of The A-list Diet.

Beyond that, I recommend supplementing with French maritime pine bark extract, otherwise known as Pycnogenol®. Clinical research has shown that one of the primary ways pine bark extract benefits your circulation is by targeting collagen and elastin, which are the building blocks that line your blood vessels and capillaries.

Unfortunately, collagen and elastin break down over time, which can lead to leaky capillaries — and a damaged blood brain barrier. But pine bark extract helps the body replenish these two critical substances — and keeps your blood vessels and capillaries working the way they’re supposed to in the process.

I recommend 100 mg of Pycnogenol a day.

Another essential tool for strengthening your microcirculation: citrus bioflavonoids. These compounds help increase nitric oxide production in the body. Boosting NO levels improves microcirculation by relaxing your blood vessels and capillaries. This helps blood flow through them easier, resulting in less damage.

The three most well-researched citrus bioflavonoids are diosmin, quercetin, and hesperidin. I recommend 250 mg of diosmin, 25 mg of hesperidin, and 50 mg of quercetin per day, divided into two or three doses.

Research also suggests just 2-3 cups of tea per day can significantly improve microcirculation. But if you’re not a tea drinker, you can also opt for green tea extract (EGCG) supplements (500 mg from a 50:1 extract that contains 60% catechins, 30% EGCG). Or black tea extract (theaflavin) supplements (300 to 500 mg per day).

Following these simple steps will go a long way toward strengthening your microcirculation. And when your microcirculation is healthy, your entire body — including your brain — reaps the rewards.



Five simple steps for keeping your brain healthy at any age

Targeting your microcirculation will help you avoid the damaging effects of mini-strokes. But there are lots of other ways to support cognitive function and help ward off dementia and Alzheimer’s disease. Here are five simple steps that will set you on the path towards optimal brain health:

Balance your blood sugar. Poor blood sugar control increases dementia risk by a whopping 50 percent. Specifically, people with a high HbA1c (10.5 percent or more) were 50 percent more likely to develop dementia than people with a low HbA1c (6.5 percent or less). High blood sugar levels can affect your brain by creating inflammation and abnormal blood clotting that increases your risk of thrombosis, embolism, and stroke. Prediabetics have been shown to have as much as 10 percent shrinkage in their brains.

Feed your brain well. The Standard American Diet (SAD) can lead to changes in brain chemistry and impair your brain’s cognitive abilities (like memory, problem solving, and attention). The good news is the specific steps I outline in The A-List Diet—to optimize your amino acid intake and to focus on whole, unprocessed, organic foods and healthy fats—completely eliminate these risks. (If you haven’t picked up a copy of The A-List Diet yet, you can get one from your local bookstore or by visiting

A workout for your body is a workout for your brain. Studies have found that regular exercise supports brain health and can also improve overall cognition. Plus, it keeps your blood flowing — right down to the microcirculation.

A healthy gut equals a healthy brain. There’s evidence that the quality of bacteria in your gut influences brain health. Three simple steps for a healthy gut: eat right, sleep well, and take a good, multistrain probiotic formula such as Dr. Ohhira’s.

Protect yourself from the everyday toxins poisoning your brain. Research has found a clear link between brain health and environmental toxins like heavy metals, pesticides and insecticides, and air pollution. To protect yourself from pollutants, I recommend quarterly detoxes. You can find my complete revised and updated detox protocol in The A-List Diet.



“Functional deficits induced by cortical microinfarcts.” J Cereb Blood Flow Metab. 2017 Jan 1:271678X16685573.

“Longitudinal association between fasting blood glucose concentrations and first stroke in hypertensive adults in China: effect of folic acid intervention.” Am J Clin Nutr. 2017 Mar;105(3):564-570.