In her mind she was talking — relaying to her hairstylist stories from her recent trip to Rome. But as Beth Bonness looked at herself in the mirror, dye still in her hair, she could see her mouth wasn’t moving. That’s weird, she thought. Snowflake-like lights appeared to the side of her left eye, and her right hand curled into a claw. Her stylist — asking Bonness if she was OK, if she needed help — sounded like she was underwater. “And there was pressure, but no pain,” says Bonness, of Portland, Oregon. The whole thing lasted a few minutes — maybe four, she recalls. So Bonness, then 49, finished up her hair appointment, met her family for dinner at a nearby restaurant, then went home and filled her husband in on the strange events of the afternoon. Soon after, Bonness was in the emergency room getting checked out. It was there she learned, blood pressure sky-high, that she’d likely had a transient ischemic attack, or TIA, which happens when blood flow to the brain is temporarily blocked. Roughly 240,000 Americans a year have a TIA, sometimes called a ministroke, according to the American Stroke Association, though this number is probably higher since they often go unreported. And though they can occur at any age, they’re most common among adults 55 and older. Bonness went home with blood pressure medication and a plan to take it easy for a few days. Knowing when to seek help TIA risk factors Major risk factors for TIA include: High blood pressure Diabetes Heart disease Atrial fibrillation Smoking Source: American Stroke Association It’s not uncommon for symptoms such as the ones Bonness experienced to be brushed aside, says Hardik P. Amin, M.D., co-director of the Comprehensive Stroke Center at Hartford Hospital in Hartford, Connecticut. A big reason: When it comes to a TIA, there’s no pain involved. “Usually if there’s a pain component, that’s going to send folks running to the hospital,” Amin says. “Here, it’s more like a loss of ability to do something.” And that loss of ability quickly resolves, often within a few minutes. A short-lived weakness or numbness in the arm? “Sometimes patients just think, Oh, I just slept on it funny. I’ll try to shake it off or just kind of work through it and see if it just gets better on its own,” Amin says. Bonness, who was a busy working mother, admits that when her TIA was happening, “there was a soft little part” of her that thought it could be stroke related. But with everything going on in her life, she says, “there wasn’t a lot of air space for the quiet warning signs to percolate.”
Doctors, however, say it’s important not to overlook TIA symptoms. In fact, they require immediate medical attention, a recent scientific statement from the American Heart Association (AHA) says. Diagnosing a TIA and understanding its root cause can help prevent a full-blown stroke, which can cause lasting brain damage and long-term disability — even death. It’s estimated that 446 people in the U.S. die each day from stroke. “TIAs can be a harbinger of something really bad,” says Arif Jivan, M.D., an interventional cardiologist at Northwestern Medicine Lake Forest Hospital. “It can be a warning sign for a more significant stroke in the future.” Members only According to the AHA, up to 18 percent of people who experience a TIA will have a stroke within three months — and half of those strokes will occur within a few days. About one-third of people who have a TIA go on to have a stroke within a year. Several days after her first TIA, Bonness found herself back in the emergency room. This time the diagnosis was a stroke. Know the TIA warning signs The symptoms of TIA are the same as those for a stroke, doctors say, only they are temporary and can sometimes resolve as quickly as they come on. Amin points to the acronym FAST to recognize the warning signs of both TIA and stroke. The first three letters stand for face drooping (typically on one side), arm weakness or numbness (again, this is usually on one side of the body) and speech difficulty, where an individual may struggle to string words together, say something nonsensical or have thick, slurred speech “where it sounds like the patient’s got marbles in their mouth,” Amin says. The final letter stands for time to call 9-1-1, and the same holds true when it comes to TIA, even if the symptoms stop before you get to the phone. How to tell if you've had a ministroke Common warning signs include sudden onset of: Weakness, numbness or paralysis on one side of your body Slurred speech or difficulty understanding others Blindness in one or both eyes Dizziness Severe headache with no apparent cause Source: American Stroke Association Another symptom to pay attention to is vision change, Amin says. “The classic type of vision symptoms that suggest a stroke or TIA is a blackout of vision. So if someone notices complete vision loss in just one eye, and it’s described as kind of a nightshade coming down over one eye, if it’s temporary or if it’s lasting, that is an emergency,” he says. In fact, some stroke awareness campaigns use the acronym BE FAST, with the “B” standing for balance and the “E” representing eye/vision changes. Thinking back, Bonness says had she known about BE FAST — she had at least three of the symptoms — she “probably would have gone to the ER sooner.” “It’s imperative that we don’t ignore those symptoms and seek medical attention very quickly,” Jivan says. “Even though they’re transient and they’re short-lived, [TIAs] are associated with long-term, worse outcomes.”
Diagnosis and treatment can help prevent a stroke Doctors can diagnose a TIA with a series of tests in the emergency room, including imaging tests to look for signs of narrowing arteries that lead to the brain, and blood work to rule out other conditions that present with similar symptoms. After a diagnosis is established, cardiac tests may be ordered to assess heart risks that may have caused the TIA, such as atrial fibrillation, an irregular heart rhythm that can increase risk for stroke. The AHA also recommends that physicians assess a patient’s risk of stroke after a TIA, taking into account their age and other stroke-related risk factors, such as diabetes, high cholesterol and high blood pressure. Those at high risk may be hospitalized. Patients at lower risk may be prescribed medications, like statins or blood thinners, or referred for surgery to open up a narrowed artery. And because behaviors like smoking, poor nutrition and physical inactivity can increase the likelihood of TIA or stroke, many TIA patients are counseled on risk reduction. “We think about how to best manage those risk factors to prevent something like that from happening again,” Jivan says. Research suggests that up to 80 percent of strokes after a TIA may be preventable when risk factors are managed. After her stroke, Bonness, now in her 60s, poured her focus into changing her lifestyle. In addition to taking medication for high blood pressure and high cholesterol, she altered her diet, set boundaries with her work and carved out time for creative projects, including poetry and memoir writing. “Your lifestyle matters — so all the stuff they tell you about eating healthy and managing your stress would have helped prevent this TIA for me,” says Bonness, who fully recovered from her stroke and was eventually able to go off all her stroke-related medications. “And it certainly has helped me prevent any future strokes now, with the lifestyle that I take very seriously.” 6 Popular Supplements That Can Damage Your Liver If you’re like nearly 80 percent of older adults, chances are, you took a supplement today. Maybe it’s an insurance policy if your diet doesn’t cut it. Maybe it’s because you have joint pain and you want to ease the ache. Whatever your reason, the overarching goal is probably not to damage the liver. Unfortunately, the reality is that many popular supplements can do just that — and little else — causing repercussions as severe as liver failure. While there are several categories of supplements, including multivitamins, single-nutrients (such as omega-3s, vitamin D or calcium), and herbals (also called botanicals), it’s the herbal supplements that pose the biggest risk for liver damage. About 5 percent of U.S. adults — that’s 15.6 million people — took potentially liver-damaging botanical supplements within the last month, according to a study published in 2024 in JAMA Network Open, with middle-aged and older adults being some of the most likely groups to do so. In the study, six specific botanicals were singled out because data from the Drug-Induced Liver Injury Network identified them as the ones that are most likely to be associated with liver toxicity. These six supplements include: Ashwagandha Black cohosh Garcinia cambogia Green tea extract Red yeast rice Turmeric/curcumin Researchers found that older individuals were more likely than younger populations to take these botanicals – and it’s not difficult to understand why. Turmeric/curcumin is often promoted to ease joint pain from arthritis, which affects roughly half of adults 65 and older, and black cohosh is marketed for menopause symptoms. Red yeast rice is taken to lower cholesterol levels and improve heart health, two leading health concerns among older adults. While the six supplements above may be the ones most often implicated in liver injury, according to this study, far more fit in this category. About 1,000 medications and herbals are associated with liver damage, research suggests. How supplements can harm the liver A hardy organ, the liver is the body’s clearing house. “Pretty much anything you ingest has the potential to be toxic to the liver,” says Don Rockey, M.D., a professor of medicine at the Medical University of South Carolina and an American Liver Foundation volunteer expert. “Everything you consume goes into the [gastrointestinal] tract, is absorbed, and the first place it goes is the liver,” he explains. Most Popular health 5 Things Your Earwax Says About Your Health benefits-discounts How and Why to Delete Your Old Text Messages Members Only health Recall Alert: Generic Medications Affected health 6 Popular Supplements That Can Damage Your LiverHepatocytes — the main type of cells in the liver — detoxify your body, but they can be damaged. Two common substances that are toxic to liver cells include alcohol and high doses of acetaminophen. Botanicals also fit into this category, even though they are often considered safe because they are natural. “Natural compounds still need to be processed by the liver, and, in some cases, can cause very severe liver injury and damage,” says Arun Jesudian, M.D., a transplant hepatologist at Weill Cornell Medicine and NewYork-Presbyterian in New York City. Age can contribute to the problem. Age-related changes in the liver make the organ less resilient to stress and less effective at metabolizing substances, resulting in potentially more damage. Liver damage can be acute or build up over time with repeated use, the latter being what typically happens with botanicals. “Some substances, including supplements, can cause liver injury in unpredictable ways, and it’s not always dependent on how much you’re taking,” Jesudian says. Damage can range from inflammation in the liver to liver failure requiring emergency liver transplant, he says. It’s not just the main ingredient in a supplement that can cause damage. Supplements can be toxic to the liver (hepatotoxic) because they are contaminated with things not listed on the label, such as medications, molds and heavy metals. That’s a huge concern: Earlier research published in Hepatology Communications analyzing 272 dietary supplements found that 51 percent were mislabeled, meaning their contents did not match their labels. That makes it more difficult to understand exactly what is causing liver toxicity. All of that is made more complex by how supplements are handled in the U.S. Dietary supplements are not regulated by the U.S. Food & Drug Administration (FDA) the way prescription and over-the-counter medications are. According to the FDA, supplement manufacturers and distributors are responsible for ensuring that what’s in the bottle is safe and accurately labeled. If there is evidence that it’s not, the FDA can step in to issue warnings and take other actions against a mislabeled or potentially dangerous supplement. But this happens after it’s on the market — not before.Tips for staying safe with supplements If you’re going to take a supplement, there are some steps you can take to help keep you safe. 1. Research. Doing some research is a key first step—just be sure you’re using a trusted source. According to the Centers for Disease Control and Prevention (CDC), older adults often use social media as a source of health information, and unfortunately, information found there is often misguided or incorrect. One resource to check out when researching supplements is the LiverTox database from the National Institute of Diabetes and Digestive and Kidney Diseases. The website provides information on medications and supplements and their effects on the liver. But your research shouldn’t stop there, which brings us to step number two… 2. Talk to your provider. This is, by far, the most important thing you can do. “Discuss a supplement that you’re thinking of taking with your doctor before you start taking it, particularly if you have any type of liver condition,” Jesudian says. If you are already taking a supplement, bring the bottle into your provider’s office to show them, and ask what they think, if it’s safe, and if it offers added value for your health. “If there is no benefit, there is no sense in adding risk,” Rockey says. The authors of the 2024 JAMA Network Open study note that “the vast majority of at-risk botanical users” took the supplements without consulting a health care provider. 3. Be careful with herbals. Rockey tells patients that supplements like vitamins or minerals (or multivitamins) are generally safe, though you should still purchase these from reputable brands. “When you start buying herbals, especially online and taking them in high concentrations, you have to be careful,” he says. That’s especially true when a product contains multiple botanical ingredients, making it tough to know exactly what you’re getting in the mix or how they will affect you. 4. Look for third-party testing. Research suggests there are 80,000 herbal and dietary supplements on the market. With concerns about contamination and mislabeling, choose a product with independent, third-party testing from organizations like the NSF or USP. The certification helps ensure that what’s on the label matches what’s in the bottle and that there are no additional hidden ingredients in the formula. 5. Skip liver supplements entirely. Some herbal supplements are marketed for liver health or liver detox. “There is no evidence that any supplement is ‘good’ for your liver. The best thing for your liver is a healthy diet and lifestyle,” Rockey says. At the very least, these are a waste of money, he adds. 6. Get regular blood work. If you’re getting blood work to assess your health, make sure that it includes a liver function test. If this test shows elevated liver enzymes and there is a concern for liver damage due to a supplement you’re taking, you should stop taking that supplement, says Alisa Likhitsup, M.D., a clinical assistant professor of medicine at the University of Michigan Health and lead author of the JAMA Network Open study.
If you’re like nearly 80 percent of older adults, chances are, you took a supplement today. Maybe it’s an insurance policy if your diet doesn’t cut it. Maybe it’s because you have joint pain and you want to ease the ache. Whatever your reason, the overarching goal is probably not to damage the liver. Unfortunately, the reality is that many popular supplements can do just that — and little else — causing repercussions as severe as liver failure. While there are several categories of supplements, including multivitamins, single-nutrients (such as omega-3s, vitamin D or calcium), and herbals (also called botanicals), it’s the herbal supplements that pose the biggest risk for liver damage. About 5 percent of U.S. adults — that’s 15.6 million people — took potentially liver-damaging botanical supplements within the last month, according to a study published in 2024 in JAMA Network Open, with middle-aged and older adults being some of the most likely groups to do so. In the study, six specific botanicals were singled out because data from the Drug-Induced Liver Injury Network identified them as the ones that are most likely to be associated with liver toxicity. These six supplements include: Ashwagandha Black cohosh Garcinia cambogia Green tea extract Red yeast rice Turmeric/curcumin Researchers found that older individuals were more likely than younger populations to take these botanicals – and it’s not difficult to understand why. Turmeric/curcumin is often promoted to ease joint pain from arthritis, which affects roughly half of adults 65 and older, and black cohosh is marketed for menopause symptoms. Red yeast rice is taken to lower cholesterol levels and improve heart health, two leading health concerns among older adults. While the six supplements above may be the ones most often implicated in liver injury, according to this study, far more fit in this category. About 1,000 medications and herbals are associated with liver damage, research suggests. How supplements can harm the liver A hardy organ, the liver is the body’s clearing house. “Pretty much anything you ingest has the potential to be toxic to the liver,” says Don Rockey, M.D., a professor of medicine at the Medical University of South Carolina and an American Liver Foundation volunteer expert. “Everything you consume goes into the [gastrointestinal] tract, is absorbed, and the first place it goes is the liver,” he explains.
Hepatocytes — the main type of cells in the liver — detoxify your body, but they can be damaged. Two common substances that are toxic to liver cells include alcohol and high doses of acetaminophen. Botanicals also fit into this category, even though they are often considered safe because they are natural. “Natural compounds still need to be processed by the liver, and, in some cases, can cause very severe liver injury and damage,” says Arun Jesudian, M.D., a transplant hepatologist at Weill Cornell Medicine and NewYork-Presbyterian in New York City. Age can contribute to the problem. Age-related changes in the liver make the organ less resilient to stress and less effective at metabolizing substances, resulting in potentially more damage. Liver damage can be acute or build up over time with repeated use, the latter being what typically happens with botanicals. “Some substances, including supplements, can cause liver injury in unpredictable ways, and it’s not always dependent on how much you’re taking,” Jesudian says. Damage can range from inflammation in the liver to liver failure requiring emergency liver transplant, he says. It’s not just the main ingredient in a supplement that can cause damage. Supplements can be toxic to the liver (hepatotoxic) because they are contaminated with things not listed on the label, such as medications, molds and heavy metals. That’s a huge concern: Earlier research published in Hepatology Communications analyzing 272 dietary supplements found that 51 percent were mislabeled, meaning their contents did not match their labels. That makes it more difficult to understand exactly what is causing liver toxicity. All of that is made more complex by how supplements are handled in the U.S. Dietary supplements are not regulated by the U.S. Food & Drug Administration (FDA) the way prescription and over-the-counter medications are. According to the FDA, supplement manufacturers and distributors are responsible for ensuring that what’s in the bottle is safe and accurately labeled. If there is evidence that it’s not, the FDA can step in to issue warnings and take other actions against a mislabeled or potentially dangerous supplement. But this happens after it’s on the market — not before.
Tips for staying safe with supplements If you’re going to take a supplement, there are some steps you can take to help keep you safe. 1. Research. Doing some research is a key first step—just be sure you’re using a trusted source. According to the Centers for Disease Control and Prevention (CDC), older adults often use social media as a source of health information, and unfortunately, information found there is often misguided or incorrect. One resource to check out when researching supplements is the LiverTox database from the National Institute of Diabetes and Digestive and Kidney Diseases. The website provides information on medications and supplements and their effects on the liver. But your research shouldn’t stop there, which brings us to step number two… 2. Talk to your provider. This is, by far, the most important thing you can do. “Discuss a supplement that you’re thinking of taking with your doctor before you start taking it, particularly if you have any type of liver condition,” Jesudian says. If you are already taking a supplement, bring the bottle into your provider’s office to show them, and ask what they think, if it’s safe, and if it offers added value for your health. “If there is no benefit, there is no sense in adding risk,” Rockey says. The authors of the 2024 JAMA Network Open study note that “the vast majority of at-risk botanical users” took the supplements without consulting a health care provider. 3. Be careful with herbals. Rockey tells patients that supplements like vitamins or minerals (or multivitamins) are generally safe, though you should still purchase these from reputable brands. “When you start buying herbals, especially online and taking them in high concentrations, you have to be careful,” he says. That’s especially true when a product contains multiple botanical ingredients, making it tough to know exactly what you’re getting in the mix or how they will affect you. 4. Look for third-party testing. Research suggests there are 80,000 herbal and dietary supplements on the market. With concerns about contamination and mislabeling, choose a product with independent, third-party testing from organizations like the NSF or USP. The certification helps ensure that what’s on the label matches what’s in the bottle and that there are no additional hidden ingredients in the formula. 5. Skip liver supplements entirely. Some herbal supplements are marketed for liver health or liver detox. “There is no evidence that any supplement is ‘good’ for your liver. The best thing for your liver is a healthy diet and lifestyle,” Rockey says. At the very least, these are a waste of money, he adds. 6. Get regular blood work. If you’re getting blood work to assess your health, make sure that it includes a liver function test. If this test shows elevated liver enzymes and there is a concern for liver damage due to a supplement you’re taking, you should stop taking that supplement, says Alisa Likhitsup, M.D., a clinical assistant professor of medicine at the University of Michigan Health and lead author of the JAMA Network Open study.