“Brain fog” is a phrase commonly used by patients when they are trying to describe a lack of mental clarity, a mild confusion, a loss of focus and attention, poor concentration, or even just a generalized sense of not feeling well. As a neurologist, it is of course my obligation to ensure nothing serious is going on and very often conventional testing will be without abnormalities. A brain MRI, an electroencephalogram, blood tests, and even cerebrospinal fluid studies will be without evidence of why the patient feels this way. But yet patients will have these symptoms and the available testing represents some of the limits of modern medicine. It is important to note that brain fog is not the same as mild cognitive impairment or early dementia, which many fear. There are no studies to suggest that a feeling of brain fog leads to a degenerative cognitive disease.
There are many reasons why we may feel we are not thinking as clearly, or having difficulty recalling recent conversations or remembering tasks to be done. Or why we cannot think of words as adeptly as used to or that we are feeling as if we are functioning in a haze where it takes us longer to do activities of daily living than it used to. We feel tired and drained. And while many may believe it is just a part of the aging process or, in women, it must be hormonal, we can thank modern day life and culture for much of what it we feel. We are exposed to so many toxins, contaminants, microbes, and chemicals each and every day. And while regulations say a minute exposure to one particular toxin is not detrimental to human health, we have to consider the multitudes of exposures over years which almost definitely has adverse influences on our natural physiological processes. This usually stems from an inflammatory response to these exposures. Our immune systems can withstand and tolerate quite a few exogenous assaults. But sometimes our immune system is simply not strong enough, or becomes overstimulated, to suppress ongoing inflammation.
Inflammation is the influx of proteins, cytokines, and other mediators which are released by cells, such as mast cells and macrophages, when triggered by a kind of an assault – which can be endogenous (inside the body) or exogenous (outside the body). For the short term, this response can be hugely beneficial for our health. However, when the body is not able to naturally control the response, or if the initial trigger remains present so that it becomes an ongoing source of inflammation, the response can be detrimental as it poses extra burden on the mitochondria of the cells and makes mitochondrial and cytoplasmic enzymes work harder. Energy for cellular function comes from the mitochondria, and the brain, a very metabolically active organ, depends greatly on the functionality of these organelles. A chronic inflammatory response can cause inflammation of organs, including, and most commonly, the gut and the brain because eventually these inflammatory mediators make their way into our central nervous system and neuroinflammation can result.
Our gastrointestinal tract, affectionately referred to as our “gut,” and our brain are intricately connected. The gut’s main control center is the enteric nervous system and it has communication with the central nervous system. When the gut is inflamed, the lining of the tract becomes a not-so-gracious host for beneficial microbes and the microbiota is altered. This can lead to defects in immune homeostasis and make us vulnerable to further inflammation and subsequent “brain fog.”
How we eat and to what we are exposed can have great effects for many of us. Foods can be either pro-inflammatory or they can be anti-inflammatory. Food can either be energy-supporting or they can be energy-draining. The effects on our microbiome from the foods we choose to eat cannot be understated or underemphasized as sometimes our diet alone can be to blame. The brain prefers glucose as its source of energy. This glucose should not come in the form of simple and processed sugar but rather in the form of complex grains as our bodies have mechanisms to appropriately break down complex forms of carbohydrates into natural glucose molecules and deliver it in a controlled manner to the brain. The brain will happily use fatty acids if glucose is not available – but only in the short term. Eventually it will revolt and energy processes will suffer bringing on feelings of slow processing and fatigue. In addition, grazing on meals throughout the day creates continuous work throughout the body, regardless of how small or healthy the meal or snack may be. The gastrointestinal tract needs periods of rest not only for its own healing and recovery but to allow energy, that otherwise would have been diverted to the gut tract for digestion and absorption, to be used for healing of other body systems, such as the brain.
But we are also exposed. We are surrounded by environmental contaminants and microbial organisms which can have effects on our immune system and other biological processes. Over time, these exposures can greatly enhance and direct the way our inflammatory response behaves and the efficiency of our biological systems. Once the microbiota is imbalanced and favors non-beneficial bacterial species, we experience systems of dysmotility, fatigue, and cognitive slowing. This is what brain fog feels like. There are certain species of bacteria that support mitochondrial function by releasing important co-factors for use by the chain of mitochondrial enzymes. Other species can be downright toxic to the enzyme complexes.
Our microbiome is complex and complicated and correcting it is not an easy task. It is certainly not as easy as taking a probiotic. There are no studies to support this method as effective. In fact, recent research suggests probiotics may even contribute to the problem. We all have individual microbiomes that depend on a great variety of factors including from birth – where and how we were born, how we were fed, what illnesses did we have, what medications did we take, etc. – and during our lives – where do we spend most of our time, what foods we choose to eat, how much we drink, the communities we live in, etc. To address an inflamed gut requires time, dedication, and motivation to make changes, sometimes significant changes, to our lifestyle habits. Our gut holds our defense to the outside world and therefore takes the brunt of all we do. If we treat it well it will keep us healthy in return.
At other times, suboptimal blood flow and supply can contribute to brain fog. We breath gases and airborne toxins are inspired with our breaths. When the air exchanges oxygen for carbon dioxide with our blood during respiration, it also adds residua of these contaminants. With sufficient quantity, these contaminants can impede oxygenation of blood, delivery of nutrients, and contribute to poor blood vessel health. Sleep apnea also impairs oxygen delivery to the brain while we sleep and prevents restorative sleep. Chronic apnea not only contributes to obesity, high blood pressure, and diabetes, but also contributes to fatigue and cognitive processing difficulties. Other causes of brain fog include poor stress management, alcohol, medications, and chronic illness.
Brain fog symptoms can be managed with proper care and attention. The following are important recommendations you can do on your own:
1. See a board-certified neurologist to rule out other potentially treatable causes of cognitive difficulties.
2. Practice intermittent fasting. There has been a lot written on this topic but if you need guidance please seek a knowledgeable practitioner.
3. Meals should consist of complex carbohydrates in the form of grains and vegetables as well as a generous amount of healthy fats from sources such as avocados, nuts, and seeds. Avoid processed foods, sugar, simple sugars, and dairy. Increase consumption of raw foods. Studies suggest almost 70% of illness may come from out guts. Treat it well.
4. Do not graze.
5. Respect your circadian rhythm. Go to bed the same time each night and wake the same time each morning. Restorative sleep is very important. If you have sleep apnea, please see a sleep doctor for evaluation. If you do not, please speak to your physician about the use of natural sleep aids.
6. Manage stress though daily movement, exercise, and meditation. Yoga and tai chi have been proven to reduce vagal tone which contributes to stress response and ultimately leads to brain fog. Meditation improves cognition and memory as it has positive effects on the size of the temporal lobes.
7. Minimize use of medications when you can. Speak to your physician for guidance. There are natural ways of combatting high blood pressure, elevated glucose levels, obesity, and autoimmunity but you have to start before it is too late.
8. Minimize alcohol use.
9. Eat only organic foods when possible. Use green cleaning agents and natural beauty and hygiene products.
10. Engage with nature at least 4-5 times per week. Studies show exposure to nature helps to combat exposure to environmental toxins, alleviate anxiety, stress, and reduce inflammation.
11. Correct your microbiome. This will take time and dedication but a focus on organic whole foods include the wide array of vegetables and fruits along with plenty of fiber, intermittent fasting, allowing for natural elimination, improved sleep, minimize or eliminate use of medications – especially those of the antimicrobial and anti-inflammatory classes. Remember that antibiotics and probiotics do not correct your gut bacterial population.
12. Practice deep breathing exercises to enhance oxygenation and blood flow. My favorite is the 4-7-8 technique. Place the tip of your tongue to the roof of your mouth and breath through your nose for 4 counts, hold your breath for 7 counts, and then breath through your mouth for 8 counts.
13. Aerobic exercise 2-3 times per week for improved cerebral blood flow.
14. Supplement with appropriate herbs, vitamins, and elements for mitochondrial and immune system support.
15. Maintain hydration with electrolytes to prevent dehydration.
16. Smile, laugh, be grateful.
At the Center for Healing Neurology, we help patients with a comprehensive functional and conventional assessment and evaluation, guidance, and management. Our treatment program includes, when indicated, IV nutrition, pharmaceuticals, herbal formulations, supplements, nutrition plans, ozone therapy, hyperbaric oxygen treatment, acupuncture, biocranial, and regenerative therapies.