Brain fog is not just in your head.
"Brain fog" was not a term I heard often in my practice until a few years ago. It's now a frequent, and often frustrating, concern that patients bring. The term first appeared in scientific literature in 2004, with a dramatic uptick in the last two years. Perhaps this symptom is becoming more common, perhaps the language now used to describe it has consolidated, perhaps science is becoming more adept at measuring it, or maybe all three. The idea seems to have struck a chord with many people who are experiencing hard-to-nail-down symptoms that something just isn't right. Brain fog is not a scientific medical term; rather, it's a non-technical, catch-all term for subjective neuropsychiatric and cognitive dysfunction. This might include a feeling of slowed down perception, difficulty with concentration and memory, and trouble with executive functions like planning and decision making. People have reported brain fog in association with conditions like celiac disease, lupus, POTS, long COVID, concussions, chemotherapy treatment, menopause, and more. The leading medical hypothesis is that inflammation in the neurological system, which may be present in many different states, is the primary mechanism (1).
Despite increasing scientific interest, brain fog is still an area without a lot of evidence to guide assessment and management. If you seek medical evaluation for brain fog, it's likely that a doctor will run some tests, rule out a few serious underlying conditions, and shrug. While maybe vaguely reassured you're not actively dying, you probably were hoping for more.
When there is not sufficient scientific evidence to guide medical treatment, patients often wind up feeling dismissed, not believed, and abandoned by the medical system. This, frankly, totally sucks. A lack of clear evidence-based treatment protocols does NOT mean there's nothing to be done. So what can you do when you've been patted on the head and sent on your way? One approach is to optimize low-risk health promotion strategies targeted towards a hypothesized mechanism-- in this care, neuroinflammation. Please remember that though these are generally low-risk strategies appropriate for most people, this is not medical or professional advice and isn't targeted specifically to your needs, so please account for your unique needs and circumstances with appropriate professional consultation. That said, here are some general suggestions to help with brain fog:
Manage systemic inflammation
Anti-inflammatory diet: focus on fresh vegetables (especially cruciferous vegetables and leafy greens), mushrooms, healthy plant-based fats (from olives, nuts, seeds, and avocado), herbs and spices (especially turmeric, ginger, & black pepper), tea and coffee, beans & legumes, whole grains, and dark colored fruits. Limit animal products, refined and fried foods, added sugars, and packaged, highly processed foods.
Environment: identify sources of pollution, chemical additives, environmental contaminants, and smoke that you may be exposed to. You might consider using an air filter and a water filter at home, exercising away from busy roads, buying organic foods when possible, and avoiding added fragrances in personal care products (look for the EWG "skin deep" database).
Rest & sleep: If you have a chronic illness and/or are recovering from an acute infection, you'll likely need more rest and sleep than your baseline. Can you arrange your day with breaks? Can you allow yourself an extra hour in bed at night? Who can you ask for support? You also might focus on improving sleep quality by practicing routine sleep/wake times, having a wind-down ritual, limiting evening screen time and work, and cultivating awareness of how substances like caffeine, alcohol, and sugar impact your sleep.
Identify & mitigate chronic stress
Can you change any circumstances? Some stress is truly unavoidable. But often, we can work towards improving the situation, even when it doesn't seem that way at first. Approach yourself with kindness and curiosity and ask "how can I make this better?".
Can you engage in practices do train the nervous system? Activities that downregulate the "fight or flight" system and upregulate the "rest and digest" system include slow, deliberate breathing (like the 4-7-8 breath), yoga, meditation, biofeedback, guided imagery, and aromatherapy, among many others.
Can you help the body adapt to stress? High-quality nutrition and consistent physical movement are key tools. Eating well and in relaxed environments helps. Moving the body results in positive neurohormonal changes and can reduce muscular tension.
Can you reduce any additional load on the nervous system? Even some enjoyable activities can stress the nervous system. Are you into scary movies, loud music, or roller coasters? This kind of activity can set off additional stress responses in the body. While you're recovering, can you find less stimulating activities?
Medications & supplements
Together with your healthcare provider, consider targeted drug therapy to treat any underlying conditions from a standpoint of lowering inflammation. This means working with a healthcare provider who is willing to look at your individual set of symptoms, diagnoses, and circumstances. If your regular PCP doesn't have the training or time to do this, consider seeking out a naturopathic doctor or functional medicine doctor to consult with.
Consider supplementation targeted to reduce inflammation. The best evidence is for turmeric (as a supplement, you can get higher amounts of the potent curcuminoids that you would get from using it as a culinary spice), and omega-3 fatty acids (look for a combination of EPA and DHA).
At the end of the day, you may go through a trial and error period, and you may not get an immediate or dramatic response. Especially if you are feeling brain fog or fatigue, undertaking lots of changes can be too much. But maybe you can find one thing to start with, and maybe you'll feel enough better to add another tiny change. Which strategy sounds doable to you? Let's start with that, and see how it goes.
Kverno, K. (2021). Brain fog: A bit of clarity regarding etiology, prognosis, and treatment. Journal of Psychosocial Nursing, 59(11).
