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Feeling Hazy? Here's Your Definitive Guide To Brain Fog

Ilene Ruhoy, M.D., Ph.D.
September 16, 2018
Ilene Ruhoy, M.D., Ph.D.
Integrative Neurologist
By Ilene Ruhoy, M.D., Ph.D.
Integrative Neurologist
Dr. Ruhoy is a board-certified neurologist practicing integrative pediatric and adult neurology in Seattle. She is the owner and founder of the Center for Healing Neurology, and received her M.D. from the University of Pittsburgh School of Medicine.
Photo by Kayla Snell
September 16, 2018

"Brain fog" is a term commonly used by patients when they are trying to describe a lack of mental clarity, mild confusion, loss of focus and attention, poor concentration, or even just a generalized sense of not feeling their best. As an integrative neurologist, my first job is to make sure that nothing serious is going on, which means conducting a brain MRI, an electroencephalogram, blood tests, and even cerebrospinal fluid studies. But, very often with brain fog, all of these conventional tests will come back without abnormalities, and yet, the patients will have these uncomfortable symptoms. What's the catch?

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What is brain fog?

If you have brain fog, you may not be able to think of words as adeptly, or you might feel like you're functioning in a haze. It may take you longer to perform daily activities, and you might feel extremely tired and drained. First, it's important to note that brain fog is not the same thing as mild cognitive impairment or early dementia, which many people fear when they come into my office. Rest assured, there are no studies to suggest that a feeling of brain fog leads to a degenerative cognitive disease. Instead, there are other reasons you may feel you are not thinking as clearly as you used to or are having difficulty recalling recent conversations and remembering tasks.

Many of my patients think that brain fog is just part of the aging process or that, for women, it must be hormonal. But, in reality, we can thank modern-day life for much of what 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 can have 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 we are simply not strong enough to withstand the overstimulation of our immune systems, which leads to chronic inflammation.

Brain fog and inflammation in the brain.

So what is inflammation? Inflammation is the influx of proteins, cytokines, and other mediators that are released by cells like mast cells and macrophages when triggered by a kind of an assault—which can be endogenous (inside the body) or exogenous (outside the body). In 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 them have to work harder.

Energy for cellular function comes from the mitochondria, and the brain—which is a very metabolically active organ—depends greatly on the functionality of these tiny structures in our cells. A chronic inflammatory response can cause inflammation of organs, including most commonly the gut and the brain. Eventually, these inflammatory mediators make their way into our central nervous system, and neuroinflammation (inflammation in the brain) can ensue.

Photo: Kayla Snell
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Brain fog, food, and the gut-brain connection.

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 what we are exposed to can have a big influence on brain fog and inflammation. Foods can be either pro-inflammatory or they can be anti-inflammatory, as well as energy-supporting or 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 for brain fog.

Once the gut 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 correcting it is not always an easy task. Most of the time, it takes more than just a good probiotic to restore gut health and eliminate brain fog. In fact, a recent study—although small and preliminary—actually suggests that, in some cases, probiotics may even contribute to brain fog in those with SIBO, also known as small intestinal bacterial overgrowth. We all have individual microbiomes that depend on a great variety of factors including the ones that start right from birth—like where and how we were born, how we were fed, what illnesses we had, and what medications we took—and during our lives—like where we spend most of our time, what foods we choose to eat, how much we drink, and which communities we live in.

Addressing 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.

Other brain fog causes you should know about.

The brain prefers glucose for energy, but 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 if it doesn't get glucose.

In addition, grazing on meals throughout the day forces the body to continuously work harder, 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.

We are also surrounded by environmental contaminants and microbial organisms that 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.

At other times, suboptimal blood flow and supply can contribute to brain fog. We breathe gases and airborne toxins that are inspired with them. When the air exchanges oxygen for carbon dioxide with our blood during respiration, it also adds residue 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.

Photo: Kayla Snell
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Brain fog fixes, from an integrative neurologist.

Brain fog symptoms can be managed with proper care and attention. If you're experiencing brain fog, here are some important recommendations:

  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 percent of illness may come from our guts. Treat it well.
  4. Do not graze.
  5. Respect your circadian rhythm. Go to bed around the same time each night and wake at 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 and still have trouble sleeping, talk to your physician about using natural sleep aids.
  6. Manage stress through daily movement, exercise, and meditation. Yoga and tai chi have been proved 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 combating 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 four to five times per week. Studies show exposure to nature helps to combat exposure to environmental toxins, alleviate anxiety and stress, and reduce inflammation.
  11. Correct your microbiome. This will take time and dedication, but focus on eating organic whole foods (including the wide array of vegetables and fruits, along with plenty of fiber), intermittent fasting (allowing for natural elimination), improving your sleep, and minimizing or eliminating the use of medications—especially those of the antimicrobial and anti-inflammatory classes. Remember that antibiotics and probiotics alone 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 breathe through your nose for 4 counts, hold your breath for 7 counts, and then breath through your mouth for 8 counts.
  13. Aerobic exercise two to three 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 and laugh.
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Ilene Ruhoy, M.D., Ph.D.
Ilene Ruhoy, M.D., Ph.D.
Integrative Neurologist

Ilene Ruhoy, M.D., Ph.D., is a board-certified neurologist practicing integrative pediatric and adult neurology in Seattle. She is the owner and founder of the Center for Healing Neurology and is on the faculty of Seattle Children’s Hospital. Her holistic approach includes full neurological care with the addition of acupuncture, neurofeedback, and herbal and nutritional guidance. She received her M.D. from the University of Pittsburgh School of Medicine and completed her neurology training at the University of Washington in Seattle. In addition to becoming a certified medical acupuncturist, she has also completed the Integrative Medicine Fellowship at the University of Arizona. Her Ph.D. doctoral dissertation studied the effects of environmental toxins on our nation’s water systems.