You can’t remember the name of the Netflix movie you saw just last night, literally hours ago. And that actor–what was his name? He was in, you know, that other movie. You think it was a thriller, but maybe a war movie. Then you get a notice from Verizon that they’re turning off your phone for nonpayment. But you’re pretty sure you handled it.
Variations on the brain fog theme, including “just can’t concentrate,” “memory shot to hell,” and “worried about Alzheimer’s,” are extraordinarily common these days. If you’re experiencing any of this, be reassured you’re not alone.
Well over half the new patients I saw last week may not have expressed brain fog as their primary reason for making the appointment, but when specifically asked about issues with memory were very straightforward about sharing their anxieties.
Brain fog as a symptom is a good place to start a discussion comparing disease-based symptoms with functional symptoms. Alzheimer’s is, as you know, a genuine disease affecting the structure and function of the brain. Like all actual diseases (the various cancers, infections, autoimmune diseases, and heart disease, for example), the initial symptoms may be mild but slowly and relentlessly worsen.
Also, with actual disease, diagnostic tests that may start out negative eventually flip to being positive. Steadily worsening symptoms and positive test results are two clues that something serious is probably going on.
Fortunately for you, however, most symptoms–from brain fog to tummy aches, from stiff joints to feeling tired all the time–are often not actual diseases at all. Your symptoms come and go, but don’t steadily worsen. They may not be getting better either, however, so you go to your doctor. After she runs you through the gamut of diagnostic tests, all negative, she tries to reassure you with “We can’t find anything wrong.”
You have mixed emotions about this. You don’t want a disease, but you’d like some sort of reason for your symptoms.
Here’s a likely answer: Although quite real and not in your head, your symptoms are functional, meaning there’s no disease causing them. What you’re experiencing is your body responding to the situation it’s in.
The word functional is quite appropriate when you realize the function of your symptoms is to trigger a behavior change in you. Sometimes the detective work needed to unearth the message of the symptom is pretty obvious. Heartburn? No more 9 pm lasagna. An MSG-triggered headache is harder. It took doctors years to be aware of the link. Being hit hard every month with PMS may require reading up on hormone imbalances to learn your junk-food diet is a significant contributor.
I know that stress is a powerful functional trigger for brain fog because, well, this is what I do for a living. Let me explain what’s happening.
Most functional symptoms are the result of unhealthy lifestyle choices. And most functional symptoms respond nicely (meaning they actually do go away) with help from a practitioner who specializes in Functional Medicine or Lifestyle Medicine.
Back to brain fog
During the pandemic, the skyrocketing number of patients I’ve seen with brain fog is a perfect example of functional symptoms. Take the stress of a government that’s not even trying to control this pandemic and add to it isolation, increased alcohol consumption, sugar cravings with accompanying swings in blood sugar, and physical and mental inactivity (Netflix…again?) and our brains slowly shut down.
However, there is a grey zone when evaluating a patient with brain fog. There are many illnesses, both acute (sudden) and chronic (ongoing), in which brain fog represents collateral damage from a primary illness itself.
Some of these primary illnesses are poorly-controlled diabetes, kidney or liver disease, autoimmune disorders (including underactive thyroid), HIV-AIDS, anemia, and systemic infections like Lyme disease. The brain fog following an especially severe viral infection, now including Covid-19, is another example.
People who’ve had Covid and are still coping with significant after-effects are called Covid-19 long-haulers, and while to date there’s no evidence that the virus is in the brain itself, something, probably inflammation or reduced oxygen supply, has affected the brain and nerves.
For people experiencing brain fog due to one of the other grey-zone disorders, resolving it is most likely when the primary illness is treated correctly. It’s a powerful thing when a patient’s mind begins to emerge from its fog.
If you must experience symptoms of any kind, let them be functional. Your conventional doctor saying your tests are all fine and she can’t find anything wrong with you is a signal for you to get to work, play detective, and discover what’s triggering your symptoms.
Here are the leading functional causes of brain fog:
Emotional stress, hormonal imbalances (sex hormones, thyroid, adrenal), toxins (food sensitivities, mold biotoxin illness, side effects of prescription drugs), and nutritional deficiencies.
This week I’ll talk about stress and brain fog because during the decades I’ve been a physician I’ve never seen so many patients suffering from stress. There are now national shortages of antidepressants, antianxiety meds, and sleep aids. Ironically, some patients react to these meds with still more brain fog.
In rolls the fog
Here’s what happening in your poor, foggy brain.
You’ve been overwhelmed with information, virtually all of it unpleasant in one way or another, and you struggle to keep track of it all. It’s shockingly similar to the Whac-A-Mole game you see at carnivals (remember carnivals?), except each mole is more like an evil gremlin. Up pops Covid-19 and you reach for a mask. Then up pop money worries, job concerns, and the stress of losing your health insurance. That’s in addition to the daily assaults of racial injustice, environmental destruction, and (let’s not even go there) politics.
As a result, your brain becomes utterly overloaded and freezes, like a computer that has checked out.
How serotonin helps
The brain chemical serotonin acts as a buffer against stress. Your serotonin levels are pretty much genetically determined and if you’re on the low side, you’re more vulnerable to stress. Women, it’s worth noting, have less than a third of this much-needed buffer than men.
When stress exceeds your serotonin buffer, you’ll start feeling symptoms of emotional turmoil (broadly called mood disorders), which include anxiety, panic, obsessive thinking, and depression. Any of these can impair your ability to think clearly.
Your adrenal glands and thyroid gland jump into action, releasing increased amounts of hormones in response to the stress. Unfortunately, the adrenal hormone (the steroid cortisol) interferes with short-term memory, which is why doctors were especially worried about the president’s cognitive abilities when he was given high doses of the ultra-potent cortisol drug dexamethasone during his Covid treatment.
After giving it all they’ve got, your adrenals and thyroid sort of poop out. They’ll recover when less is demanded of them, but in the meantime conditions called thyroid fatigue and adrenal fatigue contribute further to brain fog.
To put this in a perspective of conventional medicine, as I mentioned earlier doctors are writing an abundance of prescriptions for antidepressants (which raise serotonin) and anti-anxiety meds like alprazolam and clonazepam (which blunt your hyperreactivity to stress).
Today’s Health Tip about brain fog primarily deals with stress as a main contributor and these days, probably your main contributor to a lack of mental sharpness.
Reducing stress starts with daily exercise (a long walk is a perfect start), sound sleep, and nutritious food. Other steps include having someone to talk to; doing regular yoga, meditation, or tai chi (google any of these to learn online); and even getting a pet.
Here are some supplement suggestions:
–St. John’s Wort (450 mg twice daily) will raise your serotonin, but be patient. It takes two to three weeks to work.
—5HTP (100 mg at bedtime) will improve your sleep and help you make even more serotonin.
—L Theanine (100 mg up to three times daily) will help calm you without sedation.
—Adreset (two every morning) contains the adaptogenic herbs rhodiola and ginseng and the mushroom cordyceps to improve mental clarity and resistance to stress.
If you wish to add another supplement specifically to improve focus and mental clarity, add Cognicare, two twice daily.
Next week’s Health Tip, which I just noticed will be released on election day, will cover some of the non-stress-related causes of brain fog, including hypothyroidism, vitamin deficiencies, and hormonal imbalances.
It remains to be seen if Tuesday’s results will serve to exacerbate or calm our collective stressed-out souls and foggy brains.
David Edelberg, MD