You can\u2019t 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\u2019re turning off your phone for nonpayment. But you\u2019re pretty sure you handled it.<\/p>\n\n\n\n
Variations on the brain fog<\/a> theme, including \u201cjust can\u2019t concentrate,\u201d \u201cmemory shot to hell,\u201d and \u201cworried about Alzheimer\u2019s,\u201d are extraordinarily common these days. If you\u2019re experiencing any of this, be reassured you\u2019re not alone.<\/p>\n\n\n\n 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.<\/p>\n\n\n\n Brain fog as a symptom is a good place to start a discussion comparing disease-based symptoms with functional symptoms. Alzheimer\u2019s 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.<\/p>\n\n\n\n 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.<\/p>\n\n\n\n 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\u2019t 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 \u201cWe can\u2019t find anything wrong.\u201d<\/p>\n\n\n\n You have mixed emotions about this. You don\u2019t want a disease, but you\u2019d like some sort of reason for your symptoms.<\/p>\n\n\n\n Here\u2019s a likely answer: Although quite real and not in your head, your symptoms are functional, meaning there\u2019s no disease causing them. What you\u2019re experiencing is your body responding to the situation it\u2019s in.<\/p>\n\n\n\n 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.<\/p>\n\n\n\n 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.<\/p>\n\n\n\n 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.<\/p>\n\n\n\n Back to brain fog 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.<\/p>\n\n\n\n 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.<\/p>\n\n\n\n People who\u2019ve had Covid and are still coping with significant after-effects are called Covid-19 long-haulers<\/a>, and while to date there\u2019s no evidence that the virus is in the brain itself, something, probably inflammation or reduced oxygen supply, has affected the brain and nerves.<\/p>\n\n\n\n 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\u2019s a powerful thing when a patient\u2019s mind begins to emerge from its fog.<\/p>\n\n\n\n If you must experience symptoms of any kind, let them be functional. Your conventional doctor saying your tests are all fine and she can\u2019t find anything wrong with you is a signal for you to get to work, play detective, and discover what\u2019s triggering your symptoms.<\/p>\n\n\n\n Here are the leading functional causes of brain fog:<\/p>\n\n\n\n Emotional stress, hormonal imbalances (sex hormones, thyroid, adrenal), toxins (food sensitivities, mold biotoxin illness, side effects of prescription drugs), and nutritional deficiencies.<\/p>\n\n\n\n This week I\u2019ll talk about stress and brain fog because during the decades I\u2019ve been a physician I\u2019ve 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.<\/p>\n\n\n\n In rolls the fog You\u2019ve been overwhelmed with information, virtually all of it unpleasant in one way or another, and you struggle to keep track of it all. It\u2019s 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\u2019s in addition to the daily assaults of racial injustice, environmental destruction, and (let\u2019s not even go there) politics.<\/p>\n\n\n\n As a result, your brain becomes utterly overloaded and freezes, like a computer that has checked out.<\/p>\n\n\n\n How serotonin helps When stress exceeds your serotonin buffer, you\u2019ll 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.<\/p>\n\n\n\n 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\u2019s cognitive abilities when he was given high doses of the ultra-potent cortisol drug dexamethasone during his Covid treatment.<\/p>\n\n\n\n After giving it all they\u2019ve got, your adrenals and thyroid sort of poop out. They\u2019ll recover when less is demanded of them, but in the meantime conditions called thyroid fatigue and adrenal fatigue contribute further to brain fog.<\/p>\n\n\n\n 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).<\/p>\n\n\n\n Today\u2019s Health Tip about brain fog primarily deals with stress as a main contributor and these days, probably your<\/u> main contributor to a lack of mental sharpness.<\/p>\n\n\n\n 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.<\/p>\n\n\n\n Here are some supplement suggestions:<\/p>\n\n\n\n –St. John\u2019s Wort (450 mg twice daily) will raise your serotonin, but be patient. It takes two to three weeks to work.<\/p>\n\n\n\n —5HTP<\/a> (100 mg at bedtime) will improve your sleep and help you make even more serotonin.<\/p>\n\n\n\n —L Theanine<\/a> (100 mg up to three times daily) will help calm you without sedation.<\/p>\n\n\n\n
<\/strong>During the pandemic, the skyrocketing number of patients I\u2019ve seen with brain fog is a perfect example of functional symptoms. Take the stress of a government that\u2019s 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\u2026again?) and our brains slowly shut down.<\/p>\n\n\n\n
<\/strong>Here\u2019s what happening in your poor, foggy brain.<\/p>\n\n\n\n
<\/strong>The brain chemical serotonin acts as a buffer against stress. Your serotonin levels are pretty much genetically determined and if you\u2019re on the low side, you\u2019re more vulnerable to stress. Women, it\u2019s worth noting, have less than a third of this much-needed buffer than men.<\/p>\n\n\n\n