What is brain fog and how do you treat it?
A question, “how do you treat brain fog?” was asked to a group of headache specialists. The question was about a patient who suffers from frequent migraine headaches who had also has been experiencing brain fog. The patient felt like this brain fog was almost as disabling as his migraines. The brain fog which occurred during and outside of his migraine headaches was limiting his ability to work as a professor at a medical school. The question posed was how to best treat his brain fog.
The answers from the group of varied from recommending better treatment of his migraines to medical treatment of the underlying depression that he MUST have. Thinking about it, I realized that this would be what I would have recommended as little as a couple of years ago when someone would come see me with the complaint of brain fog.
Based on my last two years of research into the underlying causes of many neurological symptoms and diseases along with the many benefits of being in ketosis, my treatment recommendations are now different.
So what is brain fog?
Brain fog is not currently recognized as a medical diagnosis. It, however, is a symptom that is frequently reported in many different medical disorders. Depending on its severity it can be very disabling, sometimes more disabling than their underlying medical diagnosis. A precise definition of brain fog also has not been established.
People who suffer from brain fog describe their symptoms as:
- Difficult focusing
- Mental fatigue
- Cloudy or hazy thinking
- Slow thinking
- Difficulty concentrating
- Inability to multitask
Brain fog has been reported in a variety of medical disorders including:
- Chronic fatigue syndrome
- Fibromyalgia “fibro fog”
- Postural tachycardia syndrome
- Multiple sclerosis
- Celiac disease
- Autism spectrum disorders
- From chemotherapy “chemo fog”
I like many people have experienced some of these symptoms transiently related the side effects of from medications, specifically the antihistamines that I take for my cedar allergies. (I had a pretty severe episode yesterday.) The difference, however, is when it is due to an underlying medical condition such as fibromyalgia the brain fog is a continuous symptom. The brain fog often does not improve even after treatment or control of their disease. For example brain fog related to chemotherapy has been reported to last up to 15 years after completion of chemotherapy. (Orchard, 2017) This is in contrast to when it is from the “transient” causes listed below, which is typically resolved when you remove the cause.
The potentially “treatable” or “transient” causes of brain fog symptoms:
- Thyroid problems (both hypo and hyperthyroid)
- Anemia (low red blood cell count)
- Hypoglycemia (low blood sugar)
- Vitamin deficiencies (Vit. B12, Vit. D, magnesium, etc.)
- Food allergies/sensitivities (gluten, wheat, dairy, casein, etc.)
- Chronic infections/molds/toxins
- Gut dysfunction (leaky gut)
- Medication side effects
- Sleep problems (insomnia, obstructive sleep apnea)
Things that can worsen the symptoms of brain fog include:
- Difficult mental tasks
- Lack of sleep
What is the underlying cause of brain fog?
The short answer is no one knows for sure. Two potential causes that I discovered thru my review of the literature are neurogenic inflammation and mitochondrial dysfunction.
Inflammation of the brain (neurogenic inflammation) has been implicated in many neuropsychiatric diseases including migraine headaches, fibromyalgia, chronic fatigue syndrome, depression and multiple sclerosis. Neurogenic inflammation is also thought to be involved in the pathogenesis of brain fog. (Theohariedes, 2016) (Orchard, 2017) A simplistic way to think about this inflammation in the brain is that it causes slowing of the neurons in the brain, kinda like potholes in the road would cause. When there are a lot of potholes on the road, you have to slow down, and you are not able to go as fast as the speed limit. When there is too much inflammation in the brain, the brain is not able to go full speed, and the symptoms that you might experience is brain fog.
The function of the mitochondria is to produce energy (ATP) for the body. Many chronic degenerative neurological diseases have abnormalities in the mitochondrial functional as an underlying cause. This includes migraine headaches, Alzheimer’s dementia, Parkinson’s disease, multiple sclerosis and chronic fatigue syndrome. Research indicates that mitochondria dysfunction may not only be an underlying cause of these diseases but also may be the cause of the fatigue that is also seen these disorders. When the mitochondria are not functioning well, they will produce decreased amounts of ATP. It is believed that this lack of ATP in the muscles, from the dysfunctional mitochondria, is the cause of the generalized fatigue. Just as the fatigue in the muscles is due to dysfunction of the mitochondria in the muscles, the brain fatigue or fog may be due to the dysfunction of the mitochondria in the brain. (Myhill, 2009)
Currently, there are not any recommended treatment guidelines for brain fog.
Standard medical treatment typically starts with medications:
1. Often medications are tried to optimize the treatment of the underlying medical condition that it is associated with. Such that patients that have migraine headaches; the treatment approach would be to optimize the treatment to help prevent headaches or treated the migraines more effectively.
2. The use of stimulants and antidepressants
- Remove any underlying causes of the “treatable causes” listed above
- Improve sleep
- Vitamin supplementation (Vit B12, thiamine, magnesium, Vit D, omega-3 fatty acids, exogenous ketone supplement)
- Dietary changes:
- Increase healthy fats such as omega-3 fatty acids and decrease sugars: Based on research in cancer patients and animal models it has been shown that increasing omega-3 fatty acids during chemotherapy decreases neuroinflammation and improves the complaints of brain fog. Eating a diet high in sugars however caused increased inflammation and worsened cognitive function. Thus increasing Omega-3 fatty acids (both EPA and DHA) and eating a low carb diet may be beneficial.(Orchard, 2017)
- If those treatments have not helped then the next step, I would recommend is not only eating low carb but also considering being on a ketogenic diet or taking exogenous ketone supplements*. Ketones have not only been shown to decrease inflammation but also improve mitochondria function.(Achanta, 2017) Clinically people who are in ketosis (either nutritionally from diet or from taking supplements) have reported less brain fog, better mental focus, and increased energy.
Achanta, L. (2017). Beta-hydroxybutyrate in the brain: One molecule, multiple mechanisms. Neurochemical Research, 42, 35-49.
Myhill, S. (2009). Chronic fatigue syndrome and mitochondrial dysfunction. Int J Clin Exp Med, 2, 1-16.
Ocon, A. (2013). Caught in the thickness of brain fog: exploring the cognitive symptoms of Chronic Fatigue Syndrome. Frontiers in Physiology, 4 (63), 1-8.
Orchard, T. (2017). Clearing the fog: a review of the effects of dietary omega-3 fatty acids and added sugars on chemotherapy-induced cognitive deficits. Breast Cancer Res Treat, 161, 391-398.
Raffa, R. (2011). A proposed mechanism for chemotherapy-related cognitive impairment (‘chemo-fog’). Journal of Clinical Pharmacy and Therapeutics, 36, 257-259.
Ross, A. (2013). What is brain fog? An evaluation of the symptoms of tachycardia syndrome. Clin Auton Res, 23, 305-311.
Theohariedes, T. C. (2016). Mast cells, brain inflammation, and autism. European Journal of Pharmacology, 778, 96-102.
*The Food and Drug Administration has not evaluated these statements. These products are not intended to are not intended to diagnose prevent treat or cure any disease. If you are under medical supervision for any allergy, disease, taking prescription medications or you are breastfeeding contact your medical provider before adding any new supplements to your daily regimen.
The medical information on this site is provided as an information resource only. This information does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.