This October it’s not just zombies that are suffering from brain fog. 

“Why did I just walk into this room?” “Where did I put my keys?” These questions probably sound familiar as most of us will have temporary lapses in memory or focus. But when the frequency of these questions becomes excessive, it may be time to discuss brain fog with a professional. Bringing it up to your integrative family medicine provider can open the door to discovering the possible causes. 

“Brain fog” is the common term used to describe cognitive difficulties. Whether it’s difficulty with memory, concentration or finding words, it can make activities of daily living seem overwhelming. Though it seems like its own monster, brain fog has been associated with many conditions including post-acute infections, thyroid dysfunction, chronic stress, autoimmunity, and more (1, 2). You have probably heard that COVID-19 and associated long COVID come with the potential for cognitive dysfunction. In fact, more than a fifth of those diagnosed have persistent cognitive symptoms (3, 4). 

There is not a specific test for brain fog. For this reason, conventional medicine practitioners may brush these symptoms under the rug leaving you feeling frustrated or worse: feeling like it is normal. Personally, this is what brought me to integrative family medicinespecifically, the amazing team at Integrative Family Medicine of Asheville! This practice model allows the time and space to look upstream for the underlying cause of an individual’s symptoms. 

A typical evaluation for symptoms of brain fog will include blood work and potentially imaging of the brain depending on the severity of cognitive difficulty and other associated symptoms. And though it may feel like there are tiny zombies inside your head munching on the goods, in most cases there does not appear to be any structural abnormalities of the brain. So if the brain itself isn’t changing (and there are no mini-zombies found on the brain scan), then what is the cause of these symptoms?

NEUROINFLAMMATION

Spooky, right? It means “inflammation of the brain.” Small proteins called cytokinesgood name for a horror flick: Attack of the Cytokines!have been targeted as a potential cause. They are released primarily from immune cells when damage or infection is detected and are actually good in small doses. Appropriate amounts of inflammation help heal and repair damaged tissue. It also protects us from viruses, bacteria and other pathogens. When it’s on overdrive or triggered chronically, however, the normal functions of the brain are disrupted (5, 6, 7). 

As previously mentioned, there are a number of things that can cause brain fog. Sometimes the reason is discovered, and other times it is less obvious. What do we do when symptoms persist after the infection has resolved, the thyroid appears stable, stress is well-managed, or there is no clear explanation for how we are feeling? 

We work to reduce overall inflammation. 

This can be done by removing things that cause inflammation or adding things that reduce inflammation. I prefer to focus on adding things in, as it’s usually no fun (and sometimes harmful!) to focus on taking things away.

For this reason, allow me to introduce your gutthe place where things can be added: Your gut is a place of digestion, absorption, and elimination when all goes well. It is estimated that 70-80% of our immune cells are located in the gut (8), and it is home to trillions (~100,000 trillion) of bacteria, viruses and yeastcollectively known as the gut microbiome. Your gut microbiome works WITH your normal systems to promote health. Sounds like a good place to start if we want to reduce inflammation triggered by our immune cells, right?

Let’s consider what can be done in our eating strategy to move the needle on inflammation:

Eating a variety of colorful vegetables is ALWAYS a good idea. Vegetables help feed the gut microbiome and provide our body with vitamins and other key nutrients. They contain antioxidants, and many vegetables have high levels of luteolin, a flavone that has been shown to have neuroprotective effects (9). Foods high in omega 3 fatty acids have been shown to improve cognitive function, as well (10). So get some anchovies, sardines, and salmon in your life! Bone broth is full of collagen and micronutrients that are essential for normal brain function; it can help your joints too, as it’s full of glucosamine and chondroitin. Make bone broth soups a part of your eating strategy or sip on some warm broth this winter.

Here are some other lifestyle factors that you can add to your list. They all have an impact on overall inflammation and cognitive function:

Sleep:
This may come as a no-brainer (ha ha), but getting 7-9 hours of sleep for most adults is critical to healthy brain function. While we sleep, our brain is able to flush out metabolic debris, including proteins associated with dementia (11, 12). 

Movement:
Regular exercise, including 30 minutes of walking every day, is helpful to improve brain function. It increases a molecule called brain-derived neurotrophic factor (BDNF), which is associated with memory and learning (13). 

Stress:
Finding ways to unwind that you enjoy is critical. This could be meditation, journaling, exercise or even listening to music. Be intentional about reducing your stressyour brain will thank you (1). 

Wading through even the most basic lifestyle changes can be challenging when you throw brain fog in the mix. Reach out to your integrative family medicine provider or integrative health coach to help guide you through specific changes that you intend to make. 

There are things you can do to improve brain fog… you shouldn’t have to feel like a zombie. 

  1. Kverno K. Brain Fog: A Bit of Clarity Regarding Etiology, Prognosis, and Treatment. J Psychosoc Nurs Ment Health Serv. 2021 Nov;59(11):9-13. doi: 10.3928/02793695-20211013-01. Epub 2021 Nov 1. PMID: 34714198.
  2. Mary H. Samuels and Lori J. Bernstein. Brain Fog in Hypothyroidism: What Is It, How Is It Measured, and What Can Be Done About It.Thyroid.Jul 2022.752-763.http://doi.org/10.1089/thy.2022.0139
  3. Ceban F, Ling S, Lui LMW, Lee Y, Gill H, Teopiz KM, Rodrigues NB, Subramaniapillai M, Di Vincenzo JD, Cao B, Lin K, Mansur RB, Ho RC, Rosenblat JD, Miskowiak KW, Vinberg M, Maletic V, McIntyre RS. Fatigue and cognitive impairment in Post-COVID-19 Syndrome: A systematic review and meta-analysis. Brain Behav Immun. 2022 Mar;101:93-135. doi: 10.1016/j.bbi.2021.12.020. Epub 2021 Dec 29. PMID: 34973396; PMCID: PMC8715665.
  4. Theoharides TC, Cholevas C, Polyzoidis K, Politis A. Long-COVID syndrome-associated brain fog and chemofog: Luteolin to the rescue. Biofactors. 2021 Mar;47(2):232-241. doi: 10.1002/biof.1726. Epub 2021 Apr 12. PMID: 33847020; PMCID: PMC8250989.
  5. Sartori AC, Vance DE, Slater LZ, Crowe M. The impact of inflammation on cognitive function in older adults: implications for healthcare practice and research. J Neurosci Nurs. 2012 Aug;44(4):206-17. doi: 10.1097/JNN.0b013e3182527690. PMID: 22743812; PMCID: PMC3390758.
  6. Zhang JM, An J. Cytokines, inflammation, and pain. Int Anesthesiol Clin. 2007 Spring;45(2):27-37. doi: 10.1097/AIA.0b013e318034194e. PMID: 17426506; PMCID: PMC2785020.
  7. Konsman JP. Cytokines in the Brain and Neuroinflammation: We Didn’t Starve the Fire! Pharmaceuticals (Basel). 2022 Jan 25;15(2):140. doi: 10.3390/ph15020140. PMID: 35215252; PMCID: PMC8878213.
  8. Wiertsema SP, van Bergenhenegouwen J, Garssen J, Knippels LMJ. The Interplay between the Gut Microbiome and the Immune System in the Context of Infectious Diseases throughout Life and the Role of Nutrition in Optimizing Treatment Strategies. Nutrients. 2021 Mar 9;13(3):886. doi: 10.3390/nu13030886. PMID: 33803407; PMCID: PMC8001875.
  9. Kempuraj D, Thangavel R, Kempuraj DD, Ahmed ME, Selvakumar GP, Raikwar SP, Zaheer SA, Iyer SS, Govindarajan R, Chandrasekaran PN, Zaheer A. Neuroprotective effects of flavone luteolin in neuroinflammation and neurotrauma. Biofactors. 2021 Mar;47(2):190-197. doi: 10.1002/biof.1687. Epub 2020 Oct 24. PMID: 33098588.
  10. Lewis JE, Poles J, Shaw DP, Karhu E, Khan SA, Lyons AE, Sacco SB, McDaniel HR. The effects of twenty-one nutrients and phytonutrients on cognitive function: A narrative review. J Clin Transl Res. 2021 Aug 4;7(4):575-620. PMID: 34541370; PMCID: PMC8445631.
  11. Zielinski MR, Gibbons AJ. Neuroinflammation, Sleep, and Circadian Rhythms. Front Cell Infect Microbiol. 2022 Mar 22;12:853096. doi: 10.3389/fcimb.2022.853096. PMID: 35392608; PMCID: PMC8981587.
  12. Reddy OC, van der Werf YD. The Sleeping Brain: Harnessing the Power of the Glymphatic System through Lifestyle Choices. Brain Sci. 2020 Nov 17;10(11):868. doi: 10.3390/brainsci10110868. PMID: 33212927; PMCID: PMC7698404.