A Six-Step Approach to Reducing Brain Fog
By Eric Madrid MD
In this article:
There is no official medical diagnosis known as “brain fog.” However, it is a concern that physicians are frequently consulted about. In my own practice, patients have described not feeling like themselves, or having trouble making relatively simple decisions. I’ve noticed that many who report such symptoms also experience digestive issues, including bloating, diarrhea, and sometimes constipation — it is not uncommon for those with brain fog to have underlying irritable bowel syndrome or a leaky gut. In many cases, this may actually be the contributing cause of brain fog.
Common Brain Fog Symptoms
- Lack of mental clarity
- Poor memory
- Trouble processing information
- Fatigue, both mental and physical
- Depression and anxiety
Medical conditions commonly associated or contributing to brain fog (From most to least common)
- Irritable bowel syndrome/leaky gut
- Poor diet
- Medication side effects
- Chronic fatigue syndrome
- Iron-deficiency anemia
- Hormonal changes
- Sleep apnea
- Multiple sclerosis
- Alzheimer’s disease
- Parkinson’s disease
Often the cause of brain fog is a leaky gut. Focusing on gut health and ensuring that you are avoiding foods that you are sensitive to is an important health-management tool. A person with digestive issues should consider keeping a food diary in order to determine which foods cause reactions.
5 Rs To Gut Health
Those physicians who practice integrative and holistic medicine utilize the 5 Rs to optimize intestinal health and gut biodiversity: Remove, Replace, Reinoculate, Repair, and Rebalance.
Remove – Take the foods that you are sensitive to out of your diet. The most common culprits are dairy, wheat (gluten), soy, corn, and corn-related products such as high-fructose corn syrup (HFCS). Sugar, simple carbohydrates, pasta, bread, processed foods, and alcohol may also irritate the intestinal lining, especially when consumed in excess.
For some, removal of certain artificial sweeteners (aspartame, saccharin, sucralose) from the diet may help as they can potentially reduce beneficial gut bacteria and may cause diarrhea, bloating, and gas symptoms.
Replace enzymes/HCL (hydrochloric acid) - Some who wish to improve digestion will supplement with betaine HCL and/or pancreatic digestive enzymes. If a poor diet causes acid reflux, improving nutrition should come before any attempt to reduce medication. Reducing dependence on acid reducers, such a H2 blockers (ranitidine, famotidine) and proton-pump inhibitors (omeprazole, esomeprazole, pantoprazole), may be beneficial due to their potential long-term health effects. If you have been on these pharmaceuticals for more than a few months, you may need to wean off of them over time. (NOTE: Do not stop medications without consulting first with your physician. There are some medical conditions for which the benefits may outweigh the risks).
Reinoculate – Repopulate the gut with beneficial bacteria. Examples of healthy bacteria include lactobacilli, acidophilus, and bifidobacteria. Consuming a probiotic supplement at a dose of five to 50 billion units once or twice a day may be useful. In addition to bacteria, the beneficial yeast called saccharomyces boulardi may also help restore gut balance and microbial diversity.
However, taking these supplements without improving your diet will not help in the long term. When we eat nutritious foods, we also allow healthy bacteria and yeast to prosper in our intestines.
Repair - Dietary changes are recommended to help heal a leaky gut. The following dietary practices might help:
- Drinking bone broth
- Drinking kombucha tea
- Consuming kefir and/or yogurt
- Eating a diet high in plant-based-fiber (cabbage, kale, and avocados)
- Cooking with coconut oil, rich in MCTs or medium-chain triglycerides
- Eliminating grains, sugars, and processed foods
- Incorporating sprouted seeds like chia seeds, flaxseed, and hempseed
- Adding in more fermented vegetables, such as sauerkraut and kimchi, a staple food in the Korean food culture
Rebalance – Make positive lifestyle changes. Practice mindfulness and breathing exercises. Participate in stress-reducing activities such as mediation, yoga, and daily exercise. You can also drink a relaxing tea each night before bedtime such as valerian herbal tea or chamomile.
Fasting is the deliberate avoidance of food for the purpose of improving physical and mental health or seeking spiritual benefit. There are various ways to fast, but most who do will consume water, unsweetened teas, or coffee to maintain hydration.
During a fast, some may skip only a meal such as breakfast while others will fast for one day or more. Intermittent fasting is practiced by forgoing food for 12 to18 hours per day (sleep time is almost always part of fasting hours) while making sure to eat meals within a six- to 12-hour window. In a prior article, we discussed in more detail the benefits of fasting.
Engaging in physical activity is important to ensure a healthy mind and body. Humans are made to move but, unfortunately, many people around the world suffer from “sitting disease”, a sedentary lifestyle in which exercise is not routine. This not only results in weak muscles, tendons, and brittle bones but also poor memory and impaired gut health. Regular physical activity causes the body to make BDNF (brain-derived neurotrophic factor), a protein critical in the formation of new memory and keeping the brain sharp.
Getting quality sleep is important for overall health and mental clarity. Most people need six to eight hours of uninterrupted sleep — avoiding meals three hours before bed and abstaining from caffeinated beverages after lunch may be helpful.
Sometimes certain health issues can inhibit rest. For example, sleep apnea, which most frequently occurs in those who are overweight and obese but can affect anyone, is quite common. Those with this condition experience hundreds of “waking up” episodes during the night due to the brain’s inability to get adequate oxygen. Sleep apnea increases risk for fatigue, brain fog, daytime sleepiness, high blood pressure, and even heart attacks. It is important to consult with a physician if sleep apnea is a possibility.
For those who suffer from frequent insomnia, melatonin is sometimes helpful.
Humans have relied on the sun — and the energy it provides — since the beginning of time. However, over the last few decades, many people have started to think of the sun as a serious danger.
As a result of this fear, vitamin D deficiency has become an epidemic. Even in Southern California, where I live, four in five patients are low in this sunshine generated vitamin. I find it curious that in an attempt to prevent skin cancer, most of which are non-lethal, we have been avoiding the sun. Ironically, we now realize that lower blood levels of vitamin D are actually a risk factor for more dangerous chronic diseases.
Below we will discuss certain vitamins, adaptogens and nootropics which some take in an attempt to help with overall health, energy and mental clarity.
Multivitamin – take as directed on the label
Vitamin C – a potent antioxidant. Suggested dose: 500 to 1,000 mg per day
Vitamin D – 1,000 to 5,000 IU daily
Melatonin – 3 to 10 mg 2-3 hours before bed
An adaptogen is an herbal substance that helps protect a cell from damage caused by environmental and chemical stressors.
Ashwagandha – Animal studies have shown that ashwagandha can help improve energy levels and endurance. A 2015 study of athletes in Ayu showed that ashwagandha could help improve endurance and improve quality of life. Suggested dose: 500 mg once or twice per day
Licorice (DGL or deglycyrrhizinated licorice) – When most think of licorice, the candy — not an herb — comes to mind. However, studies have shown the herb’s benefits for decades, and it plays an important role in Traditional Chinese Medicine, where it is frequently used for those with adrenal fatigue, a common condition, associated with brain fog, in women. A study showed that licorice could help balance hormones in women with symptoms related to menopause. Hormone imbalance is a possible contributor to brain fog.
Panax Ginseng- Taken for a great number of medical conditions, this Korean plant has been used for over 2,000 years. Ginseng may help improve neurological health and brain function, according to a 2018 study in Alzheimer’s Research & Therapy. It can be taken as a supplement, herbal spice, and tea.
Rhodiola - This herb helps protect cells from oxidative damage caused by both environmental and climate stressors. A 2009 study in the Chinese Journal of Integrative Medicine concluded, “The combined herbal supplement of rhodiola and ginkgo could improve endurance performance by increasing oxygen consumption and protecting against fatigue.” This may be of benefit to someone who is experiencing mental dullness.
Nootropic is a term used to describe so-called “smart drugs” or “smart supplements” that can positively affect cognitive function and assist with mental clarity. According to a 2016 study in Evidence-Based Complementary and Alternative Medicine, nootropics can improve memory, alertness, creativity, and attention. This may be helpful for someone with brain fog.
Common nootropics include artichoke extract, bacopa monnieri, forskolin, ginkgo biloba, gotu kola, L-theanine, panax ginseng, turmeric, and xanthines. All have been discussed in a prior article. However, here we will discuss a few below in more detail.
Traditionally used in Ayurvedic medicine for its memory-enhancing benefits, bacopa has become more frequently used over the last decade outside India, due to studies showing its effectiveness.
A 2012 study in Evidence-Based Complementary and Alternative Medicine concluded,
“…Bacopa monnieri can improve attention, cognitive processing, and working memory….”
In addition, a 2014 meta-analysis study (a study that looked at several studies combined) concluded, “Bacopa monnieri has the potential to improve cognition, particularly speed of attention”. Similarly, a 2016 study concluded that a “statistically significant improvement was seen in the tests relating to the cognitive functions with use of Bacopa monnieri.” Suggested dose: As directed on the label
Forskolin is an herb used in Ayurvedic medicine. Traditionally grown in Thailand, Nepal, and India, this herbal extract comes from the plant called coleus forskohlii, which belongs to the mint family. Forskolin increases the body’s levels of cyclic AMP (cAMP), an important chemical that helps cells, including brain cells, to communicate and send messages to one another.
A 2013 study demonstrated that forskolin increased certain proteins in the brain that help increase brain cells to regenerate, improving memory. A 2017 study in Neural Regeneration Research demonstrated that forskolin could help protect the brain against nerve degeneration and damage from toxins. Suggested dose: As directed on the label
Gotu kola, also known as centella asiatica or asiatic pennywort, is a green, leafy herbal vegetable commonly consumed throughout Asia. It has been called the “herb of enlightenment”, and its use is described in the ancient Ayurvedic and Daoist medical texts.
A 2017 study in Neuroscience Letter also showed the active ingredient in gotu kola improved the nerves of the brain and helped preserve memory. Again, this herb may be beneficial for someone seeking to improve mental clarity. Suggested dose: As directed on the label
- J Med Food. 2002 Winter;5(4):211-20. Ashwagandha improves endurance in animal studies.
- Choudhary B, Shetty A, Langade DG. Efficacy of Ashwagandha (Withania somnifera [L.] Dunal) in improving cardiorespiratory endurance in healthy athletic adults. Ayu. 2015;36(1):63-68. doi:10.4103/0974-8520.169002.
- Hajirahimkhan A, Simmler C, Yuan Y, et al. Evaluation of Estrogenic Activity of Licorice Species in Comparison with Hops Used in Botanicals for Menopausal Symptoms. Ahmad A, ed. PLoS ONE. 2013;8(7):e67947. doi:10.1371/journal.pone.0067947.
- Lho SK, Kim TH, Kwak KP, et al. Effects of lifetime cumulative ginseng intake on cognitive function in late life. Alzheimer’s Research & Therapy. 2018;10:50. doi:10.1186/s13195-018-0380-0.
- Chinese Journal of Integrative Medicine. 2009 Jun;15(3):177-83. Epub 2009 Jul 2.
- Suliman NA, Mat Taib CN, Mohd Moklas MA, Adenan MI, Hidayat Baharuldin MT, Basir R. Establishing Natural Nootropics: Recent Molecular Enhancement Influenced by Natural Nootropic. Evidence-based Complementary and Alternative Medicine : eCAM. 2016
- Peth-Nui T, Wattanathorn J, Muchimapura S, et al. Effects of 12-Week Bacopa monnieri Consumption on Attention, Cognitive Processing, Working Memory, and Functions of Both Cholinergic and Monoaminergic Systems in Healthy Elderly Volunteers. Evidence-based Complementary and Alternative Medicine : eCAM. 2012;2012:606424.
- Journal of Ethnopharmacol. 2014;151(1):528-35. doi: 10.1016/j.jep.2013.11.008. Epub 2013 Nov 16.
- Kumar N, Abichandani LG, Thawani V, Gharpure KJ, Naidu MUR, Venkat Ramana G. Efficacy of Standardized Extract of Bacopa monnieri (Bacognize®) on Cognitive Functions of Medical Students: A Six-Week, Randomized Placebo-Controlled Trial. Evidence-based Complementary and Alternative Medicine : eCAM. 2016;2016:4103423.
- Biochem Biophys Research Commun. 2013 Feb 22;431(4):796-801. doi: 10.1016/j.bbrc.2012.12.122. Epub 2013 Jan 9.
- Mehan S, Parveen S, Kalra S. Adenyl cyclase activator forskolin protects against Huntington’s disease-like neurodegenerative disorders. Neural Regeneration Research. 2017;12(2):290-300. doi:10.4103/1673-5374.200812.
- Herb of Elightenment , accessed March 31, 2018 http://herbscoop.com/herbs-for-health/amazing-benefits-gotu-kola-enlightenment-herb/
- Neuroscience Letter. 2017 Apr 12;646:24-29. doi: 10.1016/j.neulet.2017.02.072. Epub 2017 Mar 6.