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When I was diagnosed with Hashimoto’s disease, I felt an overwhelming sense of relief. It finally gave me an explanation for some of the strange symptoms I had been experiencing—including brain fog.
As the name suggests, brain fog feels like your thoughts are wading through thick fog: It’s hard to concentrate, make decisions, or stay productive. Brain fog affected me throughout university, and it still affects me now that I’m working. Since it’s hard to pinpoint the cause of brain fog, it’s not always easy to treat, which can be incredibly frustrating.
“The term brain fog is often used to describe a decrease in alertness or mental sharpness,” says Ellen Wermter, a nurse practitioner at Charlottesville Neurology and Sleep Medicine. “This can translate into a number of measurable cognitive deficits from planning and organization to motivation and attention.” Wermter adds that brain fog could also result in forgetfulness, a lack of concentration, and a slower processing speed. As a result, you might struggle with communication and productivity.
“Typically patients complain that they just don’t feel like they are complete when it comes to mental function,” says board-certified neurologist and New York Times bestselling author David Perlmutter, MD. “They may experience memory issues, inability to multitask or even focus on a single task at hand, they are often easily distracted and find that their mental efficiency in terms of productivity is markedly reduced,” he explains. Perlmutter notes that a defining characteristic of brain fog is that it’s not consistent—it appears and disappears for no obvious reason.
Perlmutter and Wermter both note that brain fog isn’t a medically-recognized condition or a scientific term, rather, it’s a term used to describe a symptom which could be caused by a number of different issues. If you regularly experience brain fog, it might point to a serious health issue that needs medical attention.
What’s causing my brain fog?
Brain fog can be a symptom of multiple underlying health issues including the following:
Brain fog is a common side effect of certain medications. “Perhaps the most commonly identified cause of brain fog is medications, either singly or in combination,” Perlmutter says. Medications aimed at assisting with sleep, mood disorders, blood pressure, cholesterol, and more might cause brain fog, he adds. If you experience brain fog, and you think it’s because of a medication you’re taking, speak to your doctor about it. They might be able to prescribe a more suitable alternative.
“We are just beginning to unravel the chemical processes that are involved in allowing the brain to function moment by moment,” Perlmutter explains. “And what has become clear is that the chemistry that allows the brain to do its job effectively is actually very delicate. As such, medications are prime candidates for upsetting this balance and ultimately setting the stage for compromised cognition,” he notes.
“Sleep has a major influence on brain fog symptoms,” explains Wermter. “One of the processes that occurs during slow-wave sleep is a transfer of memories from a temporary and more fragile location in the brain into more long-term and stable storage,” Wermter explains. “The prefrontal cortex is the site in the brain where slow-wave sleep is generated, so changes there can have an effect on how much slow-wave sleep we are able to produce each night.”
Wermter points to two sleep disorder studies—one published in Trends in Cognitive Sciences and the other in The British Journal of Psychiatry—that show many patients experience the thinning of the prefrontal cortex. The prefrontal cortex is responsible for decision-making, memory, and social interaction. “This thinning may affect slow-wave sleep and memory, but may also have a more direct effect of impairing the function of that portion of the brain, leading to issues with planning, organization, decision-making, and so on,” Wermter says.
Mood disorders like depression and anxiety can cause brain fog. Perlmutter notes this could be because mood disorders sometimes disrupt sleep. It could also be a side effect of any medication you might take for mood disorders, he adds.
Mood disorders might also lead to inflammation, which could have a detrimental effect on your cognitive abilities. “New research is indicating that the process of inflammation seems to underlie many of the common mood disorders, especially depression,” Perlmutter notes. “And inflammatory chemicals, when they are increased in this situation, are profoundly detrimental in terms of both brain function as well as increased risk for brain degeneration in the future.”
Brain fog is associated with a number of chronic diseases, including fibromyalgia, chronic fatigue syndrome, postural tachycardia syndrome (commonly known as POTS) and rheumatoid arthritis to name a few. According to medical experts, there could be a few reasons for this relationship. Firstly, it’s believed that chronic disease affects sleep, which in turn affects brain function. Secondly, many chronic diseases are also associated with inflammation, which, as Perlmutter mentioned earlier, has a negative effect on our cognitive abilities.
Thyroid diseases, including Hashimoto’s disease, are also related to brain fog. “Thyroid disease affects brain function directly as the brain requires a ‘sweet spot’ as it relates to thyroid hormone. Too much, as is seen in hyperthyroidism, as well as too little, can both affect how the brain is able to do its job,” Perlmutter explains.
Additionally, he says it’s important that the correct amount of thyroid medicine is given to those with thyroid diseases because too much medication can also cause brain fog: “For example, [over-treating] a low thyroid situation by having too much thyroid medicine on board makes for a less functional brain.”
Food is the fuel for both your body and your brain, and healthy eating habits are important for your cognitive function. Without the correct nutrients, your brain will struggle to function.
“While weighing just 2 to 4 percent of total body weight, the brain may consume as much as 25 percent of total body energy use at rest,” Perlmutter says. “The process of converting fuel, like fat and carbohydrates, into energy is complex and requires a multitude of micronutrients like vitamins and minerals. So, a diet that makes any of these factors less available will directly compromise brain energetics and create a situation in which brain function suffers.”
Brain fog might also indicate that you have a food allergy or sensitivity. For example, a study on people with celiac disease noted that their brain fog eased when they followed a gluten-free diet, seemingly because avoiding gluten eased inflammation.
Experiencing brain fog could also be an indicator that your diet is severely lacking in certain vitamins or minerals associated with cognitive function, such as vitamin B12, omega-3 fatty acids, and vitamin D. Remember to speak to your doctor before you start taking any supplements, as supplements could interact with other medication you might be taking or conditions you’re working to treat.
How can I treat brain fog?
Since it can be caused by a range of issues, there’s no single cure for brain fog. The treatment plan you pursue has to address the root cause of the problem.
That said, there are a couple things you can do if you’re experiencing brain fog. Your first port of call should be to contact your doctor to discuss your symptoms and possible causes. If you’re on medication, it might be time for your doctor to ensure that your dosage is correct.
“Beyond that, looking at lifestyle choices like sleep, exercise, and diet may absolutely lead to symptom resolution,” Perlmutter notes. “Finally, a good medical evaluation to rule out any underlying disease is always a good idea.”
If you’re struggling with sleep-related brain fog in particular, there are a few things you can do to improve your sleep quality, Wermter says.
“If struggling to fall asleep, try not to feed the insomnia monster. The more attention you give him, the more he will rear his ugly head. Lie there and enjoy the quiet, or if you find yourself frustrated, get up for 30 minutes and do a quiet activity such as reading,” she says. “A poor night of sleep from time to time happens to most people and won’t significantly impact your health or functioning. Trust that you are not in danger of not sleeping; biologically, your brain will demand sleep.”
It’s also a great idea to follow good sleep hygiene rules, Wermter says. “Sleep in a dark, quiet, cool room and carefully control your exposure to light,” she suggests. “Getting exercise daily and spending some time in meditation are immensely helpful habits for sleep and health in general.”
If you often find yourself sleepy throughout the day, even if you’ve had seven hours of sleep a night, it might indicate that you need to see a professional about your sleep patterns. “For insomnia, a good marker is a problem initiating or maintaining sleep more than three nights a week for more than three months that is dissatisfying to the patient,” Wermter adds. “At that point, you are crossing over into a chronic situation and would benefit from a full sleep evaluation.”
How to Wade Through the Brain Fog and Get Stuff Done
Finding the root cause of brain fog is essential, but most of us can’t wait weeks, or even months, before we figure the cause out and start treatment, and some of us already know the cause of our brain fog but are in the throes of figuring out how to live with it. If you’re currently struggling with brain fog, there are a few things you can do to improve your productivity and focus, says Joe Bates, MD, a board-certified psychiatrist and the author of the award-winning book, Making Your Brain Hum: 12 Weeks to a Smarter You.
Bates explains that brain fog is often worsened when our brain is either tired or under-exercised. “It’s the ‘setting point’ of our mind trying to void out due to being overworked or even under-worked,” he explains. Much like our muscles, our brains need exercise. As with exercising our bodies, doing one exercise constantly is a recipe for fatigue. His advice: Change the nature of your activity or give yourself a break to avoid that fatigue.
Sometimes, our brain needs a rest, or at least a change, to feel refreshed. “If you’re tired, rest, even if that means you need to sit up and refresh and take three big deep breaths. You are training your brain and body to start paying attention [to] your surroundings: being mindful,” Bates says. He suggests setting a reminder on your phone to stop working and do something creative and engaging for 10 minutes each day. This could include learning a new language, working on a puzzle, listening to music, writing, or drawing.
Physical exercise can also clear your mind. “If you’ve been sitting for most of the day, rest may not be what you need—but a vigorous, kind-to-your-body walk,” Bates suggests. “Movement is such a great prescription for most foggy days as it raises serotonin levels.”
Another idea is to write out to-do lists or create a bullet journal. I find that using my organizer helps me beat brain fog, as it helps me focus on my tasks when my mind starts wandering. Since my memory isn’t great, to-do lists are very helpful. “Make sure you write a list in the morning of things you want to accomplish that day,” Bates suggests. “And make some of them are very do-able, such as ‘Make bed.’ This way you can scratch these things off your list, and your brain starts to feel completion for accomplishing something.” When you’re struggling to concentrate, revert to your list to keep yourself focused.
Again, remember that these quick fixes don’t address the root cause of brain fog, so self-care means seeing a doctor if you’re struggling with your cognitive function and energy levels and don’t know why. But, in the interim, these tips can help you power through those deadlines or errands, even when your brain isn’t cooperating.
Since I started treatment for Hashimoto’s disease, my brain fog symptoms have improved immensely. My brain fog symptoms are also less intense when I make an effort to get enough sleep and exercise. While brain fog can be frustrating and inconvenient, it’s important to remember that it can be eased.