Published on September 10, 2024

woman scratching her head, looking confused.

Is it Brain Fog or Am I Just Forgetful?

“I feel like my thinking is foggy.”

“I’m just not as sharp as I used to be.”

When patients share concerns about brain fog with Dawn Flickema, MD, her first reaction is not to give them a cognitive evaluation. Instead, she begins by asking them questions about their sleep, eating, exercise and other lifestyle factors.

“I think of brain fog as a vague symptom,” said Flickema, with Avera Medical Group Integrative Medicine. “Unfortunately, so many different things can contribute to the root cause. I ask a lot of questions so we can figure out what may be causing brain fog and work to clear it up.”

Throughout the discovery process, Flickema is also trained to look for symptoms that may suggest brain fog is an indicator of something more serious. In these cases, she refers patients to their primary care physician who can help them determine the best next steps.

What Is Brain Fog?

Brain fog is a term applied to many symptoms that impact an person’s mental processing or cognition. Brain fog symptoms can show up differently depending on the individual. If you have brain fog you may experience one or more of these symptoms:

  • Difficulty focusing or concentrating
  • Confusion
  • Mental fatigue
  • Forgetfulness
  • Losing your train of thought
  • Trouble word finding
  • Slower thought processing and reaction time
  • Trouble paying attention

Possible Causes of Brain Fog

Understanding the root cause of brain fog allows women to make lifestyle modifications that can lead to increased brain clarity. Here are things that could be an issue:

  • Not getting enough sleep
  • Poor diet filled with processed foods
  • Autoimmune diseases
  • Hormonal changes
  • Stress and cortisol levels
  • Prescription or over-the-counter drugs
  • Environmental toxins

brain fog illustration.

Lifestyle Changes that Help Brain Fog

The solution may be easy depending on your root cause. Here are some key things Flickema looks at.

Are You Getting Enough Sleep?

The brain flushes out metabolic toxins during sleep. “It makes sense that as our body’s biggest consumer of energy, the brain, also makes the most metabolic byproduct,” she said. “Without enough sleep, there is not enough time for your brain to accomplish one of the most important physiological functions. Basically, without enough sleep your brain is floating around in toxic soup.”

Flickema encourages her patients to take a weekend morning when they have no place to be and log how long they would naturally sleep without an alarm waking them up. “Most of us need about seven hours of sleep,” Flickema said. “You should wake up in the morning feeling refreshed.”

What’s Your Diet Like?

Eating habits also impact brain fog, explained Flickema. “Your brain is the highest consumer of energy in your body. If you are not feeding your body good nutrition, your brain is trying to function on an empty tank.” Flickema asks women to think about their diet.

“The standard American diet tends to have a lot of ultra-processed food and not much nutritional content to benefit our bodies,” Flickema said. “If you knock those foods off your list and replace them with whole foods, fruits, vegetables, meats and healthy grains, it can help your brain function better.”

Working with a health coach can help patients create a nutrition plan and stick with it, and address other lifestyle changes.

Are You Exercising Enough?

The stress hormone cortisol may be a contributor to brain fog. “When we are under higher levels of stress, it changes the hormonal balance in your body,” Flickema explained. “Increased cortisol levels contribute to brain fog and fatigue.”

Exercise is a practical way to reduce the impact stress has on our bodies. “Exercise helps your body down-regulate cortisol and other stress hormones,” Flickema said.

What Medications Do You Take?

Sometimes a correlation can be made between the onset of brain fog and when a patient began taking a prescription or over-the-counter medication. “Depending on the patient, many classifications of antihistamines, mental health medications and pain medications can impact an individual’s mental clarity,” Flickema said.

If you think medication is the root cause of your brain fog, ask your primary care doctor to review your medications.

Hormonal Changes and Brain Fog

Not only can hot flashes impact sleep, but research shows decreasing estrogen levels can impact cognition. “If a woman is struggling with hormonal changes to the point where it is disrupting their sleep at night and causing brain fog during the day, it may be worth investing in hormone replacement therapy,” Flickema said. “A lot of new research is coming out and looking at hormonal therapy’s impact on cognition.”

Flickema added that research shows 10 minutes of mindfulness or meditation can also help with symptoms of perimenopause and menopause.

Consider Environmental Toxins

Environmental toxins may contribute to brain fog. “Although we cannot always control the toxins in our environment, we do have some control over the toxins we consume,” Flickema said. Drinking filtered water is an easy step to take to reduce intake of toxins. “A good water filter is a good investment in long-term health,” Flickema said. “It can be as simple as an inexpensive water pitcher with a filter.”

Get Help for Brain Fog

An Avera provider can help create a plan for symptoms of brain fog.