Over the past few months, I haven’t been able to remember much. I know my name, what year it is and the current president, but I find myself continuously forgetting small things I shouldn’t. Like appointments and meetings and where I placed, well, almost everything. It’s not that I was ever particularly terrific at staying on top of mundane tasks, but they would always cross my mind at some point, which would then prompt me to make a mental note or write down whatever I needed to do. Nowadays, it isn’t until two hours after a scheduled appointment or an event that I realize I’ve completely missed it. My cognitive function, in general, has seemed to take a downwards turn as of late. My brain is severely jet-lagged. I’m often sluggish and unmotivated.
Over the past year and a half, researchers have been studying the effects COVID-19 is having on the brain. People sick with the virus or long haulers — those still experiencing symptoms weeks or even months after infection — have reported cognitive challenges associated with forgetfulness, confusion and lack of mental clarity. It’s a phenomenon most commonly referred to as “brain fog.”
Now I admit I’m a bit of a hypochondriac, and I cannot say for certain that the brain fog I seem to be experiencing is related to my own past COVID-19 infection. But I’m also not ruling it out.
Regardless of what is causing this fuzzy brain funk, though, I’d really like to get to the bottom of it, and if you’re experiencing a similar sensation you probably would, too. It’s why I spoke with Dr. James Giordano, a professor of neurology at Georgetown University Medical Center to get the lowdown on brain fog, why it happens and what, if anything, can be done about it.
What exactly is brain fog?
Notably not an official medical term, brain fog is a term used to describe “subjective feelings of mild disorientation, inability to concentrate, struggles with orientation of time of day and/or situations, problems with short-term memory and recall, difficulty in acquiring new information and some difficulties in what is clinically referred to as executive function, aka your daily tasks: remembering where you left your keys or how certain things work,” explains Giordano.
“So brain fog really represents exactly that fogginess in one’s ability to engage cognitive and motor skills, including but not limited to, learning, planning, memory and execution.”
Why does it occur?
Causes of non-COVID-related brain fog can be broken down into three categories: substance, situational and disease-induced brain fog.
“Probably the one that’s most known to everyone is the hangover effect. Hangover is a wonderful example of what brain fog would feel like. You’re not quite yourself, you’re having sort of problems getting up and going. You really can’t concentrate, you feel tired, but not sleepy tired, you feel fatigued,” Giordano says. Caffeine can also have a paradoxical effect on some people. Instead of feeling jolted, caffeine might cause you to feel tired and sleepy. Dairy products, particularly for lactose intolerant people, along with sugar, can prompt a drop in energy levels.
Next to substance-induced brain fog, shifts in metabolism throughout the day along with exercise and your body’s internal clock can be culprits.
“Some individuals find that during the course of their day, their metabolism shifts and as a consequence of those shifts, they have changed in the metabolic demands and supplies of their brain and they feel foggy. Some people feel brain fog before or after exercise,” he explains. “Some may experience what’s called circadian brain fog. They feel a little foggier in the morning, in the afternoon or in the evening. It’s just not daytime fatigue. It’s that their cognitive processes really seem to have these epochs, these periods during the day where they’re a bit sharper.”
A mild concussion or head injury can also produce a brain fog-like syndrome that can last days to weeks, and in other cases, individuals who suffer from a disease, most notably in inflammatory disease (including some infectious diseases) can have a brain fog syndrome that can last days to weeks to months, explains Giordano. Which brings us to …
The connection to COVID-19
“A disease like COVID produced by the SARS-CoV-2 virus has been known to have certain neurological effects and, as a consequence, some individuals experience COVID induced brain fog,” says Giordano, who adds that neurological effects of low level inflammation, both in the body and in the brain, is something he and other researchers are concerned about.
“This is called neuroinflammation, and we know that there are a number of conditions that can produce this low level, but progressive, inflammatory state in the brain, which can lead to certain structural and functional changes in the brain’s capacity in thinking, emotion and behavior. With COVID, this is certainly the case.”
COVID produces an inflammatory response in the body that occurs due to the immune reaction against the virus. The immune mediators the body cells release can travel and induce inflammatory effects, known as Cytokines, in the brain, which can cause symptoms associated with brain fog. In other cases, the SARS-CoV-2 virus itself can attach to angiotensin receptors that are present in neurological tissue, which can cause a direct neuroinflammatory cascade and prolong symptoms of the virus. “These are where you’re really seeing large levels of cognitive and behavioral impairment that are contributory to many of the neuropsychological long-term effects of what we now know as long COVID,” Giordano explains.
So can we do anything about it?
All of this is a bit scary. No one wants their brain fogged up ever, but especially for a prolonged period of time. And if you’ve been experiencing what feels like a never-ending cycle of fatigue and forgetfulness, it’s easy to just lie down and give your mind, body and soul to the fog entirely.
But not all hope is lost. There are activities, lifestyle changes and even drugs that can help with brain fog — starting with an anti-inflammatory regimen. This includes an anti-inflammatory diet, often a Mediterranean-type diet, one that’s rich in healthy fats and oils, fish oils, vitamin E and Omega-3. “We also know that anti-inflammatory drugs taken in moderation and certainly under supervision are equally important,” Giordano adds.
Preconditioning the body, Giordano explains, might also help reduce brain fog, which involves inducing a mild inflammatory state in the body that the body can then adapt to.
“For example, one of the beneficial effects of exercise is that it produces a mild inflammatory state that then acclimatizes the body to be able to respond more appropriately to then develop anti-inflammatory mechanisms. This essentially creates an adaptive, responsive, and resilient state,” he explains, adding that increasing levels of activity (daily walk, jog, yoga, etc) might be useful both in the short and long term. As discussed above, exercise could be a catalyst for brain fog, so understanding the relationship between your levels of activity, type of activity and experience of brain fog is important.
As always, though, if you find your symptoms are severely interfering with your daily activities, seeking some form of medical assistance is highly recommended.
“The thing that becomes important as with any neuropsychiatric sign or symptom is that you should always be referred to a clinician,” stresses Giordano.
What about brain fog supplements I’ve seen online?
Maybe you’ve seen dusts, elixirs and even chocolates from wellness brands like Moon Juice and Sakara, that claim to help with clarity, energy and concentration. These are what’s known as nootropics — any drug, supplement or substance that affects cognitive processes. Giordano tells me there is actually a lot of interest in and a fair amount of effort to explore, understand and develop more effective nootropic nutrition and even drugs.
Like all cure-alls touted by wellness brands, these types of nootropics sold by trendy health-focused lifestyle companies should be taken with a grain of salt. But they might not be a total hoax.
“[When] A particular commercial entity claims its product contains adaptogens — nutritional elements that have been suggested or shown to be nootropic — what we’re looking at is what is the truth in advertising? And there may be a lot of truth in advertising,” says Giordano.
“There are plenty of things that have been identified as potential adaptogens and even as nootropics. And we know that their activity has been shown in laboratory experiments to affect an individual’s capability because of some element of their cognitive skill set. Is it going to work for everyone? No. Many of these companies are putting a number of different agents together and trying to cocktail various adaptogens into a nootropic formula,” he adds.
I actually had the opportunity to test out Sakara’s Nootropic Chocolates, organic dark cacao bites with unrefined coconut sugar and natural peppermint that supposedly provide “instant energy, brain clarity and focus.” Now maybe it’s a placebo effect (which for the record, I’m totally on board with), how tasty the chocolates were or their legitimate ability to improve cognitive function naturally, but since popping 1-2 chocolates per day this week I have felt more awake, energized and focused. (And while I nearly missed a Zoom meeting yesterday, I remembered only two minutes after it started, which I consider an improvement.)
Of course, as Giordano notes, not every supplement, or even drug for that matter, will work for everyone.
“I think there’s sort of the search for the silver bullet, but it becomes very important for consumers to beware, to be wary of the quality control and where they’re buying their products, but only from reputable sources and also to do so in a way that is prudent and with caution.”
Ultimately, though, brain fog can be approached in a variety of ways — whether it’s an anti-inflammatory regimen or a few dozen nootropic pieces of chocolates — regardless of how it manifests. Now, you just have to find the right combination of products and lifestyle changes that work for you.