We caught up with nationally recognized, New York-based neurologist Dr. Gayatri Devi to get some answers on what is going on clinically behind the cloud of brain fog and how to get help.
Many of us women in our forties and fifties can relate to that feeling of memory slipping momentarily—searching for the iPhone while we are talking on it, struggling to recall a name or a word, walking into the kitchen and forgetting what we were there to do, or feeling unable to focus on the task at hand. Some people (and even physicians) may dismiss these symptoms as a natural part of aging or even misdiagnose them as attention deficit disorder.
But the malady known as “brain fog” has an unexpectedly long list of potential causes: hormonal imbalance due to pregnancy or menopause, head injury, medications, disease (from Covid-19 and Lyme disease to multiple sclerosis and thyroid conditions), stress, lack of sleep, even diet. Sure, dementia can be a cause too, but it is unlikely for women in younger age brackets.
“Everyone is worried that brain fog is symptomatic of early signs of dementia,” says Dr. Devi. “But in your forties and fifties that’s a very, very small percentage of people—extremely small, less than .5 percent. In most people, the brain fog can be diagnosed and treated.”
Here is more of our conversation, which delves into clinical causes, testing, treatments and prevention.
JVBCOM: Top line, do you feel that brain fog is often dismissed, even by some physicians?
Dr. Gayatri Devi: I actually saw a patient yesterday, who was a very stark example of exactly what you’re talking about, and I wrote down what she was saying, because I was so upset by it. She is 44 years old, and she had a partial hysterectomy last year. After that, she began to have trouble, saying, “I started to notice little things about forgetting; I was doing things, where I felt like I was being stupid.” She found herself stopping at green lights. When she needed to get gas, she got so nervous that she had to call her husband and ask him to follow her home, even though she had lived in that community for a decade. She was having trouble finding words.
So she went to see a doctor, who she has known since she was very young. The doctor told her, “We’re not even having an intelligent conversation right now, and I don’t know how you’re going to function in your job.” She worked as a teacher, and he told her that she should take a leave of absence. But she was so concerned about her ability to function that she actually resigned from her job, even though she had been teaching for over 20 years.
Then she tried to see a series of doctors. The last doctor she saw specializes in memory disorders. He listened to her and said, “Do you have any trouble in your marriage?” And she said, “No, we’ve been married for 20-some-odd years, and I can count on the fingers of one hand the number of times we’ve had an argument.” But the doctor said, “Well, how come your husband is not here with you?” He basically assumed that they were having issues and didn’t believe that she had a real memory problem. He thought it was all stress related. She left the appointment, pulled over to the side of the road and started crying. The reason she was having all these problems was obviously related to her hysterectomy, and she needed to go on some hormones.
“What’s going on in the brain is ultimately always just one thing: The networks aren’t functioning in the way that they should. The traffic flow of information is somehow not as smooth, and that can be for any number of reasons.”
JVBCOM: There are so many unexpected causes of brain fog, but can we dive into the causality of lifestyle?
GD: Absolutely. Our world is geared, so that we kind of think of ourselves as machines. Just like we turn our cellphones on and off—unfortunately, none of us turn off our cellphones—we think that we can also power our brains on and off. In the morning, we set alarms and drink coffee or take stimulants to power our brain on; in the evening, we take a sleeping pill or sedatives to try to power our brain off. And that’s not how our brains are meant to work. Our brains are very organic. Each of us has our own personal sleep cycle. We need to naturally get our brain to a place where it’s rested and then be alert naturally. The lack of proper sleep is a reason we have brain fog. Imagine if you are stepping on the accelerator and the brake at the same time in your car; you are going to run down the engine. So that’s what we are basically doing to our brain. And then people are expecting their brain to kind of run a marathon without any training every single day for the whole year for many years in a row.
JVBCOM: And now there is the growth trend of cannabis and CBD products said to assist with sleep, but we have read recently that they can be similar to alcohol in terms of interfering with sleep quality.
GD: One hundred percent. CBD is being promoted without any regard. Half the dogs in Central Park are on CBD. I’m serious. Because they are puppies and they are exuberant, their owners put them on CBD. Or the owners are nervous and cranky and they are responding to that. And they say, “Oh, the dog is very well behaved!” That’s because the dog is half “drunk” all of the time. Yes there is a role for CBD in some limited cases. But the way it is being used right now indiscriminately in all kinds of situations is, I think, a real problem. And there’s a huge lobby to promote it. It is like vaping. We know that vaping can kill people, and there is data now that shows that it damages the lungs. Yes, it’s better than unfiltered tobacco, but we don’t really know what the long-term effects are.
JVBCOM: What are the clinical causes of brain fog—inflammation, plaque on the brain, decreased blood flow—what’s going on that makes us feel this way?
GD: What’s going on in the brain is ultimately always just one thing: The networks aren’t functioning in the way that they should. The traffic flow of information is somehow not as smooth, and that can be for any number of reasons. In a dementia such as Alzheimer’s, it is because the nerve cells are dying. In menopause-related cognitive impairment—which I call MERCI (a double entendre as in to be merciful, but also “merci” as in “thank you for recognizing this condition”— It is basically that you need a brain where all the hormones are exactly fine-tuned for it to function well. When you have a situation like significant depression or not enough sleep, then the neuronal networks start to get sluggish. Imagine a busy city like New York City or Tokyo and some traffic lights aren’t working well. You can have roadblocks or plaque piled up in different parts of the avenues. It slows the flow of information.
JVBCOM: What are the differences in male versus female brain fog and have you noticed a higher percentage of cases in one sex?
GD: As a rule, in my experience, women are the ones who come in with trouble with language and multi-tasking, trouble finding words. It’s the rare man who will say that. A lot of us women get to where we are because we are able to express ourselves. Men have less of a verbal repertoire on average than women do. So imagine a woman in her forties or fifties in an executive position, and she got to where she is because of her ability to be articulate. Then, suddenly, her ability to be and sound cogent and logical is no longer there. So it can be very frustrating.
JVBCOM: What types of testing do you do to diagnose brain fog and what is your advice on treatment?
GD: First, you have to do a good general exam that can help to determine what the problems are, and then you do further lab testing for accuracy. If someone has a head injury, we can do brain exercises—physical therapy for the brain to figure out where the problem lies. It has to be multi-modal. A lot of times, we do medications plus some brain training. If someone has depression or stress or hormone imbalances, we can treat that. We also do brain scans or spinal taps or functional image scanning in some patients to make a diagnosis.
JVBCOM: Give us some tips on prevention; I see that you suggest a baseline brain evaluation for people in their forties and fifties for comparison later in life.
GD: Yes, it is good for people in their forties and fifties to get a picture of what their brain is like— strengths and weaknesses—through cognitive testing. We think we know what they are, but I tested a woman in her eighties, who told me that she was not the brightest person in the world. She was a homemaker and liked to decorate her home. Well, we found out that she was a genius. Her overall ability was really high, her memory was fantastic, and she had amazing visual-spatial skills. She could have been a great architect, if she only had nurtured her brain that way.
I can see a kid and say, “She is going to be really good at robotics” or “He is fantastic with visual-spatial skills.” We are really parsing out the different brain regions through a series of standardized questions, and that is kind of nice to know, because it can help you. We came to it from the path of illness, but you can also use it for wellness.
JVBCOM: Can one go to any neurologist or do this baseline testing virtually?
GD: We can now do this testing virtually, since the pandemic. You can see a cognitive neurologist or a neural psychologist or anyone who works in a memory disorders center. Some geriatrician practices have the ability to do this, too.
JVBCOM: Any other tips or advice?
“Don’t get stressed out when you forget, because we are all supposed to forget.” Forgetting is very important for our brain to be able to organize.”
GD: Women have a lot of gut issues, and I’m a big believer in probiotics; our diet has been so sanitized and factory farmed. It affects inflammatory processes in the brain. A lot of aerobic exercise to increase blood flow and remove some of the toxins—just like a good night’s sleep. And a Mediterranean diet, as diets high in refined carbohydrates can cause insulin resistance, which can contribute to brain fog. Also, I always tell people, “Don’t get stressed out when you forget, because we are all supposed to forget.” Forgetting is very important for our brain to be able to organize. Forgetting is like closet organizing. It throws out the things that you don’t need or that you put away in storage downstairs. And then you bring them out when you need them. But you kind of know where they are before you give them away. And then you give it all away to charity or you just get rid of it. But you have got to have a very organized closet. Forgetting happens all the time for all of us. When we have tons and tons of bits of information every single day, it is easier for us to forget. We put so much emphasis on remembering that we forget that forgetting is very important, also.
JVBCOM: And then the anxiety probably triggers the forgetting or the brain fog even more. There is such a stigma in our culture about forgetting.
GD: Yes, because then we are like, “Oh my God, I’m incompetent; what’s wrong?” I had a wonderful quote from a patient of mine, who I saw earlier today. She put it so beautifully, saying, “My initial shock about becoming a drooling person, who needs to be fed pureed vegetables, has passed on. And I feel very competent.”
Brain Health Checklist1
Get some baseline testing done with a cognitive neurologist or neural psychologist to get a picture of where your brain is at now, which can help diagnose, and be used for comparison later in life.2
Take a holistic approach; with your doctor(s), look for factors that could be impacting neural function like stress, sleep disruption, medications, and especially hormones for women.3
Get grounded by practicing mindful techniques to calm the mind and combat stress, like reading The Power of Now by Eckhart Tolle and viewing his three-part Conscious Manifestation miniseries, launched in 2020 on Youtube.
Some of our favorite mindful apps include Headspace, for guided breathing exercises and sleep meditations, and Luminosity, with games that focus on improving attention, multi-tasking skills, memory, problem solving, speed of information processing and more. We also love using breath work techniques throughout day.
For gut health, try a daily dose of probiotics in the form of yogurt, Yakult non-fat probiotic drinks, or a probiotic supplement. If remembering to take your vitamins sometimes escapes you, try kombucha beverages— we are into Los Angeles-based Health-Ade Kombucha — their Plus offering targets specific needs like Belly Reset.
Take at least one daily serving of Omega-3 fish oils to support brain health. When choosing a supplement, look for a formula that contains a high concentration of both EPA and DHA fatty acids, where and how the fish is sourced, and freshness. For an ocean friendly alternative, look for full spectrum algae and flax seed based sources.
Add a spritz of balancing aromatherapeutic energy to your life. Lin Chen’s New York-based company Pink Moon (focused on boosting self love through aromatics) has just introduced a trio of clean perfume oils. Each bottle is infused with charged gemstones energized by reiki master Jackie Ho; the Drops of Sunshine Perfume Oil, with charged yellow topaz, features uplifting notes of orange and mandarin balanced by lavender, rosemary and cedar wood. Arizona-based vegan hair care brand MO MI has a line of organic, botanic water Personal Space mists, including Clarity, a mix of ylang ylang, eucalyptus and bamboo designed to help improve focus. Tata Harper offers an aromatherapy set for daily peace with blends for irritability, stress, energy and a bedtime treatment.
Transform bathing into a therapeutic, relaxing ritual with meditative sounds and wellness-focused bath products designed to clear the mind–read all about our favorite ways to bathe mindfully here.