Brain Fog, Lifestyle Factors, And Supplements for Brain Health

Declining mental clarity and cognitive impairment often start with subtle symptoms that are easy to miss and often disregarded or dismissed. Sadly, more people are experiencing cognitive decline, and at younger ages than previous generations.
For people with multiple sclerosis (MS) and other systemic autoimmune diseases, thinking problems and/or cognitive decline are one of the more common reasons for leaving the work force.¹

Changes in cognition start out simply — it may be more difficult to recall names or recent conversations; take longer to learn new things; or become challenging to follow directions with more than one or two steps. Reading dense novels or nonfiction books may become less enjoyable because it’s harder to keep track of the details. You might find yourself struggling to manage the intricacies of your job or navigate delicate workplace relationships.

In this blog, I’ll review how these symptoms show up in everyday life, how I evaluate cognitive function in my clinic, and what steps you can take to improve your mental clarity and reduce the risk of cognitive impairment.

Brain Fog: The Invisible Symptom

When I was running the Therapeutic Lifestyle Clinic at the Iowa City Veteran Affairs Medical Center, we treated people with a wide variety of chronic conditions—traumatic brain injury, diabetes, heart disease, autoimmune disease, obesity, chronic pain, anxiety, depression, post-traumatic stress disorder, and more.

But the most common issues we heard about across all these conditions were brain fog and fatigue — and since the COVID-19 pandemic of 2020, the frequency of these problems has markedly increased.

Mild cognitive impairment, Alzheimer’s, and other forms of dementia are now being diagnosed in the 40s for some people. Scientists recognize that the biochemical processes that lead to declining memory and cognition begin around 30 years prior to a diagnosis of dementia; that means most of us have a 30-year window to protect our brain health.

Medications linked to brain fog

Before making any changes to your diet, lifestyle, or supplement routine, it's worth taking a look at what's already in your medicine cabinet. Several commonly prescribed medications are linked to a greater risk of brain fog and cognitive decline — and your doctor may or may not have flagged this connection.

If you're taking any of the following, it's worth having a conversation about alternatives.

Anticholinergic medications

These block the neurotransmitter acetylcholine and are often prescribed as antihistamines, antidepressants, and bladder control medications. Anticholinergics can affect learning and memory. Examples include diphenhydramine (Benadryl), amitriptyline, and oxybutynin.^2,3

Benzodiazepines

Used for anxiety and sleep, these medications can impair thinking, especially in older adults. Examples include Valium and Ativan.³

Sedative hypnotics

Also used for sleep, medications such as zolpidem (Ambien) can cause cognitive issues, particularly in older adults.³

Antipsychotics

These are used for severe psychiatric conditions such as schizophrenia and bipolar. They can increase sedation and cognitive problems. Examples include risperidone and olanzapine.²

Opioids

While they relieve pain, long-term use can cause drowsiness, cognitive impairment, and addiction. Examples include oxycodone and codeine.⁴

Proton pump inhibitors

Used to reduce stomach acid, some studies link these to a higher risk of dementia and cognitive decline.5 These drugs make it harder to absorb cobalamin (vitamin B12), an essential brain nutrient, and contribute to the development of dysbiosis (i.e. bacterial imbalance in the gut which contributes to development of chronic disease.)

If you take any of these medications, ask your physician about alternative strategies to manage your symptoms. Let them know you’d like to work together to find a solution that will protect your brain health.

How to Treat and Prevent Brain Fog with Lifestyle Changes

One of the most challenging aspects of brain fog and cognitive impairment is that it becomes even more difficult to engage in the behaviors and actions that help to alleviate it. That said, there are many things you can do to support better brain health. Here are some factors to consider.

Quality sleep

Insufficient and/or poor-quality sleep will worsen brain fog.⁶ If sleep is an issue for you, do what you can to improve it. Do you snore? Did you have braces as a child, or have crooked teeth? You may have obstructive sleep apnea.

Talk to your primary care team about your sleep. You may benefit from a sleep study or a referral for Cognitive Behavioral Therapy - Insomnia (CBT-I) to help you better manage sleep hygiene.

Regular exercise

Regular movement helps improve mental clarity and thinking.⁷ Even just getting up and taking a few steps every hour or doing a few deep knee bends can make a difference!

Mindfulness/Meditation

Chronic stress increases your risk of cognitive decline; mindfulness or meditation can help reduce the risk of dementia and increase gray matter volume.⁸ You could check out the various paid and free meditation and mindfulness apps to provide accountability and a more structured practice.

Decrease alcohol consumption

Excessive or binge drinking significantly increases risk for early dementia.⁹ Limit alcohol to less than one drink (e.g. 4 ounces of wine) per day and not every day.

Nutritional Changes to Protect Your Brain

The brain needs plenty of vitamins, minerals, essential fatty acids, and amino acids to function well. It does not need all the ultra-processed foods that most Americans are eating. The average American diet has only 1.5 servings of vegetables, with 60% of calories coming from added sugars and white flour which have been stripped of vitamins, minerals and essential fats (70% for children).

The most important first step is to eat more non-starchy vegetables and berries. Next, try to add more nuts, spices, and grass-finished meats and wild fish for the omega-3 fatty acids. Consuming added sugars and flour-based products increases risk for early dementia, while eating more whole, natural foods supports better brain health.¹⁰

These recommendations are consistent with the Wahls Protocol® and the Wahls Paleo™ diet. If that seems like too much right now, try focusing on adding one food at a time, like greens or berries. Another fun family activity is to explore other cultures by preparing meals from different parts of the world, sampling different flavor profiles and preparations.

At the very least, cutting down on alcohol and sugar consumption will make a big difference in your cognitive function.

Supplements to Support Better Brain Health

Once you've addressed the lifestyle and nutrition factors above, targeted supplementation can provide additional support for brain health. The following three supplements are ones I recommend regularly in my clinical practice for people dealing with brain fog and cognitive concerns.

D3K2 5000

This is a formulation containing highly bioavailable vitamins K2 and D3. It’s especially recommended for people who need a more substantial presence of K2.

Vitamin K2 helps the body remove calcium from the blood vessel walls and send that calcium into teeth and bones.14 It also improves blood flow the brain and supports the building and repair of myelin.¹⁵ Vitamin K2 levels are low in people with MS (relative to controls).¹⁵

Low vitamin D levels are associated with increased cognitive impairment for people with MS,¹¹ while optimal levels are linked with better cognition, better information processing, and increased brain volume.¹² People with MS who were given vitamin D supplementation (according to their baseline vitamin D level) experienced significant improvement in cognition as measured by neuropsychological testing.¹³

Taking a combination of vitamins D and K2 is good support for improving brain health. In my clinical practice, I continuously check vitamin D levels and adjust the dose to get my patients into the top half of the reference range. The most common dose for Caucasians is 5000 IU. People with darker skin will often need a higher dose.

MindFuel Omega

Omega-3 fatty acid blood levels are a key predictor of cognition and of brain volume.^16,17

The human body lacks the enzymes required to make omega-3 fatty acids; we must consume them from outside sources. Fish oil is rich in eicosapentaenoic acid (EPA)—which is important for mood and a key antioxidant and anti-inflammatory—and docosahexaenoic acid (DHA), a part of cell membranes essential for healthy myelin. DHA is also key for the development of the infant brain.

The vegetarian source of omega-3, alpha linolenic acid (ALA), is found in plant-based oils like flax oil. Your body can convert only 5-7% of the ALA in your diet into EPA and DHA, making it far less efficient and effective. Taking fish oil is preferable if you can.

Activated B’s

The brain uses a massive amount of energy in the form of adenosine triphosphate (ATP) to power processes like thinking, sensing the world, and initiating movement. The making of this ATP is facilitated by B vitamins and their associated minerals.

In a study on aging and the relationship between nutrient levels and cognitive health in people who did not have dementia, researchers found that the blood levels of B vitamins (thiamin, riboflavin, pyridoxine, folate, cobalamin) and other nutrients predicted 75% of brain volume and cognition.¹⁷

B vitamins must go through an activation step before they are fully functional, and there are some relatively common genetic variants that dictate how effective we are at this process.18

This is why I recommend taking activated B vitamins. Ideally you should also measure your homocysteine level, folate, and cobalamin levels, and adjust your B vitamin intake to hit these benchmarks:
Homocysteine level: Less than 10 micromole/L
Folate and cobalamin levels: in the top half of the reference range

Conclusion

If you feel like you’re not as mentally sharp as you should be, it’s important to notice this and take action. Check in with your medical team. Are you on any medications that may be contributing to memory problems and brain fog? Are there diet and lifestyle factors that could be addressed?

Once you’ve examined those factors, look into proper supplementation to support brain health. D3K2 5000, MindFuel Omega, and Activated B’s can be helpful for improving memory and reducing brain fog. Ideally also check in with a practitioner who is trained in functional medicine and the Wahls Protocol®.

There is so much we can do to support better brain health, and you deserve to run at full capacity for as long as you can.

Citations

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