More on brain fog in CFS and FMS

Jacob Teitelbaum, M.D.

Board certified internist and Medical Director of the Fibromyalgia and Fatigue Centers.


Brain fog is a classic part of chronic fatigue syndrome and fibromyalgia, presenting as:

1. Horrible short-term memory,
2. Difficulty with word finding and word substitution (e.g., substituting the word "fork" for "knife"), and
3. Occasional disorientation — Approximately 30 percent of those with CFS or fibromyalgia have episodic disorientation lasting around 30-60 seconds. This often occurs when driving or even turning down a supermarket aisle. It can feel scary, but is not dangerous. Though you may not know where you are (or are going) people seem able to drive or walk safely till it passes. This can also manifest as briefly not recognizing common objects or names (even of children).

In some cases, brain fog is mild.  For some, however, it can be severe and quite scary — especially in professionals who otherwise function at a very high level. Though standard testing will often not pick up the problem, in these cases the brain fog can make it difficult or even impossible to continue one's job.  It may even leave you concerned that you are developing Alzheimer's. But you're not. CFS brain fog is when you keep forgetting where you left your keys — Alzheimer's is when you forget how to use your keys!

Clearing the Fog
Poor energy production in the brain with associated alterations in blood flow, as well as alterations in neurotransmitters (brain chemicals like serotonin, dopamine or adrenaline), blood pressure, or blood sugar can all contribute to brain fog.

The good news? Brain fog responds very well to treatment with the SHINE Protocol. Let's look at the key issues and treatments.

1. Sleep — Getting eight hours of sleep a night is critical, but make sure your sleep, pain or other medications are not the cause of your feeling foggy the next day.  Add natural treatments at bedtime such as melatonin, calcium and magnesium. These are less likely to cause brain fog and will lower the amount of medications needed.
2. In men, optimize testosterone; and in women, estrogen and progesterone. If you get irritable when hungry, optimize adrenal support, as recurrent low blood sugar also can trigger brain fog.
3. If you have nasal congestion or sinusitis or irritable bowel syndrome (gas, bloating, diarrhea or constipation) you likely have Candida/yeast overgrowth, and this can leave you very foggy. If so, look into taking the medication Diflucan while avoiding sugar.   Probiotic pearls and anti-yeast herbals can also help.
4. Optimize your nutritional support with a good multi-vitamin supplement and take ribose — in a study of 257 CFS/FMS patients, a daily intake of ribose not only increased energy an average of 61 percent, but also improved mental clarity an average 30 percent and overall well being 37 percent.  Also ask your physician about B12 injections. If you have dry eyes, dry mouth or depression, increase your consumption of fish oil through supplementation or by having 3-4 servings of tuna or salmon each week.
5. Stay hydrated. If your mouth or lips are dry, you're dehydrated. It's amazing how the mind can clear significantly after simply drinking a glass of cool water. Getting fresh air and sunshine (in moderation — don't burn) can also help.
6. So called "energy drinks" loaded with caffeine and sugar are loan sharks.  Avoid them. Instead, drink 1-2 cups of tea (made from real tea bags or leaves — not the powdered/bottled stuff loaded with sugar). This is often enough to jump start your brain in a healthy way without crashing you later, and the antioxidants in 1-2 cups of tea a day help your CFS and overall health as well. 

Like CFS/fibromyalgia pain, brain fog responds well to treatment. The problem is largely that most physicians are simply not trained in these illnesses. Most of these treatments can be done on your own, and you can ask your physician to assist with those requiring a prescription. If they refuse, get a consultation with a Fibromyalgia and Fatigue Center (FFC) physician. 

With a little knowledge, you can get your brain back!

Another Study Showing CFS-Related Brain Fog Not "All In Your Head"
Meanwhile, the "you're crazy, it's all in your mind" school of thought on CFS continues to recede into ancient history. There were those who attributed the brain fog (and all of CFS) to depression — which was, well, crazy! Here is another new study showing that the brain fog of CFS and depression are not  related.

Study: The role of depression in cognitive impairment in patients with chronic fatigue syndrome
In the test, 57 women with CFS were evaluated for cognitive function using neuropsychological tests that measure mental acuity in areas such as ability to pay attention, to count forward and backward, auditory-verbal learning skills, executive functions, and psychomotor skills.

Participants were divided into two groups, with one group including those CFS patients who suffered depression (based on clinical assessment to determine scores on the Hospital Anxiety and Depression Scale) and the other including those CFS patients who were not determined to be depressed.

The results showed no difference between the two groups in their levels of cognitive deficit in performing attention and executive functions. Researchers therefore concluded that there was no link between depression and the cognitive impairments exhibited by patients with CFS.

References
The role of depression in cognitive impairment in patients with chronic fatigue syndrome. Santamarina-Pérez P, Freniche V, Eiroa-Orosa FJ, Llobet G, Sáez N, Alegre J, Jacas C. PubMed.gov. 2011 Mar 12;136(6):239-243. Epub 2010 Dec 9.