How to reduce brain fog

Natasha: Hello and welcome back to The Rest Room, the podcast about living well with chronic illness. I’m your host, Natasha Lipman. 

Thanks for joining us for part 2 of our brain fog series. If you missed part one, I recommend going back and listening to that first. In it, my guest Dr Sabina Brennan explains what brain fog is… 

Sabina: Well brain fog’s not a disease. It’s not a disorder. It’s not a diagnosis. That’s important to kind of say. It is however, a sign that something is missed and a signal to take action.So really I use the term, brain fog, as an umbrella term to describe a collection of symptoms and that’s probably why you get so many different answers from people, as to what brain fog is.

Brain fog generally is associated with loss of mental clarity, an inability to focus or concentrate, and you’ll see problems with learning and I don’t mean academic learning. I mean, just learning in the ever everyday sense and remembering also big problems with slowing of thinking and issues with language, word-finding is quite common, and trouble navigating spaces, which a lot of people would describe as clumsiness. And then just a very general mental fatigue.

Natasha: We also learnt about some of the science behind why brain fog occurs…

Sabina: The frontal lobes of your brain, they were actually, from an evolutionary perspective, the last part of the human brain to evolve. And they are a very, very well connected part of the brain. They’re connected bidirectionally to almost every other part of your brain and they’re involved in the very complex functions that, in a way, separate us from other species. Complex functions like being able to plan, to organise, to make decisions, to assess risk. It has to take … That part of the brain accesses all the information we have about various things from our senses, from our memories from previous experiences. And so, if you have impairment to executive functioning, if that’s part of your brain fog, it can really be quite debilitating and people tend to think just cause they’re what we call higher order functions, they’re complex, people think, Oh, that might mean … Oh gosh, they’ll affect when you’re making decisions about a work complex decisions about how to do X, Y, Z, but they will apply to making decisions about what to have for dinner.

Natasha: In this episode, we’re taking a look at the four main factors that contribute to brain fog and what we can do to help reduce it. I’m once again joined by Sabina, who is a neuroscientist, health psychologist and the author of the book ‘Beating Brain Fog’.

According to Sabina, when it comes to brain fog there are four main lifestyle factors which can affect it: exercise, diet, stress and sleep. But what if you have an underlying health condition?

Sabina: In terms of underlying causes, I know that the majority of your audience are people who have some sort of chronic health condition. That’s one of the main underlying causes of brain fog, but there are multiple other factors that bring about brain fog, or exacerbate it or make it worse.

I think often, for many people, multiple factors at play, do you know what I mean? Even if you identify it’s your autoimmune disease or your inflammatory disease or your chronic pain or whatever it is that gives rise to it, there may be other factors in your lifestyle that are adding to it or actually just create the tipping point that actually if you sort those lifestyle factors, the fog that’s caused as consequence of your condition, may not be as bad.

Natasha: Which is why, today, we’re going to explore those 4 factors, but we’re going to do it with an understanding that it’s not easy for people with chronic conditions, and offer tips and tricks for how to slowly, safely and sustainably work towards changes that may help with your brain fog. 

As always, use your own knowledge of your body, your health, your lifestyle and your abilities here, and seek medical support if you want to consider making changes. For example, if Sabina mentions doing something for 20 minutes, and you can only manage 2, that’s totally fine!  

So, Let’s start with diet. I know that what I eat impacts how I feel, but when it comes to both the physical act of cooking and figuring out what foods make me feel best, it can be a real challenge. 

And as Sabina explains, taking the time to think about what we eat can make a big difference… 

Sabina: Your brain only weighs 2% of your body, but it consumes about 25% of the nutrients circulating in your body at any one time. So it’s a really, really high energy organ, and it gets its energy from the food that you eat. That’s another really, really good way that you can help to minimise brain fog. And that is by eating a brain-healthy diet.

The best evidence for brain healthy diet is a Mediterranean diet, lots of colourful fruit and vegetables, pulses, nuts, oily fish, get your fat from olive oil. There are a couple of deficiencies that can bring about brain fog, so it is important to rule those out. A vitamin B12 deficiency can actually bring about really, really, really severe brain fog. In fact, so severe sometimes that it can mimic dementia.

And often in older adults, if I’m talking to older adults who might be concerned about their brain function, I say, well, go and check your B12. Get your B12 levels checked because our ability to absorb vitamin B12 decreases as we age. So it is possible to develop a deficiency. But that does not mean, and I can’t say this strongly enough, that does not mean you go out and take vitamin B12 supplements. You do not need to take vitamin B12 supplements unless you are deficient. Regular anaemia, iron deficiency can bring about brain fog, even a folate deficiency, low levels of omega-3, a deficiency in omega-3, which you can get from your oily fishes. So that’s where diet comes into it.

Natasha: But, as anyone who lives with chronic illness knows, eating a healthy diet isn’t as easy as it sounds. And what is “healthy” can look different for each of us. 

Especially if you’re in the middle of or coming out of a flare up and you just don’t have the energy to prepare food. I know that there are times when even thinking about what to eat is exhausting, let alone making it. 

But there are little things you can do to help make your cooking life a bit easier. It’s actually something we talk about in our pacing series a couple of episodes back. My Occupational Therapist Jo Southall says one thing you can do is to make healthy freezer meals ahead of time, when you’re able, which you can pull out when you’re not up to cooking but your body will really appreciate it! If you missed that episode I’d highly recommend going back and having a listen. It has so many helpful reminders of small, everyday things you can do to make life with chronic illness a bit more manageable. 

When it comes to low-energy food, I like to buy microwavable bags of grains, packs of prepared proteins, bags of mixed frozen veggies, pestos, tubs of soup, and pre-chopped veggies, as well as meal replacement shakes which I mix with frozen berries, so I have things I can easily grab when I’m not up to cooking. 

I also spread the work of food prep throughout the day, depending on what I’m doing, and pace that. If you’d like an episode that digs deeply into this, please do let me know!

There’s a fab account on Instagram @disabledmeals, which has a lot of great suggestions for both accessible foods and tools to make life in the kitchen easier.

I’m delighted to say that this episode is sponsored by my friends at Fine & Able – who will create you a beautiful accessible bathroom in a style you love.

Having recently moved into a new home with a bathroom that is straight out of the 80s and so ugly I don’t know if I love it or hate it, I’m dreaming of the day I can get my perfect accessible bathroom designed with my pain and fatigue in mind.

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Check out their website at fineandable.co.uk or on Instagram @Fine_And_Able for examples of their work, to download a brochure or book an appointment.

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Use code NATASHA200 to book your free design consultation and for £200 off any product orders over £2000 made before midnight June 30th 2022 and start building your perfect accessible bathroom with Fine & Able today.

So we know diet is a big factor in managing brain fog, and Sabina says exercise plays a big role too. And whilst the word exercise may bring up thoughts of working out at the gym in lycra, when you’re living with chronic illness, I find it helpful to redefine it, and think about “movement” instead. 

Sabina: If you’ve got pain as part of your chronic illness, even the idea of taking exercise can seem impossible thing to do, but it is really important that you do take exercise. And it’s also really important that you start small. You know, you start your exercise by swinging your legs over to the side of the bed and you do that for a week.

And then the next week you try to stand up and then you see how much longer you can stand up for, and then walk to the door. I mean, it’s, again, it’s very similar in a way to what I just mentioned about the bust and boom sort of thing. If you try to do too much, too fast, you’re going to floor yourself. Think about if you haven’t been exercising for a long time as a consequence of whatever your illness is.

Of course, speak to your doctor; check everything out that it’s okay to exercise, et cetera, but you really do have to start very small. And also you don’t… Building up to 40 minutes a day, it doesn’t have to be building up to 40 minutes in one session. You can do five minutes and then two hours later do another five minutes. It really is better than nothing. And gradually, you can recondition yourself. And if you have mobility issues, if you have a condition where maybe you can’t walk and you need assistance or a chair, whatever; if you can use your arms, learning to drum. Anything that can build up that aerobic fitness, anything that you can do will help.

And I don’t mean to sound like this is easy. It’s not easy. I’m fully functioning. I don’t have any mobility issues, but I did have such pain in the past that I couldn’t even put a handbag on my shoulder. I couldn’t stir the dinner. It just felt… My arms just couldn’t do it, and I really… I used to walk five miles a day and go to the gym three times a week. And then I just couldn’t even walk. The pain was just excruciating, but I did, as my rheumatologist said, and he just said, “Just walk a few steps at a time and just add on to that and add on to that because if you don’t use it, you do lose it.”

And that applies to exercising your brain. And it can be hard to do. But if, for example, sustained attention is an issue for you; that you can’t read, you find you’re losing focus after a sentence or two, do the exact same as you would with exercise. Say, instead of saying, “I can’t read anymore,” make sure you pick up a book or a newspaper or a leaflet or the back of the cereal box and say, “I’m going to read two sentences today, and I’m going to do that every day for a week. And then next week I’m going to read three sentences.” And you build that up in the same way. I mean, really in a way, when you have brain fog, your brain can become deconditioned. And so, you’ve got to kind of build it up again.

It really is tiny, minute steps. I know I’ve spoken to people before and they say things like, “Oh, I used to run 10K. And now, I try to start small but after a kilometre, I do a kilometre and then I can’t do any more the next day.” And I’m going, “Don’t do a kilometre. Do a hundred meters first and work on that.” What people are considering baby steps, aren’t small enough.

Natasha: I couldn’t agree with that more, and from both personal experience and talking to physios, the tiniest steps can really add up to making a big difference over time. 

I feel like this episode is already full of caveats, but of course, what we consider to be a “tiny step” is so personal, especially if you’re dealing with fatigue, so being really aware of your own body, what is within your safe energy envelope, and adjusting based on your current abilities is the most important thing. 

I actually have a whole series on movement for chronic pain, and getting started with that in a safe and sustainable way, which I’ll link in the show notes. I also recently wrote an essay on my Substack about learning not to be scared of my body anymore, which I feel is relevant here too!

I tend to find that moving as much as I can helps a lot with my pain and my brain fog, just so long as I don’t overdo it. Again, with fatigue, there’s a really fine balancing act, especially since with EDS, strength, stability and mobility are incredibly important things I need to keep working on. 

But I tend to find that even on my worst days, there’s a point when lying down in bed and not moving makes me feel worse, and getting up, even for a really short time, does help to clear the cobwebs. But I know this isn’t feasible for everyone.

One of my 2022 revelations has been going outside, and I know that probably sounds a bit silly, but I’ve never been a “go and sit in the sun and get fresh air” kind of person. 

But going outside to do what I have been calling “walking practice” or sitting on a bench outside my building in our teeny garden, has been a total gamechanger. Turns out, I love fresh air and sun? 

I take a seat cushion (because the bench is uncomfortable) and my headphones and I just sit and breathe. I’m trying to learn to just sit, with no music, and enjoy the squirrels jumping across the trees or watching plants swaying in the wind.

I do some of my PT exercises on or next to the bench in little tiny sets, and I have to say that being outside, breathing deeply, and gently moving my body, really does, as the old saying goes “clear my mind”. I really underestimated the role of sun and fresh air in helping with that, and I notice it impacts my brain fog when I’m in an unaired room for too long.

Sebastian and I often go down together to just sit and talk during his work breaks or at the end of the day as a bit of a reset. And it’s always really nice!

OK so we’ve covered diet and exercise. Now, let’s talk about stress and sleep. These two are a biggg deal for me and something I’ve been struggling with lately due to reasons outside of my control. 

I can’t sleep or rest properly, so I feel stressed and then I’m stressed so I can’t sleep! It’s so frustrating and it’s genuinely getting to the point where it’s having a really debilitating impact on my health. 

It can feel frustrating talking about sleep and stress because I feel like everything that I’m doing is to undo the stress and damage from this situation I’m in, which leads me to feeling more upset and frustrated! 

So I do recognise that this can be a difficult conversation to have, and ultimately there are always going to be things beyond our control that need to change. And frustratingly, so many of these situations can be caused by lack of care and lack of support, which make health conditions worse.

But Sabina says finding ways to manage your stress levels can really help to reduce brain fog and result in better sleep… 

Sabina: To live with a chronic health condition can in a way be inherently stressful. But I think it’s really critical to find ways to manage stress because stress impacts negatively on both the structure of your brain and how it functions. It particularly impacts on a part of your brain called the hippocampus, which is involved in learning and memory, but it also impacts negatively on your frontal lobes. In a sense, neuroplasticity is suppressed in your frontal lobes and in your hippocampus when you become chronically stressed and it is enhanced in your amygdala, which is your fear centres. So essentially, your amygdala, your fearful part of the brain, your reflexive part of the brain gets stronger while your thinking reflective part of the brain gets weaker.

So you start to function in this chronic fear state, and it’s really important to try and break that cycle. One really great way… I mean, the book is a 30 day plan and it’s about really focusing on each of those lifestyle factors for a week. But for the week of stress, really, what I actually get you to focus on is smiling more and allowing time in your day for laughter and fun because they are nature’s natural stress buster. Laughter actually lowers cortisol levels. So I think with things like a pandemic and with something like a chronic illness, we can forget to have fun. We can forget that it’s okay to have fun and laughter and those kind of things, often actually people cope with the debilitating illness by developing a black sense of humour. Often doctors do something similar and people who work in the fire service.

I firmly believe that that’s the brain’s pressure cooker release. It says this is too tough to cope with. We’re getting too stressed, have to have a release for it and it is to laugh. It is to find ways to laugh through the illness and live with it. It’s not the same as laughing at it, but it can make a huge difference. Then stress and sleep are inextricably linked. Chronic stress impairs sleep and if you’re not getting enough sleep, the chemicals that are released when you sleep, they actually help to dissolve cortisol. So if you’re not getting enough sleep, you have this vicious cycle, but sleep is absolutely critical. Again, it’s often something that is impacted by having a chronic condition, but finding ways to maximise your sleep is fundamental to brain fog. That basically when you go to sleep, your brain has a job of work to do and if you don’t get sufficient sleep or if you’re getting disrupted sleep, or poor quality sleep, that impacts on your ability to learn and remember.

When you go to sleep at night, we see electrical activity between your hippocampus, which during the day is a temporary repository for all the information that you take in during the day. It has a limited capacity. So even if you didn’t have brain fog by the end of the day, you will feel full. You say, oh my God, I can’t take anymore in and that’s because your brain needs you to sleep so that it can clear out the information from your hippocampus. Your frontal lobes speak to your hippocampus using electrical signals and make decisions about that information, whether to discard it or whether to keep it and form a memory. Later in the sleep cycle, we then see more diffuse activity. I’m using hand movements across the top of my head. Basically the new information is being embedded and linked into networks and areas of your brain, sensory information, language, et cetera and that’s the start of memory consolidation.

Then in the later part of the night, or what I’d call early morning, when you have more REM sleep, when you have more dream sleep, that new information is integrated within existing knowledge experience and memories. It’s from that, that insight arrives. Solutions to problems, new ideas. They come from that connecting. Your brain loves patterns and it loves making connections. So you really need to sleep in order to do that and if you miss any part of that cycle, well, then… If you’ve missed sleep the night before, your hippocampus won’t have been cleared out. So the next morning your brain will already feel full and you can’t take in new information.

Similarly, if you don’t sleep the night following, when you actually do take information, that information won’t be consolidated as a memory. So you lose out. So, I mean, I’m very much a fan of strategic napping if you have disrupted sleep at night. I say strategic because the timing of a nap, both the duration and when you take it are critical. So if you do decide to nap, try to keep it to before early afternoon, otherwise you will be counterproductive and you may disrupt sleep the following night. But also, either nap for sort of 10 minutes or 90 minutes. Don’t nap for a period of time in between and that’s because each sleep cycle is about 90 minutes. In the first 10 minutes, you don’t actually go into deep sleep, but you can feel restored because you can dissipate some of the sleep pressure chemicals. So you can get a little boost from that 10 minute nap.

90 minutes, you’ll have gone the full sleep cycle and you will begin, at the end of the 90 minutes, into a wake up mode where it feels okay. If you go for 30 or 40 minutes, for example, you can wake up in the middle of a really deep part of your cycle and you will wake up sleep drunk and you will feel awful and hung over and far worse. A lot of people will say, “Oh, I can’t do naps. I feel terrible.” But it’s probably they’re doing the timing, the duration of the nap incorrectly. So I think you can nap prophylactically. If you know there’s a particular period in time where your sleep is disrupted, go, well, I’m actually going to nap this evening. Or even if you think you’re going to have a late night, say, well, I’m going to take a little nap at lunchtime and you can nap to make up for lost sleep. But it is important always to try and repay sleep debts.

Natasha: As someone who has struggled with sleep her whole life (except when I was a baby and apparently didn’t stop sleeping!), I know that a lot of the sleep hygiene recommendations just aren’t feasible or helpful for people living with chronic illness. Which is why in a future episode, coming out soon, I’m going to be doing a deep dive into realistic sleep tips for people who live with long-term health conditions – and it’s one I’m super excited about.

Eating well, moving our bodies, reducing stress and getting better sleep sounds so simple, but I really do understand it can be easier said than done and it can feel overwhelming to introduce lots of changes at once.

I’d recommend picking one area that you’d like to work on and thinking about some small ways you can improve it. For example, when I’m having a day where it feels really hard to get out of bed, I try and make sure I sit up or go and sit by a window for a few minutes every so often. It feels like a little reset. 

If you’re struggling with your stress levels, I don’t know if I’m the best person to give advice right now! So, I asked Sabina what’s her one tip for reducing stress…

Sabina: I might sound odd, but I think it can make a big difference and I really think to smile more. And I just know, it sounds really odd, but it can kind of really shift your perspective and put you sort of more into a positive zone. So it’s a great way as well to manage stress and I think it can give you perspective. I mean, sometimes I forget to smile. I reckon I went through my whole menopause forgetting to smile and completely lost my sense of humour. And it’s kind of only when I came out the other side that I realised what a difference that made to absolutely everything that I did, to my relationships, and to how people perceived me. Yeah, I mean, I say smile first thing in the morning. The easiest way to introduce a new habit is to tag it on to a habit that already exists.

I say to people, if you want to learn how to smile more, smile when you pee, smile when the kettle boils, smile when you comb your hair. Do you know what I mean? Things that you just do, just smile. And I know it can sound, and I’m sure, and the reason actually I say this is because I know in the past I’ve come across people saying, “Oh, it’s very easy to say smile. I have pain every day. I can’t do this and my life is awful.” Actually then, that means you really, of all people, need to smile because you will get the health benefits of smiling. When you smile, endorphins are released, your immune function is boosted. It promotes the growth of brain cells. It helps to lower cortisol. So the act of smiling has physiological impact in your body in ways that could help you feel better, and even better still than smiling would be to have a laughter stash.

I think that could have huge impact. You know, we all have things that without fail make us laugh. Depending on your sense of humour, whether it’s watching kittens slip down the side of sofas or funny puppies or babies laughing, or people slipping on ice, or a funny podcast or a particular comedian. Create a folder on your laptop and when you feel anxiety rising, when you feel frustrated with your brain fog or frustrated with your condition, open that up, take 10 minutes out, take half an hour out, and laugh, and laugh your heart out. And it will really help to lower the stress levels and just give you a bit of perspective, and it’s fun. And sometimes that’s just… I don’t know, maybe you’re expecting me to give something more cognitive, but I actually think that the benefits of laughter are huge. They can make a big difference. It really is. Laughter really is good medicine.

Natasha: Making any kind of change requires work, commitment and consistency, and that’s easier said than done. 

I don’t have it all figured out and I’m still learning as I go along, but as I said earlier, if you need help with getting started making small, sustainable changes that may help, consider giving the episodes on pacing a listen. 

As we come to the end of the episode, I want to leave you with some final thoughts from Sabina… 

Sabina: Be realistic about what you can achieve and what others can achieve. Often we get so stressed by expecting too much from other people and expecting too much from ourselves. A great way to get around that is actually to time yourself doing a particular task. A lot of our jobs involve repetition of particular tasks, but we often underestimate how long it’s going to take us to do it. So just do the task at your pace, at your speed, and time it. And then allow yourself that time for when you do that task again.

Take breaks. Don’t schedule meetings directly one after another, you need to break. Your brain needs a break. It needs downtime. Paying attention is a cognitively demanding task, energy demanding task. Okay? Your attention naturally wants to wander after about 30 seconds or so. So to keep it focused requires a lot of energy.

So I would suggest that you take breaks every 60 to 90 minutes for about five or 10 minutes to give yourself, your brain, a little bit of a break from doing that. And I would also say very specifically avoid multitasking. Multitasking is a myth anyway. Nobody can multitask. What your brain is actually doing is task switching. And when you try to task switch like that, basically speed and accuracy are compromised. So when you try to do two things at once like talking to a friend and texting, even if it’s as simple as that, it will take you longer for example to send the text and you’ll probably make more spelling mistakes. So it’s far better to do these things in sequence.

That applies to everybody, but specifically to people with brain fog. Just do one thing at a time. Remove all distractions from your workplace because that means if you have busy wallpaper even, if you have lots of pictures, if there’s a radio going on, if there’s people walking around, your brain is trying to process all of that information. So if you remove those distractions and just say, I’m going to focus on this piece of work for 10 minutes, 20 minutes, 30 minutes, whatever your current capacity is, do that. And it will be easier to do that. You can gradually build up stamina, but that will help you in terms of the distractions as well when there’s things going on.

Natasha: Thank you so much to Dr Sabina Brennan for taking the time to chat to me. If you’d like to read her book, I’ll link it in the show notes. 

I’ll also pop a link to those pacing episodes I talked about. 

Thanks again to Fine & Able for sponsoring this episode. Whether you’re looking for beautiful inclusive products for your bathroom, or want to design your dream accessible bathroom from scratch – Fine & Able have you covered. 

Visit fineandable.co.uk and use code NATASHA200 to book your free virtual or in-person design consultation, and to get £200 off any product orders over £2000 made before midnight June 30th 2022. Start building your perfect accessible bathroom with Fine & Able today.

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Aaand that’s all from me. Thanks so much for joining me in The Rest Room. 

Ta ta for now!