Transcription
So, if I'm sitting in this computer chair all day, right, and I'm not exercising or anything like that, if I'm not physically active, what I've actually seen an alarming amount of is young people that have blood pressure problems. I'm talking about 20-year-olds, 25-year-olds, who will have symptomatic dizziness when they stand up from their computer chair because they've been sitting in the computer chair all day. There are many people who will offer solutions for life: "Do this and you will be happy; do that and be happy." It is my opinion that you must understand yourself first. That is why we made Dr. K's guide—check it out.
Now, let's talk a little bit about brain fog. I think brain fog is an increasingly important thing to discuss because it seems to be rapidly rising. We know that, for example, 19 out of 20 people on the planet have basically had COVID. We also know that about 10 percent of people, or up to about 10 percent—the numbers are probably closer to seven or eight percent—who have COVID have brain fog. But we also know that brain fog seems to be increasing across the board. The reason that this is such a big problem is that brain fog is one of the worst things to have for a couple of reasons.
The first is that if you have brain fog and you go see a medical professional, chances are they'll punt you somewhere. They'll tell you to go see a therapist, or they won't really give you any sort of constructive help. If you go to a doctor and say, "Well, my brain doesn't seem to be working quite right," first of all, what does that even mean? The doctor may order some tests; they may check to see if you have an infection, check your blood counts, and a couple of other things. But at the end of the day, brain fog really isn't a diagnosable condition, and it also appears to not really be a treatable condition.
A lot of times, what happens when people struggle with brain fog—which, by the way, can be incredibly debilitating—is that when we talk about brain fog, we're sort of talking about difficulties with concentration and difficulties with short- and long-term memory, usually more short-term memory. People are incredibly forgetful and tend to find that they require a lot more effort to do basic cognitive tasks. Studying is harder, work is harder; it just seems to be incredibly debilitating without having any kind of smoking gun in terms of what's causing it.
Oftentimes, we sort of accept that, okay, if I've got the flu or COVID, that's the reason it's hard for me to work. But the problem with brain fog is that it tends to persist for very long periods of time, doesn't have a clear cause, and even if we seek help from medical professionals, oftentimes they'll order some tests or maybe evaluate us, but then they don't really have any sort of treatment or anything significant they can do to help us, which is exactly why it's so frustrating.
The other thing that tends to be kind of unfortunate in a lot of ways is that a lot of times, if you go see a medical doctor and they can't find something wrong with you, but you are still struggling, and the ways in which you are struggling are not testable—this isn't something like, "I've got wheezing in my chest," or "my blood pressure is very high," or "my heart rate has an arrhythmia," or "I have a rash" or something like that. If it's something cognitive, what usually medical doctors will do is, if they can't find something very specific, they'll send you to a mental health professional. They'll refer you to a psychiatrist because if we can't find what's wrong with your body, it sort of must be in your head.
The best doctors will still sort of acknowledge that it's psychosomatic, which we'll get to in a minute, but they'll send you to a mental health professional. Then the problem kind of becomes, okay, so let's say I go see a therapist. I don't know if you guys know this, but as you've trained to become a therapist, you get a total of zero hours of training in how to deal with brain fog, right? It's not a DSM diagnosis, so it's not like a psychiatric illness, which is what people are trained in. We're trained in stuff like trauma, anxiety, and depression, but brain fog really isn't something that we're taught about.
The answer that you're kind of given is mental health help, which can be helpful in some ways, but then the other problem is that, as we'll sort of discover today, brain fog actually is not a psychiatric illness. There's a lot of strong evidence that it is actually physiologic in nature and neurologic in nature. So the solutions that people with brain fog are being given are ones that are actually not very useful scientifically.
Let's kind of tunnel down into this and understand a little bit more about what brain fog is and what we can do about it. The good news is that we do have a lot of research recently into sort of what causes brain fog or what are some of the culprits. The neat thing about that is, as we discover what the mechanisms of brain fog are, we'll also naturally start to discover what are some potential solutions.
So, brain fog, first of all, appears to be increasing. As we kind of tunnel down into this, brain fog has been sort of on the rise, and as people have been sort of getting COVID, what we've discovered is that the interest in brain fog is increasing, and the research in brain fog is increasing. There are a couple of key things that we've learned. The first is that brain fog seems to be associated with inflammation, specifically mast cell inflammation.
Now, this is important for a couple of reasons. The first is that if things are inflammatory in nature, we can kind of infer that they're not psychiatric in nature—or that gets a little bit complicated—but there seems to be a physiologic cause, and specifically, the target seems to be mast cells. There's a lot of evidence that shows that mast cells are actually correlated with the extent of brain fog. What we sort of have discovered is that brain fog appears to be inflammation specifically within our central nervous system or brain.
I don't know if you guys have sort of felt that, you know, if you get the flu or COVID or some kind of infection and you have this whole-body inflammation, or if you have something like lupus, what you're going to experience is some amount of cognitive impairment, right? You don't feel quite as energetic; it's hard to study, it's hard to focus, and your short-term memory will be negatively impacted. We sort of know that inflammation can cause these problems, and we also know from lots of research that mast cells seem to be implicated.
The other thing that's kind of interesting is that this inflammation also seems to be associated with obesity. Now, I know that there's a lot of tension on the internet nowadays around fat phobia and things like that. I'm not trying to be fat phobic or place value judgments on people who are overweight, but what we do know—this is something that a lot of people don't realize—is that adipocytes, or fat storage cells in our body, are not just storage; they're actually endocrinologically active and immunologically active.
What that means is that the number of adipocytes or the size of adipocytes that we have in our body correlates with a certain amount of inflammatory activity or correlates with some amount of endocrine activity. So we know that these are not just benign storage parts of our body; they're actually physiologically active and can actually lead to inflammation. We also know that obesity is actually correlated with brain fog.
A couple of other things that we sort of have discovered is that when it comes to the mast cells, the mast cells are actually either on themselves or right next to the mast cells. We have these things called CRH receptors, and CRH is essentially a stress signal that causes the release of a stress hormone. What we sort of know is that here we've got our CRH receptor, and let's say here's a mast cell. CRH comes in over here, activates the mast cell.
The key thing here is that if we say, "Okay, inflammation is one of the causes of brain fog, and it's mediated through the mast cell," what triggers the mast cell? Well, it seems that stress, specifically CRH, is one of the key things that induces mast cell activation, which then in turn leads to brain fog symptoms. You may say, "Well, what's the point of all this? I don't understand why we're learning this science."
The reason we're learning the science is because hopefully, as we start to understand the mechanisms, this will also open the path to understanding how we can sort of combat brain fog. The next thing that's kind of really interesting is that brain fog is also associated with a condition called POTS. POTS is postural orthostatic hypotension syndrome, which is essentially a condition that has to do with low blood pressure, specifically that is postural in nature.
If you want to get kind of a quick understanding of what it feels like to have POTS, if you are lying down in bed and you jump upright out of bed—first of all, don't do this if you've got blood pressure problems because you could fall over—but if you jump right up, what you'll sometimes notice is that if you stand up suddenly, you'll start to get a little bit of dizziness. What is responsible for the dizziness is that as we stand up, the blood flow to our brain actually decreases, and it takes a few seconds for our heart and our vasculature to kind of adjust to the effect of gravity.
When we're lying down, we're not really fighting against gravity, but when we stand up, our heart and blood vessels actually have to pump blood this way to increase cerebral perfusion or to get blood flow to our brain. Some of you may have experienced that if you stand up suddenly; you'll feel dizzy for a second or two, and then your body essentially compensates. What happens in people with POTS is that their ability to compensate is somehow impaired. So when they stand up or sit up, they tend to have low blood pressure, which impacts their cerebral blood flow.
The key thing here is that we know that brain fog is associated with low cerebral perfusion, which is a fancy way of saying we know that people with brain fog actually have less blood going to their brain. It requires more blood flow to complete particular cognitive tasks. The other way to kind of think about it is if you've got one person with brain fog and one person without brain fog, the amount of blood that this person needs to complete a memory task is higher versus the amount of blood that this person needs, which is relatively lower.
So, people with brain fog seem to have something around cerebral perfusion as a cause of brain fog. Another thing that's really interesting is that as people have sort of looked at certain chemical compounds, they've essentially found that flavonoids, and specifically something called luteolin, seem to reduce inflammation, have a neuroprotective effect, and appear to improve brain fog.
Now, we got to talk about flavonoids and luteolin for a second. Something has been happening recently with our diet. We know that, for example, people are eating more processed foods, which is part of the problem. But one of the reasons why I think that brain fog is actually getting a lot worse is because of the way in which our food is actually grown.
Over the last, let's say, 20 to 50 years, we've started to use a lot of fertilizers. I'm not anti-GMO or anything like that, but we have selected for vegetables. Flavonoids are oftentimes found in green leafy vegetables. The rate at which vegetables are being grown is actually increasing. You used to take, let's say, six months to grow a crop of spinach, and now we've really accelerated their growth rate using certain kinds of genetic modifications and fertilizers.
The result of that is that, sure, it grows really quickly, but the nutrient density is actually decreasing. We know that with some kinds of food, specifically, in some ways, the nutrient density is exactly the same as it used to be, but in other kinds, there are some kinds of nutrients that the faster you grow the plant, the less the plant absorbs particular things or is able to create particular things.
What we're actually finding is that there's a correlation between rapid growth or the rapid growth of a plant that is inversely correlated with its nutrient density. This is something that I sort of discovered in an interesting way. I went hiking last year in Alaska and found some wild raspberries. The wild raspberries were really, really small; they were nowhere near the size of the raspberry that you get at a grocery store.
We were picking wild raspberries and eating them, and they were super sour. They didn't taste as beautiful, but there was something oddly delicious about the wild raspberries. When I went back and got my supermarket raspberries, sure, they were big and juicy and sweet, but there was something that I could almost tell a difference between the nutrient density between the wild raspberry and the one that I could get at the supermarket.
There is some evidence that, as we're sort of having more and more rapidly growing foods, there's a correlation with a decrease in nutrient density. This becomes really, really important because when it comes to absorption, we only absorb about 10 percent of flavonoids from our diet. What that means is that our body is very, very inefficient at absorbing some of these compounds, which in turn means that if we're reducing the nutrient density from our foods, it makes it like—since our absorption is so low, if we kind of cut the nutrient density in half, we're ending up with a lot less of these compounds in our diet.
As a result, we're sort of having less of this inflammatory protective effect and neuroprotective effect. A couple of other things that we've sort of found that are associated with brain fog are poor sleep. About 90 percent of people with brain fog will report having poor sleep or insufficient sleep. The last thing that's kind of interesting is that we also know that dehydration appears to be correlated with brain fog as well. In one study, 88 percent of people who had brain fog qualified or reported some degree of dehydration.
This is kind of interesting, right? Because now we're starting to see that, first of all, I want to show you all one other thing just directly from a paper. There's also some evidence that—just to kind of the last thing—is what about things like depression? There are actually some studies that have specifically examined psychiatric comorbidities and brain fog, and what they've actually found is that psychiatric comorbidities are not associated with the cognitive impairment of brain fog, at least in certain inflammatory conditions.
This is a paper about chronic fatigue syndrome. We know that brain fog caused by these mysterious inflammatory conditions appears to be not psychiatric in nature, which is really, really important. I think this is actually what's really unfortunate because a lot of times, doctors will send people to mental health professionals to deal with brain fog because they sort of don't know what else to do. If we can't figure out what's wrong with you, let's send you to a therapist because they'll be able to sort it out.
As we take a look at this, what we actually find is that there's a lot of physiologic sources of brain fog. Now, let's take a look at these six things and try to understand a little bit about, okay, if these are the causes of brain fog, and that's it, you know, we're not quite there yet. This is just some evidence that implicates these as some of the mechanisms. What does that tell us about why brain fog is getting worse?
Now that we sort of know these are the things that are involved with brain fog, what's going on in our society with all these things? The first thing is that obesity is on the rise. What we're going to do is just take a quick look at these and very simply try to figure out if this is getting worse in society or not. Is obesity getting worse? Absolutely. Is general inflammation getting worse? Absolutely. Is stress getting worse? Absolutely.
Now, here's an interesting one: what about blood pressure? Is blood pressure, on the whole, getting worse? What we actually discover is that as we are getting to a more and more sedentary lifestyle, what we're starting to do is have a deconditioned cardiovascular system. If I'm sitting in this computer chair all day, right, and I'm not exercising or anything like that, if I'm not physically active, what I've actually seen an alarming amount of is young people that have blood pressure problems.
I'm talking about 20-year-olds, 25-year-olds, who will have symptomatic dizziness when they stand up from their computer chair because they've been sitting in the computer chair all day. We're seeing that this kind of stuff—this sedentary lifestyle—is actually getting worse as well. The other thing that we sort of mentioned already is that there's, let's say, vague non-conclusive but strongly suggestive data that our diet as a whole is getting worse.
This isn't just about processed foods; this is also about the lack of nutrient density in a lot of our fruits and vegetables. Is sleep getting worse? Absolutely. As technology usage gets worse, we've got issues with blue light, impaired melatonin production, and low-quality sleep—not to mention all these other things like lack of physical exercise and stress. Sleep, on the whole, is getting worse.
What about dehydration? Are we, as a whole, getting dehydrated? This is one where I'd say I'm not really too sure. We do know, for example, that in one study specifically on POTS, 88 percent of people who have brain fog also endorse some degree of dehydration. This is also important from a blood pressure standpoint because proper hydration is one of the most important ways to keep our blood pressure up.
Specifically, when someone has been in a car accident or something like that, to keep blood going to people's brains, what we'll sort of do is use two wide-bore IVs to pump in saline or blood products into people. One of the ways that we maintain blood pressure in the brain is by actually injecting people with saline. We sort of give them bunches and bunches of fluid, and as we increase their fluid, it maintains their cerebral perfusion.
What we're sort of seeing in society today is that I think we're seeing an increase in caffeine intake, which is dehydrating. This is especially a problem for people with brain fog because what we've sort of found is that some people will treat brain fog with things like stimulants. But what I've really found is that a lot of people who are struggling to focus, what are they going to do? They're going to drink coffee.
So we see that brain fog is oftentimes associated with a higher level of caffeine intake. Generally speaking, a lot of our diet has become unhealthy, and people may not be drinking enough water. It kind of depends on who you are and where you are, but one of the things that I've definitely seen with brain fog is an increase in caffeine intake that's almost compensatory, which can result in some amount of dehydration. As we get dehydrated, what we're actually doing is potentially making our blood pressure worse.
Now the question becomes, all right, so if this is what's associated with brain fog, the quick question is, okay, what do I do about it? This is where the sort of frustrating thing sometimes, when you go to a medical professional and they don't know what's wrong with you, is they'll tell you to just be healthier. They'll say, "Okay, if you've got brain fog, why don't you just do the diet and exercise? Just exercise more, diet more, spend less time on your screen, just get better sleep."
We're kind of giving these general ideas about what you should do to get healthy. Those are just the generally healthy things to do, and it can be quite devastating because a lot of people will have brain fog, and they'll go to doctors and they'll go to therapists, and people aren't really able to help them much.
The good news—this is good or bad news, depending on how you look at it—is that a lot of times, when people have brain fog, they actually end up in my office. Prior to doing this whole Healthy Gamer thing, my primary area of interest was actually evidence-based complementary and alternative medicine. I was focused a lot on scientifically valid meditation techniques, yoga techniques, herbs, things like that.
I had a clinic where people would refer their patients to me who were interested in more natural remedies. What I sort of found as a clinician is that when people would get referred to me a lot, what would happen is some doctor would be like, "Okay, oh yeah, this person is complaining of these vague stuff; let's send them to Dr. Kenoja because Dr. Kenoja handles these people well."
So there's a psychiatrist; this person has something wrong with their head, right? Let's send them to a psychiatrist. They would come to me, and the thing is, I'm a psychiatrist. I'm trained in evaluating people for mental illness, and as these people come to my office and I kind of evaluate them, and they've got this vague brain fog sort of stuff, what I sort of quickly conclude is that I don't think this person has mental illness.
I don't think this person is ill in their mind; I don't think they have anxiety. I don't think this is depression; this isn't bipolar disorder. It's not like their mood is very bad. The root cause, oftentimes, what we'll see in brain fog is that their mood is bad, but that's secondary to being unable to do things. It's hard for me to study; it's hard for me to work. I'm not doing as well; I'm not progressing; my energy levels are low; I can't think; I can't concentrate.
That's what causes the low mood; it's not like the low mood comes first. It's a consequence of being stuck in the situation where these people are coming to me for help, and I'm kind of the last stop on the train to nowhere, let's say. I'm sort of trying to figure out, okay, how am I going to help these people? The good news is that I've had really good success.
I can think of maybe one or two patients, and if you're watching this, I'm still sorry about not being able to help you substantially. But for the most part, I'd say about 80 to 90 percent of the people that I've worked with who have brain fog, I've actually been able to help pretty substantially. It wasn't like I therapized them; what we actually found is that by targeting all of these different dimensions, you could sort of figure out a good plan to improve your brain fog.
A couple of other things—another medical disclaimer: this is something that what I'm going to share with you all now is stuff that I have found useful in my clinical practice. I myself used some of these interventions. I had pretty bad COVID about a year ago and was also noticing some amount of brain fog, so I kind of went through my own brain fog regimen and found that I basically am completely recovered from that.
But remember that this is not medical advice and that each and every one of you should really talk to a doctor about all of these things and sort of try to figure out a customized plan. Here are a couple of things that work. The first is yoga or Tai Chi, and specifically, I found Shirsasana to be very effective. Shirsasana is a headstand pose, so it's this particular asana where you're upside down. It's definitely something that requires some degree of training, so I wouldn't try that at home. You really need a good teacher to teach you how to do it.
But Shirsasana is literally like you're just doing a headstand, right? Your head is at the bottom and your feet are at the top. The cool thing about Shirsasana is that it really trains your body to maintain blood pressure to your brain. It really wreaks havoc on your cerebral vascular system and your vascular system—not in a negative way, but it sort of trains you to be upside down. As you're upside down, it trains your body a little bit to handle blood flow a little bit better.
So, Shirsasana or any kind of yoga or Tai Chi, I think will probably be effective. There's also good evidence that yoga and Tai Chi have anti-inflammatory and stress-reducing effects, so I'd recommend yoga or Tai Chi. Specifically, I probably slightly more recommend yoga over Tai Chi, and that too, some of the yoga postures that you should do are ones that have postural changes.
Bending down and touching your toes, doing your hand above your head, maybe doing something like downward dog or Parvatasana or things like that. Yoga is actually really good at having your body move in particular ways that require you to maintain blood pressure. So, yoga and Tai Chi is number one.
The second thing that we have to consider is obesity. This is where some amount of exercise is actually really important, but we're going to tunnel down into what kind of exercise. It's not just reducing obesity for its own sake, although we do know that adipocytes are pro-inflammatory, right? We talked a little bit about that.
But specifically, the kind of exercise that we want to do is going to be cardiovascular in nature and ideally has you using your legs. Why is that? There are a couple of really important things to understand about a sedentary lifestyle and the impact of a sedentary lifestyle on specifically our leg muscles. Our heart is here, and our heart pumps things. Generally speaking, our blood tends to pool at the bottom of our feet because of the effect of gravity.
There's one really interesting thing: if you look at your body, what you'll sort of find is that even if you look at the back of your hand, you can see veins. Even if you look at your head or your neck, you can see veins. So veins tend to be pretty peripheral when it comes to the top half of your body, but if you look at your legs, it can be very hard to see your veins.
The reason for that is because a lot of times, our major veins in the legs are actually on the inside of the leg, and we actually rely on our skeletal muscle—the muscles in our legs—to pump blood back to the heart. So anytime I walk, the contraction of the skeletal muscle, anytime I take a step, is actually helping blood come back to the heart.
One of the things that I found is that with a sedentary lifestyle, we're walking less. As we're walking less, we're getting more blood pooling in our lower extremities. We're seeing increases in stuff like varicose veins and stuff like that, and all of that is associated with a sedentary lifestyle. So any kind of exercise, specifically that involves walking and a high level of cardiovascular workout, is actually really good.
This is one of the situations where I wouldn't recommend specifically like bench pressing. Bench pressing will increase your cardiovascular weight, but getting gigantic muscles on your arms or your chest is not actually what we're really shooting for here. What we really want to do is engage that skeletal muscle in our legs and ideally start to exercise and get to a decent heart rate. Essentially, cardiovascular activity using the legs is what we want to target.
That'll also have the added effect of hopefully reducing our obesity. A couple of other things—the next thing that we want to do is really think a little bit about our diet. Remember that there are actually studies that show that—let me just show you all a quick paper—brain fog, inflammation, and obesity are key aspects of neuropsychiatric disorders improved by luteolin.
We know that some of these flavonoid compounds, specifically something called luteolin, which I think is extracted from usually olives, is potentially another reason why the Mediterranean diet has positive anti-inflammatory effects because of the prevalence of olive oil. You may have luteolin in the Mediterranean diet at a high level as well.
People can also supplement with luteolin, but this is definitely something that I would encourage you to talk to your doctors about because luteolin can be biologically active with other compounds like medications and things like that. But we sort of know that supplementing with flavonoids and luteolin can actually have a positive effect on brain fog.
The other simple way to kind of think about this, though, is that if you eat nutrient-dense greens, that'll also do the trick. It's not just a healthy diet in general; it's sort of thinking a little bit about, okay, what are the dietary inputs that I need to kind of compensate for the brain fog? The specific thing about luteolin and flavonoids is that they seem to have very positive effects on the parts of our brain that appear to be affected by brain fog.
Remember this mast cell activation, this high level of inflammation? There's very strong anti-inflammatory, antioxidant, and neuroprotective effects of flavonoids and luteolin. That's something that I would definitely recommend that you all talk to your doctor about.
The last thing to generally consider is to remember two super basic things. The first is sleep and caffeine. Sleep is incredibly important. Just about every person that I've worked with who has brain fog has needed to have some kind of improvement in their sleep. If you're not sleeping properly, sleep is just the general time that our brain uses to heal itself.
If we're not sleeping properly, or our sleep is disturbed, or we have too many substances on board—if we use marijuana to help us sleep, if we use alcohol to help us sleep, even if we take exogenous melatonin—I'm sometimes a little bit concerned about the high level of exogenous melatonin use, even though from a medical standpoint, it's very, very safe. But I think good sleep is huge for brain fog.
The last thing to consider is, once again, hydration. This is where you've just got to be drinking lots and lots and lots of fluid. If we're talking about this blood pressure effect, we got to remember that fluid intake is very, very important for maintaining a healthy blood pressure. So you've got to really look at what's your liquid intake over the day. Are you drinking lots of soda? Are you drinking lots of caffeine? Are you drinking enough water?
How often are you urinating? What is the color of your urine? You generally want to be urinating like a light yellow color. If your urine is completely clear, your fluid intake may actually be too high. If your urine is very concentrated or you're not urinating very frequently, there's a decent chance that you're not drinking enough.
So these are the last kind of two things to consider. It's unfortunate that brain fog has been really expanding very rapidly. I almost get the sense that there's like a silent epidemic of brain fog that's happening in our society today. The most devastating thing about that is that as it's affecting more and more people, the solutions that we're offering people with brain fog don't seem to be working very well.
If you go see a medical professional, it's a good thing to do, by the way, because they can rule out other causes. If it's something like anemia or vitamin B deficiency, there are a lot of things that can contribute to brain fog-like symptoms. The downside is that if it's true brain fog, then chances are it's not one of those vitamin deficiencies, and you should rule all those things out.
But then your doctor has sort of left it like, "I don't know what to do." Sometimes what they'll end up doing is just referring you to a therapist or just telling you, "Oh, eat healthy and exercise," which is actually part of the solution, don't get me wrong. But then the other problem is that once you get referred to a therapist, the therapist may be able to help you in some ways, but the real problem is that brain fog is not a psychiatric condition; it's actually a physiologic and neurologic condition.
So oftentimes, what our medical system actually does is send people to the wrong professionals. When therapy or psychiatry kind of doesn't work for you, then you're sort of left feeling like, "Okay, well, I've tried everything," when it turns out that you actually started with the worst thing, right? Because it's not a mental illness. Then people feel really, really hopeless.
Then you kind of come back to your doctor and say, "Hey, the therapy isn't working," and then they're kind of like shrugging their shoulders, and we don't really know what to do. My hope today was to share with you all a little bit about what the mechanisms of brain fog are, what we're starting to understand about it, and some of the stuff that I found to be somewhat useful for some of my patients, as well as for myself in terms of my own post-COVID recovery.
Remember that your mileage may vary and that this is absolutely a situation where you want to talk to a medical professional first to get evaluated for all kinds of these other things. If you do that, hopefully, what we'll start to see is that your brain fog will actually get better. I would say that 80 to 90 percent of the people that I've worked with who have brain fog, with some combination of the stuff that we just talked about, will actually get better. So hopefully, that helps you.