Health A-Z

Brand Fog

Overview

Brain fog is used to describe ‘a usually temporary state of diminished mental capacity marked by inability to concentrate or to think or reason clearly.¹

  • Brain fog is not a formal diagnosis or medical condition but a series of neuropsychologic symptoms related to mild cognitive impairment which may affect daily function.
  • Although there are no statistics on the prevalence of brain fog specifically, it was estimated that around 600 million people worldwide suffer from cognitive dysfunction.
  • It has been reported that brain fog is one of the most common long COVID symptoms among survivors.³

Signs and Symptoms

Poor concentration⁴

Feeling confused⁴

Difficulty in learning and remembering⁴

Forgetfulness⁴

Lost words⁴

Slow thinking⁴

Haziness in thought processes or fuzzy thoughts⁴

Causes and risk factors

  • Physiological condition such as reduced cerebral blood and high levels inflammation⁵
  • Mental health conditions such as depression anxiety⁴
  • Long COVID syndrome³
  • Medications for pain and sleep⁶
  • Chronic sleep disturbances
  • Stressful lifestyle
  • Ageing

Causes and risk factors

  • Physiological condition such as reduced cerebral blood and high levels inflammation⁵
  • Mental health conditions such as depression anxiety⁴
  • Long COVID syndrome³
  • Medications for pain and sleep⁶
  • Chronic sleep disturbances
  • Stressful lifestyle
  • Ageing

Supplement recommendations

Acetyl-L-Carnitine (ALC)

Mechanism of action

ALC has the activity on cholinergic neural transmission and ability to enhance neuronal metabolism in the mitochondria⁷. It has the property to stabilize the cell membrane fluidity through the regulation of sphingomyelin levels, and to provide a substrate reservoir for cellular energy production, thereby preventing excessive neuronal degeneration on human⁸.

Benefits

Mild cognitive impairment

Taking ALC daily may improve memory and intellectual functions as resulted in better scores in clinical and psychometric assessment scales in older people with memory deficits compared to those in the placebo group⁹.

Alzheimer’s disease

As ALC levels are declined in many forms of dementia, daily supplementation of ALC may improve spacial learning tasks, timed tasks of attention, discrimination-learning tasks and personal recognition tasks. Reduction in deterioration of reaction time and short-term memory associated tasks have also been observed¹⁰ ⁻ ¹² .Long term memory performance and delay in behavioural deterioration are recorded after one-year administration of ALC¹³.

Depressions

Depressed patients have higher total cortisol secretion possibly attributed by heightened activation of the hypothalamic-pituitary-adrenocortical (HPA) axis⁹. Daily consumption of ALC may significantly improve mood and counteracting depression symptoms in elderly with depressive disturbance as measured by decreased scores in the Hamilton Rating Scale for Depression¹⁰.

Recommended dosage

Typical doses used in clinical trials are in the ranging from 1g – 3g daily, in divided doses for up to 33 months.

  • Mild cognitive impairment
    1.5g to 2g daily for at least 3 months
  • Depression
    500mg, 3 times daily for 2 months
  • Attention Deficit Hyperactivity Disorder (ADHD) and Fragile X Syndrome (FXS)
    50mg/kg – 500mg, twice daily for 12 months

Phosphatidylserine (PS)


Mechanism of action

PS facilitates activation of neuronal signaling pathways, including Akt, protein kinase C (PKC) and Raf-1 signaling which are known to stimulate neuronal survival, neurite growth and synaptogenesis¹⁴.

Benefits

Cognitive function

Delay recall is considered as one of the indicators of impaired cognitive functions at early stage of dementia. Daily consumption of PS may improve memory function, particularly in delayed recall in the elderly with memory complaints¹⁵. PS may improve attention-deficit hyperactivity (ADHD) symptoms, short-term auditory memory (the ability to process, analyse and recall orally presented information) and inattention in children aged 4 to 14 years old¹⁶. PS (in combination with DHA and EPA) may positively influence the memory skills as observed in verbal immediate memory, long term memory, learning abilities and response rate among cognitively impaired elderly¹⁷. Taking PS daily (in combination with phosphatidic acid) may have favourable effect on memory and cognition in elderly with cognitive deficiencies. Daily intake of PS has resulted in cognitive and memory enhancement in young students as measured in language and non-language memory abilities improvement¹⁹⁻²⁰.

Stress and mood

PS (with phosphatic acid and phospholipids complex) may help reduce stress response. This could be observed through the dampening reactivity of the pituitary-adrenal axis to stress as adrenocorticotropic hormone (ACTH) and cortisone levels were inhibited²². PS may improve emotional tension, mental health and daily functioning in elderly with Alzheimer’s disease²³. PS may reduce exercise-induced stress following strenuous exercise training through prevent the increase in cortisol and adrenocorticotropin²⁴.

Recommended dosage

Typical doses used in clinical trials are ranging from 200mg to 400mg daily for 1 to 3 months.

  • Cognitive Function
    – 100 mg to 300 mg daily for 3 months25
    – 100 mg twice daily for 2 months26
    – 300 mg daily (in combination with 79 mg DHA + EPA) for 15 weeks27 
    – In combination with 240 mg phosphatidic acid for 3 months23
    – 100 mg daily for 40 consecutive days28

Vitamin B12


Mechanism of action

Vitamin B12 is vital for the proper functioning and development of the brain and nerve cells. It assists in the maintenance of the sheaths that cover and protect the nerves of the central and the peripheral nervous system, ensuring fast and effective nerve impulse transmission.

Benefits

Cognitive function

Vitamin B12 is a key player in the function and development of brain and nerve cells³⁰. It is involved in the synthesis of myelin in the central nervous system³¹. Supplementation with vitamin B6, vitamin B12 or folate has positive effects on memory performance in women of various ages³². Low levels of vitamin B12 are associated with impaired cognition and memory³⁴.

Energy

Vitamin B12 works as a coenzyme in the conversion of protein and fat into energy. It is involved in maintaining the mitochondrial one-carbon transfer cycles by regulating mitochondrial enzymes along with vitamins B6 and folate³⁵.

Recommended dosage

The daily recommended dietary allowances (RDAs) of vitamin B12 are: 18 years and older, 2.4mcg; pregnancy, 2.6mcg; lactation, 2.8mcg.

  • Cognitive Function
    24 months of daily oral supplementation of 400mcg folic acid and 100mcg vitamin B12³⁶

Supplement recommendations 1

Acetyl-L-Carnitine (ALC)

Mechanism of action

ALC has the activity on cholinergic neural transmission and ability to enhance neuronal metabolism in the mitochondria⁷. It has the property to stabilize the cell membrane fluidity through the regulation of sphingomyelin levels, and to provide a substrate reservoir for cellular energy production, thereby preventing excessive neuronal degeneration on human⁸.

Benefits

Mild cognitive impairment

Taking ALC daily may improve memory and intellectual functions as resulted in better scores in clinical and psychometric assessment scales in older people with memory deficits compared to those in the placebo group⁹.

Alzheimer’s disease

As ALC levels are declined in many forms of dementia, daily supplementation of ALC may improve spacial learning tasks, timed tasks of attention, discrimination-learning tasks and personal recognition tasks. Reduction in deterioration of reaction time and short-term memory associated tasks have also been observed¹⁰ ⁻ ¹² .Long term memory performance and delay in behavioural deterioration are recorded after one-year administration of ALC¹³.

Depressions

Depressed patients have higher total cortisol secretion possibly attributed by heightened activation of the hypothalamic-pituitary-adrenocortical (HPA) axis⁹. Daily consumption of ALC may significantly improve mood and counteracting depression symptoms in elderly with depressive disturbance as measured by decreased scores in the Hamilton Rating Scale for Depression¹⁰.

Recommended dosage

Typical doses used in clinical trials are in the ranging from 1g – 3g daily, in divided doses for up to 33 months.

  • Mild cognitive impairment
    1.5g to 2g daily for at least 3 months
  • Depression
    500mg, 3 times daily for 2 months
  • Attention Deficit Hyperactivity Disorder (ADHD) and Fragile X Syndrome (FXS)
    50mg/kg – 500mg, twice daily for 12 months

Supplement recommendations 2

Acetyl-L-Carnitine (ALC)

Mechanism of action

ALC has the activity on cholinergic neural transmission and ability to enhance neuronal metabolism in the mitochondria⁷. It has the property to stabilize the cell membrane fluidity through the regulation of sphingomyelin levels, and to provide a substrate reservoir for cellular energy production, thereby preventing excessive neuronal degeneration on human⁸.

Benefits

Mild cognitive impairment

Taking ALC daily may improve memory and intellectual functions as resulted in better scores in clinical and psychometric assessment scales in older people with memory deficits compared to those in the placebo group⁹.

Alzheimer’s disease

As ALC levels are declined in many forms of dementia, daily supplementation of ALC may improve spacial learning tasks, timed tasks of attention, discrimination-learning tasks and personal recognition tasks. Reduction in deterioration of reaction time and short-term memory associated tasks have also been observed¹⁰ ⁻ ¹² .Long term memory performance and delay in behavioural deterioration are recorded after one-year administration of ALC¹³.

Depressions

Depressed patients have higher total cortisol secretion possibly attributed by heightened activation of the hypothalamic-pituitary-adrenocortical (HPA) axis⁹. Daily consumption of ALC may significantly improve mood and counteracting depression symptoms in elderly with depressive disturbance as measured by decreased scores in the Hamilton Rating Scale for Depression¹⁰.

Recommended dosage

Typical doses used in clinical trials are in the ranging from 1g – 3g daily, in divided doses for up to 33 months.

  • Mild cognitive impairment
    1.5g to 2g daily for at least 3 months
  • Depression
    500mg, 3 times daily for 2 months
  • Attention Deficit Hyperactivity Disorder (ADHD) and Fragile X Syndrome (FXS)
    50mg/kg – 500mg, twice daily for 12 months

Supplement recommendations

Phosphatidylserine (PS)


Mechanism of action

PS facilitates activation of neuronal signaling pathways, including Akt, protein kinase C (PKC) and Raf-1 signaling which are known to stimulate neuronal survival, neurite growth and synaptogenesis¹⁴.

Benefits

Cognitive function

Delay recall is considered as one of the indicators of impaired cognitive functions at early stage of dementia. Daily consumption of PS may improve memory function, particularly in delayed recall in the elderly with memory complaints¹⁵. PS may improve attention-deficit hyperactivity (ADHD) symptoms, short-term auditory memory (the ability to process, analyse and recall orally presented information) and inattention in children aged 4 to 14 years old¹⁶. PS (in combination with DHA and EPA) may positively influence the memory skills as observed in verbal immediate memory, long term memory, learning abilities and response rate among cognitively impaired elderly¹⁷. Taking PS daily (in combination with phosphatidic acid) may have favourable effect on memory and cognition in elderly with cognitive deficiencies. Daily intake of PS has resulted in cognitive and memory enhancement in young students as measured in language and non-language memory abilities improvement¹⁹⁻²⁰.

Stress and mood

PS (with phosphatic acid and phospholipids complex) may help reduce stress response. This could be observed through the dampening reactivity of the pituitary-adrenal axis to stress as adrenocorticotropic hormone (ACTH) and cortisone levels were inhibited²². PS may improve emotional tension, mental health and daily functioning in elderly with Alzheimer’s disease²³. PS may reduce exercise-induced stress following strenuous exercise training through prevent the increase in cortisol and adrenocorticotropin²⁴.

Recommended dosage

Typical doses used in clinical trials are ranging from 200mg to 400mg daily for 1 to 3 months.

  • Cognitive Function
    – 100 mg to 300 mg daily for 3 months25
    – 100 mg twice daily for 2 months26
    – 300 mg daily (in combination with 79 mg DHA + EPA) for 15 weeks27 
    – In combination with 240 mg phosphatidic acid for 3 months23
    – 100 mg daily for 40 consecutive days28

Supplement recommendations

Vitamin B12


Mechanism of action

Vitamin B12 is vital for the proper functioning and development of the brain and nerve cells. It assists in the maintenance of the sheaths that cover and protect the nerves of the central and the peripheral nervous system, ensuring fast and effective nerve impulse transmission.

Benefits

Cognitive function

Vitamin B12 is a key player in the function and development of brain and nerve cells³⁰. It is involved in the synthesis of myelin in the central nervous system³¹. Supplementation with vitamin B6, vitamin B12 or folate has positive effects on memory performance in women of various ages³². Low levels of vitamin B12 are associated with impaired cognition and memory³⁴.

Energy

Vitamin B12 works as a coenzyme in the conversion of protein and fat into energy. It is involved in maintaining the mitochondrial one-carbon transfer cycles by regulating mitochondrial enzymes along with vitamins B6 and folate³⁵.

Recommended dosage

The daily recommended dietary allowances (RDAs) of vitamin B12 are: 18 years and older, 2.4mcg; pregnancy, 2.6mcg; lactation, 2.8mcg.

  • Cognitive Function
    24 months of daily oral supplementation of 400mcg folic acid and 100mcg vitamin B12³⁶

Diet & lifestyle recommendations

  • Manage stress³⁷
  • Get good sleep
  • Get sufficient protein and healthy fats³⁷
  • Limit sugar intake
  • Address any food allergies

References :

  1. Definition of brain fog. (n.d.). Dictionary by Merriam-Webster: America’s most-trusted online dictionary. https://www.merriam-webster.com/dictionary/brain%20fog
  2. McKeever, V. (n.d.). Brain fog? Why you may be struggling to think clearly — and how to beat it. CNBC. https://www.cnbc.com/2021/05/31/why-you-may-be-struggling-with-brain-fog-and-how-to-beat-it.html
  3. Asad-Pooya, A. A., Akbari, A., Emami, A., Lotfi, M., Rostamihosseinkhani, M., Nemati, H., Barzegar, Z., Kabiri, M., Zeraatpisheh, Z., Farjoudi-Kouhanjani, M., Jafari, A., Sasannia, F., Ashrafi, S., Nazeri, M., Nasiri, S., & Shahisavandi, M. (2021). Long COVID syndrome-associated brain fog. Journal of Medical Virology, 94(3), 979-984. https://doi.org/10.1002/jmv.27404
  4. Ocon, A. J. (2013). Caught in the thickness of brain fog: Exploring the cognitive symptoms of chronic fatigue syndrome. Frontiers in Physiology, 4. https://doi.org/10.3389/fphys.2013.00063
  5. Theoharides, T. C. (2015). Brain “fog,” inflammation and obesity: Key aspects of neuropsychiatric disorders improved by luteolin. Frontiers in Neuroscience, 9. https://doi.org/10.3389/fnins.2015.00225
  6. Stuck in a brain fog? Look in your medicine cabinet. (2021, October 1). Harvard Health. https://www.health.harvard.edu/mind-and-mood/stuck-in-a-brain-fog-look-in-your-medicine-cabinet
  7. Acetyl-L-Carnitine Monograph. Altern. Med. Rev. 2010, 8, 76-83.
  8. “Traina, G. The neurobiology of acetyl-L-carnitine. Front. Biosci. Landmark Ed. 2016, 21, 1314–1329,
  9. doi:10.2741/4459.”
  10. Montgomery S. A., Thal, L. J., & Amrein, R. (2003). Meta-analysis of double blind randomized controlled clinical trials of acetyl-L-carnitine versus placebo in the treatment mild cognitive impairment and mild Alzheimer’s disease. International Clinical Psychopharmacology, 18(2), 61-71.
  11. Gecele, M., Francesetti, G., & Meluzzi, A. (1991). Acetyl-L-carnitine in aged subjects with major depression: clinical efficacy and effects on the circadian rhythm of cortisol. Dementia, 2:333-337.
  12. Garzya, G., Corallo, D., Fiore, A., et al. (1990). Evaluation of the effects of L-acetylcarnitine on senile patients suffering from depression. Drugs Exp Clin Res, 16:101-106.
  13. Rai G., Wright, G. Scott, L., et al. (1990). Double blind, placebo controlled study of acetyl-L-carnitine in patients with Alzheimer’s dementia. Curr Med Res Opin, 11: 638-647.
  14. Bonavita, E. (1986). Study of the efficacy and tolerability of L-acetylcarnitine therapy in the senile brain. Int J Clin Pharmacol Ther Toxicol. 24: 511-516.
  15. Kim, H., Huang, B. X., & Spector, A. A. (2014). Phosphatidylserine in the brain: Metabolism and function. Progress in Lipid Research, 56, 1-18. https://doi.org/10.1016/j.plipres.2014.06.002
  16. Sano, M., Bell, K., Cote, L., et al. (1992). Double-blind parallel design pilot study of acetyl levocarnitine in patients with Alzheimer’s disease. Arch Neurol, 49:1137-1141.
  17. Spagnoli, A., Lucca, U., Menasce, G., et al. (1991). Long-term acetyl-L-carnitine treatment in Alzheimer’s diseases. Neurology, 41:1726-1732.
  18. Kato-Kataoka, A., Sakai, M., Ebina, R., et al. (2010). Soybean-Derived Phosphatidylserine Improves Memory Function of the Elderly Japanese Subjects with Memory Complaints. J. Clin. Biochem. Nutr. 47, 246-255.
  19. Hirayama, S., Terasawa, K., Rabeler, R., et al. (2014). The effect of phosphatidylserine administration on memory and symptoms of attention-deficit hyperactivity disorder: a randomised, double-blind, placebo-controlled clinical trial. J Hum Nutr Diet, 27 Suppl 2, 284-91.
  20. Vakhapova, V. C., Cohen, T., Richter, Y., et al. (2010). Research on human memory enhancement by phosphatidylserine fortified milk. Dement Geriatr Cogn Disord, 29, 467-474.
  21. More, M. I., Freitas, U. & Rutenberg, D. (2014). Positive Effects of Soy Lecithin-Derived Phosphatidylserine plus Phosphatidic Acid on Memory, Cognition, Daily Functioning, and Mood in Elderly Patients with Alzheimer’s Disease and Dementia. Adv Ther, 31, 1247-1262
  22. Yong T., Qianyong Z., Mantian M., et al. (2011). Research on human memory enhancement by phosphatidylserine fortified milk. Chongqing Medicine, 30, 1671-83483.
  23. Hellhammer, J., Fries, E., Buss, C., et al. (2004). Effects of Soy Lecithin Phosphatidic Acid and Phosphatidylserine Complex (PAS) on the Endocrine and Psychological Responses to Mental Stress. Stress, 7(2), 119-126.
  24. More, M. I., Freitas, U. & Rutenberg, D. (2014). Positive Effects of Soy Lecithin-Derived Phosphatidylserine plus Phosphatidic Acid on Memory, Cognition, Daily Functioning, and Mood in Elderly Patients with Alzheimer’s Disease and Dementia. Adv Ther, 31, 1247-1262
  25. Fahey, T. D., Pearl, M., S. (1998). The hormonal and perceptive effects of phosphatidylserine administration during two weeks of resistive exercise-induced overtraining. Biol Sport, 15, 135-44.
  26. Kato-Kataoka, A., Sakai, M., Ebina, R., et al. (2010). Soybean-Derived Phosphatidylserine Improves Memory Function of the Elderly Japanese Subjects with Memory Complaints. J. Clin. Biochem. Nutr. 47, 246-255.
  27. Hirayama, S., Terasawa, K., Rabeler, R., et al. (2014). The effect of phosphatidylserine administration on memory and symptoms of attention-deficit hyperactivity disorder: a randomised, double-blind, placebo-controlled clinical trial. J Hum Nutr Diet, 27
  28. Vakhapova, V. C., Cohen, T., Richter, Y., et al. (2010). Research on human memory enhancement by phosphatidylserine fortified milk. Dement Geriatr Cogn Disord, 29, 467-474.
  29. Yong T., Qianyong Z., Mantian M., et al. (2011). Research on human memory enhancement by phosphatidylserine fortified milk. Chongqing Medicine, 30, 1671-83483.
  30. Vitamin B12. (2019, June 4). The Nutrition Source. https://www.hsph.harvard.edu/nutritionsource/vitamin-b12/
  31. Mikkelsen, K., Hallam, K., Stojanovska, L., & Apostolopoulos, V. (2018). Yeast based spreads improve anxiety and stress. Journal of Functional Foods, 40, 471-476. https://doi.org/10.1016/j.jff.2017.11.034
  32. Kim, H., Kim, G., Jang, W., Kim, S. Y., & Chang, N. (2014). Association between intake of B vitamins and cognitive function in elderly koreans with cognitive impairment. Nutrition Journal, 13(1). https://doi.org/10.1186/1475-2891-13-118
  33. Bryan, J., Calvaresi, E., & Hughes, D. (2002). Short-term folate, vitamin B-12 or vitamin B-6 supplementation slightly affects memory performance but not mood in women of various ages. The Journal of Nutrition, 132(6), 1345-1356. https://doi.org/10.1093/ jn/132.6.1345
  34. Jatoi, S., Hafeez, D. A., Riaz, S. U., Ali, A., Ghauri, M. I., & Zehra, M. (2020). Low vitamin B12 levels: An underestimated cause of minimal cognitive impairment and dementia. Cureus. https://doi.org/10.7759/cureus.6976
  35. Depeint F, Bruce WR, Shangari N, et al: Mitochondrial function and toxicity: role of the B-vitamin family on mitochondrial energy metabolism. Chem Biol Interact 2006; 163: 94 –112.
  36. Walker, J. G., Batterham, P. J., Mackinnon, A. J., Jorm, A. F., Hickie, I., Fenech, M., Kljakovic, M., Crisp, D., & Christensen, H. (2011). Oral folic acid and vitamin B-12 supplementation to prevent cognitive decline in community-dwelling older adults with depressive symptoms—the beyond ageing project: A randomized controlled trial. The American Journal of Clinical Nutrition, 95(1), 194-203. https://doi.org/10.3945/ajcn.110.007799
  37. Brain fog: Solutions to help you improve concentration. (2020, May 23). Bangkok Hospital:Brain Fog: Solutions To Help You Improve Concentration. https://www.bangkokhospital.com/en/content/brain-fog-syndrome
The material is prepared for informational purposes only and should not be construed as a piece of personal medical advice. Owing to each person’s varying health needs, a physician should be consulted before acting on any information provided in this material. Although every effort is made to ensure that this material is accurate, it is compiled for internal use only and should not be considered definitive. Neither VitaHealth nor its employees, or information providers shall be responsible or liable for any errors, inaccuracies, or other defects in the information contained in this publication.

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