Addressing Cognitive Dysfunction ("Brain Fog") in CFS & Fibromyalgia

Published: August 8, 2012

Brain fog is very common in CFS/FMS, and presents as:

  1. Horrible short term memory,
  2. Difficulty with word finding and word substitution (e.g., substituting the word "fork" for "knife," or your neighbor's name for your husband's name—not a Freudian slip in CFS), and
  3. Approximately 30% of those with CFS/FMS have episodic disorientation lasting ~ 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).

Brain fog can sometimes be the scariest part of the illness for some—especially professionals that had been functioning at a very high level. Though standard testing will often not pick up the problem (nor is it designed to), in some cases the brain fog makes it hard or even impossible to continue one's job. In other cases, brain fog can be mild.

The good news is that brain fog tends to resolve with therapy along with the pain and fatigue. In this week's feature article, we will discuss the key therapies that can help you to get your brain back!

Where do I start?

Poor energy production in the brain, with associated alterations in blood flow (e.g., to the sides of the brain where the speech centers are) as well as alterations in neurotransmitters (brain chemicals like serotonin, dopamine, adrenaline or acetylcholine), blood pressure, or blood sugar can all contribute to your brain fog. Because of this, the overall "S.H.I.N.E. Protocol" is very helpful for brain fog as well as CFS/FMS. Let's look at the key issues and therapies.

  1. Sleep—Getting your 8 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 supplements at bedtime like melatonin (1/2-1 mg), calcium and magnesium, and the an herbal supplement that promotes healthy sleep. These are less likely to cause brain fog and will lower the amount of medications needed. Work with your doctor to leave off 1 of your sleep medications each night as well, to see if any of them are leaving you hung over/foggy the next day. If so, play with the medications and doses to find a mix that works with less next day sedation. Using a low dose of several sleep (or pain) medications is more effective and has fewer side effects than a high dose of 1 or 2 medications. For more information on how to get a good night's sleep, see "Sleep and Insomnia." Explore the role, also, of any other medications which may be sedating.
  2. Optimize Thyroid function by adjusting the thyroid type and dose based on your symptoms, using only the Free T4 blood test to make sure you are staying in the normal range for safety. Do not let your doctor use the TSH test to monitor therapy in CFS/FMS. It is not reliable in this illness and you will be underaddressed and brain foggy. Some people do better taking part (or all) of their thyroid dose at bedtime. For more on addressing thyroid problems, see "Thyroid Hormone Deficiency—An Overview."
  3. 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.
  4. 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. This is discussed in my book, From Fatigued to Fantastic! (and I will do a newsletter article on Candida soon), but the key is to take the medication Diflucan 200 mg a day for 6-12 weeks while avoiding sugar and taking probiotic pearls and an herbal supplement that helps maintain healthy gut flora.
  5. Optimize nutritional support with a good multivitamin powder and Ribose. Ask your physician if you can have a series of B12 shots (1,000-5,000 mcg of the hydroxycobalmin form of B12 each few days for a total of 15 doses, then as needed). People can often learn to give their own B12 shots. If you have dry eyes, dry mouth, or depression, add 1 teaspoon of fish oil a day or 3-4 servings of tuna or salmon each week.
  6. Stay hydrated. If your mouth or lips are dry, you're dehydrated. It's amazing how the mind can clear a lot sometimes after simply drinking a glass of cool water. Getting fresh air and sunshine (in moderation—don't burn) can also help.
  7. 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. Avoid the caffeine after 2 pm so it won't disrupt sleep.

Therapies for Symptom Relief

While you are instituting the therapies above, here are a few therapies that can offer symptomatic relief:

  1. Dexedrine or Ritalin—Though these amphetamine family medications are markedly overused in hyperactive kids, they are UNDERUSED in CFS. These medications actually can help restore balance in CFS/FMS by raising dopamine levels and brain wave frequency to normal, stabilizing low blood pressure and autonomic dysfunction and decreasing the tendency to sleep apnea by causing weight loss. Most adults find 5-12.5 mg each morning to be optimal. Younger patients (under 22 years old) often find they need higher doses (I generally do not prescribe over 30 mg a day), though the reason for this is not clear. I suspect, though, that it is because younger patients have more autonomic dysfunction.
  2. An herbal supplement that promotes mental alertness—This nutrient and herbal mix can be very helpful for brain fog, and is worth using first, but frankly the Dexedrine is more effective for brain fog. It is worth trying though and can even be combined with the Dexedrine for optimal effect.

Give all of the above therapies 6 weeks to fully kick in. Even though some of these help within days, natural therapies often take 6 weeks to heal the systems involved so you can feel better.

Like fibromyalgia pain, brain fog responds well to therapy. The problem is largely that most physicians are simply not trained in these illnesses. Most of these therapies can be done on your own, and you can ask your physician to assist with those requiring a prescription. In addition, The American Board of Integrative Medicine (ABIHM) includes over 1,500 board-certified holistic practitioners who can help you. Their website can also help you locate a certified holistic physician near you.

You can get back both your life—and your mind!


Dr. T

Jacob Teitelbaum, MD

is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of eight research studies on their effective treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. His newest book (June 10, 2024) is You Can Heal From Long COVID. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.

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