Thyroid Strong

When I was first diagnosed with Hashimoto’s, I had massive brain fog. You can imagine how difficult it was to run my busy chiropractic practice in NYC with a team of 8 and see 100 patients every week. I remember forgetting what I was saying to my patients mid-sentence and struggling to finish the sentence. 

It was a journey that involved working through the root causes that contributed to my brain fog. Specifically, healing from mold exposure, cutting gluten from my diet, and stopping overtraining. All of these helped restore my brain. I’m happy to report that my brain is 100% back online, and I’m here to tell you that it’s possible for you, too.

Many women expect their brain fog to go away after getting their thyroid hormone levels in the appropriate range. While your brain fog is nearly guaranteed to improve with thyroid replacement, you may be discouraged to find that your brain still isn’t back to normal.

The good news is that there are many additional things you can do to improve brain fog. This article will help you understand why brain fog persists, even after thyroid hormone treatment, and what you can do about it.

What is brain fog?


Brain fog is a constellation of symptoms, including [1]:

  • Reduced cognition (trouble thinking clearly)
  • Inability to concentrate/focus
  • Trouble multitasking
  • Difficulty with short and long-term memory

Any condition that negatively affects brain function is likely to result in some level of brain fog. Neuroinflammation (brain inflammation), nutrient deficiencies, and the brain’s struggle to produce enough energy are common contributors to brain fog. Brain fog is also a common symptom of these conditions [1].

  • Other autoimmune diseases
  • Chronic fatigue syndrome
  • Fibromyalgia
  • Depression and other mental health disorders
  • Mold exposure
  • Mild cognitive impairment
  • Alzheimer’s disease (AD)

Other reasons for brain fog include decreased blood flow to the brain and decreased glucose available for neurons to make energy.

What causes Hashimoto’s brain fog?


Thyroid hormones regulate metabolism in all of your cells, including your brain. It makes sense that hypothyroidism slows down brain metabolism, leading to brain fog. 

Yet, many Hashimoto’s patients’ on long-term thyroid hormone replacement still have lingering brain fog that affects their wellbeing [2].

Here are possible reasons you can still have brain fog despite stable “normal” thyroid labs:

  • Chronic inflammation can slow down overall brain firings, which can make you feel mentally sluggish and tired.
  • Mitochondrial dysfunction from chronic inflammation [3], which can reduce brain energy to transmit neuronal signals and produce the right amount of neurotransmitters. For example, acetylcholine, the neurotransmitter crucial for memory and focus, is often the first to go [4].
  • Thyroid antibodies, especially, thyroid peroxidase antibodies (Anti-TPO) also bind to neurons [5].
  • Other autoimmune antibodies that attack proteins in the brain may be present. These interfere with the ability to generate myelin, the covering of nerves that is necessary for their normal function [5].
  • Increased brain cytokines can affect your neurotransmitters [5].
  • Reduced brain blood flow either from reduced circulation or high blood pressure. This can reduce oxygen, glucose, and nutrients in brain regions involved in memory and attention [6].
  • A leaky blood-brain barrier due to inflammation and oxidative stress [6]. As a result, the blood-brain barrier allows glutamate, toxins, and other inflammatory molecules to enter the brain

For the same reasons as above, Hashimoto’s is also linked to depression, anxiety, and dementia [7,8].

Hashimoto’s brain fog cure


Optimizing your thyroid hormone levels should be your first priority. Be sure to work with a practitioner who will test all of your thyroid hormones to ensure they are balanced across the board. However, if you still have brain fog, you need to:

  • Reduce inflammation and oxidative stress
  • Increase cerebral blood flow
  • Balance your immune system
  • Maintain healthy blood sugar levels

The following are the foundation of your healing path. Working on these impacts all of the above goals. Get these in order and you’ll have set the stage for everything else you incorporate to do its best work.

Intermittent fasting and the AIP diet

Intermittent fasting (IF) is a modified fasting protocol, where you consume all of your calories in a particular window of time during the day. Within 8 or 12 hours is the most common. The remainder of the time you don’t take in any calories. This decreases inflammatory immune cells and helps balance blood sugar [9].

The autoimmune protocol diet (AIP) is an effective dietary approach for Hashimoto’s [10]. It helps balance inflammation and blood sugar. It includes foods that balance inflammation and eliminates those that cause it. The AIP also has an elimination portion where you identify your personal inflammation-causing food sensitivities.

You can use AIP and IF together for a powerful anti-inflammatory diet protocol.

Manage stress and heal trauma

Chronic stress and unprocessed trauma can throw off both your nervous and immune systems [11,12]. Therefore, to clear up brain fog, you need to manage your stress response and process your trauma. These will also be helpful to manage your Hashimoto’s [13].

Helpful stress-reducing practices include:

  • Diaphragmatic breathing
  • Meditation
  • Nature walks
  • Counseling
  • Exercise

Processing trauma can sound scary but you may need to go through it to heal your Hashimoto’s brain fog. Depending on the nature of the trauma, helpful therapeutic approaches include

  • Somatic therapy
  • EMDR (eye-movement desensitization and reprocessing)
  • Prolonged exposure
  • Cognitive processing therapy
  • Cognitive behavioral therapy

Optimize sleep

Poor sleep will throw off your brain function and inflammation, so optimizing sleep is a non-negotiable if you want to clear up brain fog [14].

Aim for seven and a half to eight hours of sleep each night, but most important is to get six hours of uninterrupted sleep. In addition, I recommend getting into a rhythm and practicing sleep hygiene techniques. You can find this and much more information on Hashimoto’s and sleep in this article.

Address other comorbid health issues

Work with a practitioner to screen and address any comorbid conditions that contribute to brain fog. These may include

  • Heavy metals
  • Mold exposure
  • High blood pressure
  • Insulin resistance and diabetes
  • Digestive problems, like Irritable Bowel Syndrome and Small Intestinal Bacterial Overgrowth
  • Pernicious anemia

Exercise

Exercise increases brain-derived neurotrophic factor (BDNF) and helps balance your neurotransmitters (the chemicals that your neurons use to communicate with one another). In fact, exercise is the main way to increase BDNF in the brain [15]. BDNF helps regrow neurons, boost mood, improve neuronal connections, and enhance cognitive processes, such as memory [16]. 

The benefits of exercise on brain fog include [15]:

  • Improved memory
  • Enhanced learning ability
  • Neuroprotection
  • Neurogenesis (new nerve formation) in the hippocampus 
  • Improving blood flow to your brain and helping brain metabolism [17].

Moderation is important with exercise though. If you push beyond your current ability to recover, you could overtrain, which can temporarily worsen brain fog, fatigue, and even cause a Hashimoto’s flare [18].

By building muscles and burning fat, the right kinds of exercise like in Thyroid Strong also help balance inflammation and thyroid hormones [19,20].

Supplements for Hashimoto’s brain fog


Certain supplements help improve brain function, modulate inflammation, and provide building blocks for your brain. These are essential for recovering healthy brain function with Hashimoto’s. To ensure you get a Thyroid Strong exclusive practitioner-quality supplement, make your Fullscript account here to see my recommended supplement list and get your 15% Thyroid Strong discount. 

Omega-3

The omega-3 fatty acids EPA and DHA are found primarily in fish oil and ocean food sources. They help modulate whole-body inflammation and are neuroprotective [21]. DHA is the primary omega-3 found in the brain but both are important for balancing brain inflammation [21,22].

Omega-3 supplementation may improve mood, fatigue, memory, and cognitive function [23–25].

Choline

Choline is an essential brain nutrient to overcome brain fog. It is the precursor to acetylcholine. As discussed earlier, acetylcholine helps orchestrate nervous system function and is important for learning and memory. Loss of acetylcholine neurons is associated with brain fog, memory loss, and Alzheimer’s disease (AD) [26].

You can get choline in liver, red meat, egg yolks, salmon, chicken, and legumes. It is also available in supplement form.

Supplements that effectively increase brain acetylcholine include

  • AlphaGPC, a natural choline source 
  • Citicoline, another supplemental source that is a precursor to phosphatidylcholine, another important brain nutrient.  

Trimethylglycine

Trimethylglycine, also known as betaine, is a neuroprotective nutrient found in beetroot and trimethylglycine supplements. Betaine accumulates in the hippocampus (your brain’s memory center), where it affects a variety of neurotransmitters. It may help improve cognitive performance and memory [27].

Betaine may also enhance mood by increasing SAMe in the brain [28]. 

B complex

B vitamins are essential cofactors for cellular energy production. The brain has a very high energy need. Providing your body with enough B vitamins is a solid approach to ensure your brain cells can produce enough energy from glucose.

B vitamins also modulate inflammation and mitigate age-related cognitive decline [29,30].

Vitamin B12 is required for myelin formation on nerves. B12 deficiency can cause cognitive impairment and depression. 

Acetyl-L-Carnitine (ALCAR)

Acetyl-L-Carnitine (ALCAR) is a naturally-occurring nutrient that helps your neurons produce energy. ALCAR is an antioxidant and neuroprotective. It increases glucose levels in brain cells and modulates neurotransmitters, such as GABA.

Therefore, ALCAR is beneficial for combating cognitive decline [31].

Conclusion


By taking a holistic approach to Hashimoto’s, you can regain your brain power. As you decrease inflammation and increase the metabolism in your brain, the fog will begin to clear. In the Thyroid Strong program, we are a community of women who understand your struggles and your goals. We keep one another motivated and accountable.  

Thyroid Strong gives you the blueprint to start getting in shape and realizing the benefits of building muscle and burning. Join our tribe of powerful women today, and become Thyroid Strong!

How do you know if you have a Thyroid Issue?

Learn the 10 telltale signs you’re struggling with a thyroid issue.

References


1 Theoharides, T. C., Stewart, J. M., Hatziagelaki, E. and Kolaitis, G. (2015) Brain “fog,” inflammation and obesity: key aspects of neuropsychiatric disorders improved by luteolin. Front. Neurosci. 9, 225. Available at: https://pubmed.ncbi.nlm.nih.gov/26190965/#:~:text=Brain%20%22fog%22%20is%20a%20constellation,short%20and%20long%20term%20memory

2 Djurovic, M., Pereira, A. M., Smit, J. W. A., Vasovic, O., Damjanovic, S., Jemuovic, Z., Pavlovic, D., Miljic, D., Pekic, S., Stojanovic, M., et al. (2018) Cognitive functioning and quality of life in patients with Hashimoto thyroiditis on long-term levothyroxine replacement. Endocrine 62, 136–143. Available at: https://pubmed.ncbi.nlm.nih.gov/29959689/  

3 Martins. Autoimmune disease and mitochondrial dysfunction in chronic diseases. Research on Chronic Diseases. Available at: https://www.openaccessjournals.com/articles/autoimmune-disease-and-mitochondrial-dysfunction-in-chronic-diseases-12187.html 

4 Picciotto, M. R., Higley, M. J. and Mineur, Y. S. (2012) Acetylcholine as a neuromodulator: cholinergic signaling shapes nervous system function and behavior. Neuron 76, 116–129. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3466476/#:~:text=Acetylcholine%20in%20the%20brain%20alters,firing%20of%20groups%20of%20neurons

5 Leyhe, T. and Müssig, K. (2014) Cognitive and affective dysfunctions in autoimmune thyroiditis. Brain Behav. Immun. 41, 261–266. Available at:  https://pubmed.ncbi.nlm.nih.gov/24685840/ 

6 Nomoto, S., Kinno, R., Ochiai, H., Kubota, S., Mori, Y., Futamura, A., Sugimoto, A., Kuroda, T., Yano, S., Murakami, H., et al. (2019) The relationship between thyroid function and cerebral blood flow in mild cognitive impairment and Alzheimer’s disease. PLoS One 14, e0214676. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6447192/#!po=32.1429 

7 Siegmann, E.-M., Müller, H. H. O., Luecke, C., Philipsen, A., Kornhuber, J. and Grömer, T. W. (2018) Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis: A Systematic Review and Meta-analysis. JAMA Psychiatry 75, 577–584. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137529/ 

8 Kim, J. H., Lee, H. S., Kim, Y. H., Kwon, M. J., Kim, J.-H., Min, C. Y., Yoo, D. M. and Choi, H. G. (2022) The Association Between Thyroid Diseases and Alzheimer’s Disease in a National Health Screening Cohort in Korea. Front. Endocrinol. 13, 815063. Available at: https://www.frontiersin.org/articles/10.3389/fendo.2022.815063/full

9 Jordan, S., Tung, N., Casanova-Acebes, M., Chang, C., Cantoni, C., Zhang, D., Wirtz, T. H., Naik, S., Rose, S. A., Brocker, C. N., et al. (2019) Dietary Intake Regulates the Circulating Inflammatory Monocyte Pool. Cell 178, 1102–1114.e17. Available at: https://pubmed.ncbi.nlm.nih.gov/31442403/ 

10 Abbott, R. D., Sadowski, A. and Alt, A. G. (2019) Efficacy of the Autoimmune Protocol Diet as Part of a Multi-disciplinary, Supported Lifestyle Intervention for Hashimoto’s Thyroiditis. Cureus 11, e4556. Available at: https://pubmed.ncbi.nlm.nih.gov/31275780/ 

11 Yuen, E. Y., Wei, J., Liu, W., Zhong, P., Li, X. and Yan, Z. (2012) Repeated stress causes cognitive impairment by suppressing glutamate receptor expression and function in prefrontal cortex. Neuron 73, 962–977. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476783/ 

12 Liu, Y.-Z., Wang, Y.-X. and Jiang, C.-L. (2017) Inflammation: The Common Pathway of Stress-Related Diseases. Front. Hum. Neurosci. 11, 316. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3302010/ 

13 Mizokami, T., Wu Li, A., El-Kaissi, S. and Wall, J. R. (2004) Stress and thyroid autoimmunity. Thyroid 14, 1047–1055. Available at: https://pubmed.ncbi.nlm.nih.gov/15650357/ 

14 Irwin, M. R. (2019) Sleep and inflammation: partners in sickness and in health. Nat. Rev. Immunol. 19, 702–715. Available at:  https://pubmed.ncbi.nlm.nih.gov/31289370/ 

15 Liu, P. Z. and Nusslock, R. (2018) Exercise-Mediated Neurogenesis in the Hippocampus via BDNF. Front. Neurosci. 12, 52. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808288/#:~:text=Exercise%20is%20known%20to%20have,and%20incorporated%20into%20hippocampal%20circuits

16 Sleiman, S. F., Henry, J., Al-Haddad, R., El Hayek, L., Abou Haidar, E., Stringer, T., Ulja, D., Karuppagounder, S. S., Holson, E. B., Ratan, R. R., et al. (2016) Exercise promotes the expression of brain derived neurotrophic factor (BDNF) through the action of the ketone body β-hydroxybutyrate. Elife 5. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915811/ 

17 Querido, J. S. and Sheel, A. W. (2007) Regulation of cerebral blood flow during exercise. Sports Med. 37, 765–782.  Available at: https://pubmed.ncbi.nlm.nih.gov/17722948/ 

18 Kreher, J. B. and Schwartz, J. B. (2012) Overtraining syndrome: a practical guide. Sports Health 4, 128–138. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435910/ 

19 Tuttle, C. S. L., Thang, L. A. N. and Maier, A. B. (2020) Markers of inflammation and their association with muscle strength and mass: A systematic review and meta-analysis. Ageing Res. Rev. 64, 101185. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553046/ 

20 Zupo, R., Castellana, F., Sardone, R., Lampignano, L., Paradiso, S., Giagulli, V. A., Triggiani, V., Di Lorenzo, L., Giannelli, G. and De Pergola, G. (2020) Higher Muscle Mass Implies Increased Free-Thyroxine to Free-Triiodothyronine Ratio in Subjects With Overweight and Obesity. Front. Endocrinol. 11, 565065. Available at: https://pubmed.ncbi.nlm.nih.gov/32992047/#:~:text=Furthermore%2C%20higher%20levels%20of%20systemic,muscle%20strength%20and%20muscle%20mass

21 Dyall, S. C. (2015) Long-chain omega-3 fatty acids and the brain: a review of the independent and shared effects of EPA, DPA and DHA. Front. Aging Neurosci. 7, 52. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404917/?report=reader 

22 Orchard, T. S., Gaudier-Diaz, M. M., Weinhold, K. R. and Courtney DeVries, A. (2017) Clearing the fog: a review of the effects of dietary omega-3 fatty acids and added sugars on chemotherapy-induced cognitive deficits. Breast Cancer Res. Treat. 161, 391–398. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404917/?report=reader 

23 Sinn, N., Milte, C. M., Street, S. J., Buckley, J. D., Coates, A. M., Petkov, J. and Howe, P. R. C. (2012) Effects of n-3 fatty acids, EPA v. DHA, on depressive symptoms, quality of life, memory and executive function in older adults with mild cognitive impairment: a 6-month randomised controlled trial. Br. J. Nutr. 107, 1682–1693. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526680/ 

24 Yurko-Mauro, K. (2010) Cognitive and cardiovascular benefits of docosahexaenoic acid in aging and cognitive decline. Curr. Alzheimer Res. 7, 190–196. Available at: https://pubmed.ncbi.nlm.nih.gov/21929835/ 

25 Alfano, C. M., Imayama, I., Neuhouser, M. L., Kiecolt-Glaser, J. K., Smith, A. W., Meeske, K., McTiernan, A., Bernstein, L., Baumgartner, K. B., Ulrich, C. M., et al. (2012) Fatigue, inflammation, and ω-3 and ω-6 fatty acid intake among breast cancer survivors. J. Clin. Oncol. 30, 1280–1287.  Available at: https://pubmed.ncbi.nlm.nih.gov/20088810/ 

26 Poly, C., Massaro, J. M., Seshadri, S., Wolf, P. A., Cho, E., Krall, E., Jacques, P. F. and Au, R. (2011) The relation of dietary choline to cognitive performance and white-matter hyperintensity in the Framingham Offspring Cohort. Am. J. Clin. Nutr. 94, 1584–1591. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252552/ 

27 Knight, L. S., Piibe, Q., Lambie, I., Perkins, C. and Yancey, P. H. (2017) Betaine in the Brain: Characterization of Betaine Uptake, its Influence on Other Osmolytes and its Potential Role in Neuroprotection from Osmotic Stress. Neurochem. Res. 42, 3490–3503. Available at:  ​https://pubmed.ncbi.nlm.nih.gov/28918494/ 

28 Di Pierro, F., Orsi, R. and Settembre, R. (2015) Role of betaine in improving the antidepressant effect of S-adenosyl-methionine in patients with mild-to-moderate depression. J. Multidiscip. Healthc. 8, 39–45. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303396/ 

29 Kennedy, D. O. (2016) B Vitamins and the Brain: Mechanisms, Dose and Efficacy–A Review. Nutrients 8, 68. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772032/ 

30 Wang, Z., Zhu, W., Xing, Y., Jia, J. and Tang, Y. (2022) B vitamins and prevention of cognitive decline and incident dementia: a systematic review and meta-analysis. Nutr. Rev. 80, 931–949. Available at: https://academic.oup.com/nutritionreviews/article-abstract/80/4/931/6357328?redirectedFrom=fulltext 

31 Pennisi, M., Lanza, G., Cantone, M., D’Amico, E., Fisicaro, F., Puglisi, V., Vinciguerra, L., Bella, R., Vicari, E. and Malaguarnera, G. (2020) Acetyl-L-Carnitine in Dementia and Other Cognitive Disorders: A Critical Update. Nutrients 12. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7284336/

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