by Marcelle Pick, OB/GYN NP
Where are my glasses? It’s on the tip of my tongue! Did I turn off the iron? Am I losing my mind?
How often do thoughts and questions like these race through your mind? All of us experience forgetful, fuzzy moments, particularly during periods of high stress, and increasingly so as we grow older. I see many women at my practice who are alarmed at lapses of attention or memory, and they are frequently embarrassed to admit how bad it can get — particularly when the results compromise safety.
Many of these women are caring for aging parents with Alzheimer’s disease or other forms of dementia, and they fear that the fuzziness they’re experiencing is just the tip of some terrible iceberg for them as well. Others have children with an ADHD diagnosis and wonder if they may have it, too. Most of them are concerned that their mental lapses will only get worse. I hear versions of If I’m this forgetful now, what’s it going to be like in ten years? all the time. In my experience, women (and men!) fear the mental symptoms of aging as much or more than the physiological changes.
But for the large majority of women under 70, there’s simply no reason to. Episodes of difficulty with word retrieval, an inability to focus, or feeling overwhelmed by a rush of thoughts and ideas are common signals that your body is overburdened and not getting the support it needs — and this includes how well you are coping with stress. Fuzzy thinking is one of several symptoms that may develop during perimenopause and menopause due to changing hormones, but problems with memory and attention can also be related to other physiological imbalances that respond well to simple changes in nutrition and lifestyle. So don’t let fear or shame of your wandering mind keep you from taking stock of what’s really going on — and then doing something about it.
Let’s discuss how.
When is fuzzy thinking serious?
Less often than you might think. Current medical thinking brackets lapses in cognitive function within two extremes. On the minor side, you have a temporary state of mental deterioration that is a direct result of a traceable behavioral pattern or situation — sleep deprivation, low blood sugar, illness, falling in love, childbirth, poor eating habits, and acute stress are a few examples. In this scenario, clarity returns when the “crisis” is over. On the more severe side, you have mental lapses that do not get better with time and self-care and that may indicate onset of an underlying serious mental or physical condition, including but not limited to clinical depression, bipolar disorders, schizophrenia, ADHD (also known as ADD), dementia, Alzheimer’s disease, post-traumatic stress disorder, or brain trauma or disease. Obviously the more serious neuropsychiatric conditions are topics of scientific research and get more press, so we hear more about this end of the spectrum.
As a result it’s easy to veer into catastrophic thinking when it comes to your own cognitive symptoms — but let me reassure you that developing a spontaneous degenerative mental condition at mid-life is usually the exception, not the norm. And in the case of ADHD, there’s technically no such thing as adult onset ADHD (although it’s possible that your symptoms were overlooked during childhood). Of course, if you have a family or personal history of a clinical disorder, or recently have experienced significant trauma, it makes sense to call your health care practitioner and discuss your concerns. If your friends and loved ones are worried for you and mentioning their suspicions, it can’t hurt to listen and get more information. There are many tests available that can put everyone’s minds at ease.
What is far more likely is that you fall on the minor side of the scale. And while your symptoms may be causing you a great deal of anxiety, it is more beneficial to think of them as signals asking you to pay more attention to your whole health picture. Rather than drown those calls out with drugs or shame, take them as a sign to sit up and take notice. At our practice, we assess fuzzy thinking in the context of many other biochemical and emotional issues — a great deal goes into maintaining an agile mind! — beginning with the simplest possible explanation first.
Stress and over-scheduling — the brain foggers
Women are fantastic multitaskers. We are hardwired to spin many plates in the air at once — and make dinner while we’re at it. And while this is a most admirable trait and quite possibly a good reason our species continues to thrive, it can come at a cost — particularly in today’s fast-paced, information-dense and stress-saturated culture.
If you think of your brain as a filing cabinet and information as folders downloaded, filtered and filed by your short and long-term memory systems, we are living in a time when the cabinet is just plain stuffed — and the older you are the more jammed your filing cabinet becomes, especially if you have not been taking care of yourself. This doesn’t mean you can’t learn new things (in fact, learning new skills is a proven way to stretch your file cabinet capacity). It just means that it’s easier for the newer files to slip through your short-term memory filter and get discarded than it is to pack them into storage.
Distraction and overscheduling are also key players. If you are constantly thinking of ten things at once, rushing hither, tither and yon and barely remembering to breathe, your brain may choose to take a holiday whether you want it to or not. Spacing out and shutting down are very real coping mechanisms for chronic stress.
Chronic unremitting fatigue and mental lethargy can also be the result of overburdening your adrenal glands. Our adrenal glands evolved to function in short but limited bursts, switching the central nervous system (including our brains) into full-alert mode to pump out cortisol in response to sudden threats, then returning to resting phase. In this situation (and when you are insulin-resistant, which I discuss below), the brain calls upon cortisol for instant energy rather than the slower, but more sustaining glucose. When a woman’s adrenal glands are overtaxed with no prolonged periods of quiescence, there are huge implications for your brain function. Prolonged exposure to cortisol actually damages brain neurons and reduces your ability to think clearly and efficiently.
Reducing overt stress, both emotional and environmental, and learning positive coping mechanisms are terrific therapy for the brain, and your lifestyle and daily schedule may be the first place to start when thinking about what may be causing your mental fog.
Better sleep on it
Another lifestyle factor within your control is how much sleep you get, and the quality of that sleep. While we do not yet understand all the reasons why both too little sleep and too much sleep can be detrimental to our health, it is sleep deprivation — ranging from minimal to dramatic — that is the more pervasive problem in our culture. We all know that when we are running on empty we just don’t think well.
If your “to-do” list is keeping you up late at night, or if you are drinking excessively in order to relax, your REM sleep may be deficient, and a valuable part of information processing occurs during REM sleep. Go too long without it and you will feel the disembodied mental effects directly — as anyone who has pulled one too many all-nighters can attest.
You may think you’re functioning “normally” for days at a time on limited sleep each night, but several cognitive–behavioral functions slip, including declarative memory (your ability to recall specific facts and experiences) and memory consolidation (your ability to crystallize recent events into long-term memory), just for starters. Then too, studies show that getting less than six hours a night can very quickly reduce reaction time, judgment, and coordination, so with less and less sleep not only can you not think straight, you are also compromising your safety.
We do not metabolize glucose well without adequate restful sleep either. In recent analysis of over 70,000 women enrolled in the Nurses Health Study, researchers found both too little sleep and oversleeping were associated with an increased risk for diabetes. In other studies, poor memory function, including spatial memory (the ability to remember locations and the “lay of the land”) were found to be more common in individuals with diabetes and individuals otherwise compromised by low blood glucose.
When sleep deficits are short-term, we can generally recover well and quickly return to normal functioning once better sleep patterns are restored. But many women face each day with an ongoing sleep deficit that is cumulative over weeks, and even years. So catching up on your zzzz’s is one of the easiest and quickest ways to improve fuzzy thinking. Read our articles about insomnia in women for more practical ways to reduce the effects of this health-robbing problem. The next place to look is your diet.
Nutrition, inflammation, and exercise
Optimal nutrition plays a tremendous role in brain function, as anyone who has sat through a long meeting without eating breakfast knows. The B-complex vitamins, especially B1, B2, B6 and folate (folic acid, or B9), which are commonly associated with energy and stress, are also critical to our capacity to reason, verbalize, and remember. Not only are the B vitamins important, but research also suggests that antioxidants and essential fatty acids (EFA’s) likewise support optimal brain function, in part perhaps by reducing inflammation and plaque production along nerve endings. Studies indicate people with ADHD have lower-than-normal blood levels of omega–3 fatty acids, and numerous studies correlate behavioral and cognitive improvement with supplemental omega–3s, omega–6s, and vitamin E. Fish truly is brain food, especially if you eat the right kind and it’s free of mercury.
Omega-3 fatty acids have also been shown to reduce inflammation markers, such as C–reactive protein (CRP), in the blood. Inflammation is an immune process carried out by the body to protect itself from foreign substances. Sometimes, however, our bodies produce an inflammatory response when there aren’t any foreign substances to fight. Inflammation in the brain has been linked to neurological disorders, such as Alzheimer’s and ADHD, and may play a role in how well the brain functions. So eating your omega–3 fatty acids may be a way to protect that important function.
Exercise is also a key player in cognition. Just as less plaque on our arteries makes way for easier blood flow, exercise naturally opens your arteries to increase blood flow as well. Like all living tissue in our bodies, the brain needs oxygen (via blood) to do its job and regular exercise makes for better circulation all around. Fittingly, some common symptoms of heart disease are memory loss, aphasia (a loss for words) and fuzzy thinking, thanks to inefficient blood circulation.
Again, these conditions are at the far end of the scale, but it only makes sense to prevent inflammation as much as possible before it gets the upper hand.
Food sensitivities and mental clarity
Inflammation can also be caused by undiagnosed food sensitivities, allergies, exposure to environmental pollutants, excessive caffeine, alcohol and sugar intake, and pervasive GI issues. In regards to cognitive dysfunction, I see a lot of women who drastically improve once they remove wheat and gluten from their diet. Sensitivity to yeast (candida) can also manifest as fuzzy thinking, which can improve when you avoid yeast’s favorite food: sugar! The metabolic by-products of yeast can actually be neurotoxic.
Each one of us is an individual with a unique reaction to different substances, so you may have some sleuthing to do — but don’t disregard the possibility of mental fuzziness as the telltale sign of something awry in your diet. The cleaner you can make your diet and your environment, the easier it is to identify any possible connections — and the clearer your thinking will become. Try a gentle detox to see what comes to light. Most of my patients report a rapid increase in energy and mental alertness within days of initiating a detox diet if food sensitivities are an issue. Who knows — you may even recover that photographic memory!
And while implementing a change in your nutrition, you should also consider a reduction in carbohydrate consumption. Let me explain why this is important for your memory and attention.
Insulin resistance — an overlooked cause of depression and fuzzy thinking
Your cognitive function relies on a steady supply of oxygen and glucose. When levels dip, you yawn or begin to crave food. If your circulation and metabolism are hopping along, and your hormones are balanced, your brain gets what it needs without much fanfare. However, insulin resistance — a precursor to diabetes, metabolic syndrome, and cardiovascular disease — can make this whole process far more complicated by causing inflammation and affecting brain function.
Let’s digress for just a moment, to help you understand how insulin can dramatically affect your mental functions. Insulin and glucagon are the major hormones that facilitate your body’s ability to regulate blood sugar (called glucose). If each of your cells had a door, insulin would be comparable to a key that unlocks the door and enables the cell to access glucose. If the cell does not require any energy (in the form of glucose), insulin stores that energy for future use in fat cells. Glucagon is the hormone responsible for releasing glucose from storage if needed.
A diet high in simple carbohydrates (the kind found in the ubiquitous “white foods” – bread, pasta, cereal, refined sugars) and overly processed foods cause levels of insulin in the body to remain extremely high. Sooner or later, if insulin levels aren’t normalized, your cells become resistant to insulin’s effects and their doors stay closed and locked. What happens to all that glucose in circulation? It’s transported straight to fat cells — usually around the belly — even if your other cells are actually starving! And because your cells can’t function properly without glucose, insulin resistance can lead to other serious health problems as well.
The brain isn’t exempt. Insulin resistance prevents brain cells from accessing glucose as well. What fills the void? In some cases, possibly cortisol. Our brains are not geared to run on cortisol for long periods of time; it’s only meant to be an emergency substitute. In any event, if this situation isn’t rectified it can have far-reaching implications, including neurotransmitter imbalance, cognitive malfunction, and possibly a steady decrease in thyroid function, too. All of these conditions may present initially with a lack of mental clarity.
Some women discover that they’ve become insulin resistant when they enter perimenopause and menopause. Before that time, estrogens appear to have a protective effect; when levels decline the protective effect is diminished, but you gain the opportunity to understand what’s really been going on in your body. This is one of the many gifts of menopause.
If you are dealing with insulin resistance, reducing your simple carbohydrate load may significantly improve your mental clarity — not to mention your mood. And once you’ve stabilized your insulin and cortisol levels, addressing other components of hormonal balance becomes more straightforward. Your body can’t balance its “minor” hormones (estrogen, progesterone and testosterone among them) until your insulin metabolism is on an even keel.
Estrogen and brain circuitry
Estrogen and progesterone balance is also crucial for proper brain functioning and healthy neurotransmitter levels. Any woman who has experienced sugar cravings, bouts of fatigue or extreme mood swings as part of PMS, knows instinctively that estrogen and progesterone influence how you feel and think.
The effects of hormones on cognitive processes are being scrutinized more closely by the medical research community as recent studies show correlations between estrogen levels and the incidence of Alzheimer’s disease. Estradiol in particular appears to have a potent neuroprotective, antioxidant effect, preventing our neurons from oxidative damage and early death. Studies are showing that estrogen in general profoundly impacts mental agility by helping the brain strengthen and expand the nerve endings — dendrites — that complete the final, crucial steps in cognitive functions. Estrogens help connect the little wires in our brains to make processes like memory, reasoning, and mood run smoothly.
So, it makes perfect sense that as estrogen levels shift during perimenopause and menopause, memory and attention may wax and wane. Supporting your body’s hormonal transition with gentle endocrine support is one way to reboot your natural hormonal rhythm and help regulate estrogen levels. Changing your diet, supplementing with nutrients, and decreasing stress, inflammation and toxic exposure will also clear out the mental cobwebs.
And speaking of clearing out, this brings me to one frequently overlooked topic that should be addressed in relation to mental clarity.
Heavy metals and fuzzy thinking
Heavy metal toxicity is an extremely controversial subject and although it has been implicated for many years in neurological disorders, adequate research remains to be done to fully define the connections with cognitive impairment. At poisonous levels, a loss in cognitive performance has been documented for at least seven different heavy metals (cadmium, chromium, cobalt, lead, mercury, nickel, and silver). Although aluminum is not categorically a heavy metal, work has been done that links exposure with cognitive disorders, including reduced verbal and visual memory, visuo-spatial problem-solving, concentration, “concept formation” and attention, as well as with increased risk of Alzheimer’s and other forms of dementia. But in an overall sense, little has been done to quantify the cumulative effects of daily exposure in humans to low levels of heavy metals — the kind of exposure we all experience every day.
Mercury, arsenic, lead, and cadmium are the most common heavy metals with which we come into daily contact. Studies of songbirds, aquatic life and groundwater show that these metals are everywhere. We inhale, eat, absorb and breathe them — and the younger we are the more dangerous they can be. Toddlers are particularly vulnerable to lead poisoning, and the effects can be irreversible. To my thinking, if we have proven that high levels of heavy metals affect brain development and functioning, doesn’t it stand to reason that long-term exposure to low levels would have a detrimental effect?
This month a landmark study of 4700 children will be published in Environmental Health Perspectives that documents a causal relationship between childhood exposure to environmental pollutants with a diagnosis of ADHD. In this particular study, prenatal exposure to cigarette smoke resulted in a child being 2.5 times more likely to have ADHD, and childhood exposure to lead elevated the risk four-fold. What’s more, scientists recorded this increased risk when blood levels of lead were far below the Center for Disease Control’s definition of acceptable blood levels. I encourage you to read this report for yourself or peruse an interview with the lead researcher and another national expert on lead poisoning at Living on Earth.
To put it bluntly, heavy metal toxicity doesn’t go away just because we’ve grown up. After 20–plus years of treating women in my practice, I believe that heavy metal toxicity is a real issue for many more people than we’d like to believe — and it may be an issue for you.
Ironically, there is one metal that causes fuzzy thinking when you have too little of it in your system: iron. Anemia, or iron deficiency, is a common concern in women. From time to time anemia is the result of a blood disorder, but we see it most frequently in postpartum women and in those who experience heavy periods. Fortunately, this is a condition that is easily treatable with a few dietary changes and temporary iron supplementation, but it is a situation that deserves medical attention.
Putting the pieces together: the Women to Women approach
For the sun to burn off your mental fog, you will need to tune in to the signals your body is sending. Consider the possibility that your lifestyle and habits are getting in the way, but if you don’t feel these are your main issues, talk to your health practitioner about getting some tests. We recommend the following tests:
- Iron levels
- Fasting insulin, glucose tolerance test, & 2–hour postprandial glucose and insulin
- Homocysteine and CRP
- Thyroid function
- Adrenal function
- Hormone panel
- ALCAT or other allergy testing
- Other alternative tests we use include the organic acid profiles by Metametrix
Once your tests have ruled out any major underlying medical issues, you can put your mind at ease and begin to take steps toward improving your core foundation of health. Once you’ve made a few positive changes, I would not be surprised if you find your mental agility returning in spades. Don’t let fear of ADHD, dementia, or old age keep you from addressing mental difficulties.
For the vast majority of women, a combination approach that restores inner physiological vitality will help keep you sharp as a tack well into your older years. And if you are on medication for a more serious condition, these suggestions can only enhance your prognosis:
Eat often and well. Focus on eating three well-balanced meals and two snacks per day that include protein, richly colored vegetables and fruits, whole grains, fiber and healthy fats. Drink plenty of water and take a balanced multivitamin to fill in any nutritional gaps. I also suggest supplementing with omega–3 fatty acids, either through diet or capsules. Check to be sure your brand is lead– and mercury–free, and also make sure that any multivitamin you take has a rich complement of B’s and antioxidants like C and E.
Cleanse your system. Diagnosing hidden food sensitivities and cutting them out can do wonders in terms of mental clarity. If you suffer from headaches or joint pain along with your fuzzy thinking, you may very well be sensitive to gluten. Limit alcohol, sleeping pills, and prescription pain medications. Try a gentle detox for a couple of weeks. By ridding your body of environmental aggravators, allergens, and toxins, you can give your immune system a rest and roll back the brain fog bank.
Cultivate your relaxation and sleep habits. In fact, try to spend about a third of your life doing this! There simply is no effective substitute for the restorative effects meditation and sleep can have on your neurobiology; they are fundamental to reversing the downward spiral of fatigue and stress.
Exercise daily. Moving your body will help focus your mind. When you exercise, your heartbeat quickens and you breathe more deeply — which gets more oxygen to your brain and sharpens your thoughts. If you find yourself dull and tired, try taking a brisk walk around the block. If you feel refreshed when you move, you are suffering from lethargy, not fatigue, and may find that increasing your physical activity is fuel for your brain. Exercise also helps decrease cortisol levels.
Restore hormonal balance. Avoid simple carbohydrates, refined sugar, and processed foods to help keep insulin levels in line. Consider gentle endocrine support to kickstart your natural hormonal balance and to promote a healthy ratio of estrogen, progesterone and testosterone. This will also help keep your neurotransmitters happy.
Reduce stress through time management. Try sitting down and making a comprehensive to-do list. Decide which tasks fall into the “have-to” pile and which fall into the “want-to” pile. Don’t underestimate the value of the “too-hard basket”either: it may be that some of your life rescue missions are overwhelming you! Then take out your calendar and space the have-to items evenly across the days of a week. At the top of each month, divide the want-to items across the next six months. Be realistic. Most people can accomplish only one or two extra errands or goals per week on top of their regular activities. If there is something that can give, let it go — as long as it isn’t sleep or exercise!
Stretch your brain. Crossword and Sudoku puzzles, games of logic, and learning new skills (like a foreign language or an instrument) are great brain workouts. Our ability to generate new brain cells after age 30 might be minimal, but creative thinking exercises can help build efficiency and agility to those we already have, and hopeful new studies indicate that even damaged nerve cells may be able to recover under certain conditions. Try simple memory exercises like recalling all your elementary school teachers’ names. Don’t let your computer do your thinking! As you work on boosting your nutrition and increasing your physical exercise endurance, don’t forget to challenge your brain power! Download games, puzzles and brain teasers from Audible.com onto an iPod and do both at the same time! Your brain power is like your muscle power; you have to use it or lose it.
Thinking comes from doing
With the complicated, often overlapping symptoms that fall under the umbrella of “fuzzy thinking,” the average woman may leap to the conclusion that she is developing a variety of serious diagnoses. And often with age comes a gnawing fear that something is really “wrong” with our brains that will surely get worse.
But before you take that headlong downer, take time to assess your total health picture and face the reality of your diet and lifestyle. Are there things you can do now to give yourself more support? I’m fairly confident the answer is yes.
Brain chemistry is not a fixed state and will react for better or worse to the way we treat ourselves and our bodies. And this includes all women of all ages, whether you have a clinical condition or not. So put your mind over matter and take action — and lose those muddled moments for good.