Dr. Ayla Wolf DAOM, L.Ac.
Brain fog is one of many cognitive symptoms commonly experienced people report following a TBI. Traumatic brain injuries are highly complex injuries, and brain fog, as a symptom, is equally complex. Many factors can contribute to brain fog including decreased cerebral blood flow; dysfunctional cerebral glucose metabolism; dysregulation of the immune system of the brain; poor glymphatic function; and the presence of heavy metals, pathogens, or other toxins in the brain, just to name a few.
Decreased Cerebral Blood Flow
Following a concussion, ongoing and progressively declining blood flow specifically to the prefrontal cortex can be seen up to 12 months or more post-injury. The prefrontal cortex is an area of the brain involved in critical thinking, cognitive processing, decision making, planning, and emotional intelligence. Decreased blood flow to this area makes many aspects of cognition feel difficult, like the equivalent of kicking a horse into a gallop, only to find the horse won’t budge. Many people feel as if their brain simply won’t do its job like it used to.
Dysfunctional Cerebral Glucose Metabolism
Anyone who experiences hypoglycemia knows the brain struggles to function when blood sugar levels have plummeted. Decision making and critical thinking become close to impossible. The brain requires 25% of the body’s glucose demands. This means a large percentage of glucose needs to reach the brain (via healthy cerebral blood flow) and glucose also needs to be properly regulated and utilized in the brain in order for healthy brain function to occur. When these systems are compromised as a result of a TBI, brain fog can occur.
Immune Dysregulation
The immune system of the brain was once thought to be completely separate from the rest of the body. Science now acknowledges the blood brain barrier is not an impenetrable wall. Just like the integrity of the intestinal lining can be compromised, so can the blood brain barrier, allowing inflammatory compounds, viruses, mycotoxins, pathogens, and other molecules to enter the brain on a potentially chronic basis. Immediately following a TBI, the permeability of the blood brain barrier and an acute inflammatory response in the brain increase. In an ideal situation, this is an acute response that resolves itself. In some cases, however, inflammation can persist in the injured brain, as the immune system remains in an overactive state. This can be a major contributor to brain fog.
Glymphatic Congestion
The brain and body are a thriving ecosystem of trillions of cells, and even more trillions of co-existing microorganisms. All of these cells and “foreign” microorganisms produce metabolic waste. Metabolic waste circulates through the blood and lymphatics, and is processed and eliminated through the colon and urinary tract with the help of healthy liver and kidney function. The problem, however, is that the average person is overwhelmingly inundated by pollution, plastics, hormone-mimickers, prescription drugs, herbicides, pesticides, and an endless list of other chemicals which require processing, filtering, and elimination. The liver and kidneys are working overtime, and often can’t keep up. Toxins and waste then accumulate in the body, and potentially the brain. To make matters worse, the brain’s own lymphatic system (referred to as the glymphatic system because of the role glial cells play in this function), which serves as the waste clearance system of the brain, is most active during deep sleep. Following a brain injury, sleep architecture is often impaired, and people may spend very little, if any, time in deep sleep states. Sleep disorders can be a major contributor to a lack of clearance of metabolic waste out of the brain, which can, in turn, cause brain fog.
What is the Solution?
When we realize optimal brain function for the elimination of brain fog requires so many elements including adequate cerebral blood flow, sensitive blood sugar regulation, healthy liver and kidney function, free-flowing lymphatics, and healthy sleep cycles, we can quickly see there is obviously no one magic pill to solve brain fog. However, natural approaches to support all these systems are described above. As a Chinese medicine practitioner and a life-long herbalist, I utilize specific herbal formulations that target each of these areas and create custom treatment plans for individual patients based on their unique needs. If you are suffering from brain fog, I recommend finding a practitioner who specializes in the areas described above and can help determine a natural approach specific for you.
Dr. Amy Ayla Wolf is a Doctor of Acupuncture and Oriental Medicine specializing in neurological disorders, concussions. and traumatic brain injuries. She is a faculty member of the Carrick Institute of Clinical Neuroscience and Rehabilitation. She teaches courses for healthcare practitioners across the country on neuroanatomy, neurophysiology, functional neurological exam techniques, and neuro-rehabilitation utilizing acupuncture and Chinese medicine. www.acupunctureneurology.com
