Something we all hear a lot these days, and especially in COVID times– is the symptom called brain fog. Both when people have COVID and sometimes even months afterward (Long Covid). This is a symptom I’ve been dealing with in my medical practice for a decade, and now that it’s at the forefront of the conversation I think it’s very important to consider ways to optimize our cognitive function and understand why it might be off in the first place.

When we think about brain function. There are a couple areas of the brain that we think about. First, there are the cells of the brain themselves where memories and both short term memory and long-term memory is stored. Then there are the connections between the brain, the neurons. Our neurons must be connected in order for us to retrieve some of the information that we have stored in the brain.


Many different aspects of our daily life can affect how well we can both store and access what we know and can draw access to in our brain.

The first important factor is sleep. When we sleep, especially when we get to a deep sleep state, this is when our body is truly resting, healing, and repairing itself. But not only our body, but our brain is doing that as well. During deep sleep is one of the primary times we take our memories or the compile the things that happened during the day. Our brain moves them from our short-term memory to our long-term memory, where we can access them for a greater period of time. We know people have more trouble with cognition as they age, add to that equation COVID as a new variable, and what we see is, people can remember things from long ago, but can’t remember what they had for lunch yesterday, or can’t think of someone’s name that you just met. Our short-term memory is failing us.

Those are issues where your brain is not moving a short-term memory to a long-term memory. Sleep is one very important factor.


The next factor is stress. In the adrenal glands where the stress hormones are made, the master hormone of the adrenals is called pregnenolone. Pregnenolone is a precursor to many of the other hormones in the adrenal glands, like cortisol, DHEA, and testosterone. However, it’s also a very important hormone in our brain for cognition, memory, concentration, and focus.

When we are under stress and the adrenal glands are stressed and not functioning optimally, that hormone production can decrease. An example I use– when we’re active, in a fight or flight state because of an acute stressor, which these days, stressors are traffic, work deadlines, etc versus running from a wild animal or starvation and things that early humans used to face. Your body goes into action mode. It’s not a thought mode, it’s a reaction mode. When we’re very stressed, it’s hard to calmly think about a situation, and it’s also hard to incorporate new memories and new information into our brains. People often completely misremember traumatic and highly stressful situations. So sleep and stress are critical factors to healthy brain function.


Inflammation is the next important factor, and I think inflammation is one of the reasons COVID has so affected brain function for so many people.


This is because when there is inflammation in the brain, it can affect cognitive speed, it can affect mood, it can affect memory, concentration, and focus. Anything that increases brain inflammation has a detrimental effect on its performance. With COVID we see this inflammation of the brain consistently. Inflammation we bring upon ourselves is typically related to diet, nutrition, and how well we avoid foods that might be inflammatory. The most inflammatory food for many people is sugar.

We also often see gluten as a source of inflammation for some people. Not all gluten can be, in fact, inflammatory. Gluten is a protein that’s in wheat, barley, rye. It’s in a ton of foods that we eat. And gluten is not inflammatory for everyone, but for many people, cutting gluten out of the diet completely can decrease inflammation and lead to better cognitive function.

Dairy in some people can be another inflammatory food. Soy can be inflammatory. Sometimes corn and other grains can be inflammatory. And that’s all very individual, but it’s important to know that it can be a cause of inflammation for you.


In addition, when we are overweight or obese, particularly the fat around the belly, can increase inflammation markers both in the blood and the brain. Weight loss, movement, and activity can be very beneficial for brain health, on top of the endorphins we can get from exercise.

A study that comes to mind was conducted on older adults and showed that exercise can increase and improve brain function and memory by 200-300 times– way more than even just doing brain exercises like crossword puzzles or other cognitive tasks.

So again, we see that some of these core pillars of health apply to all topics that we discuss. Sleep, Stress Management, Exercise and Movement apply to brain function as well.


Then you have hormonal influences on the brain. In both women and men we have estrogen, progesterone, testosterone, thyroid, etc. All those hormones have critical functions in the brain.

The thyroid gland sits in the neck, and regulates energy and metabolism. If thyroid is low, that can lead to cognitive slowing, cognitive dysfunction, and brain fog.

As women lose their estrogen at perimenopause and menopause, they can start to become more forgetful. Particularly because estrogen influences the creation of brain cells and neuronal connections between the brain cells. When women are having trouble with their cognition because of lack of estrogen, it’s usually not that they have completely forgotten what they’re trying to remember, it just takes them a while. They might think of the name they were trying to remember the next day.

The information was still there, but because the connections are fewer, it takes longer to access that information.


Finally testosterone is also very important to memory and brain function both in men and women– for the sharpness of thinking, memory, etc..


The common theme here, addressing all these lifestyle factors, balancing hormones, and addressing the Pillars of Health can help with brain function. If we still need an extra boost or identify a deficiency there are various supplements, herbs, minerals, vitamins that are known to be what we call nootropics, which means that they help the brain function optimally. Adding some of those supplements to lifestyle changes can be very helpful in improving brain function.

Lauren Loya MD

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