There's a lot of fog around brain fog

Summary

Podcast Summary: “There's a lot of fog around brain fog”

Podcast: What's That Rash? (ABC News)
Date: January 28, 2025

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Episode Overview

This episode explores the complex and often misunderstood phenomenon known as “brain fog.” Hosts Tegan (C) and Norman (B) respond to listener questions, discussing the validity, symptoms, causes, history, and potential treatment options for brain fog, including its recent surge in public discussion following the COVID-19 pandemic. They share personal experiences and medical insights, aiming to clarify misconceptions and provide practical perspectives for those suffering from brain fog or curious about it.

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Key Discussion Points & Insights

1. Defining Brain Fog

• Is Brain Fog Real?

  • The hosts strongly assert that brain fog is a real experience, not a figment of imagination, even though it is not a specific medical diagnosis.
  • Quote [01:55] — Norman (B):
    “It is real. And brain symptoms are a feature of long Covid. But they're not just a feature of long Covid. [...] There's a whole list of conditions which can cause what some people call brain fog, baby brain, chemotherapy produces it [...] It is a real thing. What it's not is a medical diagnosis.”

• Symptoms

  • Forgetfulness, difficulty concentrating, feeling disconnected, slow thinking, trouble expressing oneself, head pressure or fuzziness, and fatigue.
  • Quote [03:44] — Norman (B):
    “Forgetfulness is kind of the number one symptom in most studies. Difficulty concentrating is not far behind. Dissociative phenomenon really means that you're kind of out of body, you're not feeling yourself, you're feeling a bit weird in the world…”

2. Personal and Listener Experiences

• Tegan recounts a colleague’s assumption about “baby brain” during her pregnancy and reflects on the frustration such comments can cause.
• Norman shares his own experience post-hepatitis A infection, describing lasting cognitive fogginess [02:44].

3. Brain Fog vs. Medical Diagnosis

• Brain fog is a descriptive label, not a distinct diagnosis. Causes and experiences vary widely.

  • Quote [02:37] — Norman (B):
    “...people don't agree on what brain fog actually is. And there's lots of different causes. So to say it's a medical condition is not really right...”

• Commonality: Despite differing causes (e.g., infection, autoimmunity, chemotherapy, psychological distress), symptoms of brain fog often overlap.

4. Objective Assessment & Challenges

• Standardized psychometric tests and experimental “brain fog scales” are being developed, but are not widely adopted or definitive [04:40].

5. What Causes Brain Fog?

• Physical (Neurobiological) Causes: Viruses, autoimmune conditions, chemotherapy, chronic pain syndromes, HIV, and others can affect brain function.

• Psychological Causes: Depression, anxiety, or stressful life events can contribute to cognitive symptoms, though this cause is sometimes dismissed or misunderstood.

  • Quote [06:40] — Norman (B):
    “…people really resent the idea that psychological issues can cause brain fog. And that's misplaced anger in a sense, because our brain and body are one.”

• COVID-19:

  • Noted for bringing brain fog into greater public awareness; some post-COVID brain fog correlates with observed MRI changes in the brain [08:40].

6. History of the Term "Brain Fog" [09:17–10:47]

• The term dates back to at least 1850—James Tunstall described it among sedentary professionals.
• Historical figures like Florence Nightingale and William Osler described similar conditions under different names, suggesting brain fog is not a new phenomenon.

7. Treatment Approaches

• Time: Many people recover, especially from post-COVID brain fog, but this is not universally reassuring [11:01].

• Treat the Cause: Doctors should search for treatable underlying causes.

• Psychotherapy/CBT: Particularly effective if brain fog is related to psychological factors or causes secondary depression.

• Physical Treatments: For some, cautious physical exercise might help, but this is controversial in certain conditions (e.g., myalgic encephalomyelitis).

• Experimental Approaches: Emerging research into pharmacological treatments, including repurposed drugs, is ongoing but inconclusive due to limited data [12:15].

• Quote [12:38] — Norman (B):
  “Doctors need to take it seriously and look for a cause for it. Cause the cause may be treatable in its own right. [...] With long Covid and post-viral brain fog, it does get better in most people. So there's cause for optimism…”

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Notable Quotes & Memorable Moments

• On the Subjectivity of Brain Fog

  • Tegan (C) [03:42]: “So I was actually kind of curious. […] Have you ever experienced it yourself?”

• On Cognitive Load and Stress

  • Norman (B) [07:46]: “When I'm under a lot of stress… you feel your cognitive processing slowing down. [...] I think you can call that fog, you might well call it fog, but it's one that goes away and you know what the cause is.”

• On Historic Attitudes

  • Tegan (C) [09:52]:
    "James Tunstall wrote [...] about functional disorders which afflict those who make great use of the pen and at the same time take but little exercise. Authors, journalists, solicitors and clerks. Norman. We just need more time outside hiking up and down mountains and less time in front of computer screens."

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Important Timestamps

• [00:36] – Introduction to topic and listener questions (“brain fog” as symptom in various conditions)
• [01:55] – Is brain fog real? List of possible associated conditions
• [03:44] – Common symptoms of brain fog outlined
• [04:40] – Objective assessment of brain fog and challenges
• [05:25] – Discussion on physical versus psychological causes
• [08:40] – COVID-19’s role in bringing “brain fog” into the mainstream
• [09:17–10:47] – Historical mentions and longevity of the term
• [11:01] – What is currently known about treatment options
• [12:38] – Conclusion on seriousness and treatability of brain fog

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Summary Takeaways

• Brain fog is a legitimate and common experience, though not a singular medical diagnosis. It can occur as a symptom in a wide range of physical and mental health conditions.
• The causes of brain fog are diverse. Identifying and treating the underlying issue is crucial for relief.
• Recovery is possible, particularly for post-viral and stress-related brain fog, but persistent cases may require a nuanced, multi-factorial approach.
• New research is ongoing into both the biological mechanisms and experimental treatments for brain fog.

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For listeners: If you have questions about confusing health symptoms or want your query discussed, you can contact the show at thatrashbc.com.

Transcript

[A]

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[B]

So, Tegan, when you were pregnant, did people ever accuse you of not being quite with it?

[C]

Oh, baby brain.

[B]

Yeah.

[C]

I actually remember having a conversation with a colleague where I was explaining something quite complex and he sort of looked at me and was like, oh, I thought you were meant to have brain fog. Baby, brain whatever when you're pregnant. And I, I think it was meant to be a compliment. I didn't love hearing it at the time.

[B]

You were probably pissed off, as indeed many people are when they're told they've got brain fog. Which indeed is the topic of this week's what's that Rash? Where we answer your questions.

[C]

Yes, let us get into it. So a couple of people have written in about brain fog. Catherine says there's been a lot of talk about brain fog being a symptom of COVID menopause, various other diseases and conditions. Catherine says, I know my brain sometimes gets foggy with hay fever and extreme stress and other times for no reason at all. What is brain fog? What's happening in the brain or body when you have brain fog? And then she says, ps try saying brain fog 10 times fast.

[B]

No, not today.

[C]

And Eddie has also asked, is brain fog real as a result of COVID Well, to Eddie's question, I would say, in a sense, Norman, correct me if I'm wrong. Brain fog's kind of in the brain of the beholder, you know, asking if it's real or not.

[B]

Yeah, and it's incredibly insulting to people who do have some brain fog to suggest that it's not real. It is real. And brain symptoms are a feature of long Covid. But they're not just a feature of long Covid. They're a feature of myalgia, encephalomyelitis, chronic fatigue syndrome. They can be a feature of hypothyroidism, a low active thyroid, of other autoimmune diseases. There's a whole list of conditions which can cause what some people cold brain fog, baby brain chemotherapy produces it. Some people with sleep disorders, people with depression and anxiety can feel foggy at times. It is a real thing. What it's not is a medical diagnosis.

[C]

So I was actually kind of curious. You sort of rattled off such a long list of things there. Have you ever experienced it yourself?

[B]

Yes, I have actually, many years ago. I got quite a bad infection with hepatitis A and was quite sick for a few days. So I was definitely foggy during the infection. And then when I got tired for about a year afterwards, when I got tired, that fogginess came back. So I've got a lot of sympathy with people with long Covid and indeed other post viral syndromes, because I know exactly what it's like is that you find it hard to concentrate, you find it hard to think clearly and reason. The reason I said it's not a medical diagnosis is that people don't agree on what brain fog actually is. And there's lots of different causes. So to say it's a medical condition is not really right, because it's almost certain that long Covid is different from myalgia encephalomyelitis, which is different from brain fog associated with a migraine attack or indeed a brain injury. So they all are different, but there are some common features.

[C]

Let's talk about it.

[B]

Forgetfulness is kind of the number one symptom in most studies. Difficulty concentrating is not far behind. Dissociative phenomenon really means that you're kind of out of body, you're not feeling yourself, you're feeling a bit weird in.

[C]

The world, you're kind of glazed over. Yeah, disconnected.

[B]

That's right. Slow thinking. And it takes a lot of effort to think through things. You find it hard to express yourself and communicate. There's a fuzziness or pressure on your head and fatigue. And fatigue is interesting with this one, is that when you talk about chronic fatigue syndrome, when you talk to people with chronic fatigue syndrome, it's the fog that bothers them most. And doctors, for simplicity call that fatigue. But in fact it's all those other symptoms as well.

[C]

It isn't a diagnosis, it is quite subjective. So are there any ways of sort of benchmarking what that means or assessing it objectively?

[B]

Well, some people believe that with brain fog you can do what are called psychometric tests, which might test your quickness of thinking and your memory and so on, and that some of those may show as abnormal and be one indication. There are a few research groups that are trying to develop brain fog scales. So in other words, those symptoms that I just measured and you get points for them and you get over a certain number of points, then you're scoring high on the diagnosis of brain fog, but it doesn't necessarily help you in terms of the cause because until you get to the cause, it's getting pretty hard to get to the treatment.

[C]

Yeah, well, what do we know about the cause? Like are there physical changes in a brain that could be a result of brain fog or could be driving it?

[B]

It's not been well enough studied shamefully to do that. So chemotherapy easy.

[C]

So easy.

[B]

Well, what I mean by that is they can have an effect on the brain, a damaging effect on the brain.

[C]

At least temporarily, like physically affecting neurons.

[B]

Yes. If you've got a post viral syndrome, then you can imagine that the virus has had a damaging effect on some of the nerves in the brain from which you recover. If you've got an autoimmune disease, you can imagine the immune system, and we've spoken this many times either here or on the health report, is the immune system plays a role in brain health. And therefore if you've got a problem with your immune system that could have an effect causing slowness of thinking, memory problems and what have you. There are other conditions, such as chronic pain syndromes, which are neurological syndromes, where they say 40% of people with chronic pain have brain fog. HIV can have brain fog associated with it, again probably through brain effects. People with pots, postural tachycardia syndrome, where you get faint on standing up, they often have brain fog. So this is almost certainly a brain problem. And then there's the controversial area of psychological distress. So depression and anxiety and people with depression, anxiety, having brain fog. And that's where people really resent the idea that psychological issues can cause brain fog. And that's misplaced anger in a sense, because our brain and body are one. And if you've got something going on in your brain, such as a mental health issue, then it's not surprising that one of the side effects might be brain fog. And that's why we should be open minded about something like brain fog. Because depending on the cause, some treatments, like for example antidepressants might actually help, if that's, or even psychotherapy might help because it reduces one of the cause of your brain fog.

[C]

Well, that was something I wanted to ask about because it makes sense that not to dismiss brain fog in and of itself as being its own thing, but like if you are dealing with a cancer diagnosis or you have some chronic health condition you're dealing with, or even being distracted by knowing that you're having a baby, it makes sense that your brain is in A lot of different places at once is processing a lot of things at once. How much of a factor could just the fact that you're dealing with a lot of stuff contribute to brain fog, which could also have other causes?

[B]

Well, anecdotally, I mean, speaking personally, when I'm under a lot of stress, and I'm sure a lot of other people too, and you've got lots of things going on, you feel your cognitive processing slowing down. It's very hard to cognitively switch between issues when you're feeling overwhelmed by the number of things you've got to deal with. And I think you can call that fog, you might well call it fog, but it's one that goes away and you know what the cause is. But that is diminishing the importance of brain fog. For whom? It's very hard to get rid of myalgia, encephalomyelitis, long Covid chemotherapy, all those other conditions that I've talked about, producing brain fog, much harder to get rid of than your lifestyle and how much pressure you're under.

[C]

You mentioned like you've rattled off quite a long list of potential causes. But I do feel like it's really entered the lexicon since COVID What is it about COVID that's either causing this or has brought it to our attention so much?

[B]

Well, it's the fact that a variable percentage of people have symptoms which post date their infection, sometimes by months, and some people by years. And many of those symptoms fit the descript of brain fog. It does go away in the vast majority of people and in some studies associated with magnetic resonance imaging, abnormalities in parts of the brain which might be involved in attention and memory. Again, a physical effect of the virus on the brain. And we know that Covid actually does affect almost every organ system in the body.

[C]

It is interesting because we have heard a lot about it in the last five years. I was surprised to discover how old the term is. One of the first mentions of brain fog was from 1850. British physician James Tunstall wrote a book and he's talking about the healing properties of the waters of Bath. Have we spoken about Bath waters? We have. We have spoken about Bath waters.

[B]

On. What's that rash? I think so, yes. We'll come back to in a future. What's that rash?

[C]

I'm sure I do have a little bottle of Bath waters at home. Maybe I should just drink it and see what happens. Yeah, it's from some music.

[B]

Maybe you should drink it on air. Maybe I will.

[C]

Or maybe I need to Go to Bath. So the thing that James Tunstall wrote, which I like very much, was that he talks about many functional disorders which afflict those who make great use of the pen and at the same time take but little exercise. The idea that they're overworking their mental faculties without sufficient bodily fatigue. Authors, journalists, solicitors and clerks. Norman. We just need more time outside hiking up and down mountains and less time in front of computer screens.

[B]

I think that's right. But Florence Nightingale took to her bed and she had what they called also asthenia. The description of asthenia fits with myalgic heifer, myelitis, brain fog, and so on. She had it. A leading physician, medical researcher in the United states in the 19th century, William Osler, he had it. So this was a common diagnosis under a different name in the 19th century. So it's likely that brain fog has been with us forever.

[C]

Well, James Tunstall was obviously advocating for exercise, which, you know, any excuse to get outside sounds good to me. It is a controversial space in terms of treatment for brain fog and long Covid, though. What do we know about treatments?

[B]

Well, time is probably, at least in terms of long Covid.

[C]

It's the one that's the last thing you want to hear, though, isn't it?

[B]

But it's reassuring that in many, many people, the majority of people, it does go away by itself, and it depends on the cause. So, for example, with myalgia encephalomyelitis, a lot of controversy over both psychotherapy and indeed graded exercise. But in some forms of brain fog, depending on the cause, very careful exercise psychotherapy, like cognitive behavioral therapy, to help depression and anxiety, particularly if the brain fog induces that. In other words, some of these chronic conditions, which are neurological in origin, such as chronic pain, they do, are incredibly distressing to have and do make you quite depressed. And if you actually remove that psychological effect of the chronic pain, you don't get rid of the chronic pain, but you're able to manage it better. So it really does depend on the cause. With long Covid, they're trying all sorts of things, nasal sprays with antihistamines and others, and they're really not being well studied yet. So there is something physical going on behind this. And if there's something physical, then maybe there is a physical treatment. In other words, a pharmaceutical treatment which could help. We just need to wait and see what the research throws up.

[C]

Yeah, looking through, some of them sound very interesting. On first blush, reusing drugs, say, used for alcohol and opioid Drug addiction. But the sample sizes in these studies are minuscule.

[B]

Yeah.

[C]

So to answer the questions that we got, for starters, I think we can pretty quickly cross off. Yes, brain fog is real, but in terms of causes and treatment, what do we say at this stage?

[B]

Well, the doctors need to take it seriously and look for a cause for it. Cause the cause may be treatable in its own right. And that particularly with with long Covid and post viral brain fog, it does get better in most people. So there's cause for optimism and eventually you've got to stop doing the tests because for people, particularly with myalgia encephalomyelitis, there is no test and it's a diagnosis in many ways of exclusion that that's what you have. And hopefully the research into long Covid will help people with me.

[C]

Well, Catherine and Eddie, thank you both so much for taking the time to send in your questions. If you've got a question we want to answer it, just email us thatrashbc.com which is also where people have been sending their habits feedback. Norman?

[B]

Yeah. On New Year's Day, what's that rash we talked about habit formation and breaking habits.

[C]

Well, Kieran has an anecdote for us. Kieran was on a business trip in Switzerland, was being driven to appointments. The person who was driving him was quite cantankerous and started shouting at him about something Kieran's not sure what. Anyway, he drove into a car parking space and stopped. And of course, Kieran was sitting in the passenger seat, which would have been the driver's seat in. Without thinking, during the barrage he was receiving, he reached down and pulled the handbrake on this driver, just stared at him and eventually said, what are you doing now? You want to drive my car for me? Kieran thinks that the stress put him into automatic mode.

[B]

Habits just have this habit of emerging when you don't want them to. Great story.

[C]

Similarly, Rosemary was at a shopping centre in Melbourne years ago at a bedding store. And the bedding store had a bed with sheets and a doona made up in the common area. A lady walk and tugged at the corner of the doona to fix it up.

[B]

She couldn't pass a doona without actually making the bed. Is that really what happened there?

[C]

Yeah, exactly. Which I think Rosemary sort of recognised that and laughed, as in laughing with her. But the poor lady got embarrassed and rushed off.

[B]

Well, it just goes to show that what we said on the. What's that rash is 45% of our daily behaviors are habits because we couldn't get through life without them. So when you go to your mum and dad's for dinner, how you get there is a habit. Usually what happens is your mom and dad say, you didn't go that way, did you? If you come this way, let's say 20 minutes.

[C]

No, my habit when I go to my mum and dad's place for dinner is to just look in their pantry and see what they've got. That is a habit.

[B]

You've got the same habit as me. Anyway, that's. What's that rash for this week?

[C]

Send your emails to thatrashbc.net au and.

[B]

We'Ll answer them soon.

[C]

See you next time.