Dr. Mitch Shulman: Brain fog — What you need to know

The key is to check your urine. In the morning when you wake up after an overnight fast, it’s dark and concentrated. As the day progresses, if you’re drinking enough, you should be going to the bathroom regularly and the urine should become only slightly yellow, almost clear.

Brain fog often accompanies an upper respiratory tract infection (a “cold”). The feeling can persist after the cough and fever have gone but as you regain your strength your head should clear, too.

There are some serious medical conditions that need to be considered, especially if the person doesn’t get better after sleep and hydration are considered and ruled out. Too few red blood cells to carry oxygen around to the different parts of the body (medically, anemia) can cause brain fog. A low level of thyroid hormone (medically, hypothyroidism) can also be responsible. This is often associated with any of the following: unexplained weight gain; constipation; a slow heart rate (medically, bradycardia); dry skin and thinning hair; sensitivity to cold temperatures; and weakness and/or fatigue.

Lupus is a disease of our immune system where it misfires and attacks the body. It’s often associated with a rash over the bridge of the nose and the cheeks; joint pain; extreme fatigue; and Reynaud’s phenomenon where the fingers and/or toes may change colours and go numb when exposed to cold. Other causes of brain fog include poorly controlled diabetes. In these cases there will often be a history of progressive weakness, associated with increased thirst and urinating and wounds that are slow to heal.

Brain fog can be the result of stress, anxiety and depression. Similarly, the use of drugs and alcohol can cause the same feelings.

If you always feel “spaced out” making it hard to function at school or work and interfering with your daily life, then it’s reasonable to be assessed by a health care professional. After taking a history and examining you, the tests that will be ordered will depend on what’s been found. For example, if there are signs suggesting a nutritional deficiency, anemia or hypothyroidism, levels will need to be checked.

In the meantime, while waiting for the definitive diagnosis and treatment plan there are things that you can do to help cope. You can make lists so that nothing is forgotten; you break down tasks into smaller pieces so that you can focus on one thing at a time; thinking out loud can also help you to focus.

Dealing with brain fog can be frustrating. The good news is that with the right approach a person can usually be helped.

Dr. Mitch Shulman is an Associate Professor in the Department of Emergency Medicine at McGill Medical School as well as an Attending Physician in the Emergency Department of the McGill University Health Centre. He’s also the CJAD AM 800 Medical Consultant.