Hashimoto's Brain Fog

Hashimoto's disease has become increasingly prevalent, affecting millions of people worldwide. Among the symptoms associated with Hashimoto's, one of the most challenging and frustrating is brain fog. In this article, we will explain possible root causes of brain fog related to Hashimoto’s and suggest interventions you can take to alleviate this symptom.

What is Hashimoto’s?

Hashimoto's disease is an autoimmune disorder where the immune system mistakenly attacks the thyroid gland. This attack leads to inflammation and compromises the thyroid's ability to produce hormones essential for metabolism, energy levels, and overall well-being.

The resulting damage from Hashimoto’s prevents the thyroid from producing adequate levels of thyroid hormones, leading to a more well-known condition known as hypothyroidism. Read more about symptoms, diagnosis, and our functional medicine approach to treating Hashimoto’s.

What Causes Hashimoto’s Brain Fog?

Brain fog is a term used to describe a group of symptoms characterized by memory lapses, difficulty concentrating, forgetfulness, and general feeling of mental fogginess. Unfortunately, brain fog may persist after the other symptoms of hypothyroidism resolve on conventional thyroid hormone therapy.

The exact mechanisms linking Hashimoto's and brain fog are not fully understood, but several factors may contribute to this symptom.

Thyroid Hormone Imbalance

Hashimoto’s is the most common cause of hypothyroidism in the United States. The conventional treatment for hypothyroidism caused by Hashimoto’s is a thyroid hormone replacement medication.

When diagnosing hypothyroidism, your doctor will likely look at two blood tests called TSH and T4. The conventional range for a normal TSH is about 0.5 - 4.5 mIU/L. However, most functional medicine doctors prefer a narrower and more optimal range for TSH of 1.0 - 2.5 mlU/L. If your levels are higher than this optimal range, your brain fog may be due to an ongoing thyroid hormone imbalance known as subclinical hypothyroidism. Furthermore, some people may have normal T4 and TSH levels, but continue to suffer from hypothyroid symptoms due to poor conversion of T4 into T3.

Poor Gut Health

An imbalance in the gut microbiome, known as dysbiosis, has been linked to autoimmune diseases like Hashimoto's. Dysbiosis can then cause or worsen other gut conditions, like leaky gut, food sensitivities, and inflammation.

A compromised gut can also impact the absorption of essential nutrients, including those necessary for thyroid function. Nutrient deficiencies, such as low levels of selenium, iron, vitamin D, and zinc, may exacerbate Hashimoto's brain fog and contribute to thyroid dysfunction.

How to Treat Hashimoto’s Brain Fog

Functional medicine takes a holistic approach to address the root causes of health issues. Here are some functional medicine treatments that may help reduce or eliminate brain fog in people with Hashimoto’s.

Optimize T4 to T3 Conversion

Your body must convert the thyroid hormone T4 into T3 (the active form) in order to use it. Here are a few top tips to optimize thyroid hormone balance:

Reduce stress levels
Eat foods rich in zinc and selenium, like oysters, beef, pumpkin seeds, brazil nuts, and fish
Follow an anti-inflammatory diet by filling your plate with various colorful fruits and vegetables.
Optimize gut health by prioritizing fiber-rich foods into your diet like fruits, vegetables, and whole grains

Read more about the T4 to T3 conversion.

Physical Activity

Directly, exercise offers benefits by improving blood flow to the brain, reducing inflammation, and triggering the release of growth factors. These chemicals play a crucial role in maintaining the health of brain cells and supporting the survival of new ones. On an indirect level, exercise positively impacts mood, sleep quality, and stress levels, while reducing anxiety. Issues in these areas often serve as culprits or contributors to brain fog as well.

Start by introducing short, manageable sessions of exercise, such as 15-20 minutes of brisk walking, two to three times a week. Gradually increase the duration and intensity as your stamina improves, making it easier to integrate regular exercise into your weekly routine without feeling overwhelmed.

Optimize Gut Health

As mentioned before, compromised gut health is a leading cause of Hashimoto’s brain fog. There are a few lifestyle factors you can implement today to improve the health of your gut:

Aim to eat at least 25-35 grams of fiber per day. Examples of high fiber foods include berries, apples, broccoli, quinoa, oats, and beans.
Limit added sugar, which feeds the unhealthy bacteria. The top sources of added sugar in the American diet are sugar-sweetened beverages, desserts, and sweet snacks.
Get outside. Enjoying nature exposes you to a diverse range of beneficial bacteria that can benefit your gut health.

We see significant symptom improvement in our members who follow a gut healing protocol. Our Gut Health Bundle includes our top three supplements that mimic our functional medicine gut health protocol by removing gut infections or dysbiosis, replacing missing nutrients, repairing the gut lining, and reintroducing healthy gut bacteria.

Background:

Ashna came to Root after struggling with an autoimmune condition, Rheumatoid Arthritis (RA), for years. Her main symptom of joint pain had been somewhat controlled with an IV infusion every 6 weeks, but other symptoms that she felt may be related started popping up: fatigue, brain fog, weight gain/water retention, and dry skin.

She wanted to get to the root cause so she asked her Rheumatologist about this. He replied, “I treat symptoms, not root causes.” At that moment, she knew that she needed to work with a doctor in a completely different mindset and model of care to complement her conventional team. The nutrition first approach at Root was what initially drew her to our practice, especially since she was given no helpful or personalized nutrition guidance with respect to RA in the conventional system.

Enter Root:

Month 1:

In her first doctor’s visit, Ashna learned more about her body and her condition than she had in years. Things started to make so much sense. The body is connected and inflammation that starts in the gut does not stay there. Her organs work together, not in separate silos. Foods can contribute to or improve her symptoms (something she had already thought based on experience, but had never had validated).

In her first dietitian visit, her dietitian did a thorough intake and they decided together on next steps. No one had told her about the gluten connection to auto-immunity as well as the heightened risk of celiac in people with autoimmune disease. She and her dietitian decided together to start with a celiac blood test and an additional food sensitivity test called MRT due to the strong connection of her symptoms to foods and the fact that she preferred a very spelled out and personalized diet plan that could also address her brain fog, fatigue, weight gain, and water retention.

She had a lot of blood drawn in the first month (her choice):

Root wellness panel
Celiac Screen with genetics
MRT food sensitivity test

Month 2-4

Her doctor and dietitian reviewed her blood work with her in detail. She had some important nutrient deficiencies that we began to replace right away:

Omega 3s : important for anti-inflammatory, joint lubrication and joint pain, dry skin, weight loss
Vitamin D: important for energy, autoimmune modulation, healing

Her dietitian began to guide her on a customized diet based on her testing results. She would eliminate the most inflammatory foods for her and gradually reintroduce them in stages over the next three months. Her celiac screen was negative for celiac disease, but her genetics were positive for risk of developing celiac. She and her dietitian decided it would be best for her long-term health to remain gluten free.

Month 4

Within the first 2 weeks of MRT, she was feeling like a different person. Her joint pain, energy, brain fog, and skin had all improved and she lost 5 pounds. She wanted to continue to feel this way forever. To help her be successful with food introduction, her team recommended stool microbiome testing to guide her next steps in gut healing.

Month 5-8

Ashna went through a personalized gut healing protocol to gently rebalance the microbiome and repair intestinal permeability. Interestingly, her wheat antibodies were still positive 3 months after eliminating gluten/wheat. Her dietitian helped her pinpoint potential sources of gluten. One of the foods she was eating, a healthier version of kettle chips, had barley listed down on the ingredient list (who would have thought barley would be on a potato chip?). Barley is a source of gluten. Unfortunately, since gluten is not listed as an allergen on nutrition labels (only wheat), this one snuck past her. It’s not uncommon for us to uncover sources like this in people who have thought they were gluten free for years. Working with a dietitian skilled with helping those with celiac and other autoimmune disease is a vastly different experience for our members.

Month 8-12

She continued to learn valuable tools to help her naturally calm her autoimmune condition while optimizing her health. The medication she had been taking works by blocking TNF-alpha (produced in the body with inflammation). She was surprised to learn of foods that can also block TNF-alpha as well as the vagus nerve being involved in the production of TNF-alpha. She did Root’s limbic system retaining and she’s never felt like a more calm, confident person.

Month 12+

Ashna knows how important it is to monitor her biomarkers including gut and microbiome health and she’s remaining a Root member. Her visits to her Rheumatologist have spaced out, saving her thousands of dollars a year.

Key Takeaways

Hashimoto’s brain fog is a frustrating symptom that impacts quality of life. Many people continue to experience this symptom even after conventional treatment. Main causes of brain fog are thyroid hormone imbalance and poor gut health. A comprehensive approach to treating brain fog may include optimizing T4 to T3 conversion, implementing physical activity, following a gut health protocol, and balancing blood sugar levels.

Want to get to the root cause of your brain fog? Learn more about working with our functional medicine team.

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