Dr. Kyle: Now, one of the hard things about brain fog, at least for us, is, okay your brain is not working well; I don't know why?!
Dr. Paul: There's a lot of different reasons why you might have that. Neurologically, the mechanism is that, you know, neurons just aren't communicating or firing efficiently from one neuron to the next, so it's like the speed of conductance of that signal is slowed. Where is the culprit? What's the trigger? What's the underlying root cause of why your neurons aren't talking to each other like they should? Why is that slowed?
So chronic fatigue syndrome: super tired to go through the course of the day, and they wake up they're okay; by the end of the day they're going home, eating dinner, watching Netflix, and going to bed. They have brain fatigue. Two questions we ask about brain fatigue is, do you get tired more quickly than you did in the past with Reading or with Driving? Okay, so those are huge metabolically demanding activities to the brain, and so if you do, then that's a red flag dose that we have to investigate.
Dr. Kyle: And this gets lumped under depression a lot, gets lumped under anxiety, but so much of brain dysfunction doesn't really fit great under that lump.
Dr. Paul: The reason why patients feel depressed is because this part of your brain, your orbital frontal lobe or orbital frontal cortex, does not fire or function the way it should to capacity, but still you're left with the question: why? Why is that part of the brain affected? Is it just this part of the brain? Probably not. That's the same part of the brain that controls decision-making, so this is why a lot of depression patients have a really tough time making a decision…What do you want for dinner tonight? I don't care, I don't know. Like, they go shopping, like, there's 10 of something. What one do I pick? I'm overwhelmed. I don't know which one, right? Like, it's hard for them to make decisions. That's because it's the same part of the brain. Kelly Brogan's work, in, her book, Mind of Your Own, and some of our other colleagues, they've now transferred the theory to what's called the Cytokine Model of Depression, which means inflammation. So, obviously the serotonin model is still there, but the new research, they're really going after inflammation as the root cause of depression and trying to figure out where that inflammation is coming from and why is that patient depressed. Yeah, you're just in menopause, or, for a guy, it could be testosterone.
Dr. Kyle: People will talk about mom brain, or pregnancy brain, and how much the hormones really have to do with brain function. And so we, you know, I remember learning about what stress hormone does to your brain, and what estrogen or progesterone or testosterone do to your brain, and realizing that, oh my gosh, there's a lot of brain fog coming from these hormone problems. So we look at hormones for people with brain fog.
And then into Hashimoto's and autoimmunity. Autoimmunity, thyroid, autoimmunity, you can target the brain. So you can have inflammation in the brain creating brain fog!
Dr. Paul: Over 90% of the cells in the brain are now thought to be immune cells. You know, women, there's three big triggers in their life hormonally, and like, immuno-wise. It's, you know, puberty, pregnancy, menopause. Those are the three stages where, you know, autoimmune disease can be triggered, right? So…I get pregnant…then I [could] have hypothyroidism or Hashimoto's or whatever, things like that.
Dr. Kyle: You know, and you look more and more into gut, and, oh my gosh, functional medicine and the gut, and you just go, well there's a saying in function medical, you know, “gut on fire, brain on fire. Happens the same way. So when we have gut problems and you find people with all kinds of irritable bowel disease, one of the most common things with irritable bowel disease is, you get concurrent brain function problems. So we think that Alzheimer's as a general, you know, category is a huge issue in our aging population. And we do not agree that it is, you know, normal. It's common, but we really disagree that this brain deterioration we see with age is a normal occurrence. And if you look at some of the blue zones of, you know, the healthy, longest-living people, you know, you talk to people in their elderly years and their brain is still sharp and they're still, you know, so cognizant and so thoughtful and so responsive. And then, you know, we've all talked to people who aren't that way. Who, in their later years, you're going, oh my gosh. where are you? What's happening to you? And others around you can see it before they even, you know, really realize it. And what we really find when we talk to these people about Alzheimer's and dementia is, they've had brain symptoms for years. Things that they might describe as brain fog. And it usually starts out as funny or annoying things like, I always lose my keys, I always lose my phone, I put, you know, the shoes in the wrong closet, I put, you know, different, I just start to mix things up. And people just kind of laugh or giggle or they start to get lost more or they don't remember little things, but it starts out that way. And we tell people, that's not normal healthy brain function. You should really be, you know, sharp and cognizant and not making a lot of these, you know, little mistakes.
And it's when these little mistakes start to pile up and become, you know, more repetitive, that we really want to step in and go, wouldn't it be better to help the brain now? Rather than you wait 10 years and then it's bad enough to where we go, oh my gosh, you have the beginnings of Alzheimer's.
Dr. Paul: Chemo-brain after chemotherapy treatment, you might have a food sensitivity, underlying subclinical infection that doesn't show up on a standard blood panel, things like that too, could be inflammation. High
C Reactive Protein (CRP). Then you have to investigate, well, is it a virus, a bacteria, a yeast, a fungus, a parasite? Is it a food? Is it a toxin? Is it too much stress in their life? There are symptoms associated with different issues and it can be endless on what they come from. And that's our job as doctors, is to try to figure out, why are you getting brain fog? Is it from inflammation? Is it from hormones? Is it from food? Is it from, where's the source coming from? And, just, that's where history comes into play, right? You got 80-90% of your results come from taking a good history.
Dr Kyle: And so that's where we come in, and go, okay. We ask you a bunch of different brain questions, I mean that's, some of our paperwork is all these different brain related questions. And that's why the exam from Dr. Paul is so important, and really surprising for so many people.
Dr. Paul: Brain fog: it's not a diagnosis, right, it’s a symptom! Your medical doctor is not going to give you like an ICD-10 code. And remember, functional neurology is, we're looking at how well does the brain work, how well does it function, which an MRI cannot tell you that. MRI tells you structurally: are all the pieces in place? There's no stroke, there's no tumor, there's no, you know, abnormal blood vessel, abnormality like an AVM they call it, they're ruling out the bad stuff, right? And then, if it's, like, normal, then that's where like we come in and test how is the brain working.
Dr. Kyle: When we go to a normal neurologist, which most people haven't been to, but even if you've been to, they're really looking for these big problems in your exam. They're looking for MS, looking for Parkinson's, we tell people they're looking for the bullet in your head. They're looking for, “oh my gosh, I have a tumor.” Oh my gosh, I have something that's so big and so obvious we go, oh, you know, this is a huge problem. These more subtle issues, but really, that affect your life, but they're not a tumor. And we believe there's a whole lot of nervous system problems that aren't a tumor. And this is what Dr. Paul's exam is really able to reveal; people are shocked when they’ve finished talking to my partner, Dr. Paul, about how badly their brain functions when he kind of pins them down and really starts to test it.