Meds and Brain Fog
Guideline: Beers Criteria 2023; STOPP/START v3; NICE polypharmacy guidance
What Is Meds-Related Brain Fog?
Drug-induced cognitive impairment is the most REVERSIBLE cause of brain fog — and the most overlooked. A 2019 JAMA study of 284,343 patients found anticholinergic drugs increased dementia risk by 49%. Many common medications have cognitive side effects your doctor never mentioned. You don't need a supplement — you need a medication review.
What to Do This Week
Seven actionable steps you can start today — free, evidence-based, and designed for when you're foggy.
Body
20-minute walk outside today. Evidence supports this for virtually every cause of brain fog. Start with 10 if that's all you can do.
Food
Eat a proper meal with protein, vegetables, and good fat (olive oil, nuts, avocado). Skip the ultra-processed snack. One meal upgrade today.
Water
Drink a glass of water now. Keep a bottle visible. Aim for pale yellow urine. Don't overthink it — just drink regularly.
Environment
Open a window for 15 minutes. Fresh air exchange reduces indoor pollutants. If outdoors is bad (pollution, pollen), use a HEPA filter.
Connection
Reach out to one person today. Text, call, walk together. Isolation worsens every cause of brain fog. Connection is a biological need, not a luxury.
Tracking
Rate your brain fog 1-10 each morning for 7 days. Note sleep quality, food, exercise, stress. Patterns emerge within a week.
Avoid
Don't change everything at once. One new habit per week. Don't compare your progress to others. Don't spend money on supplements before nailing sleep, food, and movement.
What to Eat: The Mediterranean / MIND Pattern Approach
The most evidence-backed eating pattern for brain health. Not a diet — a way of eating.
Sample Day
- breakfast: 2 eggs scrambled in olive oil + handful spinach + slice sourdough + blueberries
- lunch: Big salad (mixed greens, chickpeas, cucumber, tomato, feta, olive oil + lemon) + water
- snack: Apple + handful walnuts or almonds
- dinner: Salmon or chicken thigh + roasted vegetables (broccoli, sweet potato, red onion) + olive oil
- evening: Herbal tea (chamomile or peppermint)
For Meds: Support your liver: cruciferous vegetables (broccoli, Brussels sprouts, cabbage) support detox enzymes. Hydrate well. Don't add supplements that interact with your medications without pharmacist review. Priority is medication review with your prescriber, not dietary 'detox.'
This is a PATTERN, not a prescription. Adapt to your budget, culture, preferences, and what's available. The principles matter more than perfection: more plants, good fats, less processed food.
When to Seek Urgent Help
STOP — Seek urgent medical evaluation if: sudden onset of cognitive symptoms (hours/days), new focal neurological symptoms (weakness, numbness, vision or speech changes), seizures, fever with confusion, or rapidly progressive decline. These may indicate a medical emergency requiring immediate care, not lifestyle modification.
Tests and Investigations
Medication Impact Assessment
- ACB calculator (acbcalc.com)
- Beers Criteria review (for >65 years)
- If on statins: CoQ10 level (statins block CoQ10 synthesis)
- If on PPIs: B12, magnesium, iron, calcium (PPIs impair absorption of all)
- If on metformin: B12 level (metformin depletes B12 in 10-30% of users)
Evidence-Based Lifestyle Changes
Medication Audit with Your Doctor
1) List ALL medications (including OTC and 'as needed'). 2) Calculate ACB score. 3) Review Beers Criteria if over 65. 4) Ask your doctor about each medication: 'Is there a cognitive-friendly alternative?' 5) NEVER stop medications abruptly without medical guidance — especially benzodiazepines, SSRIs, beta-blockers.
Evidence: Strong — Coupland et al., JAMA Intern Med, 2019: 49% increased dementia risk from anticholinergics
Timing Optimization
If sedating medications are necessary: take at bedtime instead of morning. If stimulating medications: take in the morning. Simple timing changes can preserve daytime cognition.
Deprescribing Conversation
If on 5+ medications: ask about deprescribing — gradually reducing unnecessary medications. This is an established medical practice, not 'going against your doctor.'
Evidence: Strong — Reeve et al., Br J Clin Pharmacol, 2017 — deprescribing guidelines
Holistic Support
Morning sunlight
Strong — resets circadian clock, improves mood, supports vitamin D.
10-15 min outside within 1 hour of waking. No sunglasses needed.
Cyclic sighing breathwork
Strong — Balban Cell Rep Med 2023.
5 min daily. Double inhale nose, long exhale mouth.
Nature exposure
Moderate — cortisol reduction, attention restoration.
20 min in green space weekly minimum.
Medical Treatment Options
Discuss these options with your prescribing physician. This information is educational, not medical advice.
Pharmacist Medication Review
Many pharmacies offer free comprehensive medication reviews. A pharmacist may catch interactions your individual prescribers missed.
Supplements — What the Evidence Says
Supplements are adjuncts, not replacements for lifestyle changes. Discuss with your healthcare provider.
Only to replace what medications are depleting
Psychological Support and Therapy
If anxiety about medications → pharmacist consultation first, then CBT if persistent. If difficulty deprescribing → GP-supervised tapering + psychological support.
What People With Meds Brain Fog Say
What Helped
- • ACB score calculator — had no idea allergy medication was contributing to brain fog
- • Pharmacist medication review — pharmacist caught an interaction 3 doctors had missed
- • Switching from sedating to non-sedating alternatives — doctor changed one medication and fog cleared in days
- • Tapering benzodiazepines (with medical supervision) — hardest thing they did but brain came back
What Didn't Help
- • Stopping medications cold turkey — dangerous and counterproductive
- • Adding supplements without considering drug interactions
- • Accepting brain fog as just a side effect you have to live with — there are almost always alternatives
Common Mistakes
- • Not telling all doctors about all medications (each specialist prescribes without seeing full picture)
- • Stopping psychiatric medications suddenly — require careful tapering
- • Blaming age or stress for symptoms that started when a new medication was added
Surprises
- • OTC medications can be the worst offenders — daily Benadryl for sleep was the single biggest cause
- • PPIs long-term — B12 depleted and nobody told them to test while on omeprazole
- • Gabapentin cognitive effects — prescribed for nerve pain, nobody mentioned it could cause the exact fog they complained about
"Make a timeline: when did the brain fog start? What medications were added or changed around that time? Bring this timeline to your doctor. Correlation isn't causation, but it's a CRITICAL starting point."
Quick Reference
Quick Win
Calculate your Anticholinergic Burden (ACB) score at acbcalc.com. Enter all your current medications. Score ≥3 = significant cognitive risk. Print the results and bring them to your next doctor appointment. Common offenders: diphenhydramine (Benadryl), first-gen antihistamines, some antidepressants (amitriptyline, paroxetine), overactive bladder drugs, some muscle relaxants.
Coupland et al., JAMA Intern Med, 2019