When you are tired all the time and canโt think clearly
Brain fog is not a diagnosis, but it is a very real experience: slow thinking, forgetfulness, trouble finding words, difficulty concentrating and a constant mental heaviness. It usually comes with fatigue that sleep does not fix. Because so many things can cause it, brain fog is a good example of why a whole-person assessment matters. Treating it well starts with finding out why it is happening.
Common causes we look for
- Sleep problems. Short sleep, insomnia, irregular schedules and untreated sleep apnea are among the most common causes. See sleep and insomnia.
- Iron deficiency and anemia. Very common, especially with heavy periods, pregnancy or plant-based diets.
- Vitamin B12 and folate. Low levels can affect energy, memory and mood.
- Thyroid problems. An underactive thyroid slows both body and mind. See thyroid and mental health.
- Depression and anxiety. Both commonly cause poor concentration and fatigue. See depression and anxiety.
- ADHD. Lifelong difficulty with focus can feel like fog, especially under rising demands. See ADHD support.
- Burnout and chronic stress. See stress and burnout.
- Blood sugar and diet. Skipped meals, very refined diets and large swings in blood sugar affect energy and attention.
- Hormonal transitions. Perimenopause and the postpartum period often bring brain fog. See perimenopause and mental health.
- After illness. Lingering fatigue and cognitive symptoms after viral infections are common.
- Medications and alcohol. Several medicines and regular drinking can dull thinking.
- Inflammation. See neuroinflammation and cognition.
Sudden or severe memory loss, confusion, new neurological symptoms or brain fog with weight loss or fevers should be assessed by a medical provider promptly.
How we assess fatigue and brain fog
We take a detailed history of when symptoms began and what changed around that time, review sleep, diet, activity, mood, medications and medical history, and use standardized questionnaires. We then recommend targeted labs, typically including a blood count, ferritin, vitamin B12, folate, vitamin D, thyroid tests and blood sugar markers, with others only when your history points to them. See lab testing for mental health.
How we treat it
- Correcting deficiencies found on testing
- Treating sleep problems directly, and referring for sleep apnea testing when needed
- Stabilizing meals and energy through the day; see nutritional psychiatry
- Treating underlying anxiety, depression or ADHD
- Gradual, paced increases in activity, especially after illness
- Stress-regulation skills and therapy
- Reviewing medications that may be contributing
Our providers are licensed naturopathic physicians and mental health counselors led by Dr. Koichi Tanji, ND, LMHC. In Washington, controlled substances such as ADHD stimulants and benzodiazepines are outside naturopathic prescribing scope, so when one is part of the right plan we coordinate with your prescribing physician or nurse practitioner.
What to expect
Because fatigue and brain fog usually have more than one cause, improvement often comes in layers: sleep and diet changes in the first weeks, then the effects of correcting deficiencies or treating mood over the following months. We track energy and concentration so you can see the trend.
Getting started
We see patients in person at 2135 112th Ave NE, Suite 201, Bellevue, and by secure telehealth anywhere in Washington. We are in-network with Premera, Regence, BlueCross BlueShield, Aetna, Cigna and Kaiser PPO. Most people begin with our Biopsych Assessment. Book online or call (425) 278-6166.
If you are in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911.
