Could your gut health be the reason for your perimenopausal brain fog?

There are days when I genuinely wonder whether my brain has packed a bag and gone on holiday.

I'll be halfway through a sentence and suddenly can't remember the word I'm looking for. I'll mix up my words, walk into a room and have absolutely no idea why I'm there, or tell my twins to put their clothes in the oven - that actually happened! They often look at me like I've completely lost the plot.

Then there's the ongoing argument with my husband. I'll insist I've told him about something, only for him to swear blind that I haven't. Yes, it sounds funny when I put pen to paper, but living it day in, day out, really isn't.

Brain fog can be frustrating and surprisingly time-consuming. If you're trying to work, remember school dates, organise family life and keep all the plates spinning, losing your train of thought halfway through a sentence isn't exactly helpful.

So, is this just another joy of being midlife? Or is something else going on?

Brain fog is real, but what actually is it?

Brain fog isn't actually a medical diagnosis. It's a term women commonly use to describe a collection of cognitive symptoms, including forgetfulness, difficulty concentrating, losing your train of thought and struggling to find words.

It’s commonly reported during the menopause transition. Research shows that women can experience changes in memory, attention and learning during perimenopause. Interestingly, what women experience as ‘brain fog’ doesn't always show up on a cognitive test. In other words, you can feel like your brain isn't working properly, even if a test says everything is technically fine.

Dr Naomi Newman-Beinart PhD, a nutritionist and health psychology expert, knows the feeling herself. ‘While brain fog isn't a medical term, women know exactly what they mean when they talk about it,’ she says. ‘I'm 47, so I know it well. It's that feeling of not being as mentally sharp as usual. The brain's working, but more slowly than it used to.’

So, if you've found yourself standing in the kitchen wondering why you're there, you're certainly not alone.

Why does it happen?

The hormone oestrogen gets some of the blame here. Oestrogen is one of the main hormones produced by the ovaries. As we enter perimenopause, the ovaries gradually become less responsive and oestrogen levels start to fluctuate and, over time, decline. That's why the menopause transition can bring such a wide range of symptoms, from hot flushes and sleep problems to changes in mood, memory and concentration. ‘Oestrogen also plays a role in how the brain works,’ explains Dr Naomi. ‘There are oestrogen receptors in areas of the brain involved in things such as memory and mood, which is one reason researchers think changing hormone levels may contribute to some of the cognitive symptoms women experience during perimenopause.’

That may help explain why some days you feel completely on the ball and others you can't remember your own postcode. However, Dr Naomi is keen not to blame everything on hormones. ‘Oestrogen isn't going to be the only reason we have brain fog,’ she adds. ‘It’s quite multifactorial. Brain fog doesn't happen in isolation. Poor sleep, stress, exhaustion and other menopause symptoms can all make it harder to concentrate and remember things.’

What does your gut have to do with your brain?

The gut and brain are in constant communication and this is known as the gut-brain axis. That doesn't mean your gut is secretly running the show, but researchers now know that what's happening in the gut can influence more than digestion. The gut microbiome, the trillions of bacteria and other microorganisms living in your digestive system, has been linked with things including mood, stress, inflammation and brain function. Researchers are also increasingly interested in how the gut interacts with our hormones, particularly oestrogen during the menopause transition.

So, could what's happening in your gut have a bearing on brain fog? Possibly. ‘The gut and the brain are constantly communicating with each other, and this can happen through several different pathways, including the nervous system, hormones and substances produced by gut microbes,’ she says. ‘Where we have to be careful is when people state: “brain fog is caused by your gut microbiome.” But, it’s definitely an influence.’

Research into the gut-brain connection during menopause is still in its early stages. Scientists are looking at how gut bacteria, oestrogen and the brain interact, including the role gut bacteria may play in processing oestrogen. But there is still a lot we don't know, particularly when it comes to brain fog.

Meet the estrobolome

Yes, it sounds like something from a science-fiction comic, but the estrobolome is a real scientific term. It refers to the gut bacteria involved in processing oestrogen in the body. Researchers are becoming increasingly interested in this gut-hormone relationship, particularly during menopause when oestrogen levels are changing. ‘There is a two-way relationship between our hormones and our gut microbiome,’ says Dr Naomi. ‘The estrobolome refers to the collection of gut microbial genes involved in oestrogen metabolism. It's a fascinating area of research, but, as with many things involving the microbiome, there's still a lot we don't know.’

Nutritionist and health psychology expert, Dr Naomi Newman-Beinart

So, could improving your gut health help?

While the gut-brain-oestrogen connection is fascinating, we're not at the point where we can say an unhealthy gut microbiome causes perimenopausal brain fog, or that changing your gut bacteria will make it disappear.

If you are interested in understanding more about your own gut health, microbiome testing can provide some insights. ‘The YorkTest Gut Microbiome Test looks at the microorganisms present in the gut and provides personalised insights into areas such as microbial diversity and balance,’ explains Dr Naomi. ‘It can give you a much more detailed picture of your gut microbiome and help inform practical dietary and lifestyle changes. What it can't do is tell you that a particular microbiome pattern is the cause of your brain fog, because we're simply not at that stage with the science yet.’

Nutrition is also a good place to start. ‘One of the most practical things we can do to support gut health is eat well,’ she says. ‘The foods that support gut health are also the foods we recommend for brain health and cardiovascular health. Make sure to include plenty of plant foods and fibre, so things like, fruit, vegetables, lentils, whole grains, nuts, seeds. Rather than having an obsession with one kind of superfood, variety is key as different gut bacteria thrive on different kinds of fibre and plant compounds.’

She also recommends thinking about omega-3 fats from foods such as fish, protein and nutrients including iron, folate, B12, vitamin D and magnesium. Fermented foods such as live yoghurt and kefir can be useful for some people too (if they like it), although Naomi doesn't say they're essential for everyone.

‘No one needs to be obsessing over the perfect diet,’ she says. ‘Just remember to eat regularly; don’t have massive gaps between meals, because that's not going to help brain fog and stay hydrated. The other big ones to think about are not relying on caffeine and sugar to drag yourself through the day and staying clear of alcohol which can disrupt sleep and affect brain fog.

Don't assume it's all menopause

If you're constantly exhausted, experiencing severe or ongoing brain fog, getting frequent headaches or noticing significant changes in your cognition, it's worth speaking to your GP rather than simply writing it off as hormones. Naomi says possible causes can include iron deficiency or anaemia, low B12 or folate, vitamin D deficiency, thyroid problems, blood glucose issues, medication side effects and conditions such as sleep apnoea.

And don’t just reach for supplements to try and cure brain fog and other menopause symptoms. ‘I always start by looking at the whole picture,’ she says. ‘That means looking at sleep, food intake, protein and fibre, alcohol and caffeine, stress, exercise, movement and any digestive symptoms before deciding what's going on.’

Takeaway…

The gut-brain connection is real. The relationship between the gut microbiome and oestrogen is a fascinating area of current research, and there are sensible reasons to look after your gut health as part of your overall wellbeing. However, there's a big difference between saying the gut may influence brain function and saying your gut is the reason you're forgetting why you walked into the kitchen.

‘So I guess the big question is: could improving your gut health help you think more clearly?’ asks Dr Naomi. ‘In my clinical experience, I say yes. I think there are some really interesting mechanisms and definitely some decent emerging evidence supporting the fact that the gut may have wider benefits for the brain and also for general wellbeing.’

Brain fog is complicated, so for the time being, if you walk into the kitchen and forget why you're there, we just say: ‘Welcome to the club!’

Dr Naomi Newman-Beinart (PhD) is a Chartered Psychologist specialising in health and Registered Nutritional Therapist. She is also an ambassador for Yorktest.com, which offers a range of home-to-laboratory health tests, including its Gut Microbiome Test.