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Complementary Approaches to “Brain Fog” from ADHD

Written by Carlos Tello, PhD (Molecular Biology) | Last updated:
Puya Yazdi
Medically reviewed by
Puya Yazdi, MD | Written by Carlos Tello, PhD (Molecular Biology) | Last updated:
complementary approaches to brain fog

“Brain fog” is a set of subjective symptoms people with ADHD often complain about, such as reduced mental clarity, forgetfulness, and fatigue. This post compiles research about complementary approaches to “ADHD brain fog.”

Remember to talk to your doctor before making any major changes to your lifestyle, diet, or supplements regime. Supplements can interact with the medications you’re taking. Additionally, many supplements have neither been thoroughly researched nor approved by the FDA for medical use.

Psychological Interventions for ADHD “Brain Fog”

1) Behavioral Therapies

Behavioral therapies improve psychological disorders through behavior modifications and are a mainstream approach approved by the FDA for children with ADHD. They improved cognitive and behavioral symptoms in 8 trials on almost 1500 children and adolescents [1, 2, 3, 4, 5, 6, 7].

Their combination with cognitive techniques is called cognitive-behavioral therapy. It improved ADHD symptoms in 12 trials on over 500 adults and over 150 adolescents, especially combined with medication [8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19].

2) Cognitive Training

Programs training working memory improved the performance of tasks involving this function in 5 trials on over 300 children and adolescents with ADHD. Because they were less effective than medication and only helped with some working memory areas, the studies suggested they may only be used as add-on therapies [20, 21, 22, 23, 24].

Programs for training attention improved this area in 4 trials on over 100 children but had little or no effect in 3 trials on over 100 children [25, 26, 27, 28, 29, 30, 31].

Two meta-analyses concluded that, although they may slightly improve working memory and attention, cognitive training programs have limited effects on overall ADHD symptoms [32, 33].

Clinical research suggests that behavioral therapies improve cognitive symptoms in children and adolescents with ADHD, while cognitive training may slightly help as an add-on.

Devices & Brain Interventions for ADHD “Brain Fog”

3) Neurostimulation

Neurostimulation is the activation of specific brain regions to improve psychiatric disorders. A few studies have investigated different non-invasive neurostimulation techniques in people with ADHD [34+].

Vagus nerve activation improved ADHD symptoms and was well tolerated in another pilot trial on 24 children. A device using this mechanism (called Monarch external Trigeminal Nerve Stimulation System) is approved for children with ADHD who are 7 to 12 years old and not taking medication if prescribed by a doctor [35].

Similarly, transcutaneous electrical nerve stimulation (TENS) improved executive function and behavior in a small trial on 22 children [36].

Another non-invasive technique, transcranial magnetic stimulation (TMS), rapidly improved attention in a small trial on 13 children with ADHD but not in one on 9 adolescents and young adults [37, 38].

Transcranial electrical stimulation has only been tested in adults and showed contradictory results. It improved overall ADHD symptoms in a small trial on 17 people but was ineffective in another one on 30 [39, 40].

A device that activates the vagus nerve is approved in children with ADHD not taking medication. Promising research about the effects of neurostimulation techniques like TENS and TMS on cognition in ADHD is emerging, but more studies are needed.

4) Neurofeedback

Neurofeedback is a form of biofeedback training in which brain activity is measured so that people learn how to modify it [41+, 42+].

In 5 trials on 13 adults and 69 children with ADHD, a neurofeedback type based on brain imaging (fMRI) helped increase the activity of brain regions involved in selective attention and impulse control (prefrontal cortex, cingulate cortex, bilateral insula, thalamus, caudate nucleus and substantia nigra) [43, 44, 45, 46, 47].

In 12 clinical trials on over 700 children, other neurofeedback variants (SCP, theta/beta, and EEG) improved cognitive function and behavior. However, 2 trials on 55 children found EEG neurofeedback wasn’t more effective than placebo [48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61].

Neurofeedback was as effective as cognitive-behavioral therapy and more effective than cognitive training in 2 clinical trials on over 200 adults and children with ADHD [62, 63].

Its comparison with stimulants showed mixed results. Neurofeedback was more effective in a trial on 23 children, less in 3 trials on almost 200, and similarly effective in 2 trials on over 100 [64, 65, 66, 67, 68, 69].

All in all, evidence suggests that several neurofeedback techniques may help with ADHD. Note, however, that neurofeedback is not approved for ADHD. You or your child may try this approach if your doctor determines that it may be helpful.

According to some clinical trials, neurofeedback may improve cognitive function in children and adults with ADHD but the results have been mixed.

5) White Noise

Although noise generally worsens cognitive performance, white noise (the one created by combining all frequencies) may improve signal transmission in the brain. In people with ADHD, it seems to do so by increasing dopamine release [70+, 71+].

White noise improved working memory, attention, and language skills while reducing distractibility in 4 trials on over 150 children and adolescents with ADHD [72, 73, 74, 75].

While promising, the evidence is still insufficient to support the use of white noise for ADHD. Further clinical research is needed.

According to limited research, white noise may improve attention and reduce distractibility in children with ADHD. Large-scale studies are needed.

Lifestyle Changes for ADHD “Brain Fog”

6) Get More Exercise

Exercise may improve cognitive function in people with different conditions. It may do so by stimulating the birth of new cells, increasing synaptic plasticity, reducing inflammation and oxidative damage, and improving blood flow in the brain [76+, 77+, 78, 79+, 80+].

Physical exercise programs improved attention, information processing, executive function, and behavior in 14 trials on over 400 children with ADHD [81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94].

Similarly, a 20-min bout of moderate cycling improved motivation for cognitive tasks, increased energy, and reduced confusion and depression in a small trial on 32 men with ADHD [95].

In a trial on 35 adolescents with ADHD, aerobic exercise enhanced the effects of Ritalin [96].

Taken together, evidence suggests that exercise may help with ADHD symptoms. Given its multiple health benefits, it’s a good idea to do more exercise whether it helps with your “brain fog” or not.

Exercise enhances cognitive function and brain health. Clinical studies show it may also improve “brain fog” symptoms in children and adults with ADHD.

7) Improve your Sleep

Poor sleep reduces cognitive areas such as attention, memory, creativity, language and numerical skills, and executive function [97, 98, 99, 100, 101, 102].

Sleep loss increases free radical damage in the hypothalamus by reducing the production of the antioxidant glutathione. It also increases the production of pro-inflammatory cytokines (such as TNF-alpha, IL-6, IL-17, and CRP) [103, 104, 105, 106, 107, 108].

Nine studies on over 1600 children associated ADHD with sleep disturbances, including longer time until sleep onset, more night awakenings and nightmares, reduced sleeping time, and longer REM sleep (which is less restoring). Those belonging to the combined subtype or taking medication had more disturbances [109, 110, 111, 112, 113, 114, 115, 116, 117].

In 5 studies on over 600 children with ADHD, poor sleep reduced their attention, working memory, word skills, and response to medication [118, 119, 120, 121, 122].

Sleep interventions improved cognitive performance and overall well-being in 4 clinical trials on almost 700 children [123, 124, 125, 117].

Adults and adolescents with ADHD have fewer sleep disturbances than children. Nevertheless, the condition is associated with later sleep onset, interrupted sleep, delayed waking time, and daytime sleepiness [126, 127, 128, 129, 130].

As was the case of exercise, getting a good night’s sleep has multiple added benefits and is always recommended. Whether you have ADHD or not, read this post to learn how to fix your sleep.

The brain needs enough sleep to be healthy. In clinical studies, sleep interventions improved ADHD cognitive symptoms in children and less so in adults.

8) Spend More Time in Nature

According to the Attention Restoration Theory, urban environments are tiring because they require us to constantly use our voluntary attention. Conversely, outdoor environments with green space rely on involuntary attention and are more relaxing [131].

In a clinical trial on 17 children with ADHD, concentration and attention performance improved after a 20-minute walk in the park but not in urban settings. In 2 surveys, over 500 parents of children with ADHD reported symptom improvement after outdoor activities [132, 133+, 134].

Another advantage of outdoor activities is that you will get more sun exposure. By doing so, you will produce a nutrient suggested to improve inattention and other ADHD symptoms: vitamin D [135, 136, 137].

Spending more time in nature may help the mind take a well-deserved break from constant stimulation. Studies show outdoor activities may improve attention in children with ADHD.

Mind-Body Interventions for ADHD “Brain Fog”

9) Meditation and Yoga

Mindfulness is a technique derived from Eastern meditation practices. Its combination with psychotherapy helps reduce distractibility and control emotions [138, 139].

Mindfulness-based therapies improved ADHD symptoms in 11 trials on over 800 adults and 2 trials on over 100 children and adolescents [140, 141, 142, 143, 144, 145, 146, 147, 148, 149, 139, 150].

The therapy was more effective when applied to both children with ADHD and their parents. It reduced ADHD symptoms in over 200 children and stress in their parents [151, 152, 153, 154, 155].

Yoga is a different technique that combines meditation with posture and breathing control. In 4 clinical trials on 100 children with ADHD, yoga improved hyperactivity and inattention symptoms [156, 157, 158, 159].

Although the results are promising, mindfulness and yoga are not approved therapies for ADHD. Discuss with your doctor if they may help you or your child and never use them in place of what your doctor recommends or prescribes.

Some researchers think mindfulness meditation and yoga may improve ADHD symptoms (including stress, hyperactivity, and inattention).

10) Massage

In 2 small trials on 58 children and adolescents with ADHD, massage therapy improved focusing at school, behavior, and mood control. Larger, more robust clinical trials are needed to confirm these preliminary results [160, 161].

Dietary Changes for ADHD “Brain Fog”

11) Eat More Omega-3 Fatty Acids

In 5 studies on almost 200 children and adolescents, those with ADHD had lower omega-3 than omega-6 fatty acid levels in their blood and cell membranes. This was associated with more severe cognitive and behavioral symptoms [162, 163, 164, 165, 166].

Dietary fatty acids such as EPA and DHA restored normal omega-3 levels in 6 clinical trials on over 700 children with ADHD. This improved attention, working memory, learning capacity, and behavior [167, 168, 169, 170, 171, 172].

Two meta-analyses concluded that omega-3 fatty acids may improve ADHD symptoms. However, they warned that they may have little or no effect unless you have omega-3 deficiency [173, 174].

You can increase your omega-3 fatty acid intake by taking supplements or eating foods rich in them such as [175+, 176+]:

  • Fish and other seafood (such as mackerel, salmon, tuna, sardines, and oysters)
  • Nuts and seeds (such as walnuts and chia seeds)
  • Plant oils (such as flaxseed, soybean, and canola oil)
  • Fortified foods (such as juices, soy beverages, and dairies)
Clinical research suggests that children with ADHD may benefit from higher omega-3 intakes, especially if deficiency is suspected.

12) Restriction Diets

In 3 clinical trials on over 200 children with ADHD, restriction diets reduced inattention and hyperactivity. The foods identified as most commonly causing the symptoms included chocolate, dairies, fruits, wheat, and tomato [177, 178, 179, 180].

In many cases, the food may only worsen ADHD symptoms in intolerant people. For instance, gluten is a well-known “brain fog” trigger only in celiac people. In a trial on 26 adults with ADHD and celiac disease, ADHD symptoms improved after going gluten-free [181, 182].

Other foods that may cause food intolerance leading to “brain fog” include those rich in [183, 184+, 185, 186+, 187, 188+, 189]:

  • Lectins (such as beans, peanuts, lentils, tomatoes, and eggplants)
  • Casein (dairy products)
  • FODMAPs (such as many fruits, vegetables, cereals, and dairies)
  • Salicylates (such as apricots, oranges, pineapples, dates, and raspberries)
  • Amines (such as chocolate, cheese, wine, beer, and fish)
  • Tannins (such as bananas, chocolate, tea, nuts, and whole spices)
  • Trypsin inhibitors (such as legumes, cereals, potatoes, and eggs)
  • Oxalates (such as leafy vegetables, dark chocolate, legumes, and nuts)
  • Yeast (such as gluten-free bread)
  • Food additives like carrageenan and carboxymethylcellulose (such as ice cream, almond milk, candy bars, and some cheeses)
  • Caffeine (such as coffee, tea, and cocoa)

However, more clinical research is needed to confirm their role in ADHD symptoms. Additionally, maintaining a restriction diet in the long-term can lead to deficiencies and it’s better to identify which food caused the unwanted effects by adding foods one at a time back in. Be sure to follow your doctor’s instructions carefully when it comes to restriction diets [190, 191+].

According to some studies, restriction diets may improve cognitive symptoms in people with ADHD and food intolerance. More research is needed.

13) Preserve Your Gut Microbiome

Some researchers believe that the gut microbiota plays a key role in cognitive function and behavior. The communication between the gut and the brain is often called the ‘brain-gut axis’ [192].

In animal studies, diets rich in saturated fats and added sugars reduced beneficial bacteria in the gut, ultimately causing obesity and cognitive impairment [193+, 194, 195].

In a study on almost 1k children with ADHD, a diet rich in sweetened desserts, fried foods, and salts was associated with more learning, attention, and behavioral problems. A small trial on 17 children with ADHD also associated eating sugar with impaired attention [196, 197].

Interestingly, a probiotic given to babies prevented them from being diagnosed with ADHD later during childhood in a clinical trial on 75 children [198].

Further research is needed to confirm the role of the gut microbiome on ADHD symptoms.

Research suggests that unhealthy, fast food causes microbiome imbalances and worsens cognition in children. Research about the potential benefits of probiotics is ongoing.

Supplements & ADHD “Brain Fog”

Single Ingredient

The following supplements improved ADHD cognitive symptoms in clinical trials:

It is not certain whether any supplement is effective in treating any ADHD. Medicinal use of these products has not been approved by the FDA. Supplements should not be used in place of medication prescribed for you by your doctor. Talk to your doctor before taking any supplements to avoid potentially dangerous interactions.

Complex Formulations

A commercial supplement with 14 vitamins, 16 minerals, 3 amino acids, and 3 antioxidants (EMPowerplus) improved language abilities, mood, and behavior in 3 small trials on 28 adults and 11 children with ADHD [218, 219, 220].

Another supplement (with taurine, glutathione, alpha-lipoic acid, vitamins, minerals, plant extracts, amino acids, essential fatty acids, and probiotics) was as effective as Ritalin at improving cognitive symptoms in a clinical trial on 20 children [221].

Research about the benefits of specific supplements for ADHD “brain fog” is sparse. Additional studies should explore the nutrients and herbs that show promise.

Limitations and Caveats

The effects of most natural methods to fix ADHD “brain fog” have been studied in few, small trials, sometimes with contradictory results. Some of them are promising, but more studies are needed to confirm the preliminary results.

Takeaway

ADHD is marked by cognitive difficulties, some of which are subjectively described as “brain fog.” This term covers a range of attention, focus, and memory problems, which are often accompanied by fatigue and mood imbalances.

Research is currently exploring complementary approaches to improve these symptoms. Among them, strong evidence supports the use of behavioral therapies.

Promising results were also seen for cognitive training, neurofeedback, and meditation. Among dietary changes, studies reveal that children with ADHD may benefit from higher omega-3 intake (if deficient). They should also avoid saturated fats and high sugar intake, which worsen overall health and cognition.

Studies about the effects of dietary supplements on “ADHD brain fog” is sparse. Additional research should explore the most promising compounds.

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About the Author

Carlos Tello

Carlos Tello

PhD (Molecular Biology)
Carlos received his PhD and MS from the Universidad de Sevilla.
Carlos spent 9 years in the laboratory investigating mineral transport in plants. He then started working as a freelancer, mainly in science writing, editing, and consulting. Carlos is passionate about learning the mechanisms behind biological processes and communicating science to both academic and non-academic audiences. He strongly believes that scientific literacy is crucial to maintain a healthy lifestyle and avoid falling for scams.

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