Out of the Fog

Out of the Fog: Strategies to Prevent Brain Fog and Sharpen Cognitive Function

It’s easy to take your mental health for granted until one day you realize that you haven’t been feeling as mentally sharp as you once were. Maybe you’re having more frequent slips in memory or you feel like you’re walking around with your head in a cloud. When these moments occur, you may be quick to dismiss them, but brain fog, in a sense, is the body’s way of indicating that the brain is not working the way it’s supposed to be. So, what is brain fog and why does it happen?

Brain fog is not an actual clinical condition, but rather a term for a subjective set of symptoms that people experience. Some may be affected by poor concentration or a decrease in intellectual productivity, while others may experience memory problems (difficulty with recalling words, details, etc.). Other symptoms can include feelings of confusion, depression, and headaches. People of any age and gender can experience any one or all of these symptoms at any given time.

These changes in cognitive function are not only mentally exhausting, but they can also have a very real effect on a person’s emotional wellbeing. Operating in a reduced state of mental acuity can knock down a person’s self-confidence, cause workplace productivity to suffer, and may even be a reason to withdraw from social outings. But it’s important to understand that brain fog is not a normal part of the aging process.

There are many factors that can initiate symptoms of brain fog; some that you may not think are related. Unlike dementia, which can be permanent, and in some cases, progressive, brain fog symptoms are likely to improve when contributing factors are addressed.

Here are 6 common contributors with tips on what you can do to improve or even eliminate your symptoms altogether.


1. Poor nutrition.

The connection between the brain and the gut is also known as the “gut-brain axis.” It’s a bi-directional connection, which means that the gut and the brain essentially speak to each other. This means that when the integrity of one component is compromised, the other is directly affected. Therefore, poor nutritional choices will have a direct effect on brain function.

Highly processed meals and drinks that are loaded with simple sugars and other artificial ingredients can cause a disruption in the gut flora and lead to a condition called intestinal permeability, or leaky gut. When the gut lining is weakened unwanted substances are able to break through the protective filter between the intestines and our bloodstream. The are several issues that then become a problem. The first is that the body will start to make antibodies to foods, causing allergies to foods we would not have been sensitive to when the intestine was healthy. The other issue is that when the intestinal barrier is impaired, the barrier around the brain that helps protect our brains from immune substances floating in the blood now can enter the brain and incite an inflammatory reaction. This can show up as fatigue, sleep disturbances and alterations in mood, anxiety, and depression, and brain fog.

In addition, common food additives like aspartame, Monosodium Glutamate (MSG), and nitrates/nitrites promote widespread inflammation and oxidative stress by producing free radicals that cause damage to brain cells and DNA when they overwhelm antioxidant levels in the body.

Solution: We should never take our food choices for granted! There are things that can be done nutritionally to help clear brain fog, boost energy, and increase productivity. Start by cutting down on processed foods and eating whole, organic, and non-GMO foods whenever possible. Next, eat probiotic-rich foods to help balance your gut flora and get rid of harmful bacteria. Probiotic-rich foods include sauerkraut, kimchi, Kombucha (watch out for sugar content), and kefir. If you have trouble getting these foods onto your plate, another great way to get good bacteria into your diet is supplementing with a daily probiotic.

2. Biotoxicity and Neurotoxicity

Biotoxins and neurotoxins are environmental toxins that can poison our physical and mental health. As toxins penetrate the blood-brain barrier, they are free to circulate throughout the body – including the brain! Once there, the glial cells that work to defend the nerves and brain cells from damage are compromised and unable to do their job. Although the symptoms vary, a common complaint of someone diagnosed with some form of toxicity is brain fog.

Solution: Eliminating biotoxins and neurotoxins from your home is the first step in any detoxification process. This may mean professional removal of mold-infested areas, air purification, and a change to buying “green” products that do not contain harmful ingredients like pesticides and other toxic ingredients. You’ll also need to make changes to your diet to exclude food items that may contribute to leaky gut. A compromised gut lining will allow more toxic substances to circulate through your body instead of being eliminated. If you have symptoms of brain fog talk to your physician about whether getting tested for the presence of biotoxins or neurotoxins make sense for you.

3. Sleep Disorders

In the United States, as many as one-third of adults do not get the quality of sleep the body requires. It’s during sleep when the body is able to repair itself by calming inflammation and maintaining hormone production. When these two processes – both important elements in brain health – are compromised it can negatively impact your memory, decision-making, the capacity to focus one’s attention, and the ability to complete complex creative activities, among other things.

Solution: There are a lot of things you can do to improve your sleep pattern. Breathing techniques, meditation, dietary adjustments, starting an exercise routine (or adjusting your current one), and establishing a bedtime routine are just a few examples.
If you think you may have an actual sleep disorder, a first step in further evaluation is to answer the eight questions on the Epworth Sleepiness Scale. If your score is equal to, or higher, than 10 the results should be discussed with your doctor.

4. Celiac Disease

People with Celiac Disease (CD) are no strangers to brain fog. Just like poor nutritional choices can lead to leaky gut, so can an allergy or sensitivity to gluten. The difference is, with Celiac Disease your immune system mistakes gluten, a normally benign food ingredient for most, as a foreign and deadly invader. When it’s detected in the body, the immune system begins to attack and destroy the gut lining and causes leaky gut. Once the villi are damaged the body is unable to absorb the nutrients it needs to keep the brain and body healthy and allows harmful substances to enter. Brain fog is a common symptom of people who are ultimately diagnosed with Celiac Disease or gluten intolerance.

Solution: Patients who have been diagnosed with Celiac disease and/or gluten intolerance report a noticeable and significant improvement in cognitive impairment after eliminating gluten from their diet.

5. Estrogen

In women, the onset of menopause can trigger a myriad of symptoms including fatigue, weight gain, mood swings, hot flashes, joint pain, and brain fog. Research suggests that when it comes to changes in memory and other mild cognitive impairments that accompany menopause, the decline of estrogen levels may be partly to blame. We know that the brain is full of estrogen receptors that have neuroprotective and antioxidant benefits. The decline of estrogen during menopause compromises neuronal function and increases the risk of developing age-related neurodegenerative disorders.

Solution: Although there is no single solution that works for every woman, bioidentical hormone replacement therapy can relieve many of the unpleasant symptoms that most women experience during menopause, including brain fog. Talk to your doctor about a screening that will help identify hormonal imbalances so they can be effectively treated.

6. Side-Effects from Medication

Statistics show that over 20% of US adults report using 3 or more prescription drugs in the past 30 days and nearly 12% use 5 or more. Additionally, it’s not unusual that patients receive prescriptions from specialists in addition to their primary care physician, and supplement use is not always reported accurately. This leaves a lot of room for unwanted side effects, including brain fog.

Solution: Make sure to review your medications with your primary physician annually, and more often if necessary, particularly if you feel like you haven’t been yourself.

In sum, the good news about brain fog is that there are ways to help clear it up, boost your energy, and improve your productivity and memory. The key is keeping your brain well-fed, your body well-rested, and keeping your physician in the know about any changes in your mental acuity.

For individuals who would like to work directly with our providers, we offer comprehensive services that utilize the best alternative and conventional medicine solutions to keep your brain young, healthy, and vital. For more information, visit KaplanClinic.com/building-a-better-brain/. To make an appointment with one of our physicians please call 703-532-4892.


Carabotti M, Scirocco A, Maselli MA, Severi C. The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Annals of Gastroenterology. 2015;28(2):203-209.

Jedrychowski, Et al. Cognitive function of 6-year old children exposed to mold-contaminated homes in early postnatal period. Prospective birth cohort study in Poland. Physiology & Behavior. Volume 104, Issue 5, 24 October 2011.

Lichtwark , Et al. Cognitive impairment in coeliac disease improves on a gluten‐free diet and correlates with histological and serological indices of disease severity. Alimentary Pharmacology & Therapeutics. Volume 40, Issue 2, July 2014.

Yelland GW, Gluten-induced cognitive impairment (“brain fog”) in coeliac disease. Journal of Gastroenterology and Hepatology. 2017 Mar; 32 Suppl 1:90-93. doi: 10.1111/jgh.13706.

Zárate S, Stevnsner T, Gredilla R. Role of Estrogen and Other Sex Hormones in Brain Aging. Neuroprotection and DNA Repair. Frontiers in Aging Neuroscience. 2017;9:430. Published 2017 Dec 22. doi:10

Glutathione: Master Antioxidant, Detoxifier, and Immune Booster

In recent years, there has been increasing interest in glutathione (GSH) and the role it plays in the progression and treatment of a wide variety of illnesses and conditions.

Glutathione is the most abundant and arguably the most important antioxidant in the body. Several biological processes rely on it to perform optimally, but levels diminish as we age, opening the door to premature cell death, aging, and age-associated diseases and conditions.

Glutathione is critical for the detoxification process. Low glutathione compromises liver function, which works to flush the body of damaging free radicals. Free radicals, like reactive oxygen species (ROS) and reactive nitrogen species (RNS), are naturally occurring, toxic compounds that are formed when the body converts food to energy. They roam freely, targeting and altering different types of molecules in the body through an exchange of electrons. In ideal circumstances, free radicals are kept in check by antioxidants that prevent them from causing damage.

However, when the scales tip in their favor free radicals can cause significant damage to our cells and our DNA. The result is oxidative stress (OS) which is linked to numerous disease processes including cognitive decline (Alzheimer’s disease) and other age-related conditions like cancer, cardiovascular disease, and diabetes.

Studies confirm the link between low GSH and cognitive impairment:
Oxidative stress predicts cognitive decline with aging in healthy adults: an observational study
Glutathione relates to neuropsychological functioning in mild cognitive impairment

Closely tied to this is glutathione’s role in mitochondrial survival. Mitochondria are responsible for creating cellular energy and they are directly linked to the pathways of cellular death. Without adequate levels of glutathione cellular health and longevity are compromised.

Over time, toxins, poor diet, medications, infections, and stress all contribute to depleting levels of glutathione. Without enough of it in our cells we become “unbalanced” in terms of inflammation and anti-inflammation. When the body’s normal cycle of destruction and repair tips more towards destruction and moves away from repair we see disruptions in the proper functioning of the immune system, we see an increase in inflammation, and we see an increase in neuropsychiatric and neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disease, depression, ME/CFS, and fibromyalgia.

Optimizing Glutathione Levels

Vitamin and mineral IVs are a wonderful way to deliver and replenish vital nutrients to the body. By bypassing the digestive system, you get maximum absorption into the bloodstream and maximum bioavailability. Glutathione has shown it can cross the blood-brain barrier (BBB) and can, therefore, be an important tool in preventing and treating neurodegenerative conditions.

Some of the benefits of glutathione IV supplementation include:

  • Encourages cellular health
  • Lowers inflammation
  • Boosts immune system function
  • Helps maintain the body’s detoxification process
  • Improves cognitive function (clarity, focus, executive function)
  • Improves muscle repair and muscle development
  • Improves muscle endurance and energy

Bottom line: Increasing glutathione is one more way to slow down the aging process, encourage recovery, prevent disease, and maintain optimal health.


Ballatori N, Krance SM, Notenboom S, Shi S, Tieu K, Hammond CL. Glutathione dysregulation and the etiology and progression of human diseases. Biol Chem. 2009;390(3):191–214. doi:10.1515/BC.2009.033

Mol Neurobiol. 2014 Dec;50(3):1059-84. doi: 10.1007/s12035-014-8705-x.

Forman HJ1, Zhang H, Rinna A. Glutathione: overview of its protective roles, measurement, and biosynthesis. Mol Aspects Med. 2009 Feb-Apr;30(1-2):1-12. doi: 10.1016/j.mam.2008.08.006.

Ribas V, García-Ruiz C, Fernández-Checa JC. Glutathione and mitochondria. Front Pharmacol. 2014;5:151. Published 2014 Jul 1. doi:10.3389/fphar.2014.00151

Mytilineou C1, Kramer BC, Yabut JA. Glutathione depletion and oxidative stress. Parkinsonism Relat Disord. 2002 Sep;8(6):385-7.

Aoyama K1, Nakaki T. Impaired glutathione synthesis in neurodegeneration. Int J Mol Sci. 2013 Oct 18;14(10):21021-44. doi: 10.3390/ijms141021021.

Hirrlinger J1, Gutterer JM, Kussmaul L, Hamprecht B, Dringen R. Microglial cells in culture express a prominent glutathione system for the defense against reactive oxygen species. Dev Neurosci. 2000 Sep-Dec;22(5-6):384-92.

Kannan R, Kuhlenkamp JF, Jeandidier E, Trinh H, Ookhtens M, Kaplowitz N. Evidence for carrier-mediated transport of glutathione across the blood-brain barrier in the rat. J Clin Invest. 1990;85(6):2009–2013. doi:10.1172/JCI114666

Regular Aerobic Exercise Allows for Longer, Happier Lives

Two recent publications reinforce the benefits of aerobic exercise and provide even more motivation to get out and break a sweat on a daily basis.
The first study, published in JAMA Network Open last week, found that sedentary lifestyles are as harmful to one’s health as having a chronic illness. Over the span of 23 years 122,000 adult patients underwent periodic stress testing to determine the link between mortality and aerobic exercise. The study found that better cardiorespiratory fitness was directly associated with longer life spans and better overall health, with the inverse also being true.

A review and meta-analysis, published in the journal Depression & Anxiety, looked at the association between aerobic exercise and major depressive disorder (MDD). The results of 11 qualifying studies were examined and it was determined that aerobic exercise had a significant anti-depressant effect and can be considered an effective intervention for MDD and other mental health disorders. Click here to read the abstract.

Look, we all know about the benefits of exercising, but we don’t always stick with it. These studies really highlight the importance of daily movement in living longer and happier lives. Start off slow and find something you like and most importantly stick with it, as consistency is the key to reaping the long-term benefits and safeguarding your health.

Addressing the Fear of Cognitive Decline & How to Be Proactive

Alzheimer’s disease, the most common form of dementia, is the sixth leading cause of death in the U.S. For most people, the subject of Alzheimer’s brings fear and trepidation. Why? Because the thought of deteriorating brain function and memory loss is frightening. Unfortunately, current medical treatments are inadequate, dealing only with its end result.
Alzheimer’s is characterized by the destruction of synapses in the neurons, the nerve cells in the brain, by amyloid plaques. In addition, “tangles” form in the cells leading to loss of brain function. This leads to progressive loss of memory and behavioral problems like aggression, hallucinations, and delusions, as well as deterioration of activities of daily living. This is heartbreaking for patients and their families.
Despite years of ongoing research, there are still many unanswered questions about what causes Alzheimer’s disease. Let’s explore some of the known risks associated with dementia and learn how to lower those risks.
You may not have heard the term “type 3 diabetes” as another name for Alzheimer’s Dementia. Type 2 diabetes and prediabetes, also called insulin resistance, are both strongly linked to the development of Alzheimer’s dementia. This could actually be good news because it means this is a preventable risk factor.
Why has the term Type 3 diabetes been coined?  Let’s start by discussing sugar, which in large quantities is a poison. The body is not designed to handle more than 15-20 grams per day yet a soda has at least 40 grams and the average American consumes 82 grams per day.
Excess sugar causes an outpouring of insulin from the pancreas and over time causes the cells in the body – including the brain – to become resistant to insulin. This leads to chronically elevated blood sugar which causes Advanced  Glycation Endproducts or AGES to be produced. These AGES then attack the eyes, kidney, peripheral nerves, and the brain!
Other causes of dementia include recurrent traumatic brain injury (concussions), infections like Lyme disease and syphilis, excess alcohol and drugs, prolonged general anesthesia, and sleep apnea. Heavy metals such as lead in pollution and mercury in dental amalgams, and large fish, like tuna, swordfish and shark increase the risk of dementia. In the 1800’s the term “mad as a hatter” came about because hat makers were using a form of mercury to make fur hats and it destroyed brain cells. Studies also show that living near major highways is a risk factor for Alzheimer’s, as well as living or working in a water-damaged building leads to growth of toxic mold, which poisons the nervous system.
There are several genes that predispose to Alzheimer’s such as the ApoE4. However, just because we have a gene does not mean it will be expressed. Every time we eat, exercise, sleep, meditate, communicate, create something, play, learn and love, we are turning genes on and off.
The good news is the brain can actually grow and change in a positive way, even as we get older.
Lifestyle strategies can promote neurogenesis (new brain cells) and neuroplasticity (changes in the brain and its pathways). These strategies involve a substance called BDNF or brain-derived neurotrophic factor, which promotes brain cell growth and connectivity as demonstrated on MRI scans. In fact, the hippocampus, which is involved in emotional memory, gets larger the more BDNF is available. A large part of the lifestyle strategy involves modifying the diet to lower unhealthful carbs and increase healthful fats thus lowering the risk of diabetes.
Strategies include:

  1. Reducing (non-vegetable) carbohydrate consumption, including sugars and artificial sweeteners, and grains, which can cause inflammation of the lining of the digestive track, or “leaky gut”. An inflamed gut causes an inflamed brain and reduces the size of the hippocampus.Functional testing looking at stool, urine and breath can determine if your gut is leaky. Replace nutrients lost from a leaky gut or poor diet like B12, folate, B6, magnesium and iron.
  2. Increase healthy fat consumption by increasing omega-3 fat intake and reduce consumption of damaged omega-6 fats (like processed vegetable oils) in order to balance your omega-3 to omega-6 ratio. Omega-3 from fish sources shows lower risk of cognitive impairment.
  3. Add prebiotic fiber which nurtures gut bacteria and hippocampus. Probiotic supplementation which enhances the healthy bacteria in the gut, decreases the inflammatory marker, C-reactive protein, increases the antioxidant  glutathione , and improves mental status as measured by the Mini Mental Status Exam
  4. Exercise! Physical activity produces biochemical changes, increasing BDNF, that strengthen and renew not only your body but also your brain – particularly the hippocampus, the area associated with memory and learning. This is especially important for carriers of the ApoE4 gene. A good exercise regimen includes aerobic and resistance training at least 3-4 times per week for 30-45 minutes.
  5. A ketogenic diet is linked to an increase in BNDF, which causes the hippocampus to get bigger (better memory).This involves cutting down on carbohydrates which reduces insulin resistance (diabetes), and increasing good fats like avocado, olive oil, MCT (medium chain triglycerides found in coconut oil) and intermittent fasting 12-14 hours between dinner and breakfast so that the body breaks down fats and produces ketones.
  6. Consider getting tested for heavy metal and toxic mold exposure and work with your doctor to eliminate them.
  7. Balance hormones such as thyroid, cortisol, sex hormones and Vitamin D (which is actually a hormone).
  8. Work on getting at least 7-8 hours of solid sleep. If sleep is poor rule out sleep apnea. Low oxygen in the brain can lead to stroke and heart attacks, which are risk factors for dementia.
  9. Find out whether you are insulin resistant by getting a HgA1C test and fasting insulin.  Eliminating the risk of Type 2 diabetes (insulin resistance), can lower the risk of Alzheimer’s dementia (Type-3 Diabetes).
  10. Remember to take time to slow down, be mindful (meditation and yoga) spend time with loved ones, and take time to laugh and have fun. This is medicine for our minds.

Lisa Lilienfield, MD

Stop Eating These Foods, And Clear Up Your Brain!

Feeling unproductive? Fatigued? Having trouble concentrating? These are just some of the complaints associated with brain fog – or when your brain is not on top of its game.

Brain fog is characterized by cognitive impairments to memory, attention, executive function, and the speed of cognitive processing. It is not a medical condition itself, but rather symptomatic of an underlying condition that can range from poor nutrition or illness to undiagnosed food sensitivities or sleep deprivation.

If you haven’t already spoken to your physician about how you feel, make that priority number one in determining what may be causing your brain fog. In the meantime, there are things you can do right away to “clear up” your brain for optimal functioning. Environmental factors, particularly nutrition, can worsen or improve your symptoms; here are 5 types of foods and drinks that may be contributing to your brain fog – and why!

Salad dressings & pre-cooked meals

If your lunch salads get a good dose of dressing, it may be one of the causes of your brain fog. The food additive Monosodium Glutamate (MSG), used as a taste enhancer and flavoring agent, is hidden in almost all processed foods, ranging from bottled salad dressings, soups, and canned goods to many restaurant meals. People can experience physical symptoms when eating foods that contain MSG that last from a few hours to days, and the most common of these is brain fog. Here’s how it works:

  • Free glutamic acid is the active component in MSG and is converted to glutamate in the body.
  • Glutamate is a neurotransmitter, or simply a chemical messenger, that transmits signals between neurons in the brain. However, too much glutamate is toxic to the brain as it triggers an excitotoxic state which leads to cell death.
  • In addition, glutamate overload depletes glutathione and other powerful antioxidants that are needed to scavenge free radicals (toxic cellular waste) in the body.

Identifying foods with MSG can be tricky, however, because it goes by many names. For more information on how MSG can be identified on food labels, visit http://www.msgmyth.com/Hidden_Names_for_MSG.pdf.

How can you make a difference? Focus on eating a variety of whole and unprocessed foods, for one, and eating food products with as few ingredients as possible. Supplementation may also help; a 2016 research study found that curcumin, the active component in turmeric, decreases the glutamate toxicity in the brain.

Image courtesy of NeONBRAND | Unsplash.com

Your “must-have” daily diet soft drink

Aspartame is one of the most widely used artificial sweeteners worldwide, and also one of the most controversial. The public health crisis of rising obesity drove us to embrace the idea of sweetness without the calories. But study upon study has shown that artificial sweeteners, such as aspartame, can do more harm than good.

When aspartame is ingested, it breaks down into 3 different compounds: aspartic acid, phenylalanine, and methanol. Phenylalanine and aspartic acid are amino acids (protein building blocks), that are beneficial to the human body when they occur naturally with other amino acids in foods. However, when consumed in isolated and large amounts, like it is in aspartame, they then are able to cross the blood-brain barrier, excite the brain cells and trigger their death. Even worse, methanol further breaks down to formaldehyde, which is neurotoxic and carcinogenic.

Common symptoms of aspartame toxicity are headaches, mental confusion, problems with balance, and numbness.

Image courtesy of Unsplash.com

Processed meats – bacon, jerky & hot dogs

Sodium nitrite, sodium nitrate, and sodium/potassium benzoate are salts added to processed foods, particularly meats, to preserve freshness. The food industry relies on these additives as taste enhancers, and as a way to preserve bright colors that will catch the eye of the consumer.

Although the use of these additives is approved by the Food & Drug Administration in regulated amounts, these chemicals are classified “Group 1 Carcinogen” by World Health Organization (WHO) experts. A large number of health complaints have been reported by consumers; among them skin issues, respiratory problems, headaches, dizziness, and brain fog.

The best way to avoid these additives, commonly found in bacon, jerky, hotdogs, pepperoni, and sausages, is to read the labels and choose to eat unprocessed foods whenever possible.

Image courtesy of Yutacar | Unsplash.com


Various components in alcohols can cause sensitivity, and the severity of the allergic reactions depends on the person’s genetic profile; one major symptom being brain fog.
Here is a list of the ingredients in wine, beer, liquor, and spirits that may be worsening your brain fog.

  • Sulfite additives are used to sterilize barrels and tanks before fermentation takes place.
  • Histamines are suggested to play a major role in allergic-like reactions to wine.
  • Ethanol is found to play a role in inducing allergic reactions – especially in Asians and certain other populations – due to their lack of the enzyme that metabolizes ethanol.
  • Most beers contain gluten. People who are sensitive to gluten report an improvement in brain fog when gluten is cut out of their diets.


Image courtesy of Darren Coleshill | Unsplash.com


Milk and dairy products, such as cheese, yogurt, and whey protein (found in bodybuilding and energy drinks) are just one of the food categories that the FDA has also recognized as a major allergen, potentially causing allergic reactions in some people that can range from mild to severe, and in some cases can be fatal.

Other foods considered major allergens are: gluten, soy, egg, shellfish (two kinds: crustacea and mollusk), tree nuts (such as walnuts, almonds, and cashews), peanuts (in the legume family), certain types of finned fish, and sesame. For people with sensitivities or allergies to these foods, the body sees the proteins as a threat and produces antibodies to chase them out.

If you experience symptoms of brain fog, headache, or digestive discomfort when you eat a specific type of food, you may have a sensitivity but not necessarily an allergy. With either situation it is best to avoid those foods altogether; and be careful when reading labels, as there may be hidden ingredients, especially milk and eggs.


Abu-Taweel, G. M., A, Z. M., Ajarem, J. S., & Ahmad, M. (2014). Cognitive and biochemical effects of monosodium glutamate and aspartame, administered individually and in combination in male albino mice. Neurotoxicology And Teratology4260-67. doi:10.1016/j.ntt.2014.02.001

Ahluwalia, P., Tewari, K., & Choudhary, P. (1996). Studies on the effects of monosodium glutamate (MSG) on oxidative stress in erythrocytes of adult male mice. Toxicology Letters84(3), 161-165.

Foran, L., Blackburn, K., & Kulesza, R. J. (2017). Auditory hindbrain atrophy and anomalous calcium binding protein expression after neonatal exposure to monosodium glutamate. Neuroscience344406-417. doi:10.1016/j.neuroscience.2017.01.004

Khalil, R. M., & Khedr, N. F. (2016). Curcumin Protects against Monosodium Glutamate Neurotoxicity and Decreasing NMDA2B and mGluR5 Expression in Rat Hippocampus. Neuro-Signals24(1), 81-87.

Onaolapo, O. J., Onaolapo, A. Y., Akanmu, M. A., & Gbola, O. (2016). Evidence of alterations in brain structure and antioxidant status following ‘low-dose’ monosodium glutamate ingestion. Pathophysiology: The Official Journal Of The International Society For Pathophysiology23(3), 147-156. doi:10.1016/j.pathophys.2016.05.001 

VALLY, H. and THOMPSON, P. (2003), Allergic and asthmatic reactions to alcoholic drinks. Addiction Biology, 8: 3–11. doi:10.1080/1355621031000069828

Whitehouse, C. R., Boullata, J., & McCauley, L. A. (2008). The potential toxicity of artificial sweeteners. AAOHN Journal: Official Journal Of The American Association Of Occupational Health Nurses56(6), 251-259.

Wild, C. P., & Gong, Y. Y. (2010). Mycotoxins and human disease: a largely ignored global health issue. Carcinogenesis31(1), 71-82. doi:10.1093/carcin/bgp264






Research has shown that certain nutritional supplements may help limit and possibly even reverse the damage of inflammation in the brain, by calming the neuro-inflammatory process that can damage neural tissue, cause or exacerbate physical pain and emotional suffering, and erode mental clarity.

View Dr. Kaplan’s guide to 10 Brain-Boosting Nutritional Supplements to nurture and even heal the brain for improved memory, mood, and overall cognitive health!


Download the Guide!


Moving Beyond Trauma: Healing Therapies for PTSD

Earlier this week, news of the horrific Manchester Arena bombing spread rapidly over the internet and news media, sending shock-waves worldwide. Innocent children and families were exposed to unimaginable and unforgettable events.

For spectators, when events like this occur, it can trigger intense emotions ranging from feelings of anger to sadness, confusion, fear, and even a sense of hopelessness – and these are all “normal” reactions to an abnormal situation. But the witnesses and survivors of this tragedy, lucky as they are to have escaped death, are likely to suffer far more serious consequences in the long term.

According to the U.S. Department of Veteran’s Affairs, it is estimated that approximately 8% of the population will experience Post-Traumatic Stress Disorder (PTSD) at some point in their lives.

That percentage increases to 34% for people who have been exposed to a traumatic event, such as the bombing in Manchester. To be diagnosed with PTSD one must meet a specific set of criteria that include:

  • exposure to a traumatic stressor
  • a re-experiencing of symptoms (physical and/or emotional)
  • avoidance behavior and emotional numbness
  • hyperarousal
  • symptom duration of at least one month, and
  • significant distress or impairment of functioning.

So, how does one move beyond this emotional pain, or provide support to the most vulnerable population, our children?

These 3 therapies have shown to be effective in treating PTSD in clinical settings for both adults and children:

Family or Couples Therapy: PTSD is a family illness. Family members often experience feelings of guilt, sadness, and isolation when a loved one is suffering. A safe setting where emotions, fears, and concerns can be communicated under the guidance of a therapist can help strengthen relationships and promote group healing during difficult times.

Mindfulness-Based Stress Reduction (MBSR): MBSR is a program that uses meditation, breathing techniques, and movement, such as yoga, to bring awareness to the present moment, without judgment. There is a growing body of medical research that shows that a mindfulness-based meditation practice can help people bounce back after highly stressful situations. A 2015 study reported that veterans suffering from PTSD who participated in a mindfulness-based stress reduction program for a period of 8 weeks, reported a decrease in symptom severity. Children can also benefit from the practice. This 2016 review of research concluded that “high-quality, structured mindfulness interventions improve mental, behavioral, and physical outcomes in youth.”

Eye Movement Desensitization and Reprocessing (EMDR) therapy: EMDR is an integrative psychotherapy that has proven highly effective for the treatment of trauma. Traumatic memories are memories that tend to be “frozen in time” and each time they are triggered a person may re-experience the same disturbing sights, sounds, smells, feelings, and sensations suffered during the original event. Traumatic memories have long-lasting impact because they change core beliefs that we hold about ourselves and the world around us.

EMDR helps the brain adaptively process traumatic information by replicating what naturally happens during dreaming or REM (rapid eye movement) sleep. During EMDR therapy, a person is asked to bring a difficult thought or memory to mind, holding it in awareness, while also following the therapist’s hand movements across the field of vision, mimicking the biological process of REM sleep. Over time, though an event may remain as a bad memory, it eventually ceases to be a physiological stressor, because the person has learned to experience disturbing events or memories in a new and less distressing way.

Left unresolved, PTSD can be devastating, but with appropriate support, there are ways to move beyond the pain. If you or a loved one may be affected, please seek help – no one needs to suffer alone.

Additional Resources:

National Suicide Prevention Lifeline –24-hour hotline for anyone in emotional distress: 1-800-273-TALK (8255).
National Alliance on Mental Illness (NAMI) – Helpline: 1-800-950-NAMI (6264)
TRE® – Tension and Trauma Releasing Exercise methods by Dr. David Berceli
Veterans Crisis Line –  For veterans and their families and friends: 1-800-273-8255

Revised 5/25/2017

Build a Healthier Brain – With Fat!

By Gary Kaplan, D.O. and Vanessa Berenstein, M.A., R.D.
We don’t usually associate increasing the amount of fat in our diets as a way to improve health, but when it comes to a particular type of fat, that’s exactly what the doctor ordered!
Omega-3 Fatty acids are polyunsaturated fatty acids (PUFAs), a type of essential fat involved in several metabolic processes, and they are a crucial component of good health.
Research shows omega-3 fatty acids reduce inflammation and may reduce the risk of chronic diseases such as heart disease, cancer, and arthritis – conditions that often have a high inflammatory process at their root. But most impressive is the research that confirms Omega-3’s benefits on the brain.
There are 11 different types of Omega-3s, but the most well-known for their beneficial properties are: Alpha-linoleic acid (ALA), Docosahexaenoic acid (DHA) and Eicosapentaenoic acid (EPA).
Dietary sources of ALA, DHA and EPA
The modern American diet is typically low in Omega-3 and high in Omega-6 fatty acids (another form of polyunsaturated fatty acid). Too much Omega-6 causes inflammation, but interestingly enough, too much Omega-3 can also be bad; it’s all about keeping the ratio of Omega-3 to Omega-6 in check.
A well-balanced diet with natural sources of ALA, DHA and EPA is fundamental to maintaining a healthy ratio that prevents inflammation and promotes long-term health.
ALA comes from plants and is the most largely consumed form of Omega-3 in the typical American diet. It serves as an energy source for our cells and a small percent is converted into DHA and EPA. Dietary sources of ALA include flax seeds and flax oil, walnuts and walnut oil, chia seeds, pumpkin seeds, hemp seeds and hemp oil, mustard oil, most leafy green vegetables, and tofu. Some research is being done on algal oil, as it may be more bioavailable, meaning it will be easier to absorb and converts easily to DHA in the body. One study found micro-algae were able to increase blood erythrocyte and plasma DHA, a marker of absorption. For vegans and vegetarians, this may be a promising alternative to fish oils. Some supplement brands have already started creating vegetarian EPA/DHA supplements from algal oil for those who prefer not to take fish oils.
DHA and EPA are found in fatty, cold water fish, such as salmon, trout, cod liver, herring, mackerel, and sardines, as well as shellfish such as shrimp, oysters, clams, and scallops. These sources of Omega-3 are most bioavailable. However, it’s important to purchase wild caught fish and check out SeafoodWatch.org to see which fish are lowest in mercury and other environmental toxins. A balance of sources from plants and seafood will help you find the right balance of these essential fatty acids.
When diets don’t meet the mark, supplementation may be recommended, but should always be done under the supervision of a doctor and dietitian for these reasons:

  1. A doctor and/or a dietitian-nutritionist can monitor the ratio of Omega 3:6. Certain health conditions may benefit from additional Omega-3; in this case, proper dosage should be determined by a doctor.
  2. When a diet is already rich in Omega-3, supplementation may throw a proper Omega 3:6 ratio off-balance and unintentionally cause inflammation.
  3. There are some supplements of omega-3 that are actually inflammatory. Many retail brands of Omega-3 or fish oils come from sources of fish that are fed an atypical diet of corn and soy, which alters the composition of fatty acids in the fish oil. This can cause inflammation. As supplements do not require FDA approval, a dietitian or doctor can recommend a trusted brand.

Effects of Omega-3 Fatty Acids on the Brain
– Neuropsychiatric conditions: Research shows that Omega-3 fatty acids can be effective in treating depressive conditions, such as Major Depressive Disorder and bipolar disorder.
Post-stroke & post-concussion: A recent study published in the Journal of American College of Nutrition found that giving DHA post-concussion helps in the repair and recovery from injury.
A 2015 study published the Journal of Neuroimmunology found evidence that supported the clinical use of Omega-3 in treating “stroke and other acute neurological diseases” due, in part, to its anti-inflammatory and anti-apoptotic (prevention of cell death) properties.
– Neuropathic pain: Neuropathic pain, or pain due to damage of the peripheral or central nervous system, can cause debilitating pain for those affected. In 2010, a review of case studies found that patients with neuropathic pain who were treated with high doses of Omega-3 fish oil had “clinically significant pain reduction” and improved function.
– Migraines: Diets high in Omega-3 fatty acids have been found to lessen the frequency and occurrence of migraine headaches.
– Neurodegenerative disease: DHA is extremely important for brain development and function. Studies show that when DHA levels are low, the brain is more susceptible to degeneration. Omega-3 fatty acids help scavenge free radicals (atoms, molecules, or ions with unpaired electrons) that attach inappropriately to tissue and damage it.
A recent study published in The FASEB Journal found that “omega-3 polyunsaturated fatty acids, which are found in fish oil, could improve the function of the glymphatic system, which facilitate the clearance of waste from the brain, and promote the clearance of metabolites including amyloid-β peptides, a primary culprit in Alzheimer’s disease.”
Studies also show that DHA supplementation can improve cognitive performance.
How much is enough?
Eating a Mediterranean diet with plenty of fruits, vegetables, whole grains, nuts, lean meat and cold water fish will help a person consume more Omega-3’s on a regular basis. Current literature advises that at least 2, 3.5 oz. portions of oily fish should be eaten weekly, but does this amount support long-term health?
Determining the correct intake of Omega-3 fatty acids depends on an individual’s age, overall state of physical and mental health, and whether there is history of trauma that suggests heightened inflammation. To find out the amount that is best for your unique condition, make sure to consult with your health care provider or schedule an appointment at the Kaplan Center.
Additional research:
Omega-3 DHA and EPA for cognition, behavior, and mood: clinical findings and structural-functional synergies with cell membrane phospholipids.
Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: a randomized trial.
Association between serum long-chain omega-3 polyunsaturated fatty acids and cognitive performance in elderly men and women: The Kuopio Ischaemic Heart Disease Risk Factor Study
Omega-3 fatty acids and brain resistance to ageing and stress: body of evidence and possible mechanisms.
Therapeutic use of omega-3 fatty acids in severe head trauma.



Research has shown that certain nutritional supplements may help limit and possibly even reverse the damage of inflammation in the brain, by calming the neuro-inflammatory process that can damage neural tissue, cause or exacerbate physical pain and emotional suffering, and erode mental clarity.
View Dr. Kaplan’s guide to 10 Brain-Boosting Nutritional Supplements to nurture and even heal the brain for improved memory, mood, and overall cognitive health!

Download the Guide!

Coping With the Emotional Impact of Cancer

Receiving a cancer diagnosis can be a profoundly stressful event in a person’s life. According to the American Cancer Society, over 14.5 million Americans are living with – or have survived – some form of cancer. The emotional blow of the diagnosis, combined with the pain and discomfort of the disease and treatment, can impact one’s ability to work, provide financially for dependents, or engage in social and recreational activities. Surgery, chemotherapy, and radiation treatment can cause unwanted changes in a patient’s physical appearance and self-esteem, undermine his or her ability to relate to loved ones emotionally or sexually, and lead to an increased sense of isolation and depression. Often, the diagnosis and the reality of living with cancer challenge an individual’s spiritual beliefs, their sense of purpose, and their life priorities.

Given the scope of cancer’s effect upon a person’s life, ideally, the treatment should not be focused only on the physical aspects of healing. It is estimated that as many as 65 percent of cancer patients seek complementary therapies to augment the conventional medical care they are receiving. Medical research has demonstrated that interventions such as psychotherapy, relaxation, prayer, meditation, and massage can reduce stress, improve sleep, encourage a sense of optimism, and boost the body’s immune response.

Here are 4 alternative therapies that, when used in conjunction with conventional medical care, can enhance the quality of patients’ lives by helping them to cope more effectively with the effects of cancer and its treatment:

Psychotherapy can help patients find the inner strength they need to cope more positively with their diagnosis. Talking about their feelings with a qualified and caring professional, and receiving ongoing emotional support can help reduce the sense of isolation, anxiety, and hopelessness that cancer patients commonly experience. There are many different kinds of psychotherapy; some patients meet individually with a counselor, others meet in a group setting to discuss common problems and coping strategies.

EMDR (Eye Movement Desensitization and Reprocessing) is a relatively new protocol used by some psychotherapists that can facilitate a remarkably swift and permanent healing of negative and distressing thoughts and feelings. It can also alleviate certain types of physical pain that have become “locked into” the memory of a person’s central nervous system.

Guided Imagery is a process where patients use their minds to visualize and sense soothing experiences, like the sight of a favorite place, or the feeling of warm sun on the skin or cool water on the toes. Guided imagery and hypnosis can help channel the power of a person’s own mind to produce real physiological benefits for the body, including boosting the immune response, reducing blood pressure, increasing the sense of well-being, and even decreasing the pain of cancer and cancer treatment.

Mind-Body Stress Reduction Programs help patients learn stress management and meditation techniques. Medical studies show that mind-body meditation can improve a patient’s mood, coping skills, and quality of life. It also can boost a patient’s immune response and help to alleviate disease-and-treatment-related symptoms, such as nausea, vomiting, and pain. Meditation programs have proven to be so successful in improving patient outcomes that they have become a reimbursable medical service under many health insurance plans.

Additional Resources:

Psychotherapy, EMDR, and Guided Meditation

How Can I Confront a Friend With Destructive Behavior?

Q: Someone near and dear to me suffers from such powerful, long-standing shame that he cannot, or won’t, admit engaging in behaviors that are destructive to his personal relationships (e.g., verbal abuse). Is there any way to confront him gently, in a way that helps him feel safe so that he and his loved ones can start healing their respective relationships?

Jodi Brayton, L.C.S.W., M.S.W.: This is such a great question on many levels. It involves a universal emotion – to be human is to feel shame – and the very wording of the question shows that the writer already understands the antidote to shame: love, connection, and compassion. I like that the writer gets the fact that destructive behavior should be confronted (in a safe way) in order to begin healing any relationship. There are some very thoughtful experts exploring current research on the issues of shame and compassion and I want to share some information that may be useful to you.

One of my favorite writers from a psycho-therapeutic point of view is Janina Fisher, Ph.D., a therapist who looks at the shame and self-loathing associated with childhood trauma from a neurobiological perspective. Fisher does a beautiful job of explaining that many of our negative behaviors are, or were at one time, beneficial adaptations to traumatic circumstances. Anger, for instance, may be a self-protective maneuver designed to push people away before they can hurt us. She explains how shame and perfectionism are adaptive strategies that drive responses such as hypervigilance, automatic obedience, and total submission; strategies that help young victims survive abuse[i].

The dilemma with confronting people who struggle with shame is that even the kindest, most gentle approach can confirm their worst beliefs about themselves. The thought, “it’s my fault,” can activate areas of the brain that lead to emotional and autonomic reactivity, according to Fisher, which may explain reactions that are destructive to personal relationships, such as verbal abuse.

Curiosity and mindfulness, on the other hand, tend to activate the medial prefrontal cortex, the part of the brain that regulates such emotional and autonomic reactivity[ii]. The job of a therapist is to help clients remain in the medial prefrontal cortex part of their brain because when we are curious and mindful we find meaning and gain perspective. Your friend is more likely to accept a recommendation of therapy if you come from the approach that he is not where he wants to be. The website janinafisher.com has several informative articles that can be downloaded for free.

Understanding the hard science behind behavior can help many people recognize and accept the need for change and there is fascinating research on the physiology behind the healing power of self-compassion. It seems that our body responds to an emotional attack of self-criticism just as it would to the physical threat of having a gun pointed in our direction. The fight or flight response is triggered and the stress hormone cortisol is released in order to mobilize our body to avoid or confront the threatening situation. We all know that too much cortisol over a long period of time can be destructive to our bodies; however, recent research shows that generating feelings of self-compassion can actually decrease those cortisol levels and increase the release of the hormone oxytocin in our system. When we increase the level of the oxytocin we increase feelings of calm, trust, safety, generosity, and closeness to others – all of which are needed to counter the painful emotion of shame[iii].

Kristen Neff, Ph.D., one of the leading researchers on the physiology of self-compassion, has a website – self-compassion.org – that many of my clients find useful. It offers several guided meditations and various exercises designed to help people increase their self-compassion skills. There’s also a self-administered test that measures the elements of self-compassion, as well as the things that hinder our self-compassion, such as self-judgment, isolation, and over-identification. You can recommend this site not only to counter the effects of shame but to anyone who wants to live a more contented and fulfilling life.

The last writer I want to mention is a researcher who has an exceptional ability to inspire people to go to those deep, dark places of shame and fear. Brené Brown, Ph.D., believes that we begin healing by sharing our difficult stories with appropriate others in order to feel worthy, connected, and lovable. She gave a 2010 TEDx Houston talk on the power of vulnerability that was one of the most popular talks on TED.com. She followed up with a second talk in 2012 called Listening to Shame, and together these talks have received over 25 million views. They are chock-full of humor, humanity, and interesting information and you can recommend these talks based on the entertainment value alone.

Another thing I hope you consider reading, and/or offering to your friend, is Brené Brown’s book, The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are. Brown has devoted most of her professional career to the study of human vulnerability, courage, worthiness, and shame, and she really leads by example in this book. In order to help others find the courage to explore their own feelings of inadequacy, Brown fearlessly, and wholeheartedly shares hers. This leaves the reader with a sense of connection to our common humanity, as opposed to the feeling of isolation and alienation that results from keeping things hidden. Many people find this book a valuable tool for self-exploration.

The concept that permeates all the works cited above – and that can help your friend find the non-judgmental state of mind he’ll need in order to observe his own thoughts and behavior in a safe way – is mindfulness. Suggesting mindful practices, such as meditation, prayer, and journaling (especially a gratitude journal) could prove most valuable in helping your friend gain perspective and find a sense of peace even in the most complicated and difficult situations.

Thank you so much for this opportunity to share this information. Your question is important and the task is a challenging one, but Brené Brown sums up what is at risk with the following quote[iv]:

“Owning our story can be hard but not nearly as difficult as spending our lives running from it. Embracing our vulnerabilities is risky but not nearly as dangerous as giving up on love and belonging and joy – the experiences that make us the most vulnerable. Only when we are brave enough to explore the darkness will we discover the infinite power of our light.”

– Jodi Brayton, L.C.S.W., M.S.W.

[i] Fisher, J. Working with the Neurobiological Legacy of Early Trauma: Paper presented at the Annual Conference, American Mental Health Counselors July, 2003.
[ii] Fisher, J. Brain to Brain: The Therapist as Neurobiological Regulator. Psychotherapy Networker. 34:1, January 2010.
[iii] Neff, K. D. (2012). The science of self compassion. In C. Germer & R. Siegel (Eds.) Compassion and Wisdom in Psychotherapy. New York: Guilford Press.
[iv] Brown, B. (2010). The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are (p. 6). Center City, Minnesota: Hazelden Publishing.