If you are losing your words, walking into rooms and forgetting why, or feeling like the woman you used to be has gone quiet, this episode is for you.

Dr. Alison kicks off a four-part May series on brain health by breaking down the five root cause drivers of brain fog in midlife women: hormones, infections, sleep, mood, and insulin. You will learn why “mom brain” is a dismissal, not a diagnosis, and why your normal labs may not be telling you the full story. Includes evidence-based citations on perimenopausal brain imaging, the glymphatic system, and the post-viral cognitive landscape, plus a brief look into Dr. Alison’s own post-viral journey.

Topics covered: perimenopause and the brain, estrogen and neurotransmitters, full thyroid panels, Epstein Barr Virus reactivation, long COVID, the glymphatic system, sleep architecture, the inflammatory hypothesis of depression, insulin resistance and cognition. A foundational episode that sets up the rest of the May series.

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Transcript:
Hello and welcome back. I’m Dr. Alison with Little Black Bag Functional Medicine and today we are starting something a little bit different. We are kicking off a four-part series for the entire month of May on brain health, and specifically the brain of the mother, the woman in midlife, the woman who has been told over and over again that this is just what motherhood does to you, this is just what aging does to you, this is just stress.
And I am going to tell you right out of the gate, that is not the conversation we are having here. Not on this podcast. Not for the next four episodes. Today’s episode is called The Mother’s Brain, and it is going to be the foundation that the rest of this month is built on.

So whether you have been losing your words mid-sentence, walking into rooms and forgetting why, reading the same paragraph four times, crying because you cannot find your phone that is in your hand, or just feeling like the woman you used to be has slowly gone quiet on you, this is for you. And I want you to know before we even get into the science, you are not alone, you’re not making it up, this isn’t an overexaggeration. You are not too complicated. You are not aging out of your own life. Your body is talking to you, and we are going to start translating today.

Dr. Alison DiBarto Goggin (02:14.520)
Before we dive in, the friendly reminder that I share at the start of every episode. What I share on this podcast is for educational purposes only. I love sharing this information, but nothing here is personalized medical advice. It does not create that provider-patient relationship between us. So if you are working through any of this on your own, please do that with a clinician who knows your full picture. You can come find me at littleblackbagmedicine.com to start a new patient process, or you can work with someone in your area who is going to look at your whole story and not just your last lab panel.

And one other quick note. Everything I share today, all the labs, all the markers, all the specific things to look for, is going to be on the blog at littleblackbagmedicine.com with the full transcript and links. So if you are driving, if you are folding laundry, if you are hiding in the pantry from your kids while you listen to this, you do not have to take notes. It is all there for you when you are ready.

Dr. Alison DiBarto Goggin (04:08.730)
Okay. Let’s get into it. I want to start by telling you about a woman who came into my practice. With permission, of course, but she is a composite of probably 50 women I have seen in the last two years. She is 43. She has three kids. She has a job she actually likes. She has a partner she actually likes. And she came in and the first thing she said to me when she sat down was, I think I am losing my mind.

She told me she had walked into the kitchen that morning and forgotten what she went in there for. Three times. She told me she could not remember the name of her son’s teacher, even though she had just been at a conference with her the week before. She told me that her husband had asked her what she wanted for dinner and she had cried, because she could not even hold the question long enough to come up with an answer.

She had been to her primary care doctor. The labs were normal. She had been to her gynecologist. She was told she was probably perimenopausal but it was nothing to worry about, just hot flashes coming. She had been to a therapist, who told her she was stressed. She had tried meditation. She had tried more sleep, but that wasn’t even possible. She had cut out gluten. She had cut out caffeine. She had taken a B-complex. Nothing had moved the needle.
And by the time she got to me, she was not asking what was wrong. She was asking if it was always going to be this way.

Dr. Alison DiBarto Goggin (06:55.481)
Here is what I want every woman listening to this episode to hear. Brain fog is not a personality trait. It’s not a social media diagnosis of autism or silly ADHD, or simply perimenopause. Brain fog is not a phase of motherhood. Brain fog is not the natural consequence of having children, having jobs, having lives. Brain fog is a symptom. And symptoms have causes. And in this case, there are five of them. Five drivers I see over and over again, in almost every woman who walks into my practice with cognitive symptoms in midlife. And very few people are tracking these things and understanding why they are happening or when or how they relate to symptoms.

These five are going to be the framework for the entire month of May. We are going to take each one and go deeper into the science across the next four episodes. But today, I want to lay them all on the table, because I want you to start hearing your own story inside this list.

The five drivers of brain fog are hormones, infections, sleep, mood, and insulin. Hormones, infections, sleep, mood, insulin. I want you to write that down or save this episode, because that list is going to come up over and over again.

Dr. Alison DiBarto Goggin (09:03.215)
Let’s start with hormones, because for most women in midlife, this is where the conversation has to begin. Estrogen is not just your period hormone. Estrogen, specifically estradiol, is also a brain hormone. It supports the production and the receptors of your major neurotransmitters. Serotonin, which is your mood. Dopamine, which is your motivation and reward. Acetylcholine, which is your memory and your focus. When estradiol drops, which it does in perimenopause, those neurotransmitter systems get less support. And the very first symptoms women report, before the hot flashes, before the cycle changes, are often the cognitive ones. The word-finding. The memory. The attention.

There is research from Weill Cornell that has actually shown this on brain imaging. Women in perimenopause show metabolic changes in their brains that look more similar to early Alzheimer’s patterns than they do to chronologic aging in men of the same age. That is a 2017 paper in Neurology. And what it told us is that the perimenopausal brain is in a real, measurable transition state. It is not in your head. It is in your imaging.

And then there is progesterone, which is the brain’s primary calming hormone. Progesterone metabolizes into a compound called allopregnanolone, which acts on your GABA receptors, the same receptors that calm anxiety and help you sleep. When progesterone drops, which often happens before estrogen does, you lose that calm. You feel wired. You wake up at 3 a.m. You cannot turn your brain off. And that wired exhaustion is part of the cognitive picture too, because a brain that cannot rest cannot consolidate memory. Which is also why insomnia during PMS and menstruation is so common.

And we cannot leave thyroid out of this conversation. Thyroid hormone is essentially the gas pedal for your entire metabolism, including the metabolism of every neuron in your brain. And here is something I want you to take note of. A normal TSH is not the same as an optimal thyroid. So many women are walking around with TSH at 3.5 or 4, being told that is normal, and yet their free T3 is bottoming out, their reverse T3 is elevated, and their brain is starving for thyroid hormone. We have to run a full thyroid panel. Free T3, free T4, reverse T3, TPO antibodies, thyroglobulin antibodies. Anything less is not the full picture.

Dr. Alison DiBarto Goggin (13:21.940)
The second driver is infections. And this is the one nobody is talking about and it is, in my opinion, the most under-recognized cause of brain fog right now in midlife women. I want to be very clear about what I mean by infections. I am talking about chronic, often hidden, often reactivated infections that are driving inflammation in the brain. Epstein Barr Virus reactivation. Long COVID. Mold and mycotoxin exposure. Lyme disease and the co-infections like Bartonella and Babesia. Hidden yeast and gut dysbiosis. Reactivated cytomegalovirus and herpes simplex.

Every single one of these can cross the blood-brain barrier or signal across it. Every single one of these can activate your microglia, which are the immune cells of your brain. Activated microglia release inflammatory cytokines. Inflammatory cytokines disrupt synaptic function. Disrupted synaptic function feels exactly like brain fog. So when a woman tells me she has had brain fog since a viral illness, since a tick bite, since a water-damaged house, I take that very seriously.
I have a personal story to share here, briefly, because I am going to go much deeper into it next week. I have had Epstein Barr since I was in high school, with multiple reactivations, even though mainstream medicine says that should never happen. After COVID in 2022, I developed MCAS with full body hives head to toe, the kind that no immunologist, no allergist, no functional medicine doctor could help me with for almost a year. I also developed asthma, POTS, and chronic fatigue at the same time. And then 2024 into 2025, I had a combination viral infection with five separate infections back to back over that winter. I was not functioning at all.

Last March, I started nicotine patches and I was actually able to be free of POTS, which was huge. And I had a year of feeling like myself again. Then in February of 2026, I had COVID. And here is the thing about post-viral effects that I want you to hear. They do not always show up immediately. The classic timing is eight days after COVID for MCAS onset, but it can also be weeks or months. For me, this time, it was three weeks. Three weeks after I thought I was through it, the long-hauler symptoms kicked in. Severe brain fog. POTS in full flare. The chronic fatigue that makes you cry trying to load the dishwasher. The kind of brain fog where I, the functional medicine doctor, could not find the word fork.

I am telling you this because I have lived inside the very thing I am going to teach you about for the next four weeks. I have done my own labs. I have done my own protocols. I have built my own routine, the one I am going to share across this whole podcast season. And I am healing. We are going to spend all of next week’s episode on the post-viral brain, but I want you to know right now, today, if your brain has been different since an illness, that is real, that is treatable, and you are not alone. And the reason this matters so much for the women I work with is that nobody is asking the right question. Nobody is asking, when was your last viral infection? When did you have COVID? Have you ever had mono? Have you been in a water-damaged building? Have you had a tick bite? These are the questions that unlock the why behind so many of the symptoms that are getting written off as anxiety or stress or perimenopause.

Dr. Alison DiBarto Goggin (18:24.815)
The third driver is sleep, and not in the way you have been told. Everyone tells you to sleep more. Get your seven to nine hours. Sleep is the cure-all. And sometimes I want to scream because the women I see are sleeping eight hours and still feel like they got run over by a truck. So let me tell you what is actually happening at night.

Your brain has a cleaning system called the glymphatic system. This was actually discovered relatively recently, in a landmark 2012 paper by Maiken Nedergaard’s lab. The glymphatic system clears metabolic waste out of your brain, including a protein called beta-amyloid, which is the same protein that accumulates in Alzheimer’s. And this system is most active during deep sleep, specifically slow-wave sleep. So if you are sleeping eight hours but barely entering slow-wave sleep, your brain is not getting cleaned. The trash is staying in. And tomorrow, you wake up foggy, even though the clock says you slept enough.

What disrupts slow-wave sleep? Alcohol. Even one glass of wine. High cortisol at bedtime. Blood sugar that crashes in the middle of the night. Sleep apnea, which is hugely under-diagnosed in women. Perimenopausal hormone shifts. Anxiety. Too much screen exposure in the evening. Magnesium deficiency. The list goes on.

So if you are doing everything right and still waking up foggy, the question is not how many hours did you sleep, it is what kind of sleep did you get. And we have ways to actually measure this now, with wearables like Oura and Whoop, with at-home sleep studies, and with actual sleep architecture testing if we need to go that far. The point is, sleep quality is the real variable, and we can move it.

I want to add one more piece here that does not get talked about enough, especially for women in midlife. Progesterone, which we already talked about as your brain’s calming hormone, is also one of your major sleep hormones. As progesterone declines through perimenopause, women start waking up at 2 a.m., 3 a.m., 4 a.m., wide awake, brain spinning, unable to fall back asleep. That is not insomnia in the way most doctors are thinking about it. That is hormonal. And the work we do with progesterone support, sometimes with bioidentical progesterone, sometimes with adrenal and nervous system support, can absolutely move that needle.

And the last thing I want to mention here is sleep apnea in women. This is so under-diagnosed it is almost criminal. Women present differently than men. We do not always have the loud snoring, the witnessed apneas, the obvious daytime sleepiness. We present with insomnia, with anxiety, with morning headaches, with fatigue, with brain fog. And we have been told it is hormonal or stress for years before anyone thinks to actually do a sleep study. So if your sleep is fragmented, if your blood pressure is creeping up, if you are grinding your teeth, please ask for a home sleep study. I have had so many women treated for anxiety for years when what they actually had was untreated sleep apnea.

Dr. Alison DiBarto Goggin (22:08.443)
Okay. I want to pause right here, because if your inner voice is starting to say, oh my gosh, this is so much, or wait, that is me, or how did I not know this, I want you to take a deep breath. Just breathe. I am going to wait.
This is a lot. The fact that you are here, you are listening, you are still in the car or on the walk or in the kitchen with this episode playing, that means something. That means some part of you knew there was more to your story than just stress, just aging, just motherhood. That part of you was right. And we are going to honor that for the rest of this series.

You do not have to figure this out today. You do not have to start a protocol tomorrow. You just have to keep listening, keep learning your own story, keep asking questions that no one else has been asking with you. We are going to walk through this together, all of May.

Dr. Alison DiBarto Goggin (24:18.002)
Driver number four. Mood. And I want to reframe this one for you because mood and cognition are so deeply linked that we cannot really separate them. Depression and anxiety are not just feelings. Depression and anxiety often have a deeply inflammatory component. There is a whole body of research now on what is called the inflammatory hypothesis of depression. The idea that elevated cytokines like IL-6 and TNF-alpha actually drive depressive symptoms by disrupting neurotransmitter availability and creating that low-grade brain inflammation.

So when a woman is brain fogged and also flat and also anxious, that is not three separate problems. That is often one inflammatory pattern wearing three different hats. And the same root cause work, the gut work, the infection work, the hormone work, the nervous system work, addresses all three together.
This is also where I want to mention the nervous system piece, because it is impossible to talk about brain fog without talking about chronic stress and dysregulation. If your nervous system has been stuck in fight or flight for years, your prefrontal cortex, which is your thinking brain, your planning brain, your word-finding brain, is going to be operating at half capacity. That is not a personality flaw. That is your sympathetic nervous system telling your body that survival is more important than executive function.

The work here is real, and it is the slowest, and it is also the most worth it. Vagus nerve work. Breathwork. Cold exposure. Heat. Stillness. Time outside. Reiki. Somatic practice. Whatever doorway works for your body. The brain does not heal in a body that is still in fight or flight.

I want to also name something specifically for the mothers listening, because this matters. The nervous system of the mother who has been holding everyone for years has been in a particular kind of chronic activation that we do not talk about enough. The mental load. The constant anticipation of needs. The waking up at the smallest sound. The carrying of everyone’s schedules in your head. That is a unique flavor of sympathetic dominance, and it is part of why so many women hit a wall around the time their kids are eight, ten, twelve years old. The nervous system has been on for a decade, and the perimenopausal hormone shift just removed one of the buffers that was keeping it managed. So if you are feeling like you have hit a wall and you cannot understand why, this is part of the answer. And the way out is not pushing harder. The way out is regulation. Real regulation. The kind that requires you to stop and let your body remember it is safe.

And the last piece of the mood driver I want to mention is the gut connection, because we cannot talk about mood and not talk about the gut. Roughly 90 percent of your serotonin is produced in your gut, not your brain. The bacteria that live in your gut are actively involved in producing neurotransmitters, regulating inflammation, and maintaining the integrity of the gut lining, which when it breaks down, drives systemic inflammation that crosses the blood-brain barrier. So if you have IBS, if you have bloating, if you have food sensitivities, if you have had antibiotics or hormonal birth control or chronic stress, you have a gut piece in your brain story. And we cannot fix the brain without addressing the gut.

Dr. Alison DiBarto Goggin (27:42.768)
And the fifth driver, insulin. This one, I think, gets the least respect, and it is one of the most powerful. Your brain is incredibly sensitive to blood sugar swings. There are insulin receptors all over your brain, and when they get desensitized, which is what happens in chronic insulin resistance, your brain literally has trouble taking up glucose efficiently. There is research now actually calling Alzheimer’s disease type 3 diabetes, because of how much insulin resistance shows up in those brains.

So when you skip breakfast, have a coffee with no protein, do an aggressive intermittent fast, and then crash at 11 a.m., that is the brain fog. That is the irritability. That is the anxiety spike. That is the inability to find words and remember names. Your brain is in a metabolic emergency, and it is telling you.

The fix here can be really simple, and that is part of why I love this driver. Eat protein and fat with breakfast within an hour of waking. Stabilize your morning. Stop doing the strict intermittent fasting if you are a perimenopausal woman, especially if you are not sleeping well already, because it is making the cortisol problem worse. Add fiber, soluble fiber, to slow your glucose response. And we can also use targeted supplements like berberine, magnesium, chromium, and bergamot to support insulin sensitivity directly.

I want to spend just one more minute on the intermittent fasting piece because I get asked about this constantly. Intermittent fasting in your twenties or your thirties as a woman with regular cycles and intact hormones is one situation. Intermittent fasting in your forties as a perimenopausal woman with shifting hormones, elevated cortisol, disrupted sleep, and a thyroid that is already working hard is a completely different situation. I am not anti-fasting. I think there are absolutely uses for it. But I see so many women in my practice who started fasting because everyone on the internet told them to, and they have only made their cortisol pattern worse. They have only made their thyroid suppression worse. They have only made their reactive hypoglycemia worse. The brain that is in a chronic energy emergency cannot focus. So if your fasting is making you foggy, that is your body telling you it is not the right tool for you right now.
And one of my favorite tools to use with women on this driver is a continuous glucose monitor. Even just two weeks of wearing one can be eye-opening. You start to see exactly what foods are spiking your glucose. You see your overnight pattern. You see the relationship between sleep, stress, and morning blood sugar. The data is right there on your phone. And once we have that data, we can make really specific changes that move the brain fog needle within a couple of weeks.

Dr. Alison DiBarto Goggin (31:14.341)
So there it is. Hormones, infections, sleep, mood, insulin. Five drivers. Every single one of them is measurable. Every single one of them is changeable. Not one of them is just stress. Not one of them is just aging. Not one of them is just because you are a mother.

And here is something I want you to understand about these five drivers. They do not run in isolation. They run together. The hormone shift in perimenopause makes you sleep worse. The poor sleep makes your blood sugar more reactive. The reactive blood sugar drives more inflammation. The inflammation feeds neuroinflammation. The neuroinflammation makes the post-viral patterns worse. And around and around and around. So when a woman tells me she does not know where to start, my answer is, you start anywhere. Because every one of these is connected to all of the others. Pick the door that feels most accessible to you, walk through it, and you will be working on all five whether you mean to or not.

If you want one thing to take away from this episode and use this week, it is this. Tomorrow morning, eat protein and fat within an hour of waking. Get 10 minutes of morning sunlight on your face. And do one thing that lowers your nervous system before lunch, even if it is five slow exhales. That is it. Three things. Free. Ten minutes total. And it will start moving the needle on three of the five drivers right away. We will keep building on that across the rest of the series.
Every single one of these is going to get its own deeper conversation across the next three episodes of this series. Next week, episode two, we are going deep into the post-viral brain, long COVID, EBV reactivation, and what neuroinflammation actually looks like and how we treat it. Episode three, the brain-hormone conversation. Estrogen, progesterone, thyroid, the estrobolome, and how all of this is running your cognition behind the scenes. And episode four, the forgotten brain foundations. Mood, insulin, and sleep as the daily practices that change everything.

If you have made it to the end of this episode, I want you to do one thing for me. I want you to think about which of those five drivers hit the hardest when I named them. Which one made your stomach drop. Which one made you say, oh, that is me. That is the door. That is where your body is asking you to start.

Dr. Alison DiBarto Goggin (33:08.927)
And here is something I want you to know. I have been quietly building something for the woman who has heard this episode and recognized herself in it. The woman who is ready to actually do something about her foggy brain, with a real framework and real support and a real container. I am not going to tell you what it is yet. But I am going to say this. Something is coming May 11. Stay tuned.

In the meantime, if you want to start working with me directly on any of this, you can find me at littleblackbagmedicine.com. I do functional medicine consultations, ongoing care, and lab work for women who are tired of being told their labs are normal while they feel anything but.
Thank you so much for being here today. I am so glad you are listening. Make sure to like, subscribe, and share this episode with the woman in your life who has been told it is just mom brain. She needs to hear this. And remember, you are doing an amazing job taking care of yourself. Keep it up. And we will see you next time.