Q. Many mito-adults have “mito-brain fog” condition.  Is this a physiological condition related with mitochondrial diseases/disorders and/or drug induced as well?  And, how to treat?

A.  In my experience the “brain fog” is usually a combination of fatigue, concentration problems and sometimes anxiety and depression. All these three symptoms are common in mitochondrial disease. Our brain is only 5% of our body in volume, but it consumes 20% of our daily energy need. In case of an energy metabolism problem central nervous system symptoms are very common, even in patients with normal intelligence.  The treatment is very complicated. First of all because of the “different energy budget” available for each patient daily, there is no good advice for all mitochondrial patients but each patient would need to figure out his or her daily energy limits. This means that they

1. Should plan daily activities and restricty certain activities which are stressful or overwhelming

2. Get enough sleep, even if it seems excessive, listen to their body’s need for rest

3. If they can’t fall into sleep try Melatonin therapy 1 hour before bed time

4. If they struggle with depression or anxiety use medication which is not negatively affecting mitochondrial function

5. Several exercise types have been proven effective and available for patients with decreased physical abilities to improve concentration, including meditation, adapted joga, tai chi etc.

6. Avoid regular use of strong stimulants because of possible rebound effects, but patients can use caffeine before an important meeting

7. Avoid overstimulation, don’t plan to meet multiple people at once, avoid background music or busy cafes when meeting other people, protect the ears from loud noise because continuous noise can be tiring (and mito patients frequently have an increased noise sensitivity)

8. Take a friend or family member with them for important events or meetings to have a “second brain” present

Ava Morava-Kozicz, MD
Mayo Clinic

About Dr. Morava-Kozicz, MD., PhD

Eva Morava-Kozicz is a pediatric metabolic geneticist at Mayo Clinic in Rochester, MN, where she is also a professor of medical genetics. Additionally, Dr. Morava is a clinical biochemical geneticist and a professor of pediatrics at Tulane University Medical Center in New Orleans, LA, and she is also editor-in-chief of the Journal of Inherited Metabolic Disease at the Society for the Study of Inborn Errors of Metabolism.

Dr. Morava is from Budapest, and it was there, in Hungary, where she first earned a medical degree and completed her residency. After that, she specialized in metabolic and biochemical genetics through fellowships, clinical positions, and professorships first in the Netherlands and in Belgium and then later, in the United States, at Tulane and Mayo.

Dr. Morava’s primary research interests are mitochondrial disorders, phospholipid disorders, and congenital disorders of glycosylation, all of which she has studied for decades. Her lab focuses on translational research and on developing dietary therapies for genetic disorders.

She is a longstanding, strong supporter of patient groups like this one. Dr. Morava is regularly involved in patient educational events, and she always strives to share difficult genetic material with her patients as her partners.