The Workarounds: Six Ways Your Brain Has Been Quietly Compensating

For years I could not dial a phone number. I never told anyone — and I am a doctor. Here is the field guide to the six most common cognitive workarounds of middle age, the real science of each one, and the honest version of why a change of fuel might touch any of it.

For years, I could not dial a phone number.

I never told anyone. Not my wife. Not my own doctor. And I am a doctor.

Here’s what I did instead. I’d look at the number and grab the first three digits. Dial them. Then go back and look again for the last four. Every single time. Eventually I stopped even trying to hold the whole thing. The trick became so automatic that I forgot it was a trick.

Then, sixty-two days into my ketosis experiment, I found myself without a pen. I had to hold the time and three meter readings in my head — ten digits — while I walked across the room. I did it without thinking. Then I stood there, a little stunned, because I knew exactly how many years it had been since I could do that.

I’ve written elsewhere about why I don’t fully trust that moment. This article is about something bigger. The phone number was never my only workaround. And I promise you it isn’t yours.

So here is a field guide. Six things your brain has probably started doing — the going back twice, the lost keys, the word that won’t come. For each one, I’ll show you what’s actually happening inside your head. And then, at the end, the honest version of why I think a fuel might touch some of it.

Six words we’ll need — explained like a human

Working memory. Your brain’s scratchpad. The little whiteboard where you hold a phone number between reading it and dialing it. It’s tiny, and it wipes itself in seconds.

Episodic memory. Your brain’s diary. Events, with a time and place attached. Where you parked. Where you put the keys.

Prospective memory. Your brain’s to-do list. Remembering to do something later — take the pill, turn off the oven, tell your wife the thing.

Lexical retrieval. Fancy words for “finding the word you want.” Its famous failure is the tip-of-the-tongue moment.

BHB — beta-hydroxybutyrate. The main ketone. A fuel your liver builds out of fat when you’re not eating carbs. It’s the number I measure with a finger-prick every day.

BDNF — brain-derived neurotrophic factor. A protein that acts like fertilizer for brain cells. More on it later. It’s worth the wait.

1. You walk into the bedroom. You have no idea why.

This is the most famous one. Scientists have a name for it: the doorway effect. And the experiments behind it are almost funny.

A psychologist named Gabriel Radvansky had people carry objects from one table to another. Sometimes the walk crossed a big room. Sometimes it was the same distance — but through a doorway. Then he tested their memory for what they were carrying.

The doorway people forgot more. Same distance. Same object. The only difference was the door. It worked in video-game rooms and it worked in real rooms.

Here’s what scientists think is going on. Your brain doesn’t record your day like one long movie. It cuts the day into scenes, like a TV show. And a doorway is where the brain cuts.

When you walk through one, your brain says: “Scene over. Put it in the filing cabinet.” The problem? Your reason for going to the bedroom was in that scene. You filed it. So now you’re standing in the bedroom holding nothing but the feeling that you came here for something.

The memory isn’t gone. It’s filed. That’s why it comes back the moment you return to the kitchen — you just walked back into the scene where the file lives.

Now, the part that matters for us: this happens to twenty-year-olds too. The filing system isn’t broken in you. What changes with age is how loudly the errand got written down in the first place. A thought you barely wrote down doesn’t survive the filing. A thought you wrote down hard does. Keep that idea — “how loudly it got written” — because it’s about to come up again and again.

2. You lose things constantly. Like a dog burying bones.

My patients say this one with real fear in their voice. I put things down and they’re just gone. All day long.

Here’s the secret that takes most of the fear away: you are not forgetting where you put your glasses. You never knew.

Let me explain. Saving a memory isn’t automatic. When you set your glasses down, your brain has to write a little diary entry: glasses + kitchen counter + just now. Three pieces, tied together with string. That tying takes attention. Not much — but some.

And when do you put your glasses down? While you’re doing something else. Walking, talking, thinking about lunch. Your attention was somewhere else, so the diary entry never got written.

Then, an hour later, you go looking for the memory... and there’s nothing there. Not a faded page. A blank page. You can’t find what was never filed.

This is why it feels so spooky — “it vanished!” No. It was never recorded. There’s a real difference, and it should comfort you: the searching-and-finding machinery is fine. The problem is upstream, at the writing step, and the writing step is exactly what gets stingy with age, because it runs on attention, and attention is the thing that shrinks.

By the way — I compared myself to a dog burying bones, and I looked it up. It’s worse than I thought. Dogs forget most of their burial spots too. They refind the bones by smell. The dog has a backup system. We don’t.

The fix, at any age, is beautifully dumb: give every important object one single home. Keys live on the hook. Glasses live on the shelf. Always. You’re not improving your memory — you’re firing it from that job and giving the job to habit, which doesn’t need attention at all. Every organized person you’ve ever envied is secretly doing this.

3. The word is right there. You can feel it. It won’t come.

You know it. It starts with M. Or maybe P. You could describe it for an hour. It will arrive, in triumph, at two in the morning.

Scientists call this a tip-of-the-tongue state, and the leading explanation comes from psychologists Deborah Burke and Donald MacKay. It goes like this.

Every word you know is stored as two cards, in two different drawers. One card holds the meaning. The other card holds the sound. A little string connects them.

In a tip-of-the-tongue moment, the meaning card is in your hand. Fully. You know it’s a fruit, it’s tropical, it’s spiky. But the string to the sound card has gone slack — from age, and from how rarely you use that particular word. You pull the string. Nothing comes up.

That slack-string idea even has a proper name: the transmission deficit hypothesis. The signal transmits, but too weakly to light up the sound.

This explains everything annoying about the experience. Why rare words fail first — their strings get the least exercise. Why the word pops up hours later — the string never broke, it just needed more tugging than you had patience for, and your brain kept tugging in the background. And why it gets more frequent with age — measured, confirmed, completely normal.

And it explains the cruelest case: names. Psychologists have a favorite example called the Baker/baker paradox. If I tell you a man is a baker, you’ll remember — because “baker” comes with a whole web of strings: bread, flour, ovens, the smell at 6 am. But if I tell you his name is Mr. Baker, that’s one lonely string tied to nothing. Same word! Different wiring. The face lights up, his whole biography lights up, and the label dangles by its single thread.

So when a name escapes you, you are not losing your mind. You are losing a tug-of-war with the worst-connected word in your entire vocabulary.

4. You interrupt people — because the thought won’t keep.

Maybe you’ve noticed yourself doing this. Someone’s talking, a thought lands, and you break in — politely, but you break in — because you know from hard experience that if you wait, the thought will be gone.

I want to defend you. That interruption is not rudeness. It’s engineering.

Two systems are involved. First, the scratchpad — working memory. An unrehearsed thought survives on the whiteboard for a matter of seconds. And here’s the rub: listening to your friend and holding your thought use the same whiteboard. They compete for the same marker. The longer you politely listen, the more the thought fades.

Second, the to-do list — prospective memory. “Say this when they pause” is a future intention, and future intentions are their own memory system with their own failure rate. Researchers Gilles Einstein and Mark McDaniel have spent decades on this system, and here’s the number that should make you feel normal: by some estimates, half of all everyday forgetting is prospective-memory failure. Not facts. Not names. Intentions. The pill, the oven, the thing you meant to say. And forgetting intentions over short delays is precisely where aging bites hardest.

So your brain ran the numbers and found a workaround: say it now, while it exists. You interrupt for the same reason I dialed phone numbers in two halves. The buffer shrank, and you adapted. Half the room over fifty is doing the same thing.

5. Faces yes. Names no.

Covered above — the Baker/baker paradox — but it deserves its own line in the catalogue, because it’s the one people are most embarrassed about at parties.

You remember the face. You remember she’s a cardiologist, has twins, plays tennis. Everything about her lights up... except the label. Because the label is arbitrary — one string, no web — and arbitrary connections are the first to go slack.

This is why memory coaches all teach the same trick: make the name mean something. Turn Mr. Baker into a man kneading dough. You’re not strengthening the old string. You’re tying new ones.

6. And underneath it all: the tempo slows.

One more, and it’s the quiet one. From mid-life on, the brain’s overall processing speed declines. The clock rate. The tempo at which any mental step completes.

Think of it as the drummer in the band slowing down. No single instrument is broken — but every song takes longer, and the fast passages start to smear.

A slower tempo makes all five problems above a little worse. Diary entries get written more shallowly. The whiteboard erases before you’ve used it. The tug on the string takes longer to work. It’s not a disease. It’s a multiplier.

So what’s “normal”? Let me be a doctor for one minute.

Everything in the catalogue above is textbook normal aging. If you have all six, congratulations: you have a standard-issue 58-year-old brain. Not a disease.

Here is the line clinicians actually watch, and I want you to have it:

Forgetting where you put the keys is normal. Forgetting what keys are for is not. Getting lost in a new city is normal. Getting lost on your own street is not. Pausing for a word is normal. Constantly substituting wrong words, or losing the thread of whole conversations, is worth a proper evaluation. If that paragraph worried you, the answer is your own physician — not a newsletter.

But notice what “normal” actually means. It means common. It means slow. It does not mean “nothing can be done.” And that is where my experiment comes in.

Why a fuel might touch any of this

Now I have to be careful, because this is where people in my field start selling. So let me state my rules first.

I’ll tell you what’s established, what’s plausible, and what’s speculative — and I won’t blur them. And one rule sits above all the others: none of this happens fast. Your brain does not change between breakfast and lunch. Everything below works on a scale of weeks and months — a slow tide, not a light switch. That fact matters so much that it decides my whole strategy, as you’ll see.

Established: the aging brain has a fuel-line problem — and ketones bypass it.

Picture your brain as a house with two fuel lines coming in. Line one carries sugar (glucose). Line two carries ketones.

Here’s what brain scans show, over and over: as we age, the sugar line starts to clog. Slowly. Quietly. Years before you’d notice anything. And it clogs worst in exactly the neighborhoods where memory lives.

Now the finding that changed how I think about my own brain. A researcher named Stephen Cunnane spent years asking the obvious follow-up: what about line two? And the answer, from those same scans: the ketone line doesn’t clog. Same aging brain. Sugar deliveries dropping. Ketone deliveries coming through fine.

Cunnane calls the result the “brain energy gap” — rooms of the house going dim, not because the wiring failed, but because the fuel stopped arriving. And an under-fuelled brain cell does everything on our list badly. It writes diary entries faintly. It erases the whiteboard early. It loses the tug-of-war for the word.

Why do I find this so compelling? Because it’s a plumbing problem. And plumbing problems have a special appeal to a doctor: you can do something about them. You can switch lines. That is, in one sentence, what my entire experiment is.

Established in humans — one small, remarkable study.

In 2020, researchers in Denmark did something wonderfully direct. No diets, no willpower — they put ketones straight into people’s veins. Eighteen adults. Placebo-controlled, double-blind: neither the patients nor the testers knew who got what. Then, cognitive tests.

Of everything they measured, exactly one ability improved: working memory. Up seventeen percent. The scratchpad. The whiteboard. The phone-number system. Everything else showed no change once the statistics were done properly.

One small study — I won’t build a castle on it. But think about what it rules out: no placebo effect (blinded), no weight loss, no lifestyle change. Just the molecule, and the scratchpad responded. Of all the systems in this article that could have moved, the one that moved is the one I’ve been describing from inside for years.

Established mechanism, plausible relevance: the smoke alarm.

Regular readers know my favorite villain: a protein complex called the NLRP3 inflammasome. Think of it as a smoke alarm wired through your whole body. Real fire — infection, injury — and it screams usefully. But in much of middle-aged biology it gets stuck screaming all the time. Low-grade, chronic inflammation. No fire. Endless alarm.

A brain marinating in alarm chemicals does attention badly and encoding worse. One research group has even linked everyday to-do-list lapses to inflammation markers in older adults — the alarm and the forgetting, measured together.

In 2015, researchers showed that BHB — the ketone I measure every day — directly silences this alarm. Not muffles. Silences, at the switch.

This mechanism is fast, and it’s my leading explanation for what happened to me in the first six weeks — the joints, the headaches, the mood. Whether it also explains memory changes? I’ll say plausible. I won’t say proven.

Lab-established, human dose unknown: the fertilizer.

Remember BDNF from the glossary? Fertilizer for brain cells. It maintains the connections between neurons — feeds the strings, if you like our earlier picture.

Here’s the chain, and every link is real laboratory science. Inside your cells there are enzymes called HDACs that act like strict librarians, locking certain books — certain genes — away so they can’t be read. BHB politely relieves some librarians of duty. Among the books they’d been locking up: the one for BDNF. More BHB → fewer locked books → more fertilizer → better-fed strings.

Now the honesty: that chain is solid in lab animals. How much of it happens in a 60-year-old human hippocampus, at what ketone level, over how many months — nobody knows. That’s not me being modest. That’s the actual state of the science.

Real but slow — and I’ve argued against myself on this one in public.

The last mechanism is mitochondrial biogenesis — growing new power generators inside your cells. It’s documented under ketogenic conditions in animal work. It’s also slow. Months, not weeks.

When I published my 46-day symptom scorecard, I argued against this one as the explanation — too slow to explain a six-week turnaround — and I wrote a prediction in advance: if it’s real, the later months will show it. I’m now past day sixty. This is the edge of the window where my own prediction starts to be testable. Today I’d say some contribution is possible, even probable — that’s a change in my position and I’m stating it plainly. The full effect, if it exists, belongs to months four, five, six.

Ask me in December. I mean that literally. The answer will be in the daily numbers either way.

Put it together

So: a clogging sugar line that ketones bypass. A screaming alarm that BHB silences. A fertilizer gene that BHB unlocks. New generators, maybe, slowly. Four mechanisms, four levels of certainty, all pushing the same direction — and all of them cumulative. The tide, not the switch.

Which brings me to the strategy, and to why my daily rule is what it is. My target — ketones above 4.0 once a day, at the day’s peak — is not the level at which the brain switches on. There is no such level. It’s the level at which food stops arguing with me, which is what lets me stay on the protocol month after month. And staying is the entire game. The tide only works on the shore it reaches every day.

What I’m doing about it — and how you’ll know if I’m fooling myself

A good story — even mine, even this one — is the weakest kind of evidence I publish. So this week I started measuring.

Every day now, right after the meter: a digit span test. A machine reads me random digits. I type them back — forward, then backward. Fixed scoring rules, written down before the first session, that I am not allowed to change.

And because I know how this test behaves, three protections, declared in advance:

The first fourteen days don’t count. This test improves with simple practice, and I refuse to sell you my practice effect as a recovery. My real baseline is whatever week three says.

Every session gets published. Including the bad ones. Especially the bad ones — if the score never falls on a bad day, the test is broken, and I’ll tell you that too.

And the rival explanations get named every time. Practice. Expectation — I want this to work, and I know it. Above all, sleep: mine has improved enormously over these two months (I used to wake at 3:33 am; it’s 6:00 now), and better sleep, on its own, improves working memory. Whatever happens in my head this autumn will be several mechanisms braided together, and I will never be able to tell you which strand did what.

What I can do is measure honestly, publish everything, and let you watch.

That’s the real offer of this whole experiment. Not a miracle. A meter, a man, and the discipline to write the rules down first.

The receipts — every study in this article, and what it actually found

1. Radvansky GA, Copeland DE. Memory & Cognition 2006;34:1150–1156. — The original doorway experiments: walking through a doorway makes you forget what you were just doing; the same distance without a doorway doesn’t.
2. Radvansky GA, Krawietz SA, Tamplin AK. Quarterly Journal of Experimental Psychology 2011;64(8):1632–1645. — Doorway effect replicated in virtual and real rooms. It’s the doorway, not the distance.
3. Burke DM, MacKay DG, Worthley JS, Wade E. Journal of Memory and Language 1991;30(5):542–579. — The slack-string (transmission deficit) theory of tip-of-the-tongue; older adults have more of them, names worst of all.
4. Einstein GO, McDaniel MA, Smith RE, Shaw P. Psychological Science 1998;9(4):284–288. — Aging and the failure to carry out intentions: the science of the forgotten errand.
5. Cunnane SC, et al. Frontiers in Molecular Neuroscience 2016;9:53. — The brain energy gap: sugar uptake declines in the aging brain; ketone uptake does not.
6. Jensen NJ, et al. European Journal of Endocrinology 2020;182(2):233–242. — Ketones by IV, placebo-controlled: working memory up 17%; everything else unchanged.
7. Youm YH, et al. Nature Medicine 2015;21(3):263–269. — BHB directly switches off the NLRP3 inflammasome — the stuck smoke alarm.
8. Shimazu T, et al. Science 2013;339(6116):211–214. — BHB relieves the librarian enzymes (HDACs), unlocking protective genes.
9. Sleiman SF, et al. eLife 2016;5:e15092. — BHB raises BDNF, the brain’s fertilizer protein.
10. Bough KJ, et al. Annals of Neurology 2006;60(2):223–235. — Ketogenic conditions build new mitochondria — on a months scale, not weeks.