Wellness by Designs - Practitioner Podcast
Wellness by Designs is a place for healthcare practitioners to expand their knowledge base. A place to deepen your nutrition, herbal medicine, naturopathic, integrative medicine and business management expertise. Sit back, grab a cuppa. Wellness by Designs has your continuing education covered. Tune in as fellow practitioners, and researchers share their expertise and clinical pearls, taking you on their professional, sometimes personal journies. For show notes and references: www.designsforhealth.com.au
Wellness by Designs - Practitioner Podcast
Understanding Adult ADHD with Jules Galloway
Join us for an eye-opening conversation with naturopath Jules Galloway as she demystifies adult ADHD, particularly focusing on its increasing recognition among women and those assigned female at birth.
With over two decades of clinical experience, Jules shares invaluable insights into understanding ADHD as a unique brain type rather than a disorder, offering evidence-based strategies for supporting neurodivergent individuals.
From exploring the neuroscience behind attention and impulse control to discussing practical management strategies, this episode provides healthcare practitioners with essential knowledge for supporting ADHD clients. Jules' holistic approach emphasizes the intricate connections between gut health, hormones, and neurotransmitter function in ADHD management.
Key Episode Highlights:
- Understanding the recent rise in adult ADHD diagnoses, particularly among women, and how past underdiagnosis is being corrected through increased awareness and reduced stigma.
- Deep dive into ADHD neurobiology, including the crucial roles of norepinephrine and dopamine in attention regulation and impulse control.
- The concept of "neuro kin" and its importance in addressing rejection sensitivity and social challenges common in ADHD.
- Practical insights into the relationship between gut health, nutrition, and ADHD symptom management.
- Evidence-based approaches to managing ADHD through nutrition and naturopathy, including the strategic use of herbs and supplements.
- Collaborative treatment strategies, combining conventional medication with holistic support for optimal outcomes.
This episode is essential listening for healthcare practitioners seeking to enhance their understanding of adult ADHD and develop more effective, compassionate approaches to supporting neurodivergent clients
About Jules
Jules is a passionate naturopath, podcaster, speaker and writer, based in sunny Queensland. Jules is one of the coolest, calmest Naturopaths you will ever meet. But she wasn’t always calm. After suffering burnout herself, Jules now specialises in helping fatigued women finds their shine again. Jules’ practice uses a unique blend of cutting edge science, real food, and natural medicines (with a little bit of mindset thrown in!) to help her patients regain their zest for life.
Connect with Jules
website:www.julesgalloway.com
email:hello@julesgalloway.com
Facebook: https://www.facebook.com/JulesGallowayHealth
Shownotes and references are available on the Designs for Health website
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DISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes only; the information presented is not intended to be used as medical advice; please seek the advice of a qualified healthcare professional if what you have heard here today raises questions or concerns relating to your health
Music. This is Wellness by Designs, and I'm your host, andrew Whitfield-Cook. Joining us today is Jules Galloway. She's a straight-talking naturopath, a speaker, a mentor and a podcaster with over 20 years of experience, and Jules has made it her mission to help people recover from fatigue, anxiety and mental health issues. Today, we're going to be talking about mainly adult ADHD. Welcome to Wellness by Designs, jules. How are you?
Speaker 2:I'm really good. Thank you, and thanks so much for having me.
Speaker 1:Thank you for coming on board today. Thank you for taking time out of your busy day. So, jules, tell us why there seems to be a sudden rise or there definitely is a sudden rise in diagnosis. Is there a rise in prevalence, or are we just catching people who have previously fallen through the net?
Speaker 2:I love this question because at the moment, it doesn't matter where you turn, you hear people saying it just feels like everyone is getting an ADHD diagnosis at the moment, or everyone's identifying as an ADHD right now. And it does kind of feel that way because, like when you're on social media, the algorithm's going to show you more of the thing that you've already clicked on or that you've hovered on or that you're interested in. So if you're already interested in a topic, it's going to show you more of that topic, and so if you're already looking down that rabbit hole of ADHD, it's going to show you more ADHD. The other thing is that ADHD is roaming packs, right, family packs and friend packs. So once one person becomes diagnosed with ADHD, there's a really high chance that there's going to be a ripple effect through that pack where other people start to go oh, actually, that kind of makes sense for me too. And so there's this huge rise right now in awareness of ADHD, and it's partly being driven by, you know, the internet, like a lot of social media and just people talking about it. There's a lot of celebrities are coming out in the news saying that they're ADHDers as well. Like there's just that huge rise in awareness and then also there's this huge decline in shame around it, which is amazing. So, rather than keep it under wraps and be like, oh yes, I'm an ADHDer, but I'm not going to tell anyone because it's really embarrassing and I don't want anyone to judge me and I don't want it to harm my job prospects or whatever Like people are actually finding that they can talk about it more openly now because the shame has declined, because the awareness has grown right. So then of course, we do feel like it's everywhere, because suddenly more people are talking about it without the shame attached, which is amazing. And then more people are learning about it and then starting to go oh geez, I think that might be me, maybe I should get an assessment, and so we're seeing this huge increase in diagnoses at the moment.
Speaker 2:But what has actually happened is that it's a course correction, because there was actually an under diagnosis going on for so long. There were so many people that were being missed. For so long they were either being missed completely or they were being misdiagnosed. So and this is particularly uh, this is particularly prevalent for uh women and those assigned female at birth, because a lot of us were being misdiagnosed with just general anxiety disorder or perimenopause, or even, like some people were being misdiagnosed with like bipolar, etc. Or because women and those assigned female at birth actually present differently to men.
Speaker 2:We just weren't picked up in the first place because we don't look like the typical ADHDer that we were taught so like it was only three years ago that my husband went to a GP to get the ball rolling for his own ADHD diagnosis because you need to get a referral from the GP to get to the next stage, and the doctor looked him up and down and actually said, oh ADHD, yeah, that's just young hyperactive boys on red cordial.
Speaker 2:I don't think that's you and I was like what. We were both like what, and so imagine how that would be for women. Like we're not hyperactive, like there's a type of ADHD called inattentive ADHD, where traditionally and this is very, like you know, sweeping generalisation but it was the girl at school who was just staring, dreaming out the window, right, or just talking to everyone around her, but maybe she still got her work done, so she wasn't the squeaky wheel in the classroom, the kid who was hyperactive, who was like throwing something across the room or being violent or yelling or acting out. They were the squeaky wheels that got diagnosed. So what we're seeing is we're playing this giant game of catch-up now, where all the people got missed who all the people who got missed are suddenly actually being diagnosed, and so, of course, you're going to see the pendulum swing from underdiagnosis to a bit of what we feel like is this overdiagnosis at the moment, but actually it's just a course correction.
Speaker 1:I think you've made so many interesting points there, one I want to get back to. But firstly, you made a really salient point there and it's a warning for any practitioner. You were talking about medical practitioners, but for any practitioner to project your opinions onto the patient presentation and I understand you know we're saying sort of in my medical or health opinion I get that, but you've got to look at facts rather than prejudice. So, for instance, your husband was like a you know kids on red cordial sort of thing, more than that. So I have a couple of other questions and that is how would you easily what would be a hallmark of teasing, apart from adhd versus bipolar?
Speaker 2:oh look, bipolar is yeah, it's it's a whole other rabbit hole. Um, there is a lot of crossover of symptoms and this is the problem and again, especially in women, uh, there seems to be like a real like misdiagnosis going on there. Um, bipolar go. You know, people with bipolar will generally go through manic periods, so they will actually have periods in time where they might not sleep or they might exhibit manic behaviours, and then there will be times when they are completely the opposite of that.
Speaker 2:People with bipolar do feel emotions very, very strongly. I was listening to a podcast the other day and they were interviewing an author who was bipolar, who's written a book, who described it as, like the average person feels emotions on like a scale of one to 10 and he feels the emotions on a scale of like minus five to 15. So it's just that, and a lot of ADHDs will feel the same way, but with bipolar it does tend to cycle. So it's just that, and a lot of ADHDs will feel the same way, but with bipolar it does tend to cycle. So you will actually have these cycles and these flips where you go from one end of that 10 to minus 5 to 15 to the other. You know, and sometimes maybe just from 2 to 8, right, but like you know, it can be quite wide.
Speaker 2:So I don't know personally enough about bipolar to really speak on all the symptoms and the science, although ask me again in a couple of years and I'll probably have more knowledge of it because it seems to be something that we do have to look into more Because, again, it's one of those things that is popping up a lot more in our clinics, whereas before we never really used to see so much of it and I used to consider it to be outside scope of practice a lot. But now there's so much we can do to support the other therapies bipolar people are doing. But with ADHD there's, there, are there's, you know you can. Actually what you need to do first is look at the three different types of ADHD and I think where it starts to get confused with bipolar is that some of the hyperactive and risk-taking and impulsive traits of ADHD were being mistaken for like manic behaviour of bipolar.
Speaker 1:Do you tend to, though, if I can ask it this way, with people with ADHD, do you tend to get pressure of speech, flight of ideas? I get the hyperactivity and I get the mind hyperactivity and the squirrel sort of sensation, that sort of thing. But do you get that flight of ideas in a very quick, sweeping response and the the pressure of speech where people it's almost like a volume has to come out in one breath, sort of thing?
Speaker 2:some adhd is, yes, not all. Uh, we all present differently there. There's so like, like I said, there's three different types. So there's inattentive adhd, there's hyperactive adhd and then there's combined, where you get to have both right sometimes. So it really and it also depends on so many other things about that person, like how fast their processing speed is like, how fast they think, how fast they respond it might have to do with, like you know, different types of intelligence or different types of thinking in the world, whether there's any autistic traits happening for that person as well.
Speaker 2:But yes, with ADHD there is something called hyperfocus. That happens when we really hone in on something that we're very interested in. And I have heard it described before. I think it was Michelle Livick, a psychologist, who said we have an interest-based attention system or an interest-based nervous system.
Speaker 2:So once we get hooked into something and really hyper-focused on something, we can focus and concentrate on that thing to the exclusion of a lot of other things. So when we get into a hyper-focused mode, we might forget to eat, we might forget to go to the toilet, we might forget to move, we might be locked in, and you can see this not just with me, it might happen with work, because obviously my special interest is natural medicine, so if I end up down some PubMed rabbit hole, I might forget to come up for air With other people. It might be gaming, it might be something else, it might be exercise. So there's lots of different kinds of hyperfocus. But yes, when you do get really focused and honed in on something like that, there is that, you know, that kind of dialogue and thinking that goes along with it, because we do get really excited and really revved up, especially if something is of special interest.
Speaker 1:Can we go a little bit into the physiology, pathophysiology, whatever you want to call it. What's going on in the brain with ADHD?
Speaker 2:Yeah, so we don't know everything there is to know yet, but I'll give you what science, where the science is currently at. So what we know is that it's well, first of all, it's classed as a neurodevelopmental disorder. Now, the word disorder, right, like, don't shoot me for that, I'm just quoting, like what the DSM is up to. But I personally wouldn't call it a disorder. I think I would prefer to call it a disorder. I think it's. I would prefer to call it a brain type. But yeah, it's a neurodevelopmental disorder, in inverted commas, which means you were born that way. This is not something that develops later in life or develops after a virus or an accident or this or that. It was there since birth. You came out of the womb with this brain type already, okay. And so with this brain type comes an issue in the prefrontal cortex where there's problems with information processing. So the brain can't tell the difference between signals and noise. Okay, it has trouble working out what to focus on and where to place its attention. Okay, we know that we've got problems up there with norepinephrine and dopamine, and you'll notice that if you dig into the pharmacology of ADHD stimulant medications like that's what they're doing, like the mechanism of action is that they're increasing norepinephrine and dopamine at certain points in the brain and so say we're off. Meds say you know, we've got this beautiful, amazing brain type that is considered a disorder by some and we've got problems with norepinephrine and dopamine. Okay, now, if it was all working, hunky-dory. Norepinephrine enhances the signals in the brain, dopamine reduces the noise.
Speaker 2:I've also heard heard it can um described as like a conductor of an orchestra and I went to. I went to the ballet recently because I've recently moved to Melbourne and I'm binging on culture as you do, and I went to the ballet recently and they had a live orchestra in the pit and prior to the show starting, the orchestra is warming up. You know, guy with the oboes like playing a few notes, guy over there with the tubas playing a few notes, guy over there on the whatever is doing a few bit. The guy with the drums has turned up. No one's doing anything that really resembles music yet yet there's a little bit of noise. And it was really interesting because, as an ADHD, I was like listening to them walking, warming up and I didn't know who to pay attention to, right, I was like, oh, that guy's making noise. Oh, that guy's making noise.
Speaker 2:My attention was being pulled in all these different directions and I have heard it described that the prefrontal cortex, when it's working, you know, when you've got your beautiful norepinephrine and dopamine humming along nicely, it's like having a conductor in front of that orchestra.
Speaker 2:That then shows you who to pay attention to. But it also cuts the noise of the other instruments so that you focus on this one. And, sure enough, at the ballet this conductor came out and, you know, taps the baton and everyone shuts up and then he points and he's like you play, you stop, you louder, you quieter, and suddenly you've got someone in charge that shows you who to focus on and then suddenly it functions. And so if you can think of the brain like that, if you can think of the brain like that, if you can think of the prefrontal cortex like that, it helps you to understand. Then when it's not working for an ADHDer, like what is going on in that brain, we can't differentiate the signals from the noise and that then starts to show up in our daily lives as problems with like focus, problems with attention, problems with staying on task, problems with problem solving, issues with executive function, emotional regulation, impulse control, and the list goes on. So that's how it's showing up for ADHDers, especially when they are dysregulated and their conductor isn't working correctly.
Speaker 1:Just before we move on to our next question, here's another question. It took my interest earlier. You said ADHDers tend to group in family packs. I get that genetics, vertical transmission, but friend packs as well. That's really interesting. Why is that? Is that because ADHs understand what other ADHs are going through?
Speaker 2:There's a couple of different ways of looking at this. My psychologist who did my initial assessment, she called it neuro kin. She's like you meet someone, you vibe with them. Oh, your brain's like my brain, you get me. Oh my god. Sometimes when you're an adhd you feel like you're from another planet. And I know autistic people have this going on as well, sometimes even more so for them.
Speaker 2:But ADHDers, we, you know, we're very, we're keen to connect, we're often quite. I mean, there's introverts among us, but we're often quite social people. We vibe off other people. That's great. But then when we go somewhere we sometimes feel like we're a bit awkward or we don't fit in or we blurt out the wrong thing at the wrong moment, because you know, impulse control right and we will often go away after a social engagement going oh my God, did I say the wrong thing? Oh my God.
Speaker 2:There's this thing with ADHD in the ADHD community called rejection, sensitivity dysphoria, where we take it really badly when we think that someone is rejecting us or doesn't like us or doesn't approve of us or who's you know who's thought that we said the wrong thing. And, of course, when you've got kind of the blirty outy personality where you go out and you say stuff before you think it through because, remember, it doesn't get to go past the conductor first, it just comes out the mouth. Then often what will happen is, after some sort of social engagement or social interaction, we'll be overthinking it and getting really anxious about it. Now that's cool, like that's part of life and we learn strategies to deal with it, and that's awesome. But let me tell you, when you meet up with a fellow ADHDer and you realize they're like you, a lot of that anxiety and awkwardness goes out the window because it's like oh my god, I'm. I say, you know like I, I we made a new friend recently, um, and it was someone in our you know, in our local neighborhood that we've, you know that we've met and we had dinner and he and you know he actually said at one stage he's like oh my god, I'm so sorry. Um, I tend to say things without thinking it through first. I kind of like I blurt things out a bit, um, and we're like oh my god, it's fine, me too, right?
Speaker 2:So when you meet your neurokin, you feel like they get you, but you also feel like you can drop the mask. You don't have to mask around them. You don't have to act like a neurotypical person around them in order to be accepted. And so, of course, what happens? We congregate in packs. We all find each other right Because we feel comfortable around each other, and perhaps sometimes we gravitate towards each other in other ways as well.
Speaker 2:So ADHD is they. Like. You know, when they're younger especially, but sometimes even when we're older, they like to engage in risk-taking behaviors. They're impulsive, they're edgy, they're a bit out there, they're a bit naughty, they, you know, sometimes we, we do things that are considered risky, like. Sometimes, when you do those things, you'll end up being friends with other people who do those things.
Speaker 2:So you know, for example, when I was young, I used to go out to a lot of rave parties, right, I was very naughty, but, yeah, I was like a party kid, right, and of course, like I don't do that now, I've done a complete 180 on that one.
Speaker 2:But of course, I met other people who also went out and partied a lot, rather than, you know, being very responsible in their 20s.
Speaker 2:And so, of course, now, looking back, a lot of the people from that era of my life were probably other ADHDers. There's probably a more generous sprinkling of them through that community than out there in the real world. And also I've seen it in extreme sports. You know, I've literally got ADHD clients who are like stunt people, who are martial artists, et cetera, who are, you know, athletes and sports people. So when you think about what it takes to be, you know, in that community as well, like, of course we're going to form packs of, you know, dysregulated ADHD people, it's just natural. Like, if you look at the entrepreneurial community, right, we already know like there's actually been research done on this that ADHDers are more likely to try and start their own business than you know, than neurotypical people. So there's a greater percentage of us in the entrepreneurial community than there is out there in the regular world. So of course we find each other and of course we vibe with each other. That was a really, really long story, wasn't it?
Speaker 1:Yeah, but it's poignant in that I love that neuro kin. That's really funny. Jules, can I ask, with regards to gender differences of presentation with adhd symptoms, anything specific there with regards to, let's say, presentation in women?
Speaker 2:presentation in women. Okay. So, uh, women and those assigned female at birth, have a bunch of hormones running around in their bodies, and I'm sure we're all pretty across, uh and we have these beautiful cycles, er. So, um, unless we're perimenopausal which I'll get to in a minute, because, oh god, that's like adhd danger, danger time okay, so we already know, uh, there's been research done that, uh, adhd symptoms increase and the symptoms of ADHD comorbidities. So you know, like things like anxiety, sleep disorders, etc.
Speaker 2:But we already know that ADHD symptoms increase during the luteal phase of the cycle. Okay, and we already know that ADHD and PMDD are co-occurring conditions, and so we already know that there's something going on in that luteal phase that is really not good for ADHDs and can really spark a lot of mental health issues. We already know some of us have issues with serotonin. So I definitely think there's like a serotonin connection there as well. It's not just about dopamine and norepinephrine. I know like every time you open up research on ADHD and neurotransmitters and all of what's going on in the brain, like you know, the focus is placed so much on dopamine and norepinephrine, but we have to consider some of the other stuff that's going on as well, and serotonin is a big one. So we already know, like ADHD, luteal phase, like, yeah, not a great time for us. Adhd and PMDD if you happen to be someone who's you know you've got both of those in the same person yeah, not going to be great for that person in their week before their period as well. We know that stimulant meds become less effective going up to the period. So again, in that luteal phase, and especially in that second half of that luteal phase, the closer you get to your period, the less you know, the less effective the medications are. And there's some amazing psychiatrists out there now who are actually open to changing the dosage of medication depending on where the person is in their cycle. So that's really great to see Like we're coming along in leaps and bounds the last few years. Let me tell you it's really wonderful.
Speaker 2:So then we get to peri-per territory and and god help us all because estrogen is needed for the transmission of dopamine, okay. So if adhd is have problems with dopamine and you drop the estrogen, what happens? Right? Yeah, shit hits fan, okay. So that's where you see a real danger time for women. And also you see a massive spike in diagnoses at perimenopausal time, not just because the estrogen's dropping away and all of a sudden these ADHD symptoms are coming to the surface, but like, of course that's happening. But it's also the exact point in time where a lot of people's children are getting diagnosed.
Speaker 2:So mum is like 45 years old, she's got a 10 year old who's going through a diagnostic, you know, through an assessment themselves, and the child is, you know, being asked all these assessment questions. Mum's being asked all these assessment questions and's being asked all these assessment questions. And mum is sitting there going well, holy crap, this sounds like me too. I just thought that everyone was like this. Most people in my family are like this is really normal for me. I thought everyone had that problem.
Speaker 2:No, because ADHD runs in families, right? So of course everyone you're close to has that problem. Of course it feels normal to you. So suddenly mum's like going what? And then she goes off and gets her assessment. And so it's like this perfect intersection of the awareness coming in because of you know, she's learning about what ADHD looks like, because she's sitting in on her child's assessments and she's down that rabbit hole every night googling on behalf of her, of her child. But then it's a perfect intersection of that and her own hormones deciding to have a bit of a party on their way out. And then boom, right now we've got a mum who's in crisis, who's got you know, who's really struggling, who was like I don't understand, like I've always been a bit scatty, or I've always had trouble focusing, or I've always had a bit of anxiety, but now it's ramping up. Okay, because perimenopause just decided to set that on fire for her.
Speaker 1:What about addressing? You're speaking earlier about the importance of serotonin. We know about the gut brain superhighway and we're talking here about neurodiversity, definitely, which will be affected by diet and lifestyle. So you've potentially got neuroinflammation on top of the genetic imprint, if you like. What are the important points to think of as practitioners when trying to treat this, to manage this gut and the inflammation and the signals that are being sent to the brain?
Speaker 2:Yeah, so much inflammation begins in the gut and we know this Like we're naturopaths and nutritionists, we're practitioners, like we know this inside out right, like if you've got a gut problem, you've probably got an inflammation problem somewhere, and we've already known this from dealing with our autoimmune patients or our chronic fatigue patients or our osteoarthritis patients or whatever it is that you see in clinic that is inflammatory. Chances are you were always looking at that gut, okay, you always brought it back to the gut and you've got to get that gut right in order to get the inflammation down. Neuro-inflammation is no different. So when we've got neuro-inflammation going on, even if it's super, super mild we're not talking that it's at a level where any scan would pick it up, but we're talking about super mild it can still change moods, thoughts, it changes brain function, okay, and so even a mild amount of neuroinflammation is going to be huge for an ADHDer ADHDers we already know like there is research to show that we produce more inflammatory cytokines than neurotypical people, and so it becomes even more imperative that we look to that gut and we sort that gut out. Now, unfortunately for ADHDers along, you know, with some of that impulse control and you know some of those other ADHD symptoms.
Speaker 2:A lot of ADHDers have a poor diet. They might, you know, they might not be able to have the executive function to shop for healthy food and cook healthy food every day. They might have binge eating issues. They might have sugar issues. They might have caffeine issues because they're using caffeine as a stimulant to actually calm themselves down, like a lot of ADHDers have caffeine, and actually feel more calm rather than revved up. That's a fun fact. So, you know, a lot of ADHDers will come to us already with, you know, diet and lifestyle drivers that are causing the gut issues.
Speaker 2:Okay, so they're already more predisposed to having gut issues. They're already more predisposed to the diet and lifestyle factors that cause the gut issues. Okay, so they're already more predisposed to having gut issues. They're already more predisposed to the diet and lifestyle factors that cause the gut issues. They're already more predisposed to creating inflammation when they have a gut issue. Well, great, we're screwed now, aren't we? But what we need to do is we peel it apart very slowly, very gently, but we definitely, definitely have to get that gut right. And so I'm always looking for bacterial overgrowth in the gut, fungal overgrowth in the gut, increased intestinal permeability you know, all the things, all the things that we look at.
Speaker 2:I look at, you know, I do a lot of functional testing, I do a lot of microbiome testing. I often do some SIBO testing to pinpoint what's going on. But then we have to sometimes throw the textbook out the window of what we would normally do with a client and work out what is achievable for the person sitting in front of us, for this beautiful, you know, neurodivergent, struggling person who's sitting in front of us. So you might be like, oh my God, like I really think this person needs a SIBO diet or a low FODMAP diet or this diet or that diet, and they, they're struggling to just go and buy food from the supermarket after work, right. They're struggling to do work and shopping in the same day, right, because their executive function is being tested, they're stressed, they're tired, they're inflamed, right. So we have to go very gently with with our adhd's, we have to be very interactive with them. Sometimes we have to put little appointments in between the big appointments to check up on them or check in on them or get someone else to come in and like a health coach or someone to come in and and help to coach them to keep them on track.
Speaker 2:We make small changes rather than big ones. If needed, we ask questions of that client around sort of bandwidth and capacity and what they can do and sometimes like it's a massive struggle just to get them off gluten or just to get the sugar down. But sometimes we have to also throw not just the textbook but the timeline out, the window of how quickly we want these changes to happen for the person. And then also, like you know, there's plenty of beautiful like gut healing supplements and herbs and things that we can do in the meantime and anti-inflammatory herbs and supplements and things that we can do in the meantime to help bring some of those symptoms, some of that neuroinflammation down, while the other changes are being made.
Speaker 2:So, yeah, there's a lot going on, but just treat it like in terms of what you're looking for that's driving the inflammation. Treat it like any inflammation patient that you've ever had in front of you. Right, it all comes back to what gut stress. Yeah, it's no different. Different it's just this time you might have to change. You know your treatment plan a little bit um, can I ask with regards to stimulants?
Speaker 1:you know it's commonly said that, for instance, that you know people with add adhd often do well on caffeine or caffeinated drinks, and I should. I'm going to change that, forgive me. They do well on coffee, and the reason I'm saying coffee, not caffeinated sugary drinks, is because I'm asking the question is it the caffeine that's good for these people as a mind stimulant to help settle things down, or could it be that the chlorogenic acid and the antioxidants and the other components of a good coffee are actually helping the gut inflammation because, as we know, coffee is the prime therapy for, for instance, fatty liver disease?
Speaker 2:I hate to burst your bubble mate, but I think it's. I really think it's the stimulant activity.
Speaker 2:The stimulant yeah, yeah, I really do um, so a double shot I've and I only say this because I've, yes, I've had, I've had clients come to me and have quad shots, quad shots. I'm like how are you alive? But anyway, uh, I only be. You know. Look, I, I get what you're saying and I love that we have spun coffee in a way that it is now healthy and is going to heal our gut. I'm so stoked for that because I personally drink coffee and my husband works in the coffee industry, so I'm on board with that cherry picking of data.
Speaker 2:The reality is that, then, why have I got so many clients? When they come to me, they have a coffee habit and a gut issue all in the one person Like, why is the coffee not fixing their bacterial overgrowth in the gut? Why has coffee not fixed their leaky gut? Maybe it's the milk and the sugar in the coffee, who knows? Maybe it's the milk and the sugar in the coffee, who knows? Maybe if you were just to have like a, you know, a cold brew black coffee, that was you know who knows. Although, actually did you say it was the acid, because cold brew is lower in acid, I think. So scrap that. But just thinking out loud, but look, if you're in a perfect world, I would swap out all the coffee for green tea, because the green tea's got the L-theanine and we know L-theanine is, like, super useful for ADHDers. However, in reality, it's more likely they're going to have a coffee in the morning and down an L-theanine capsule.
Speaker 1:All right, let's keep it real. Can I ask from there, though? We talk about stimulants having a calming effect? This is something I've struggled with, even though I do it, and that is we talk about stimulants having a calming effect because of the norepinephrine and the dopamine activity, but then we go and prescribe calming herbs like kava, like lavender, like hops even for some people, but ashwagandha more of a tonic sort of herb, I get that one, but I've struggled with this. Why am I prescribing, and why does it appear to work for these people, these calming herbs?
Speaker 2:Do they work on ADHDs?
Speaker 1:Okay.
Speaker 2:It depends on the person. It depends on the person. It depends on the presentation. It depends on which, which flavor of adhd they are like, are they inattentive, are they hyperactive, etc.
Speaker 2:I've I've had a lot of hit and miss with giving calming herbs to my adhd, like I know you're meant to do it if someone's stressed, if someone is stressed and they're anxious and I don't know, like here have some passionflower, here have some kava, here have some magnolia, here have some L-theanine, like you know, because, don't forget, you're calming nutrients as well, like your GABA. Honestly, I have had more success with nutrients to calm people down than herbs in my adhd clients. It's not to say that the herbs don't work and I have given, you know, beautiful, like lemon balm and passion flower type formulas to people and it works. But it really depends, I think, on why is the anxiety happening in the first place. Like you know, there's a difference between the calming effect of a stimulant compared to the calming effect of, like a beautiful anxiolytic or, you know, sedative or something right. So what is the reason that that person is anxious, like? Why are they anxious? Okay, are they anxious because they're stressed, because their executive function has been tested and they're overwhelmed because ADHD is. We love a bit of pushing the red button into overwhelm, right, we do too much and then we hit that overwhelm button and then you know that's when mental health, can you know, escalate in terms of, like anxiety, depression, moods, et cetera.
Speaker 2:So, if and also ADHD is quite prone to having a history of trauma, okay, so, and they're like it really does, and that's a whole other conversation about. You know whether the trauma has increased the ADHD symptoms or whether the ADHD symptoms have predisposed the person to having a life that just happens to have more trauma. And ADHD families often have more trauma in them. That's a whole other conversation. But we do know that ADHD and trauma do go hand in hand, right. So we're also talking about vagus nerve dysregulation then. Right, so we've got, you know, we've got things for that, we've got lifestyle things, we've got vagus nerve toning things we can do. We've got herbs for that as well.
Speaker 2:But we, yeah, I think we need to look really deeply into why the person is anxious and then work our way back from there, because I think in the past, as herbalists years ago, we were taught person is anxious, give them anxiolytic herb, watch person get better and it's like great, I'm happy for you if that works, I'm so happy for you. But it's just not like it's not what I always see in clinic. But I also find that with my ADHD is you might need to give them anxiolytics in the afternoon and the evening, but in the morning, like let them have their stimulants, et cetera. So you might need to pace it according to what that person needs throughout the day. And I'm not saying don't try anxiolytic herbs, I'm not saying don't do that.
Speaker 2:And, by the way, saffron is amazing because that brings down the neuroinflammation right as well as dealing with the anxiety. So we're like we're doing more than one thing with saffron, like give them the saffron, I love it, it's honestly, it's it's honestly it's probably my number one herb for anxiety in adhd. But saffron is different to your. You know if, if someone had acute anxiety, you will often reach for, like the passion flower or the carver, like you said, but you wouldn't be thinking saffron as your first line. And so I think with our adhd's we just need to approach it from just a slightly different angle.
Speaker 1:I think this is one of the reasons I respect you so much, jules is that you don't just look at the symptom. You look at why that person is having that symptom. Don't treat the symptom, treat the person.
Speaker 2:I love you, thank you.
Speaker 1:Now what about medications? And in here I think we need to sort of address an elephant in the room and that is the sparsity of medications on the market at the moment, because ADHs are going through all sorts of issues trying to get their methylphenidate and things like that, even the correct dosage. Some doses are in and out of stock at time to time. It's an abhorrent time in the Australian market with medicines at the moment. But take us through how we can best serve our patients with regards to them being on medications and probably wanting to stay on them if they're, you know, severe, at least how we can support them so that we can actually A not interact and B benefit their symptom picture.
Speaker 2:Yeah, the first thing we need to do is learn what each medication does, because when a person comes to you saying they're on ADHD meds, we need to understand the nuances between the different types of meds, and you know even the different types of stimulant meds. So I think we need to get really clear on what each one is and what it does. This is what I teach in, like, my ADHD for Practitioners course. There's actually like a whole bit on medication, because it is so important when someone sits in front of you and tells you what they're on, like you, you need to immediately be able to go oh, I know how that works, so I know what that's doing in your brain, so now I know how to work with it or around it. So, yeah, and obviously the first thing I would say is we need to be very respectful of the fact that if someone is choosing to be on medication, that we need to be supportive of that. If someone is choosing to be on medication, that we need to be supportive of that. If someone is choosing to not be on medication, we can be supportive of that too, but I work in with whatever the patient wants because, don't forget, a lot of people have lived their whole lives up till 40, 50, even 60 years old, struggling throughout life, raw-dogging it as they call it in the ADHD community. Raw dogging is where you're going through life without any meds and then they're finally given an opportunity to try what they think is this magic pill that is going to fix them in inverted commas and that is going to help them to get through life like a neurotypical person, like, hey, I just wake up and I do my dishes, and it's not a struggle to do my dishes right, like that sort of stuff. So the we need to understand that, like, when people are being late diagnosed as adults, they're often very medication curious because they're like, oh what if this fixes things for me? Okay, we often know it doesn't, but that's, that's the culture. Is that that people? They want this to be a magic pill. Okay, and we, you know it's not our job to tell them that it's not going to, because for some people it is, but for some people it's not okay. So, yeah, there's three.
Speaker 2:There's three different kinds of common stimulant meds on the market. So there's dexamphetamine, okay. There's methylphenidate, which is also known as Ritalin, which comes in like a short acting, which is a more common one, but sometimes a long acting one, which is like a slow release. And then there's lisdexamphetamine, which is also known as Vyvanse, which is the one that has been out of stock the most in the last 12 months. Two years, however long, is still going to have out of stock issues for a little while, I think. And they're the ones that are the first line. So often the doctors will often just prescribe the one that's their favourite or the one that they seem to get the best results with. It's a bit like if you had to choose between passionflower and lemon balm, like sometimes you make a different decision for different people based on your own logic or your own experience and research, right. So doctors are no different. There isn't a guide for which one of those three.
Speaker 2:To start with, when I went to try stimulant meds after I was diagnosed I'm not on them anymore, but I wanted to give them a run. I wanted to experience what it felt like. So I was like right, I'm going to give this a go, right. So off I went to the psychiatrist and he actually said which one do you want to try? And I was like hold up, mate, that's your job. And he's like you know, there's a long acting one and a medium acting one and a short acting one, and I was like, huh, all right. So I think he meant the long acting one was liz dexamphetamine by vance. The medium acting one was methylphenidate ritalin. Then the short acting one was dexamphetamine, because I think he was talking about how long it takes for that drug to really leave your system. But yeah, he had like this collaborative approach where it was like if I'd said, yep, I've done a lot of reading and I think I'm a Ritalin girl, he would have been like, yeah, sure, we'll start with that one.
Speaker 2:So there's no exact science to what people are prescribing out there out of those three. So then there's going to be side effects and you know issues that go along with that potentially for a lot of clients. The biggest one that I see is crashes, where people like bomb out at like 3, 4, 5 in the afternoon and struggle to function for the rest of the day. So it's like a big crash, and that can sometimes change depending on which medication. So if a medication is not working they might try a different one. Often people forget to eat. Their appetite gets suppressed on medication. That's another big one that we see. So getting healthy food into them becomes even more of a struggle. Ps, best tip is to give them a smoothie before they have their stimulant meds, at the start of the day, and make things easy to get down, like soups for lunch, anything that's easy, just get it down.
Speaker 2:But you know we do have agitation, jitteriness, anxiety, sleep problems, like there are lots of things that can happen. I've had people come to me who had an increase in tinnitus in ringing in their ears, which I'm like okay, is this causing some neuroinflammation for them? What's going on? So you know, we've had like increases in restless leg syndrome, which is, by the way, really common in ADHD as well. It's a co-occurring condition. So, as you can see, like I could go on and on. But there are bunches of side effects.
Speaker 2:But there are also things we can do as a practitioner to help alleviate those side effects. Did I mention saffron, our good friend? So then, if the side effects really are too great, or if the person is not a good candidate for stimulant medication in the first place perhaps they've got got a history of addiction or high blood pressure, which is like a red flag to a doctor. They won't prescribe them. Then you go to non-stimulant medications. The most common one is an SNRI called atomoxidine, also known as Stratera, and then if that doesn't work or if they are looking for other options, and also if the person has high blood pressure pressure, they will often go to a different type of non-stimulant family called the alpha-2 agonists, and that is like. Clonidine and guanfacine are the two there that you'll come across most often. So, as you can see that it's not just about dexamphetamine or Ritalin or Vyvanse. There are other options that people are going to be given if the first line of medication isn't the right option for them.
Speaker 2:So we need to get across all the different types of medications and what they do and what the side effects could potentially be, how we might be able to help with that. A big one, by the way, with stimulant meds is it can irritate the stomach. So have a think about what you might do. If someone came to you with an irritated digestive system, I would be immediately thinking like your beautiful sort of gut healing, gut sealing, gut soothing kind of powders, because that way it might help them to tolerate that medication better. So you've also got off-label prescribing, which we're not supposed to speak about but does happen where medications that we think might be helpful for ADHD, that in the future might be listed as being officially helpful for ADHD, are currently being prescribed in an off-label way and, lo and behold, it does help. So there are a few things there.
Speaker 2:And then also there's prescribing that's probably going to happen in a lot of your clients for co-occurring conditions, and the biggest ones that come to mind there's plenty, but the biggest ones would be like SSRIs and antidepressants, and then you know like anxiety meds, sleep medications as well and then you know like anxiety meds, sleep medications as well. So you know we can, you know we might not. I know that traditionally, naturopaths were always kind of thinking that part of our role was to sort of get the client to a point where they can come off their medication. You know, if you normally, if you get a client who comes to you who's got anxiety and they've, you know, got this anxiety disorder and the doctors put them on an SSRI, then, like, they come to you and they're like look, I'm on esotelopram, I'm on 20 milligrams, I'd love to get off it. I feel like I've done the work with my psychologist and trauma therapy. Da, da, da, da, da. I'm ready to give this a go.
Speaker 2:Can you support me as I wean off the meds Sick? Like this is our time to shine, like this is what we do, and we've always had that mindset. That that's what we do is like if someone comes to us, we help them get off the meds, but sometimes with ADHD and stimulant meds, our job is to help them to tolerate the meds better. They might want to stay on the meds because maybe it is life-changing for them. Like I said, it's not for everyone I'm not on them anymore but it does work for a lot of people. So I think we also have to have a little bit of a mindset shift about what it means to be a naturopath or a nutritionist or a natural health practitioner and what the goal is here for the client and how we can best get that person to their goal.
Speaker 1:Jules, this again ties into why I respect you so much, and that's that you're addressing the human, the patient in front of you, not just addressing the symptoms but the cause. Can I lead in to that one and that is my opinion is I wish the Australian government, the medical fraternity, would realise that part of a naturopath's job is not to just simply take people off medications but indeed to help, using evidence-led medicine, maybe manage that patient's medication's safety or efficacy. For instance, zinc has been shown to help in many people, the efficacy of an SSRI. So we're not talking about decreasing the medicine, unless the doctor chooses that. But what we're talking about is helping the patient to get more benefit from that medicine Because, as we know, it's a 50%.
Speaker 1:It's a flip of a coin on the first choice of SSRI, whether it's going to work or not. So wouldn't it be great if we could improve the chances of your medicine, doctor, working? That's what I love about nutritional medicine. Leading on from there, what other tools have we got? You mentioned the gut superhighway. You've mentioned saffron. So let's throw in a probiotic in there, because there's a bifidobacterium longum that's been used successfully to help people with their mood stability.
Speaker 2:What else do you use? Flexibility, what else and not only, not only that, but with neuroinflammation, a lot of the probiotic stuff that's coming out is is to do with, like, the research that's coming out around these beautiful bacteria. It has to do with getting that neuroinflammation down. So again, like, if you know, while you're doing your gut work and while you're like getting them off the gluten and while you're doing all of that stuff, like there are things you can be doing that are anti-inflammatory. Yeah, yeah, sorry, got off track.
Speaker 1:What was?
Speaker 2:the question.
Speaker 1:Well, the question was what are the nutrients? What else do you use? You mentioned L-theanine, yeah.
Speaker 2:Yep, l-theanine. I do use a bit of GABA as well if they're not sleeping well. I use a lot of tyrosine because it's a precursor for dopamine, but don't forget good old iron. Iron is also needed for dopamine production. Everyone goes towards the tyrosine because like that's the fancy one, like that's the one that you often see on social media, because you know you need that to make dopamine. Well, you need iron as well. It's just not as exciting to talk about that on instagram, right? So get their, get their iron checked, even if they're not bleeding monthly. Like get their iron checked even if they're not vegan. Get their iron checked. So. So magnesium huge, like needed, very much needed to keep that nervous system calm, to keep the blood sugar stable. You know all the things that magnesium does helps them sleep, helps with muscle soreness and stiffness, because you know that can be a side effect of stimulant meds as well. Helps with restless leg syndrome. So does iron, by the way. So does fixing up the SIBO, but that's another story.
Speaker 2:Vitamin D like good old vitamin D often very low in ADHD is especially the ones who like to sit inside and hyper-focus on things like gaming or who work long hours, who aren't really great at having like an outdoor fitness regime or anything Like. So many of my ADHD clients are low in vitamin D and, just you know, not getting enough sun. We need to put them all outside like a pot plant on the regular. Omega-3s fish oils huge, like so needed, almost cliched, it's so needed, right? If you've got an adhd, you need to be considering omega-3s. Uh, there's so many other things, you know. There's b vitamins, activated b's, iodine, like we could go all day.
Speaker 2:Um, but I I would say if, like I had to pick like a handful, I would be looking at iron, vitamin d, omega-3s, zinc, yeah, and then sprinkle in that L-C-N-E, right, sprinkle it in, get it in there, If you know, if you think it's appropriate, of course. And then don't forget also, you might want to also not just focus on that dopamine, but look at things like serotonin as well. So don't forget, like you know, all your beautiful precursors for serotonin as well. So don't forget, like you know, all your beautiful precursors for serotonin as well.
Speaker 1:Jules, I love your mind. You talk about ADHD and going down the rabbit hole, but your rabbit holes are dedicated to the care of your patients and you've helped so many women's, and indeed couples to not just with fatigue, which you're very well known for, but also with these neurodiverse or diverse conditions, and I just, I really thank you from my heart for what you've put in for the community, for the Australian community. That's what it is so just thank you for your diligence and your dedication to your patients. I really appreciate you.
Speaker 2:Thank you so much and look like my attention is now starting to really turn to, you know, getting the next generation of practitioners like up to speed on this, and to not only give other practitioners the knowledge they need on this, because this is this is why I run my adhd course for practitioners. But this, you know it's. I love those kookaburras in the background. I hope they make it onto the, onto the podcast.
Speaker 1:That's beautiful, um that's through the window I know right.
Speaker 2:Um, I don't just want them to have the actual science and the knowledge, I also want them to adopt a neuroaffirming you know, neurodiversity-affirming framework for their practice, so that we can then help these beautiful neurodivergent clients from a place of non-judgment, from a place that's trauma-informed, from a place that's neuroaffinformed, from a place that's neuro-affirming, so that our customers have our customers sorry, our clients our patients have the best experience with us as well, so that they feel heard, so that they feel seen, so that they feel held, and that's where we're going to get the best clinical outcomes for them.
Speaker 1:I love your work, jules, gallow Galloway and everyone. If you want to delve further into this, remember that Jules has got a course up on the designsforhealthcomau website. You just click in, go in in your practitioner login and then go to education and they're all under there and I think it's under the nervous system. Everyone, thank you so much for joining us today and Jules, thank you for joining us today. And Jules, thank you for joining us. Remember everyone. You can catch up on this and all the other podcasts on your favourite channel or the Designs for Health website. I'm Andrew Whitfield-Cook. This is Wellness by Designs.