Andrew: 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?

Jules: 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 gonna 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 gonna 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 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 gonna 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 of 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 [inaudible 00:03:08] it, which is amazing. And then more people are learning about it, and then starting to go, “Ooh, 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. 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 prevalent for 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 bipolar, etc. Or, because women and those assigned female at birth actually present differently to men, 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. 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, this sweeping generalization. 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 was, 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 under-diagnosis to a bit of what we feel like is this over-diagnosis at the moment. But actually, it’s just a course correction.

Andrew: I think you’ve made so many interesting points there, and one I wanna 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, you were saying sort of, “In my medical or health opinion.” I get that. But you’ve gotta look at facts rather than prejudice.

Jules: Yes.

Andrew: So, for instance, your husband was, like, you know, “kids on red cordial” sort of thing. Mmm. Mmm. More than that? So, I have a couple of other questions, and that is how would you easily…ha. What would be a hallmark of teasing apart from ADHD versus bipolar?

Jules: Oh, look. Bipolar is, yeah, it’s a whole other rabbit hole. There is a lot of crossover of symptoms, and this is the problem. And again, especially in women, there seems to be, like, a real, like, misdiagnosis going on there. Bipolar go, you know, people with bipolar will generally go through manic periods. So, they will actually have, you know, periods in time where they might not sleep, or they might exhibit manic behaviors. Or, and then there’ll be times when they are, like, completely the opposite of that. 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 the average person feels emotions on a scale of 1 to 10, and he feels the emotions on a scale of -5 to 15. So, it’s just the… And a lot of ADHDers 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 -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. So, I don’t know personally enough about bipolar to really speak on all the symptoms and the signs, 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, 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 behavior of bipolar.

Andrew: 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 and things? 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 pressure of speech where people…it’s almost like a volume has to come out in one breath, sort of thing?

Jules: Some ADHDers, yes. Not all. We all present differently. There’s so…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. But yes, with ADHD, there is something called hyper focus, that happens when we really hone in on something that we’re very interested in. And I have heard it described this before. I think it was Michelle Livock, a psychologist, who said we have an interest-based attention system, or an interest-based nervous system. So, we, once we get hooked into something and really hyper focused on something, like, we can focus and concentrate on that thing, to the exclusion of a lot of other things.

So, when we get into a hyper focus mode, it might, you know, 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… With me, it might happen with work because, like, 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 hyper focus. But yes, when you do get really focused and honed in on something like that, there is a, 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 a special interest.

Andrew: Can we go a little bit into the physiology, pathophysiology, whatever you wanna call it, what’s going on in the brain with ADHDers?

Jules: Yeah. 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’s up to, but I personally wouldn’t call it a disorder. I think 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 a this or a 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 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. I’ve also heard it described as, like, a conductor of an orchestra. And 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 oboe’s, like, playing a few notes. The guy over there with the tuba’s 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 ADHDer, I was, like, listening to them warming up, and I didn’t know who to pay attention to, right? I was like, “Ooh, that guy’s making a noise. Oh, that guy’s making a noise.” My attention was being pulled in all those 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, 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 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.

Andrew: Just before we move on to our next question, here’s another question. It took me…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 ADHDers understand what other ADHDers are going through?

Jules: Oh, 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 ADHDer, 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. But ADHDers, 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.” 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 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 say…” you know, like, I… We made a new friend recently, 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, you know, he actually said it once. He’s like, “Oh my god. I’m so sorry. I tend to say things without thinking it through first. I kind of like, I blurt things out a bit,” and we’re like, “Oh my god, it’s fine. Me too.” Right? So, when you meet your neuro kin, 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. So, ADHDers, 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 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. 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. 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.

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. I’ve actually, I’ve literally got ADHDer clients who are, like, stunt people, who are martial artists, etc., who are 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 gonna 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 neurotypical people. So, there is 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?

Andrew: 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?

Jules: Presentation in women. Okay. So, 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. And we have these beautiful cycles. Er. So, 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, there’s been research done, that ADHD symptoms increase, and the symptoms of ADHD comorbidities, you know, like things like anxiety, sleep disorders, etc. 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 ADHDers, and can really spark, you know, 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. Serotonin’s 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 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. So, then we get to peri-peri territory. And God help us all, because estrogen is needed for the transmission of dopamine. Okay? So, if ADHDers have problems with dopamine and then you drop their 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. 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 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.”

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 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 has just decided to set that on fire for her.

Andrew: What about addressing… You were 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 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?

Jules: Yeah. So, 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 gotta get that gut right in order to get the inflammation down.

Neuroinflammation’s no different. So, when we’ve got neuroinflammation 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, with some of that impulse control, and, you know, some of those other ADHD symptoms, a lot of ADHDers have a poor diet. 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. Right, 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, 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, and 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. 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 a this diet or a 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 our ADHDers. 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 help to coach them, to keep them on track. 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 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, we, there’s, you know, 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. So, yeah. There’s a lot going on. But just, like, 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. It’s just, this time you might have to change, you know, your treatment plan a little bit.

Andrew: Can I ask, with regards to stimulants, 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 gonna 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.

Jules: I hate to burst your bubble, mate, but I think it’s, I really think it’s the stimulant activity of…

Andrew: The stimulant? Yeah.

Jules: Yeah. I really do. Yeah.

Andrew: So, a double shot?

Jules: And I only say this because I’ve… Yes. I’ve had clients come to me and have quad shots. Quad shots. I’m like, how are you alive? But anyway. I only think… You know, look, I get what you’re saying. And I love that we have spun coffee in a way that it is now, like, healthy and is gonna heal our gut. Like, I’m so stoked for that, like, because I personally drink coffee, and my husband works in the coffee industry. So, like, I’m on board with that cherry-picking of data. But, 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 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, in a perfect world, I would swap out all the coffee for green tea, because the green tea’s got the L-theanine in it, and we know L-theanine is, like, super useful for ADHDers. However, in reality, it’s more likely they’re gonna have a coffee in the morning, and down an L-theanine capsule, right? Let’s keep it real.

Andrew: 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?

Jules: Do they work on ADHDers?

Andrew: Okay.

Jules: It depends on the person. It depends on the presentation. It depends on which flavor of ADHD they are. Like, are they inattentive? Are they hyperactive, etc.? I’ve had a lot of hit and miss with giving calming herbs to my ADHDers, right? Like, I know you’re meant to do it if someone’s stressed. If someone is stressed, and they’re anxious and [inaudible 00:36:03] 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 your 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 passionflower 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, why, 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 is being tested, and they’re overwhelmed? Because ADHDers, 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, etc.

So, if…And also, ADHDers, 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 ADHDer families often have more trauma in them. Like, 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 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. 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,” right? 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 ADHDers, you might need to give them anxiolytics in the afternoon and the evening, but in the morning, like, let them have their stimulants, etc. 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. 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 probably my number one herb for anxiety in ADHD. But saffron is different to your… You know, if someone had acute anxiety, you will often reach for, like, the passionflower or the kava, like you said, but you wouldn’t be thinking saffron as your first line. And so I think, with our ADHDers, we just need to approach it from just a slightly different angle.

Andrew: 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. I love you.

Jules: Thank you.

Andrew: 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 ADHDers are going through all sorts of issues trying to get their, you know, methylphenidate and things like that, even the correct dosage. Some doses are in and out of stock at time to time.

Jules: Yeah.

Andrew: It’s a horrid 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?

Jules: 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 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 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 when 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 gonna “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, 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, the culture is 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 be, because for some people it is, but for some people it’s not. Okay. So, yeah. 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 the more common one, but sometimes a long-acting one, which is, like, a slow release. And then there’s lisdexamfetamine, which is also known as Vyvanse, which is the one that has been out of stock the most in the last 12 months, 2 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 favorite, 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 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, “Well, I’m gonna give this a go,” right? So, off I went to the psychiatrist, and he actually said, “Which one do you wanna try?” And I was like, “Hold up, mate. That’s your job.” Right? And he’s like, “No, well, 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 lisdexamphetamine, Vyvanse, the medium-acting one was methylphenidate, Ritalin, and 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.” 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 issues that go along with that, potentially, for a lot of clients. The biggest one that I see is crashes, where people bomb out at, like, three, four, five 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’s 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. P.S., 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.

But we’ve got…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, “Mmm, 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 ADHDers 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, 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 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 atomoxetine, also known as Strattera. And then, if that doesn’t work, or if they are looking for other options, and also if the person has high blood 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, 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.

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. 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.

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 escitalopram. I’m on 20 milligrams. I’d love to get off it. I feel like I’ve done the work with my psychologist in trauma therapy, da, da, da, da, da. I’m ready to give this a go. 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 wanna 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, like, get that person to their goal.

Andrew: 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 realize 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%. It’s a flip of a coin, on the first choice of SSRI, whether it’s gonna 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 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. What else do you use?

Jules: Yeah. And not only that, but with neuroinflammation, a lot of the probiotic stuff that’s coming out 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. Then, what was the question?

Andrew: Well, the question was, what other nutrients? What else do you use? You mentioned L-theanine.

Jules: Oh. Yeah. 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 that’s the fancy one. That’s the one that you often see on social media, because 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 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, magnesium. Huge. Like, needed. Very much needed, to keep that nervous system calm, to keep the blood sugar stable. All the things that magnesium does helps them sleep, helps with muscle soreness and stiffness, because 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.

Vitamin D. Like, good old vitamin D, often very low in ADHDers, 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 ADHDer 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. There’s so many other things. You know, there’s B vitamins, activated Bs, iodine. Like, we could go all day. But I would say, if 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-theanine. Right? Sprinkle it in. Get it in there. 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.

Andrew: 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.

Jules: Aww. Thank you so much.

Andrew: So, just thank you for your diligence and your dedication to your patients. I really appreciate you.

Jules: 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 why I run my ADHD course for practitioners, but it’s… I love those kookaburras in the background. I hope they make it onto the podcast. That’s beautiful.

Andrew: That’s through the window, too.

Jules: So, not… Yeah, I don’t… I know, right? 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 neuro-affirming, so that our customers have… Yeah, 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.

Andrew: Love your work, Jules Galloway.

Jules: Aww. Thank you.

Andrew: And everyone, if you want to delve further into this, remember that Jules has got a course up on the designsforhealth.com.au website. You just click in, go 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. Remember, everyone, you can catch up on this and all the other podcasts on your favorite channel, or the Designs for Health website. I’m Andrew Whitfield-Cook. This is “Wellness by Designs.”