Girls don't get diagnosed for many, many years. It becomes internalized for a much longer period of time than for a young boy who might be quickly taken to the doctor and the there's a really dramatic difference in treatment outcomes. So boys are medicated double and they're given ADHD medicines like stimulants, girls are very infrequently taken to the doctor for medicine, and they're most often given antidepressants.
Okay, I have been looking forward to recording this episode for such a long time. We have a really exciting guest coming to speak with us today, all about ADHD. I get so many questions from patients about ADHD, and it's really pretty unique in women. So I'm really excited to welcome to today's episode Dr James Greenblatt. He is a pioneer in functional and integrative psychiatry. He is board certified in both child and adult psychiatry, and the author of a wonderful book finally focused the breakthrough natural treatment plan for ADHD, he has decades of experience, has written numerous books and has helped 1000s of patients find lasting improvements in their focus, their mood, their mental health, by looking beyond a purely medication based model. So today, in our conversation, we're going to explore what's different about ADHD in women and girls compared to boys and men. We're talking a little bit about how hormonal shifts can influence these symptoms and what the typical presentation looks like in adulthood versus childhood. We're also going to walk through his plus minus treatment plan. This is his very practical and approachable framework about what to add to the brain, to give it what it needs and remove what it doesn't. This can include anything from magnesium and omega threes to protein balance and gut health. And then we're going to talk about which tools have the biggest impact. He is sharing all of his secrets with us if you have ADHD, or whether you think you might have ADHD, or you're a parent trying to help your child with ADHD, this episode is so helpful. It is science backed. It's hopeful with highly actionable insights. So I hope you'll listen along as always. If you like it, please let us know. Leave us a review. Send us a DM. If you'd like to hear more like this, please let us know so we can continue to offer exactly the type of episodes that will be most helpful to you, and please share with your friends. This is how we get the word out, so that we can keep offering this free content for you that hopefully is helpful to you and helps you live your healthiest life and feel really good. So let's get started.
If it's a new onset, then look at the cause, hormones, nutritional deficiencies. I can't tell you how many times I've seen celiac disease go undiagnosed, and it might just occur at age 30 or 40, and ADHD symptoms could be one of it. So go to a functional doc and get that tested.
Dr Greenblatt, thank you so much for sharing your time. I know that you are a busy person sharing information and teaching and taking care of patients, and I'm so grateful that you've decided to come spend an hour with us to talk about a really important topic today. So it's so nice to meet you and thanks for being here.
I'm very glad to be with you, and hopefully we can educate your listeners.
Oh, I love it. We are focusing on ADHD today, which is, I'm really excited to dive in, because I think that there are a lot of ideas about ADHD, and we really want to focus on women and ADHD. There's lots of misconceptions. There's lots of, I think, gaping holes in treatment of ADHD. So I want to jump right in and hope this can be a really helpful episode for people who are wondering, do I have ADHD and or how do I treat ADHD? But before we get to that, will you tell us just briefly about your transition or your journey into integrative psychiatry, and what that experience has been like for you changing your model of psychiatry, I know it's been a long time.
Yeah. I mean, I'm not even sure I changed my model, because I went into medical school thinking I was going to cure the world with brown rice and kale at the time, 40 years ago. So I was interested in nutrition, alternative health, and then I came out, you know, nine years later, as a child psychiatrist using medications. And then very quickly realized that medications were band aids. I'm glad I went to training as a physician, but my entire career has been helping educate physicians and clinicians about an integrative and functional approach to mental health and mental illness.
Well, I know you could speak on this forever, and this could be a whole episode in and of itself, but will you just give us an idea? Because when we think about mental health, most of us think about just prescription medications. Will you give us an idea of the difference that you're able to achieve with your patients by taking an integrative approach, and what exactly that looks like, as opposed to just prescription medications? Sure, I make a distinction between integrative medicine and functional medicine. And I think the work that we've been doing is a combination. So integrative medicine looks at adding some well researched lifestyle changes, from mindfulness to sleep hygiene to yoga to diet to all the things that we now know are good for us. I mean, 30 years ago, only our grandmother was telling us, you know, we needed so much sleep and shouldn't eat all the junk food. But now we have the research, and I call that integrative medicine, and that's critically helpful for ADHD and other disorders. But functional medicine, functional psychiatry, what we've been teaching is looking at root cause, looking at underlying nutritional, metabolic, genetic vulnerabilities that either cause the symptoms or exacerbate the symptoms. So it really looks at the individual, and it's a really personalized approach, and I think that's critical,
and you're able to get the same results as when you were prescribing medication, or better, or quicker, or, well, certainly much better. And what I tell every patient is, I haven't thrown away my prescription pad. I'm very confident, if we can utilize nutrition and medicines, I'm confident that we can completely eliminate the symptoms they're struggling with. Some people just want meds, and they could have side effects. Some people just want supplements, and it might not be enough, but with the integrative approach, I'm confident that we can make a huge dent in completely eliminating ADHD symptoms. My goodness, that's a big statement. I love it. I love it. I want to get more into it, maybe briefly. Let's start at the beginning and say, What is ADHD? How is it diagnosed? And is that standard, or is it still a little loosey goosey? Yeah. I mean, I think the challenge is that ADHD is a clinical diagnosis, meaning there's no blood test and there's no great neuropsychological tests. We send, you know, kids to neuropsychologists to do sometimes very expensive testing, and they can say there's a hint of attention, but it is a clinical diagnosis. It's based on a list of symptoms, and those symptoms interfering with functioning, having to do with inattention, impulsivity and over activity. And that diagnosis has changed over the years. Some of the criteria, and that's one of the tragedies, why women have been missed, girls and women have been missed, you know, 20 and 30 years ago. Tell us a little bit more about that, because that's one of my follow up questions. What is the difference between young boys and young girls, or older men and women when it comes to the diagnosis? Well, one thing you know I'll be saying throughout our talk is everyone's different, and we got to keep remembering that. But the kind of general way, if we look at boys, they're typically classic in terms of having hyperactivity, so they're motorically moving and impulsive and inattentive. So those three broad categories, and there are women and girls who have the same symptoms, but there are many women, many young girls, that were missed as kids because they were inattentive and they were impulsive, but they weren't hyperactive, so they weren't noticed by their teachers or their coaches, and so they and they were smarter, so their grades were okay, and they lasted through seventh grade or or middle school, and then it was kind of high school where they the poor attention kind of caught up with them, and they couldn't work up to their potential. So that's the biggest difference early on, not having that hyperactive, impulsive subtype for girls, and the diagnosis being missed for many years. And what does that look like for girls or women, when, when it's starting to have this aha moment of I think this, these symptoms are due to ADHD, what are those classic symptoms for women, you know? What are the things that they're saying they're struggling with, either in school or life? Yeah, certainly for young girls and adolescents, it's inattention, so very bright but not able to work up to their potential at school. So grades start.
To foster sometimes social skills, you know, and not aware of this social cues, interrupting and just frustration tolerance in my world, I've all had this dual career in the world of eating disorders for 25 years, and there's a huge overlap between ADHD and disordered eating. Oftentimes, some of these young women who are inattentive and impulsive,
tend to get drawn to food and then can't control
the impulsive to continue to eat. So very high correlation between eating disorders and ADHD, particularly untreated ADHD, and is that restrictive eating disorders or overeating as well? Well, there's research for both the
restrictive is not not as simple, but certainly for the binge eating disorder and bulimia, there's high correlations with ADHD and then just obesity. If high correlations of ADHD and obesity. So one of the things you're talking about is impulsivity and inattention. Will you take just one more minute and tell us, what does that feel like? Because I think it's a it's a clinical term, but for a patient listening for them to say, ah, that's me. How what does that feel like to them as they're getting older, in terms of irritability or in terms of relationships? Are there, is there anything else you can tell us about that? Well, it's really interesting question, because I think it's important to explain that ADHD is not a feeling disorder. So it depression. You feel sad. So ADHD is manifested in how you behave
and your poor impulse control or inattention. So the feelings are just frustration and then repeated low self esteem because you can't get these projects done. And you know you're as smart as the next person. And then, as you described, irritability, so it's frustration and low self esteem and irritability are great words to describe the feeling state, but ADHD is kind of the behavior and other people noticing, Why are you interrupting? You know, Sally so much. Or, you know, why is it so hard for you to finish your paper,
so that the feeling is just overwhelming frustration and disappointment, and that kind of assault on self esteem is, Am I stupid, or am I lazy? Or what's wrong with me that gets internalized and over years is really destructive and can really start to become part of their identity. You know, they see themselves as this, yeah, and again, since sometimes girls don't get diagnosed for many, many years, it becomes internalized for a much longer period of time than for a young boy who might be quickly taken to the doctor and the there's really dramatic a difference in treatment outcomes. So boys are medicated double and they're given ADHD medicines like stimulants. Girls are very infrequently taken to the doctor for medicine, and they're most often given antidepressants which does not necessarily help, ADHD, right, right?
Is ADHD typically? I mean, regardless of when it's diagnosed. Is it a condition of the brain that is there when they're born and it just manifests at some point? Is it something that we acquire or develop, where it comes on at some point. Can you give us an idea of the origins of ADHD and and, yeah, the origins? Well, if you ask 20 doctors, you might get 20 different opinions, but we can say the science is quite clear. There's a genetic vulnerability, so taking a family history is critical, because genetics are important, and then what happens with that genetic vulnerability really depends on lots of different things, and that's where there's difference. I mean, I can tell you from my clinical work and research that diet will affect the development of symptoms, so someone eating a lot of what we call sugar sweetened beverages. You know, these seven or 10 scoops of sugar in each soft drink, seven or eight of those a day. We know dramatically increases ADHD symptoms. We know iron deficiency dramatically increases lead toxicity, copper toxicity. So the one thing we definitely can say is a genetic vulnerability, and what happens after that really depends on one's environment, and that can change pretty dramatically.
So with that then, is there a point at which if someone develops.
Symptoms of ADHD at a certain point in their life that, based on their history, you're saying, Ah, that's probably not ADHD, even if it's the symptoms. So for example, if a woman says, you know, none of those symptoms really sound like me until I turned 35 or 45 or 55 at what point do you feel like that is ADHD versus probably not. Meaning, does a woman always look back and say, I've had this since elementary school,
not all the time, but often again, depending on how old and what year I mean, I think we're more sensitive to diagnosing women. I probably would say last 10 years, not the last 20 years so 20 years ago we missed a lot, and certainly 30 years ago as much so someone might have not excelled in school and gotten by and and in retrospect, realize when their son gets diagnosed, her daughter that I had ADHD and that might hit them At age 30 or 40, but there are others in their 40s or 50s that start to have the symptoms of ADHD. They're not paying attention, they're not as focused, and they're impulsive, and that's when functional psychiatry is so important. And we look deeper iron deficiency anemia. You know, you treat the iron, and guess what? They pay attention and focus better. Hypothyroid, other metabolic disorders can all look like in intention and poor focus, Lyme infections, mold infections, covid, the flu. I mean, we've all had it, so it's just critical that your physician makes sure there's no other medical causes, nutritional or hormonal. But there are times that someone would first make the diagnosis, you know, in their 40s or 50s.
One of the arguments that I see banding around is, is the
rate of ADHD going up, or are we just better at detecting it? Right? You hear doctors argue about this all the time. No, the rates aren't actually going up in children. We're just better at screening for it, and parents are taking their kids to the doctor for it more so we have it recorded more on records. What is your opinion on that? Is the rate of ADHD actually going up, or are we just getting better at spotting it and therefore counting it more?
Well, I would have to say both sides are right. But my opinion you're doing this for 30 years is that clearly the rates of mental illness is increasing. I mean anxiety and depression. I mean, the use of stimulant medications are dramatically increasing. I mean, so I think our environment, our diets, our lifestyle, everything that's happening is interfering with our ability to focus and sustain attention, as well as other childhood psychiatric disorders, like, you know, anxiety or depression. So I'm quite convinced that more kids are struggling with attention.
Is ADHD, preventable in any way?
I think
treatable is an easy word. And, you know, I'm not sure we need to prevent it, because ADHD individuals have incredible strengths, right? And so that's gets missed sometimes in the conversation, we focus on their inability to pay attention in fifth grade, you know, in a boring subject, but these are often our passionate, creative individuals that you would want on your team if you are hiring, you know, for a job, depending what that job is, probably not accounting, but maybe 1000 other jobs. So I think the real goal is kind of helping parents and spouses and friends understand the individual's strengths and optimize those strengths and minimize those weaknesses, and sitting in a physics class for two hours might not be the easiest for someone with ADHD, but we don't want to prevent or take away the creativity and the passion and the excitement that ADHD individuals bring to the conversation. I love that you bring that up because I think that's so important, and I think it's so easily missed when we're just talking about, you know, kids should behave or adults should behave a certain way. And we often miss the point that the world is built around, you know, brains that work a certain way, right? College is built around it. Elementary school is built around it. We are built to sit in a chair and listen to a teacher talk for, you know, whatever period of time, and then to go take a test with it. And that's pretty unfair, you know, that's just one way of one type of brain working, and doesn't necessarily mean that the right answer should be to make all.
Brains work that way. You know, one term I used many years ago, but I think is very accurate, is someone said, Maybe we should call this disorder variable attention disorder, attention deficit disorder, because some of these kids who can't pay attention in some areas. You know, I've had patients who could sit and fish sit there for eight hours holding a rod, you know, where I couldn't sit for two minutes doing that.
And you mentioned, you know, the educational system, the kids that struggle in middle school and high school, some with ADHD, just excel in college because they're taking courses they want to. Yeah, they're studying geology or dance or things that their brain gets very excited about. But in high school, they were told what to take.
One of the questions I get asked all the time is, what supplements do you recommend? Now, whether this is for daily essentials, sleep support, gut health, what to take during pregnancy. I know how overwhelming it can feel to choose the right products. I have spent hours myself combing through these brands and ingredients, trying to make sure that I can find things that I'm comfortable taking myself and that I'm comfortable recommending to my family and to my patients. I'm then able to get feedback from my patients and family to see, did these supplements actually accomplish what we were hoping that they would accomplish, and this is why I created a curated, full script storefront with the brands and supplements I trust most. These are the same ones I use in my clinic and in my own home. When patients say, what do you recommend for magnesium, or what do you recommend for fish oil or what do you recommend as a fiber supplement? All of these supplements are listed in this storefront. If you're curious, just visit the link in the show notes. There's also a link on our website and through our Instagram account to explore all of my favorites in one place. When you purchase through the link, you get 15% off. Now back to the show well, I want to shift gears a little bit. You have written a book that is so good, and I am. I've I've read it and I've reread it, and I've used it as a resource all about treating ADHD. Will you tell us a little bit about the birth of that book and how that became a passion of yours, and then we'll dive into a little bit what's included. Sure the book is finally focused, and it's material I've been using in my practice for almost 30 years, but much of it was not supported by double blind, placebo controlled research, so I didn't put it on paper. We gave lectures and we treated patients, and there were colleagues around the country doing the same thing, and I remember giving my first lecture in the 90s where I had to say there was no evidence that sugar sweetened beverages affected behavior, because that's what the research showed at the time. But now we have clear research. So number of years ago, we had enough research for me to support telling parents that there are paths looking at nutrition and a diet and lifestyle to treat ADHD symptoms. So that's why we waited. We had the research, and we're coming up with a second edition with even more research than all done in the past year to support some of these very simple concepts with profound implications. And before we go further, you are you mentioned you're a child psychiatrist. Tell us about your experience with treating women. I just want to preface that. You know, we're going to be talking about this as at ADHD in children a lot, because that's where we see it diagnosed, but that these treatments you're talking about also apply to adults and women and anyone else who's diagnosed at any point. Absolutely. Yeah, no, my work has been with adults in hospitals and residential and outpatient settings. So we treat adults. The book was written for parents. The new edition will have a separate section on adults, but everything we talk about can be utilized by adults. Awesome. Thank you for that. Now the book is laid out in what you describe as a plus minus approach. Will you tell us what that means? Yeah, sometimes it's overwhelming to think of
biochemistry. And now people on Tiktok and social media, everyone's talking about different vitamin and mineral and as a parent or as an individual looking for help, it's overwhelming. I mean, it was overwhelming 20 years ago, and I think it's even more so now and then you see patients or individuals, you know, just buying every supplement they hear about, and they're walking into my office with a shopping bag. What do I do? So we just outlined the book and called it the plus minus plan, just as a way to help individuals remember there are things you want to add and things that you need to subtract.
Right? And the only way you're really going to know is is testing, and every ADHD adult is different.
Now, if someone, a child or adult, feels like they they probably have ADHD, or they've been told they have ADHD, you lay out in the book. And I think in your practice, you kind of start everyone in a similar place, is that, right? Well, because it's really focused on a personalized approach, I wanted a few things that everyone should take. And I start the first chapters on magnesium, and there's some research, not a lot, but my clinical experience is the vast majority of adults and kids with ADHD are deficient in this mineral. I actually believe that there's a genetic vulnerability to have a higher need for magnesium, and so that is the simplest, safest place to start for any child or adult with ADHD, is understanding how to supplement with magnesium.
And then you kind of marched through in the book, and we won't go into too too much detail, but you lay it out so nicely in the book about what tools can be beneficial. And then the data behind it, you talk about magnesium, and then copper and zinc levels. Will you tell us a little bit more about OPCs? I think that's something that most people are not familiar with, yeah, and that's another thing that we try to talk the beginning, and I talk a lot about because someone walked into my office when I opened a practice and said their daughter got better with this, these supplements. And at the time, I was doing EEG brainwave neurofeedback. So we tested her and other people and found it to be incredibly helpful. So the OPCs, oligomeric pro in cyanidins, I'll only say it once. We'll just say OPCs. They're just the things we're all reading and hearing about that are good for us. So it's the blue and blueberries and the grape seed and the pine bark and the red wine extract and green tea and curcumin, these very, very bright colors in nature that protect the plants have incredible benefits for brain health, and they're actually shown to kind of decrease dementia in adults, and just help individuals pay attention. So we use extracts of combining this, grapes and blueberries and pine bark, high concentrations of these chemicals, and they just help people focus and pay attention. And I love that you talk about combining because I think a lot of people have heard of curcumin, and they buy it at Costco, you know, this giant bottle of turmeric, or curcumin, and they've heard of resveratrol, which is one of them that you're talking about. But will you tell us about that interplay between them, that some people may do better with one of them, some people may do better with another one of them, but it takes us a lot of time and work to go through each one of them and figure out what's best. So by combining them, we really get to hit more more opportunity there. Yeah, over the years, particularly in the 90s, where we're doing the testing, we just found that the combination of products, people just did better. And so over the years, I've used two or three different combination products, because if you just take one of them, it's unclear if someone's gonna pay attention. But the combination products, and we don't quite understand the physiology, they are all slightly different. They work a little differently, but combination products have been much more helpful in my practice and and feedback from patients. Yeah, I also wanted to ask about this idea of nutritional lithium. So this is something that I think sounds very scary to people, because they hear lithium and they think bipolar prescription medication. This is something that that I know you've used widely in your psychiatric practice, will you tell us about this idea of nutritional lithium? I think most people have not heard of that. Sure nutritional lithium, tiny doses, the amount found in our food supply are now in supplements and probably one of the most helpful tools I've used for ADHD, particularly for those symptoms of irritability and impulsivity.
And I will say, and this the first time I get to say it in public, that yesterday, multi year study from Harvard Medical School, published in the most prestigious journal Nature, just came out. I don't know if you saw it, discussing lithium orotate and the prevention of Alzheimer's, something that we've been talking about for 25 years, but now it's all over the news and a major headline. So it's very exciting that the research is supporting something we've been talking about for a long time. This.
Low dose lithium orotate as critical important for brain function, decreases inflammation, actually helps the brain grow, and that research was just incredibly well done in a multi year trial from Harvard Medical School just published yesterday. Oh, I love hearing that. Will you spend one more minute there, because this is something that you have used also in depression, and as you mentioned, dementia. Will you explain a little bit more about lithium, where it comes from? I know in the past, you've talked about soil supplies or water groundwater supplies, and how they can actually track with a map those areas that have lower amounts of lithium in the soil or groundwater and the coordinating amounts of mental health illness, sure. I mean, we have a book on lithium and lots of courses. The short story is, Lithium has been around on this planet from day one.
Right? We all know zinc, or is it before
one of the first three elements in the Big Bang, the formation of the universe. So when the earth was formed, lithium was here. It's in our water supply, and it's critical for brain function, and it is not the same lithium that we use as a prescription medication. That's what people get nervous about. If we're talking about nutritional lithium as a couple two milligrams, if we think of a prescription medicine for bipolar disorder, it might be 1500 milligrams, and that has side effects, and that is something we only use for severe mental illness, but the low dose nutritional lithium that you can buy over the counter has really significant effects for particularly irritability associated with we use it for autism, ADHD, depression and impulsivity. We use it with eating disorders. Depression and addiction is probably one of the most significant uses for low dose nutritional lithium. Well, that's so good to hear is there, Are there risks with taking low dose lithium like that, two to five milligrams you're talking about. I mean, the two milligrams is the average that many of us would get in our diet, you know, particularly if we're drinking tap water, because lithium is mostly in our water supply, so I see no risk. I've seen no side effects on the two milligrams. As you begin to increase the dose, 510, 20 milligrams, it begins to have potential, you know, for maybe the only side effects I've seen over the years is things like getting a headache or getting a little tired. One patient said they felt too calm, but these are very tiny amounts of
a nutrient that research has now demonstrated is essential for brain function, and as levels decrease, it makes us higher risk for dementia and Alzheimer's. I just want to take a slight aside, because it's so interesting to talk about this. When we talk about mental health and labels, right? Depression, anxiety, dementia, ADHD, autism, we talk about these labels, and it makes us feel like the brain is like taken out of the body and over here on its own, with its own little labels, but actually the brain is part of the entire function of the body, and so this is just a nutrient you're talking about that really changes the function of the brain, that manifests in different people in different ways, but it's still just, it's just a function, a Need that's not being met, that results in a symptom, just like if I don't have enough iron, I might feel dizzy if I stand up too quickly. If you don't have enough, in this case, lithium, or you mentioned earlier, iron, your brain may not work the same way. Absolutely, I have a slide I've been using recently. You know, anatomy for psychiatrists. You know, we have a neck. Everything that you know happens in the body affects our brain and vice versa, we have, yeah, appreciate that when we're treating patients with a mental illness, and that's really where you get those better results, is when you realize that, I think the pharmacologic world is looking for the one little disconnect, right? They want to find the pharmacological
tool that's going to get into that one little spot and turn that one lever, but actually the brain does best when we turn all the levers in the right direction, right absolutely. And our current model is just symptomatic based care. We're just using a medicine to treat a symptom with no concept of what might be causing that. I mean, in medical school, we might learn 15 things that could cause depression sadness, right from low thyroid to cancer to B 12 deficiency. But we forget that when we're in practice, we just think it's a Prozac deficiency.
And prescribe a medication. Yeah, yeah, exactly. Well, take us through. Are there any other I can list them here, but the other pluses that you talk about in your book, The thing I'll just kind of list a few of them here, you talk about probiotics and digestive enzymes, making sure that you have essential fats and vitamin D, omega threes, protein and blood sugar regulation, and then sleep, exercise, mindfulness. And then there's one more I'm going to come back to. I love that you lay it out in this way, because these are not big, scary things. All of those would seem normal to us. How do you see this actually playing out in practice when you start adding these things in? Do you see them get better within a week or two weeks, or three months or six months. You know, it depends on what we find. I mean, there's certain things helping parents appreciate that exercise and walking in nature, and even mindfulness will help improve attention. Sleep hygiene is critical. But for some of the other things, it depends if we have a vitamin D deficiency that responds very quickly, if we have elevated copper that can take, you know, three or four months. So it really depends. But I think the important part is, if we look at the entire plus minus plan, we have a roadmap.
We have many things that are just going to be part of the trip. We're going to take with us, and then we're going to find if there are particular deficiencies. You mentioned probiotics. And for the second edition, I mean, in the past year, the past 12 months, must have been 20 or 25 new articles looking at the role of the gut and ADHD, so it really is a growing area, and we can test for some of these problems, but certainly understanding where probiotics fit in has been really helpful for many ADHD patients.
And I love in your book, because you do go into specific examples of products that you like, which is important, because a lot of people, if they try to DIY this, that there are countless numbers of probiotics, and they're not all created equally, and they're not all all beneficial. Is there anything you want to add about that? No, it's really important. And I went back and forth recommending supplements, not but there's some. There's no regulation in our industry. If you go to the drugstore and you pick up a bottle of vitamin X, you have no idea, if anyone has tested that there really is that amount on the label. And we know, if we go to these consumer report websites, they vary. It might also 10 milligrams, and some bottles might have zero and some might have 100 Yeah, so it is important that you go to reputable companies. So that's why I have listed supplements in the books, just to guide parents and individuals to know some of the higher quality companies, which really is one of the benefits of learning from a practitioner, a clinical practitioner. I think there's a lot of influencers out there, and even other healthcare practitioners that may not be fully licensed. You know who? Who will recommend things based based on, quote, unquote, a study. And the study will be like in mice, this one molecule showed one improvement in symptoms, but to actually take the advice from a clinician who said, I've treated this hundreds of times, 1000s of times, and this is what I see that should be how we do things, that in the conventional medical world, that is how we try to do things. But of course, we like to do it when it's published and and some of these things just don't get published in the right ways. So to learn from a clinician who can say, this is what I do, and this is when it works, is I as another clinician, I really value that, so I appreciate you sharing that so openly. No, very important. I'm glad you said it. It truly is amazing to me. How many of us will buy a product it says, focus on it, and we just assume it's, you know, legitimate. It's the right doses, yeah, and you're absolutely right. People just take a research article that might have used 100 milligrams, they might put one milligram in the bottle and try to sell it to you, and it's just, it's a tragedy, and people are wasting a lot of money, and there's lots of very effective marketing out there, so it's, it's easy to kind of be sold on that, and you hear other people's good experiences, and that's honestly the best information you have. You don't, you don't have anyone else to ask, so you just take the advice of Instagram. But I'm glad that we have have advice from you. Now, that was one of the questions that I wanted to follow up with is there are so many combo supplements for ADHD, you know, ones that have saffron and ones that have all of them, Bacopa. And you know, all of these combo supplements that will say, This is what's going to help your brain, whether it's cognitive health or focus or, you know, I think they're careful to not say, ADHD.
But they'll say attention or focus. What are your thoughts? Do you like those combo supplements? Or, I mean, I can kind of assume your answer. Or you think you should kind of go by these more well studied individual elements? Well, I mean, over the years, and these were, I think, 10 years ago, I formulated two combination supplements because I was giving patients 10 pills, and these kids couldn't do it. And one is
tyrosine precursor called dopa plus, so instead of medications, and then another one is in the OPC product, so mixing the OPCs based on what we got the best results with. But other than those two or something similar. I don't
like combination products because you really don't know what's helping and you don't know what the side effect is going to be. So, I mean, I like saffron, but I'd rather not be with seven other, you know, supplements. I like Bacopa, I like magnesium, I like zinc. I mean, all these things I would like as a physician to be able to give to those individuals that need it at the doses that I know, and if there's a problem I would know by using individual supplements.
I'm often asked exactly what items I use and recommend. So I have a little gift for you. I have gathered my go tos in one spot on our Amazon storefront. If you need deeper sleep, you'll find the light blocking sleep mask that lives on my nightstand and that I use every night. If you're working on your bone density or your posture, check out the weighted vest I recommend for walks and workouts. We've also added the magnesium body lotion I reach for to calm the nervous system, my favorite laundry soap and cleaning products, and even the cast iron skillet that's currently sitting on my stovetop. All of these and more are organized by categories, so you can browse trusted products without the overwhelm of trying to figure out what's the best thing to buy. You can head to amazon.com, backslash shop backslash uplift for her, or tap the link in the show notes, or from our website to explore the items I personally use and love. I hope this makes your life just a little bit easier. Now, back to the show. I'm glad you say dosing. You mentioned it before, but I think a lot of people will say, Oh, I heard curcumin was good, and they take a supplement with curcumin. And I just want to re emphasize that you got to look at the dose and know what dose you're going for, because so often those multi even a multivitamin or a combo. When people come to me and they show me their supplements, when I go through it, it's like you're hardly taking anything, like you're taking a lot of very little, but none of it is targeted. So understanding what dose you're taking is is really key. There one of the pluses. The last one we skipped was neurotransmitter precursors. Will you take us down that road a little bit in what are neurotransmitters doing in ADHD, and how taking some of these precursors can be beneficial? Sure, and that's that dopa plus supplement I mentioned. So when you take a medication. The medicines that are helpful 90% of the time are the stimulants, amphetamines, and they have potential side effects, and they only help when you take in the medicine you stop ADHD comes back, and what they do is they kind of increase dopamine and norepinephrine in the brain. And we have research gone back 30 plus years that we can also increase dopamine and norepinephrine in the brain by the amino acid precursor, the building block to that neurotransmitter, and that is something called phenylalanine and tyrosine. So by taking those amino acid precursors with the nutritional co factors. We can improve attention. We can improve impulse control. And for some individuals that have side effects with medications, this can become dramatically helpful. Other individuals trying to get off medicine, or families that just don't want to use medication. So we're looking at a similar mechanism trying to support dopamine and norepinephrine in the brain by using the molecules that the body builds to make dopamine,
and so are people with ADHD. Then, do their brains require more genetically or why? What is the deal with neurotransmitters in the brain of a person with ADHD, there's probably lots of mechanisms that have to do with
either requiring more the receptors not working efficiently, or the, you know, requiring the stimulation. So there are many, many kind of abnormalities that scientists have found. There's not one that means you have ADHD. There's probably many related to, you know, sustained attention and focus, related to dopamine receptors and metabolism in the brain.
So along those lines, then one of the things that you mentioned in your book is and you.
Talk about it several different times, but is how long to stay on these things, right? So some of these you'll be on forever, and others, you correct an iron deficiency and then maybe go off the Iron Will you talk about why? If you find a set of supplements that's working for you. So you go through your plus list and you've added, you know, five out of 10 of them. How do you know at what point you stop it, because you've replenished it, and it's good to go versus you have a vulnerability or a, you know, higher need genetically, and this is your regimen for life. Yeah. I mean, I think that's very individualized. And, you know, if, and the way the book was written for many of these parents and kids who that were eating a standard American diet, and you know, the Fruit Loops and the Twinkies, and hopefully over time and profoundly nutritional, deficient and malnourished over time, as diet gets better and sleep gets better, they might not need all the supplements. I think most of these kids will benefit from magnesium, B vitamins and essential fatty acids for as long as they're able to continue to take them. Now, someone who's eating fish every day probably doesn't need to take omega threes. Someone who hates fish would benefit. And again, depending on the quality of the diet in the house or what happens. It really varies. There are some supplements that we're just repleting, like iron deficiency and others that might be more maintenance, and I would use those as the omegas, the B vitamins and the essential fatty acids. Okay, now the next part of the book you talk about, we're going to just go through quickly, because I want to spend a little bit our last few minutes on women specifically. But in that minus category you talk about, you want to take away any intestinal imbalance or gut issues, food sensitivities and allergies, sugar sweetened beverages, anything you want to say about that. Otherwise, I'll just leave it to your book that explains it so well? Yeah. I mean, I think
both adults and kids with ADHD not discussed enough, tend to have blood sugar abnormalities, you know, not necessarily diagnosed, but they they don't respond. So the increasing protein in the diet and limiting Ultra processed foods and the refined carbohydrates will benefit everybody with ADHD. And sometimes that can reflect right as like being hangry or being super irritable, either with sugar or without food, right? Is that kind of how you're seeing that? Yeah, and there was some research done at Yale a number of years ago that demonstrated the ADHD kids that their hormones were
not responding the same way as non ADHD kids, causing that disruption and that angry feeling. Is
there anything you want to add speaking to specifically adult women. I mean, you mentioned that all of these steps would be the first thing that you would take anyway, doing testing and adding in and subtracting these other things. But is there anything else you want to add about ADHD in adult women?
Yeah, well, sure, first of all, it's treatable, and if it's new onset, then look at the cause, hormones, nutritional deficiencies. I can't tell you how many times I've seen celiac disease go undiagnosed, and it might just occur at age 30 or 40, and ADHD symptoms could be one of it. So go to a functional doc and get that testing. It's critically important. And the second thing, after you have the testing, if you're still struggling with symptoms, I would recommend two things quickly, the OPCs, the OPC product, the curriculum, Sorb mind and the herb Rhodiola. So the combination of those two has been just kind of this magical, quick, you know, within a couple months, people noticed a dramatic difference, but not one on one. I have found no, what do you mean one on one? Well, doing just rhodiola, I haven't seen a ton of magical results with that one. No, no. So the OPC, so the Kirk himself, mind with Rhodiola? Yeah, can be very helpful for some adults with ADHD. Not for how much Rhodiola? Do you recommend I start with 100 and go up to 300 Yeah, yeah.
One of the other things that I skipped over, but I think it's really relevant here, is the conversation about stimulant medications. So in in your clinic, typically, you'll do everything else, and then you'll still visit the idea of stimulant medications, if possible, speaking in this case, specifically about adult women. What are your thoughts about using stimulant medications?
Them. Yeah. I mean, let's start with kids or adolescents or college or grad school. I mean individuals struggling with ADHD symptoms, and, you know, don't respond sufficiently to the nutritional approach. No problem with stimulants. When I get a 50 year old women I was treating her daughter and did well with stimulants. And the mother took a stimulant and felt,
wow, I got my work done better. But this person was a successful business owner, lawyer, you know, very organized. I just don't find stimulants to be something that I would prescribe, but, but someone who's really struggling with ADHD, then I think medications are absolutely an option at any age, and there are many options, yeah, how much do you think just all of us would feel better with a stimulant medication like the reason I ask that is, if you give someone you know they're struggling, they're really having a hard time, and you give them a stimulant, one of The questions that I have come up from them is, from them is, does that mean for sure that I have ADHD if I responded well to the stimulant, or does everyone just feel a little bit better with that stimulant? Well, take away your morning coffee. Yeah, no, absolutely. Most people will feel better on amphetamine. These are amphetamines. You're going to focus better. You're going to pay attention better. You're not going to need as much sleep. You're going to get the paper done more quickly. Your project work. I mean, you know, they give it to pilots say people abuse it for lots of reasons. So feeling better on amphetamines does not mean you have ADHD. Most of our ADHD patients actually don't like, you know, to be dependent on it, and so they don't get that supercharged feeling. But having a positive response to a stimulus does not mean you have ADHD. So what would you say to a woman who, because, again, a lot of my patients are after having babies, so anywhere 35 to 55 right? And a lot of them will come in and say,
My child is being diagnosed. A lot of these symptoms apply to me, or my brain is just not working well. Could it be? ADHD, what would be your guidance to them to figure out next steps? Because I think in some ways, getting the diagnosis can be helpful. But in on the flip side, you could say, just make your brain work better, period, and don't worry about the label at first. What are your thoughts about that? Yeah. I mean, particularly around the perinatal issues, there's so many zinc, copper challenges with women that affect attention, iron. I mean, all the things we've talked about, so I would just strongly encourage that those get addressed first, and the label to me would really be dependent on, did I struggle early on? And it might not have been grammar school, but it could have been high school or college. You know, if those issues have been present for 10 or 15 years, then ADHD likely is part of the kind of package and should be addressed Absolutely.
If someone you're I'm talking to an adult woman, she says, Nah, that doesn't really apply to me in the past, just my brain is feeling fuzzy. It's hard for me. Women call it brain fog, right? It's hard for me to remember, like, Why did I come in here? What do I do?
There can be this early stage where it's like, is that ADHD? Is it perimenopause and lack of estrogen? Is it, you know, early cognitive changes? What are your steps to help women get better to figure out what, what to do next. Yeah. I mean, a good, functional psychiatry workup would assess all those, yeah. And I could, you know, beyond the ADHD book, we have books on depression and all these other things like we could add, you know, I think there were 250 biomarkers that we might look at to help someone sort through, you know, what might be contributed to that brain fog, to not feeling as good as you did 10 years ago. And usually we find something, if not many things, that could be contributing. So my recommendation is a good functional psychiatry workout. Yeah, and I love that you say that, that we may find many things. I think that's one of the things that's frustrating when people experience the functional medicine world after being used to the conventional world. Is in the conventional world, even though it's annoying, you go to the doctor, they find one problem, they give you one pill, and you go home, right? Your blood pressure is high. Take the pill. You have depression. Take the pill. You have ADHD. Take the pill and like, that's not great, but it's very simple. You know, it's very it's one step. You came to the doctor, you take the pill, you go home. And when we get into functional medicine, it can be quite a shock to people. They come saying, I want this holistic experience. I want you to look at my whole person. I want you to find all of the root causes. But there.
Usually is more than one. You know, oftentimes we'll find gut imbalance and vitamin D deficiency and iron deficiency and celiac and and and and and and and it can take a really layered approach to get better. It's worth it, but it's helpful to set that expectation of this is not going to be a one thing that we find and fix it? Yeah, a lot of it
stems to with digestion. And as we get older, less acid and digestive enzymes. And we talk a lot about this in depression and that deficiency in digestive enzymes will create, as you just described, multiple nutritional deficiencies, but if we fix the digestive problem, recovery is just much simpler. Yeah, I find that as well. It's it can be tricky to convince people to take digestive enzymes, because magnesium, for example, if you give it a little while, they'll start feeling better. Digestive enzymes, I find some people feel way better, but some people take it on faith, like my doctor told me to take this, so I'm taking it. I don't know if it's doing anything. Has that been your experience as well sometimes, but I think the right digest enzymes, particularly with hydrochloric acid, yeah, exactly for the right individual. And so we would be testing to see if they need it. So that really is the goal. My last question for you is, and this is probably too long of a question, so maybe you can give us categories. Is, what kind of functional testing are you doing for a woman, you know, adult woman who feels like she's done the questionnaire and done the initial stuff, and it feels like, Yeah, this is ADHD for me. Can you go through that work up at all quickly?
Yeah. I mean, we actually just working with a laboratory, DHA labs, and they have all the testing there, so it's in one spot, so it might be under psychiatry redefined labs, or James Green lab. So you know, we're looking at amino acids and fatty acids and lots of nutritional deficiencies like B 12 and vitamin D. We look at crypto pyrrole, which is an organic chemical that takes b6 out of the body.
So it's a lot of tests, many are bundled to make it easier, but if someone hasn't gotten better with a simple intervention, in my experience, it's just much better test for everything upfront, we know a really what the personalized treatment path would be for that individual, rather than taking years and going to different doctors and, okay, I'm going to do this test, then you go to this specialist who does this test, and you struggle for too long. Yeah, exactly. Well, the last question I'll ask is just any parting kind of conclusions that you would say for women with ADHD that either we haven't covered or that you want to reiterate,
well, I mean, the most important part of any discussion that I have is that everyone's different, so you might have the same symptoms as your best friend, you're not paying attention, you're focused, and that individual might Have a B 12 deficiency due to celiac disease and your symptoms might be related to something completely different. So really, the most important thing I can share as a functional psychiatrist is that individual difference. We can look at each other and see the difference. We know our lives are different, but sometimes we forget our biochemistry is different, and that's really important in making a treatment plan that's going to be effective for you.
Well, thank you so much for being here. I think this is such important information. I'm so grateful to you for writing this book and your other books. I think it your style of writing is very straightforward and very approachable and scientific enough, but not overwhelmingly scientific where you can't follow it. So I would encourage anyone interested to check out your book. Finally focused. It's it's really so well written. If you have a child with ADHD, or you yourself are struggling, will you share with us where people can find you or resources? I know you have a lot of resources, not just through you as well, that that you offer patients with mental health. Sure my work and my books and
clinic I'll be working with will be on James Greenblatt, md.com,
and then my educational platform for professionals want to learn more. Is psychiatry redefined.org?
Wonderful. It's It's so good. It's so well done. So thank you for all of your work, and thanks for sharing your time with us today. Dr Greenblatt, my pleasure. It's great to be with you. Have a good night. You too.
Thank you so much for tuning in to today's.
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