The Melanie Avalon Biohacking Podcast Episode - #375 - Dr. Jolene Brighten

TRANSCRIPT

Jolene Brighten
Untreated and unmanaged ADHD could cost you 10 years off of your life. We understand that ADHDers are at much higher risk for accidents, for example.

It's not that diet causes ADHD, it's not that it cures ADHD, it's that it influences the symptom expression. And in fact, the research tells us that perimenopause has about twice the symptom severity in the ADHD woman compared to the non-ADHD woman, and it may come 10 years earlier.

Melanie Avalon
Welcome to the Melanie Avalon Biohacking Podcast, where we meet the world's top experts to explore the secrets of health, mindset, longevity, and so much more. Are you ready to take charge of your existence and biohack your life? This show is for you. Please keep in mind we're not dispensing medical advice and are not responsible for any outcomes you may experience from implementing the tactics lying herein.

So friends, are you ready to join me? Let's do this. Welcome back to the Melanie Avalon Biohacking Podcast. Oh my goodness, friends, what a fascinating, enlightening, eye-opening conversation we have today with the legendary Dr. Jolene Brighten. I know you guys know who she is. She's been on the podcast before for her book Is This Normal? And of course, she is also the author of the legendary Beyond the Pill, and today she is here for a super paradigm-shifting episode on all things ADHD and women. I personally do not have ADHD. I don't even know what that experience is like, and reading this book was so eye-opening for me, especially because this disability affects so many women. Even if you don't have ADHD, so much of the work in this book is so applicable to optimizing women's hormones in general. Like Dr. Brighten says, the time of perimenopause is kind of like a time where women can experience what a normal day in the life is like for a woman with ADHD. I cannot recommend this book enough, and in today's show, we talk about so many incredible topics, including the similarities between ADHD and autism, what it's like to be neurodivergent in general, the different types of ADHD, how stimulant medications affect the brain, why people with ADHD get bored, seek novelty, and may love kinky sex, the role of dopamine, estrogen, progesterone, and especially testosterone, three incredible super foods for ADHD, how you can shock yourself with a sour taste, the utter exhaustion of masking yourself in society, and so much more.

The show notes for today's episode will be at Melanieavalon.com/adhd. Those show notes will have a full transcript as well as links to everything that we talked about, so definitely check that out. I can't wait to hear what you guys think. Definitely let me know in my Facebook group, IF Biohackers, Intermittent Fasting + Real Foods + Life. Comment something you learned or something that resonated with you on the pinned post to enter to win something that I love, and then check out my Instagram Find Me Friday announcement post, and again, comment there to enter to win something that I love. All right. I think that's all the things. Without further ado, please enjoy this fabulous conversation with Dr. Jolene Brighten. Hi, friends. Welcome back to the show. I am so incredibly excited about the conversation I'm about to have. It is with a legendary guest, a repeat guest. I'm here with Dr. Jolene Brighten, and she is the author of books that I'm sure many of you guys are familiar with, so Beyond the Pill and Is This Normal?, which is what we talked about last time.

Melanie Avalon
And she has a new book coming out, actually, like, right when this airs, I think. I think ... Yeah, I think the day ... No, no, no, 'cause it comes out on the 6th. It c- comes out around the time this is coming out, and the book is called ADHD and Women: A Guide to Optimizing Your Hormones and Thriving with ADHD.

And friends, so the backstory on this conversation, when I saw that Dr. Brighten was writing this book, I was so excited because it's a topic ... I love when there's a topic that I know relatively very little about. So, we can talk about this. I feel like I'm the opposite of ADHD, especially, like, going through the book and reading, and, like, the quiz to figure out which, which type you are and how it manifests, and the symptoms, and what that experience is like in your head. It's so different from what I have experienced in my life. And so I hear this word, ADHD, and I'm sure we'll talk about the role of it in society, and what it actually means, and do we over-prescribe it to people. Um, Dr. Brighten mentions how people in this world will say, "Oh, everybody's a little ADHD," but it's an actual, it's an actual diagnosis. Now I feel like my eyes have been opened about, A, what this actually is, the symptoms, how it functions in the brain, the different ways that it manifests, how it overlaps and, and can get confused with other neuro- neurodivergent disorders.

It's just given me a whole new perspective on, on myself actually, and my friends, and all the people who experience this. And the book is such a deep dive, friends. Oh my goodness. So we're gonna talk about the role of neurotransmitters and dopamine, and the, the different life stages, and the experience of a woman having ADHD in this world, and the, and the stress of that, and how, how it can lead to different habits and different behaviors and, and most importantly, how to have your ... I mean, like it says, how to have your best life and thrive with your ADHD.

So I have so many questions. I'm so, so grateful for this work. Dr. Brighten, thank you so much for all that you do, and thank you so much for being here.

Jolene Brighten
Thank you so much for reading the book. It's like an author's dream when you get on a podcast and someone's like, "I've actually read the book," and then you're like, "Oh my God, okay, I'm gonna get, like, real-time feedback." But also, you know, you put all this stuff in the book, and you think, like, "I've answered all the questions," right? But then there's more questions, and I get an opportunity now to answer it essentially from a reader.

Melanie Avalon
Oh, I am, I am so excited. Yes. I, I love this so much.

And I mean, that's a whole tangent about I feel like a lot of podcasts, the avenue don't actually read the book. But no, I, I love this. And, and like I said, I just wanna emphasize because I ... The word ADHD in society, I think, especially because I don't personally experience it, at least not the, definitely not the, you know, diagnosed form, it's such a- Like broad, casual word that we just throw around. So to like experience this through the book myself was just so fascinating and eye-opening. Like I, I really, really enjoyed reading it. To that point, I think everybody can benefit from reading this book because, well the, the lifestyle habits and the, and everything that you apply is applicable to, to anybody and then on top of that, like I said, it, it just gives you a whole new lens if you don't actually have ADHD. Which to that point, okay, so, so your story. So you actually identify as having, you- like you called it, I, I haven't said it out loud, O- O-A-D-H- A-U-A-D-H-D? Like the, the combination of autism and ADHD?

Jolene Brighten
AuDHD is how people say it. It's not a diagnosis, it's just like, you know, a, a combination of two conditions. Like we, we smash it together 'cause we l- wanna say autism and ADHD, so we're just like AuDHD.

Melanie Avalon
Okay, okay. Yes. AuDHD. Love it.

So your story. What has been your experience? When did you realize that you, like what you... Uh, do we say like, what's the terminology, that you have this? Um, I don't wanna make it sound like a negative thing. When did you realize where your brain fell on the ADHD spectrum, and what ha- what has it been like with that experience and what made you wanna write this book today? And um, and also just like the history. It's fascinating that, like with, with, with what you just said, that AuDHD, that um, in the past, like women couldn't even get simultaneously diagnosed with ADHD and autism, so you said like so many women would just be told that they were like one or the other because, um, they couldn't get both at the same time, which is fascinating. So your personal story. What, what happened?

Jolene Brighten
My children were a mirror, like many, many women. And so what was interesting about my journey is that all of this came about in my 40s, but there was always like this like knowing that I was different, that I was working harder in some ways and looking at other people and trying to understand why, why is it so easy for them? Not understanding why it was no matter how hard I worked in relationships, I kinda like got excluded from things, left out from things, or people would say things about me like, "Oh," like she's, you know, she's trying to gossip about someone because I would ask all these clarifying questions about an interaction that I had and to like another friend. So for example, like one friend would do something and I would not understand the interaction and so then to a, a mutual I'm like, "Can you explain to me what's going on?" But then that would be perceived as like, "Why are you trying to like talk smack on that person?" I'm like, "No, I'm trying to, trying to understand because I cl- I clearly don't understand." So you know, for me there was that feeling throughout my entire life, but I, I really didn't realize that how different I was until I entered into my 40s.

I first get a diagnosis of endometriosis. Weird, 29 years of menstruating and nobody thought to check me for endometriosis. Fun times there. And then I get this diagnosis of ADHD in the same way a lot of women do in their midlife in that their child's being evaluated, through the evaluation they see themselves. Except that I started bringing up to, I started challenging the psychologist of like, "No, of course this isn't normal. Like I do this too." And not because I'm like, "Oh, you're wrong," but because I'm like, "No, how could this be abnormal about my child when I also do this?" So first was the ADHD evaluation, which didn't totally feel like it fit, and then, you know, until I get into my luteal phase, and we can certainly talk about that, then there's no denying my ADHD. Like, like Lord help me, I started a Substack the day I was supposed to start my period because I just had thoughts, I hyper-focused, I wrote 'em down, I published it, and then I didn't realize that like, oh, Substack's like this whole thing and it has like 30 steps you have to do before you should publish, and like so ADHD. But you know, through all of the evaluations it was like this doesn't quite totally encompass what's going on for me. And I do have to share that last weekend I was with a group of clinicians and one of 'em said to me, she evaluates people for ADHD and autism, and she was like, "So you wrote this book on ADHD, and I can see that you say you're ADHD, but like are you sure you're not also autistic?" And I'm like, "I am 1,000% also autistic." And she's like, "Yeah, because I can just see how when things were not going to plan how like you, you started to have like this freakout, but then you were like deep breathing and you were do-" I was like, "That's very observant of you," because yes, I'm very- I very much like a plan and I like the plan to be executed a certain way.

Jolene Brighten
So that's how it went for me. And you know, for me when, when it was like, oh, you- you're autistic, I, I mean it was, it was two things. It was like one, I cried because I was like, "Oh, my God, like this makes so much sense." And like fo- so much grief just came flooding in because like what could my life have been if someone had seen me a lot sooner?

And then there was just this other side of me that was like, "Well, wait a minute. I was taught in medical school that only boys were autistic and that like autism was just like only this certain thing," and I, you know, I really had to wrap my mind around the fact that like yeah, like- The, this is a true diagnosis, and I think a lot of people who don't know me very well, like, they're like, "No, I see you. You're super verbal. You're speaking on stages. You're doing all these things." But they don't ever see the other side of it. And as one example I'll give is that I spoke to... I, I spoke on a stage. The next day I signed books. I spoke to probably 300 people, signed all these books, and by the end of the day, like, I was not functional enough to get on my plane, and my husband was there with me, and he was so concerned that he's like, "At the next event, I'm coming because I don't think you could actually make it home," because your n- whole nervous system just starts shutting down, and you go non-verbal. Which I should say is I go into a verbal shutdown. That's more of, like, the accurate, 'cause I'm not a non-verbal autistic, but it's a verbal shutdown. And so even, like, at the airport, TSA is talking to me and I'm just like, "I can't, I... My brain can't physically make the words come out of my mouth right now."

Melanie Avalon
Wow, okay. So many things.

So with what you just described, like, like, that response from shutting down, so is that attributed to the... Like, what is the overlap between the autism versus the ADHD and for, like, all of the, the different experiences that you just described?

Jolene Brighten
Yes. So that is such, like, a sorting of baskets there. It's funny because I was watching these creators today, Rich and Roxy Pink. She's ADHD, he's autistic, and they're like, "Oh," like, "the autistic needs to have, like, you know, total silence in the room, like, needs no sound, doesn't want any stimulation. And then the ADHD brain wants to have, you know, music playing and background noise to be stimulated." So just as one example.

These are polar opposite experiences, and yet it's happening in my brain and at different times. And so there are times where it's like I absolutely need to have music playing so that I'm motivated and I'm doing things and I'm feeling good, and then at other times I can't have any sound coming in whatsoever, and I've got a... I'm under a weighted blanket. I- I'm so sorry. My computer just dropped. I was talking with my hands so animated that I just slapped my computer.

Melanie Avalon
Oh my gosh, I love it. Is it okay?

Jolene Brighten
Yeah. It's okay. I'm like, oh my God, thank goodness my husband's not here 'cause he's always like... So that's, like, such an ADHD clumsy thing.

Melanie Avalon
I know. We're gonna keep that in.

Jolene Brighten
You can keep it in. Um, so the lack of spatial awareness and understanding my body in space, this is why so many ADHDers are, like, constantly covered in bruises 'cause we're, like, running into a wall. But also I'm, like, so engrossed in, like, in my head seeing this story of other people taking place that, like, now I'm not paying attention to where my hands are. And like, you know, as I say all this stuff, I just want people to know that, like, you can be neurotypical and have really similar experiences.

I think, you know, I like to say that perimenopause likes to cosplay as ADHD, and it does it temporarily because the perimenopausal brain transition, it... The, the neuroendocrine transition that it goes through, it in a lot of ways looks like what the ADHDer has been living with their whole life, which is why perimenopause is so much more intense for neurodivergent women, and specifically the research being on ADHD and autism. So anyhow, as I was just saying, but, like, there, there's these polar opposites going on. And so for me, the verbal shutdown, that's very much something that overstimulated autistic individuals go through. Now, what's very interesting is that I actually timed this book, and it was non-negotiable. It had to be, like, peak follicular phase, and I told my publishers that. 'Cause they were like, "Oh, let's push it off by, like, a week." And I'm like, "You cannot because you don't understand who I become and how hard things are. And now that I'm mid-40s, I can't just push through in the same way in my luteal phase the way I used to." And I go through explaining how the hormones affect the brain, the behavior, the neurotransmitters, the neuroinflammation, the mitochondrial function of the brain that contributes to that. So with this example of me having gone through book signings, you know, stepping on stage, being able to do all of that, like, I rallied, and my brain knew that, like, this is what we have to do and there is a finite amount of time that we're going to do this. And I was, what was that? Like, two days before starting my period. So there was nothing left in the tank to give, so to speak. So if we're thinking about it like it being a gas tank, there's not much left to give. I gave everything. And so then when it came to, like, basic functioning, like, I probably wouldn't have eaten. I would've forgot to eat. Usually what my assistant does is she has me stay an extra night at the hotel, so I just, like, go back. She'll order me room service. These are accommodations that I pay for in my life so that I can function. And then food comes to me, and she says leave it at the door, just knock and leave her alone. And then I grab the food, I eat the food, and I'm... Sleep, I recover, I regulate my nervous system, and then I'm up and I can do a plane the next day, and I can travel the next day. But, like, airports are incredibly over-stimulating. So when I tried to go home the same day, we really learned a lesson there, and my husband observing it was like, "Oh, no.

Jolene Brighten
I've already booked a plane ticket. I'm going with you to your next event." And I was like, "No, I'll be in my follicular phase. It'll actually be a lot easier." And he's like, "No, I'm not totally comfortable that you could actually get on a plane and, like, make all of that happen and get home to us, so I just wanna be there with you." And so that's to just illustrate, like, what the disability can look like because this is a disability. And so when people see what they see on the internet, they, they get the highlight reels. They get the best of me. And I am very careful, and I've... Ever since I had my first son- I became very aware of how quickly I can go into a meltdown when I'm dysregulated. So for people listening, a meltdown is an extreme activation of the HPA axis in which the body believes that it may very well be dying. And so it looks like a tantrum kind of on the outside. You might, you might be like, "This is a choice," but it's not a choice. It's the nervous system becoming so overwhelmed that you, you crash out. And so maybe you fight, maybe you're yelling, maybe you freeze, you go into, like, complete shutdown. Maybe you, you flee and you're like, you, you run away and you're like, "I can't be seen. I have to get away from everyone." And it's very rare that you do any fawning, which is the other aspect of that, but you, you very rarely see that, and it can look, um, like complete emotional overwhelm. And so when I saw, like, how, you know, as a new mom, lack of sleep and dis- like, just everything that is bad for our nervous systems that we know, that's motherhood in the, in, in the first-year postpartum, that I'm like, I have to start the day regulating my nervous system, non-negotiable. And so that's so often why I can show up and, and show up the way I do, and people don't see the, like, two to three-hour routine that happens before I even leave my house so that I'm well-regulated in my body, very present, have met all my needs, and made all my plans, so that I can show up and really thrive in this life.

Melanie Avalon
Yeah, 'cause when I started reading the book, I had... I mean, I had no idea that you were this. Like, the way you present outwardly, like you just said, you clearly, you put so much into making sure that you can show up and do the things even when having this disability. So something I'm really fascinated by as well, and I'm having, I'm having flashbacks to when I was younger because you mention in the book, well, you mention for yourself, you know, when it actually first started showing up later, but you make it very clear in the book that there's not... it's very rare to have, quote, "late onset ADHD." It's just more that certain life situations like perimenopause, you know, children, things like that, um, may- the pill. You go through, like, you know, five different Ps that they unmask it or they make it, you know, people realize that they've had it all along. They were just managing it. And so a question about that, because the flashback I'm having, I got, I got hit with this, like, massive wave of, of guilt just now because my best friend in middle school, she had ADHD, and I remember she went on medication for it, and then her personality, like, completely changed. Like, prior to that, she was, like, very hyper and spazzy and quote, "fun," and then she went on the meds. And I feel so bad 'cause I think I, I think I and my other friends, like, we kind of gave her grief. Like, "Why are you different? Why- you're not fun anymore." Like, I feel so bad. Who knows what I said about that? I remember, I remember being annoyed that she was on the meds 'cause I thought, I was like, "She's not fun anymore, and she's not the same person." So the, the questions here, besides me needing to go talk to my therapist and, like, deal with this guilt, um, and probably maybe call her and apologize then, number, number two is so clearly it presented in her as a child, and we just mentioned, though, that a lot of women might have it and it doesn't appear until later. So yeah, what is that like for when it normally appears? Is the experience the same if a child does present with it youn- when they're younger? Is- what is that life experience like? Like, looking back, when do you... Like, looking at your child self, do you see this now? Just what, what is it like as far as, like, when it appears and how it appears?

Jolene Brighten
Yeah. I think it's important for the listener to understand that ADHD does not stop being real because a woman learned to over-perform through it, and that's what masking is. It is putting all your energy into the performance of who everyone expects you to be and, and show up as. And so that's an important distinction, 'cause people will say, "Oh, you're a high-functioning autistic woman." I'm like, "I am a high masking," and, and that is not a brag-worthy thing. Like, I'm grateful that I have the capacity to do it because it affords me a lot of opportunities and at the same time, uh, it comes with a cost.

And so this is something I think is important for women to understand is that ADHD is a neurodevelopmental condition. You are born with it, and as you alluded to, the five Ps in the book, these are major hormonal transitions, one of them is happening cyclically, like, cycle over cycle, that change the neurochemistry and the operations of the brain and that can unmask it. So this might be the, the woman that is like, "Oh, you know, uh, there's, like, a part of the month where, like, I've got it together. I send the emails. I'm on top of my do-to-do list. Like, I can actually put away my laundry. Like, I remember what the thing is that I was told to do, and I said, like, 'Yes, I will do it.' And then there's, like, a couple days where I'm bad at life. And like, you know, there's, there's, like, maybe five or seven days where I'm a lot more emotional." And so they start to make it a them issue and start to excuse away what is happening. And certainly doctors, a lot of them are there to tell us that everything we struggle with is either normal or deserves the birth control pill or an SSRI, and outside of that, like, you're a woman and you have access to all these things. Why are you whining? Why are you here complaining, right? So when we think about masking, I want people to understand, you may see this person who has shown up. They may be people-pleasing. They're looking overly organized. They're showing up really early. And then there are times where it's just really a struggle for them. And I would say that perimenopause is the hardest transitional phase of those five Ps because it goes on so much longer. And in fact, the research tells us that perimenopause has about twice the symptom severity in the ADHD woman compared to the non-ADHD woman, and it may come 10 years earlier.

And why is this so hard? Well, there are three mechanisms that happen, and there's a lot I talk about with hormones and how they change and how they change the brain, but I want to just zone in on estrogen here for a second. So as estrogen declines, mitochondrials function, ability to generate energy also declines. Now, the brain doesn't have enough energy to do that really energetically demanding thing called masking. We also see that estrogen changes, neuroinflammation can rise. Okay, that's going to disrupt neurotransmitters, other hormones. And then we also see that the neurotransmitters themselves aren't produced or utilized in the most efficient way possible. So we're talking about dopamine and norepinephrine.

Jolene Brighten
That is focus, that is motivation. That's very classic ADHD, but acetylcholine is involved in there. It's why I know where my keys are right now. It's why I know what I'm saying mid-sentence, and I'm able to keep saying it.

We also see that serotonin declines, and that can, yes, lend itself to mood changes, but it also affects neuroplasticity, the brain's ability to actually adapt and recover. And then because it's not usually a gentle transition of estrogen smoothly declining, there can be histamine issues as well. And as estrogen spikes, histamine can follow. And while we think about it giving us like period flu or achiness or, you know, the just the "I don't feel well" or hives or allergies, it's also rage, waking in the middle of the night, having anxiety. And so all of these changes can be just due to estrogen. Now, that's in any perimenopausal brain. But when I tell you that the ADHDer has been experiencing that their entire lifetime, imagine what perimenopause is for them now as they actually like start to make this transition and all of this gets turned way up and amplified.

Melanie Avalon
And to that point, so that, that is a, you know, lot of different hormones and neurotransmitters you're mentioning, and we haven't even mentioned dopamine yet, which is what I think... Well, at least that's what I think of when I think of ADHD is, is dopamine regulation being a, a big part of that. So and it's funny, so like, like for me, I've always said that I, that I'm like a dopamine girl. Like, I, um... I, I, I don't know. Like, as far as like the feeling of dopamine and like cha- and like striving and trying to achieve goals and, and all the things, I just like thrive on that, and I, I'm very like consistent with it.

Like, like i- it- for me, it feels like... So here's my question . Is, is ADHD when it comes to like dopamine and focus and things like that and, and pursuing things, is it like that but without a through line? Like, I've heard examples where people say, "Oh, kids with ADHD, they c- they can focus. It's just they focus on what they want to focus on." So what, what is the role of actual- of, is dopamine playing in everything?

Jolene Brighten
Relevance. Relevance is the word that I would give you on the role of dopamine. ADHD is not a dopamine deficiency. It is the brain r- like actually registering what is relevant and what is worth your attention. And when the brain says, "This is something that's worth giving attention to," then we see the ADHDer can lock in.

So you know, I will give the example of my book. The book has a cheat sheet for people who are like, "Yeah, I do have... You know, I do struggle to read and maintain my focus." Great. Take the quiz in chapter two, jump to chapter 12, do the 14-day reset. Brain starts working better. Fantastic. Go where you need to go next. But when I was told by a publisher like, "No, no ADHDer is capable of reading a book on ADHD," and I was like-

Melanie Avalon
I was just gonna ask that.

Jolene Brighten
Like, "Your pardon?" And I'm like, "That's absolutely not true." In fact, I've done podcasts where the host has ADHD, and they've read the book in less than two days because they were so locked in, and it was so interesting to them. So I think it, you know... Especially as we talk about dopamine, we should also talk about serotonin because there was a very interesting study where it showed that dopamine and serotonin are working together. They're not exclusive.

Then, so what the brain does is it comes across something and it says, "This is relevant. Let's pop off that dopamine," and, and the, "This is very relevant. We should pay attention." Maybe this was a food source ancestrally speaking. Then the brain says, "We must also upregulate serotonin," so we solidify the memory of reclaiming this food source again in the future and coming back to this. So the brain is s- say scanning the environment and looking for what is actually relevant. And I think this is also important to understand that like this is why it can be such a struggle to do the dishes, then why ADHDers have a doom pile in their house they can't like seem to put away. And it's because as they step over this pile of clothes over and over, the brain is not registering as relevant, and putting it away is not going to be stimulating enough. But as you were saying, checking off a to-do list and doing something that you're really excited about, that is not just relevant. That is stimulating, and so then you get dopamine. So the ADHD brain, there's this relevance issue, but there is also a dopamine clearance issue. So some pr- uh, of the newer research is showing us that, I like to call it like the trash truck, like the, the, you know, mechanism that comes through and cleans up neurotransmitters. Instead of that trash truck coming once a week, in the ADHD brain, at least some of them, it may be coming every single day. And then it's like, you know, as soon as you have like a little bit of trash, that guy is there taking it straight out of your hand. You don't even have time to fully consume the item, put it in the trash can, and take it out to the curb because the proteins are already there saying, "We're just gonna take this dopamine away now."

Melanie Avalon
Wow. So well, do you know historically when this first appeared in humans as a species and, and how... Because this sounds ... counterintuitive to survi- to normal survival traits.

So how did, how does this trait sur- survive? Like, how did it not get weeded out?

Jolene Brighten
Oh my gosh. I think that this is just like Dr. Brighton's hypothesis, but the entire species survived because of neurodivergent people.

Melanie Avalon
Okay, this is amazing.

Jolene Brighten
Just take the case of an ADHDer, and we consider that ADHDers, s- they often... So ADHD is not one gene that's inherited and, and we can't even identify all the genes that might be involved, but we know there's these clusters. And so one example is that you may be slow at clearing catecholamines. So that is those stress hormones you surge with. And so that alone makes it that if there was a threat to your tribe, well, then you are gonna defend that tribe, and you're gonna go all night. Like, you're not gonna run out of stress, like your hormones. You're not gonna be like, "Oh, okay, downtime." You're gonna keep going 'cause you're so much slower at clearing those catecholamines. That also lends itself to a modern-day dysregulated nervous system. But ancestrally speaking, you'd throw down for the tribe, and you would not quit until the threat was either extinguished or it ran away.

Additionally, ADHDers are very creative, and you know, people often use the term, like, outside the box thinkers, but they are. If there is a status quo, they'll probably be the first one to challenge that. But in doing that, they can be very inventive, very, very creative in problem-solving itself. I think additionally, you know, as I talk about the whole, like, you know, dopamine and relevance, like you're, you're walking through the woods as a tribe, and maybe everybody's just walking and, you know, they're looking at the ground. But the ADHDer's little squirrel brain is like, "Over there, over there, over there. There's berries, y'all. There's berries. Relevant. Lock in. Let's get them." Like, and so there are things that I think we often see as problematic, but if we were to... You know, this is why, you know, you'll hear parents say, like, "My ADHDer thrives in an outdoor school," like in a different environment, somewhere where they're able to move their body, where they're able to actually be ADHD, and they thrive in that environment.

Why is that? Well, because what we're doing currently is we're taking a n- a, a neurodivergent individual, and then we're trying to shove them in the box of neurotypical and demand that they act that way. We already did this with people with, who were left-handed, and we found that, you know what? We were cutting years off their life. They were getting chronic disease. Like, they were very stressed and very unhealthy. But we still are persisting to do this with the ADHDer. And so this is why we see, you know, I speak at a lot of conferences with entrepreneurs, and I always talk about how entrepreneurs are often ADHDers. Like, we see this. Why? Because they don't do corporate well. They're not gonna follow rules that don't make sense, and they're gonna come up with fresh new ideas, but corporate can't pivot on a dime, right? It's, it's this very slow-moving machine. In addition, they might have something like delayed sleep phase onset, so that's something roughly 70% of ADHDers have. They don't fall asleep and, you know, until like 12:00, 1:00 AM because that's when their cortisol's rising opposed to the 9:00 to 10:00 AM.

Jolene Brighten
Also really good for, like, your tribe person who's gonna do the night shift at the fire, right? Also, ADHDers and fire, like very fun thing very relevant to be playing with.

So you know, and we see a lot of ADHDers, very creative, doing things at night, very innovative, and that doesn't totally fit into a 9 to 5 job.

Melanie Avalon
That's so interesting 'cause I was literally gonna bring up as an analogy comparison, although it, it relates with ADHD as well, the, the, uh, insomnia piece. Like, just as its own trait, like the benefits of that evolutionarily because there was somebody, you know, awake at night keeping keeping the, the watch out 'cause I'm definitely, like I'm majorly a night owl, so I'm like, "Okay, that, this is, this is here for a purpose." So, so to that point, um, oh, and one other analogy I love that you made in the book was that it's kind of like just a different operating system, like Android versus iPhone and, you know, how they, they both have incredible benefits to them and one is not right or wrong. They're just, they're just different. So okay, so to that point and, and you know, you mentioning how, how stressful it is trying to make people l- like this fit into a neurotypical society, and then going back to my example of my friend from middle school, when people go on medication for ADHD, how does that work? I remember, I remember even middle school, I was so confused 'cause I knew it was a, quote, "stimulant medication," and I was like, "If it's a stimulant medication, why is she so not, why is she so, like, one tone now and, and not, not seemingly stimulated?" So what is the, uh, the paradox going on there with, with stimulant medications?

Jolene Brighten
You know, we used to think for a very long time that this was just a dopamine-norepinephrine story with medications. But interestingly enough, we've gotten newer research, which is in animal models, that's shown us that the mitochondrial dysregulation that may be taking place in the ADHD brain may be optimized with something like methylphenidate. So this is Ritalin. And what they found in these animal models is that if they gave them Ritalin, the reactive oxygen species that were being generated by the mitochondria actually decreased. On the flip side, they found that in a non-ADHD brain, if you are taking a stimulant medication, that we saw an increase in oxidative stress in the brain and potentially neuroinflammation as well.

So I think it's really interesting because, you know, the- there's a lot of strong opinions about ADHD medication, and when parents say, like, "We shouldn't just be flippantly medicating kids," uh, 100%, I definitely agree with that. ADHD is a rule-out diagnosis. That means we've ruled everything else out before we arrive there, and we don't just decide that just because you have a classroom full of like 36 kids and this one isn't doing what they're told every moment of the day, that like, oh, the answer is just medication. That's not how any of that should go. But we do understand from the research that those who have untreated ADHD, which doesn't always mean medication, okay? There's, you know, lots of things I, uh, detail in the book, and I go through everything that you won't get in a doctor's visit when you get the diagnosis of ADHD. But untreated and unmanaged ADHD could cost you 10 years off of your life.

We understand that ADHDers are at much higher risk for accidents, for example, and when ADHDers receive adequate treatment, and a lot of the studies do focus on medication, we see a decrease in accidents, substance abuse, different factors that can shave years off of someone's life. And so I think it is a really important conversation, but it's very nuanced because for the right brain, these medications can be really helpful. But for the wrong brain, they could be really harmful. So we want to know for sure the person has ADHD. And then, you know, anecdotally, what a lot of my friends who are in the AuDHD camp, so that's those of us who got the autism and the ADHD diagnosis, say is that they're- they've never been able to handle using a stimulant medication, and they knew something was wrong when they got just the ADHD diagnosis. They were given the medication. It didn't work for them. And then they went and later pursued a, a, you know, further evaluation, thinking like, "Well, then it must not be ADHD," and lo and behold, there's this co-occurring autism, which is pretty common. Research is anywhere from 40 to 60% do we see the co-occurrence of both ADHD and autism. So I think that's something, like, worth considering as well. When the individual says, like, "This doesn't actually work for me," then we don't say, "Well, this is the treatment." We say, "Okay, tell me more. What can we do to support you?"

Melanie Avalon
Awesome. Okay. And, and why for the longest time could they not be co-diagnosed? Like, why did they have to be one or the other?

Jolene Brighten
They didn't believe it could be one or the other. Like, I mean, let's just be honest. Psychiatry is a very intangible medicine, right? It's like you, you have no, n- no objective measurements other than DSM criteria, and for all intents and purposes, those are not always objective. I, I would actually say not at all in a lot of instances.

It's very subjective based on your retelling of your symptoms, your story, the people in your life who share those stories with the clinician, the clinician's interpretation of those things. And so that's really the short answer is that for a long time they didn't believe they both could coexist, but I think there is this... Like, if you get under the hood of medicine, what you actually find that was said was it was too complicated for clinicians to diagnose and treat both, therefore we just simplified the DSM for clinicians, which I'm like, "Okay, so you did DSM for dummies at the expense of the patient. Like, well done."

Melanie Avalon
Okay. And okay, so I have a, um, delicate question 'cause you were mentioning people who are entrepreneurs are often, or can coexist a lot with ADHD because, you know, they don't fit into like the 9 to 5 model. So I'm an entrepreneur, not an not in a 9 to 5 job, and reading the book, I had some... 'Cause like I said, I, I really had no idea what this experience was like, so this was so eye-opening for me. And then I realized some people that I work with, well, I knew, I knew they were ADHD. It explained a lot some of the, I don't want to say problems, but some of the things that have not worked so well because of how they are ADHD as far as the planning and the, the time blindness and, like, getting things done.

And so my very sensitive, delicate question here is... 'Cause now, now I'm... 'Cause I, I always want to I'm like really intense with my, my job and my, my work, and I want things to get done, and so now how do I... It's like I almost want to be very aware of where somebody is on, if they're on this spectrum, when I'm making decisions about who I'm going to work with in a workspace because if they're not taking action to function at their best and, and work in the right environment, I don't want to set anything up for potential issues business-wise. So but I don't want to... I, I feel like what I'm saying, I don't want to be a ADHD-ist, where I'm like, "Oh, they have ADHD. Now I need to be wary because they might, these issues might surface in a business setting." So, so what do you suggest for as far as being aware and supportive of people who have ADHD and also making sure, like in a business setting, that, you know, things are gonna get done?

Jolene Brighten
I think you have to have honest conversations. And so a lot of ADHDers, especially women, tend to be people pleasers because that has been a survival skill for them. But that means saying yes and, and taking on too much and being at capacity and continuing to say yes on the outside while silently begging that no one hands them one more thing. And that, I think, is, it deserves an honest conversation with them.

So- We all, so what you're talking about is executive functions. ADHDers have executive dysfunction, and that executive dysfunction is impairing parts of their life and certainly can impair work as well. So if we can identify what executive functions are basically like their kryptonite, then we can understand, okay, how, what's the workaround? What's the strategy? Maybe you're not in charge of carrying that to the end. We know that you can hit a honeymoon phase with a project, and you'll be the person to get everything like 30 to 60% along the way, but then there has to be a time where we hand it off to the next person to complete the project, to get it completely done.

You know, I can use myself with time blindness. It's so interesting because if my period, I know when my period's gonna start because I will be like, "Oh, I have to be there at 9:30. Not a problem. I have to start getting ready at 8:00. I'm gonna be out the door by 9:15," and I'm like, "Well, who is this person? Oh my God." But in my luteal phase, like my husband knows. I will tell... So my husband and I work together and, and that's why this is relevant here. So my husband and I work together, and so I will tell him like, "Okay, this is where I'm at in my cycle. My time blindness is starting to get bad. I'm observing it. I have this to do at this time. I'm gonna need you to check in on me. I'm gonna need you to..." Because the time blindness is not only my inability to plan time, it also is that I will get sucked into a project. So I'm like, if I'm working on something, especially if he knows it's something I'm like really into, like RIP my life right now is Substack 'cause I love writing. And so if he knows that, then we're like doing the check-ins where like an hour before he's like, "Hey, you're gonna have to leave." Because otherwise what will happen is he'll be like five minutes before, "Oh, you have to go." Now my nervous system is freaking out.

I'm not ready to go. I can't make the transition. Like that's another thing ADHDers can have trouble with, autistic people as well, is going from one thing to the next, and really we need to have that transitional time. And so we've learned it's also good for our relationship. But work-wise, if we're going into a meeting, I'm the person who's gonna need more prompting. And sometimes what... Now let me just say like AI is amazing because you, like this is too much to be like if I was in a workspace to be like, "Oh, I need my boss to do all of this with me." Like, I'm working with my husband and I am technically the boss.

Jolene Brighten
So with that, I will go into AI and I will be like, "Hey, this is when I have a meeting. This is when I need to do things." So this actually just happened. My husband was out of town. I had to pick up my kids from school. Like I was solo parenting it, and I put it all into AI and I was like, "Give me the schedule and tell me when to set all the alarms." And then I went through and I just, "Hey Siri, I need you to set an alarm and a reminder for this." And it'll say like, "This is your transitional phase. Like you need to be putting on your shoes phase. You need to..." And it sounds like completely ridiculous. Now Siri's trying to talk to me 'cause I said that. It sounds like completely ridiculous, but it is that kind of prompting that keeps my brain on task.

So it's just a matter of identifying like... So the other, eh, thing ADHDers can really struggle with is task initiation. So the ADHDer might be the person that you give them the 25 steps you need to have done, and you just give them the first and then the second and they slay. It's amazing. But if you say, "Hey, I need this by the end of the week," their brain might not be able to conceptually go from what's the finished product and then work its way backwards to say, "This is how you break it all down." And because of that, they can't get started. So I will also give an example. My husband struggles with that. I think it's the autism in me who loves a plan. Like give me a whiteboard and I will plan everything out because I want every detail decided. I wanna know who owns what. Like I, you put me in a sauna and like watch out, it is a masterpiece because like that's the la- I have to have a plan. So like with my husband, instead of me being like, "Hey, I need you to like get the, you know, make sure that like the team is done with the website and like the, the, this website's completed, like we need this page," I have to be like, "Hey, I'm gonna hand you over the copy. Like the first thing that I need you to do is proofread this and make sure that it makes sense." Because like, okay, autistic, I have communication issues. Make sure that it makes sense to other people what lives outside my brain. Okay, great. He sends that back to me. I say, "Okay, here's the next step." Or sometimes what I'll say is that like, "Here's what needs to get done. Here's the five steps it'll take to do that. Are you able to own this or should we, should we outsource some of this to someone else?" Because for him, that's what the struggle is.

So I know there's a really long-winded answer, but I hope that helps for people listening, not just working with an ADHDer, but understanding like yourself as well, and you have to just be honest. And that's the thing an ADHDer doesn't wanna do a lot of times, not because they're like big liars. No. It's because during their childhood they heard so many negative things about themselves that they can't, their heart can't break one more time to hear that. So they're gonna do whatever it takes to try to show up and try to get it done, but they might fail.

Jolene Brighten
So if you can be honest with yourself as an ADHDer what the needs are, and that doesn't mean being like, "Oh yeah, I just can't do this, therefore everyone else do my work for me." Absolutely not.

It means being like, "Okay, this is, this is actually where I struggle. This is where things get tough. Please, can you make sure that like this is really clear for me?" Or the objective deliverables have actual dates on them because if you give me this like, "Oh, I need this like in a few weeks." Ooh, like that's weird. That's a weird timeline. No, I need this by this date can be a lot of, a lot firmer deadline that then holds the container of what needs to happen.

Melanie Avalon
This is so enlightening and so eye-opening and, and so many things that you said, 'cause I'm thinking of like a specific situation with somebody and like, like I said, that I've worked with with ADHD. And when they're like doing all the things, it's like amazing. Like, there's all this stuff done and it's incredible and the, and the momentum. But then it's just... And I'm realizing now talking to you about this, that I probably was seeing things through my perspective of how... 'Cause I'm like I'm very good with like, I don't have time blindness. I'm, I'm pretty good with like time and like making a plan and sticking to it and, and like you said, seeing the end goal and then working backwards. So for me, my experience, I'm like, you know, "Why can't these people just, just do that?" Or I'm like, "If, if they can't keep track of time, why don't they just set an alarm?" And I'm like, I, in my mind, I, I don't understand it. So it's so helpful to hear what it's like for them.

And going forward, I think if I work with somebody like this again, I know that I would need to make it more clear, like, you know, very clear deliverables and, and timelines and, and when things will be due and, and checking in. So, um, yeah, this is so, so helpful. To that point, so to what extent, 'cause we talked about medication and you've talked about how different life stages and your menstrual cycle and hormones and how it all affects everything, and you have a whole section in the book on like diet and sleep and all of these things. So to what extent can a neurodivergent person with ADHD via lifestyle mechanisms regulate themselves pretty quote well? Like, how much of an impact does that have?

Jolene Brighten
Yeah, it has a tremendous impact. I always say like, I'm so grateful that my special interest became nutrition. So I was like this nerdy like nine-year-old. I remember like I would love to get medical textbooks and like try to diagnose people in my life. Like, and um, then I got like really into nutrition and I feel like that I wouldn't be who I am today or where I'm at in life had I not been so focused on the optimization of my nutrition, my sleep, my exercise, my digestion from a really young age. And really, that started around 17. So it can have a tremendous impact.

I will say that sometimes people need the medication to have even the brain energy to get started on working out or being able to feed themselves. That's a very real thing as well. But what we understand when we look at the research is that, you know, you'll see things like, uh, when you collate all the research, it'll say, "Children who eat ultra-processed food and diets high in saturated fat, they have higher incidences of ADHD, and children who are eating more fiber, polyphenols, like whole foods, right? Less incidence of ADHD." It's not that diet causes ADHD. It's not that it cures ADHD. It's that it influences the symptom expression. So when you hear more incidences of ADHD, it's not that, oh, the way they ate caused their ADHD. It exacerbated their ADHD symptoms to be so pronounced that we were able to screen it and catch it. I think a lot about this in the context of like PMOS, formerly PCOS, so polycystic ovarian syndrome, now called polyendocrine metabolic ovarian syndrome. And with that condition, you will see this outward expression. Sometimes women are overweight, but not always. But they often will have things like oily skin, acne, hirsutism, hair growth in places they don't want it, like chin, chest, abdomen, hair loss on the head, and their periods will be missing or irregular. That condition is highly responsive to nutrition and lifestyle. This woman begins working out. She is eating a whole foods diet. Maybe she's taking things like myo-inositol and chromium. She's optimizing her blood sugar, and then she goes back to her doctor in three years and she doesn't have any of the symptoms of PMOS, and we wouldn't actually be able to make that diagnosis anymore. That doesn't mean she cured her PMOS, because I could load her up on three months of McDonald's and be like, you know, tie her to the couch and be like, "You're not going anywhere," and also like, "We'll have people say mean things to you all the time, so that we'll just make sure you're good and inflamed." And lo and behold, all those symptoms will come back. So I use that because there are ver- there are very many incidents or conditions in women's medicine where we can see things can im- improve substantially to where if you went to a totally new provider, you may not see that you actually have that condition anymore. They can't, they can't actually measure it and see it. And so ADHD can be a lot of the same, where you are eating so well, you're doing things so well that like the executive dysfunctions are not as impairing as they could be.

Jolene Brighten
You still know it because you're still compensating for it. You're still struggling. Like, there are still areas that like, it's never gonna be 100%, right?

Like my time blindness, every time my estrogen decides to dip out, my brain is like, "Forget time. That is some weird Albert Einstein stuff we ain't even gonna play with right now, okay?" Like, that can happen, but you know, considering, you know, where you're at and where you could be versus, you know, when you improve your diet versus, you know, not having a quality diet, I think is, is something that I would ask everybody to reflect on. And I say all of this knowing how hard it is to feed yourself. So I'm a nutrition nerd, and I love to try to like, ooh, how do I get 30 plants like a week, and how do I like polyphenol max and like, you know, how am I getting the variety of fiber? Like, I love the game of it every single day, except for those times where like I have a brain burn out, uh, brown out. My husband, on the flip side, he's the type of ADHD-er who's like, "I'm hungry. I will just eat an entire bag of chips." And I'm not talking about like the individual size, I'm talking about the full size. And that's not because like, oh, he just like has poor discipline or anything like that. He just doesn't, he doesn't have the interception like many ADHD-ers To be able to understand when he's hungry, and then by the time he's hungry, then he's like, "Okay, I'm gonna eat this thing. Oh my God, I ate the whole, whole bag of chi- like, what happened there?" And that's, like, you know, just two sides of the coin as an example of, like, what it can be for the ADHDer.

Melanie Avalon
Yeah, it's, it's so fascinating. I, I was fascinated by the eating section because, like you, I'm, I'm obsessed with nutrition and how food affects the body.

And, you know, I interview so many different people about all these different diets, and I had never... I've never read about these specific issues that people have with ADHD and how it can manifest different ways as far as struggles with eating. And, and for listeners, get the book now, and especially if you have ADHD 'cause there, there are quizzes, and you will figure out, like, what type you are. So for, like, the eating part, it's like, you know, y- it might be because you're struggling with, you know, decision paralysis or forgetting to eat or... Oh, I actually had a question about this. Like, the one that was about, like, food aversion and sensory satiety, why do ADHD people sometimes become, like, have an aversion to, to food?

Jolene Brighten
So we can get, like, really obsessed and wanna eat the same thing every single day. I went through this, like, while writing the book where I was like, "I just wanna eat sushi for lunch every single day." And then 10 days in, I was like, "I never wanna see sushi again." It's like you o- you can overdo it, but there can also be texture issues. So it might be the sensory input, the way something smells. Uh, you know, it's, it's very interesting, so I'll use myself as an example here because I'm a foodie. And then I got, like, really, like, sad the other, like, last cycle because my food aversions, like things that I will just power through where I'm like, "I don't love this, but, like, it's good for you, so just eat it," was much harder in my luteal phase. And I'm like, man, how many patients have told you that, like, in their 40s, sometimes 50s, they're like, uh, and even sometimes 30s, "I can no longer eat the eggplant if it's on my plate. I can't even smell it. I can't touch it. Like, it doesn't matter. Like, I used to be able to, like, be like, suck it up, power through, it's good for you, and no, now I can't do that anymore." And so that can be the way that you are perceiving taste. For perimenopausal women, it a- also can be changing estrogen, changing their mucus membranes, changing the way that they're, uh, and, and changing their nerves as well, so the way they smell and taste food changes. But in ADHDers, we see this, like, really common. I actually was out to dinner with a group of ADHDers and we got Caesar salad, and there were anchovies on there, and everybody was taking their anchovies off. And my husband was like, "Give them to me." And I was like, "Hell yeah, dementia be damned." Like um, but I was, like, really taken back. And everybody said, like, "It's the smell and the texture. Like, I just can't do it even though I know it's good for me." So you're right. Like, in the book, I do have quizzes for exactly that. Like, why is it that you're struggling to feed yourself? 'Cause it's not enough to tell you, like, "Hey, you should eat good food," which is what so many doctors are doing. And so many ADHDers, they hear all this stuff in the wellness world, and then they feel like they're the failure because, oh my God, like, I, I tried it, but I failed at it. That's why I came up with the focus plate method, which is a visual breakdown. ADHDers do a lot better with, like, visuals. So it's a visual breakdown. You can put it on your fridge. You can see exactly what your plate, you want it to look like. And then I have the chill girl meals approach, which is literally being like it doesn't have to be a 25-step, like, three pans that you have to be cooking in endeavor just to feed yourself. Like, you can go into the fridge, grab four hard-boiled eggs, a handful of raspberries, maybe you have some leftover rice, and done. That's a win. That's a meal. And so these chill girl meals are putting these meal, these lists of food on your fridge so that you can just look at it, grab it, be done with it. What does that do?

Jolene Brighten
It externalizes executive function, and it takes away decision fatigue. I always say every human on the planet only has capacity for so many decisions in the day. The perimenopausal woman has far less than anyone else, and the ADHDer is even less than that. So the less decisions you have to make about feeding yourself means more capacity for doing other things in your life that actually need to get done, like, you know, paying your taxes.

Nobody wants to do it, but we also don't like the penalties of not doing it.

Melanie Avalon
So to that point, I wonder what the, um... And you do touch on this briefly, so there's actually, like, two questions here. One is how, what would be the interaction if somebody on ADHD is engaging in this?

And then number two, I'm, I'm curious how similar the experience is, but when you're talking about just not wanting the food, is that similar to the experience people are having on GLP-1s where they're just not wanting the food? And then also, what happens when somebody with ADHD goes on a GLP-1?

Jolene Brighten
Yeah, that's really interesting. I had not considered that before, but yeah. It is kinda like being on GLP-1s in terms of not getting the hunger cues, so that lack of introception, that is something ADHDers can struggle with. They don't know when they're thirsty. They don't know when they're hungry until they're, like, crying, screaming, shaking, having a hangry attack.

With GLP-1s, I do talk about in the book there's no evidence in the research, no clinical trials at this point, but ADHDers are reporting using a GLP-1, ADHD gets a lot better. Why is that? Well, I talk a lot in the book about how insulin optimization can help ADHD, and it can help dopamine effectively work better. There's also the inflammatory component. And so GLP-1s may be reducing inflammation, which hormones and neurotransmitters work a lot better when we're not inflamed. And in the ADHDer, because we understand that there's already- You know, low microbial diversity. There can be a lot... There was just a study that came out showing that ADHDers, roughly 50% are having IBS-like symptoms. We can see intestinal hyperpermeability. We can see, uh, abdominal pain. So, I mean, certainly if you're having that, you're gonna have food aversions, right? Because if food makes your stomach hurt, like your intestines hurt, why do you wanna eat it? But with that in mind, when we have all that inflammation in the gut, that can actually travel the vagus nerve. It can also go to the brain itself. It can be in circulation, and it can change the way the brain operates. It can make the brain start to produce more inflammatory cytokines. It can also make the brain become leaky. And so there's three foods that I recommend ADHDers consider eating on a weekly basis, and the first one is ghee, and that's because it's rich in butyrate. I'm gonna circle back to that one, but the second is potato salad, and not the kind with lots of sugar, but potato salad, cooked and cooled potatoes, or cooked and cooled rice, and that is because that's rich in short-chain fatty acids. So why does that matter? Short-chain fatty acids feed the microbes in your gut that should make the postbiotics called butyrate or short-chain fatty acids, but butyrate's our big one here. So that brings us back to the ghee. That butyrate has been shown to not only be healing for the intestinal lining, but also may heal the blood-brain barrier n- and it may help lower neuroinflammation, and it's been shown to be beneficial for those with ADHD. And then the th- third food is, uh, I want people to be-

Melanie Avalon
Tacos?

Jolene Brighten
It is tacos. You knew it was gonna be tacos. What do I say in the book?

Melanie Avalon
Capsaicin. Yeah, you go through, like, all the different ingredients of the tacos.

Jolene Brighten
Yeah, I say tacos are the cure for ADHD, which is a joke, y'all. I'm not saying... I mean, that you- it will make you happy if you have emotional dysregulation, like having a taco may cure that.

Melanie Avalon
Oh, I love it. That's amazing.

And actually, one other, this was a, a tangent, it wasn't even in the diet section I don't think, I think it was in the anxiety section, however, I love when I learn a little fun fact that's, like, so specific and so unique, and I've never heard before. So I had no idea that the sour taste can, like, reset your brain.

Can you talk a little bit about that? I was like, "Whoa." I had no idea.

Jolene Brighten
It's a, it's a shock to the system. It's, like, so y- you can do, like, a lemon shot, like lemon juice shot, you can do a sour candy. I just, like, ugh, my good friend Dr. Stacy Wittman would kill me if I told you just to have straight lemon juice, so make sure you chase it with water.

But having that sour, it disrupts what's happening in the nervous system, and it wakes everybody up to be like, "Okay, be very present in your body." That's why the other thing that can work is if you don't have something sour and you're experiencing anxiety, emotional dysregulation, is to start naming what you can feel, what you can see, what can you can smell, what you can hear. So just start going through all of your senses. Like, I feel myself sitting right now in this chair. I can smell, like, you know, whatever it is that you are smelling. This is what I hear right now. So it's getting very, very present. And so the sour can get you there a lot quicker, but if you don't have access to that, this little act of mindfulness, of just naming everything that you're experiencing, can also disrupt the anxiety.

Melanie Avalon
Wow, okay. I, I wonder if that's why, I haven't had one of those since I was a kid, but those, like, Warhead candies, do you remember those? That kids, like, kids, like, love those, and it's because it's, like, an experience. It it, like, it does, like, reset your brain and, like, shocks you. That's so, so interesting.

Jolene Brighten
Well, I also think, like, that is also something a lot of ADHDers will move towards very stimulating food sometimes as well. So we often think about, like, noise or, like, social media, like visual stimulation, but also things like the spicy food that I talk about, why it's good for your brain, sour foods, things that are a lot more extreme.

I have an ADHD teen, and he's very much about the most adventurous food. So he's like, "Ooh, I'm gonna eat cricket or ant tacos. Like, of course I want the frog legs." Like, he's very into the novelty of food.

Melanie Avalon
That's so, so fascinating. Oh, my goodness.

Before we leave the, well, the DLP-1s, tangential to that, do you know if there are, 'cause, like, peptides in general are, like, all the rage now, do you know if there are any peptides that, like other peptides that might in the future be applicable to ADHD?

Jolene Brighten
Not at this time. You know, I think not directly for ADHD, but when people start looking at peptides that help regulate inflammation, that are healing for the gut and supportive of the microbiome, when we start looking at different aspects of what ADHDers are struggling with, so, like, mitochondrial function and health, I don't... I, like, talk about saunas a little bit in the book, but I'm like, I could literally probably write, like, a whole chapter just on how good saunas could be for you. But when you start looking at these things that co-occur, coexist, or are driving the ADHD operating system, that's where I think things start to become really interesting. But we don't have, we don't know what is actually, like, going on with ADHD that everybody is, like, just inheriting this one thing, and then we could go in and target that. We're just not there yet in the research.

But we do understand enough to know that neuroinflammation, gut dysbiosis, gut dysfunction, vagus nerve, parasympathetic tone, uh, im- neuroinflammation, all of these things, absolutely problematic for the ADHD operating system.

Melanie Avalon
Just to comment on the sauna piece, I, I as well am obsessed with sauna. I have a, an sunlight and infrared solo unit, and I liter- I will go in it for, like, three hours and I just, I love it. It's, it's so good. Like, I get so much work done in there.

And okay, so we haven't actually even talked about, so one of the, um, like, biggest parts of the book is people take a quiz, and then you actually have, you break down ADHD into different types. So stepping back, and you also discuss how maybe we shouldn't even call it ADHD, maybe it should be ex- executive function disorder. So what are the different, when people, like, take the quiz, what are the different types? Did you come up with those individually? And, like, what, what's going on there? And l- again, so for listeners, 'cause clearly we can't cover all of it extensively, but when you get the book, it, it is, it is all in there, so. But what are, what are those different types?

Jolene Brighten
Yeah, so I came up with these different types. It's really a romance story between research meets clinical practice. And so it's five profiles. One is low estrogen. Another is progesterone sensitivity, so not necessarily low progesterone in the way that people think, but a sensitivity to progesterone. The third is low testosterone. Then we have insulin dysregulation and cortisol dysregulation, and these are all clinical patterns that help women so that they can have better understanding about the timing of their symptoms, the amplification of their symptoms, the manifestation of their symptoms, why they look the way they do, why their sleep, their appetite, their mood, even their medications are being affected as well.

Because I think, especially for the ADHD-er, so often the propensity is to say, "I'm struggling with sleep. I'm bad at sleep. I'm a bad person," and that's not often what's going on. There's a lot more to the story.

So these are not... Like, I just wanna be clear. It's not like these are five new diagnoses. This is about understanding the dominant hormone that's really driving the pattern of ADHD that you're experiencing.

Melanie Avalon
And which, which version are you?

Jolene Brighten
Which version am I right now? I was low testosterone, and so now I, I've actually, uh, supplemented with testosterone. Uh, very interesting. I'm gonna be 46 soon. Estrogen's fine. Progesterone's fine. But my testosterone was not fine, and that was following a, a emergency surgery, which is to be expected at this stage of life for your testosterone to tank. But otherwise, with having supplemented with that, things are pretty optimized for me right now, but ooh, the low testosterone.

Like, I'm like, "I can't believe I didn't see it," but of course you can't see it for yourself because low testosterone manifests as this, like, blah, kind of meh emoji way of being in life. You have trouble getting started in a task. You have trouble following through on tasks because of the mental energy. It just feels like such a slog, and you feel kind of flat about your life. You're not so excited as you would usually be, and that's something that when I started testosterone again, people in my life were like, "Oh my God, I re- you- I forgot how excited you get about stuff." I'm like, "I do." I have big, big emotions, big feels about things, even sometimes the littlest things. Like, I get so excited and that, like, all came back when I brought back in testosterone. So right now I'm in a good place, but oof, that low testosterone place, I don't ever wanna be there again.

Melanie Avalon
And that's another example of where I think society has done women so much injustice because, like, testosterone is so important for women, and it is such a marketed to men, you know, thing. And even, for example, I had on... I think it's probably the only pharmaceutical company I've had on the show, but I had Kyzatrex.

They made the first FDA-approved oral testosterone supplement, and it's only a- it's only approved for men, I think.

Jolene Brighten
Everything's only approved for men. We don't have a woman-only testosterone.

Melanie Avalon
It's so upsa- it's, like, it's, like, really upsetting, especially, like, having that interview and, like, just understanding the massive benefits of testosterone, and testosterone is such a huge part of... Like, a woman's testosterone stores are massive, and yet relatively speaking, and, you know, it's not, it's not conventional to test for it or to address it. It's just, it's really upsetting, honestly, in my opinion.

Jolene Brighten
Well, and if you even look at the FDA, they're like, "Okay, when do we approve testosterone for women? If you have such low sexual desire that it stresses you out, okay, then, then we'll give you testosterone." But, like, nowhere in the story of low testosterone did I ever say anything about my libido, right? Like, I didn't even bring that up.

It's the least interesting part of testosterone, and that's not to dismiss. Like, I- I'm a certified sex counselor for everybody listening, so it's not in any way to dismiss low sexual desire and how that can be distressing. It's just to say that the testosterone story is so much more than libido, and when you work with women and you listen to women and you read research, like, it... Testosterone is so much more interesting than that, especially when we consider it's such a key player in regulation of the immune system. I think that's absolutely fascinating, but then we just act like, oh, yeah, it's just this nice to have negotiable hormone, but it's not.

Melanie Avalon
Yeah, it's, it's really, really frustrating. I know even with the... Even on the men's side of things, one of the things we talked about in that episode was the problem that, like, to, in order to qualify, you basically have to be low, so then once you actually get normal, if, like, that's maintaining your normal, now you don't qualify anymore. So it's like this catch-22.

Yeah, just it's really problematic.

Jolene Brighten
For listeners, just I was gonna say it's DEA regulated, so I have to have a DEA license to prescribe testosterone because they consider it, like, a controlled substance, so I think that's, like, a, a, another problem. You know, you look at some other countries, in, like, uh, Mexico, testosterone's over the counter.

It's, like, completely over the counter. Um, and you don't... I'm like, I... Not hearing cases of people out here abusing testosterone, and women are not going to abuse testosterone. I think that's... I'll hear that from clinicians where they're like, "Women are just, like, wanting testosterone 'cause they don't wanna do the work." And I'm like, "Nobody wants to lose the hair on their head, to grow, like, facial hair, to have a deepening of voice that they can't ever walk it back from." Like, women don't want these side effects. You're very silly, and you don't know women if you're saying that.

Melanie Avalon
I know. Like, the... Women will even, like, not wanna, you know, do weights because they think they're gonna get bulky or something. Like this is not something to be concerned about, in my opinion.

Okay, I have to ask, especially since you said you're a certified sex counselor, are there sexual stereotypes with people with ADHD, and in particular, if people with ADHD often seek novelty? Is, like, kinky sex a thing for people who are, have ADHD?

Jolene Brighten
I don't know why you're giggling at such a brilliant question. I actually wrote all about this in my last book, Is This Normal?

Because, yes, we see both ADHD-ers and autistic people will fall into the kink community and for different reasons. So the ADHD-er may be looking for different stimulation. You know, sometimes they, they need more of that novelty. The autistic person is because within the kink community, there are rules, there are outlines, there are guidelines, there are guardrails. It is very, very clear, and consent is a non-negotiable. It has to be very, very explicit. And so that's why when you look at the research, autistic people gravitate towards that. It's because they don't, they don't wanna be guessing it. Was this true consent? Was this a soft yes, no? Like, what's happening? And so it's not necessarily that they're like- ... into anything, quote, "kinky" as much as they're like, "I just want to know the rules, and I want to be, like, super, super clear with it." But the other thing that we can see with ADHDers, and I talked about this in Is This Normal, is that the research says that they have more sexual, quote, "dysfunction." I don't like using the word dysfunction 'cause I, I don't think you're actually dysfunctional. But what it often is is that the brain sometimes can't focus on the stimuli. Or if you think about sex, so for everybody who's listening, sex usually follows a really predictable pattern. Autistic brain loves it. ADHD brain, bored with it. And it's not because their lover is boring. It's not because they think this whole act is boring. It's because the brain is like, "This is so predictable, I don't really need to be engaged." But we do know that you need to be engaged to be able to achieve an orgasm. And so I think, you know, when we look at the research and it's saying, "Oh, these people are dysfunctional," I don't think that they're actually dy- dysfunctional. There is a clinical sexologist, Dr. Leanne Bornman, that talks about the executive de- uh, desire model, which also brings in the piece of there's also a lot of executive functions that go into having a good time in the bedroom, and sometimes that can be very challenging, if not exhausting, if not impossible for the ADHDer to overcome.

Melanie Avalon
So, so fascinating. Do, do people with ADHD tend to be attracted to people with ADHD, or is that even a factor?

Jolene Brighten
Ooh, I don't think we've studied that. That would be fascinating. But before we get there, could we just, like, get some more research on like the female ADHD? Because I feel like, 'cause it, it's very reminiscent of the study where they were like, "Oh, yeah, we only gave like $1 of funding per endometriosis patient for any endometriosis research, and then we decided to fund, are men attracted to women with endometriosis?" What the hell? What the hell? So I'm like, you know, I want to be, like, cautious there, but I think it is a really fascinating thing because I will always say, like, the ADHD in me, like, sees the ADHD in you. Bas- like a namaste for, like, neuro-typical or neurodivergence of like, yeah, we see each other, and there's definitely things we're attracted to. I, I don't know. I, like I struggle with that because it's like there is this spontaneity that my husband and I have. Like, we will decide to buy a plane ticket to go somewhere, like with our kids, and not have a return ticket and be like, "We'll figure it out on the way back." And my autism is like, I'm okay with that because the plan is there is no real plan. Like, we're gonna figure it out, and it's kind of a game, and that, like, that, that's what the plan is. But then there are other aspects that are just such a challenge in my relationship, especially communication-wise, where sometimes I'm like, I just don't get what he's saying . And he's like, "You're so annoying. Why are you not getting this?" And I'm like, "Ah," because you have to be, like, very, very direct with me, otherwise, like if you're being like, you know, kind of d- beating around the bush, so to speak, I'm like, "I don't really understand." But you do see, like, a lot of neurodivergent people gravitate towards one another. So that's just an observation I have. I don't know. I would love people to pop off in the comments and let me know what have you observed. Like, what's been your experience with that? Because also when you look at couples online who are, like, very public about being neurodivergent, they're often talking about their different neurodivergent conditions. Like, they both are, you know, operating with different systems.

Melanie Avalon
Yeah. No, it, it's fascinating. I mean, I would imagine at th- at the very least, like, we know even if... Like, they've done studies, and even like completely arbitrary made-up labels, people like people with the same label. So I th- there's definitely probably a community aspect at the very, very least.

But then beyond that, you know, like you said, you, you, you feel like you understand each other. To that point on the studies, what would you, if you could conduct like a dream study for ADHD, what would you, what would you con- do for the study?

Jolene Brighten
Ooh, I really would like to... Oh, gosh, there's so many. I would like to understand the use of ADHD medications in clinical trials based on where women are at in their menstrual cycle, but also understanding perimenopause and how dosaging could really get dialed in to serve those women better. So I think that's a big question mark right now in the research.

And then the other thing that I would definitely want to explore more is more of the co-occurrence between endometriosis and ADHD and understanding, like, the, the different, you know, ways that endometriosis presents and how that actually changes the ADHD operating system. And I, I'm getting, like, very, very nerdy here, but there's also something called central sensitization, which is where the nervous system changes to believe that pain is always present, even once the lesions that are causing the pain are removed. And I would want to know, are ADHDers or perhaps autistic people who are twice as likely to be diagnosed with endometriosis, are they perhaps the ones who are at higher risk for this central sensitization because of the operating system they have?

Melanie Avalon
Hmm. 'Cause they're, like, locking in on it, basically, the phantom pain.

Jolene Brighten
Wondering, too, because we've seen, like, more neuronal connections in the ADHD brain, even more in the autistic brain, and there's so much more, like, sensory sensitivities, right? So what is happening in the immune system?

Does the immune system adapt more quickly? Does the immune sys- or excuse me, not the immune system, the nervous system. Does the nervous system adapt more quickly? Does it start changing for the pain experience? I just want to know who's at risk for that because I think if we could understand who is at risk for central sensitization, because it is something that can be reversed, but it's a long road. It's like three, sometimes five years of working on it consistently, which is exhausting. But if we can identify who's at risk, then those women should qualify sooner for bigger interventions, like surgical interventions, to remove the lesions that could potentially activate that central sensitization. So I think we could really shape the algorithm in healthcare and the way things are being done. And then the other thing I would throw in there, actually, I'm gonna do one more study.

Melanie Avalon
You can have as many as you want.

Jolene Brighten
... hormone therapy guidelines for m- menopause, but never once considered the neurodivergent woman. And I have a whole chapter where I go through the differences and why a neurodivergent woman may respond differently, sometimes paradoxically, we're not expecting it, to certain hormones. We need a lot more research around that because I do not believe the standard go-to prescribing works for every neurodivergent woman. Actually, I know it doesn't.

And I'm using the umbrella term of neurodivergence because it's not just ADHD, it's not just autism. I- OCD, women with tics, like, different neurodivergent conditions, they, they have different sensitivities. They don't always follow the script. And so I think we've done a huge disservice considering that, you know, roughly 6% of adults are currently diagnosed with ADHD, but se- up to 75% of women aren't getting diagnosed until they make it to adulthood, and there are some experts who say the majority of those with ADHD don't even know they have it.

Melanie Avalon
Yeah, and to that point, because the timelines, 'cause there's already, you know, a conventional recommended, you know, window for, for prescribing HR- HRT, but then you talk about how women with ADHD enter perimenopause, you know, way earlier. So it's like, how do you adjust for that as far as, like, the timing of it and e- how everything would go?

Jolene Brighten
Absolutely. That's such a great question, and you know, I talk about in the book that personally, I don't wait until someone's last menstrual period before I start them on hormone therapy, and I never have. And I've been prescribing for, like, 15 years, so I, this, I, this is not my first rodeo here. And the reason I never have is because I've never agreed with making women suffer.

Like, how dare you, anybody, ever set guidelines saying it's completely acceptable that women suffer and they be in the poorest quality of their life, but we just go based on a period, and once that's done, then we can give her relief. Like, that is absolutely ridiculous, and it didn't take a leap of critical thinking to know that. I mean, you know, so I was prescribing still after the Women's Health Initiative came out. I'm so grateful I had an attending who was in perimenopause, and she was like, "I don't care what the Women's Health Initiative said. We're not gonna use Premarin anyways. It's not what, like, I'm using, it's not what we're using, and a- we're not using progestin either. We're going to use bioidentical progesterone, bioidentical estrogen" And she was like, "And I'm sure as hell not gonna drop my hormones, like, based on this study because, like, I'm, this is not how we're doing anything at all." And so she was really the one who taught me that, like, we, we... A- and now we know there's the critical window. The research shows us that, like, we need to get those hormones in before 10 years post-menopausal, so before 10 years from your last menstrual period. Otherwise, we may raise the risk of dementia if we do the standard treatment. That doesn't mean you can't have hormone therapy. It just means that if we go in in the same way we would with, like, a 51-year-old woman with a, like, 76-year-old woman, we may have very bad outcomes, so we don't, we don't, we gotta approach her a lot differently. So I think it's really important that we look at the person who's in front of us, and that we treat the person in front of us. What I think clinicians are missing, and I teach clinicians all over the world. I'm a doctor who teaches doctors how to do women's medicine even better, and I love that there are so many doctors that are invested in doing this. So if, if nobody walks away with anything else, walk away with some hope on this. But one of the biggest things that I think they're missing is that the brain isn't just adapting to lower estrogen. It is adapting to a frenetic estrogen, to an unpredictable estrogen before it adapts to a low estrogen, and that can be highly destabilizing, especially for a woman with ADHD or autism because we see these spikes and these drops and these estrogen just being all over the place. And yeah, you can have hot flashes, you can have night sweats, you can have vaginal dryness, but you can also have anxiety, depression, nuance at PMDD, thoughts of self-harm. Like, these are not things that we should be flippant about. We should take them very seriously.

Melanie Avalon
Wow, okay. Well, this has been absolutely incredible.

So, so two very last quick questions. So listeners, friends, go get ADHD in Women now, especially if you have ADHD, and then, like I said, even if you don't, so much of it is applicable to all women anyways. And like I've been saying all throughout this interview, if you don't have ADHD, it gives you an entirely new perspective and opens your eyes and helps you understand our fellow humans better, so that's a win. I'm really curious because your other books, like Beyond the Pill and Is This Normal, apply to, like, all women automatically. Writing a book that is focusing on a segment of the population of women, did you have any, like, hesitations or concerns or, like, did the publisher because, because now you're potentially, like, limiting the audience? Or did you approach it the exact same way as, as your other books?

Jolene Brighten
Oh, this is such a great question. So the book is applicable for every perimenopausal brain because, like I said, perimenopause likes to cosplay as ADHD. The good news is, is that about two years post-menopausal, which, you know, could be seven, 10, 15 years from when symptoms start, but about two years post-menopausal, things will get better.

And so there are lots of women who have already been reporting to me so that, like, you know, in doing the things that I do for the ADHD, that they work for perimenopause as well. So it, in that way, it is broad, but yeah, I mean, there were publisher, there were publisher concerns where they were like, "Oh, this is such a small subset of the population" But I was like, "It's such an underserved subset of the population" And this is the first book Ever in the world to detail ADHD and hormones and then give you a hormone-specific protocol that you can implement in your life. And I'll say Beyond the Pill was the first book ever in the world to go through birth control and give you a very specific protocol so that you could successfully get off the pill. So I just wanna say thank you to publishers who take a risk on me because, yeah, it is kind of a risk when no book like that exists out in the world, but that's why it has to exist, is because why has it taken so long? And women deserve so much better.

Melanie Avalon
I, I could not agree more. And but I was thinking about that when you said, you know, the 6% stat. I was like, "Well, 6% of women is still a lot. That's a lot of women." So it's no small pool by any means, and then like you said, it, it really is applicable to everyone. So, I cannot thank you enough.

Thank you for this life-changing work. Friends, go get the book now. It should- when this airs, I believe it's coming out, I, I like I said, I think that day. So it's called ADHD and Women. The last question that I ask every single guest on this show, and it's just because I am so appreciative of the role of gratitude and mindset, so what is something that you are grateful for?

Jolene Brighten
So I actually have to share with you that we do gratitude every night at dinner. We call it our avocado, 'cause right when you get that ripe, perfect avocado, it's like the best thing of the day.

So uh, we do this every single night, but I'll definitely say like my avocado right now is that I got to actually hand the first copy of ADHD and Women to the very first like reader. Not the, not the, the, the PR people, not the podcasters. All, this was the very first hard copy in the world to go to a reader, and I got to meet her and sign her book. I might cry because I've never done that before, and I never realized like h- what an incredible moment that is as an author to like meet the first person in the entire world that is just like just a reader that has your book for the first time.

Melanie Avalon
Oh my gosh. That's amazing. Was it like a giveaway or how did they select the reader?

Jolene Brighten
So it was a conference that I was at, and the publishers green lit like giving advance copies to clinicians. And so it was, I, it, the first time I ever even held my book. I hadn't even seen my book yet.

And they opened them up at the conference, and I did cry 'cause I was like, "Oh my God. This is amazing." Like, this was like three years of my life, and like, oh, and I know people like they'll call it a book baby, and then people get mad 'cause they're like, "It's nothing like a baby." And I'm like, "I don't know. It kind of is." Like, it is such ... Like, you don't gestate a human for three years. Like, it is so, so much. But yeah, so it was, um, it was a book signing for clinicians, and I'm really grateful because I wanted what I had said to the publishers like when this opportunity came up, and they were like, "Ugh, should we do this?" And I'm like, "Think about how impactful it is to make sure that we've got 200 clinicians that a week ahead of time read the book and are ready to go and are a place where women can land when they get the book." Because I, you know, I believe wholeheartedly that we've been telling women to DIY too much of their life, and women feel like they have to DIY it because there's just not clinicians there to support them. And so the book, I call it my little beastie because it is a bit of a beast because it's also written for clinicians so that the clinician who gets the book can actually start on a treatment plan with that patient and, and be able to go deeper and really understand. Because when they surveyed clinicians and asked them, "How confident are you in treating adult ADHD?" it was less than 10%, and it only dropped when they said, "Well, what about women?" And so I'm really grateful that my publishers were like, "Let's do this. Let's make sure that there are clinicians who are already getting into this work and going to be ready to go to support these women." I just think what a beautiful collaborative thing to not just have a publisher who's like, "No, we just wanna sell the books." They're like, "No, let's make sure that like if we're gonna raise awareness and we're gonna change these women's lives that like we're with you on your mission of let's change medicine too."

Melanie Avalon
Amazing. Well, thank you so much, Jolene. This has been absolutely incredible. I, I cannot thank you enough.

We'll put links to everything in the show notes. Is there an- anything else you wanted to put out there for people to follow your work, get the book, all the things?

Jolene Brighten
Yeah. So, uh, you can find me all over social media. I also have The Dr. Brighton Show, and I did the most ADHD thing I've done in a while and I started a Substack. I'm writing really bossy, really mouthy kinda pieces over there, things I can't say anywhere else on the internet. So find me there, especially if you're a reader.

Melanie Avalon
Amazing. Well, thank you so much. I am so, so grateful.

Can't wait, I can't wait for the book launch. That's, it's in a few days, so congratulations in advance and would love to have you back in the future. I really appreciate it.

Jolene Brighten
Yeah. Thank you so much for having me. I appreciate all your support.

Melanie Avalon
Have a good rest of your day. Thank you so much for listening to the Melanie Avalon Biohacking Podcast.

For more information and resources, you can check out my book, What, When, Wine?, as well as my supplement line, AvalonX. Please visit Melanieavalon.com to learn more about today's guest, and always feel free to contact me at contact@Melanieavalon.com. And always remember, you got this.