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Huberman Lab
ADHD & How Anyone Can Improve Their Focus | Episode 37
ADHD & How Anyone Can Improve Their Focus | Episode 37

ADHD & How Anyone Can Improve Their Focus | Episode 37

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Andrew Huberman
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Sep 13, 2021
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Episode Transcript
0:00
Welcome to the huberman Lab podcast, where we discuss science and science based tools for everyday life. I'm Andrew huberman, and I'm a professor of neurobiology and Ophthalmology at Stanford school of medicine. Today. We are going
0:16
to talk all about attention deficit,
0:18
hyperactivity disorder or ADHD. We are also going to talk about
0:23
normal levels of focus.
0:25
What are normal levels of focus and how all of us, whether or not we have a
0:30
PhD, or not can
0:32
improve our ability to focus.
0:34
Our ability to rule out. Distraction turns out, those are two separate things, as well as remember information better. We are also going to talk about how we can learn to relax while focusing, which turns out to be a critical component of learning new information and for coming up with new creative ideas.
0:54
So whether or not you have
0:56
ADHD or know someone who does
0:59
or if you're somebody
1:00
Who feels that they do not have ADHD,
1:02
but would simply like to improve their ability to focus or to be more creative. This episode is definitely for you as well.
1:10
We are going to talk about drug based tools that are out there. We are
1:15
going to talk about behavioral tools. We will talk about the role of diet and supplementation
1:19
and we will talk about new emerging brain machine
1:22
interface devices, things like transcranial magnetic stimulation. If you don't know what that is, don't worry, I will explain it to you.
1:30
These are non-invasive methods for rewiring your brain, in order to make focusing more natural for you and to teach you how to increase your depth of focus.
1:41
Now, just a quick reminder that any
1:43
time we discuss a psychiatric disorder. It's important that we remember that. All of us have the temptation to self diagnose or to diagnose others. So, as I list off some of the symptomatology of ADHD, some of that symptomology might resonate with you. You might think. Oh, maybe I.
2:00
I have ADHD or you might decide that someone, you know, definitely has ADHD. However, it is very important that you don't self-diagnose or diagnose. Somebody else
2:10
the clear and real diagnosis of ADHD
2:14
really should be carried out by a psychiatrist a physician or a very well trained clinical psychologist. There are clear criteria for what constitutes a full-blown ADHD.
2:27
However, many of us have constellations.
2:30
Symptoms that
2:31
make us somewhat like somebody with ADHD
2:35
and if you're struggling with Focus
2:36
nowadays, as a lot of people are because of stress because of
2:40
smartphone use which
2:42
turns out can induce adult ADHD will talk about that.
2:46
Well, then pay attention to the
2:48
symptomology. You may actually require professional treatment. You might not
2:52
equally important is to remember that some of the terms that we cover
2:54
like impulse control and attention, and concentration are somewhat
2:59
subjective and
3:00
They can change over time. Sometimes we have a better level of attention than
3:04
others. Maybe depends on how we slept or other events going on in our life or something, that we're entirely unaware.
3:09
Of the important thing to remember is that we can
3:12
all improve our attentional capacity. We can all rewire the circuits that make heightened levels of focus, more accessible to us. We can do that through multiple types of interventions and we are going to cover all those interventions today
3:27
before we March into the material. I'd like to
3:29
remind that
3:30
Podcast is separate from my teaching and research roles at Stanford. It is however, part of my desire and effort to bring zero cost to Consumer information about science and science related tools to the general public
3:41
in keeping with that theme. I'd like to thank the sponsors of today's podcast. Our first sponsor is rokka rokka makes eyeglasses and
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3:51
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3:54
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3:58
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4:00
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4:00
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4:10
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4:12
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So let's talk about ADHD
7:58
attention deficit, hyperactivity disorder.
7:59
Disorder. Let's also talk about focus and attention and everybody's ability to focus and attend not just people with ADHD. We are also going to talk about tools that would allow anyone whether or not they have ADHD or not to enhance their level of concentration and focus.
8:18
ADHD used to be called add attention deficit disorder. We have record
8:25
of add in the medical literature dating back to as early as
8:29
1904. Now, there's nothing special about 1904. That's just the first time
8:33
that it showed up in the standard medical literature. We have to believe that, add, which we now call ADHD existed before 1904, and probably long before 1904. Why?
8:47
Well, because it has a strong genetic component. If
8:50
you have a close relative that has ADHD, there's a much
8:54
higher probability that you will have ADHD.
8:57
And that probability goes up depending on how closely related to
9:00
that person, you happen to be. So for instance, if you're an identical twin
9:04
and your twin has ADHD,
9:06
there's a very high concordance as we say, a very high probability that you will have ADHD up to 75% chance. If
9:15
you have a fraternal twin with ADHD.
9:17
That number goes down a bit in the 50 to 60 percent range and so on, if you have a parent with ADHD
9:23
that number ranges anywhere from 10 to 25 percent likelihood that you will have ADHD if you
9:28
have two parents and so on and so on. Okay, so there's a genetic component that genetic component. It turns out
9:33
relates directly to how specific neural circuits in the brain, wire up the chemicals they use. And the way they use those chemicals, a topic that we are going to discuss in depth
9:43
today. Now if you have a closed,
9:47
Relative with ADHD, that does not mean that you are fated
9:50
to have ADHD. And if you happen to have ADHD, there are ways to
9:54
overcome those
9:56
symptoms of lack of attention impulsivity. And so on,
10:00
another important
10:00
point about ADHD
10:03
is that it has nothing to do with
10:05
intelligence whether or not we're talking about intelligence measured by a standard IQ test rather controversial issue. As many of you probably know they're lots of forms of intelligence that a standard IQ test just
10:17
And pick up. Emotional intelligence. Musical, intelligence, spatial intelligence, all sorts of
10:22
intelligences.
10:24
None of them
10:25
are related to ADHD being very high.
10:28
Functioning doesn't make you more likely to have ADHD and
10:32
being ADHD doesn't necessarily mean that you have a low IQ. So there are people with ADHD. You have low IQs people, with ADHD, with high
10:39
IQs, people with ADHD,
10:40
with high emotional
10:41
IQ, or with low IQ, in the emotional scale. It's all over the place. The important point is that your ability to attend and focus does not
10:50
relate to how smart you are or your IQ.
10:54
Any type, not just a standard IQ, the renaming of the add to ADHD took place in the mid to late 1980s when the psychiatric community, and the psychological
11:06
Community started taking better
11:08
notice of the fact that so-called hyperactive kids also had attentional
11:14
issues. This might seem obvious, but there's been extensive and ongoing
11:18
revision of the criteria, for designating a psychiatric disorder. And this is still an
11:24
an ongoing process even today.
11:27
So in the mid 80s, we started hearing about ADHD. And then
11:30
gradually that term, a TD has been dropped away. However,
11:34
just the
11:34
renaming of add to ADHD has led to much better diagnosis and detection of ADHD. So right now the current estimates are that about one in 10 children and probably more have ADHD,
11:53
the current estimates are
11:54
Anywhere from 10% one intend
11:56
to as high as 12 percent. Now fortunately about half of those will
12:01
resolve with proper treatment, but the other half typically don't the other thing that we are seeing a lot, nowadays
12:08
is
12:09
increased levels of ADHD in adults and there's some question
12:14
as to whether or not those
12:15
adults had ADHD that went undetected during their childhood or whether or not ADHD is now cropping up in adulthood.
12:24
Due to the way that we are interacting with the world in particular smartphone,
12:29
use the combination of email
12:32
text, real world
12:33
interactions.
12:35
Multiple apps and streams of media and social
12:39
media, all coming in at once, trying to manage life. All of the things that are going on, are
12:44
creating a kind of cloud of pulls
12:47
on our attention. And so, there is this question to whether or not we are creating ADHD in adults that never had ADHD prior to being an adult. So, let's talk about attention. And first, let's just Define what we mean by attention
13:04
out there in the scientific.
13:05
Richard and discussions about ADHD. We will hear things like attention and focus and concentration and impulse
13:12
control for sake of today's discussion attention, focus and concentration are essentially the same
13:18
thing. Okay, we could split hairs and the scientific literature, does split hairs about
13:23
these but if we want to
13:24
understand the biology and we want to have a straightforward conversation about
13:28
ADHD, if I say attention or Focus,
13:31
I'm basically referring to the same thing unless I specify otherwise,
13:35
okay.
13:35
Okay, so people with ADHD have trouble holding their attention. What is attention? Well, attention is perception. It's how we are
13:47
perceiving the sensory world. So just a
13:50
little bit of neurobiology 101. We are sensing things all the time.
13:54
There's information coming into our nervous system all the time. For instance, right now, you're hearing
13:58
sound waves. You are seeing things, you are sensing things against your skin, but you are only paying attention to some of those
14:06
And the ones that you're paying attention to our your
14:08
perceptions, so if you hear my voice, you are perceiving my voice, you are not paying attention to your other Senses at the moment. Okay, you might even be outside in a breeze and until I said that you might not be perceiving that breeze, but your body was sensing
14:23
it all along. So attention and focus are more or less the same thing. But impulse control is something separate because
14:31
impulse control requires pushing out or putting the blinders
14:35
on.
14:35
To sensory events in our environment. It means lack of perception. Impulse control is about limiting our perception.
14:44
People with ADHD
14:45
have poor attention and they have high levels of impulsivity. They are easily distractible.
14:52
But the way that shows up is very surprising. You might think that people with ADHD
14:58
just simply can't attend to anything. They really can't focus even if they really want to but that's simply not the case
15:05
people with ADHD. Yes, they are.
15:08
Distractible. Yes. They are impulsive.
15:12
Yes. They are easily
15:13
annoyed.
15:14
Things happening in the room. They sometimes have a high level of emotionality as well. Not always, but
15:18
often however, people with ADHD can have a hyper
15:23
focus and incredible ability to focus on things that they really enjoy. Orange are intrigued by.
15:31
Now. This is a very important point because typically we think of somebody with ADHD as
15:37
being really wild and hyperactive or having no ability
15:41
whatsoever to sit still and
15:42
attend.
15:44
And while that
15:45
phenotype as we call it, that
15:47
Contour of behavior and cognition can exist, many people. If not all people with ADHD. If you
15:55
give them something, they really love. Like if the child loves video
15:59
games or if a child loves to draw, or
16:01
if it's an adult loves a particular type of movie, where a
16:05
person very much,
16:07
they will obtain laser
16:08
focus without any effort.
16:11
So that tells us that people with ADHD.
16:14
Have the capacity to attend but they can't
16:17
engage that attention for things that they don't really, really want to do. And as we all know, much of life, whether or not you're a child or an adult involves doing a lot of things that we don't want to do much of our schooling involves doing things that we would prefer not to do and sort of forcing ourselves to do it to attend. Even though we are not super interested in what we are attending to,
16:39
there are a couple other things that people
16:40
with ADHD display quite often.
16:43
One is challenges
16:45
with time, perception
16:47
time perception is a fascinating
16:49
aspect of how our brain works. And later. We're going to talk about time perception and how you can actually get better at time perception. It's very likely that right. Now you are doing
16:58
things that get in the way
17:00
of optimal time perception. And I will tell you, how to adjust your ability, to measure time with your brain,
17:08
people with ADHD, often run late. They often procrastinate.
17:14
But what's interesting and surprising is that if they are given a deadline,
17:17
they actually can perceive time very well and they often can focus very well. If the
17:23
consequences of not
17:25
completing a task or not attending are severe
17:27
enough, a little bit like the way that people with ADHD can really focus if they like something. Well, if they're scared enough about the consequences of not attending often times. Not always but often times, they can attend. If they're not really concerned.
17:43
Learned about a deadline or a consequence. Well, then they tend to lose track of
17:48
time and they tend to underestimate how long things will take. Now, many people
17:52
do that. Not just people with ADHD, but people with ADHD have challenges
17:58
understanding, how to line up the activities of their day in order to meet particular
18:04
deadlines. Even if it's just a simple thing. Like finishing
18:07
one set of tasks before lunch often times. They will remember that lunch starts
18:12
at noon.
18:14
Somehow, they aren't able to fill the intervening
18:16
time in a way that's productive and they can obsess about the upcoming deadline. For instance. We will talk about how to remedy
18:23
this. In addition, their spatial
18:26
organization skills are often subpar,
18:30
not always, but often you will find that somebody with ADHD uses What's called the pile system.
18:37
In order to organize things. They will take many belongings in, this could be in the kitchen or in their bedroom, or in the
18:43
Their office
18:45
or in any space and they will start piling things up. According to a
18:48
categorization system, that makes sense to them and only them. It doesn't really have any logical framework.
18:55
Many people use the pile system, and if you use the pile system, that doesn't mean that you have ADHD. In fact, if
19:00
you're unpacking a house or you've moved recently or you've received a lot of presence recently, the pile system makes perfect sense to organize your space,
19:09
but people with ADHD tend to organize things according to the pile system.
19:14
All the time and that pile system doesn't
19:16
work for them. Okay, so that's the key distinction that they use a filing system, and it's not really files. They're
19:21
piling things up in a way that makes sense to them, but then, it doesn't work for them. In terms of what tasks. They
19:27
actually need to perform. They can't find things or if anyone moves. One thing that it's very disruptive to their overall plan because their overall plan doesn't really work in the first place. So that's a common phenotype as we call it a phenotype. By the way, is just an expression.
19:43
Ian of a particular set of underlying genetic or psychological components. Okay. So we see the phenotype. So if you want I can be brown hair and green eyes, like for me a phenotype could also be that somebody uses the piling system.
19:59
Okay. The other thing that people with ADHD have real trouble with is so
20:05
called working memory. Now,
20:07
you might think that people with
20:07
ADHD would have really poor memories. But in fact, that's not the case people with ADHD often
20:13
can
20:13
Terrific memory for past events.
20:16
They can remember upcoming events. Quite
20:18
well, their memory is clearly
20:20
working. However, one aspect of memory in particular that we call working memory is often
20:25
disrupted working memory, is the ability to keep specific information
20:30
online to recycle it in your brain over and over again. So that you can use it in the immediate or short-term
20:36
a good example of this would be you meet somebody. They tell you their name. They give you their phone number verbally and you have to walk
20:43
back to your phone.
20:43
And enter it into your
20:44
phone. People without ADHD might have to
20:48
put some effort into it. It might feel like a bit of a struggle. But typically they would be able to recite that phone number in their mind over and
20:53
over and then put it into their phone people with ADHD tend to lose the
20:58
ability or lack. The ability to remember things that they just need to keep online for anywhere from 10 seconds to a minute or two. Okay. So, a string of numbers, like, 643 781
21:10
for most people would be pretty easy. Six,
21:12
four three, seven, eight one.
21:13
Six were 3781. You could probably remember that a minute from now, without writing it
21:17
down. But if you add one more number to that 643, 78130 it
21:23
gets tougher. Okay.
21:25
So there's a reason why phone numbers
21:27
typically have seven digits in them. Of course, there's an area code
21:31
but remembering information that strings out longer than seven numbers
21:37
or a
21:38
sentence or two. That's challenging for most people people
21:41
with ADHD have severe challenges even with
21:43
With much smaller batches of information over even much smaller batches of time.
21:49
Deficits in working memory are also something that we see in people who have frontotemporal dementia. So damage to the frontal lobes or
21:56
age-related cognitive decline, and is so it will come as no surprise that later when we discuss
22:03
treatments
22:03
supplements and other tools for ADHD that many of those treatments supplements and tools for ADHD are similar to the ones that work for age-related cognitive.
22:13
And have decline.
22:15
Okay, so we've
22:18
More or less established. That kind of menu of items that people with ADHD, tend to have some have all of them. Some have just a subset of them, their severity
22:26
can range from very intense to mild but in general its challenges with attention and focus challenges with impulse control. They get annoyed easily have kind of an Impulse civet e. They can't stay on task time. Perception can be off.
22:44
They use the piling system or a system that
22:46
doesn't work. Well for them in order to organize their
22:49
things in physical space and they have
22:52
a hard time with anything. That's mundane that they're not really interested in. But again, I just want to highlight that people with ADHD, are able to obtain heightened levels of focus, even hyper-focus for things that are exciting to them and that they really want to engage in.
23:07
So now you have the Contour of what ADHD is and if you're somebody who doesn't have ADHD, you
23:12
should also be asking yourself.
23:14
Which aspects of ADHD
23:17
are similar to things I've experienced before because, what we know
23:22
about the healthy brain is that there's also a range of abilities to
23:26
focus. Some people focus
23:28
very well on any task. He give them a task. They can just laser in on that task
23:33
other people that have to fight an
23:35
internal battle. They have to convince themselves that it's important or interesting. They have to incentivize themselves. Internally other
23:43
people.
23:44
Doesn't matter if they could be bored to tears with the information, but they can do it just because they
23:49
are quote unquote. Very disciplined people. We tend to admire those people, but as you'll see
23:53
a little bit later, it's not clear that, that's the best way to run your attentional system. There might be something to this business
23:59
of having heightened levels of attention for the things that you are most interested or excited
24:04
by.
24:07
So let's drill into this issue of why people
24:09
with ADHD, actually can focus very intensely on things that they enjoy and are curious about now enjoyment. And curiosity are psychological terms. They're not even really psychological terms there, just the way that we describe our human experience of liking things wanting to know more about them, but from a neurobiological perspective, they
24:31
have a very clear identity and
24:33
signature and that's dopamine.
24:37
Dopamine is released from neurons. It's what we call a
24:39
neuromodulator and as a neuromodulator.
24:43
It changes, the activity of
24:44
the circuits in the brain such that certain circuits are more active than others. And in particular,
24:50
dopamine creates a heightened state of focus. It tends to contract our visual world and it tends to make us pay attention to things that are outside and
25:01
Beyond the confines of our skin. It's what we call, Xterra
25:05
reception.
25:06
Dopamine also tends to put us in a state of motivation and wanting
25:11
things outside the confines of our
25:13
skin. So whether or not we're pursuing something physical in our world or whether or not we're pursuing information
25:20
in our outside world, dopamine is largely responsible for our ability and our drive to do that.
25:27
But dopamine, as a neuromodulator is also involved in
25:31
changing the way that we perceive the world. So as I mentioned earlier, you have all these
25:35
senses.
25:36
Coming in and you can only perceive some of them because you're only paying attention to some of them dopamine.
25:43
When it's released in our brain,
25:45
tends to turn on areas of our brain, that narrow our visual
25:49
focus, and our auditory Focus. So, it creates a cone of auditory attention, that's very narrow. It creates
25:56
a tunnel of visual
25:57
attention. That's very narrow.
25:58
Whereas, when we have less dopamine. We tend to view the entire world. We tend to see the whole
26:03
scene that we are in. We tend to hear everything.
26:06
All at once. So as I describe this,
26:09
hopefully you're already starting to see and understand how having dopamine release can allow a
26:16
person whether or not they have ADHD or
26:18
not to direct their attention
26:21
to particular things in their environment.
26:24
All right. So now what we're doing is we're moving away from attention as this kind of vague ambiguous term and we're giving it a
26:31
neurochemical identity. Dopamine and we are giving it a neural circuit identity.
26:36
Tea and just to put a little bit of flavor and detail on which neurocircuits. Those are? I want to
26:41
discuss two, general
26:43
types of neural circuits that dopamine tends to enhance.
26:46
So let's talk neural circuits. And
26:48
for those of you that
26:49
love hearing Neuroscience
26:51
nomenclature, you're going to eat this part up. And for those of you that don't like a lot of names of brain areas. I invite you to tune out or just try and grab the top Contour of this. I will describe it in
27:02
pretty general terms, but I will give some detail because I know there.
27:06
Some of you out there who really want to dig deeper into what the exact structures and connectivity is our. Okay.
27:12
So there are two main types of
27:14
circuits that we need to think about with respect to ADHD attention and
27:18
dopamine. The first one is called the default mode
27:21
Network. The default mode network is the network of brain areas in your brain, and my brain and in everybody's brain, that is
27:29
active when we're not doing anything when or just sitting there idle at
27:33
rest. Now, it's very hard to not think about anything.
27:36
Thing,
27:36
but when you're not engaged in any type of
27:38
specific tasks, so you're not driving. You're not playing a video game. You're not trying to study. You're not trying to listen. You're just sitting there letting your brain kind of go wherever it wants to go. Your default mode Network underlies that state of mind the other set of circuits that were going to think about and talk about with respect to ADHD are the task networks. The
28:01
networks of the
28:02
brain that make you goal-oriented or that, or at least.
28:06
Trying to make you goal-oriented and those are a completely different set of brain areas. However, the default mode Network, and these task networks are
28:17
communicating with one
28:18
another and they're doing that in very interesting
28:20
ways. So first, I want to
28:22
describe how these two sets of brain areas the default mode Network and the task networks normally interact. Okay, so
28:29
little bit of naming here again, feel free to ignore it
28:32
if you don't want this level of detail, but the default mode
28:36
A network includes an area called the dorsal lateral. Prefrontal cortex
28:41
frontal cortex. No surprises in the front and you have a dorsal, the top
28:45
and side lateral part. Dorsal lateral, prefrontal cortex. You got one on each side of your brain, right?
28:51
And then you have a brain area called the posterior cingulate cortex. And then you have an area called the lateral parietal lobe, again. You don't need to remember these names for these are three. Brain areas that normally are synchronized in their activity. So when one of these areas is active in a typical person,
29:06
And the other areas would be active as well. So it's a little bit, like a
29:09
symphony or a band. Like a three-piece band is, like, drums guitar and bass. They're playing together.
29:15
Okay, that's how it is in a typical person and a person with ADHD, or even a person who has subclinical ADHD or, in any human being who hasn't slept.
29:25
Well, what you find is the default mode network is not synchronized, these brain areas are just not playing well together. Now, the task networks
29:34
include,
29:36
A different set of structures.
29:37
It still involves the prefrontal cortex, but it's a different part of the prefrontal cortex. Okay? Tends to be the medial, prefrontal cortex. And there are some other brain areas that
29:47
the medial prefrontal cortex is communicating to all the time, mainly to
29:51
suppress impulses. It's
29:53
shutting down the desire to stand up or to scratch the side of your cheek or your nose. If you're trying not to do that, any time, you're restricting, your behavior. These tasks
30:02
directed networks are very active. Okay?
30:06
Now normally in a person without ADHD,
30:09
the task networks and the default mode networks are going and kind of seesaw fashion. They are actually what we call anti-correlated. So it's not just that they are not correlated. They are actually opposing one another. They are anti-correlated
30:24
in a person with ADHD
30:26
the default mode networks and the task networks are actually more coordinated
30:31
that might come a surprising. I think that we all have this tendency to kind of
30:36
Jump to conclusion and assume that somebody who
30:39
doesn't have an easy time paying attention or has ADHD that, their brain must be completely incoherent. That that's not working. Well, and because everything is out of whack, but there's something interesting about people with ADHD, whereby, the task networks and the default mode networks are actually working together in a way that's correlated. And that is what's abnormal. So this would be like the guitar bass and the drums
31:04
playing together in a way.
31:06
Way where
31:07
the base is in, keeping the BackBeat and the drums aren't keeping the back beat that they're playing together. They're all playing The Melodies and harmonies in a way. That just doesn't sound right. That's what's going on in the brain of somebody with ADHD
31:21
and we can now confidently, say based on brain Imaging studies that when somebody
31:25
gets better when they're treated for ADHD or when they age out of ADHD, as sometimes is the case that the default mode networks and the task networks tend to
31:36
Come anti-correlated again. Okay, so that's the underlying neurobiology, but you'll notice that I didn't mention dopamine at all.
31:45
What dopamine is doing in this context, is dopamine is acting like a conductor. Dopamine is saying,
31:51
is this circuit should be active than that? Circuit should be active. It should be
31:54
default mode Network. And then when the default mode network is
31:56
not active, then it should be the task Network. So it's really acting as a conductor, saying, you go, now you go. Now you go. Now, you
32:02
go and in ADHD, there's something about the dopamine system.
32:06
Item. That is not allowing
32:08
it to conduct these networks and make sure that they stay what you know, the engineers are physicists or mathematicians would say out of phase 2B anti-correlated okay, out of phase and anti-correlated essentially the same thing at least for purposes of this discussion.
32:23
So that raises two questions. Could it
32:26
be? That dopamine is not at sufficiently high
32:29
levels or could it be the dopamine is just doing it all wrong. In
32:33
other words. Is there no conductor or is the conductor?
32:36
With a little tiny toothpicks and so the instruments can't see what they're supposed to do. They can't get the instruction because it's just not loud enough so to speak. Or could it be that the information is getting out? But the information that's getting out
32:48
is wrong, the conductor is there? But the conductor is in very good at conducting.
32:54
Now we can gain insight
32:55
into how this system works and fails
32:58
and how to treat it by looking at some of the current and previous treatments for ADHD as well as some of the recreational.
33:06
Rugs that people with
33:07
ADHD tend to pursue. And like now I'm certainly not a proponent of people with ADHD taking drugs. Recreationally. That's not what this is about. But if you look at their drug-seeking behavior and
33:18
you couple that drug-seeking behavior to their desire to
33:23
remedy their attention deficit,
33:25
you start getting some really interesting insight into how dopamine is regulating these circuits in normal circumstances, and in people with ADHD, so,
33:36
Exactly is going on with the dopamine system in people with ADHD. And what's going on with the dopamine system in people that have
33:43
terrific levels of attention for any task.
33:46
Well, in the year 2015, an
33:49
important paper came out, the first author is
33:51
Spencer and it came out in a journal
33:53
called biological Psychiatry
33:55
and it formalized, the so-called low dopamine hypothesis of ADHD. The idea that dopamine was somehow
34:03
involved or not at the appropriate level.
34:06
As in people with ADHD have been around for a long time,
34:09
but a formal proposition of the low dopamine hypothesis led
34:15
to some really important experiments and understanding of what goes wrong in ADHD.
34:20
It turns out that if dopamine levels are too low, in
34:24
particular, circuits in the
34:25
brain that it leads to unnecessary firing of neurons in the brain that are unrelated to the task. That one is trying to do. And
34:35
that is
34:36
Unrelated to the information that one is trying to focus on. So, if you think back before you've got this default mode Network and a task related Network and they need to be in this kind of concert of anti-correlation and an ADHD. They're firing
34:49
together. Well, the problem seems to be that when dopamine is low.
34:55
Certain neurons are firing when they shouldn't be. This is like a
34:58
band, right? We'll go back to our band. That's a guitar or bass in it and person playing the
35:02
drums and it's as if one of those or several of those instruments are playing
35:07
notes when they shouldn't be playing, right? The pauses and music are just as important as the actual playing of notes.
35:15
When dopamine is too low neurons fire more than they
35:19
should in these networks that govern attention.
35:23
This is the so-called low dopamine hypothesis. And if you start looking anecdotally at
35:29
what people with ADHD have done for decades, not just recently since the low dopamine hypothesis has been proposed but what they were doing in the 1950s and then the 1940s and the 1960s what
35:42
you find is that they tend to use recreational drugs or they tend to indulge in non-drug.
35:52
Stimulant so things like drinking 6 cups of coffee or quadruple, espressos, or when it was
36:00
more prominent
36:01
smoking, a half, a pack of cigarettes and drinking four cups of coffee a day, or if the person had
36:06
access to it using
36:08
cocaine as a recreational drug or amphetamine is a recreational drug. All of those substances that I just described and particular cocaine and amphetamine but also coffee and cigarettes
36:20
increased levels of multiple.
36:22
Neurotransmitters, but
36:24
all have the quality of increasing levels of dopamine in the brain and in particular in the
36:29
regions of the brain that regulate attention and these tasks related and default mode networks.
36:35
Okay. Now young children, fortunately don't
36:37
have access to those kinds of stimulants. Most of the time
36:41
and those stimulants all have high
36:44
potential for abuse in adult. So we will talk about the potential for abuse in a few minutes,
36:49
but if you look at children, even very young
36:52
Children with ADHD,
36:53
they show things like preference for sugary foods,
36:57
which also act as dopamine inducing stimulants. Now, of course, once they get access to soda pop and coffee and tea, they start to indulge in those more than other people
37:09
for a long time. It was thought that children with ADHD consume
37:12
too many sugary Foods or drank too much soda or
37:16
adults. With ADHD would
37:18
take recreational drugs like methamphetamine or cocaine or
37:22
Wood, drinked coffee to excess or smoke, cigarettes
37:25
to excess because they
37:26
had poor levels of attention and because they couldn't make good decisions. They were too impulsive and so forth. And while that certainly could be the case,
37:35
knowing what we now know about dopamine and the fact that having enough dopamine is
37:40
required in order to coordinate, these neural circuits that allow for focus and quality decision, making
37:47
And equally
37:48
valid idea, is that these
37:50
children and these adults are actually trying to self-medicate by pursuing these compounds, right things, like cocaine lead to huge increases in dopamine. Well, what happens was when somebody with ADHD takes
38:02
that drug,
38:03
it turns out, they actually obtain heightened levels of focus their ability to focus on things other than things. They absolutely
38:10
care. Intensely about
38:12
goes up likewise children who consume anything that increases
38:16
Increases their levels of dopamine. If those children have ADHD, they tend to be calmer.
38:23
They tend to be able to focus more.
38:25
Now. This is very different than children. Who do
38:28
not have ADHD. When they consume too much sugar, they tend to become super hyper
38:32
active when they consume any kind of stimulant they tend to go
38:35
wild and run around like crazy. Actually have an anecdote about this just to illustrate
38:39
it. I have a friend. He has
38:41
two children that are now in their teens and twenties, but when they were little one time, I brought them some
38:46
Chocolate. Just as a gift when I showed up at their
38:48
house and within 30 minutes, we the kids were running
38:52
around like crazy. I mean, they were pretty high energy kids, but they were going bonkers and that's actually when the mother, my friend at the time, unfortunately, still now looked at the
39:02
chocolate realize that it was chocolate with
39:04
espresso beans in it was like dark chocolate espresso beans. So I was really at fault there. You don't want to give kids dark chocolate with espresso beans, but
39:12
what you're really seeing that hyperactivity that is dopamine.
39:15
Okay, it's the sugar combine.
39:16
Bind with the
39:17
caffeine. In this case, combined with a few other compounds that exist in chocolate that really increase our levels of alertness and our tendency to
39:24
want to move around a lot.
39:25
Okay, so dopamine and low levels of dopamine. Apparently are what's wrong
39:32
and people with ADHD,
39:33
that dopamine hypothesis is what led to the idea that treating people children and adults included with dopaminergic compounds would somehow
39:45
increase their ability to
39:46
The focus. And if you look at the major drugs that were developed and now marketed by pharmaceutical companies for the treatment of ADHD.
39:56
Those drugs have names like Ritalin
39:59
nowadays. It's typically things
40:01
like Adderall modafinil and some of the other derivatives they all serve to increase levels of dopamine in particular dopamine in the
40:10
networks that control task directed behavior and that coordinate the default mode Network.
40:16
And these tasks related networks. So many of you have probably heard of Ritalin. Ritalin is a prescription.
40:22
Stimulant that is
40:24
prescribed for ADHD as well. As for narcolepsy, narcolepsy is a condition which people tend to fall asleep during the daytime quite a lot, excessive daytime sleepiness, not due to lack of sleep at night, but also tend to fall asleep when they get excited, if they're really emotionally excited or about to eat or any other kind of activity. That would normally get somebody really aroused and
40:46
Hurt people with narcolepsy, tend to fall asleep, or they tend to become
40:50
what's called cataplectic. They tend to just sort of go limp in the muscles. So it's this Invasion or sleep into the daytime. It's dysregulated
40:57
by emotion. You can imagine why a stimulant something that would wake you up. Make you very alert focused,
41:03
and motivated would be a good treatment for narcolepsy.
41:06
Adderall also is used to treat ADHD and to treat narcolepsy.
41:12
Things like modafinil
41:14
also used to treat ADHD.
41:16
HD and narcolepsy, so you're sensing a theme here. So what are the differences and similarities between these drugs? And what can that tell us about ADHD?
41:25
Well Ritalin was one of the first generation drugs that
41:29
was prescribed for ADHD in order to deal head-on with this dopamine hypothesis. This idea that in ADHD dopamine levels are too
41:39
low nowadays Adderall
41:41
is the more typically prescribed drug for ADHD
41:45
that has to do with some of the
41:46
so-called.
41:46
Kinetics the rate at which those drugs enter the system and how long they
41:51
last in the system. So for instance, Ritalin was a drug that
41:55
was packaged into various time-release
41:57
formulas. Whereas initially Adderall
42:00
was only released in a form that had a very short life. So meaning that it wasn't in the bloodstream very long and didn't affect the brain for very long. And so the dosages could be controlled in a more typical way, without going into a lot of tangential detail, as you all know.
42:16
At different times of day, you tend to be more or less alert. So a long sustained release drug while that might sound like a really
42:23
terrific thing. If that drug is having an effect
42:26
of making you more alert and it's released across very many hours of your day. There might be periods of your day. When you feel to alert periods of your day, when you feel just right and periods of your day. When you wished that you were more alert. These are some of the pharmacokinetics kinetics meaning movement of the different compounds within the bloodstream and brain that could.
42:46
I could imagine in a very real way would impact whether or not someone would feel really good on one of these drugs or whether or not they would feel too anxious or too sleepy and so
42:54
on.
42:56
Let's take a step back for a second and just ask. What are these drugs? We know they increase dopamine. But what are they really? Well? Ritalin also called methylphenidate is very similar to amphetamine
43:10
speed or what's typically call speed in the street drug nomenclature Adderall, which goes by various other names? Okay. So adderal Adderall XR, my my - my diocese.
43:26
Things like that. Adderall is basically a combination of amphetamine and dextroamphetamine. Now, some of you probably
43:34
realize this that Adderall is amphetamine, but I'm
43:37
guessing that there are a good
43:38
number of you out there, perhaps even parents and kids that don't realize
43:42
that these drugs like cocaine and amphetamine methamphetamine, which
43:45
are incredibly dangerous and Incredibly habit-forming and have high potential for abuse. Well, the
43:54
pharmaceutical versions of those.
43:56
Those are
43:56
exactly what are used to treat ADHD. Now, they're not
44:00
exactly like cocaine or Methamphetamine, but they are structurally and
44:03
chemically very similar
44:05
and their net effect in the brain and body
44:07
is essentially the same, which is to increase, dopamine primarily, but also to increase levels of a neuromodulator called epinephrine or norepinephrine also called noradrenaline adrenaline, those names of the
44:18
same and to some extent to increase levels of serotonin in the brain and
44:23
blood, but not so much serotonin that
44:26
Kind of a small smidgen of
44:27
effect. Okay, so dopamine way up
44:30
norepinephrine and adrenaline way up, so that motivation
44:34
Drive, focus and energy. And to some extent a little bit of Serotonin,
44:40
which is really more about feeling, calm and relaxed. And you can imagine why that would be a good balancing effect for dopamine and norepinephrine.
44:51
So what I'm essentially saying is that the drugs that are used to treat ADHD
44:55
Dr. Stimulants, and they look very
44:57
much. Like, in fact,
44:59
nearly identical to some of the so-called street
45:02
drugs stimulants that we all here are so terrible. However, I do want to
45:06
emphasize that at the appropriate dosages and working with a
45:12
quality psychiatrist or neurologist or family physician does have to be a board-certified MD that prescribes these
45:18
things, many people with ADHD achieve
45:22
excellent relief with these drugs, not all of them, but many of
45:26
Do especially if these treatments are started early in life.
45:30
So now, knowing what these drugs are. I want to raise the question
45:33
of
45:34
Why prescribe these drugs? I mean,
45:36
everyone has to make a decision for
45:38
themselves or for their child as to whether or not they're going to take these things or not.
45:42
I also want to acknowledge that many people out
45:45
there. Many, many people out. There are taking these drugs even though they have not been clinically diagnosed with ADHD. When I say these drugs, I'm specifically referring to ritalin and adderall and modafinil, but more typically, it's Adderall. Okay, people using cocaine and amphetamine for recreational purposes. That's a completely different.
46:04
Beast and it is indeed a beast and it's something that I strongly discourage. However, I am aware that
46:12
up to 25% of college students
46:15
and perhaps as many as 35 percent of all individuals between the ages of
46:21
17, and 30
46:23
are taking Adderall on a regular or semi-regular basis in order to work in order to study and in order to function and focus in their daily life. Even though,
46:34
They have not been diagnosed with ADHD. There's a whole black market for this. They're getting it from people with prescriptions.
46:40
I'm not here to pass judgment. I just
46:42
want to emphasize how these drugs work.
46:44
Some of the things that they do to
46:46
enhance cognition and focus that actually serve the brain. Well in certain
46:50
individuals, and how they can be very
46:52
detrimental.
46:54
In other individuals,
46:55
I sort of blew right past it. But the fact that in upwards of 25
46:59
percent of young people are taking things like Adderall, despite not having a clinical diagnosis of
47:06
ADHD. Well, that's a ridiculously high number. A few years ago. It was estimated
47:13
that Adderall use and Ritalin use without diagnosis of ADHD
47:18
was second in incident only to cannabis, but actually now the consumption
47:24
Of Adderall without prescription.
47:27
Is higher than the consumption of cannabis in that age group?
47:31
So what that means is
47:32
that there's a lot of stimulant use in that age group. And there are a lot of adults also using and abusing stimulants in order to gain focus. And we could have a whole discussion about whether or not life is becoming more demanding, whether or not the need for focus is excessive and that's why people are doing
47:49
that frankly. It's an interesting discussion, but it's not one that would
47:52
deliver us to any answers rather. I'd like to focus on the
47:55
ways that people now,
47:57
People have always been self-medicating to increase Focus.
48:01
Right?
48:02
Caffeine, which I indulge
48:05
some, I don't think to access has long been used as a stimulant to increase dopamine. Increase norepinephrine, increased focus and energy. And in addition to that, it works through the so called cyclic, a MP
48:17
phosphodiesterase pathway. Remember anytime you see you here in a sec. That's an enzyme phosphodiesterase is involved in the conversion of things like cyclic, A and P into
48:27
Energy for cells, and so
48:28
forth. Basically coffee gives you energy, and makes you feel good. And it increases Focus because of the circuits
48:34
that it engages in the brain.
48:37
People have been taking caffeine and continue to take caffeine for
48:40
ages. People also used to smoke
48:44
cigarettes nicotine, in order to gain Focus nowadays, that's less common, because of the concerns. Quite valid concerns about lung cancer from smoking, but there's a lot of vaping out there. There are a lot of people. Now, consuming nicotine, which is the active substance in cigarettes, and in most nicotine Vapes that stimulates the brain to
49:07
More focused and more
49:08
alert. So the idea of taking stimulants of consuming things or smoking things,
49:14
in order to increase alertness is not a
49:16
new idea. It's just that an ADHD. It's surprising that these things
49:21
would work. Right. I mean, if the problem is attention deficit, hyperactivity disorder, what we're really talking about here or children that are prescribed a drug that ought to be a stimulant and it ought to make them hyper hyper active and rather than doing
49:36
that.
49:37
It actually somehow
49:38
serves to calm them a bit or at least allow them to
49:41
focus. Here's the reason children have a brain, that's a very plastic meaning. It can remodel
49:49
itself and change in response to experience very, very quickly compared to adults
49:54
taking stimulants as a
49:55
child. If you are a child diagnosed with ADHD
50:00
allows
50:00
that forebrain task-related Network, to come online to be active at the appropriate times.
50:07
And because those children are young, it allows those children to learn what focus is and to sort of
50:13
follow or enter that tunnel of focus.
50:16
Now, by taking a drug, it's creating Focus
50:19
artificially. It's not creating Focus because they're super interested in something. It's
50:24
chemically inducing, a state of focus and let's face it. A lot of
50:28
childhood and school and becoming a functional adult is about learning how to focus even though you don't want to do something. In fact, when I was in college, I had this little trick that may or may not work.
50:37
For some of you which is, if I couldn't focus on the material, I was trying to learn. I would delude myself into thinking that it was the most interesting thing in the world. I would just kind of lie to myself and tell myself. Okay,
50:49
this I won't mention the subjects.
50:52
I absolutely love this. I would just I would tell myself that I loved it and I noticed that just that selective or
50:59
deliberate engagement of that desire to know, circuit. Whatever that is in my brain. No doubt. Involves dopamine allowed me to focus and remember the information and somewhat, surprisingly, or perhaps. Not surprisingly. I would often fall in love with the information. I find that. That was my favorite class. Where was the what I wanted to learn the most. So
51:18
that's one way you can do it artificially, but kids with ADHD, they can't do that right there.
51:22
Told to sit.
51:22
Still. And they end up getting up 11 times. They are told that they can't speak out in class or that they have to remain in their seats for ten minutes and they just despite their best efforts. They simply cannot do it. They're highly distractible.
51:37
So what are we to make of this whole picture
51:39
that we need more dopamine? But these kids with ADHD, they're getting their dopamine by way of a drug, which is for all the world amphetamines, right? Its speed. That's really what it is. What are the long-term consequences? Where the short-term consequences?
51:52
Quinces,
51:54
and what should we make of people
51:56
taking these drugs without a clinical need? What are the consequences there?
52:00
Well, in order to get to some of those answers, I went to one of my colleagues. This is a colleague that I've
52:05
actually known for a very long time. I was there teaching assistant when they were an undergraduate, they went on to get an MD, a medical degree as well
52:13
as a PhD and become a
52:16
pediatric neurologist, that specializes
52:19
in the treatment of epilepsy and ADHD and kids
52:22
of
52:22
All ages, from Age 3 to 21. That's the age range. Pretty broad age range and has extensive knowledge in this.
52:30
And what makes
52:31
them particularly interesting for sake
52:33
of this discussion is that they have a child a young boy who's now showing
52:39
signs of ADHD and they are on the threshold of trying to decide whether or not they will prescribe Adderall or something similar. So we had a discussion about this and prior to
52:52
Learning that their child may have ADHD. I asked the following
52:57
questions. First of all, I asked, what do you think about giving young kids amphetamine and their answer was, you know, on the face of it, it seems crazy but provided that the lowest possible dose is used and that that dosage is
53:13
modulated as they grow older and develop those powers of attention.
53:18
Their observation was that they've seen more kids benefit than not benefit from that. Now, I'm
53:25
certainly not saying what people should do, you
53:27
obviously have to go to a doctor because as I always say, I'm not a doctor, I don't prescribe anything. I'm a professor. So I
53:33
profess things and here I'm
53:34
professing that you talk to your doctor. If you're considering giving ritalin or Adderall or any type of stimulant to your child, of course, what could be more important than the health of your child
53:44
but is a very interesting answer because typically
53:46
we hear yes medicator don't medicate.
53:48
Rarely, do. We hear that? The medication should be adjusted across the lifespan and in any particular kind of way. Now, the fact that this person this now friend of mine, and colleague of mine
53:59
has so much expertise
54:00
in the way that the brain works
54:02
and is considering putting their child on such medication. I said, you know, why
54:09
wouldn't you wait until your kid reaches puberty? I mean, we know that in boys and girls that are increases in testosterone and estrogen during puberty that
54:18
Matically change the way that the body appears but also that dramatically change the way that the
54:23
brain functions in particular.
54:25
We know this that puberty triggers the activation of so called
54:30
frontotemporal task-related executive, functioning. That's
54:34
just fancy science
54:35
speak for being able to focus being able to direct your attention, being able to control your impulses. Look at a small child or look at a puppy and then look at an older child, or look at a dog, very different levels patterns of spontaneous Behavior, young children.
54:48
Around a lot their shit there. I don't say Shifty because that makes it sound like they're up to something bad, which they might be, but they don't have to be up to something bad. They fidget a lot. So two puppies, everything is a stimulus as animals and humans get older they learn how to control their behavior and sit still
55:04
listen and focus even if they don't want to. So giving a drug that allows a child to
55:11
access that Stillness early on, it's thought will allow them to maintain that ability as time.
55:18
Goes on but I decided to push a little bit further. I said, well, why would you do it now as opposed to
55:25
during puberty or after puberty
55:28
and their answer was very specific and I think very important what they said was look,
55:33
neural plasticity is greatest in childhood and tapers off after about age 25,
55:40
but neuroplasticity from Age 3 until age 12 or 13 is exceedingly high and they're
55:49
When you sit back and you look at the literature on neuroplasticity, you'd say,
55:52
childhood plasticity in young adult plasticity is much greater than adult plasticity, but that early childhood plasticity is Far and Away the period in which you can reshape the brain at an accelerated rate.
56:05
So this lines up
56:06
really well with the clinical literature, not surprisingly, their clinician
56:10
that early treatment is key if you have the opportunity to
56:14
work with a quality physician and treat these things early.
56:18
These drugs can allow these fronto circuits. These tasks related circuits to achieve their appropriate levels of functioning and for kids to learn how to focus in a variety of different contexts.
56:30
Now, is that the only thing that they should be doing? Of course not. So the next question, I asked was,
56:36
what should we make of all this diet related stuff,
56:39
right? I've heard before that, the so-called
56:43
Elimination Diet or ingesting, no sugars, or no dairy or no.
56:48
That all of these things have been purported
56:51
to improve symptoms
56:52
of ADHD and people, and parents with ADHD.
56:56
Go to fnatic lengths, to try and find the
56:59
exact foods that are causing problems. And the exact foods that kids can eat in order to try and get their brain wired up, right and correctly and to avoid lifelong ADHD. And their answer was really interesting. But before I tell you their answer,
57:16
I want to tell you the studies and the data.
57:18
Related to this question of whether or not food and the constellation of foods that one avoids and Willie has anything to do with our levels of attention and in particular, whether or not that can be used as a leverage
57:30
point to treat ADHD.
57:33
So you can imagine the
57:34
challenges of exploring the role of diet and nutrition
57:38
in any study but especially in a study on
57:40
ADHD. Why? Well, because, as I mentioned before
57:43
children with ADHD, and it turns out adults with ADHD tend to pursue sugary Foods,
57:48
Any types of food that increase their levels of dopamine, they are naturally drawn to those Foods whether or not they realize it or not.
57:55
Presumably as a way to try and treat their lack of focus and impulsivity.
57:59
So in this study that I'm about to share with you,
58:03
there was no drug treatment. It was just a study manipulating diet
58:07
and involved a hundred children 50 in the
58:10
so-called Elimination Diet group, the special diet, where certain foods were eliminated and 50 in the so-called control group. However, being
58:18
a
58:18
Design randomized controlled trial. This study also included a crossover, meaning where the kids would serve, as their own
58:26
control or control group, at a certain portion of the studies. They will be one group where they eliminated certain foods and then after a period of time in the study, they would swap to the other group. This is a
58:35
powerful way to design a study for reasons that you can imagine because you start to eliminate change is an effects due to individual differences. In any case, hundred children total
58:45
50 in each group at any one period in time.
58:48
And the effects that they observed were extremely dramatic in the world of statistics and Analysis of scientific data. We talked about p-values probability values. What's the likelihood that something could
58:58
happen according to chance? And typically the cutoff would be something like P less than 0.05, that's
59:05
less than .05 chance. Essentially of
59:09
the effect being due to
59:10
chance. However, in this study every single, one of the effects is p less than point zero zero, zero one, very, very
59:18
Be infinitesimally, small probability that the effect
59:21
observed could be due to chance. So what were these effects? These effects were enhanced ability to focus less
59:27
impulsivity even less tendency to move when trying to sit still. So everything from mental focus to the ability to control their bodies. Improved when they were in The Elimination Diet group. What was eliminated? Well, the Elimination Diet in this particular study was a so-called all ago, antigenic diet. It was a died in
59:48
Each kid took a test to determine which
59:51
foods, they had antibodies for meaning that they were mildly allergic to
59:56
now, in this study was very important that the kids not be extremely allergic to any food because as I mentioned before, they actually served as a control
1:00:03
at one point in the study where they were eating all sorts of foods including foods that they had mild allergies to.
1:00:08
So, basically, what this study said was that eliminating foods to which children have allergies can
1:00:16
dramatically improve their symptoms of
1:00:18
ADHD. And this study, not surprisingly because it was published in such a
1:00:23
high-quality Journal, Lancet, Etc. Large number of subjects
1:00:27
set the world on fire people. We're extremely excited about these results because here in the absence of any drug treatment, there was a significant Improvement in
1:00:36
ADHD symptoms
1:00:37
observed and then came the criticisms. So many papers were
1:00:43
published after this specifically
1:00:45
dealing with reanalysis of these data and I
1:00:48
To be fair in saying that the data in the paper, look good, but there are criticisms of the overall structural
1:00:56
design in the study. I don't want to go into
1:00:58
all the details, exactly. Because it gets really nuanced about some of the statistics
1:01:02
in the way that one examines these types of data, but there was skepticism and in science, skepticism is healthy,
1:01:09
especially when making decisions about whether, or not
1:01:11
to treat or feed children, one food or another, or give them one drug or
1:01:15
another,
1:01:17
Now I want to return to the
1:01:18
story of my friend who is a pediatric neurologist and treats ADHD
1:01:23
and has a child who is on the precipice of
1:01:26
perhaps starting to take drugs for the treatment of ADHD. I ask the simple question.
1:01:31
Do you see an effective diet meaning when parents control the diet of their children? Does it make a
1:01:38
positive or negative or no difference in terms of the way that the kids respond to ADHD drugs like ritalin and adderall.
1:01:46
Or whether or not it can help them avoid treating, with those drugs entirely. And her response was very straightforward. She
1:01:52
said elimination of simple sugars. Has a dramatic and
1:01:56
positive effect. She's observed that over and over and over again in many dozens if not hundreds of patients. Well, now that's not a peer-reviewed study. That's a statement that I'm conveying to you anecdotally, but it's a highly highly informed
1:02:08
one. I said, what about these elimination
1:02:11
diets. She said and I found other sources to support
1:02:15
this that these
1:02:16
Oligo antigenic diets are controversial. There are many people who really believe in identifying all the things
1:02:22
that you're allergic to, and making sure that you and especially your kids avoid those Foods. However, there's another camp that starting to emerge in the
1:02:31
peer-reviewed scientific literature showing that when kids are not exposed to certain foods
1:02:37
in particular nuts and things of that sort. They develop allergies to those foods and then when exposed to them later they cause real problems. So there's a whole
1:02:46
Galaxy of discussion and controversy and
1:02:49
outright fighting about allergies and kids and whether or not the oligo antigenic diet is the appropriate one, however,
1:02:55
out of the for
1:02:56
neurologist and psychiatrist that I spoke to about ADHD in preparation for this,
1:03:01
every single one said, children with ADHD, as much as possible should be encouraged to
1:03:06
avoid high sugar and simple sugar foods of most kinds.
1:03:11
And if they can find particular foods that exacerbate, their symptoms.
1:03:16
Obviously eliminating, those Foods is beneficial and the foods that exacerbate their symptoms change over time. So I don't like giving a complicated
1:03:28
answer but I also don't like giving an incomplete answer. What this tells me is that
1:03:34
children, especially young children who have ADHD should probably not
1:03:40
eat much sugar in particular simple sugars. In addition to that exploring whether or not
1:03:45
they have
1:03:46
Listing allergies to Foods. They already consumed might be a good idea. At least that's what
1:03:53
this paper. The pellicer
1:03:54
at. All Lancet, paper seems to speak to.
1:03:56
And I should mention that that paper was published in 2011. Since then there have been
1:04:01
many dozens of studies exploring the same thing as well as meta-analyses of all those data. And it
1:04:07
does appear that diet can have a highly
1:04:10
significant role in eliminating or at least reducing the symptoms of ADHD
1:04:15
so much. So,
1:04:16
That
1:04:16
some of the children are able to not take medication at all, or eventually wean themselves off medication as young adults. And as adults,
1:04:25
one, interesting question is whether or not adults
1:04:28
should modify their diet in order to increase their levels of focus if they're already having normal levels of focus, but would like more or would like to reduce existing adult ADHD.
1:04:41
That's an interesting and even more controversial topic it brings us right into the
1:04:46
What are called, Omega 3, fatty acids. I talked many times on this podcast about the known benefits of omega-3 fatty acids. In particular getting one gram, 1000 milligrams or more. Even as much as 2,000 milligrams each day of the so-called EPA component of omega-3 fatty
1:05:05
acids known to have antidepressant effects mood,
1:05:08
elevating effects known to
1:05:10
have important effects
1:05:13
protecting the cardiovascular system. I think it's now
1:05:16
Clear that the immune system also
1:05:18
benefits that omega-3 fatty acids that
1:05:20
include a gram or more of epa's are very beneficial. Typically that's done through fish oil, liquid fish oil is going to be the most cost-efficient but their capsule forms.
1:05:30
For those of you who don't like fish oil.
1:05:33
You can adjust this. Through other means you can get from certain algae's or Krill, etcetera. You have to make, make it compatible with your particular diet, whether or not you're vegan or vegetarian or omnivore
1:05:42
etcetera.
1:05:44
Omega-3s have shown been shown to have all these positive health benefits. Do
1:05:48
they have positive effects on focus and attention? And the answer is, you can find studies that support that
1:05:55
statement and the effects are significant, but the effects are modest. You can also find studies that show, no effect. However, much like with Omega-3s and antidepressants where by ingestion of
1:06:14
Omega-3 fatty acids of a
1:06:16
grammar more of EPA per day. Allows people with major depression to get away with taking lower doses of antidepressant medication.
1:06:23
It does seem that ingestion of omega-3 fatty acids in adults.
1:06:30
That include epa's of a thousand milligrams or more can allow adults with ADHD or mild attention deficit issues to function. Well on Lower doses of
1:06:42
medication and in rare cases to eliminate medication entirely. So what this says is once again that the omega-3 fatty acids are
1:06:50
beneficial, will they cure or
1:06:53
eliminate ADHD? I think it's safe to say. No.
1:06:57
They are playing a supportive or what we
1:06:58
call a modulator.
1:07:00
Roll just like good, sleep
1:07:02
plays a supportive and module
1:07:03
ettore role for essentially, everything your immune system, your ability to think your ability to regulate your emotion. It's modulating that process
1:07:10
this component of modulation is extremely important to
1:07:14
highlight. And I think I want to spend a moment on it because this is
1:07:18
especially important in the context of ADHD
1:07:20
and all the information that's out there. There are biological processes that are mediated by particular compounds like dopamine. So, for
1:07:29
instance, the ability,
1:07:29
Bility to feel motivated. And to attend to
1:07:32
focus is mediated by the circuits in the brain that release dopamine.
1:07:38
However, attention is also
1:07:40
modulated by how rested you are. If you want to eliminate your ability to think, well at all, just stay up for two nights and don't sleep at. All. Right. If you do that, you will have modulated the circuits in your brain that respond to various things and you will be highly distractible. You will be highly emotional, you will feel like garbage,
1:07:59
but that
1:08:00
Don't mean that sleep, mediates, focus and attention. It. Modulates it indirectly likewise. I think these omega-3 fatty
1:08:07
acids in particular, the epa's, which are so beneficial for mood and apparently also for attention. They don't directly
1:08:15
mediate attention and mood. What they do is they modulate those circuits. They
1:08:20
make dopamine more available. They make whatever dopamine is available more likely to bind to the
1:08:27
various receptors that are present on neurons.
1:08:29
And so forth. And I
1:08:30
think this is very important because likewise diet and any discussion about nutrition has to include this framework of is the diet, The Elimination Diet or
1:08:40
whether or not, it's some other diet or esoteric that ketogenic diet. Is it modulating or mediating a process and most likely in the context of ADHD. It's modulating that process.
1:08:51
So, if the ADHD is mild or if it's caught early enough, or if it's in conjunction with pharmacology with a prescription treatment, well,
1:09:00
It might help guide the child or adult to a better place of being able to focus, but it's not going to be the switch that flips
1:09:06
everything. Now,
1:09:07
that does not mean that consuming the wrong Foods, sugary Foods, or
1:09:11
foods that you happen to be allergic. To is a good idea. It will
1:09:14
still be detrimental. So, I hope that conceptual framework helps, because if you go online, if you're somebody with ADHD or not, you are going to be bombarded with the ADHD diet. The only go antigenic diet, the elimination this, the, this supplement that EPA, and you, I
1:09:29
Think it's very important to understand whether not you're talking about something mediating, a process or modulating
1:09:35
a process now. Drugs, like Ritalin drugs, like Adderall, they are tapping into the circuitry's and the neurochemistry. He's that mediate attention and focus.
1:09:45
They are not the only Alternatives or the only choices
1:09:48
rather for treatment of these circuits and enhancement of the circuits for Focus. I'm going to talk about other Alternatives and some behavioral Alternatives that are not very well known but are very, very effective.
1:09:59
In a few minutes, but I really want to
1:10:02
make this clear distinction between modulation and mediation because it's
1:10:06
vital for anyone
1:10:07
that's trying to modulate or mediate anything within their own brain. If
1:10:11
any of you are interested in this oligo antigenic diet as it
1:10:14
relates to ADHD
1:10:16
and you want to explore a more
1:10:18
recent study besides that classic 2011 Lancet, study. That's rather controversial. There's a paper that was published in
1:10:25
Frontiers in Psychiatry. Just last year 2020, the title of the paper.
1:10:29
/ is only go antigenic diet. Improves children's ADHD rating, scale scores
1:10:34
reliably in added video rating. The added video rating is just that they're using an additional measure of focus and attention.
1:10:43
Again, that's Frontiers in Psychiatry 2020.
1:10:46
I'll put a link to it in the caption and that's a more recent study for you to peruse.
1:10:51
So we've talked about the neural circuits of focus and the chemistry of focus, but we haven't talked yet about what would make us better at focusing.
1:10:59
Saying and what focusing better really is. So, let's take a step back and think
1:11:03
about how we focus and how to get better at focus. And
1:11:08
I'm going to share with you a tool for which there are terrific research data that will allow you in a single session to enhance your ability to focus in theory forever.
1:11:22
What I'm about to read, you is from an excellent book
1:11:24
that I recommend, if any of you are interested in neuroscience and things like meditation and default mode networks and things of that sort. The book is called altered
1:11:33
traits science, reveals how meditation changes your mind, brain and
1:11:38
body? And no, I'm not going to try and convince you to meditate. I'm going to share with you a small passage in the book that relate. Some research data related to focus that are very important if you want to meditate, that's your choice. That's a separate matter. This is
1:11:51
By Daniel, goleman and Richard Davidson, and I should just mention that Goldman is a well-known author has written books on emotional intelligence. And so forth. Richard Davidson is a also a PhD, he's a professor of psychology and Psychiatry, and that he's at a University of Wisconsin-Madison. It's done terrific work on brain States and modulation of brain States and so forth.
1:12:15
What we're about to talk about is when attention works and when attention
1:12:20
falters
1:12:21
and what we are specifically going to talk about are what are called attentional? Blinks not actual eye. Blinks. We're going to talk about that in a few
1:12:29
minutes, but we're going to talk about attentional blinks.
1:12:33
I'm paraphrasing here, because
1:12:36
Goldman and Davidson wrote about this, so beautifully, I'd rather paraphrase from them, then try and just make up a new way to say it. That is less interesting or less good, but I want to credit them
1:12:46
attentional, blinks are really easy to understand. If you think about a, where's
1:12:49
Waldo task, you know, this task, where's Waldo where? They're bunch of people and
1:12:54
objects and things in a picture. And somewhere in there,
1:12:57
is Waldo with the striped hat, and the glasses and going to skinny, dude, and you have to find Waldo.
1:13:02
And so it's a visual search and it's
1:13:04
visual search for an object that has distinct features, but is embedded in this ocean
1:13:09
of other things that could easily be
1:13:11
confused as well. Those you tend to look. Look, look look look. Look look, look
1:13:14
look and then you find Waldo. Kids can do this. They enjoy doing this adults may or may not enjoy it, but they can do it too. They find Waldo when you find Waldo or when you search for a Target in some other visual search. Task at that moment, your nervous system celebrates a little bit.
1:13:32
And it celebrates through the
1:13:33
release of neurochemicals that make you feel good. You found it and you pause.
1:13:38
Now the pause is interesting because when you pause what we know from many experiments is that in that moment of pause and Mild celebration, however, mild you are not able to see another Waldo
1:13:54
sitting right next to
1:13:55
it. So what this means is in attending to Something in searching and in,
1:14:02
Buying a visual Target, your attention blinked,
1:14:05
it shut off for a second
1:14:07
and there's a more formal and more laboratory type way that we look at this. The more typical way to do. This is to give someone a string of letters or a string of numbers and beforehand. You tell them be on the lookout for the letters, r and Z. Okay, you're just going to watch
1:14:28
this string of numbers go by and there will
1:14:30
be a letter r in there and there.
1:14:32
Will be a letter z in there and try and spot them both. And what you find is when you present that string of numbers and then they see, the
1:14:41
are they see, the are they register it consciously
1:14:46
and they tend to miss the Z.
1:14:48
Just like in the wall, though, type example. Now, of course, the numbers are going by pretty quickly, but they can spot. The are
1:14:56
they could also spot the Z
1:14:57
if you told them beforehand, just spot the Z and the numbers are moving through.
1:15:02
Same rate in both conditions. So what that means is that in every case you are capable of seeing the r or the Z. It's when you try and see both that seeing the first one prevents you from seeing
1:15:15
the second one. It's what we call an attentional blink.
1:15:19
We do this all the time and people with
1:15:22
ADHD tend to have many more attentional blinks than people that don't. And this is true for children. And for adults.
1:15:30
This is an important point.
1:15:32
So important that I want to
1:15:33
emphasize it twice, in case, you attention only blinked, if
1:15:36
you see something that you're
1:15:38
looking for or you're very interested in something you are definitely missing other information
1:15:45
in part because you're over focusing
1:15:47
on something and this leads to a very interesting hypothesis about what might go wrong in ADHD,
1:15:53
where we've always thought that they cannot focus and yet we know they can focus on things, they care very much about well, maybe just
1:16:02
Maybe they are experiencing more attentional blinks
1:16:06
than people who do not have ADHD
1:16:09
and indeed there are data. Now to
1:16:10
support the possibility that that's actually what's happening.
1:16:14
And that should be exciting to anyone that has ADHD. It should also be
1:16:17
exciting to anyone that cares about increasing their focus and their ability to
1:16:21
attend what this is saying is that the circuits that underlie focus in our ability to attend and our ability to eliminate distraction.
1:16:30
They aren't just failing to focus. That's just a semantic way of, describing the outcome. They are over focusing on certain things and thereby missing other things. And so, our distractibility or the distractibility of somebody with ADHD could exist because they are over
1:16:46
focusing on certain elements and they are there for missing other elements that they should be attending to.
1:16:53
So, what they really need, is this property that we call open monitoring now open.
1:16:59
Is something that's described in the book that I just refer to and that typically is associated with people who have done a
1:17:06
lot of meditation. So called vipassana meditation or have spent a lot of time learning
1:17:11
how to do what's called open gaze visual analysis, and open gaze thinking, but there's a simpler version of
1:17:17
this that allows us to bypass all that. First of all.
1:17:22
Your visual system has two modes of processing. It can be highly focused a soda straw view. So, looking for the
1:17:29
are in this string of numbers, and the example that I just gave, or if you're very excited about, something you're that soda, straw view of the world and you're missing other things. Okay, that's high levels of attention.
1:17:40
However, there's
1:17:41
also a property of your visual system that allows you to dilate your gaze to be in so-called panoramic, Vision.
1:17:47
Panoramic vision is something you can do
1:17:48
right now, no matter where you are and I can do it right
1:17:51
now. You won't know that.
1:17:52
I'm doing it. But
1:17:54
even though I'm still looking directly at you. I'm consciously dilating my gay so that I can see the ceiling, the floor and the walls. All around me that panoramic vision is actually mediated by a separate
1:18:04
stream or set of neural
1:18:06
circuits going from the eye into the brain. And it's a
1:18:09
stream or set of circuits that isn't just wide-angle view. It also is better at
1:18:14
processing things in time. It's frame rate is higher.
1:18:18
So you've seen slow-motion video and you've seen standard video, slow motion video.
1:18:22
Dio gives you that slow motion look because it's a
1:18:27
higher frame rate. Your thin slicing time.
1:18:30
Okay, you can use panoramic Vision to access the state that we call open monitoring. When people do that, they are able to attend to and recognize
1:18:42
multiple targets within this string of numbers. They can see the are and they can see the Z and they can see additional things.
1:18:50
So this is something that can be trained up.
1:18:52
People can practice whether or not they have ADHD or not. What it involves is learning how to dilate your gaze consciously. That's actually quite easy for most
1:19:00
people whether or not you wear
1:19:02
corrective lenses, or contacts, or not. You can consciously going to open gaze and then you can contract your field of view as well.
1:19:09
There have also been studies done where people were taught to think in a
1:19:15
particular way for a very short period of time and that forever changed their ability to
1:19:21
limit or reduce the number of
1:19:22
Of these attentional. Blinks. There are now published accounts in the literature of a
1:19:26
simple practice done for about 15
1:19:28
minutes. Where subjects were asked to just sit quietly eyes closed and do what is sort of akin to
1:19:34
meditation but to not direct their mind into any particular, state or place.
1:19:38
But simply to think about their breathing and to focus on their so-called interoception,
1:19:42
focus on how their body, feels their mind drifted to bring it back. Okay, so it's basically meditation for about 15 minutes.
1:19:49
That might not seem like a significant or
1:19:52
unusual practice or that it would have any impact at all. But remarkably
1:19:56
just doing that once for 17 minutes, significantly reduce the number of attentional blinks that people would
1:20:05
carry out. In other words, their focus got better
1:20:08
in a near permanent way, without any additional training. There's something about that. Practice of reducing the amount
1:20:15
of visual information coming in and learning to pay attention to one's internal State. What we
1:20:20
Interoception that allow them in a wareness. Such that when they needed
1:20:24
to look for visual targets, when they need to
1:20:26
focus on multiple things in sequence.
1:20:29
They didn't experience the same number of attentional blanks
1:20:32
and I should mention not incidentally as people
1:20:35
age and their working memory gets worse and their ability to focus gets worse. The number of attentional blinks that they carry out goes up
1:20:44
and there are now studies exploring whether or not the simple meditation like practice of 15 to
1:20:49
Twenty minutes or so of sitting and just quietly resting and paying attention to one's breathing, and internal State can also offset some of that
1:20:57
age-related. What is called cognitive decline.
1:21:01
So what these data tell me is
1:21:03
that regardless of whether or not you're a child or you're an adult whether or not you have ADHD
1:21:08
or not, whether or not you're experiencing age-related cognitive decline or you would simply like to avoid age-related cognitive decline a simple practice of taking 17 minutes.
1:21:20
Sitting and paying attention to your internal State. Just intercepting registering, your breathing registering, the
1:21:28
contact of your skin, with whatever surface you're
1:21:30
on, can forever rewire your brain to be able to attend better
1:21:35
and possibly even offset some of that age-related attentional drift.
1:21:41
Now, I don't expect anyone to start meditating
1:21:43
regularly. I
1:21:44
don't expect anyone to do anything. They don't want to do, but I think most of us could handle one meditations session of 17 minutes or so.
1:21:53
And so if ever there was a tool that stood
1:21:55
to rewire our attentional circuitry in a powerful way,
1:21:59
this seems to be it. And in addition, the ability to engage in
1:22:04
panoramic Vision to dilate our gaze, this so-called open monitoring that allows the brain to function in a way that it
1:22:11
Detect more information faster. That's a powerful tool as well. And the beauty of that tool is that it works the first time and it works every time. Now how exactly it works is a little bit
1:22:22
unclear. Is it, for instance, orchestrating this synchrony or a
1:22:28
synchrony between the default mode Network. In the task related networks? We don't know those Studies have not yet. Been carried out.
1:22:35
Nonetheless. The effects are significant. They are long-lasting and they appear to exist after.
1:22:41
After just one session of this quiet
1:22:43
17-minute interoception, which to me makes it seem like a very worthwhile thing to do for everybody. So we just talked about attentional blinks, which are essentially blinks of thinking it's your mind shutting off for a moment and missing information. Now, let's talk about actual blinks the sort that you do with your
1:23:01
eyelids. This might come across as somewhat obvious, but you can do
1:23:07
fast. What are called spontaneous blinks? And they are always coordinated.
1:23:11
Between the two eyes or you can do long, blinks, like, when you go to sleep at night, you do one very long blink, and I'm not being facetious.
1:23:19
When you go to sleep at night, you are shutting your eyelids and you are limiting, the amount of
1:23:25
information coming in
1:23:27
and your perception of time, starts to
1:23:29
drift as you go into sleep, your perception of time
1:23:34
changes from very fast at one moment, to very slow, meaning the frame rate
1:23:40
at which you are.
1:23:41
Are analyzing information dreaming Etc, is variable when you were in sleep, sometimes it's very fast.
1:23:48
Meaning, you experience things in slow motion. Sometimes it's very
1:23:50
fast in waking
1:23:51
to your
1:23:54
experience of time. Can sometimes be very fast. Sometimes be very slow.
1:23:58
Typically the more alert you
1:24:00
are, the higher the frame rate your thin, slicing your experience. You've probably had this happen if you're ever very stressed and you're waiting for something or somebody it seems like it takes forever.
1:24:11
Forever. Because your frame rate is higher. You're analyzing time. We're finally conversely. If you are very relaxed or even
1:24:19
sleepy, you wake up and you have to think about all the things you have to do. It will seem like the world is going by very, very
1:24:25
fast and that you are moving, very
1:24:26
slow. Time is going at the same rate, but your
1:24:30
perception of time is, what's changed? Believe It? Or Not, Your perception of time is also
1:24:37
changed on a rapid basis, moment-to-moment basis.
1:24:41
By how often you blink. This is a well-established literature in the world of Neuroscience
1:24:47
that unlike the literature
1:24:50
and claims about blinking and sociopathy which have no basis,
1:24:54
the science of
1:24:57
blinking as it relates to time. Perception has some
1:24:59
very good data to
1:25:00
support it. I want to just emphasize one study in particular which is quite appropriately, titled time. Dilates after spontaneous blinking. This is a paper that was published in current biology.
1:25:11
She, the first author is Terhune. Trhu. Any,
1:25:15
It's a Wonderful paper. They examine the relationship between fluctuations in timing and blinking and to make
1:25:24
a long story
1:25:25
short. What they found is that right after blinks. We reset our perception of
1:25:31
time. Okay. So blinks in that sense are a little bit like the curtain coming down on a
1:25:37
scene between scenes in a
1:25:39
play or takes in a
1:25:41
A movie, you know, and they clap the clap thing. They start it take you know, what do they say
1:25:46
action? And then at the end they do the thing. And they click it down and they say it's a take that's
1:25:51
one take when you blink. It's a take,
1:25:54
okay.
1:25:56
Now, what's interesting and will immediately make sense to you as to why this is important, is that the rate of blinking is controlled by dopamine. So what this means is that dopamine is controlling
1:26:10
attention, blinks relate to attention and focus
1:26:14
and therefore the dopamine and blinking system is one way that you constantly modulate and update
1:26:21
your perception of time. Unfortunately. It's also one that you can
1:26:25
control
1:26:27
So the basic takeaway of this study was that blinking controls time perception, but also that levels of dopamine can alter your sense of time and stay with me here and that blinking and dopamine are inextricably. Linked they are working together to control your attention. When dopamine levels go up. People tend to
1:26:49
overestimate. How long something lasted? Why? Because they are processing time more finally.
1:26:56
It's slow motion mode
1:26:59
when dopamine levels are lower. They tend to underestimate time intervals.
1:27:04
Let's remember back to the very beginning of the
1:27:06
episode. What's going on in people with ADHD.
1:27:10
They are not good at managing their time. They tend to run late or they are disorganized. They are not just
1:27:15
disorganized in space, meaning in the physical space
1:27:19
around them.
1:27:21
They're disorganized in time.
1:27:23
Their dopamine is low. We know that as well and so they are under estimating time intervals.
1:27:29
And so it makes perfect sense that they would be late. It makes perfect sense that they would lose track of time or the ability to focus.
1:27:36
This is really exciting because what it means is that children with ADHD adults with ADHD or people with normal levels of focus that want to improve their ability. To focus can do so through a training that involves learning.
1:27:51
How often to Blink and when and how to
1:27:53
keep their visual focus on a given Target. And it turns out this study is actually been done.
1:27:59
There's a study. Again. I'll link to the study entitled Improvement of attention in elementary school students through fixation focus training activity. I won't go through all the details, but what they found was a short period of focusing on a visual
1:28:15
Target
1:28:16
allowed. These school children to greatly
1:28:19
enhance their ability to focus.
1:28:20
Focus on other types of information
1:28:23
and a significant component of the effect was due to the way that they were
1:28:27
controlling the shutters on their eyes, their eyelids and controlling their blinks.
1:28:31
So what they did in this study is that they had these kids Focus, their visual attention on
1:28:36
some object that was relatively close like their hand for a minute or so, which actually takes some effort. If you try and do that. They were allowed to Blink.
1:28:45
However, it's known from other
1:28:47
work that if people can consciously override the desire to Blink,
1:28:51
At least to the point where they feel like they have to or else Their Eyes Were dry out that actually can increase attention even further
1:28:58
and they had conditions where they would look at a
1:29:00
point further across the
1:29:01
room and even further across the room. It only took a few minutes each day to
1:29:06
do this, 30 seconds in one condition or maybe a minute. And then at another station of looking a little bit further out a little bit further out.
1:29:13
However, there was an important feature of this study, that is definitely worth mentioning, which is before they did this visual Focus.
1:29:21
Just ask or training. They did a series of
1:29:25
physical movements with the kids so that the kids could sort of
1:29:29
eliminate or move out some of their desire to move and would thereby enhance their ability to sit still. Now, it's long been known. That kids need a recess. They need time to run around and play and roll around. Do whatever it is that they do in order to be able to sit still at all.
1:29:44
Adults. Probably need this to frankly but kids need it more. Because the circuits in the brain that control
1:29:51
Reflexive movements. And as we say, kind of rhythmic undulate in behavior, and things like that. That's an active suppression and kids have less of that circuitry built up until they hit about age 15 or 16.
1:30:03
So they have the kids move around a bit and then do this focus training. That brings me to another
1:30:10
treatment that's actively
1:30:11
used nowadays in schools, for kids with ADHD, but also starting to be used by many kids and by parents in order to keep their kids.
1:30:21
Focusing and not going crazy in the car or not acting out in general. And that's the prevalence of these so-called fidgeter toys or things that kids can do actively and repetitively in order to move out some of their underlying reverberatory activity in their nervous system. So what you
1:30:40
will find is that some kids with ADHD
1:30:42
are now given a rubber band on their desk, literally a rubber band that's attached to their desk and they're able to pull on it, even snap it against the desk. If I'd done that when I was a
1:30:51
I think my teachers were throw me out of class, but I think it's great that they're allowing them to do this. Now as a
1:30:56
way of moving, some of their physical
1:30:59
energy out or engage their physical energy rather
1:31:03
as opposed to trying to sit
1:31:04
statue, still all the time and
1:31:06
attend and turns out that does enhance these children's ability to focus
1:31:10
mentally when they have some physical activity to attend to
1:31:13
and it turns out. It also can work for adults. I'll
1:31:17
share with you a related anecdote, because it illustrates the underlying mechanism.
1:31:21
I've had the great privilege of being able to do a number of surgeries brain surgeries during my career. So one thing you find when you do brain surgery is that the brain is pretty small, regardless of the species that you're
1:31:33
working on and you're in there and you're trying to do something very specific and the more, you try and hold your hands
1:31:39
really steady the more they want to shake. All right, so it's
1:31:43
not natural for any of our limbs
1:31:44
to sit perfectly still,
1:31:46
depending on how much coffee you had, how well rested, you are, and you're sort of
1:31:50
Baseline level of autumn.
1:31:51
Arousal, some of you may find that you can hold out your hand, it absolutely rock-solid others, will shake a little bit more.
1:31:58
Doesn't mean you're nervous. If you're shaking, doesn't mean you're calm, if you're still
1:32:03
What it relates to is the amount of what we call
1:32:05
promoter activity, the number of commands to move that are being sent through the system. And that's what I mean by Reverb, ettore activity.
1:32:12
And it does seem that kids with ADHD and adults with
1:32:15
ADHD have a lot of Reverb. Reverb ettore activity in their nervous system. And so that's that constant desire to move. It's hard for them to sit still and therefore, it's hard for them to attend a harness, their attention.
1:32:27
When you do a surgery and you find that your hands are shaking, what you learn from your mentors, which I did, and what works extremely well, whether or not you're doing a surgery or not, is that you simply tap your foot or you, bounce your knee a little
1:32:40
bit, which you might think,
1:32:41
would make your handshake even
1:32:43
more but provided that it's subtle, what it does. It did. Is it actually shuttle some of the activity, from those premotor
1:32:50
circuits to elsewhere in the body and then you're able to sit much more still with your hand, you are able to perform the surgery with much more precision.
1:32:57
You are able to write with much better handwriting. And
1:33:00
for those of you who engage in public speaking. If you ever too
1:33:04
nervous, that's why pacing while you public speak helps. If you're nervous, that's why bouncing your knee behind the podium works as well. That's why nodding your head? And just to collating can help.
1:33:13
It's not a matter of
1:33:15
quote-unquote moving energy out of the body that doesn't actually
1:33:17
happen. What it is is you're engaging, those Prix
1:33:20
motor circuits that are sending through commands. It's like trying to stuff a bunch of stuff through a
1:33:24
funnel and it creates this tension. So you're giving it an
1:33:27
An outlet for
1:33:29
the neural circuitry to be able to move something so that you can keep other components of your body and your mental attention, engaged and locked onto something. What we call, Focus
1:33:41
one thing related to this whole business of blinking and focus and training yourself to focus and not blinking etcetera. Is that
1:33:48
most all of the drugs, Ritalin Adderall, and recreational drugs
1:33:53
that increase dopamine, even coffee and
1:33:56
tea and other forms of
1:33:57
Laughing. They tend to make us blink
1:34:00
less and when we get tired, we tend to Blink more. Now. This is sort of a duh, right? But being wide-eyed with excitement or fear or with your eyes, barely being able to keep
1:34:13
them open.
1:34:15
Now, it should make perfect sense that these Shutters on the front of your eyes. They aren't just there for winking and they aren't just there for cosmetic purposes. They are
1:34:23
there to regulate the
1:34:25
amount of information going into your nervous system.
1:34:27
Mm,
1:34:27
and they are there to regulate how long
1:34:31
you are bringing information into your nervous system. And in what bins how widely or finally You are bidding time is set by how often you
1:34:40
blink and how widely or specifically you are grabbing attention from the visual world is set by whether or not you're viewing, things very specifically like a Crosshair through a soda straw view like this
1:34:51
or whether or not you were in this panoramic, sort of whole environment mode. This kind of
1:34:57
Fisheye lens or wide angle lens
1:34:59
mode and In fairness to the pharmacology in the circuitry while dopamine and heightened levels of alertness and excitement tend to make us blink less and attend more. There's actually a study that's looked at the other neurochemical systems and
1:35:17
drugs and how those relate to blinking. And so this will all be obvious by the title of the paper. I'm about to share with you. This is a paper
1:35:24
entitled decrease spontaneous eye. Blink rates.
1:35:27
He's in chronic cannabis users evidence for striatal cannabinoid, dopamine interactions. Okay, I'm not going to go into all the details here. But one thing that is somewhat surprising is that many people with ADHD use or abuse cannabis. You might think we'll why would they do that? Because I thought that a increase in dopamine is actually what's going to lead to heightened levels of attention. And that's what these people and children crave. Well, it turns out that cannabis also.
1:35:57
Increases dopamine Transmission in the brain, but because of the other chemicals, it increases namely serotonin and some components of the cannabinoid and opioid system, it creates that kind of alert, but mellow feel. And again here. I'm, I'm not a proponent of this. I personally
1:36:15
am not THC or cannabis User. It's just not my thing. And obviously, it's illegal, some places. And so, you have to determine that for yourself. It does have medical purposes. And in some
1:36:26
places, it is
1:36:27
Is legal, but th see increases dopamine and increases neurochemicals, that can also create a state of calm. So it's that sort of middle ground, and this paper has a beautiful demonstration, whereby not just. Wow, people are using cannabis, but depending on how long they've
1:36:44
been using cannabis across their lifespan, the rates of eye
1:36:47
blinking change. So if you look at the number of years that people have been using
1:36:53
cannabis on a regular basis either daily or up to excuse me, weekly.
1:36:57
Up to daily. What you find is that for people that have not been using cannabis at all or have only been using it for about two
1:37:04
years? Their rates of eye blinks are much higher than people have been using it chronically for 10 years. In other words,
1:37:10
people who be using cannabis for 10 years. Don't blink very often at all. Now, cannabis has well-known effects in depleting memory, but it does seem to engage the focus and blinking system in a way that increases Focus. So basically what I'm saying is men,
1:37:27
Rwanda seems to increase people's Focus, but then they can't remember what they were focusing on something. I'd like to discuss, just briefly is
1:37:34
the so-called interoceptive awareness that's present in people with ADHD. Both children and adults. Interceptive
1:37:41
awareness is one sense of One's Own internal State
1:37:45
heartbeat breathing. Contact of skin with a given surface, etc
1:37:50
for a long time. There was
1:37:51
this hypothesis, this idea that people with ADHD were just not in touch with how they felt.
1:37:57
That somehow they weren't
1:37:58
registering all the stuff that was going on inside them
1:38:01
changes in, heart rate and so forth. And so they were behaving in a way that
1:38:05
was dysregulated or appear
1:38:06
dysregulated. And that if they could just learn to attend to their internal State better, that somehow
1:38:14
they would function better in the world. Now, before we described a process,
1:38:19
literally a
1:38:19
17-minute interoceptive exercise
1:38:23
that does seem to lead to improvements in one's ability to
1:38:27
focus for a longer period of time. However,
1:38:31
it's very unlikely that that was due to
1:38:34
increasing interceptive awareness per se.
1:38:37
It probably wasn't because people gain a much heightened
1:38:41
or improved ability to understand what's going on internally.
1:38:46
In fact, you can imagine how that might
1:38:47
actually prevent one's ability to pay attention to things in the outside
1:38:50
world. So while there is benefit to just sitting there and being in Stillness as they say or focusing on
1:38:56
one's breathing and
1:38:57
State for sake of then,
1:38:59
accessing information in the external World,
1:39:02
a really nice study.
1:39:05
Called interoceptive awareness and attention deficit. Hyperactivity disorder explored, whether or not intercept of awareness was different in people with ADHD or
1:39:14
did not have ADHD.
1:39:16
And the findings were essentially that there's no difference that people with ADHD children and adult, they are aware of what's
1:39:23
going on. Inside them just as much as anyone elses and the
1:39:27
typical measure of interoceptive awareness,
1:39:29
is one's ability to count their own heart
1:39:31
beats. This is actually challenging.
1:39:34
For some individuals
1:39:36
and very easy for other individuals regardless of their attentional
1:39:39
capacity. Some people just can really feel their heartbeat
1:39:41
without taking their pulse, other
1:39:43
people cannot and these
1:39:45
studies are pretty straightforward to do you ask people to sit there and to count their heartbeats and then you are monitoring their heartbeats and you get to gauge how accurate they are. So
1:39:56
it's important to understand that people with ADHD are in touch with how they feel. It's really a question of whether or not they can take the
1:40:04
demands that are placed upon them and enter a cognitive state of mental state. That allows them to access
1:40:10
the information. They need to access in other words, whether or not they can focus but it is
1:40:13
absolutely wrong to think that the child that's getting up 11
1:40:17
times during a short six, you know, six minute interaction at the table or whether or not a child who somehow has to venture off every moment or a co-worker of yours.
1:40:27
Who's an adult who's constantly fidgeting or moving things around that somehow, they are
1:40:30
unaware, that they are oblivious. They are not oblivious to how they feel. Chances are.
1:40:34
Every challenged in the situations that they're in and they're doing everything they can to try and regulate their attention. So I think it's an important study to highlight because it really underscores the fact
1:40:44
that something else is going on and that something else has everything to do with this ability to
1:40:49
coordinate, these tasks directed networks and to coordinate that in the proper way with that. Default mode Network. And that is a process. As you now know, that's
1:40:58
regulated, exquisitely, by certain neurochemicals. And in particular, the neurochemicals dopamine.
1:41:04
Norepinephrine and serotonin and a fourth one. I'd like to throw into the
1:41:08
mix which has a seed of choline which is very vital for cognitive
1:41:12
Focus. So now I want to switch back to talking about some of the drugs that are typically
1:41:16
used to access those systems prescription drugs. And I want to talk about
1:41:20
some of the new and emerging non-prescription approaches to increasing the levels of dopamine.
1:41:25
Acetylcholine and serotonin in the brain using various supplement type compounds
1:41:30
because several of them are showing really
1:41:33
remarkable efficacy.
1:41:34
An excellent peer-reviewed studies.
1:41:36
So before moving to some of the newer, a typical compounds and things sold over-the-counter. I'd like to just briefly returned to the classic drugs that are used to treat ADHD.
1:41:49
These are the ones I mentioned earlier. Methylphenidate also called Ritalin, modafinil are modafinil is another one and Adderall. Again, all of these
1:42:01
work by increasing levels of dopamine and norepinephrine.
1:42:03
Typically, they are taken orally in pill form or sometimes in capsule form the dosages that are appropriate vary according to severity of the condition for a given person and the age of
1:42:19
The person this is a complicated landscape
1:42:23
for each individual. They have to figure out the pharmacology that's best for them. Some individuals are even
1:42:28
layering long or time to release Ritalin with
1:42:32
Adderall and in smaller doses. It can get
1:42:35
quite complex or it can be quite straightforward. If you are really interested in these
1:42:39
drugs and how they work and you'd like to
1:42:43
get a glance at a table of all the results from all the studies of which there are now hundreds.
1:42:49
Yes, there's an excellent review about these drugs and their use, and their comparison to similarly structured drugs, in particular, MDMA and
1:42:58
cocaine, and amphetamine. Meaning Street
1:43:02
amphetamine to really illustrate the similarities of action. And some of the problems associated with long-term use, I don't expect you to read this article in full. I'm
1:43:11
here so that you don't have to go read these articles. But in case you want a ton of information,
1:43:17
the paper is Esposito at all Frontier.
1:43:19
And biosciences. It's an excellent excellent review of the entire literature. It is quite long.
1:43:26
I can put a link to that study in our caption
1:43:29
and it essentially describes all the studies that have been done peer-reviewed and published and it refers to these drugs. In an interesting way. It doesn't just refer these drugs. As, for treatment of ADHD. It
1:43:42
actually refers to them
1:43:43
using language that ordinarily. I'm not very fond of,
1:43:46
but I'll agree to hear, which is so called.
1:43:49
Smart drugs, or nootropics.
1:43:52
It also covers caffeine which
1:43:55
again as I mentioned earlier, increases dopamine norepinephrine and to some extent
1:44:00
serotonin, but what I liked about this review so much is that in putting these drugs of abuse methamphetamine and cocaine,
1:44:08
right alongside these drugs, like ritalin and adderall. And also
1:44:11
caffeine, we start to realize that the distinction between drugs of abuse and the distinction between drugs of treatment is actually a very fine and sometimes even a blurry line.
1:44:21
And in thinking about whether or not one wants to use these
1:44:25
prescription, I want to emphasize
1:44:27
prescription, not drugs of abuse, but prescription drugs for treatment of One's Own attentional capacity. I think it is important to understand the extent to which they all carry more or less the same side effects. The one exception being caffeine caffeine side effects, can be anxiety. If you ingest too much of it. Insomnia, if you drink it too late in the day, but typically, it will not cause
1:44:48
the major side effects of the other drugs
1:44:50
such as
1:44:51
As high propensity for addiction and abuse.
1:44:55
Amphetamines of any kind as well as cocaine can cause sexual side effects because they're vasoconstrictors.
1:45:02
So, you know, men have trouble achieving an
1:45:04
erection. There can often be the intense
1:45:07
desire or libido
1:45:10
for sex,
1:45:11
but an inability to actually
1:45:13
perform. So that's an issue with any kind of stimulant. So, these drugs are not without their consequences in addition. And here, I had lump caffeine
1:45:22
back into the, into the mix.
1:45:24
In addition. They almost
1:45:25
Kerry cardiac effects, right? The increase heart rate, but they also have effects on
1:45:31
constriction of blood vessels and arteries, and veins and so forth in ways that can create cardiovascular problems.
1:45:37
Now, caffeine is a bit of a complicated one talked about this on a podcast long
1:45:42
ago, but I'll just remind you
1:45:43
that. It turns out that if you are caffeine adapted, in other words, if you are
1:45:47
used to drinking caffeine,
1:45:49
then the ingestion of caffeine most often will
1:45:52
cause vasodilation. Oh actually allow more blood flow through.
1:45:55
However, if you are not caffeine adapted, it will cause vasoconstriction due to an
1:46:00
increased stress response. So if you're familiar with caffeine caffeine can
1:46:05
actually have a little bit more of a relaxation response. Although if you drink enough of it, it will make you amped up. These
1:46:11
other drugs, almost always lead to vasoconstriction, increased heart rate, dilation of the pupils less, blinking heightened levels of attention, which looks very much
1:46:20
like stress.
1:46:21
And at its extremes looks very
1:46:23
much, like the effects of street drugs, like cocaine.
1:46:25
An amphetamine
1:46:27
because of the large amounts of dopamine, the released in the brain. People tend to Crave that state over and over. And yet with each subsequent, use
1:46:36
are able to get less and less of that euphoric feeling or that really, really focused feeling. So one thing that's being explored, quite extensively. Now, in the treatment of ADHD
1:46:45
are drug schedules, whether or not people should take Adderall every day or every other day, whether or not, they should take it only every
1:46:54
once in a while whether or not
1:46:55
Young children can take it, just a few times, end engage in
1:46:58
behavioral training of the sort that I talked about before, where they're doing. Maybe it's a 17 minute meditation, type exercise, but
1:47:06
more likely it would be the movement followed by
1:47:09
the visual focusing because that's only done for 20 or 30, or 60 seconds. Why would you do that?
1:47:13
Well, in a
1:47:15
chemically enhanced State, your brain is more plastic, the circuits are able to modify and learn better.
1:47:22
That's the optimal
1:47:23
time to engage in focus in a very deliberate way.
1:47:27
So, just taking a drug and expecting Focus to just work at any point in being able to turn focus on and off at will that's an unrealistic
1:47:36
expectation right?
1:47:38
More likely the best use of things like
1:47:42
adderal modafinil are modafinil. And Ritalin
1:47:46
is going to be to combine those treatments with
1:47:49
behavioral exercises
1:47:51
that actively
1:47:52
The very circuits that you're trying to train up and enhance. And then perhaps,
1:47:56
I want to highlight, perhaps tapering off those drugs, so that then one can use those circuits without any
1:48:02
need for chemical intervention.
1:48:03
So despite any
1:48:05
controversy that might be out there. I think it's fair to say that
1:48:08
the consumption of omega-3 fatty acids, can positively modulate, the
1:48:14
systems for attention and focus.
1:48:15
So then the question becomes how much, EPA, how much DHA does that differ
1:48:22
from?
1:48:22
For what's helpful for depression,
1:48:24
Etc. And actually, it does differ in reviewing the studies for this. It appears that a threshold level of 300 milligrams of
1:48:32
DHA turns out to be an important inflection point.
1:48:37
So typically fish oils or other sources of Omega-3s will have DHA and EPA and typically, it's the EPA
1:48:45
that's harder to get at sufficient levels. Mean, you have to take quite a lot of fish oil in order to get above that 1,000 milligram or
1:48:52
Thousand milligram threshold to improve mood and other functions, but
1:48:56
for sake of attention, there are 10 studies that have explored this in detail. And while the EPA component is important, the most convincing studies point to the fact that getting above
1:49:09
300 milligrams per day of DHA is really where you start to see the attentional effects.
1:49:14
Now, fortunately, if you're getting sufficient EPA for sake of mood and other biological functions almost, without
1:49:22
Question, you're getting 300 milligrams or more of DHA. So that usually checks that box just
1:49:27
fine. What's interesting is that there's another compound phosphatidyl steering that has been explored for its capacity to improve the symptoms of ADHD. Again. I don't think this is
1:49:38
any direct way, but rather, in a
1:49:40
module ettore way, but it appears that phosphatidylserine taken for two months for 200 milligrams per day was able to reduce the symptoms of ADHD.
1:49:51
Children, it has not been looked at in adults yet. It's at least as far as I
1:49:56
know, but that this effect was greatly enhanced by the consumption of omega-3 fatty acids. So now we're starting to see synergistic effects of omega-3 fatty
1:50:06
acids and phosphatidyl staring again. That was
1:50:09
200 milligrams per day. This is something that sold over the counter in capsule form.
1:50:13
At least in the u.s., There were
1:50:15
two studies, both were double blind. Studies carried out for anywhere from one to six months on
1:50:21
both.
1:50:21
Boys and girls. And it really was boys and girls,
1:50:23
not men and women. This was kids age 1, to 6, or 7 to 12, and it was a fairly large number of subjects. So a hundred forty seven subjects. In one
1:50:33
case in 36, and the
1:50:34
other, the takeaway is that getting sufficient levels
1:50:38
of epa's in particular. There's 300 milligram threshold of DH a
1:50:42
plus, if you are interested in it, and it's right for you 200 milligrams of. Phosphatidyl steering can be an
1:50:49
important augment for improving the symptoms.
1:50:52
Of ADHD,
1:50:53
you'll also find literature
1:50:54
out there and many claims
1:50:56
about so-called Ginkgo Balboa, which has been shown to have minor effects and improving the symptoms of ADHD. Not nearly as effective as ritalin and adderall. Ginkgo Balboa is
1:51:10
not appropriate for many people.
1:51:12
I am one such person. I don't have ADHD, but when I taking Ginkgo even at
1:51:18
very low doses, I get absolutely splitting headaches.
1:51:21
Some people do not experience those headaches, but it's known to have very potent, vasoconstrictive, and vasodilating, properties that vary depending on when you
1:51:30
took the compound. So, for those of you that are exploring Ginkgo Balboa,
1:51:35
and you will see a lot of claims about Ginkgo Balboa, for attention and ADHD, definitely take the
1:51:41
vasodilation vasoconstriction headache issue into consideration. So I'd like to talk about the drug modafinil and the closely related drug are
1:51:50
modafinil. That's a are
1:51:51
- no,
1:51:53
because modafinil, and armodafinil
1:51:55
are gaining popularity out there both for treatment of ADHD and
1:51:59
narcolepsy, but also for communities of people that are trying to stay awake long periods of time. So it's
1:52:06
actively used in the military by First Responders. It's gaining popularity on college campuses. And people are using it more and more as an alternative to Adderall and Ritalin and excessive amounts of coffee. It does increase Focus.
1:52:21
- and to a dramatic extent,
1:52:24
modafinil to typically was very expensive. You know, I don't know if it's still this expensive, but when one has a prescription for it, it could still cost as much as
1:52:34
eight or nine hundred dollars, or even a thousand dollars a month.
1:52:37
Our modafinil is a far less expensive version. That's chemically slightly. Different than modafinil,
1:52:44
regardless of price. People are taking mode after known are
1:52:47
modafinil, want to emphasize that unlike Ritalin and
1:52:51
All modafinil and our modafinil are
1:52:55
weak dopamine reuptake
1:52:56
Inhibitors and that's how they lead to increases in dopamine. So whereas Ritalin and adderal
1:53:02
amphetamines and cocaine lead to Big increases in dopamine.
1:53:05
Also through reuptake mechanisms. And so forth. Modafinil is
1:53:08
is a weaker dopamine reuptake stimulator. And so what that means is that it leaves more dopamine
1:53:15
around to be active at the synapse, the, the gaps between neurons.
1:53:19
However, it also activates other
1:53:21
Systems. It acts on the orexin system, which is actually a peptide that we talked about in the episode on Hunger because it regulates hunger and
1:53:30
appetite and it regulates sleepiness and feelings of sleepiness. In fact, the excuse me, orexin also called hypocretin system. The orexin hypocretin system is what's
1:53:39
disrupted in narcolepsy. That was the important discovery of my colleagues Emmanuel mignot
1:53:45
and say gee nishino
1:53:46
at Stanford, some years ago. They identified the biological basis of narcolepsy and it's a disruption.
1:53:51
In the cellar, Exon
1:53:53
hypocretin system. And
1:53:55
modafinil is one of the primary treatments for
1:53:57
narcolepsy. It also has these other effects
1:54:00
on the dopamine system and on the norepinephrine
1:54:02
system, even though it doesn't lead to quite as intense levels of dopamine and arousal and focus. It does have the property
1:54:12
of raising levels of attention and focus and that's why people are using it. So it's a somewhat milder form of Adderall
1:54:19
are modafinil for some people.
1:54:21
Works as well as modafinil. And as I mentioned before, it's much lower cost for other people, it doesn't.
1:54:26
I have an experience meaning. I do have an
1:54:29
experience that I'll share with you. With our modafinil few years ago. I was suffering from jet lag, really terribly and I was traveling
1:54:37
overseas. I went to a meeting to give a talk. I took half of the
1:54:42
prescribed dose of our modafinil. It
1:54:45
was just prescribed to me. I took that half dose and I gave my lecture and then I
1:54:51
Around to answer questions and then
1:54:54
4 hours later. A friend of
1:54:56
mine came up to me and said, you know, you've been talking for four and a half hours and they're only a few people still here. Luckily. There were still a few people be a lot weirder if the room was completely empty. So it wasn't being recorded. So I
1:55:09
have first-hand knowledge of
1:55:11
the sorts of cognitive effects that it can create. I personally would not want to be in that state for sake of studying or learning or for doing this podcast, for instance, and
1:55:21
I can honestly say that today. All I've ingested is some coffee and some yerba mate tea, and some water. I'm not on any of the compounds that I've described during the course of today's episode.
1:55:32
You might ask why I took half the
1:55:34
recommended dose of our
1:55:36
modafinil. And the reason is that I'm somebody who's
1:55:40
fairly hypersensitive to medication of any kind.
1:55:44
What you find if you look in the
1:55:46
literature, is that about 5% of people are hyper hyper sensitive to medication. They require
1:55:51
Far lower doses of any medication than other people in order to experience the same effects. I'm somebody
1:55:57
that I think is or modest
1:55:59
hyper if that sort of oxymoronic statement, but a modest hypersensitivity to medication. So I've almost always been able to get by on taking less of whatever was prescribed for me and feel just fine or in this case to feel like it was still too much. It turned out that the right dose of our modafinil for me was 0 milligrams.
1:56:19
Now, you may notice that I haven't talked much about
1:56:21
Acetylcholine, acetylcholine is a neurotransmitter that at the neuron to muscle connections. The so-called neuromuscular Junctions is involved in generating muscular,
1:56:30
contractions of all, kinds for all
1:56:31
movements. Acetylcholine is also released from two sites in the brain.
1:56:37
So, little bit of nomenclature here again, feel free to ignore the nomenclature, but there is a collection of
1:56:42
neurons in your brain stem that
1:56:43
send projections forward, kind like a
1:56:45
sprinkler system. That's very diffuse to release acetylcholine and those neurons
1:56:51
reside in an area or a structure that's called the
1:56:54
pedunculopontine, nucleus the
1:56:56
PPN and then there's a separate collection of neurons in the basal forebrain
1:57:01
called, unimaginatively
1:57:02
nucleus basalis the nucleus at the base
1:57:05
and they also hose
1:57:07
the brain with acetylcholine, but in a much more
1:57:10
specific way, so one is sort of like a sprinkler system and the other one is
1:57:14
more like a fire hose to a particular location and
1:57:16
those two sources of acetyl, choline collaborate to
1:57:21
Activate particular locations in the brain and really bring about a tremendous degree of focus to whatever is
1:57:27
happening at those particular
1:57:28
synapses. So it could be a focus on
1:57:30
visual information or auditory information. If you're listening closely to what I'm saying right now, you just heard
1:57:36
closely step out from the rest of my sentence. No doubt. There was a seat of choline
1:57:41
released at the sites in your brain, where the neurons that represent your recognition of the word closely occurred. Okay. So now you have an example and you have an understanding and hopefully,
1:57:51
A picture in your mind of how the all this is working.
1:57:54
Not surprisingly then drugs that increase, cholinergic or acetylcholine transmission will increase focus and cognition. One such compound is so called
1:58:04
Alpha GPC which is a form
1:58:07
of choline and
1:58:08
increases
1:58:09
acetylcholine transmission dosages as high
1:58:12
as 1200 milligrams per day, which is a very high dosage spread out typically its 300 or 400 milligram spread out throughout the
1:58:20
day have been
1:58:21
I shown to offset some of
1:58:23
the effects of age-related. Cognitive decline, improve, cognitive
1:58:27
functioning people that don't have age-related cognitive
1:58:29
decline. That's a very high dose.
1:58:30
Typically, when people are using Alpha GPC to study
1:58:34
or to enhance learning of any kind. They will take somewhere between 300 and 600 milligrams. That's more typical again. You have to check with your doctor. You have to decide. If the safety margins are appropriate for you. Obviously, you'll want to check that out.
1:58:49
But Alpha, GPC is
1:58:51
effective.
1:58:51
Creating more focused by way of this, cholinergic system. It stimulates called acetylcholine release from both of those liquid locations. The PPN in the back of the brain and nucleus bacillus in the front of the brain.
1:59:04
There are two other over-the-counter compounds
1:59:07
that are in active. Use out there for treatment of ADHD and in use for simply trying to improve focus.
1:59:15
And the first one is l-tyrosine. It's an amino acid that acts as a
1:59:19
precursor to the neuromodulator.
1:59:21
Dopamine and now knowing everything, you know about dopamine attention in the circuits involved. It should come as no surprise as to why people are exploring the use of l-tyrosine for that
1:59:30
purpose l-tyrosine does lead to increases in dopamine. They are fairly long lived and l-tyrosine can improve one's ability to focus. However, the dosage in can be very tricky to dial in, sometimes it makes people feel to
1:59:48
euphoric or too jittery or to alert that they are then.
1:59:51
Able to focus. Well, so, the dosage range is are
1:59:55
huge. You see evidence for a hundred milligrams all the way up to 1200 milligrams. It's something that really should be approached with
2:00:02
caution, especially for people that have any kind of underlying psyche,
2:00:05
psychiatric or mood disorder because dysregulation of the dopamine system is,
2:00:11
you know, Central to many of the
2:00:13
mood disorders such as depression, but also, especially Mania Mania, bipolar disorder, or schizophrenia things of that sort. So, it's
2:00:21
Nothing that really should be approached with caution. Nonetheless in exploring, what's out there? And even some studies online that we're done. Either
2:00:31
animal studies are human studies. It's clear. That
2:00:33
l-tyrosine is being explored for that purpose,
2:00:36
as is Peña and phenylethylamine, which is a essentially Peña, but some related compounds. So there's a whole class of dopaminergic or
2:00:46
dopamine stimulating supplements that people are using to try and get their dopamine levels up and again,
2:00:51
A, it's kind of a fine line between
2:00:55
too little enough and too much. If you want to get the literature on those two compounds
2:01:00
there. I will refer you to this great website at examine.com, just as it sounds, and you can put in l-tyrosine or Peña and you can get the details on that, but I highly recommend also going to their section on ADHD to see how those particular comment owns relate specifically, to ADHD and cognitive focus
2:01:20
and last but
2:01:21
Not least in terms of these different compounds. I do want to mention the racetam S. These are somewhat esoteric and probably most of you haven't heard about them. But some of you probably know a lot about them and they are becoming more popular. They go by names, like new pepped and things of that sort the racetam Czar illegal. In certain countries. They are gray Market in other countries, and they are sold over the counter in this country in the US.
2:01:50
So they have different margins for safety. You definitely need to
2:01:55
consult your doctor, especially if you have ADHD,
2:01:58
but new pepped has been shown when taken. You know, at 10 milligrams, twice daily can be more effective than some of the other racetam shows. What is new pep new pepped Taps into the cholinergic system. The acetylcholine system in ways, very similar to Alpha GPC, but seems to have a slightly higher affinity for some of the receptors involved and can lead to
2:02:20
To those heightened states of cognitive capacity. And there are these studies one in particular comparative. Studies of new pepped in press, the Tam in the treatment of patients, with mild cognitive disorders and brain disease of vascular and traumatic origin. That's a mouthful. What this study basically points to is the fact that people who are experiencing some degree of inability to focus due
2:02:42
to Prior concussion, or some vascular event a stroke, or
2:02:46
ischemia of any kind because neurons need
2:02:48
blood when the blood supply.
2:02:50
Cut off two neurons or when there's a bleed in the
2:02:51
brain subsequent to that often.
2:02:54
There are challenges in maintaining Focus. This is very common for people who have done Sports where there's a lot of running into each other with your head like Rugby Football, hockey and so forth, but also people have experienced head blows or often overlooked is the fact that most traumatic head injury is not actually from Sports even football. It's from things like construction work from, high-impact work of that kind.
2:03:16
So there does seem to be some efficacy of new pepped in.
2:03:20
Piracetam and things like, it. It's an emerging area. And as I mentioned in the u.s., these
2:03:25
things are sold over the counter. Again. You have to figure out if it's right for you, but they are
2:03:30
beginning to show some promise, and I'm intrigued by them, because of the way that they tap into the cholinergic system, which is both directly involved in focus and the ability to focus but is also important for
2:03:44
things related to age-related cognitive decline. So a decline in cholinergic
2:03:50
Mission or acetylcholine as we call it in.
2:03:52
The brain is one of the things associated with cognitive decline in it does seem that increasing
2:03:56
cholinergic transmission can offset some of that cognitive decline and perhaps
2:04:00
even more. So, in conditions, such as
2:04:03
vascular damage or concussion to the
2:04:05
brain, if you're interested in a typical treatments for ADHD
2:04:10
compounds to improve focus and related themes and you like, reading
2:04:14
about this stuff. There's an excellent review article that I can refer you to it's by on at all, Ahn.
2:04:20
When it was published in 2016, so it's a little bit behind the times. Although it's surprisingly comprehensive given that which lines up all the various drugs that I've
2:04:31
discussed racetam and adderall and Ritalin and various forms of dopaminergic agents and cholinergic agents spells out whether or not, they are sold over the counter or
2:04:41
prescription, and really lines them up in all their affects their drawbacks,
2:04:46
Etc,
2:04:48
refer you to that study. It's available.
2:04:50
It's full length form online for free.
2:04:53
It's on at all that the journal is neuroplasticity neuro,
2:04:57
plasticity. 2016
2:04:58
should be very easy to find. If you put those keywords in and while it is a review, it is a very comprehensive review. And if you're really into this stuff and you also want to learn a thing or two about how these things interact with neurofeedback, Etc. There's some information in there as well.
2:05:13
I know I've already covered a lot of information, but there is one more
2:05:16
category of technology for the treatment of ADHD.
2:05:20
D and for enhancement of focus in anyone that I would like to emphasize.
2:05:26
And that's transcranial magnetic stimulation. Transcranial, magnetic stimulation also called TMS is achieving increasing popularity,
2:05:33
nowadays for the treatment
2:05:35
of all sorts of
2:05:37
neurologic conditions in psychiatric
2:05:39
conditions. It is a non-invasive tool, it involves
2:05:42
taking a
2:05:43
coil. It's a device with a coil, that's placed over particular locations in the brain. And then
2:05:50
And magnetic stimulation into the brain. It can actually pass
2:05:53
through the skull without having to drill through the skull
2:05:56
and nowadays can be used to both lower the amount of activity or increase the amount of activity in
2:06:02
specific brain areas.
2:06:04
Its spatial Precision is not
2:06:08
remarkable.
2:06:09
That doesn't mean it's not of use but it is not a super fine grain tool. Okay, it's not a cannon, but it's also not a needle. It is.
2:06:20
Somewhere in between, it can direct the activity
2:06:22
of particular brain regions at particular depths and as I mentioned it can increase or decrease that activity. So, for instance,
2:06:29
I've had a TMS coil placed
2:06:30
on my head, not for therapeutic purposes, even it was, I wouldn't tell you,
2:06:34
but rather just for
2:06:36
well, I'm a neuroscientist and I worked in a lab with one for entertainment, exploratory purposes, please don't do this at home.
2:06:44
It was placed over my motor
2:06:46
cortex, which generates voluntary action
2:06:49
and it was a coil that at that time could
2:06:52
only inhibit neurons. And so what I was doing is I was moving objects around on a table just like I am now. It was actually a pencil, not a pen and I was tapping the
2:07:01
pencil and then the TMS coil is turned on. And for the life of me, I could
2:07:05
not move that pencil. Okay, because it was inhibiting. My upper motor neurons in the portion of my cortex that controls.
2:07:13
Voluntary activity.
2:07:15
As soon as the coil
2:07:16
was turned off. I could return to tapping the pencil. Again,
2:07:19
nowadays. It's possible to
2:07:21
stimulate motor cortex or any area of the brain with some degree of precision, that
2:07:26
could create the impulse to move without
2:07:30
actually, making the decision to move. So, you can literally, engage, certain neural circuits in there for behaviors and certain thought and emotional patterns. By way of transcranial magnetic stimulation.
2:07:40
This has far-reaching and vast implications.
2:07:43
As you
2:07:44
can probably
2:07:45
imagine in discussing ADHD with a colleague that uses TMS what they are doing is they are taking the TMS coil to children and adults that have ADHD and they are using it to stimulate the portions of the prefrontal
2:08:02
cortex that we talked about earlier, that engage task directed focused States. So, rather than using a drug that generally increases dopamine and some of the other chemicals involved they are you
2:08:13
Using directed TMS stimulation of the
2:08:16
circuits. And fortunately, I was quite relieved to hear this. They are combining that with a focused learning task. So they're literally teaching the brain to learn
2:08:25
in a non-invasive way. No drug at all. And right now there are
2:08:30
experiments clinical trials. Going on comparing TMS of
2:08:33
this sort to the drug treatments of the sort that we described earlier that engage these circuits through pharmacologic mechanisms. So, very exciting times for TMS very
2:08:43
Times for pharmacology related to ADHD and for enhancing focus in
2:08:49
general. And when I say very exciting times, I mean no drug is perfect. But the constellation of drugs that's out there is getting much larger, but because they tap into different aspects of their circuitry. I do think that we are well on our
2:09:03
way to identifying the ideal combinations of drug treatments technological treatments and behavioral paradigms for increasing focus in both children and adults with ADHD.
2:09:14
And as a final final point, I
2:09:16
also want to mention something about technologies that are making it harder for all of us to focus regardless of whether or not we have pre-existing ADHD or not. You
2:09:26
can probably guess where this is going. Everybody. Nowadays seems to have a smartphone. I'm sure there are a few individuals out there that don't have a smartphone nonetheless. Most people have them. Most kids want one as soon as they can get them and they are small, they
2:09:44
Our attention entirely. But within that small box of attention, there are millions of attentional Windows scrolling by
2:09:52
right? So, just because it's one device that we look at does not mean that
2:09:55
we are focused. We are focused on our
2:09:57
phone, but because of the way in which context switches up so fast within the phone, it's thought that the brain is struggling. Now to leave that rapid turnover of context, right? Many, many shows. Many, many Instagram Pages, many many Twitter feeds, many, many websites.
2:10:13
Besides basically, the whole
2:10:15
world at least in Virtual format is available within that small box.
2:10:20
Unlike any other
2:10:21
technology humans have ever dealt with before, even though there are
2:10:24
trillions. Infinite number of bits of information in the actual physical world, your attentional window
2:10:30
that aperture of constriction
2:10:32
and dilating that
2:10:34
visual window is the way in which you cope with all that overwhelming information.
2:10:37
Typically. Well within the phone,
2:10:40
your visual aperture is set to a given width
2:10:44
It's about this big. Typically, the phone seem to be getting bigger. But nonetheless, it's about that big
2:10:48
and within their, your attentional window
2:10:52
is grabbing it near infinite. Number of bits of information, colors movies. If a
2:10:57
picture is worth a thousand words, a movie is worth a billion
2:11:00
pictures, the brain loves visual motion. And so
2:11:05
the question is,
2:11:07
Does that sort of interaction on a
2:11:08
regular basis, lead to deficits in the types of attention that we need in order to perform well in work and school relationships, Etc. And the short answer is, yes, it does appear. So we are inducing a sort of ADHD and while the studies on this are ongoing because prominent use of smartphones really took off right around 2010 and we're only in 2021
2:11:30
long-standing studies take time, which is essentially to say the same thing as long-standing.
2:11:36
There are some studies and one in particular that I'd like to highlight one was actually carried out pretty early in 2014. This is a study that explored smartphone use
2:11:45
at the time. They called it mobile phone use. But smartphone, use
2:11:48
and inattention difficulties in attending in 7,000 and 102 adolescents. There's a huge study of population-based cross-sectional study and you will be probably surprised and somewhat dismayed to hear.
2:12:06
Hear that in order to avoid this decrease in attentional capacity, adolescents needed to use their smartphone
2:12:16
for less than 60
2:12:17
minutes per day in order to stay focused and
2:12:21
centered on their other tasks. Otherwise, they started to really run into significant issues. So,
2:12:26
60 Minutes is not much. I'm a feeling that most young people are using their phone more than 60 minutes per day. I
2:12:33
know I am,
2:12:35
I think, for adults the number is
2:12:36
Probably higher.
2:12:38
Meaning, if you're an adult. I could have, I'm gonna
2:12:41
just extrapolate from what I read in
2:12:43
this study. It seems that probably
2:12:45
two hours a day on the phone, would be the upper limit Beyond, which you would probably experienced pretty severe attentional. Deficits.
2:12:54
I'm a big fan of Cal Newport. Who wrote the book
2:12:57
deep work. He's also written an excellent book, a world without email. I've never met him, but I'm a huge admirer of his work and I will
2:13:03
paraphrase something that he said far more eloquently.
2:13:06
Than I ever could. Which is that the brain does not do well with constant context, switching? Meaning it can do it. But it diminishes our capacity to
2:13:17
do meaningful work of any other kind. And So
2:13:21
Cal, as I understand is very
2:13:24
he's out computer science. Professor at Georgetown, by the way, is very
2:13:27
structured and very disciplined in his avoidance of cell phone
2:13:31
use.
2:13:33
I think we're all striving to do that. I'm not here to tell you what to do. But I think whether or not you have ADHD or not, if you're an
2:13:39
adolescent limiting, your smartphone use to 60 minutes per day or less. And if you are an adult to two hours per day or less is going to be among the very best ways to
2:13:53
maintain just to maintain your ability to focus at whatever level you can now. And as I always say,
2:14:01
most of the things that we get
2:14:03
For Life success in life. In every Endeavor whether or not it's School relationships sport. Creative works
2:14:09
of any kind are always proportional
2:14:12
to the amount of focus that we can bring that activity. It is important to rest. Of course to get proper sleep, but I stand behind that statement and I leave you with that study about attention and cell phones and how cell phones are indeed eroding. Our attentional capacities.
2:14:28
So I realize that covered a lot of
2:14:29
information about ADHD and the
2:14:32
g of focus and how to get better at focusing. We talked about the behavioral and
2:14:37
psychological phenotypes of ADHD.
2:14:40
We talked about the underlying neural circuitry. We also talked about the neurochemistry and we talked about the various prescription drug treatments that are aimed at that, neurochemistry, and
2:14:51
aimed at increasing,
2:14:52
focus in children. And adults with ADHD.
2:14:55
We also talked about over-the-counter compounds.
2:14:58
The role of particular types of diets and elimination
2:15:01
diets, and we talked about
2:15:03
Actions between these various features in dictating outcomes for ADHD and enhancing focus in general. We also talked a
2:15:10
little bit about emerging
2:15:12
neurotechnologies and how certain Technologies like the smartphone are no doubt. Hindering our ability to focus and put us at greater risk of developing ADHD at all ages. I do
2:15:23
acknowledge the irony and somewhat the contradiction of doing a two-hour + episode on ADHD, if indeed people who are watching this
2:15:32
Have
2:15:33
challenges with attention. I want to emphasize that this podcast, like all of our podcast episodes are time-stamped for a specific reason. They are designed to be digested in whatever,
2:15:43
batch one chooses,
2:15:45
right? You don't have to watch or listen to the entire thing all at once. However, if you've gotten to this point in the podcast, I want to thank you. I do hope that you've
2:15:53
learned a lot about this condition. I hope
2:15:55
you've also learned a lot about your own capacity to focus and things that you can do to enhance your focus. We even talked about a tool that takes just one.
2:16:03
15 minute session to enhance your ability to focus their after presumably forever.
2:16:09
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2:16:18
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2:16:20
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2:16:21
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2:16:26
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2:16:32
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2:16:37
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2:16:40
And for those of you that would like to support research on stress, neurobiology and Human Performance. You can go to huberman lab Dot stanford.edu and there. You can make a tax-deductible donation
2:16:50
for research on neurobiology in my laboratory.
2:16:53
In addition. We have a patreon. It's patreon.com slash Andrew huberman. There, you can support the podcast at any level that you like during today's episode. We
2:17:03
Talked a lot about supplement based compounds if you're interested in supplements and you want to see the supplements that I personally take you can go to Thorn. That's th o RN e / the letter U / hubermann and you can see everything that I take and you can get 20% off any of those supplements. Or if you navigate into the thorn site through that portal, you can get 20% off any of the supplements that thorn makes supplements aren't for
2:17:28
everybody. You, by no means have to take
2:17:29
supplements. But if you are going to take supplements, it's important that you take.
2:17:32
Supplements from a source that's
2:17:34
reputable and which the ingredients are very
2:17:37
high quality and in which the amount of the ingredients that
2:17:40
listed on the bottle actually matches. What's in the bottle? That's
2:17:43
why we partnered with Thorn because they have the highest levels of stringency in terms of quality
2:17:47
and specificity of the ingredients.
2:17:49
And finally I want to thank you for your time and your attention. And as always, thank
2:17:54
you for your interest in science.
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