Leading ADHD & Hypermobility Expert: '3 Ways ADHD Affects Collagen In Women!' | Nick Potter

0:00ADHD people are no different to anybody else. We've got everything we need, but there's a balance. You've got to balance what you need at the right time. The problem with ADHD is we can do all that, we just can't regulate it. So we don't find that balance. Lots of different subtypes of ADHD, and I think we should be careful of that. And we can't just say that because somebody's just a bit over-vigilant and a bit this and a bit of a worrier that they've got ADHD. We've got so obsessed with cognition, the brain, how clever we are, etc., is that we've forgotten that we are an embodied brain. Dr. Nick Potter is an ADHD and hypermobility specialist.

0:27Nick Potter:World-renowned author with three decades of medical experience. Nick is behind pioneering research into how our ADHD mind can drastically impact our physical body. So there's a dissonance, a mismatch between what your vision is telling you and what your body is telling you. That's what we call prediction error. If you're on the planes, which is where our brains really are manufactured to be, that meant you got eaten. So we've still got that mechanism and it sets off fear and it sets us to move. That's why we fidget. it means also that we're constantly very often being drawn into the periphery to know what things could take us out.

0:56We just don't know we're doing it. Quick one before I get distracted. I just wanted to say a very brief thank you to all of my listeners. Thank you for tuning in and thank you for subscribing and following the podcast. It really, really helps. At ADHD Chatter, my mission is to ask the world leading experts the hard questions to give you access to the most pioneering advice the world has to offer and with an aim to help you feel seen. Following and subscribing helps me on my mission to book these incredibly insightful guests and to give you these incredibly insightful interviews. Remember, you're not broken, just different, and you have always been enough.

1:35Nick, thank you so much for joining us. Absolute pleasure. It's lovely to be here. It blew my mind when I learned about hypermobility and the links to ADHD. But just to set the foundation, Nick, what would you say your mission is in the world of ADHD and hypermobility? It's a great question. I think for me, it started with hypermobility. And as I was saying earlier, I worked in primary care down in Fulham, actually. So we were seeing families. And it was conspicuous to me how many of the population were hypermobile, particularly I and myself. And actually also its connection to other conditions, problems we were seeing.

2:08And I did flag it up to the GPs who were very receptive, actually, and sort of grew. But I think that as with so many, medicine's a funny institution, it takes probably 15 years to change consciousness around certain concepts. And I think certainly rheumatologists who were seeing these patients were like, oh, blimey, there's a whole new thing coming and we don't really know what to do with it. And then it was, oh, everybody's hypermobile. And it's actually, well, not really. And then the consciousness developed. But I also just noticed that increasingly they did have a neurotype, a body type was producing a way of, they fidgeted more, they twisted their ankles all the time.

2:42It's a classic question I say to patients is you know did you always twist your ankles as a kid and they go yeah yeah i did a lot and of course once you keep we've done it once you keep doing it but that's very important because proprioception which is what we use our feet for a lot which is to tell where we are in space relies on ligaments and if those ligaments are damaged and they come off they don't rehabilitate them properly then they keep doing it so then they get into a vicious cycle but i think my mission is awareness i'm very lucky i have a busy practice i don't necessarily need more patients but I'm very passionate that I actually wrote a book in 2018 on pain in which I included hypermobility and realized looking at data that if you look at the pain society data that 43 % of the population have pain chronic pain the NHS is unfortunately unable to really provide anything for it other than medication which doesn't work very long and that's 23 million people that's an awful lot of people and some of those people couldn't afford to either come and see me they're too far away I see a lot of international patients that's how desperate some of them are and I thought I'd like to put something back to a certain extent.

3:45It's not a financially driven thing, it's purely awareness and education and I think I found a bit of a talent for being able to explain it. I mean, I do it every day to my patients, but to explain it simply because it's quite complex, it's multifactorial. And it was at the heart of a lot of pain syndromes and it's at the heart, I think we know now, very, very connected to the ADHD domain. Do you think we're seeing a similar movement in awareness towards hypermobility as we've seen towards ADHD? It feels like over the last 15 years in the ADHD space, what people thought it was is very different to what they think it is today.

4:23Yeah, I think the more awareness you get, the more the people involved are kicked into doing it. So in the academic world, and a lot of the trusts within the NHS are attached to hospitals, but they're also attached to universities. And so you get the PhD students suddenly looking at this stuff. And so we now start getting a plethora of data. You've got to be careful that that data is good. They've got to be properly done studies. It's difficult to do because it's so multifactorial. And generally, research doesn't lend itself very well to the human organism because by the time you've reduced something down to a tiny amount, it's very useless.

4:55It doesn't tell you the relevant to anything else. So I think I would say hypermobility has taken longer. I think in the occupational therapy world, they're very aware of it. One of the things I'm passionate about and why I want Polly to come today is I want these tests done more on children in all schools. They're incredibly simple. They cost nothing. Even a teacher can do it. If you can flag hypermobility up, then you can say to the parents, and I would do it to all children, so that you're not isolating anybody and it's not an academic test it's not educational psychology it's just a physical test and if you flag it up and you say look to the parents just to let you know we know that hypermobility is more commonly linked to certain neurodevelopmental disorders and if we could get him doing very specific exercise to integrate himself better etc we would it is now proven that it would reduce the chances of loss of those neurodevelopmental problems coming on.

5:46It's much better to produce a resilient kid than it is to have to fix a damaged adult. What would that test look like for someone listening, someone watching? How could they test? Really simple and you can Google it immediately. It's called the Baton's score. There is one called the Brighton's score, which is slightly different. And as my colleague Jess Eccles, who's a dear colleague, they've sort of developed that. Brighton and Sussex have been leaders in this. But the Baton's score is a nine-point score and it's very easy to do. it involves things like having very extensible fingers on both sides so that's two and then whether or not you can get your thumb pretty close to your wrist I mean I really can't that's something I don't particularly do well but it's a lot more than most most people get past there extensible elbows so if you can go extend your elbows past about 10 or 15 degrees then we would consider that hypermobile okay which means your joints can go further than they should do okay and then the same with your knees and then the other one is that you can you can pretty much early in the morning no matter how stiff you may feel you can get pretty close to touching your toes and if you feel very high you'll just go straight flat on the floor the one that i'm particularly interested in which isn't in the test and is difficult to validate which is what we're trying to do at the moment is that you have what we call extensible skin so you do it at the neck and on the back of the hand and even quite young people obviously as you get older it tends to happen but even quite young people can extend their skin a lot longer off the surface of their body and that's very interesting because skin is a multi-sensory tissue and so it gives us a lot of feedback about the world and if that's very flexible or overly flexible it moves in relation to the body so we get impaired proprioception through it so that's something i'm looking at at the moment but then i have to get the dermatologist involved so there's lots of ologists uh who i have to talk to but they're actually really open to it because they're all sitting in silos and they all kind of know it but it just needed someone like me to come and say dudes i think we need to have a dinner at least and got talking and that's what we did with the ADHD hypermobility group and then I will factor in those other elements.

7:41But they're loving it. They all want to do something new and exciting. We all get a bit bored of doing the same thing every day. So how common is hypermobility in ADHD? Because you think of ADHD, right? And you don't necessarily think joints. How common is it? It's a really good question. I mean, really big studies. If you're going to prove this stuff, you've got to do 20 ,000 patients and then correlate it, et cetera. But in real terms, we're looking at probably the general population about 20 upwards in the adhd study done by jess uh at sussex it looked like it was about 40 of the adhd group but interestingly about 75 of the female group which is initially so it was higher and that's certainly anecdotally in my own practice you see more female hypermobile patients um so uh and then tie in with their what we call psycho neurotype um and the fact that they they have less bodily awareness and so on then it produces a form of anxiety um but so my passion is that these are not neurotic females you know these are people with an internal system that is constantly hyper vigilant and that ultimately turns which is a fear response and fear turns into anxiety if so it is more common in women and if what are the sort of consequences physiological emotional consequences of living with hypermobility um and adhd but not knowing so again as we were saying earlier i think all these there are some lots of different subtypes of adhd and i think we should be you know we need to be careful of that and we can't just say that because somebody's just a bit over over vigilant and a bit this and a bit of a warrior that they've got adhd there's lots of other reasons it's childhood reasons and so on i think maybe to wind back a little bit and without getting too technical the way i try and explain it to patients is our brain spends two-thirds of its capacity on visual information.

9:30We're very big on eyes, okay? So we have the most developed ocular system in the world and way more than hawks and everything else. And we use our peripheral vision to tell us about new information coming in from the periphery. So we orientate towards it. You know, Bambi in the headlight, she looks across when she hears, and they freeze and they hold their breath, right? But we integrate that with what our body is telling us. And my big zid is that we've got so obsessed with cognition, the brain, how clever we are, etc., is that we've forgotten that we are an embodied brain. We cannot build models of the world unless we have a body, because you have multi-sensory information.

10:05And it's a phenomenal piece of kit. That's why I don't believe we'll make a robot that's sentient for literally years, because it can't be made of metal, it's got to be made of tissue. So what we rely on is those five senses coming in, one of which, the most important ones, is proprioception that doesn't get talked about, which is stretch receptors in our body. There are there are millions of them, they're nano-sized, and they're particularly in your joints, they're particularly in the capsules and ligaments of your joints. They feed back to your brain about where you are in space, because if you can't tell where you are, you don't know everything relative to anything else.

10:34And it all gets quite metaphysical, but that's the point. The problem for hypermobility is that we have a collagen disorder. We lack a particular type of collagen. That collagen binds us together. So we have tissues that are like marshmallow instead of chewing gum. We don't have a sticky, agile form of soft tissue. Those receptors, are just mechanoreceptors. They just measure movement. And they're a propeller shape. They're called piezo-receptors. And interestingly, we actually have them in moving organs. So it's anything that moves, these receptors. So we've got the heart that moves, the chest that moves, even your bowel moves to a certain extent.

11:06So they're in both of those, and they correlate with each other where they are. And your brain is monitoring that at very high resolution. You just can't possibly know about it because you couldn't be thinking about it all the time. It literally knows what your big toenail is doing right now and is processing that for you. but it only makes you aware of what you need to do something about the problem for us is if you have a movement the soft tissues will not pick up that movement these receptors as high resolution as normal so there's a dissonance a mismatch between what your vision is telling you and what your body's telling you that's what we call prediction error which i know jess eccles talked about a little bit which is that my perception of the world is off now that's great in our safe world that's relatively easy in the modern days but if you're on the plains which is where our brains really are manufactured to be um that meant you got eaten because if you tripped up a tree stump over a tree stump when you were being chased uh you were toast so we've still got that mechanism and it sets off fear and it sets us to move that's why we fidget because we're trying to find we're constantly taking little parameters little little soundings about where we are and it means also that we're constantly very often being drawn into the periphery okay because we're constantly seeking to know what things could take us out.

12:20We just don't know we're doing it. So if there's a mismatch, the brain has to take many more flashes of the world. We burn much more neural energy. Again, we don't know we're doing it. And then we can crash much quicker. So it is a Ferrari brain that has its advantages. The way you can integrate that is actually physical exercise. And that's what these people don't like doing because they're clumsy. So girls are particularly susceptible to feeling shame. So the classic thing in the playground is if they're doing PE, is they just don't get it as quickly when their other friends are. So they actually just tend to give up and then they don't do it.

12:53Whereas actually, if you said to them, look, you just need to do 10 times what somebody does five, but you will get it. Then you will start integrating your body. So you're just knocking out that error by practicing. It's what any sport's about. The more you practice it, the more you get. The problem for us is we have to spend a bit longer doing it. But then we get bored or we find everyone else is doing it. I'm crap. I'll walk away. And girls, I've seen it with my own daughter and family, you know, they're much more aware of Who saw me fluff it? Who saw me get it wrong? Boys tend to be actually in those situations more competitive, more focused, so they will just drill it harder.

13:24The problem is then you don't get into the sporty group. Sporty group's often sometimes the cool group, and then they feel more isolated. And that's where the kind of social anxiety, I think, begins to develop. And it's quite an early age. It's so interesting. Shame seems to be such a common characteristic of the ADHD experience. Is it quite easy to look at the executive functioning challenges of ADHD, I think disorganization and forgetfulness, but I think the emotional aspects of it are so much more significant and impacting. How would you describe ADHD to an alien, for example? ADHD people generally, I mean, without getting into sort of the learning disorders of executive function, etc.

14:04In general terms, ADHD people are no different to anybody else. We've got everything we need, but there's a balance between it. The yin and yang sign that you see in the ancients really knew it right for every every action there was a reaction whether it's in your chemistry and your movements or your behavior you've got to balance what you need at the right time and the problem for adhd is we can do all that we just can't regulate it so we don't find that balance and i think that starts early in childhood for lots of reasons uh it can be parental familial uh those things traumatic all those sorts of things which just knock you and and if you don't recover from it properly then um you go forward in the world and the problem is if you and i've done this with traders when we stressed them deliberately looking at volatility what we didn't realize was that within less than two days if they were feeling they wouldn't know they were stressed but they were feeling it through their physiology they would actually change what we call the search algorithms so they would actually see the world in a different way when you say traders these are traders on a financial floor so they're trading masses of data that's why they're all they need to be at least that because that that's their superpower right they can they can see market movements way before i have an anesthetist colleague and it's fascinating he can tell before the computers whether the patient's going to do something weird well suddenly say oh hold on a minute and he sort of injects something into the body and then i said how did you know he said oh i can just because just from millions of patients he knows that lots of parameters are happening and from learned experience and i said what happens if you don't do it's all i don't there you go and then suddenly the computer went bing bing bing and it was picking it up so he was actually quicker than the he was he was seeing it quicker than the computer was pattern recognition pattern recognition exactly and we're very good at that So it is a talent.

15:37And we see it in medicine and we see it in, you know, surgeons are quite similar. They have to do very focused and intense operations. But most of the time they're, you know, they're also having to take in an awful lot of other stuff going on in the room. I don't think you could do that if you didn't have the superpower. So I think, you know, I think a lot of it's about finding what we're good at rather than feeling judged by, because we're slightly irritating in a classroom. You mentioned earlier, Nick, that women are more likely to have hypermobility. Does that mean that therefore women are more likely to have ADHD?

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16:44Timo is here to help you simplify planning, build focus and make life happen. No more decision paralysis. The new AI planning assistant makes it so quick and easy to insert information. You can do it before you've forgotten or been distracted. Give it a go and use the link in my bio for 30 % off. Just a note though, this code is only applicable on the web browser, not the smartphone. Anyway, back to the episode. Very good question. This is where we have to have caveats. But I think I would certainly say in my experience, yes. Certainly in all my other colleagues' experience, yes. The data studies have got to be really big to be able to say that categorically.

17:19And certainly for NICE and people like that to buy into it, they've got to say. And obviously we get into what we call the correlation causation trap, which is just because two things coexist doesn't mean they cause each other. But if you look at the neuroscience, and this is something I found that I just had a bit of a talent, and I think is the talent of ADHD with, is the seeing the interconnectedness of things. You know, you don't need to be too much a rocket scientist to see why these things would happen. If you know some neuroscience and you know some psychology, you can actually say, well, it's obvious that this causes that.

17:46And actually maybe here I would mention the work of Carl Friston at UCL, which has been seminal, and he actually wrote an equation for how it is the brain thinks. and I contacted him and said, could you rewrite it for me? Because it's way above my pay grade to know the physics. Could you rewrite it with the arm that is proprioception and say that there's a mismatch? And so we are actually writing an equation for hypermobility, which would ultimately be probably really what ADHD is. It's an equation. And it's quite nice to be able to prove it mathematically. And I think that certainly Jess Eccles' studies, is Professor Critchley, Garfinkel, they have certainly seen in their experience that the ADHD people they're coming seeing through psychiatry, who they can simply do a Baten score, there's a huge amount of overlap.

18:34And I've done it with a very nice educational psychologist friend of mine. I rang her up and said, could you possibly just get all your ADHD kids a Baten score? And she rang me about three weeks later and said, Jesus, they all are. I went, yeah. So I think it's probably that one causes the other, but is interrelated. Sure. It's a problem of perception. So, and you have body perception as well as cognitive. I remember Dr. Jess Eccles when she came on and did her brilliant interview. She said, if you're hypermobile, you probably have been told that you've got a great party trick of, for example, being able to bend your thumb back and touch it.

19:09It is a party trick. I mean, you see some of these guys who can do it. I mean, look at these, the circuses and Cirque du Soleil. You know, these poor kids and Malaysians are very, very hypermobile So they come in and they're stretched because, of course, their parents see an opportunity. But I mean, they can get themselves through a tennis racket, you know. So it is amazing, but it's also, isn't it? You know, so it's a bit freaky. So I'm not sure. I think it's a party trick, but I think you're also, at least you can laugh at yourself maybe. But I think to a certain extent, it's also you're a bit weird, which we're quite used to being told probably.

19:39I mean, on the flip side, what problems do you think having a body like that could cause? Well, this is where I come in with the sort of body stuff. I think that the problem is having too much movement isn't just a neurological feedback thing. It's also that unfortunately joints rely on a reciprocal relationship between picking up tension and stiffness to support your joints. So we tend to fatigue quite quickly. Just we get tired, we fidget, we're constantly shifting. The classic is, do you shift all the time in the cinema? Do you twist your ankles? Can you flex your joints? But more importantly, do you constantly get neck pain, back pain?

20:11Yes. If I'm working the laptop, all those sorts of things, they're going to get it. They're going to fatigue earlier and they're going to get much more bodily pain, which again, makes them feel like there's something wrong with them. But once they, a lot of, a lot of my treatment is education. I mean, it's just, they go, wow, finally, somebody's told me why I'm like, and that's, um, that is the treatment really. Um, but it's, it's integrated with pain. Um, and if you don't understand it, then your brain starts saying what's wrong with me. And then you build that into a fear and you actually stop moving because not moving is easier and moving hurts when it's actually the exact opposite of what you need.

20:44to do with the pain thing i mean are there any real life examples that someone with hypermobility might avoid because they are more susceptible to feeling pain in that situation absolutely i mean it makes you retract if you know something it's like migraine migraineurs will begin to retract from the community because they tend to get it in social environments from stimulated environments so they just don't do it right they go back into a hole so the same thing is you know if you've got a sore hip you'll start limping and then you'll accommodate it then that becomes tiring so you you walk less and you know we see this in the elderly once they get injured they deteriorate very quickly because they can't move and you need your well brains are designed to move not to think and that's what people forget every affect every feeling that we have involves a movement if i'm thirsty i drink if i'm hungry are these sex horniness that you know you couldn't tell me what horniness was but you just know what it is right and it's a compulsion to do the sexual act they're all affects that's why i tend to call them affects their feelings they're not emotions then you have the other they're the survival ones then you have the other emotions which are socially based and parentally based so fear sadness despondency rejection etc they're much more subtle but even crying if you think about it if you're upset there is no function to crying physiologically producing tears doesn't do anything for it other than to show to the group that you're upset and if your sensitivity is higher your tolerance for doing that's lower so you are a more sensitive person that means you have a lower hypermobile don't like being told this only because i think i've got quite a high pain threshold by definition if you've told me that you haven't because you're feeling the pain so we can measure that and they do tend to have lower pain thresholds but that's because they see the world as a fearful place so you're as like an alarm system your brain makes everything more sensitive so they don't you can't see it there's nothing you can go and measure other than ouch or tickle they generally don't like being touched much they don't like being tickled they don't like being poked and they get very claustrophobic you do it to a child tickle a child who's hypermobile they really don't like it they don't really giggle they go get off you know so it's a generalized sensitivity and does that apply to emotional pain too yeah you're going down going down another hole yeah i wouldn't separate the two i mean when we call what we call nociception which is if i just prod you with a needle which is that the tension receptors will tell you that they're being so stimulated that it's dangerous there is there are no look the freaky truth is there are no pain fibers anywhere in the body there are no pain nerves.

23:03And everybody rejects that, but it's completely true. There's nowhere in your body that specifically fires pain. It's when a particular receptor is so overstimulated, heat, you know, you can put your finger on a hot plate and this is getting hotter, you go, ouch, right? That's just a tolerance at which your brain says, no, you're going to get damaged. Okay? If I start with a pen on your knee and I keep pressing it in slow and slow and slow, and then, oh, ouch, right? All you're feeling is summation. So that's what we call nociception. that's very different if you go on to feel chronic pain which you can't get out of that pain that's a very different that's when the the information coming in what we call somatossensory information coming in turns it flips into the emotional circuit so that's when it's gone deeper into the brain it's gone it stopped being here and in the spinal cord it's been sent up to the top and in my book i likened it to the cia this is where you know your bureau bureau out in hong kong's picking up a lot of noise it's then got to start reporting it back to langley and then langley makes a response okay so it's a it's a similar concept but it's so emotional pain yeah is is it hurt you know emotional pain hurts we know what hurt is it's very difficult to describe but something can have a physical hurt and it can be you know if you lose a loved one or you find out your girlfriend's um two-timing you that is a physical hurt because your narrative which is i'm in a relationship i'm happy i'm loved etc suddenly is catastrophically broken so you could say that pain is the felt sensation of a neurological network, which could just be story, relationship, or it could be leg broken, those circuits are broken and the brain's saying they need to be attended to and fixed.

24:38It's fascinating. So the brain to body connection is so strong. I mean, I don't know, is there research to suggest that heartbreak might be more painful for someone with ADHD, hypermobility? Well, you just said it. We have language. No other animal has language. Why? Because that means you and me can communicate. But we have to have an understanding, a mutual understanding of what we're talking about is. And it's endemic. That's why being articulate is really important. Because if I say on that, I was on the BBC once and I said to a whole lot of pain patients, I said, look, you've got to understand that pain is not in your head.

25:09It's not in your mind, but it is in your nervous system. Okay. And your brain. And it's weird. They will go, okay. If you say it's in their head, it implies malingering. It's all your fault. Again, it's a shame thing. As soon as you say it's a nervous system disorder, they go, okay, right, okay, I feel validated. I'm listening now, you know. And you see them in chat rooms. They're quite angry. They've got angry emojis. They're pissed off. They're in their room too much and they hurt, right? So who's this guy telling me that it's all in my head? I agree with him. But if you say it's in your nervous system and then you take them, once you've hooked them, you can then take them down this pathway saying, well, look, actually the only place that hurts is your brain.

25:43It's just taking information. but um so you have a representation of your body on the surface of your brain and when people can't i know when somebody's dissociated from an injury because they'll say to me hey doc it's the knee not my knee and that's very important because it means he's seeing it something other and that's part of rehabilitation you have to say to them no no it's your knee and we're going to fix it and then you the rehabilitation is reintegrating a model on the surface of your brain well what you just said is probably enough to make someone instantly not feel crazy to feel validated i mean i was i'm very passionate about i teach quite a lot and i'm very passionate about teaching students how to be with patients you know be understand amazing i went to go and speak at a quite a big um conference recently and i just asked them all what does where does the word patient come from and very few hands went up a couple went up and said young keen chap said oh it's because they're like they're patient they're waiting in the room i said no it comes from patio which is to suffer right patty ends is the participle they're suffering so we're very mindful to remember that right these people are giving us the privilege of them coming to us saying i can't cope anymore that's why they're here and that i'm suffering at whatever level my role is to find out what what's causing that and try and help them with it but it's about empowering them whereas i think now you know you go into some of the areas of the nhs who are over busy and demoralized, but they actually see patients as irritants.

27:07So when somebody comes in and says, I'm giddy, it's like, oh, it's either something or nothing. You know, I'm in pain. Oh, okay. Wow. And they've only got seven minutes. So what are they going to do? They're going to give you a medication. I think a lot of my doctors know what they should be doing, that my doctor colleagues, but they just haven't got the time and they're inundated with it. And the problem is medicine has gone into a reductionist point of view, which means that we, you know, you see your cardiologist and this, so hypermobile patients invariably will have seen a cardiologist, a neurologist, a rheumatologist, a psychologist, a psychiatrist, and none of them independently have given them the answer.

27:40Why? Because these patients sit at the intersection between all of those. That's why they get missed. So they get sent around this sea of endless practitioners and never get an answer. And that's why I have them crying of joy in my room. My nurses, when I first joined the King Edward, they said, they're all crying. I said, yeah, but they're actually happy because they just said somebody has told me why unlike i am and then that's where it starts and then you can give them all the little things and they actually fix themselves just by understanding not being afraid saying look this isn't actually broken anymore it's healed but your brain's got a representation that it is so we've got to change your perspective give you the give you the things to do and they and it happens quite quickly seven minutes appointment is i mean it's terrible ten minutes i mean if they were longer would that be more time for the doctor to maybe...

28:28Well, look at the private centre. I mean, the reason I can't do what I do in the NHS is because I simply, I take an hour with my patients to start with, and they're half an hour to 40 minutes. I'm always running over, right? Because you don't know what you're going to bump into. And it's a wonderful ride because a human isn't a sort of an organism, right? Somebody coming in with back pain is you. It's Alex with back pain. It's not just back pain. And Alex will manifest that pain in a completely different way and his perception of it. So I've got to know what makes up Alex, right from childhood, right through to that.

28:54So people, I think sometimes a bit surprised by what they get from it because they think oh you're an osteopath you're a backcracker it's like no that's not what osteopathic medicine is about and um but also I've worked in rehab medicine in Germany and whatever you know you formulate and you have to know the neuroscience then you start thinking god this is very limited what we're doing and you get a bit disappointed and with that knowledge of the brain and the body connection I mean are there other physical conditions that are linked to ADHD I would slightly change that by saying, are there other conditions that are a manifestation of neural state?

29:26If that doesn't sound too complicated. But yes. And in fact, I've got a nice little slide, in fact, of about 11. And gastric reflux, for example. 90 % of it is stress. You secrete much more gastric acid. But they'll just give you an antacid for it. They're not interested in why you're stressed. Okay? Could be emotional. It could be work. Could be any number of things. And if you are migraine, it's centered in the brain. And a lot of it is related to stress, a lot of it is backgrounds and so on. But they're not going to do that. They're just going to give you immigrant. They're going to give you something to a triptan, which also zonks you out and also works for a bit.

29:59Everything works for a bit with pain unless you get to the root of it. So I, again, I'll probably be shouted down for it, but I would say that CFS, chronic fatigue syndrome, fibromyalgia, and ME are effectively the same thing, just manifesting in a different way. So why do we keep calling them three different things? Because the people with each one say, well, no, that's not the case. I get this. Yes, yes, you do. But it's just your brain is inhibiting you either through brain fog, fatigue, or pain. They're the three horsemen of those conditions. And surely those three horsemen perpetuate the ADHD burnout cycle if you're giving so much energy to something that...

30:38So going back to what we're saying about how you've got to take many more samples of the world, we call it sampling rate, if you've got much more error in the system. So you keep taking more flashes, right? You need more resolution. So you're taking more flashes. You don't know you're doing it but that means you're burning a lot of neural energy you're only given 20 of the body's energy every day and it won't give you any more this is something that again friston's labs they discovered is that you get a certain amount of energy as a packet and you've got that for the day and you can't have any more sir where does the other 80 percent go body but 20 of your body is and the other god certainly 20 30 of it is muscles muscles are very heavy on energy it's just chemical energy we're not talking waga waga energy this is this is real energy you're burning You're sitting there burning the heat of about a 60 watt light bulb right now.