Psychiatrist who’s assessed 1000’s of ADHD women: ‘This will always terrify me!’ | Dr Asad Raffi

39:09How much of a conversation needs to happen around this? You should not be assessing any female for mental health issues, for their physical health, or just their health in general, without consideration of hormones. Do we do that? No, we don't. I will not see a female without consideration of at what age did she go through puberty. That's relevant. what were her menstrual cycles like? Were they regular? Were they irregular? Tell me about the nature of those cycles because that tells us a hell of a lot, okay? Tell me about that seven to ten days before you're due on your period, the luteal phase of the menstrual cycle.

39:52Then let's talk about what it was like when you were pregnant, what was it like postnatally, okay? and the catastrophic impact that many females can face when they reach perimenopause and menopause, which can often be very early in females with ADHD. It interests a lot of my female clients when I ask them questions like, tell me about your heavy periods, tell me about your cramps. Were you ever diagnosed with endometriosis? and they're going, why? What's that got to do with it? Well, I'm sure we'll come on to it a hell of a lot. Okay? But hormonal fluctuations and hormonal change, and this is something that I talk regularly about to some of the schools where I do a lot of educational work, is let's just take away the whole principle, the purpose of why we're here, which is to talk about ADHD.

40:56let's just talk about the human brain and we're all neurodiverse we're not neurodivergent but you think about the neurodiversity that exists and when you walk into a workplace or you walk into an academic environment and you say to them that the likelihood is that every single female within this school is going to be compromised for at least 7 to 10 days every single month that they're here. Okay? So that makes up 25 % to 30 % of the time within academia, within the workplace. Because in that luteal phase, you're losing the protective effect of estrogen on dopamine, your ability to focus, your ability to concentrate.

41:44It's affecting serotonin. Okay? So estrogen has a protective effect on serotonin and invariably then the mood-related issues, motivation all of these things become compromised it's then further exaggerated when you have adhd so for someone who doesn't have adhd yep they're going to see that gap for seven to ten days it's not persistent okay for someone with adhd the difference is it's always there it's persistent but it's more exaggerated within that time period and that's that's that's telling isn't it where going back to that first question about the female agenda, if that impacted males, do you not think we'd have found a solution for it?

42:30Do you not think we'd have a policy in place? Okay, that for 25 % of the time, it's all right, Alex, take some time out. We won't expect as much for you. We'll make sure that exams are designed at a time when you're not compromised. You're at your absolute best. No. That places them at a distinct disadvantage. It's not a level playing field, is it? I mean, it's a travesty. And I think, like, do you think the injustice is closing? Is it the emotional knock-on effects for women just having an understanding and awareness of what we're talking about now must be huge? Because I don't want to speak on behalf of women, but the amount of women I've spoken to who have said that the fluctuations in their mood throughout the month, coupled with their ADHD, has genuinely led them to believe that they're crazy.

43:20And then they hear someone like yourself explain almost their entire life through hormones. And it's like, oh my God. Well, they're in a persistent state when they reach menopause. And that's when you start to see the significant impact of the estrogen levels dropping, progesterone levels dropping, not just on mental health, on physical health. I refer to estrogen as the second most powerful hormone in the human body. I'll reveal what number one is later, in my humble opinion. Yeah, yeah, nice little hook for the fish. Yes, there you go. So how would you say stress impacts ADHD, and how can that manifest in the physical body?

44:06I've often said that, going back to the conversation before about reframing ADHD, you could almost reframe it as a condition where people are in a chronic state of stress and where we talked before about stress being something where there's an external trigger it evokes a response you know and there will be a spike in cortisol okay which prepares your body your brain towards an action okay now that's an adaptive response i have no issue with that if you're chronically stressed, this is when cortisol becomes dysregulated. And what that can then lead to is actually low-grade inflammation. So going back to calling ADHD a condition where you're in a chronic state of stress all the time, that sense of fight or flight, okay, it doesn't come as any surprise that most people with ADHD that I see of significant signs of low-grade inflammation.

45:13And what's really fascinating now is, I will name-check actually because it's really important to highlight the work, the really important work of people like Jessica Eccles, James Cousteau, who talk about ADHD being a brain-body condition. and something like stress or even anxiety. If I had a pound for every time someone said to me, I've been diagnosed with anxiety, and I say, well, don't tell me what it is. Describe the experience. It doesn't have that hallmark of what might seem to be anxiety. They'll describe this experience of internal restlessness, which often doesn't have a trigger. It's always there.

46:05and for a lot of females actually that's the experience it's not external a lot of it's internal that's the fundamental difference and as we get older a lot of the external physical hyperactivity also internalizes so number one that stress itself is something that you subjectively experience more interestingly then for someone like me because I'm always keen to try and find objective data and evidence to support that. We can measure it. So the best, currently the best physiological marker of stress that we have is something called your heart rate variability. Now you can wear a device like this, it's a wearable tracker, I won't name the company but you can wear various devices.

46:53Heart rate variability is your heart's changeability or reactivity between consecutive beats the more adaptable it is the higher it is the better the less adaptable it is the lower the score and what we tend to find is that hrv especially when it's lower shows that dysfunction of the autonomic nervous system so this is where your fight or flight your sympathetic starts to outweigh your parasympathetic which is your relax and retreat or chill out, okay? And that's regulated by your vagus nerve, okay? So when people talk about vagus nerve stimulation, jumping into a cold plunge pool, all of these elements, these are the things that will readdress that balance.

47:46So this is kind of helping the ADHD agenda here. So that stress or that so-called anxiety or whatever you want to call it, the internal restlessness, it's tangible. It's experienced objectively, it's measurable through HRV, but also then we can see it physically. So we'll talk about the concept of dysautonomia and connective tissue disorders and dysautonomia presenting as things like POTS, which is postural orthostatic tachycardia syndrome, or in simple terms, feeling quite dizzy when you're going from sitting to standing really quickly, easily bruising, that cold intolerance, issues with your blood pressure, your heart rate.

48:28So again, we're seeing it physically. Gives it a lot more credibility now, doesn't it? And this is why we're referring so many people to cardiologists for tilt table testing, etc. and to try and understand why there is that difference. And this is usually within the context of lots of other physical health issues. So we see that. And certainly that so-called, call it what you want, the stress, the anxiety, internal restlessness, it's a real thing because you can see it across all of those areas. But then what's really interesting is the link to the inflammation. And recent studies certainly kind of back that up, that rates of inflammation, as they start to increase, we're seeing an increase in mental health conditions.

49:19Now, I referenced earlier on that estrogen was the second most powerful hormone in the human body. And I actually regard histamine as being the number one hormone. Very potent. Even when, especially when, should I say, it's very high. And certainly what we know about people who are neurodivergent is they're more likely to have higher levels of histamine in their body. Okay? They don't break it down as well. They lack the enzymes that break it down, but they'll also possibly produce more. They might also have gut health issues and higher rates of gut inflammation. So when histamine levels start to rise, what we then see is an impact.

50:04So histamine will have an impact on estrogen levels. and I've asked this question of hormone specialists many, many times and they will say that estrogen and progesterone, depending on the level, so what they will say is estrogen and progesterone have anti-inflammatory effects. So actually, it's fine. Histamine's going up, estrogen should bring it down. That doesn't tend to happen. Histamine will actually help release more estrogen. Oestrogen has a cyclical effect on histamine release. So both of them are going up at the same time. And when you get oestrogen dominance, this is when it can have pro-inflammatory effects.

50:50So I would much prefer to call the oestrogen a modulator rather than being anti-inflammatory. What that then means is when you've got high levels of oestrogen, high levels of prostaglandins, you're ending up with the menstrual issues, with cramps, heavy bleeds and invariably, you know, if you look at conditions like endometriosis if you take samples from those particular areas high levels of mast cells, mast cells produce histamine and, you know, we're having these conversations now because those same females will then tell me that blood loss and that heavy bleeding led to iron deficiency. You then need iron because it's implicated within the production of dopamine.

51:39So it's, again, you're going around in this vicious cycle. Now the problem is no one wants to speak to the psychiatrist. The gynecologist doesn't. The hormone specialist doesn't. But actually we should all be talking to each other and that it needs to be an interconnected, multidisciplinary team approach, especially when it comes to females. but look at the other features that we will see my and look at the link between histamine and things like migraine histamine and respiratory issues they're the obvious things allergies but skin related issues acne you know eczema psoriasis all of these things are significantly overrepresented so we see this whole plethora of physical health issues starting to emerge but then have a think about how histamine levels have a detrimental impact on dopamine so you start to get the brain fog on serotonin you start to get the fatigue but also the impact on melatonin sleep related challenges and issues so not managing inflammation within the context of managing adhd you're doing you're doing half a job how does this whole conversation translate into sleep.

52:51I want to go into that a bit further. Do you see any unusual sleeping habits with those who have ADHD? Let's just think about poor sleep in general, regardless of whether you have ADHD. It's going to affect your executive functioning. It's going to affect your ability to concentrate, to focus, to sustain attention, your decision-making abilities, your emotions. When you have ADHD, that's going to be even exaggerated even more. So, again, that's the reason why you've got that bidirectional relationship. You then bring stress into the mix. So when you don't sleep, stress levels are going to go up.

53:29You're putting stress on your body. And invariably, if you're stressed, you're going to overthink. You're not going to sleep. So you've got this trifecta of ADHD, sleep, and stress. And then there's a third friend called hormones, which we've spoken about. So they're the three things that certainly impact brain function and certainly amplify how ADHD then manifests. And here's a simple, simple, it's not simple, but here's the trick. If you can manage a large part of your stress, sleep and your hormones, you will manage a large part of your ADHD. okay and one of the things that we certainly look at to qualify this is your cortisol what we call your cortisol awakening response and what we know is that when you don't have a problem with cortisol release or if you're not stressed naturally there should be a spike in cortisol about 30 to 45 minutes after you wake up it's kind of your it's nature's starter motor in that respect now for many people with ADHD that can be exaggerated, it can be blunted, or it can be delayed.

54:42But it's fundamentally important because that will set the tone for the day. What do we usually do within that particular circumstance? Well, people are going to start using coffee as a means to try and get them going. And that's probably the worst thing you can do because that will blunt your cortisol response, your natural cortisol response. Okay. So actually try and delay having that coffee in the morning for about 30 to 45 minutes, get some light exposure, do some yoga, take a cold shower. Okay. These are some of the things that might well help and they're all natural in, in, in, in their, um, you know, in, in terms of their accessibility.

55:25So, you know, we absolutely need to understand ADHD as a condition where we need to also then consider sleep, we need to consider the stress and hormones. Do you think RSD, we mentioned earlier, rejection sensitive dysphoria, is an ingredient that goes towards people struggling to sleep? Because I think having spoken to many people, it's often the worry of letting someone down. You know, they set 10 alarms because they're so scared about being late for their appointment in the morning, or they're sat overthinking about a social interaction that day, and that's what's keeping them awake. Is RSD a key contributor to poor sleep?

56:07I'll echo what I said before. RSD is the primary driver of ADHD, and it's understanding how it comes about. That in itself is triggered by those stresses. Consider them to be almost kind of accumulating micro traumas over the course of someone's life and the significant number that people face you know that if you think about the experiences of a condition like rejection sensitivity it mimics a condition like complex PTSD and it brings into question that whole debate around you know stress and at the other extreme of stress i guess is trauma and invariably there's always been that dialogue around trauma and addiction and actually think we're missing a part of the equation here where we know that people with adhd are more likely to face traumatic situations or traumatic events.

57:22And due to the nature of their risk-taking behavior, the situations they've put themselves in, but the trauma itself and what the nature of that trauma might be different for different people, but the impact of that trauma can then have a significant detrimental impact on their ADHD and even expose their symptoms. We often see that. It can be a traumatic event that can expose people's, I often say it compromises a psychological toolbox and exposes the symptoms beneath. And I see RSD as being an accumulation of those micro traumas. And that's something that we really need to address because trauma isn't just about what's happened.

58:12it's also the absence of repair so we need to be doing both 20 000 micro traumas right that's the estimation neurodivergent children i think that's that one quote that really riles many people doesn't it and i think sometimes we need to be less hung up about you know the the statistic and try and understand the message behind it which is yes people with adhd are going to be facing a significant number of perceived. It doesn't necessarily always mean that that trauma has occurred. It might be a perceived trauma. It might be an actual trauma. And what they've not had the ability to be able to do is to articulate it, to verbalize it, to actually manage it.

59:00So there's lots of unresolved trauma that people with ADHD end up accumulating over a period of time. and invariably then that shapes their coping mechanisms. Be they adaptive, what we might see is kind of positive outcomes, but invariably a lot of the time they can be seen to be maladaptive, leading to negative consequences. What do you think the most common addictions are that someone who has been told so many times, 20 ,000, whatever the number is, and they're dealing with the pain of that, what common addictions do people turn to to ease that? I think the propensity towards what might be deemed addictive or problematic, because we have a notion around addiction, and I think a lot of the time we need to kind of reframe it again in the context of if used excessively, is it likely to become problematic or does it have addictive potential?

1:00:01Because the way I see addiction evolving from ADHD through that loop of micro traumas, the stresses, the sleep issues, the hormonal issues, the RSD, it gets to a stage where being impulsive means you're more open to new experiences. There's a degree of suggestibility and vulnerability about you. People take advantage of that, okay? You're a people pleaser, don't forget. You're going to struggle to say no, so you're game for a laugh, you'll try it, okay? You don't wake up one day and decide, I fancy becoming addicted to alcohol. You didn't have that day, did you? You were open to new experiences.

1:00:43That's the likelihood. So how much of an influence did impulsivity and people-pleasing have? But also then think about the compulsive nature of some of those behaviors. What do compulsions do? They ease that internal emotional turmoil. you're getting that quick fix from the RSD anything to take that pain away and invariably will turn towards substances that might well give us some rebalance of that dopamine in the prefrontal cortex that manages the executive function challenges you bring those three things together you've got the perfect cocktail towards addictive behaviour and I'm conscious I'm not answering the question what you're likely to use in a problematic way so substances or even behaviors in my view is dependent upon what you've got access to and what you can get away with okay so it's accessibility and what i say is concealability so we see an emerging pattern or a variable or a changeable evolving pattern throughout the life course and it's different in different cultures um and and certainly within the the genders as well if i was to look at the whole population the number one in fact i'll do this because i do this with my clients i'm going to do it with you what do you think is the number one substance of abuse within my clients here in the uk sugar correct number one Number two?

1:02:21Alcohol. That's number three. Number two is actually processed food. Okay. And again, go back to conversation about gut health. Okay. How many of the things that we eat these days, do we actually understand the ingredients on the actual packet? It's not worth eating if you can't understand it. And I also say to my clients, if your great-grandparents can't recognize that food, Ain't worth eating. If it's not at the sides or at the front of the supermarket or at the back where all the boring stuff is, don't buy it. Because the hyperpalatable processed rubbish is usually at eye level right in the middle.

1:03:03It's retail psychology for you. Number three, as you say, is alcohol. Number four, caffeine. Number five, nicotine. You get cocaine and cannabis way down the list. but then if you think about something like nicotine and that evolving nature if you look at Gen Z's now they're not smoking behind the bike shed they wouldn't be seen with a cigarette it's going to be a vape but invariably then something like a vape isn't like cigarettes where you can actually quantify how many, I ask them how many puffs do you have a day on your vape? No idea. So you can't quantify how much you're using. The other worrying trend that we're now seeing is the use of a substance called snuzz.

1:03:56I've heard about this, yeah. That's right, like it goes in your gums? That's right. Well, it's a small nicotine pouch, Scandinavian origin, and you put it between your lip and your gums, and you're getting that instant hit of nicotine. Do you think people pleasing can be an addiction? Because I've heard a few people refer to themselves as a recovering people pleaser. And I think like I drink to escape from pain. But with people with ADHD, the thought of being criticized or rejected is so painful. And we people please to avoid that. Can we be addicted to people pleasing? seeking validation from others 100 absolutely okay and but how tiring is that or how exhausting is that for that particular person and invariably then that will also start to influence your the likelihood of you being able to say no to things like you know like snus and and i say they're the things that we might see in certain populations adolescents you can hide it in the classroom you don't know if I've got snus in my mouth right now I haven't but you know it's easily concealed kids are using it more now older adolescents we're seeing more of it within the classrooms elite football and football in general has a massive problem with snus because a footballer can't be seen with a vape or a cigarette in their hands it's easily concealed but big issue within the context of other stuff so you don't necessarily just see one particular substance of abuse over a period of time and you need to understand the trends what have been the other things alcohol might become a gateway into trying cannabis into trying cocaine other things but then the behaviors that we see phone use social media okay impulse buying gaming as we start to see the trends now we're even seeing certainly within the female population, cosmetic procedures, an addiction to having procedures done when they don't need them, seeking validation in a different way from others physically, self-esteem issues, confidence issues, okay?

1:06:11Binge-watching television programs. In my day, we only had four channels, couldn't do it. But now with the advent of things like Netflix, and we're in a quick-fixed, instant gratification society. What about masking? Because I guess you like the feeling you get when you are approved and you're able to fit in. You can get addicted to the response from being a different version of yourself? I guess you could, but I think when you're in a situation where the mask drops, when you're at home and you don't need to mask, okay then that's not going to be as apparent but actually when you start to see trends like impulse buying disordered eating um phone use etc these are the things that i usually see when you're off camera okay and and i often say that night time going back to these looping back to those things that we talked about before these are the times when it's your danger zone look at the trends around your impulse buying when did they happen i think night time okay when do the arguments occur when when you stood at that fridge door waiting to pull the chocolate out that's if you refrigerate your chocolate that is okay things like that i do i don't know whether that's an ad it's got to be yeah that's a different podcast for different shop in the fridge yeah that's episode three that we'll have to do yeah chocolate in the fridge or outside the fridge yeah definitely in um and um you know have a look at those trends and and track it goes back to what i say to people track your behaviors yeah timeline them you'll start to see it and then if you can see that trend i spend more at night time i spend more around the time of my you know luteal phase of my menstrual cycle yep at least it will just raise that awareness not just within yourself but in in others as well okay but you know look at things like driving related issues work success gambling isn't just going to the bookies or you know going to the casino it's things like cryptocurrency it's investments in businesses it's things like that okay so we see all of those elements and certainly we start to see trends move up and down dependent upon the stresses and pressures that people have at that time of their life so when it comes to menopausal females within the research and the studies that we did we certainly then started to see a spike rather than it being sugar and food, alcohol became number one.

1:08:43Work, you know, in terms of a behavioral addiction, then started to come to the fore. Because I guess the pressures are very different, aren't they? And we see that trend. Culturally, we'll see things differently. You go to the Middle East, it's not going to be alcohol. It's not going to be things like drugs, okay? What is it? It's sex, obesity, type 2 diabetes. it's food, it's nicotine, shisha cafes, it's caffeine, there's a coffee shop in every corner, it's simple, it's buying, driving erratically. Highest rates of road traffic accidents within that region. And you start to see that trend, you're seeing exactly the same behavior manifest, but in a different way.

1:09:27Truly fascinating, Dr. Asad. I could chat to you all day. I want to draw attention back to your ADHD item. Yes. which has been patiently waiting underneath that cloth on the table in front of us. And I'm going to reveal it now. It is, that is a paddle racket. Absolutely. I'll give that to you. And if you could kindly explain why a paddle racket represents ADHD. I need to hold this in a way that it shows I actually know what I'm doing with it. But paddle, if anyone knows what paddle is, it's the fastest growing sport in the world. and I certainly start to see this trend and certainly the benefits of a sport like paddle and I'm guilty of someone who is now almost kind of addicted to playing because what does it give you?

1:10:18Certainly for someone with ADHD, it's really fast-paced, it's intuitive, it's plug and play, but it gives you connection, it gives you that social element and you know i think it's almost kind of the perfectly designed for people with this condition okay and um you know i'm certainly seeing many of my clients on social media or linkedin what's lyrical about their paddle playing and i'm going this is not a coincidence the two must be linked okay so i i would highly recommend you start playing and um we'll then have to have a game fascinating and you've promised me a game right in the next couple of months after this in manchester you're gonna have to come come to manchester absolutely yes i'll look forward to it and it will grace the uh the shelves behind us absolutely as with all the other adhd items i want to move on to the adhd agony art section penultimately dr assad um a member of the community writes in and it goes in the washing machine because my adhd item is a washing machine because my item represents memory loss because I always forget my laundry in the machine after the cycle's finished and to make myself feel better hopefully I ask do you do the same no I don't even know switch the washing machine on because I was absolutely useless and um yeah so I'm you don't even switch it on no who does the washing my long-suffering wife I see yeah the ultimate hack.

1:11:48The ultimate external scaffolding and structure and you know. I've got the T-Mail app which is the sponsor and they have been helping me but yeah actually it's the smell of damp which gets me a lot of the time because I walk past the room that it's in and it's like oh I've forgotten again Yeah I know that feeling. It's like a public service announcement at this point so anyone listening watching, I see it in the comments, you just reminded me to go empty my machine Dr. Asad this week someone has written in and asked, one of my children throws the worst tantrums. How can I help them manage his stress?

1:12:27What a great question. It's not a simple answer. Okay, tantrums, stress. First and foremost, let's try and understand how old the child is. Let's not try and pathologize everything. So first and foremost, is this just a normal part of being a child? Got to answer that question. If it isn't, and it's something that's persistent, it's pervasive, and it's genuinely having an impact not just on the child, but also on the extended family, then we've got to do something about it, okay? And one of the first things that I say to any parent, to a child with ADHD, to a neurodivergent child, or to a neurodivergent parent, invariably, usually both, they might lack that insight, is to do some parenting intervention.

1:13:23Some form of a parenting course. And this isn't an indictment or a criticism of their ability to parent because I always say none of us were given a manual on how to be a parent. We learn on the job and we wing our way through. I'm still winging it. My daughters will tell you that. and we have good days, we have bad days and we certainly weren't given a manual on how to be a parent to a neurodivergent child so it's learning the skills and many might expect a psychiatrist to turn around and say well let's medicate the child okay, no and I'm going to coin the term that Matt Gupwell used in his interview with you which was it's pills and skills and the skills will be the things that get you through in the long term.

1:14:12Okay. So what other thing I forgot to mention was this. What we're increasingly now realizing is that at low doses, ADHD medications actually have an anti-inflammatory effect. Now, if you're overcompensating by using high doses of ADHD medication and not fixing sleep, stress, not doing the parenting intervention and everything else, you're going to revert to what? High doses. Okay? It's like saying to a diabetic, use more insulin. It doesn't matter if you've eaten loads of cake and you've not lost weight or done anything else. We're doing exactly the same thing with people with ADHD. We're giving them high doses.

1:14:53In animal models now, we're seeing that high doses of ADHD medication, especially stimulants, promotes inflammation. Okay? And actually exacerbates those who are susceptible to it. So I wanted to use the opportunity to bring that in. But this just echoes that point that we've made throughout the course of this conversation on a serious note that number one, managing ADHD isn't about one approach. It's not about medication. It's about optimizing sleep. It's about reducing that stress. It's about understanding what support and help can be given to that child at school. because invariably what will happen is a lot of the time parents will say my child's perfectly fine at school but there's a build-up of that emotion almost kind of like that coke bottle mento effect that explosive reaction because it's the only place where they feel safe to be able to kind of express themselves and the rsd comes out at that point so this is about behavioral approaches this is about considering medication but only when it's absolutely necessary use it as a you know a foundation less less is more start to get the understanding behind it start to get the the skills around parenting be consistent okay um be boundaried because there's no point in in you know being in a relationship where parent father saying one thing mother saying another and you've got sometimes, you know, parents who you've got dual households and then you've got the grandparents who contradict everything.

1:16:32So it's a real melting pot and it's tough, it's hard work. It is never going to be perfect. Set the expectations realistically. Would the answer be similar if the question was tweaked slightly? Because having tantrums isn't exclusive to kids, right? If the question was my partner keeps throwing tantrums, would it be a similar answer? There is a term that, well, we've got to understand the nature of the tantrum. And is it problematic? And is it impacting on your relationship significantly enough to warrant doing something about it? Use that same principle for anything in life, yeah? And it'll give you the answer.

1:17:14She's entitled to have a tantrum. Maybe he as well. Maybe he, yes, yeah. They are absolutely... I've been guilty of many tantrums in the past. Yeah, absolutely. And we often show that type of behavior where we know we can get away with it because we're not facing consequences. Sometimes we've got to think about that. You won't do it at work unless you know you can get away with it. But actually we usually do it in front of those where we know there aren't going to be significant consequences. And that's not really fair, is it? Because, again, think about the impact that ADHD has on relationships.

1:17:51It's significant. the rates of divorces breakups is it's tough it's really really hard so yeah with respect to your partner if you say anything like my wife then she's putting up with a hell of a lot so we've got to let it go Alex we'll have to have you back Dr. Asad for a whole other episode on relationships it sounds like there's a lot to go into I'm not an expert in that area so yeah you might need to find someone else just finally I'm going to deliver to you a letter that was written by the previous guest where they wrote their three rules to live by wonderful There we go. If you could kindly open that and read them out.

1:18:25Three rules to live by. Your gut feelings are probably just. And you feel that something's going on for you or your child. There probably is. Number two, success. Oh, sorry, school is difficult. Socially, emotionally, and academically. Listen to your children when they say it's tough and acknowledge their feelings. That can be hard sometimes when you've got ADHD yourself. So many competing interests. You are doing your best, and your best is always enough. I think that's really important. Sometimes we feel that we always need to be doing the best. Good enough is satisfactory. Amazing advice. Very wise words, those.

1:19:14Especially the first one. Listen to your gut. I wish I knew that sooner, I think. As soon as your gut says no, it's a no. I guess learning to trust it or be able to take action on it is harder, but it's such a good bit of advice. Well, knowing the link between that gut-brain axis and the significant issues that people have with gut hypermobility, inflammation, there's probably a lot more to it than just meets the eye there. Dr. Asad, truly fascinating. Thank you so much. Thank you so much. Absolute pleasure to be here. Thank you. All We Know