621- How Gut Health Impacts ADHD Symptoms: New Insights on Food, Microbes, and Inflammation

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0:37Welcome to the Attention Deficit Disorder Expert Podcast Series by Attitude Magazine.

0:47Everyone, I'm Carol Fleck, and on behalf of the Attitude team, I'm delighted to welcome you to part two of our series on ADHD and immune system disorders. Last week, we discussed inflammatory conditions and their ties to ADHD with Dr. Beth Krohn. Today, we'll focus on how gut health influences ADHD symptoms. Dr. Miguel Toribio-Matteis will lead us off with his presentation, how gut health impacts ADHD symptoms, new insights on food, microbes, and inflammation. Dr. Toribio Mateus is a clinical neuroscientist, a microbiologist, and a nutrition researcher focusing on ADHD, mental health, and the gut-brain axis.

1:36He is the author of the book ADHD Body and Mind. He's also an honorary research fellow at Cardiff University's School of Psychology and a senior lecturer in nutrition, health, and well-being at the University of West London. You know the saying, you are what you eat? Well, research suggests that eating well is associated with a healthier gut, and a healthier gut may help the ADHD brain function better. That's because our brains are in constant contact with our immune system, our autonomic nervous system, and the trillions of microorganisms living inside our digestive tract. A diet rich in vegetables, fruit, legumes, fermented foods, whole grains, fiber, and thankfully dark chocolate can actually improve focus, emotional regulation, and mental energy in some people with ADHD.

2:35If you value the work we're doing here at Attitude to support the ADHD community, and we hope you do, please consider subscribing to Attitude Magazine. Your subscription enables us to continue providing trusted resources and information to help you and your family live better. Visit attitudemag.com slash subscribe or click the subscribe now tab on your screen to receive 15 % off and a free ebook. So without further ado, I'm delighted to welcome Dr. Miguel Turibio-Matteas. Thank you so much for joining us and leading this important discussion.

3:18Hello, everybody. Thank you for joining me today. We're going to spend the last, the next 40 minutes looking at something that's really exciting, at least for me. I've spent the last few years of my life researching into the conversation between the gut, brain, food and gut microbes and the immune system, because the gut cannot really be disentangled from the immune system. is you might have heard that 70 % of the immune system actually resides in the gut. That's probably a really accurate statistic, if not higher than that. So that gives you an understanding of how important that connection between the immune system, the brain and the gut is.

4:11So I also wanted to, apart from welcoming you and thank you for being here, set expectations that I'm not going to give you an ADHD diet. I wish I had the magical ADHD diet that made us all, all of us with ADHD. I'm an autistic ADHD myself, so I would love to have the magic diet that takes away all of the kind of quirkiness that comes with ADHD. But the science is not quite there yet. So what I would like to do is to go through the science, what the science is actually telling us, give you loads of practical tips based on the science as well, translating that science, and help you understand this connection between gut-brain immune system.

5:01So that's what my background is on, as Carol has kindly introduced. So So first of all, I wanted to go into your questions. I've read as many of the questions that you have sent as possible. There are nearly 15 ,000 people registered for this webcast. So there have been many thousand questions sent to Attitude. And what I have done is to try and pick up the cave themes. So there were loads of questions about what foods to eat and what foods to avoid. So we're going to be talking about those plenty. We're going to be talking about gut symptoms, including IBS type symptoms and also IBD type symptoms.

5:52So there's some overlap between IBS, IBD and ADHD that we're starting to realize is emerging. So we'll talk about that. We talk about children and families as well. Many parents, you want to know about how to feed your child in a way that it's less challenging if they are picky eaters or if they find it difficult to eat new foods. Probiotics and fermented foods is an area that I've done a lot of research in and I'd like to share some evidence. And also, I'll take into account capacity, sensory differences, appetite differences as well, maybe based on medication, whether you're on meds or not on meds.

6:36And we'll talk about lifestyle as well, rounding that. So this is kind of the plan for the session. and uh let me just sorry um so i wanted to start also by reminding a little reminder of what nutrition can and cannot do so before we get all excited about gut microbes which i get completely excited about and this is probably a really important slide because nutrition can support digestion it can support microbial diversity so the diversity of the of the bacteria and other microbes that live in your gut and make your whole body, including your brain and nervous system, healthier. It can also support more balanced energy, better sleep and better mood.

7:23So all of those things are really important, but it cannot replace ADHD medication as such. It can support ADHD really well, but it is not a straightforward replacement for ADHD meds. And also, I'd like to step away from all or nothing thinking that it has to be meds only or nutrition only because they can very well be combined. And that actually can be a very beneficial way of managing ADHD. So also, when somebody with ADHD says, can I treat ADHD by fixing my gut? This is the million dollar question. We are not there yet. So I would love us to have the perfect diet that tackles gut health and makes ADHD symptoms less severe and make us experience life more balanced.

8:22But, yeah, the science is really not there yet. So this is an important disclaimer, so to speak, before we get into all of the fine print of the conversation. So let's talk about gut microbes. And gut microbes, you'll see a lot in mainstream media about gut microbes now. So people used to normally talk about bacteria. There are many more things than just bacteria in the gut. And in fact, you also have heard about the gut microbiome or the gut microbiota. So scientists like to talk about the gut microbiota when we're talking about the actual microbes and the microbiome when you also talk about the genes and what the microbes produce so when they eat the lovely foods that you're actually eating when they digest the fibers that you're eating the healthy oils that you're eating and so on then they will produce certain molecules that will be beneficial for the whole of the body including potential benefits for adhd symptoms as well so as carol mentioned as well there are trillions of bacteria living in the gut as well as other microbes like yeast that they are not always bad even though we get this idea that yeast might actually be detrimental to the gut there are beneficial yeast in the gut as well viruses and archaea even some parasites that might actually have a beneficial function in the gut.

9:50So that's just about gut microbes. And also just to put things in perspective, the gut doesn't just start in the gut. The gut is a whole kind of system that will start in your mouth and will go all the way through the digestive tract, the stomach, the small intestine, the large intestine, or the colon, all the various parts, increasing in diversity as it flows down like a river and allowing you to process food at different stages and extract the nutrients from the food at different stages. So it is reasonable to think that the colon has got the most diversity because it's where you extract the most complex nutrients from the colon into the body and those nutrients then need to make it into the rest of the tissues in the body including the brain.

10:43So we're going to have a look at how that actually happens. So just from this slide, I'd like you to not remember all the names, but just remember that diversity increases as this tract follows from your mouth all the way to the other end of the GI tract. And also you might ask, what is the gut-brain connection? Well, the gut-brain connection is a very interesting system that is bidirectional. It means that it works both ways. So the brain is talking to the gut all the time and the gut is talking to the brain all the time. But crucially, the information or the amount of information that is being sent from one end to another is much larger from down going up.

11:27So upstream from the gut, you get probably about 80 percent of all of the information being sent to the brain. it's uh it's going upstream and then we only get about 20 around 20 percent of the information is being sent from the brain down and those messages are actually uh um uh simpler uh from the brain down and and the the the ways that this system communicates are physical so you have a the vagus nerve for example which is a let's say a a thick cable part of the nervous system that is tangible you can touch it you can see it in a body if you open a body you will you will see it there whereas you cannot see hormones but they are actually doing a really important job and as well as immune molecules like tnf alpha c-reactive protein immunoglobulins and so on and neurotransmitters obviously again they are microscopic you cannot see them but they are part of this communication system as are microbial metabolites.

12:29So the byproducts of the digestion of those microbes that live inside of your gut when they digest the foods that you actually put in your mouth. So all of that is part of this communication system. This episode is sponsored by Element. Earlier this year, Attitude Magazine surveyed 3 ,500 adults with ADHD. And we learned that up to 78 % of people who treat their ADHD symptoms with stimulant medication experience an afternoon crash. What does this look like? Inertia, increased distractibility, sleepiness, brain fog, and slowed processing speed for about half of survey respondents. Okay, so what helps?

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15:04So there will be certain microbes that will support your blood sugar control, for example, which is also involved in this communication system. There will be certain microbes that will support your immunity and will make you more resilient to infections or to your immune system attacking itself, i.e. autoimmunity, for example. And there will be neural pathways as well. So the nerves in the body actually doing part of the job as well. And the vagus nerve coming to this crucial part of the network is a really important pathway in this communication system because when we talk about the two sides of the autonomic nervous system, and I think I have a slide on this coming up.

15:54so we're talking about sympathetic and parasympathetic sides of the nervous system in fact I'll just move to the slide now so you can see that and I'll jump back to where we were before in a moment so you can see the sympathetic branch of the autonomic nervous system is the branch responsible for keeping us alert whenever we feel that there is a threat that is imminent And the parasympathetic branch of the nervous system is the branch that kicks in when we need to enter a calm, rest and digest kind of mode. And when we talk about this branch, which is very important because a lot of the time in ADHD, we might actually be in sympathetic overdrive.

16:41we might be in hyper arousal we might find it difficult to switch off not just physically but mentally as well overlapping thoughts and so on um so that is the sympathetic um um branch of that um part of the nervous system um not not switching to the parasympathetic branch and the parasympathetic branch is large largely made by the nerve by the vagus nerve so a lot of people talk about the vagus nerve it's become quite a trendy anatomical region in the nervous system to talk about and crucially the most important thing is something I said before that a lot of the instructions that are being communicated between gut and brain are coming upstream from the gut so most of the fibers are afferent as opposed to efferent so and the complexity of the messages as well is much larger from the gut to the brain.

17:44And this is important because in ADHD, interoception is a thing. Interoception is our ability to understand what our body is actually telling us. And we fail to understand that routinely. So I myself find myself at the computer needing to go to the washroom. and I'm thinking, I really know that I need to go, but I am hyper-focusing on something else and deprioritize that. So I'm kind of like canceling out those messages that my body is telling me, as well as hunger, for example. Many of your questions are about how do I deal with hunger when I can go for hours without eating because I might be on meds, but some people are not on meds and they have the same problem.

18:34Or actually knowing when to stop when you have eaten enough, but then you cannot listen to, you cannot understand that signal very clearly. And that is a thing, it's very well reported in literature and it's something that is quite important. So all of this background really takes us to how food is a really important part of this communication system as well. Why? Because you need food to nourish your body. You need food to nourish your gut. A lot of the energy that is released from the food and a lot of the nutrients that are released from the food via the gut bacteria are actually kept in the gut to nourish the gut itself and to keep it as healthy as possible.

19:20So it doesn't contribute to inflammation being distributed throughout the body. It doesn't actually alert the immune system. And this is very important because, as I mentioned initially, most of the immune system actually resides in the gut. That interface between gut and the rest of the body is where you have around 70 % of immune cells all around those nerve endings in that very thin layer of tissue. separating the inside of the gut from the bloodstream. So that is a really important function that foot has, connecting those three parts, the body, the nervous system, including the brain, and the gut itself.

20:07So in a nutshell, really, as part of this really broad introduction, which I could have talked about these individual elements for hours and hours, I just wanted to say that the gut basically is not like Vegas. So what happens in the gut, that does not stay in the gut. The gut will communicate with the rest of the body. It will send signals to the rest of the body, including the gut itself or the parts of the gut. And it will contribute to conditions such as ADHD, as well as other coexisting conditions in terms of neuro, in the neurosphere. So anxiety, depression, and so on, and other mental health conditions as well.

20:57And food is one of the factors that affect this risk of developing these conditions. um genetics obviously will be one but uh um food is part of the picture and the more i know about uh food the more i think about the fact that we tend to focus on food almost too much and we don't realize how um important some of the other factors are so meds that we might be taking thinking that they may be um you know fan safe such as all the counter painkillers that aspirin you know, ibuprofen or, you know, anything like that, that may be actually damaging the gut lining to a point that it's not allowing us to absorb nutrients in a particular way.

21:49Lactations are going back. You could find that the effects of having breastfed don't actually emerge until your 30s or your 40s because of your genetics. Smoking, the environment where you live, whether you live rural or you live in an urban environment, physical exercise and mode of delivery, all of those are really, really important and as important as food. It's just that food, we talk a lot about food because it's tangible. We eat several times a day. So it makes a lot more sense to talk about it and dedicate a lot more research time to it. So I understand the fascination with food, but many of the factors also affect ADHD.

22:29And when we come to that interface between ADHD and microbes. Diet, one thing to remember is that it doesn't actually work in isolation. So you have plenty of studies talking about the effects of dietary patterns, such as, let's say, the Western diet. When scientists talk about Western diets, they typically talk about a diet comprising foods that you can get in fast food outlets. So it will be deep fried foods. It will be really carbohydrate rich foods that are devoid of essential nutrients. Not that there's anything wrong with carbohydrates, but the processed carbohydrates might actually in large amounts might actually contribute to this regulation in the gut ecosystem, sugar in excess.

23:29And again, none of those things in isolation will cause ADHD, and that is very clear in the literature. But combined with the genetics, combined with the environment, so if you are eating these kind of foods all the time, if they are the bulk of your diet, so every day you go to a fast food outlet and you pick up a meal and those are the two main meals that you have in a day and you do this day in day out for years and you combine that living in a with living in an urban environment and perhaps smoking or being sedentary that is going to increase your chances of developing a range of conditions including the severity is going to affect the severity of your ADHD symptoms so that's what the science is saying as opposed to diet will will cause ADHD or conversely that having this perfect diet this Mediterranean diet that everybody keeps talking about I was born in Spain so I'm I'm quite familiar with what the Mediterranean diet looks like and it's fresh vegetables and fruit and oily fish and loads of olive oil and but we still have loads of people with ADHD in Spain as well so it doesn't mean that because people eat that kind of food or around or in Italy or in Greece or you know anywhere around the Mediterranean there will be ADHD as well and they haven't got less incidence of ADHD because of the diet so they might have better outcomes in certain areas based around the the kind of microbes that they might have in their gut and there's plenty of evidence that this kind of diet that is made up of fresh fruit and veg, legumes, nuts and seeds, olive oil, lots of colours, eating a rainbow of different foods every day is going to have an impact throughout the body that is beneficial and that's going to come largely from the gut but is it going to cure ADHD so to speak?

25:32No. So what we do now as well just to make things a little bit quirkier, is that microbes can be involved in some of the wiring of the brain that contributes to the production of neurotransmitters, such as dopamine, for example, which is really important in ADHD. Why is it important? Because we produce it in a glitchy kind of way. So sometimes we could have a bit too much dopamine, but then we struggle to keep it in the right areas of the brain for long enough so we can sustain attention or we can keep interested in a task or move from one task to another or actually get a task initiated. So all of those things are going to largely happen in the prefrontal cortex and that dopamine needs to travel from where it's created to that area of the brain and we struggle to get that going there because it may actually be used by other areas of the brain like the limbic system because we tend to have emotional reactivity or we tend to not manage our emotions in a way that is uh um energy efficient and so we use a lot more dopamine for processes that may not be the ones that people want us to use it for be productive and be normal in inverted commas and do a um keep a nine to five job and always be attentive and be quiet in school and don't be chatty and you know don't be hyperactive so all of those things that society wants us to be that we struggle with so some microbes actually can benefit that metabolism so it's not that they're going to give us more dopamine it's just going to make dopamine actually work better and how does that happen by putting the right foods in the body so some of the foods that we're talking about i'm going to give you plenty of examples not only do they affect dopamine and how it's distributed throughout the brain and the rest of the nervous system but also other neurotransmitters such as noradrenaline or norepinephrine if you're in in north america serotonin gaba acetylcholine they're all a compendium of neurotransmitters that are as important as one another.

27:50In fact, the new meds that are being developed for managing ADHD tackle now dopamine, noradrenaline and serotonin and not only just dopamine as initially developed. So there's an overlap with noradrenaline anyway or norepinephrine in a couple of types of meds anyway, but now they are tackling serotonin as well. And I wouldn't be surprised if in the next five, 10 years, there will be some meds as well that will tackle other neurotransmitter systems as well like GABA so we can relax properly in the evening because some of the effects that we get from meds is that they can leave us a little bit wired towards the end of the day so how do we feed these microbes that are doing all these wonderful things well we could go through hundreds of different foods but I like to focus on patterns as opposed to it's also my autistic brain as opposed to going into the individual food what is the pattern connecting these foods and the pattern seems to be largely plants because plants are um sources of what is what are called microbiota accessible carbohydrates so they are carbs that are like fertilizer for the good bugs that you have in your gut and that will help you to stay healthy, active, keep your nervous system ticking along and like well nourished as well as your brain as part of the nervous system.

29:23So they matter because they produce these things called short-chain fatty acids and I can give you plenty of examples and they all have different types of fibers or polysaccharides or kind of like sugars in a way that again when i say sugars don't panic they are not sugars as in you know sweeteners they are natural sugars that your gut bacteria understand they can break down they can feed on and they can produce beneficial compounds that are going to nourish your brain and keep it uh making you experience the world the best you can experience it so there will be examples like inulin in chicory or pectin in apples or resistant starch in cooked and cooled potatoes, for example, or green bananas.

30:11You don't need to do anything with green bananas. They have a bit dry mouth, kind of like texture, but they provide you with that very interesting resistant starch. Bita-glucans in barley, in oats, also in mushrooms that I failed to say in there. So mushrooms are really interesting. um um uh fructooligosaccharides in also bananas garlic asparagus and galactooligosaccharides really interesting goss in dairy if you tolerate their or impulses in legumes a lot of that in legumes as well a different type but also understandable by gut bacteria and if we wanted to actually have a quick look at some of the important names of some of these microbes so bifidobacterium i'm sure most of you will have um heard of because why?

30:58Well, it's in yogurt. It's kind of like it's been mainstream for a long time. It supports immune balance. It reduces inflammation. It balances the pH, making it more acidic in the gut. And when the pH is more acidic, then fewer nasty microbes that might want to stay in the gut are able to stay and colonize the gut. So they just transit out and they go out in your poo when you go to the toilet, basically. And that's normal. everybody's got different microbes coming in and out different parasites different viruses they are not always going to trigger a reaction that is going to make you sick they might do they might contribute to autoimmunity being tricky or to symptoms being tricky but in general all of this kind of a balance of good and bad is sorted quite nicely by itself in the gut by having this nice supportive microbes so droseburia is another one it's a butyrate producing microbe what is butyrate is that short chain fatty acid that i was talking about it's a little bit like butter it's waxy it feeds the colonocytes the cells lining the gut um uh so that that creating that one layer of cell uh a piece of tissue that separates the gut from the the rest of the world the rest of the body and you'll find all of these microbes that could go on for a long time telling you about different names they they feed on different food sources that are almost and again in inverted commas their preferred food sources are these the only foods that they feed on no do i want to just go for these foods only and and ignore all other foods no i want you to have a very diverse diet if you can tolerate that if you have the capacity to think about that because that's going to have the dig up benefit rather than really hyper focusing on giving yourself walnuts all the time because they fit your rumino coca or your asparagus for rosaburia that's the kind of like tricky way to think about things that can become quite reductionist.

33:10So I wouldn't want you to go too much into that. But fiber-rich, if you can tolerate, and again, we can go into individuals that might have IBD and they need to limit the amount of fiber, I can understand that. If you have IBS that is really flaring up and you need to limit the amount of fiber, I can understand that. But in most people who can tolerate fiber, eating fiber-rich polyphenol dense foods daily is going to be the way to keep that gut microbiota nourished and balanced and diverse so these are compounds that are linked in endless amount of research papers really good quality clinical data supporting gut barrier health immune balance brain signaling and that brain signal is that communication between gut and brain as well so that actually helps us with sleep with mood with stress regulation which again they're all related to ADHD so we're not tackling ADHD directly but we're tackling loads of other aspects that are heavily featured in an experience of ADHD and crucially from my point of view as a researcher in this field, kind of bridging microbiology with neuroscience and nutrition, what I see is that nutrient synergy is where it's at.

34:39So when you combine these polyphenols and these fibers in whichever way you have the capacity to do, because some days I wake up and I have the best of intentions and I have the knowledge. So it's not a lack of knowledge or being lazy, but I just having got the energy to put up a lovely diverse meal together i have my safe foods as well i've been autistic as well and i want to repeat the same things every day and i go through phases that i just want to eat tofu with a squirt of sriracha and some nori on top and you know or chickpeas i'm completely obsessed with chickpeas and so i will find it difficult some days to actually be this diverse and be you know so don't take me as an ideal person that does everything perfect because i am not uh so i see the struggles but if you can think about combining different colors and having carol said said that she was happy that dark chocolate was included in this list of foods well it is it's a source of flavor notes that uh if you combine with olive oil around at the same time, or if you combine with the polyphenols, the colors in berries like strawberries, blueberries, blackberries, they will synergize in ways that make that anti-inflammatory power that they have stronger.

36:04So this is really, really important whenever you can. That's going to really help with that gut-brain communication and the potential benefit to ADHD is going to be greater. also optimum oils so when we're talking about optimum oils i'm talking about plant sources so i talked about olive oil already at natin seeds really effective at nourishing cell membranes but also what we have found from a microbiology and gut brain connection point of view is that omega-3s from marine sources so fish oils can be very beneficial for replenishing similar oils in the human brain and if you don't eat animals and you prefer to be plant-based then you'll find similar compounds that are slightly less available to the body but they will have the added advantage that they can rub in fiber that will nourish those gut bacteria that we've been talking about so And both types can be eaten by some of these gut microbes to produce these short-chain fatty acids and to acidify the pH of the bowel to keep the nasties away.

37:20Going towards the last bit of the presentation, there's a lot of talk about fermented foods. And I have done some research in fermented foods for a while now. I've researched kefir, for example, is a really interesting mix of microbes when it's traditionally made. Fermented foods can be really good for ADHD if you can tolerate them. So I will have a look at a caveat on this in a moment, which is potential histamine reactions that many of us ADHDers can have. And they can be random and we cannot figure them out. But if you can have them as a staple of your diet, even in small amounts, that can be a really interesting way to support things like sleep, for example.

38:10So we published, my research team and I, a clinical trial last year on the effects of kefya on ADHD symptoms in children from 8 to 13 years of age. We found that the symptoms of ADHD weren't affected, although they were more positive or less severe in those that took the kefia compared to those who didn't take the kefia or took the placebo. But the most important finding is the effect on sleep. And sleep was actually reported as being better, less disrupted, better quality, and deeper in quality as well. So we measured it with actinography, which is wearing a machine that actually measures the quality and the duration of your sleep while you're in bed.

39:02so we also asked teachers as well as parents to report on the symptoms such as impulsivity hyperactivity and so on and there were some positive outcomes in those drinking the kefir but we attribute the benefit largely to changes in gut microbes and that communication between finger and brain actually supporting better sleep. So this is interesting. And we also did another study using keffia at work to manage mental resilience and better psychological health. In general, this was not an ADHD study, but a lot of the outcomes that we measured can be attributed to ADHD experiences as well. And we found that in the small sample that we work with, and drinking kefir can be a really good thing for things or joy in life uh experiencing joy at work and actually having a better satisfaction in life um that there were some of the outcomes that we found that i'll have that if i can and again you may be plant-based so you might actually choose a kefir that is made of coconut instead of uh or soy uh you know as opposed to a an animal milk clear and again some caveat some people actually react to histamine uh sources in food um and and that is to be taken into account if you do have that experience then don't feel that because i've told you that these foods are good for you you need to include them in your diet just always take these things with a pinch of salt and look at how are these foods affecting you as opposed to a scientist or an influencer telling you about the marvels of this of these foods so moving from food on to something related because I feel that nourishment is much wider than just food and I feel that the culture that we are in that is fast and we want quick rewards looks at quick solutions in just one food only or a meal that is really rich in a particular compound like really rich in polyphenols or in healthy fats so and then we basically get really hyper focused on a particular area of nutrition whereas nourishment is more about feeling safe I mean having the capacity to actually choose the right foods depends on sleep for example if you If you have ADHD and you have had a bad night's sleep, you'll realize that in the morning, the kind of foods that you want probably will be less healthy or less beneficial for your body than if you have had a wonderful night's sleep.

41:51you'll probably have more capacity to like i was saying before you have if i have slept really well i'll probably have the ability to think more rationally about putting protein early in the day whether it's in the shape of some eggs that i'm still eating i'm largely transitioning to plant-based as a ethical my own choice but i still have eggs or if i want a scrambled egg tofu kind of thing or if I want a smoothie with some some protein just making sure that I've got protein early in the day so I've got the building blocks for neurotransmitters in there in early parts of the day but if I haven't slept really well I might be drawn to having some quick cereal just to like give me something quick and some quick energy or or just run out of the house literally on an empty stomach and think oh my god i'm starving like two hours later and just grab a banana on the way to to the university so these are things that we need to take into account that capacity is largely dependent on rest and rest is dependent as well on a really interesting set of brain regions called the default mode network that is only activated when we are not doing anything.

43:13So when we are sewn out in ADHD and we kind of like, you know, imagining things and letting our imagination run wild, that's actually the DMN kicking in. So we have our own way of regulating because the brain, the human brain is not made for being focused all the time. We need to focus and then do nothing. Focus, then do nothing. And then we get the best of that traction, of that ebb and flow of the brain going deep into a task and then removing ourselves from the task so we can go back to it. And we push it too much because of toxic productivity. The DMN needs rest. So rest is doing nothing, having a bath without needing the computer by the bath so you can binge watch something on the computer.

44:01Just abstracting yourself in nature, going for a walk without needing to listen to a podcast or to be on your phone all the time sending messages. Just taking a break from things in general, just allowing your brain to navigate your imagination can be a very beneficial thing. So I'm coming to the end of the presentation. I could be talking for hours about this and I'm looking forward to your questions. But a lot of what I covered really quickly in this session I've talked about in my book, which is called ADHD, Body and Mind. It's available worldwide. And if you want to read it, I'd be delighted.

44:42I think that if you've enjoyed what I've talked about, the gut brain is a crucial part of the book. I talk a lot about emotional regulation. And I take you through a bit of a journey of how to implement nutrition that goes beyond food and into nourishment, that takes into account that need for us to rest and to be kind to ourselves. So I really enjoyed sharing this with you, and I'm going to pass the button to Carol now for questions. Thank you. Thank you so much, Dr. Toribio-Matteis, for such an informative presentation. It was great. We have a ton of questions. But first, I'd like to share answers to the poll question we asked, which factor has the biggest impact on your ADHD symptoms?

45:34Sleep, food, stress, digestive health? Several of these factors or none of these factors? And the top answers, 51 % said a combination of these factors. 17 % said stress and 14 % said sleep. Now to your questions, a mom writes, How can I get my teen to eat when his ADHD medication diminishes his appetite, especially in the morning?

46:05Yeah, this is interesting. So the best thing that we can do for any age group in ADHD is to put some protein early in the day. because as I mentioned towards the end of my presentation, that's going to give you the building blocks to create your own dopamine, norepinephrine, and so on. So if you can find some foods that your child is, your son is interested in and you're able to put together a combination of foods that can become an anchor and they can become safe foods that they can return to over and over again. Even if they are repeating the same foods every day, that would be a wonderful thing.

47:02So I find that a lot of the people I work with, they are keen to have a smoothie with a particular fruit that they like. They might really like bananas or they might like pineapple, but they feel pushed to change or to have eggs just because of peer pressure. People are saying you need to have a varied diet. You don't repeat things all the time. And they just get really confused. Well, ignore all of that. And if you're happy having your protein of choice, that could be whey protein. If you have animal foods, it's a really good protein to support the liver as well as the gut to have an impact on glutathione, which is really beneficial for the brain as well.

47:46And it's really satiating as well. So it will keep you full and it will give you plenty of protein that is really high quality. If you're more plant-based or drawn to plant-based, then pea protein can be really nice with a banana. if you like that sweetness you can make a smoothie sweeter with a couple of dates there are foods that are naturally sweet like mango for example i really love mango in my smoothies uh strawberries so you can make something to your taste that you can just return and it can be that safe food that makes you feel like it's not really a chore of a meal because you've really enjoyed the flavor and even if you have a small amount of that it's better than just being on an empty stomach especially on meds as well um what about frozen overripe bananas um to put in a smoothie to sweeten is that healthy if they're yeah that's fine but yeah bananas yeah so green bananas are good for a reason because they have this resistant starch that will feed certain bacteria in the gut and and that has are beneficial knock on effect but ripe bananas um in again i'm not against fruits anyway some people are funny with fruit but ripe bananas just for the right amount of sweetness sometimes it can be a bit overpowering when it's just too banana sweet yeah but just if you've frozen um that those ripe bananas or banana bread i'm obsessed with banana bread at the moment i'm making banana bread all the time because it's been really hot in england so my bananas have gone brown really quickly and I'm making banana bread with plenty of eggs so it's got that protein in there but it's got the sweetness of the dates I don't put any sugar in there I just put dates bananas and oats or buckwheat so it's like a really nice loaf to eat.

49:39And you could put very ripe bananas in oatmeal too to sweeten it so that you don't need brown sugar or maple syrup. Absolutely.

49:51A few people asked, what are the effects of ADHD meds on the gut, both stimulants and non-stimulants? Do we know? yeah so um it tends to be uh a decrease in transit time so it's not unusual for people to need to go to the toilet uh more uh urgently sometimes when the meds are starting to work and also for the consistency of the stool to be slightly different so if you notice that your stool has changed because of the meds and now it's a bit more runny as opposed to, you know, more perfectly form or the idea that we have of a perfect bit of stool, then what I suggest is try to focus on complex carbohydrates that are rich in fiber.

50:40So those whole grains that are going to be binding, legumes, things like flaxseed, for example, as well, or even psyllium husk, which is another type of fiber that you can mix. is the powder you can mix it even with other things like chia seeds for example as well you can mix chia seeds psyllium husk orange juice or your favorite fruit juice or even like a few mashed strawberries banana and you can make almost like a jam that is quite nice and it doesn't have any it goes quite quite gooey it's kind of like jam texture but completely sugar-free and you can have a couple of spoonfuls of that to top up your fiber every day and see if that actually regulates the consistency of the stool.

51:31Some people don't feel much, but some people tend to have that experience that if the transit time is sped up, so you can even see certain foods like sweet corn or something from the night before quite quickly the following day, whereas it should normally take about 18 hours for the whole of the transit to to take place so yeah um someone says my child is a very picky eater so it's hard to get her to try anything new how should i how should i introduce new foods yeah i think uh food is such a sensory thing as well i i i would involve i don't know what age the child is but sometimes uh it's about involving the child in the in the whole sensory experience of food and allowing them to to see it to touch it to smell it to leak it to kind of like play around with it so so they get used to something that is safe as opposed to have this pressure even with the best intentions sometimes parents can put a lot of pressure on a child that can feel things extremely sensitively and even if we want the best for them the child is going to feel that kind of an overpowering sense of i'm being told what to do and then of course there's you know there's the the defiance bit as well that can be a thing in your divergence and you know rebelling against the the the figure of the mother or the or the father telling them that they need to eat that so letting them make a decision that is safe for them and if they stick with something like that and they go through the phase of strawberries let them eat all the strawberries let them eat all all the blueberries let them let them have those those safe faces and and experience the food in uh in their own rhythm as opposed to want to impose uh a more adult uh rhythm onto their nutrition and I'm not a pediatrician but this is what I have plenty of mother friends with ADHD who tell me about these tricks because they have ADHD and autistic children and I see the kind of like the sensory element because I have experienced those sensory situations myself as well being a very picky eating child as well I only wanted to drink milk until I was about six I didn't want to eat I just wanted liquids so I know all about that myself Wow.

54:07My dad said that his parents made him eat green vegetables and he never touched a green vegetable in his whole entire adulthood. And he lived to 93. yeah yeah you know it's uh it's it's not we we have these ideas that some foods are extremely uh healthy and you need them and then that you have other foods that are more beige and they are going to be bad for you but you know bad and good is very relative and I think unless something is um uh you know extremely processed in a way that is also very repeated every day I was saying about the idea of a Western diet that is from a fast food outlet all the time.

54:54That is going to have a completely different effect on somebody's health. Someone asks, are there specific foods to avoid or include during the different phases of the menstrual cycle and in the different phases of a woman's life, such as perimenopause and menopause? um this is tricky because it's very emerging so uh from the very few studies that are talking about this kind of uh thing i would say that in follicular phase thinking about um recycling of the hormones in a more efficient way uh so cruciferous vegetables such as broccoli cauliflower um caballonero all of like green leafy vegetables they are really rich in sulforaphane which is a kind of like a compound that helps with with liver detoxification of hormones so it makes the whole turnaround of hormones more effective um so colorful plants are always a must anyway but I would say cruciferous vegetables, colorful plants, probably fermented foods as well, because they come with fiber and also with some added live microbes.

56:19I think around ovulation, probably antioxidant-rich foods. And again, a couple of studies are talking about ovulation and berries and pomegranate and these kinds of really intense color berries that are really high in polyphenols, blueberries blackberries you can go with the season as well and you know in the northern hemisphere like blackberries are a thing at the moment so they are popping up and then in luteal phase i would say more of the binding carbohydrates that are going to remove excess hormones like oats, pulses as well, flax seeds, resistant starches, and also to support a more steady, balanced energy in that phase.

57:10For peri - and postmenopause, I would use the same kind of principles, but just rotating them as opposed to just thinking, I must do this for a particular phase, because obviously the phases can be inconsistent in perimenopause, and then in menopause there are no phases. So I would definitely keep going with cruciferous vegetables. Flaxseed, always really good. It's a phytoestrogen, so it supports that natural balance of estrogens anyway. And regular plant diversity as well, I think is really important in peri and menopause. Okay. A few people have asked, what role do probiotics play in gut health?

57:54So, the best understood role is by keeping the gut more acidic. So, it's as simple as that. We want the sophisticated kind of like, what do they do? Do they kind of like make my brain work better and all of this kind of sophisticated stuff. But the most basic function is just keeping the gut very acidic. so less of the unwanted microbes can actually make a home of the gut so that can actually have a positive effect on the immune system because it takes a load of the immune system to have to think about unwanted microbes being in the gut and having to deal with them so that can like relieves the pressure of the immune system in a way and that can be one of the benefits um a lot of the probiotics don't actually stay in the gut so most of the studies on probiotics actually show that if you do a washout period so if you stop taking a probiotic product for four weeks there's very little left from what you started taking so they are very transient so what they are doing is is very temporal it's kind of a you know it's temporary it's just happening for a few weeks and some of them maybe even for a few days, but they are helping the overall balance, the overall community to talk to one another in a more balanced way.

59:26Okay. How do GLP-1s impact the gut-brain connection in people with ADHD and autism? Do we know? This is a very, yeah, this is a very interesting question that is actually being reported mostly anecdotally from people who are taking the GLP-1s that they feel that their meds are actually not working as effectively and also they are struggling to find interest in things apart from food because one of the really interesting findings in that kind of a big world of GLP-1s right now is that not only people start losing interest in food, they seem to start experiencing anhedonia, which is a lack of interest in other areas of life.

1:00:20And now we're starting to realize, okay, food maybe is not just food. Food is related to who you eat it with and, you know, and the place that you go and eat. And So basically, because you start losing the cues because you're not hungry, then maybe going out for a meal is not that interesting anymore. So you prefer to do something else or do nothing and just stay at home and watch television. So at the moment, it's kind of emerging. But the main finding, anecdotally, if you go Reddit and all these places where people talk about different symptoms anecdotally, there seems to be a lot of conversation around meds not being as effective when they are taken alongside the GLP-1s.

1:01:06Wow, that's really interesting. Unfortunately, we're out of time. That has to be our last question, but Dr. Toribio-Matteis, thank you so much for sharing your research and expertise with our ADHD community today. We really appreciate you. Thank you, Carol, for having me. It's been a pleasure. And thank you to everyone here today. If your question wasn't answered during the webinar, we do share audience questions with our experts and yours may appear in a future edition of Attitude Magazine's Ask the Advisor column. If you would like to access today's event resources, visit attitudemag.com and search for podcast 621.

1:01:47The slides and recording are posted a few hours after each live webinar. If you're listening in replay mode, simply click on the episode description. Please know that our full library of Attitude webinars is available as a podcast. It's called the ADHD Experts Podcast, and it's available on most streaming platforms. Get alerts for future Attitude webinars by signing up at attitudemag.com slash newsletters. Thank you, everyone. Have a great day. for more attitude podcast and information on living well with attention deficit visit attitudemag.com that's a-d-d-i-t-u-d-e-m-a-g.com