Welcome to the ADHD Women's Wellbeing Podcast.

I'm Kate Moore Youssef and I'm a wellbeing and lifestyle coach, EFT practitioner, mum to four kids and passionate about helping more women to understand and accept their amazing ADHD brains.

After speaking to many women just like me and probably you, I know there is a need for more health and lifestyle support for women newly diagnosed with adhd.

In these conversations, you'll learn from insightful guests, hear new findings, and discover powerful perspectives and lifestyle tools to enable you to live your most fulfilled, calm and purposeful life wherever you are on your ADHD journey.

Here's today's episode.

Hi everyone.

Welcome back to another episode of the ADHD Women's Wellbeing Podcast.

And today I'm really excited.

I say this every, every episode, but I am really, genuinely excited about this one.

We've got Nick Potter, who is a consultant osteopath in London and he has also consulted for the Brevin Howard asset management for 11 years.

He's the head of Health and Wellbeing and he helps the employees with their musculoskeletal problems.

He creates personalized health and performance programs for the traders and he has pioneered the use of interoception, which we've talked about on the podcast, to manage the traders stress level.

He also runs busy clinics at the King Edward VII Hospital in London and he specializes in chronic spinal and pain conditions, chronic fatigue and brain fog.

I know it's hypermobility as well is a big topic and he's written a book and he knows from personal experience of spinal injury what pain is all about.

He's also very aware of all the connections with the neurodivergent community.

And I'm just so excited to bring you onto the podcast.

So I can just ask you lots of questions and hopefully give the audience some answers because I know that you have got them.

Not everything, but I've listened to you before and I know that this is going to be a good conversation.

So welcome to the podcast.

Thank you.

Great to be here.

You're doing great work.

Well done with your book.

It's a big thing.

Oh, thank you.

It has been a big thing and I am proud of it actually.

And I do talk about all of this in the book.

I touch on hypermobility, pain, chronic fatigue, gut issues, hormonal fluctuations.

So much of this anxiety adrenaline profile which we are now understanding shows up physically as well.

And I also know you do work with Dr. Jessica Echols and she's been on the podcast quite a few times.

She's been amazing on the podcast, just so generous.

We've also had Dr. James Custo on the podcast, who has also been incredible.

We've talked about interception, we're piecing together all these dots and that's why I'm so excited to bring you on.

So we can just help more people gain better understanding and self awareness so they can live better and healthier lives.

Well, also actually from my angle, a lot of it comes from people who are experts in sort of neuroscience and cognition.

But actually I'm coming more from the body element and in a sense, widers, we are an embodied brain and in fact our brain is blanc mange without our body.

And I think sadly in medicine what's happening too much is we're seeing people as a set of symptoms coming in rather than we're kind of losing the humanity a bit from.

I can see the Same problem in 20 people a day presenting in different ways and presenting with different problems.

So I love that and I couldn't do that in anywhere else where I am now giving proper time to it.

And I'd rather see fewer patients and do it properly than put a plaster on many more patients.

Well, you know, and I mean, we'll start from the basics.

The reason why I was excited to bring you on is because I'm a huge fan of osteopathy.

I've used it for myself and I've used it for many, many years without quite understanding how it works, why it works.

But physio never helped me and I a really awful traumatic spinal injury which stemmed from a couple of different things.

And I thought I was going to have to have surgery and thankfully I went to a osteopath and over several sessions she helped realign me.

And touch wood, thank God I haven't had any chronic back pain since.

I've also done a lot of strength work and, you know, really supported my core and a lot of other understanding.

But osteopathy, not only did it help with my pain, it also helps calm my nervous system.

And I just felt, felt after a realignment like something had shifted, like something had dissipated somatically out of my body.

And I found it really hard to explain why these sort of gentle movements, but then a crack and then a realignment and then, you know, all of that, I felt calmer in my body.

Are you able to explain a little bit about that?

I think.

Well, I think let's take it from the point of view of if we wind it back a little bit the skin, as well as the body is the sensory system by which we read the world.

And we build models of the world to then have them represented onto our, what we call the somatosensory cortex, which is where we have an internal representation of the surface of our body and internal body relative to the outside world.

And this can take you down a rabbit hole with physics.

And also that's why I've been very lucky.

I've looked at, worked with Carl Friston's work of the free entropy theory, which is about how the brain actually perceives the world and cognition.

They've realized that we're so obsessed with cognition and thinking and personality.

What we haven't done is spent enough time with how we gather that data on the world.

And we do that through our bodies.

And it is in fact six senses, not five.

And the sixth sense, as I've always called it, which is proprioception, which is where am I in space?

And the fact that I know that I am where I am and you are where you are is because I can get a relative positioning of who I am relative.

And that is in fact self consciousness.

And babies do that early in their development, separating from the mother at about two.

And then they interact with the outside world, which is friends, colleagues, and learning how to behave, how their behavior matters.

So I've literally taken sort of child neural development, neuroscience, neuropsychology, physiology.

I've done a lot of work into it.

Osteopathic medicine was really my sort of first foray into realizing that these things were connected.

I think some people give you different definitions of what osteopathic medicine, whether you look at chiropractic, physiological, the physical therapies.

For me, osteopathic medicine was so attractive because it was really neuro, orthopaedics.

So how does our brain interact with the world through our bodies?

So it's helping patients to realign themselves with the outside world relative to it.

And then that feeds back into the nervous system.

So it's almost a concept of perception.

And a lot of what I treat in the chronic pain world is that the patient's perception of what's actually going on.

There's a mismatch, there's a dissonance between either what they've been told or, or this concept of bone on bone, degeneration, cracks, spinal injuries, et cetera.

I personally, for my rugby career, have a car crash of a spine.

If I did it just by mri, I have multiple discs protruding, I have multiple spurs, but I don't have any pain, I keep slim, fit and strong and have an understanding of what's going on because ultimately everything heals.

So very often when you get pain, it's when the perception is that it hasn't healed or that something's broken and your brain wraps a fear cycle around that injury which you don't get out of.

And we understand a lot more about that, really.

So in a sense, all pain resides in the brain.

There's a lovely saying which is the reign of pain resides mainly in the brain.

There are actually no pain fibers, no pain processing pathways anywhere in the body.

It's a fallacy and it's still taught at medical school.

There is.

That's beginning to change.

But nerves only give information and when the brain decides that information has met a certain level, it will then wrap fear and emotion around it, which is what we know in chronic pain is when your perception systems move into the emotional centres of the brain.

Wow.

And then wrap meaning around it.

Which is why I called my book the Meaning of Pain was because pain is very, very malleable, adaptable, changeable and there's even ethno cultural elements to it.

You can play with all of that because you can teach patients, that's why they're seeing the world in the way that they are and you can radically change how they see the pain.

So it looks like you can do really miraculous work, but actually a lot of it is just changing the perception of what's going on in their body.

So, I mean, this is fascinating and I want to bring this back to neurodivergence and maybe why we see a higher relation of pain, inflammation, sort of, maybe hypermobility, that type of, sort of presentation in neurodivergent communities.

And I work so much with late diagnosed women, that's my, that's my community.

And they have all.

Historically, I don't think I've met one that hasn't had some form of presentation of this.

You know, whether it's injuries, ongoing injuries, whether it is that pain, it's fibromyalgia or migraines or all different types of things.

And I do see it wrapped up in this.

Well, why am I like this?

Why can't I do this?

And why do I struggle with this?

And so much of it is the emotional pain of not understanding themselves, of not having the answers or being dismissed or not, or like you say, going to so many different doctors and no one quite having an explanation.

But all these overlapping presentations and especially from a hormonal perspective, and I feel that when we get this understanding the.

Pain dissipates, well, you're getting a handle on the problem.

So, I mean, there's.

I've been so lucky in the different environments I've worked in.

I worked in rehab medicine in Germany, I've worked in cancer clinics, etc.

I've actually had.

Going back to what you said about diagnoses, it is very important for a patient to have a diagnosis.

Hopefully it's the correct one, obviously.

But the reason for that is because it allows you to build a concept of what's wrong with you.

And I have actually had patients who said to me, it's like when you're waiting for a blood test, you say, well, now I know what's wrong.

It's just such a relief.

The waiting is worth.

And they'll actually say to you, not knowing was worse than the cancer diagnosis.

So I said, what, you mean knowing that you've got cancer is better?

Yeah, it is.

Because now I know what I'm tangibly dealing with.

I can get fine ground zero and now I can move forward.

It's a base point for them.

And I think that so many of these patients sit at the intersection between the specialties, what I call the ologists, you know, the sea of endless practitioners, that they don't get diagnosed and therefore they're constantly at odds with themselves and what's going on.

And it actually ramps up in physics terms.

We call it entropy, which is chaos.

And as Jess would explain to you, Jess Eccles, who, as you know, we work with, it's what we call surprisal in the brain.

And surprisal is a bad state for the brain.

It's really a stress state.

And so what you're really dealing with patients who are now locked into a chronic stress response.

And my background was studying stress from the day I read Hans Sele in 1995, who said in 1937, read a whole book on this, and he found that there were consistent changes that occurred in the body when patients were stressed.

And I would call it neural state rather than stress.

Stress isn't a thing, it's a response.

And of course, Viktor Frankl's great work, he said, in the junction between input and output, there is a space, and in that space we can choose how we respond.

And that's very true.

And he'd been very stressed by his experiences in the concentration camps, but he actually managed to find a way to keep going because he found a meaning in what he was doing.

But I think going back to hypermobility Hypermobility itself is a collagen deficiency.

I don't like the word disorders deficient, but that's what it is.

It's a variance in the amount of collagen of different types that we have in our bodies.

And what I try and do with patients is to explain physically where we start with.

So if you have soft, soft tissues, which is effectively so they're like marshmallow instead of chewing gum, instead of being tight and agile in their perceptiveness, that they're a bit spongy, a bit boggy, then we know about things called piezo receptors.

And this was something that was elucidated by two clever ladies who got the Nobel Prize for them.

Called piezo one and two.

They're little tiny propeller shaped receptors that sit in your soft tissues.

They also sit in anything that moves.

So that includes piezo one actually sit in your heart, your lungs, because those organs move and they register movement.

And the brain correlates whether that relative movement is consistent with the state that they're in.

And there's endless integration going on.

99.6% of what your brain is doing, you have absolutely no idea.

It's all in the background.

And in fact, we know that if you look at the surface of the human brain, it is actually constantly.

It's all folded and full of ridges.

And that's because if you look at a monkey brain, for example, who are our nearest ancestors, they actually have a smooth brain because we had to develop an incredibly enormous cerebral cortex, which is where all this processing is done, and we had to literally pack it into our craniums, otherwise you could never be born.

So we know that this enormous amount of evolutionary developmental changes that have occurred mainly around processing sensory information and building models of the world, and we understood about utility and using tools and what our hands are for, we actually orientate ourselves around objects, not the other way around.

So understanding all this has been massive to me, but also radically changed the way that I look at patients.

But if we go back to the hypermobility, if these receptors are sitting in marshmallow, then there has to be a bigger deflection of movement in that tissue to register the movement in the little receptor on the back of it is a nerve.

And the nerve goes back and tells the brain it's constantly learning.

The problem for us, and this is where the clumsiness in hypermobile patients comes from, which is different from dyspraxia, is that the constant inflow of messages from the body relative to vision, which by the way we spend two thirds of our brain capacity processing, we're very, very.

We have very high visual resolution.

In fact, there's about 100 times, I think, more nerves coming down from the brain to process the information than there is actually in the optic nerves coming in.

So it's not just the data coming in.

It's this enormous amount of processing that we're doing all of the time.

And we developed to use that very cleverly, which is that the central vision is very high resolution, peripheral vision is very low resolution.

And black and white, we just don't realize that the brain fills that in for us.

But the peripheral vision is there to look at the periphery and notice things that change.

There's things that move.

Called Sokolov's orienting reflex.

And it's a fascinating subject.

Gibson's work was seminal and most people haven't read it.

But why we need to do that is because what I'm seeing needs to be constantly updated relative to what's coming in from my body.

And we call that reality.

Okay, so if we were together right now, and I said, I'm a hallucination, you'd eventually come and touch me, right?

Because you'd say, no, you're not.

Yes, I am.

No, you're not.

It'd be like a mirage.

I could attach you, touch you to feel.

You'd smell my aftershave, you'd hear my voice.

You can build up a model of me in every way.

The problem is if you're hypermobile, because there has to be a bigger stimulus from the body to match what the vision is telling you.

There is a dissonance.

There's what they call delta, is called prediction error, which is that I set a prediction about what I expect from you.

I back it up with the information I'm getting from you, and all I update is the tiny bits of difference between.

Okay, okay.

So I'm afraid it does get complicated.

But that's what the brain's doing constantly at about 4 bits per second.

It's called your sampling rate.

So right now, you sitting in your chair there, your body's taking lots of information, knows it's in the chair.

It can feel your bottom on the seat.

It knows your elbows are on the arms, you know you're looking at me through a screen and so on.

That's going on all the time in the background.

Now the problem for us is if there's a constant level of prediction error, we need to take more flashes of the world.

We need to create a higher resolution image of the world to update the difference.

Because if you were roaming the plains and you couldn't run away from your predator without not tripping up over the tree stump in front of you, the world's a dangerous place.

And don't forget, our brains are back.

This is what we forget.

We have brains designed for being on the planes 40 million years ago.

That's the problem with modern society.

We have a brain maladapted to the way that we currently live our lives, which is endless sensory information.

We wouldn't have had any of this information coming in, in the woods, you know, you and me, if we were partners, mates, et cetera, you would have been maybe cooking, caring for children, et cetera.

I probably lay around for six hours a day, then I'd get up and say, I'll go find an antelope.

Come on, lads, we're off.

Let's go hunt, come back, have a bit of a rest, take in the.

We didn't take all this, okay, you'd argue that.

But the sensory information is infinitely less than those days.

Now.

You are at constant siege from a constantly stimulatory world.

And that's high populations, it's cities, it's things that are moving.

We're constantly distracted by things.

So that's difficult enough even if you have a neurotypical brain.

So if you're looking at the world at many more high resolution flashes, we think it's actually about 16 bits per second, right?

That's four times higher.

That is why we get fatigued, because we have a Ferrari brain.

Now, that has certain advantages.

We can see things in the world that are different.

We really are the sentinels.

We would have sat up over the tribe.

This is why a lot of my special forces guys, they're definitely ADHD level, but that's why they're good at sitting up and spotting the changes in the dark, right?

Because they're taking many more flashes and they can update the differences, which might be a man moving, it might be a muzzle of a shot, a gun.

So you can see where these things are actually useful.

But if you've got a brain that is processing at that speed, you're going to burn energy very quickly.

And I call it the Ferrari brain, not the Ford Escort brain.

Okay?

And why that's important is the other thing that Carl Friston's unit has decided, which I think is seminal, is that we have a body budget, right?

We're burning you with your body mass, maybe 1500 calories.

Mine might be 2000.

I'm just a Bit bigger than you are.

And that's a minimum amount of energy we have to burn.

That's raw energy, electrical energy, 60 watts per minute.

It's the same as a light bulb.

That's a lot of energy going to burn to satisfy the needs of the body and the nervous system.

Now the head, the brain gets 20% of that.

That's a lot relative to its size.

So we know it's a center of high turnover of energy.

Now, what we didn't realize, it can't ask for any more.

And to me, this was a seminal finding.

So if you know that 20% a day, that's the fuel that you've got.

And you've got a brain that's burning at four times that, you're going to burn out.

And that's what burnout is.

And that's what I discovered.

We saw with rats at Oxford when you stressed them with cat hairs in their cage, etc.

They would gnaw the bars to get away, to get away.

And then they wouldn't.

They would sit back into a state of what we call learned helplessness.

They would become depressed and sit in the corner.

Because the brain subconsciously lets you know if you continue this, you will die.

It's that serious.

If you burn out to an nth degree.

That's why if you deprive people of sleep where they don't recover, I believe it takes as little as 14 days of no sleep for a human to die.

It's that serious because it can't recover.

I mean, I mean, so much of this is relevant because so many of us who relate to hypervigilance, overstimulation, overwhelm, differences in processing, feeling over, sort of stimulated by the sensory output or input.

Sorry, but you talked about something called body budget.

I call it bandwidth.

So when I'm teaching people about burnout and how to prevent burnout and guiding and creating more awareness around what is creating that burnout, I always say, have an idea about what your bandwidth is, because like you said, our output is a lot more like what we can achieve in a day or what we can achieve in a few hours.

A lot of neurotypical people, it might take them, you know, two or three times that amount of time.

Yeah, it's a superpower.

Yeah, it's an amazing superpower, which comes at a huge cost as well.

But you will crash.

That's the problem.

That's what happens.

Yeah, and I think what just going back to.

And I think this is an important point and it will certainly be seen as contentious.

In my 30 years of practice, I saw patients, and they were mainly female, coming to me in my clinic.

And these were people with chronic fatigue, main fibromyalgia, which, by the way, and this may be the contentious bit, I think are all the same thing.

And I'll qualify that in a minute.

And I promise you, because people about this.

What are you talking about?

You don't talk about.

They are.

And the reason is that they're just presenting with different symptoms.

And what I was sawing, I saw these women who had been constantly being told that they had.

Oh, in those days, in the late 90s, it was Candida, you know, oh, you've got yeast infections, etc.

And they were treating them with supplements.

I mean, so their perception was they were infected.

Now, it's a very difficult thing to get out of somebody's head.

Then it was Epstein Barr, glandular fever.

60% of the population has glandular fever.

It doesn't mean it's causing your problem.

And yes, you certainly get it reactivating if you burn out.

But they're not compliant, they're not correlated.

Then it was Lyme disease.

I mean, I see all this chronic Lyme, I'm afraid I think it's a complete fallacy and I'll come back to that in a minute.

Then it was long Covid and many of my patients were saying, so how bad was your Covid?

Well, it wasn't that bad, actually.

But then you say to him, so tell me about before you got Covid.

Oh, yeah, well, you know, I was locked up with my husband because he's a dick.

And, you know, I was at the top of the 70 story building a 40 with two kids, single mum with a lift.

That doesn't work.

Right.

These are stressed people.

And so 90% of the time, most of my colleagues are saying this and they're not honest about it because they're so terrified that they're going to get cancelled or they're going to get whatever, right.

These are patients who have literally burnt out.

So when they do crash, they can't and don't want to come to terms with the fact.

And it's not psychological, it's neurological.

And they see this as failure.

And I come from a very, very.

I was highly educated.

I went to an incredibly intense school in London.

Two schools, actually.

My father was a very senior judge.

No pressure there.

And it was all to achieve.

It was all about achieving, being better.

So we were constantly on it.

And even if you had the advantage of a relatively high IQ, instead of saying, well, my 90% is other people's 120%.

Enjoy the ride.

I just wanted to use that extra bit, my bandwidth, as you call it.

I want to push the bandwidth to its limit.

But like the rats in the cage, the brain said, you can't do this or you're going to, you're going to be in a very bad.

And I saw this with elite athletes.

We deliberately pushed them to the very limit of their capacity.

Right.

To force that extra things.

But the two things we knew would happen, and this is why we measure HRV, we were looking at that back in the early 2000s.

You could predict that if their HRV, their ability to absorb further stresses, became flat and immaleable, then what would happen is two things.

They would get a virus, right.

Or they would, which you see all the time in athletes, or they would injure because they've pressed themselves to fatigue, they're not recovering.

Can I ask, would you say that?

Because what I'm hearing is something that I see all the time.

It hasn't come out of nowhere.

We know, you know, we're born neurodivergent.

We, you know, the ADHD or the autism or the combination is there from birth.

And how it presents shows differently, especially in women.

Hormonally, the way I see it is we have got sensitive nervous systems, hormonal systems, we're just sensitive systems.

But there's also.

I've been reading this book.

I don't know if you've read it or know of it.

The Adrenaline Dominance by Michael Platt.

Yeah, I know.

And the combination agreement with it.

Yeah, the, the combination of this very sensitive system in all different ways alongside this sort of predisposition to adrenaline or to feeling stress, because of all the reasons that you've been talking about, means that we are going to be more prone to things like, you know, all the different ways that could show up, like the chronic fatigue or the long Covid or the Epstein bar, because our immune system is already compromised by inflammation and stress.

I, I so just going back to Hans Seley.

Sorry.

Because I think this is a good, it's a good baseline.

Hans showed two, three things that if you chronically stress somebody, it doesn't have to be that long, could be a month or so.

He saw the consistent changes which were increase in the size of the adrenal gland, which is cortisol.

Right.

So you can see that it was obviously secreting something.

They didn't know this in these days.

They didn't have sophisticated.

But he could See that from his observations, a decrease in shrinkage of the thymus gland and the lymphatic system.

So the T cells were shrinking away.

Ergo they get viruses, okay, they get sick.

And the third one was chronic irritation of the mucous membranes.

And that is mouth all the way down to anus, right?

The bowel, the gut.

So this is why gastric reflux is predominantly a stress response.

It is not a disease.

Most forms of asthma are actually breathing pattern disorders in stressed children.

And what do we do?

We give them cortisone in a puffer.

So that's why they effectively get worse because you have to keep topping up with more cortisone.

I saw this working in Liverpool.

All the nurses said, Ms.

Body, you're absolutely right.

They said the most stressed asthmatics that we see in the pediatric department are the ones with the worst domestic environments.

We're talking, you know, and this is single moms, highly financially stressed.

This is at the source of a lot of this.

This is not just, this is why it's unfair that these women are not coping.

The new stressor is finance.

So if you're not affording the mortgage, if you can't switch the lights on.

So what we're seeing a lot of this stuff around mold, I'm afraid I just don't believe it.

But if you look at, on the BBC, I was watching this lady the other day, she was complaining that her landlord wasn't cleaning the house, it wasn't whatever there was mold and think, well, mold builds up in a bathroom because of condensation and wetness, right?

And this is the new, this is going to be the new infection that we're going to see.

But when they said to the children, so it's hurting my children, what are their symptoms?

Headache.

Well that's not mold, that's tension, that's stressful, mild asthma, stress, not sleeping stress.

What is stressing that family is their financial situation.

So this is social justice stuff at that heart.

Those are the patients I used to see.

My father was head of family justice and he said this is the biggest problem that we have is the breakdown of the family, the stress on single moms, particularly if they're financially stressed.

And that's the same to us in the old days as, not that I'm being attacked by the saber toothed tiger, but that I did see him in the hedgerow last week.

I'm constantly vigilant and worried all the time.

And just to go back, I think just to fine tune what you were saying about the Female, I'd like to call it female because I don't want.

I'm a middle aged man.

I'm probably white, pale and stale.

You know, I'm really not coming from that.

I'm deeply sympathetic to the situation that women find themselves.

But I think we've got to be really clear.

You've got to be really articulate about this.

Otherwise people misread what you're saying.

If you look at why, and this goes to other interesting points about pain, somebody said to me, why do more women get chronic pain than men do?

Which is the statistics, okay?

And there are reasons for that.

And it's not just that they have a sensitive nervous system.

We can talk about that, why that is.

But I learned something right in my book, which I think is fascinating.

Again, many people and my medical colleagues didn't realize this either, is that only hollow organs feel painful.

That was a major wake up call to me.

You can't have liver pain, you can't have kidney pain.

You can have ureter pain because it's hollow and it's where you get the infection.

Because hollow organs were open to the outside world, so they were open to foreign bodies.

Infection, and you had to have an alarm system around them.

But women have one more organ than we do.

And women have a womb which is highly innovated.

It has huge amounts of nervous systems, sensory systems going to the brain, which all end up in places like the hippocampus, the amygdala, okay.

Which are all wrapped around emotion and meaning.

Because arguably, biologically, it's why women were put here was to procreate, right?

So this is why women are so protective of the abdomen.

Men are protective of women's abdomen.

I get very protective when I see a pregnant woman out there.

It's ingrammed into me to be protective.

It's prehistoric, a priori, as we call it.

And so they just have an extra organ which endometriosis.

All the problems you get with your uterine issues, all of those are potential of creating inflammation and pain.

So they're almost preset to be more sensitive to a whole subset of extra things that men aren't.

And if you, if you also look at psychological data, and these are, these are well established five trait personalities, et cetera, these are big cohorts that they've studied.

These from men and women are most similar across about 60% of those domains, okay?

Extraversion, introversion, neuroticism, which by the way, in psychology does not mean you're neurotic, it means you care more and if you look at where men and women are most different, it's two domains, agreeability, which is the need to be liked and want to get on with people.

So sociability.

And the other one is neuroticism, which is caring and worrying about.

And they overlap like this.

It's really interesting.

And of course, don't forget, they overlap.

So it's no surprise that the most difficult people in the world are men.

Right?

Because we're less agreeable and we're less worriers.

And the most of the opposite way are women because they're the other end of those bell curves.

But in the middle you get overlap.

So those things overlap.

But they're very important because if you have a brain that is more bothered about being liked, being social, being in the group, and you are also put here a priori to do one thing, which is to produce a child and to care for it, then you were programmed to be more sensitive, right?

To everything.

Everything's sensory because that's your alarm system.

Pain is your alarm system.

Then you add in hypermobility, which means you have the prediction error, blah, blah, blah, blah.

Right?

We're producing a really sensitive person.

Not as in I'm neurotic, just that my alarm system will go off when a butterfly lands on it instead of when somebody walks in the room.

Yeah, that is highly validating.

I mean, I hope so, because it's it.

And it's not because I think women are only here to have children.

It's just that biologically, that's what they were there.

Yeah, biologically.

That all makes, you know, so much sense.

And I'll speak for myself, I fall under that bracket.

Sensitive warrior.

I have been called neurotic before, but I also can see things way before they happen.

I tend to spot things and I'll.

You know, and you see the threats coming.

Don't forget, anxiety, by definition, is a forward fear of immediate destruction.

As I say to my students, never take a patient's pain level or fear level for granted.

Because all fear, wherever you are on the spectrum of fear, really, really, really, really worried or mildly anxious, is a fear of death.

So take it seriously.

Say to them, why are they so scared?

What sensitized them that this amount of input creates this amount of response?

It's inappropriate.

That's where the childhood input comes in.

That's why.

Why were you, you know, if you grew up in a domestic violent household, right.

Everything was a threat to you.

Relaxing is not a safe place.

I've got those patients every day when I'm teaching them breathing, they shake, they go into this and they say, what's happening?

I said, your nervous system is saying, what are you doing?

That will pre sensitize the nervous system more than anything else.

So it's not personality, it's not even psychiatry, it's not a disorder of personality, it's a nervous system in a neural state that learnt from an early stage that it needs to be afraid of the world.

And that's why I spend a lot of my time doing is working out.

Why is this patient not getting better when they've seen everybody else?

Because it probably isn't to do with their alignment or their whatever.

It's a constant neural state which they're in fright flight.

A lot of adhd, by the way, is highly correlated with single parenting and stressful house.

That's well correlated.

We can't ignore that these are hyper vigilant people in the first place.

Then you layer in their hypermobility, then you layer in their sex, their influences, their current marriage, their status, whatever it is.

You've got to look at all of that.

The problem is for the poor old nhs, they can't do that.

The average consultation time will be seven to 10 minutes.

A lot of my doctor colleagues in NHS who work, they say, we know it, it's just that the patient's demanding us to do something and give us a prescription.

And I know that I'd love to, I'd love to be telling this person that I can see the barn door in front of them them, but I've just got to help them with something medicinal and that's not going to cure these patients.

Yeah.

So I mean I.

This is what drives me with the podcast, you know, getting information like yours out there to the masses.

Your work is so, honestly, it's so important and this is why really responsible social media like this is going to change the world.

Because I was saying to my diversity group, Jess Eccles, etc, right, these are eminent people sitting in silos, knowing this stuff.

Lovely Ali Price at Oxford, you know, she's sitting there looking after these people, she's a neurologist.

And I said, what?

So I had them all to dinner.

I said, guys, look, we can all write PhDs, master's programs, we can go and write seminal papers, they will get buried in a journal that no one's going to read.

And so we're doing this stuff and we're getting a bit demoralized, but then I said, wait a minute, why don't we just create a forum, a portal through which we can speak to thousands if not millions of people and they can make their decision.

There's no judgment on them.

They can make a decision about what they want to do.

But if you're consistently reliable, you make sense.

That is as transformative as anything else.

And you can always transcend your.

And that was Viktor Frankl's work.

He said it doesn't matter how things get, as long as you get a handle on it, you get a plan, you can share it.

Right.

With like minded people.

Yeah.

It's logotherapy as well.

Always get better.

Yeah.

Yeah.

And the Buddhists always said, which I love, they said it is not my role as a healer to make you better, it is my role to remove the obstacles to your recovery.

And I love that.

Yeah.

I don't want people to feel like, well, now what?

Like what do I do?

I know I've heard you on other podcasts and you talk about we need, we do need to be protecting our gut, you know, eating well, making sure that we're moving our bodies and eating lots of protein, which is great well being advice.

Is there anything else that you can suggest to people who maybe can't afford to see privately or thinks that GP is just not going to have any interest in any of this?

What can they do themselves with very little kind of financial implication to help themselves feel better?

I mean, we're going to, on this Instagram feed we have called Backbone Clinic, which is what something we're launching, but we're getting at that.

We are going to actually give quite a lot of stuff like that.

But I'll tell you what it is to me, and it is one thing, we're actually postmenopausal women and the hypermobility, ADHD actually have a commonality, which is the type of exercise that you're doing, that, you know, walking is great, but it is not stressing the soft tissues.

You cannot change your collagen, but you can thicken it.

So fascia, which is the membrane that binds us together, like cling film, it runs throughout our body.

The thing that osteopaths are really we're fascinated by because it also, it's very, very rich in these proprioceptors.

It tells you where you are.

Now the pulling of those membranes on the bones also thickens your bones.

Okay.

So you're building up resilience.

That's why I've called it backbone, because it's not just about spinal pain, it's about your resilience.

Okay.

The backbone to your health is women have Serially, particularly if they feel pain when they initiate it will back off exercise.

And it's not just movement.

You need to be doing resistance exercise.

Pilates won't hack it.

Open chain exercise is not good for people with hip pain, pelvic pain, spinal pain.

They need to do closed chain exercise.

The Tai Chi of this you can get on YouTube, the Qigongs, etc.

But also even if you just buy some cheap weights or, you know, we'll come up with stuff, therabands, which you can.

These special bands or handles.

They're 26 quid from Amazon.

You know, this is not expensive stuff but you can set up, attach it to your door and you need to stress the soft tissues and it will take while, but the tissues are infinitely adaptable.

And that's what I realized because I see a lot of private school kids coming through and what's interesting, they've done so much more sport from an early age.

They don't get, they don't get nearly as much pots and they don't get nearly as much pain.

They get the clumsiness and they will get the ADHD ness.

But even that, they're more regulated, they're less emotionally malleable and labile, they fluctuate between emotions much better.

The mistake is to think that your emotions are not attached to your interoception, which is your awareness of internal state, which is palpitations, feeling breathless, those sorts of things.

So breath work.

Yes, but again it should be the 5, 7 ratio, the parasympathetic arm.

The breathing out must be longer than the breathing in.

Always for us, because that's what realigns our pulse rate and our blood pressure.

I love that we do a lot of this stuff with.

We call it duvet disco is you've laid in bed all night, your blood system's pooled into your limbs because you haven't been pumping your muscles.

So when you get up, you're going to feel dizzy and you're going to feel like faint and you're going to panic and you'll.

Everything's going to go away.

Lie in bed.

We actually get them to set their alarm clock to a techno.

You know, I don't care if it's Petunia and the waves, whatever you like.

But somebody's going to make you dance and literally dance in bed, right?

Be physical, get up and you won't get the pots because your pulse rate will go up the pool, the vessels will contract.

You'll also feel more embodied because your muscles have woken up.

Before you've even got out of bed.

And it's quite fun and it's silly, but it's a body brushing, something I use all the time.

Vigorous global body brushing, right?

It's stimulatory, it's sensory, it brings the brain back and it wakes up all those little plexuses on the surface of the brain to say, oh, hello, I've got a body, I'm here, I'm in the world.

Okay?

And the vigorous.

More vigorous it is.

You fire the little receptors in your joints.

So what you're doing is you're switching them on.

It's just like a reboot.

Turning on the car, right?

Turn on the car, it wakes up and it's a car.

When it's off, it's not there.

So you're waking everything up to living and you've come out of a dream world, right?

You are, by definition paralyzed in bed at night.

That's why you can't.

Otherwise you'd be acting out, you'd be doing all the things you're doing in your dreams in bed.

That's why we are paralyzed.

So by definition, you've been shut down.

Suddenly back into the world.

Switch on.

But I've got all this error in the system I'm having to do.

It's stressful.

Their anxiety immediately calms down.

Compression garments.

There's lots of Lululemon garments.

You know, all these, they're very cheap.

Underwear, weighted blankets, weighted blankets.

Helps you with the sleep.

Absolutely, yeah.

Because again, it's giving you bodily stimulation.

We fidget all the time because we're trying to get reference points.

We sit in corkscrew pretzel positions because torsion in the body.

Body tightens fascia.

You wring a cloth, right?

It tightens up.

That's why we sit with our legs crossed and twisted.

And we can do, you know, flexi, flexi stuff.

If you look at Sri Lankan population who are super hypermobile, it's in their dancing, right?

Their fingers can go into ridiculous positions.

So they kind of bought it.

It's in their consciousness to do this stuff.

But yoga's not going to help them unless it's power yoga, because you don't want to be more stretchy.

I've injured myself with yoga, so I'm really careful with my yoga.

You can do discs and all sorts of things.

So really, yoga is not your friend if you're hypermobile.

Yeah, I love it.

I do the more sort of restorative yoga, but I'm so careful.

I've learned now not to over stretch.

You know, I've done resistance work now for a long time.

Love it.

Been amazing for my anxiety.

And dancing.

Yeah.

Why are we not.

We were born to dance.

Right.

It's in every ethnocultural environment around the world.

The cultures that aren't even connected, they've never even met each other, but they all dance around.

The far.

The commonality.

The women also love to do things in groups.

I actually set up a program years ago, and what was interesting, the one thing we had got, we'd misread, is they don't want to do it on their own.

They want to go and have a little chat before the class, they want to have a little chat afterwards, but they also want to do it together.

It's in Your Instagram is 87% female attendance.

What does that tell you?

Story, narrative.

Okay.

And commonality.

What's everybody else doing?

Yeah.

Community matters.

It really matters.

And let's embrace it.

Go and do something in the park.

I was out in Vietnam with an NGO a couple of years ago.

It was conspicuous.

These little old ladies really are doing their tai chi in the park.

And they don't have.

Look at Islamic praying.

It's a downward dog.

Because it is in the Quran that it is godly to look after your body and to move.

And if you look at my patients who are praying it five times a day, even if they've got arthritis, they haven't got pain.

Their knees are very flexible.

They've done it every day of their life.

Now, you could argue that they've used religious guilt to make you do it, you know, but.

But it's.

But it's at the part of it even.

Even in the Christian church, you know, going down on one knee, being prostrate before God, that movement is a downward dog type movement.

It's flexion, extension, stand up, sit.

Flexion, extension, stand up, sit.

And they're doing it five times a day, so no wonder they're so flexible.

Yeah.

I mean, it's absolutely fascinating, all of this, because of the so many different overlaps.

And I just want to thank you so much, Nick, because you've been so generous in all this information.

How can people find you?

What work are you doing that where people can touch with you?

I would love people to embrace my book.

I mean, it came out in 2018.

It's in six languages now.

But what's lovely is people have been picking up and going.

In fact, I had a team of physios from Cornwall weirdly get in touch with saying this stuff.

Is not taught at undergraduate level Y this has been sentinel for us to understand more.

So we are going to start trying to sort of run courses on it and that sort of thing in amongst trouble with the clinical practice, it's tough.

But the Backbone Clinic it's called which is on Instagram I'd love people to do.

We're really not doing this to make money.

It's to get consciousness out there.

We know that currently when I did my book that actually 43% of the population of this country alone have chronic pain, 85% of which is back pain.

That's 23 million people.

Right.

That's a lot of people that nobody's helping.

But actually we can bring this stuff together.

And my clinic is called the center for Physical Medicine.

But we are actually going to be launching a new clinic which I'm very excited about where we will be incorporating everything which is mainly spinal, chronic hypermobility, bone health.

Actually DEXA scanning is horribly unreliable and I think a lot of women are on the wrong either on the wrong medication or shouldn't be on medication.

So that's a big thing and that's been out there for ages and it's not changing.

You know, I'm a disruptor.

I get that I'm probably an irritating swine but I do make sure it's right.

I do talk to people.

I talk to much better qualified colleagues than mine.

So yeah, so center for PhysicalMedicine.com and also Backbone Clinic on Instagram and then that leads to YouTube clips and other podcasts and things and your presence and well done you because it's not easy to get this stuff out there to do a book.

I mean that's a major piece of work.

Thank you.

So well done.

It's as big as a PhD by evenly and much more useful.

I hope so because people are going to read it.

Really many congratulations.

Well, thank you you.

Thank you so much, Nick.

If today's episode has been helpful for you and you're looking for even further support, my brand new book, the ADHD Women's Wellbeing Toolkit is now available to order from anywhere you get your books from, I really hope this book is going to be the ultimate resource for anyone who loves this podcast and wants a deeper dive into all these kinds of conversations.

If you head to my website, ADHD women's wellbeing.comco.uk you'll find all the information on the book there, which is going to be out on the 17th of July.

Thank you so much.