And welcome to another episode of adhd Women's Wellbeing Wisdom.

Little short, bite sized pieces of wisdom that I've curated from all the many, many episodes that have been recorded over this time.

And I really hope that this short insight will help you on the week ahead.

And I'm delighted to welcome back Dr.

Asad Rafi.

He is part of the Ask the Psych sections.

I loved speaking to Dr.

Rafi because he was able to answer lots of questions from a psychiatric perspective because he is an ADHD psychiatrist.

He's an expert clinical lead in this area and he is working at the forefront of being able to help more people thrive alongside adhd.

And in this clip we discuss about understanding overall brain health and how this affects our age and hormonal changes like perimenopause and menopause and how that impacts our brain function.

And we also discuss things like getting an accurate diagnosis and recognizing the skepticism that people may have alongside, you know, certain medications and having this understanding that ADHD can present in lots of different ways.

So we need to understand it from an evidence based, from a clinical perspective, something I hope having a psychiatrist on the podcast can really break down all the different questions that many of us have and hear it from, you know, someone on the ground that is diagnosing and assessing people every single day.

So here is a short conversation with Dr.

Asad Rafi.

This person's come and they've written.

As an older person, 60, who has only recognized my neurodivergence this year, having spent my whole life as somebody else, how on earth do I survive this?

My workplace is toxic and I've now discovered the Mariner coil is in me too.

On top of everything else, I'm at breaking point.

Everything is expensive supplements, the non synthetic progesterone, food, how do I look after myself, my differently wired brain and this whole self.

So there's a lot there, isn't there, Asad?

I think.

Yeah.

Where do you want to start?

I guess it's starting with just kind of demonstrating the complexity of a.

That question, which underlines the complexity of the condition that is adhd.

Okay.

We've all got a very different viewpoint and perspective on what this condition is based on preconceptions, what we might see online, what we might have read about.

So there are inevitably going to be biases in place.

And the way I'd like to frame ADHD is for people to start to think about the concept of their brain health.

Okay.

Rather than ADHD itself.

And if we mirror a different condition, say like diabetes.

Okay, we'll talk about diabetes in the context of metabolic health.

So why shouldn't we be talking about ADHD in.

In the context of brain health?

Because when we look at brain health, we're going to incorporate lots of different elements and those elements are going to have an impact, either positively or detrimentally, upon your ADHD symptom control, and therefore it will give individuals and people a better understanding of exactly what they're dealing with.

Now, that particular question poses lots of different features and elements of the difficulties and challenges that people face with adhd.

And first and foremost, I guess what we've got to question here is not to assume that this is ADHD.

You said that this particular listener was 60 years old and invariably we've got to think about, is it adhd?

And if that is the case, what do we then do about it and how do we.

How do we understand it?

Well, first and foremost, if the individual who's posing this question is relating to certain features of adhd, doesn't necessarily mean they've got the condition people will talk about, and I hear it sometimes in clinic, the naysayers, the people who are very negative and add to that stigma that's attached to adhd.

We'll talk about.

We're all about adhd, aren't we?

I'm sure you've heard that.

And if I had a pound for every time I heard it, I'd be a very wealthy man.

And I think at one stage I used to hear that, and be it really used to hurt me and upset me when I'd hear it and I would respond in a way where I'd sound quite defensive.

And actually, now I take that question and I say, yes, the answer is, we are all of it adhd.

It also means that if we're suffering with low mood on occasion, it makes us all a bit depressed.

We could all be a bit anxious, we're all a bit everything.

We've all got features of these conditions.

It doesn't mean that we've got symptoms.

What differentiates a feature from a symptom is the fact that there's got to be past evidence.

So the lady who's writing this question needs to look at, is there past evidence, okay, from childhood all the way through her life, you know, of symptoms of adhd?

Has it been persistent?

Is it pervasive?

That is, is the impact of the ADHD present in different areas of her life?

And then, most importantly, is it causing a problem?

And there's a fifth P which is, has it limited her potential, and that potential may not necessarily be in the workplace or academically.

It could be in friendships, relationships, could be within herself.

And then she's got to have the prerequisite number of symptoms to meet the, you know, the diagnostic criteria.

So I just wanted to kind of set the scene there in terms of just, first of all, answering an element of that, which is, if this is adhd, then that's how we would get to that point.

That's.

That's number one.

But then also there is going to be natural cognitive difficulties and challenges at that age.

Is this a part of the normal aging process, number one?

Number two, is this the consequence of someone who potentially may not have adhd, but due to hormonal changes that we know about, the drop in estrogen and progesterone following menopause, which may well have then unmasked those particular symptoms?

Okay, so what we're trying to say here is that female reproductive hormones have a significant impact on your brain functioning, and when those hormone levels drop, it has a detrimental impact.

Okay, so we do see women at different ages and stages, but most importantly, we see a huge number now at the time of the perimenopause and menopause.

Could this be one of those cases where the ADHD has become now exposed, or is this a normal part of the process where there's going to be some inevitable.

And the terminology that we'll use in menopause circles is brain fog.

Is it the attentional difficulties?

Is it brain fog?

Is it the same thing?

It effectively is describing the same thing.

That's a different terminology.

So thank you to Dr.

Asad Rafi for those insightful words.

And now onto another clip with Lucinda Miller.

Now, I absolutely love Lucinda.

She is a naturopath, and she's also the author of a fantastic book called Brain Brilliance.

She's a functional medicine practitioner, and she's the clinical lead of the Nature Doc team.

And her insights and understanding about neurodivergence, specifically with regards to nutrition, are groundbreaking.

And I've absolutely loved connecting with her reading a book.

But the conversation on this podcast was just brilliant.

So we wanted to tie in the theme of brain health and hormones and give you some more of these tips from Lucinda Miller.

And we go into how diet can significantly impact the function of the brain.

Chemicals like dopamine production, which is crucial for managing our adhd, and different foods we can introduce to.

To help our ADHD brain.

Here it is.

So just I thought it'd be a good idea to sort of delve into the science a little bit without overwhelming anyone too much.

Absolutely.

It's essentially the neurotransmitter or brain chemical that we need for.

Mainly need for ADHD is something called dopamine.

And most people that have been diagnosed with ADHD understand this concept of making dopamine.

And we've all learned about dopamine snacks from different inputs in our lives and so forth.

So when our estrogen is changing in our body, when it's going up and down and fluctuating, oestrogen is really important for that re uptake of dopamine, which is what the medication does.

Okay.

And so what you need to do is you need to work on optimizing your ability to make dopamine if that oestrogen is going a bit sort of awry.

And the key building block for dopamine is something called tyrosine.

And tyrosine is an amino acid which comes from eating meat, dairy, you know, fish, etc.

So this is protein.

And why protein is such an important thing, you'll hear over and over again any conversation about ADHD and diet will always include how important it is to consume lots of protein.

And the most important change that I personally made was switching to a very high protein breakfast.

So this morning I had three eggs and some feta cheese.

Okay.

Whereas previously, this is, you know, prior to diagnosis, etcetera, I was probably having, I was trying to be gluten free and dairy free for my various autoimmune things.

So I'd probably have the equivalent of cornflakes and some oat milk.

And I literally was a wreck.

45 minutes later, I'd feel wobbly, tired.

My brain went to mush.

And it was because my brain wasn't being fed with those amino acids.

So tyrosine is super duper important to have some people do supplement with it on its own.

But actually I think just that high protein diet is usually enough, okay.

And then that tyrosine needs to be converted into dopamine.

And the key nutrient that's needed for that is iron.

And iron is the most abundant mineral in your central nervous system, okay?

So it's really important neurologically.

It's important for energy.

It pumps oxygen around to the brain.

So key, and so many women, literally on a daily basis through my Instagram or our clients, people are getting the wrong messaging from their doctors.

So they're having a blood test saying, I'm feeling lousy.

And there's something, there's a measure called ferritin, which is your iron stores.

And for a woman, it should be between 12 and 400.

So anything sort of 12 and below is anaemic and anything.

And basically if you're still menstruating, it should be over 30.

But ideally for the ADHD brain, experts have found that between 70 and 100 is ideal.

So it's not even close to the top range, which is 400.

So, you know, it's pretty hard to get.

But most women we see, especially those struggling with menopause, especially with the ADHD kind of profile, they're often at 12, 13, 14, 15, 16, like super low.

So they're almost on the edge.

There just isn't enough iron to convert that tyrosine into dopamine.

So I'm just going to give you an understanding of the levels that someone needs.

Okay, So a menstruating teenage girl needs 14.

That's 14 milligrams of iron a day.

Now a chunky piece of steak, 100 grams of steak is only about 5 milligrams.

So even if you're eating lots of red meat, it's pretty difficult to have enough.

Once you get to 18 for some reason, the recommendations change a little bit and it goes up to 18.

Okay.

So if you're continuously only having say 8 or 9 or 10 in your diet every day and you have a heavy period, you're going to become depleted quite easily.

Spartone, lovely stuff, easy to absorb.

Most people don't mind the taste.

It's only 5 milligrams per sachet.

So yes, if she's eating a really good rounded diet, so she's having, I know Bolognese and greens and eggs and, you know, black beans and things like that a lot, then 5mg may be all she needs just to top herself up.

But in most cases you need more.

Now a doctor if you are anaemic.

So if you're below that 12 and often if actually you're below 30, they sometimes because when it's menstruating woman, they will give you 200 milligrams a day.

So five Spartan 200 milligrams.

Dr.

Okay.

However, that 200 milligrams is not that easy to absorb and it's quite tough on the gut.

So if they've got gut issues, sometimes it just feels funny in their tummy.

So my middle ground is to go with a beetroot based iron and you can take up to 40 milligrams.

So that would be four capsules a day because it's quite regulated.

How much is in each capsule because There are a very small layer of the population who, who naturally has too much iron in their system.

So they have to be careful.

They maintain to 10 milligrams per capsule.

And that's if you know your child is low.

So if you know your child's below 30, for sure, it would be four a day, but, you know what I mean?

Or 40 milligrams a day.

And so, yes, sometimes you have to go higher.

Obviously, some younger kids are not very good at taking capsules, so there are sprays as well.

But it's basically, I think people are very, very cautious.

They go, what if I'm taking too much?

Yeah.

And actually what you have to say is, I need to get my level up.

It's not how much I'm actually taking.

Because people with gut issues often don't absorb very well.

So you've got a problem with your stomach.

That's one area where your.

Where your body absorbs iron.

And then further down as well, in small intestine, again, you absorb the iron.

So if there's celiac disease or autoimmunity or, I know, some sort of malabsorption or, you know, even, you know, gastritis or something like that, you may not be absorbing enough iron.

It's a really, really big problem across the board whether you have ADHD or not.

And there are lots of people who may think they might have adhd, but it may just be low iron.

And, you know, I learned this the hard way, being quite more relaxed about my iron levels.

And it's when I eventually got to around 70, 80, suddenly my brain was on fire and it's made an enormous difference and I had to work quite hard on it, but I did get there.

So I hope you enjoyed listening to this shorter episode of the ADHD Women's Wellbeing podcast.

I've called it the ADHD Women's Wellbeing Wisdom, because I believe there's so much wisdom in the guests that I have on and their insights.

So sometimes we just need that little bit of a reminder.

And I hope that has helped you today and look forward to seeing you back on the brand new episode on Thursday.

Have a good rest of your.