Dr. Kay (00:14)
Well, hello, hello guys. You're listening to Beauty Bites with Dr. K, Secrets of a Plastic Surgeon.

And today on our podcast, we are interviewing someone fabulous who I've known on Instagram for a long time. Now I get to meet her in person, virtually here. It's Dr. Jolene Brighton. She is a board certified naturopath, endocrinologist, nutrition scientist, and a certified menopause specialist. She's an author. She's one of the leading voices in women's medicine, and she really helps women a lot to understand connections between brain health and hormones and metabolism, mood, wellness, well-being.

She has written an amazing book. Her upcoming book, ADHD in Women, talks about female hormones and how this influences ADHD symptoms so differently than what we've ever known about ADHD in the past. So I'm really excited to have her. She's the host of the top-rated Dr. Brighton show. It's a wonderful women's health podcast and she is an educator. So more than anything, she's gonna teach us today all about ADHD. Welcome to the podcast.

Dr. Jolene Brighten (01:19)
Thanks so much for having me.

Dr. Kay (01:21)
Yeah, of course. I just found out that she's all the way in Mexico City. And well I'm really excited to hear about this podcast. I myself think I have ADHD and and like so many people and readers of your book, I think I did not realize this to for many, many years. Can you start with what's the basic definition of what is ADHD?

Dr. Jolene Brighten (01:43)
Sure. Well, you know, let's start with what people think ADHD is. So it's called attention deficit hyperactivity disorder. So what they think is little boys who cannot pay attention bouncing off the walls in school. And as it turns out, ADHD is far more complex than that. And it really needs a rebrand. You know, my book, I have a whole section on why ADHD is a bad name because it's not an inability to focus, it's not a lack of attention.

It's an inability to regulate your attention. So you may be the person who cannot pay attention in class because it's boring, but you find something you're very interested in and you can hyperfocus on that. So it's about regulating attention. At the same time, the hyperactivity doesn't always look like external hyperactivity. It can look like hyperactivity of the mind, a mind that doesn't quiet down at night, a mind that is constantly racing, having continuous thoughts going on. So

It doesn't always look like what we think it does, but at the core, what ADHD is, is extreme executive dysfunction. So within the prefrontal cortex, we run all these executive functions, depending on how you split it up, there could be 12, 15 buckets you put it into. And so these are things like emotional regulation, planning, organization, things that many of us take for granted. And while every single human on the planet will struggle with executive functions in some capacity.

For the ADHD year, it is so extreme that it is interfering with their life, their relationships, their school, their work, their ability to complete sometimes activities of daily living.

Dr. Kay (03:21)
I mean that's that sounds like a very disruptive problem. Why does it hit women harder precisely when their hormones start to change?

Dr. Jolene Brighten (03:31)
Right. So what we see with ADHD is that it's a neurodevelopmental condition. So it's with you from birth. There are instances in which you can suffer a brain injury and develop ADHD. But for women, we see these five P's, these phases of their life in which there's huge hormonal transitions. And it's through those hormonal transitions that not only neurotransmitters begin to change, but also mitochondrial function.

Immune system activation, increased reactive oxygen species. So this is what I call the brain hormone immune triad. And as any one of those systems are shifting, the other systems are going to shift as well. And sitting in the middle of that triad is the mitochondria, which is either the benefactor of systems who are working optimally or the collateral damage of systems that are struggling.

Dr. Kay (04:22)
It's interesting that you say that because I've been doing a deep dive into mitochondria and it's such a central organelle that it literally all of the toxic reve you know, the reactive oxygen species that it emits start to create this whole senescence of the cell and that becomes a low geographic effect where senescence is globally happening. So do you postulate that this happens in the brain? It's in a mitochondria of the brain that are giving you problems.

Dr. Jolene Brighten (04:49)
Absolutely. So newer research that we are seeing in both autism and ADHD show that mitochondrial dysfunction is central to the experience of the ADHD brain. And the reason for that is that the ADHD brain already struggles with glucose metabolism. And so what does the mitochondria do for people who are like, wait, I vaguely remember this from being 12. At one point, someone said this. So the mitochondria is the powerhouse of the cell.

It takes your glucose, your blood sugar, and it creates ATP from that. That's the energy currency of the cell. And so in the ADHD brain, mitochondrial dysfunction leads to a reduction in energy production. And so this is part of why ADHD ears move so much. Why the most detrimental thing that you can say to someone with ADHD is to sit still, because they need to generate lactate. They need a backup energy supply in their brain.

Now, going further with the mitochondria, when the mitochondria become dysfunctional, they begin to produce reactive oxygen species. And so this is something that we can see, especially in perimenopause, that is, estrogen declines, inflammation rises, reactive oxygen species rise because estrogen is a mitochondrial hormone, but it's also a hormone that regulates the immune system. And it has not just anti-inflammatory properties, but also antioxidant properties.

And so as these reactive oxygen species rise, as cool as your mitochondria are and making energy, they're kind of lame because they get hit with these reactive oxygen species. They're like, is that what we're doing? Cool. I will also produce these reactive oxygen species. And so the same phenomenon that we see in the perimenopausal brain, we actually see through the lifetime of the ADHD brain, which is why it's hypothesized that.

ADHDers experience perimenopause symptoms at twice the symptom severity compared to neurotypicals, and then those symptoms come about a decade earlier.

Dr. Kay (06:44)
Wow, I did not know that. So I think it sem sounds like early diagnosis of perimenpause is important. How do people check their biomarkers for mitochondrial dysfunction or what would you start noticing?

Dr. Jolene Brighten (06:57)
Yeah, so you know, checking for these things, I first want to acknowledge is not completely accessible. These lab tests can be very expensive. And when we start talking about neuroinflammation, which is really the underpinning of all of this, we don't have great lab tests to know that. I can test your CRP, I can test your inflammatory cytokines. And even if those are elevated in the bloodstream, doesn't mean they're elevated in the brain. But if they're not elevated in the bloodstream, doesn't mean you don't have elevations in the brain. So

When it comes to neuroscience, I need people to understand that we have a lot of limitations, including our understanding of neurotransmitters and how all of this works. Like right now, we're like, this is how we think it all works, but because we're not, you know, dissecting somebody's brain who is live action living, there's limitations in everything that we know. Now, one thing that we can look for with mitochondrial dysfunction is we can look for a marker of DNA damage. So 8OH DG.

This is a test. you can get it via Dutch test. There's other labs out there that do it as well. And it can tell us about how much you know DNA damage is happening. If we see that, we can start to infer that like we are also seeing mitochondrial damage happening as well. And then we can look at somebody. So there's tests out there that look at, you know, what is somebody's reactive oxygen species burden. But I think one of the biggest things that we can do is.

Take a good history with a patient and understand that patient's history. So, what do I mean by that? Let's talk about something that you might not think of when it comes to brain mitochondria, but it could be related. And that is primary ovarian insufficiency. So if you're losing your period in your early 30s, that could be pointing towards mitochondria dysfunction. The brain, the heart, the ovaries are packed with mitochondria. When the mitochondria are not functioning optimally,

We can see that there is lower egg quality, there's poorer ovulation, there can become infrequent ovulation, and the ovaries are aging a lot more rapidly. Now, if that's happening in your ovaries, then I can infer that is happening in your brain as well. And so, you know, for people listening, I think what is important is the data you can track yourself, and then you can start looking at more specialized tests. So there are tests out there that are measuring mitochondria health.

A lot of these tests are early in their inception. And so it's at a place that it's like it's, you know, it's it's not directly measuring the mitochondria, but it's giving us data to make inferences about the mitochondria function. But I think it's a really exciting avenue because I think we're gonna see.

a lot more development in this arena. But for the most part, a lot of these tests aren't completely accessible to people when I acknowledge that. And also they're being used in laboratories right now. And so I do think we should get excited because I think this is all coming on the horizon, much better testing.

Dr. Kay (09:59)
I hope so. I think like hormone testing were there. We can I mean, would you say you fix your hormones first and then we're gonna fix mitochondria after that?

Dr. Jolene Brighten (10:10)
I think it's a little more complicated than that. So I think you cannot help your mitochondria if you have not optimized your hormone. So, and the reason why I say that is that we look at the research and we've come to understand that as estrogen declines, mitochondrial function declines as well. There is a transition that happens through perimenopause, which is why perimenopause without ADHD can still feel a little bit of ADHD because.

You have a reduction in glucose metabolism, roughly about 10%. By the time you're postmenopausal, it's about 20%. But when you are postmenopausal, you switch into using fat instead of using just glucose, like primarily glucose. You're also using ketosis as a way to create energy as now as well. So why I say it's complicated is because we also have environmental toxins that are going to affect the mitochondria. We have antibiotics and certain medications that can affect the mitochondria.

We can think about medications that lead to nutrient depletions, like statins that deplete CoQ10. And as we age, we make less CoQ10. And the mitochondria very much need CoQ10. So it becomes, you know, you know, really, I think important for clinicians to be looking at the whole person. Hormones, yes. Gut health, yes. Oxidative stress. Are you eating your polyphenols? Are you smoking cigarettes?

How much alcohol are you taking in? What's your antibiotic use history? What other medications are you on? what was your mom exposed to environmentally? when you were in utero, there's so many factors that we need to go through and we need to assess. But I would say when it comes to mitochondria health, if we're not thinking about hormones and we're not addressing hormones, then we are missing a huge portion of the picture for women.

Dr. Kay (11:55)
Can you talk a little bit about that relationship between hormone levels and dopamine? I've heard so much about ADHD being like a dopaminergic issue, a imbalance between dopamine and norepinephrine in the brain. how does that relate to the hormones too?

Dr. Jolene Brighten (12:11)
Yeah. You know, I love that you bring this up because so many people have been taught, and it's the belief we were under in medicine for a long time, that ADHDs just don't make enough dopamine. Well, as it turns out that's wrong. There is a possibility you don't make enough dopamine, but what is often happening is that your receptors are not responding and you're clearing it too quickly. So one of the phenomons I talk about in the book is this ADHD hormone profile that's the cortisol profile.

And I'm sure people are like, why are we going with cortisol right now? Well, this is really important to understand. Now, if you're someone who's like, if the deadline's in a week, I can't do anything. But when the deadline's tomorrow, I am locked in. I am focused. Yes, because your procrastination is leveraged cortisol and that stress hormone spikes. And in the short term, it makes the dopamine receptor work better. In the long term, under chronic cortisol exposure,

That becomes much more difficult to dock the dopamine onto the receptor to get the signal to the cell so that the cell does what it's meant to do. And so that's when we can start to see this major dopamine issues arising, is under that chronic cortisol. And so it's yes, you may have ADHD, and the chronic cortisol is also compounding the problem for you. And so that's why I go through all these ADHD hormone profiles in the book for people to understand which hormone is it for you. Now,

I think what you were alluding to is estrogen's connection to dopamine. And what's interesting is I call estrogen the it girl because wherever she goes, these neurotransmitters follow, but very specific ones. And ADHD isn't just a dopamine story, as I explained in the book. It is also an acetylcholine story, which is about memory, about how I know what I'm gonna say next while I'm still saying it. And I remember what we're talking about here. And I know where I have my keys right now in my house. If you know, you know.

It's also about serotonin, which everyone thinks serotonin is just about mood. But as we've come to understand, serotonin's about neuroplasticity as well. There was an interesting study looking at the dopamine-cerotonin connection. And when you come across something relevant, dopamine spikes says this is relevant. This is important. This is worth us paying attention to. And then serotonin says, check, see that. Let's solidify this memory because this is so important. Let's make sure.

That we remember about this moment. We remember the details here. And so when it comes to ADHD, there is a dysfunction that we see happening with epinephrine, norepinephrine. We can see it with dopamine. We see it with acetylcholine. We see serotonin. And those are following estrogen up and down, but also so is histamine, which is also part of the ADHD story. And unfortunately, you know, every hormone is a Goldilocks story here. Okay. It's like you gotta get the sweet spot, not too hot, not too cold.

Because when estrogen is just right, we've got the the neurotransmitters working for us. But when it starts to go high, especially in those who have sensitivities like histamine intolerance, we see higher histamine levels. We see more irritability, anxiety, nighttime waking, 2, 3, 4 AM. So when it comes and and you know, for people listening, you may have heard me say histamine and said, okay, allergies, yes. And also a neurotransmitter. And so I think it's really important to understand.

That estrogen, while it is really important, sometimes women go on estrogen therapy and they're like, I feel absolutely worse. I'm raging. I'm more irritable. Like I feel like I have the flu all the time. That's a histamine issue going on. And so we have to be looking at all of the neurotransmitters in concert with things like how is your gut health as we start you on hormone therapy.

Dr. Kay (15:54)
Right. Yeah, it's very tumultuous time in a woman's life to have so much fluctuation all at once. And I I think that we don't have that many good tools as clinicians. Like literally I still see so many of my female patients just coming in on Adderall. I mean, is that the exactly wrong thing to do for them? 'Cause they're trying to have a a lifetime of

Dr. Jolene Brighten (16:13)
Not necessarily. Yeah.

Dr. Kay (16:16)
Adderall and they can't let go of it or they can't rebalance without it.

Dr. Jolene Brighten (16:21)
Well, what's been really fascinating about the newer research is that we always just thought that the stimulant medications worked via dopamine and norepinephrine. But as it turns out, that whole mitochondria journey that we went on is incredibly relevant when we talk about these stimulant medications. So there was a study on methylphenidate, which is Ritalin. And what it found is if you truly have ADHD, you take this medication.

It lowers reactive oxygen species and it lowers inflammation. So it's actually helping modulate some of the mechanisms that are harming your mitochondria. So these medications aren't just a neurotransmitter story. They're also about a brain function, about mitochondria function overall. Now, the flip side of that is that we know, you know, as clinicians, we all hear about these people, tend to be tech bros sitting in Silicon Valley, who are like,

I'm just gonna pop an Adderall this weekend and then I'm gonna hyperfocus on my app and I'm gonna get that done. Well, flip side of that, and I should say this is all done in rodent models. We don't wanna do this in human models because these animals get sacrificed, but these are in rodent models. And what they found is if you give this medication in a non-ADHD brain, it will increase inflammation reactive oxygen species. So it's actually harmful.

Now, the other thing they did, and this is relevant for perimenopausal women, they induced neuroinflammation in these rodents. And what they found is that the stimulant medication, specifically Ritalin in this trial, was able to bring down the inflammation. And that is why we've seen there was a study on perimenopause in Vivance where women are like, This is actually helping my brain. It can be used temporarily to help bring down neuroinflammation, but I would caution everybody.

Because it does also depend on estrogen. And some people have side effects like feeling really jittery, really anxious, heart palpitations at times. So it's not this panacea, it's gonna solve everyone's problems. And I would also challenge the notion that we should only be trying to modulate neuroinflammation. Because if you have neuroinflammation, the first thing I think of as a clinician is why? Where is this coming from? Odds are this is not just a brain story.

Often what we see is, you know, endometriosis patients, they're twice as likely to have ADHD. So this could be a driver of why you have neuroinflammation. We also see that ADHDers are more likely to have intestinal hyperpermeability and gut dysbiosis. That's a major driver of inflammation in the body. It can lead to autoimmune disease, as we've seen in research. Autoimmunity, also very common with ADHD. So I would always say, like, as promising as these drug trials can be.

I think that it is harmful to stop at, okay, let's just give a drug and modulate brain inflammation, and not ask the question about well, what's the full body experience right now? Because I think too often in medicine we start to compartmentalize things. So ADHD, you see the psychiatrist, you know, perimenopause, you're gonna see the endocrinologist, maybe the gynecologist.

Endometriosis, that's just a pelvic story. We just see the gynecologist, autoimmune disease, you only see the rheumatologist. And you know who doesn't care about any of that is your body. Your body just frankly does not care how medicine wants to silo things. And it's where I really think the future of medicine needs to have better integration between practitioners in which they're talking and they're collaborating on patient cases.

Dr. Kay (19:56)
I think at some point in the future we're gonna have full metabolomic testing as like a standard of care. Like wouldn't that be so exciting if we came if patients came and we had their metabolomic map of like what really how really can they handle stressors, foods and you know, everything that's epigenetically ha hitting them. I'm excited for that day. But what can people do in terms of like everyday lifestyle things like

Protein intake, making sure their blood sugar is stable or exercise or supplement nutrients. Can any of those

Dr. Jolene Brighten (20:30)
Right. We

Dr. Kay (20:31)
help the ADHD issues?

Dr. Jolene Brighten (20:34)
my gosh, yes. I mean, that's like I'd say probably 80% of the book. So

Dr. Kay (20:39)
Okay.

Dr. Jolene Brighten (20:40)
you know, it's something that people who have read my book early are like, you don't talk a whole lot about ADHD medications. And the reason is because I'm a hormone doctor. I prescribe hormones, I work with hormones, I work in a like integrative lens. So yes, I will be looking at gut health. I my background's a nutrition scientist. Of course, we're gonna talk about food. When it comes to ADHD medication, I you know, is my

While I can prescribe psychiatric medications, I've always taken the stance that if I feel like that a patient needs that level of care, then they need that level of support from the clinician who only does that. And then I can dialogue with them about how we're supporting them. So the other thing I would say is that I also know that anybody who's got an ADHD diagnosis, they will be offered a medication. So I'm like, why am I gonna have a whole conversation about the things I know you're gonna be talked to about? Let's talk about the things that your doctor's not.

Talking about doesn't have time in seven minutes. So, you know, I started this off earlier on saying the worst thing you could tell an ADHD or to do is sit still, to not move their body. If anyone's been watching this, you've seen me move my hands how many times now? This is a masking technique. I'm also a Latina. So, like culturally speaking, like if you're not talking with your hands, you must be like, you know, bored, checked out, indifferent, like the worst thing, like because this is just how we talk.

But it's also a way for me to keep moving my body. Now, why is that important? I told you about lactate or lactic acid. So exercise is incredibly powerful for the brain. We know this. If you don't want your brain to age, if you want to dodge dementia, like daily activity is one of the best things you can be doing. When it comes to ADHD.

I told you the glucose metabolism can be hindered. Well, the backup energy supply is lactate. So if your mitochondria is the powerhouse of the cell, it's giving you all the energy for the full house, then I want you to think about exercise as your crank generator. And you literally gotta crank it. You literally gotta move. And you're gonna build up this lactic acid. That's what like gives you that sore feeling. You don't have to do so much exercise that you're sore, but that's you know, a way for people to understand it.

Your brain will take that lactate and then it will help generate some energy for the brain. If you want to buy yourself two to three hours of peak cognitive performance, give yourself 20 minutes of physical activity, moderate physical activity, doesn't have to be a sprint, doesn't have to be CrossFit, doesn't have to be anything crazy. That can absolutely be beneficial to your brain health, but better yet, to your brain energy. So if you're somebody who's like,

Two, 3 p.m., maybe even 4 p.m., I'm crashing out. My brain doesn't have the energy to keep going. Like we want to investigate why, but I would also say to you, after lunch, take a 10-minute walk. Take a 10-minute walk. It's a little reset for your energy supply, but it's also going to optimize your blood sugar. Now, you mentioned protein, and I think this is a really interesting one because ADHDs have metabolism issues. And we ain't talking about this. And research has literally just discovered this in the last couple of years.

When it comes to omega-3 fatty acids and when it comes to protein, we may actually need more because what we are finding out is that the same cluster of genetics that contributes to the neurodivergent condition, which is ADHD, also may be contributing to why we have different metabolism needs. So when it comes to protein, absolutely want to stabilize our blood sugar. When your insulin is off, your brain chemicals will be off as well and your behavior will be off.

Your brain doesn't require insulin to be able to take in glucose, but that insulin does lead to dysregulation of neurotransmitters when it's being elevated, because like we've got blood sugar dysregulation happening. Now, the other thing you have to know is that protein becomes an amino acid, and amino acid is what's a building block for many of these neurotransmitters. And so if I told you that you already have issues metabolizing protein.

I actually had this huge section in my book all about this, and I had to cut it out because it was already a beast of a book. But I did include getting ample protein within the meal plans. And so while people are saying, 1.2 to 1.6 grams of protein per kilogram, the ADHD is gonna have to be above that 1.2 most days. So we give this range and it's like these are the goals that you want to hit. ADHDers.

And and this all depends on your activity, your lifestyle, muscle wasting, a lot of factors. But they need to have more protein, which honestly, as an ADHDer, I'm bitter about because I'm like, great, I'm already perimenopausal and I'm ADHD, and protein's already like hijacking so much of my mental space. And like, it's like, you know, everybody who's trying to get their protein goals knows about the struggle of like, did I mean enough protein today? But it's absolutely

Dr. Kay (25:26)
Pretty hard. Yeah, it's hard to eat that much.

Dr. Jolene Brighten (25:28)
essential.

Dr. Kay (25:29)
Mm-hmm. How about with the GLP ones, to how is that impacting the population of ADHD women? And I mean generally they're really great for metabolic health and control of sugars and you know, you definitely need your protein if you're on a GLP. How does it impact ADHD women?

Dr. Jolene Brighten (25:47)
Two things that

I will say. So, number one is you're talking about a population that has a propensity towards eating disorders, undereating, forgetting to eat. So we have to be cautious with this. And but I wouldn't say that it's any different than anyone else. If I prescribe a GLP one, then I need to make sure that I know what you are eating every day, how you're moving every day, and then we're keeping tabs on that. So we have to make sure that we've solved the problem of feeding yourself regularly before we start a GLP one.

The other thing I'll say though is the GLP one may actually help with that. Because what ADHDers are reporting is that they're functioning so much better on a GLP one. Why would that be? We do not have clinical trials on this. So I want everybody to know that like so much of this is speculative. But what we understand is that GLP1s lower inflammation. They lead to blood better blood sugar regulation. They may very well be a longevity drug in the way that they operate. And so for the ADHDer,

This may be lowering neuroinflammation. And I want people to think about the most common, you know, you know, insulin resistance, the most common resistant hormone that we know of, right? Everybody's like, yeah. If you talk about like resistance, people think insulin resistance. So oftentimes the cell becomes inflamed and you can't dock insulin on the receptor. This is true of any hormone and any neurotransmitter.

And so the same is true in the brain. If you're inflamed, you may not be able to dock those neurotransmitters. And I told you, you know, part of the story of ADHD is that dopamine can't actually get on the receptor and get utilized well or it's getting swept out too soon. So the GLP ones may be helpful with that. We need clinical trials to actually understand this better. And to also understand for the specific population, are there any downsides to this? Like one of the things I definitely see is that if people can't feed themselves already, don't put them on a drug that

Causes them to ignore their hunger. Like that could be really problematic. However, there are also people who are not using it for weight loss who are using it at the starting dose and staying there just to modulate inflammation. And I have seen this in autoimmune patients. I have seen this in endometriosis patients. I've seen this objectively on measuring a CRP, a C reactive protein, a marker of inflammation, starting someone on a GOP1 six weeks later.

CRP is down, something that's like been repeatedly elevated on former tests. And so I think it's a really exciting area. And I'd love to see more research on it. Right now we're seeing research about dementia and cardiovascular disease that is all very promising. And those are also areas that ADHDers are at higher risk for. So again, it's that full body picture we want to be talking about, not just the fact that you have an ADHD brain and as if you are nothing else.

Dr. Kay (28:37)
Interesting. And then do you feel like, with all of the distractions of an ADHD person that's sleep, which is so central to like cognition and metabolic health, how does poor sleep intensify that? And what are we doing that's, you know, making our sleep worse? What can we do to correct it? I know we need to throw away our phones and do the social media detox, but what else is impacting

Dr. Jolene Brighten (29:01)
Yeah.

Dr. Kay (29:02)
sleep?

Dr. Jolene Brighten (29:03)
Well, the first thing they'll say is that 70% of ADHDers have been found to have delayed sleep phase onset. What that means is that your melatonin rises more like 12, 1 a.m. rather than the 9, 10 p.m. of the neurotypical brain. So the idea would be like, let's not start work till 10. But unfortunately, society just doesn't doesn't work that way. So I in the book, I actually go through here's the major reasons why ADHDers struggle to sleep.

Let's figure out what yours is and let's address that. So the sleep hygiene, nobody can ignore that. We have to be sleeping in a dark room. We have to have it cool. it's really important to avoid this blue light that doesn't occur anywhere else in nature except our cell phones at night. So it's really important to be avoiding all of those things, but you may be doing that and being like, it's not enough. Sometimes it's an issue of not enough progesterone stimulating GABA.

Sometimes it's an issue of you just need to spend some time, like actually giving yourself space to sort your day out, to go through the events of your day. And, you know, what I say is just like, you know, putting it into buckets or file folders and being like, not today, you know, tomorrow issue, never gonna happen issue. Why are you talking about this brain? Like, and sort through all of those things. You know, ADHDs also sometimes benefit from things like using L theanine.

That's been shown in the research to be helpful for the ADHD brain. apigenin is a great, it's a chamomile derivative. It's what I love about apigenin is that it not only helps with sleep, but there's starting to be emerging research about inflammation, about endometriosis, about some of these other conditions that ADHDers are struggling with. And then the other thing that, you know, I would consider when we're talking about sleep is.

Cognitive behavioral therapy for insomnia. This has been shown to be highly efficacious for ADHDers and really helping them like reset their brain so that they can make all these other things that we're talking about work, but also get that quality sleep. And if anyone's listening right now and they're like, what is the one thing I could do? The one thing I would say is wake up at the same time every day. And the reason for that.

Is that a molecule called adenosine will build up during your day and that builds sleep pressure. And that, and as soon as you feel sleepy at night, you gotta go to bed. Otherwise, you're gonna get a second wind, you're gonna sabotage all of that. But waking up at the same time every day is a great way to start putting that pressure on the body, and this is in a positive way, to go to sleep at a reasonable time.

Dr. Kay (31:42)
Mm. I think are ADHDers more likely to be night owls or early birds, or if it's variable?

Dr. Jolene Brighten (31:50)
You know, it's I would say it's definitely variable, but we see a lot more ADHDers who talk about being night owls, who talk about doing their best work at night. We see a lot of entrepreneurs, artists, creatives, that are also ADHDers. And part of that is because they can set their own work schedule. And because there's actually a lot of reasons. I could do a whole podcast on why ADHDers are entrepreneurs, but you know, the sleep problem is definitely part of that. And they'll just say, like, my brain won't shut up, or I'm, you know, not.

Tired at night, like I don't know what's wrong with me. And it's like, well, it's it's just the way that you're programmed. This is the operating system that you were handed. But we do have to start switching things. And so, you know, one of the other things I talk about in the book is moving your bedtime ahead by like 10 to 15 minutes every night until you get to reasonable sleep. Because, you know, the thing I didn't mention in all this, I like jumped right to solutions, is that poor sleep affects anybody cognitively.

We see more distractions. We see more car accidents. We see a lot more decline in cognitive performance the less sleep people get. Sleep deprivation has been likened to like drinking like a six-pack of beer and then trying to operate. And you know, there was an interesting study showing that when you don't get quality sleep, you can actually do like a mega dose of creatine.

And that can be tremendously helpful for your brain operating. I typically just recommend people are using three to five grams daily. And then maybe they're going up to like seven grams in their luteal phase if they're really struggling with like their brain energy. I've seen that be really helpful for people. But I'm not a fan of doing like 20 plus grams of creatine for the average person. That's what that study was talking about. You will probably have a lot of gut issues. You'll be very mad at me if you if you hear this and you do that.

but in addition, you know, there is some preliminary evidence that there may be a connection with endometriosis and creatine. I don't find it particularly compelling at this point, but it's something that women are concerned about, which is why I'm always like, let's just stick to that lower dose. And as I was saying, you know, ADHD and endometriosis, they very commonly co-occurring together. So that's why I bring that up and bring that caution in.

Dr. Kay (34:00)
So creatine could make that worse than endometriosis.

Dr. Jolene Brighten (34:03)
Hmm, we're not at a place where we can say that. They did an animal study, and what they did is they're like, we're we supplemented with creatine. But what they did is they actually injected their peritoneum with creatine. Friends, we do not take creatine via injection as humans. We actually drink it. So we can't say the endometriosis lesions for people listening, many times you'll find it lining the peritoneal cavity. And so that's why they were injecting it, like right where they could get it to the lesions. And then things got worse. And it's like, well, I mean.

You this is like you know injecting you know a cancer lesion with something that would make it grow and then being like, it got worse. And it's like, well, you gave it exactly what it needed where it needed it. And the other thing, the other study that you know people are citing and and correlating with this is that ADHD's excuse me, endometriosis, they may have higher levels of creatine. And what we may see is that it interferes with the immune system actually removing these lesions.

And that might be a mechanism of action. But it's one of those things that, like anything in medicine, we do risk versus analysis. And if you drinking creatine means that you are working out consistently, you're getting a better workout, your brain is working better, those are serious benefits that are actually gonna help endometriosis. So if you're drinking creatine and you're like, I have more energy to actually lift in the gym and do all these things.

That's gonna have a very positive impact on your immune system and on endometriosis. So, as I bring that up, we don't have evidence to say that that's actually driving endometriosis, that it would make endometriosis symptoms worse. There are women who will say, I took creatine, my endometriosis symptoms got worse. As I've explored this, because I very much believe that how we learn is listening to women. But as I've explored this, it's been GI symptoms. And it's very hard to differentiate endometriosis symptoms from GI symptoms because endometriosis symptoms

RGI symptoms. So like IBS, that's endometriosis in a woman until you've proven otherwise. Like, and so that's where it gets so tricky with this. And so it's like we don't have any research to say that, it made your endometriosis worse, but we do have research to say, yeah, it can cause gas, bloating, intestinal cramping, like you know, creatine can do that. And that just your intestines being upset by way of where the lesions live.

That could make it feel like endometriosis is worse. It may even aggravate the endometriosis lesions, especially if you have like strictures around the intestines, if your bowels are tied to your uterus, like mine was. So it's one of those things that I'm like, don't dismiss women. We should definitely listen to women. But at this point, I just haven't found anything compelling enough to say that like nobody should be using creatine if they have endometriosis. I have endometriosis.

I still take creatine because I'm forty-five and I need my brain to work. I have two kids. I run a company and I'm here talking to you. So I'm like, I need my creatine friends.

Dr. Kay (36:56)
well on that note, what other supplements are you really into? Do you take methylene blue, urolython A, magnesium, what are like your core stacks up? Saffron. Wow, I love that.

Dr. Jolene Brighten (37:06)
Saffron. Saffron. So particularly affron.

So I actually formulated this supplement called Radiant Mind, and it has Afron in it, which is a clinically studied form of saffron that has been shown to help with hot flashes, with sleep, with ADHD, with PMDD. There's been a lot of clinical trials on saffron. Now, never ever, I want everyone to understand.

Would we say a supplement is a replacement for a pharmaceutical? It's not, it's not how supplements are designed to work. Like if you need a pharmaceutical, that's a that's a different story altogether. But I do love saffron for those reasons. Cidicoline is another one. There's been great studies showing that it helps with memory and like especially in aging populations.

And so, you know, I always think about these things from the lens of like, why wait until we've aged and we have the problems? Like we want to be preventative in that. The other thing I would say is bucopa, especially for a brain that has reactive oxygen species burdening it. So free radical burden, if you're having you know.

neuroinflammation, but COVID has been shown to be anti-inflammatory, to be an antioxidant. And there's been good trials with ADHDs as well. And so, and what's really interesting that I do in my patient population is things that I know work for ADHD brains, they always work incredibly well for a perimenopause brain as well. So for people listening who's like, does that only work for ADHD? The same mechanisms I told you,

Are happening in the ADHD brain, they're happening in perimenopause. So these things can be tremendously helpful. You brought up magnesium immediately, yes. Magnesium glycinate every night that can be a great way to support your sleep. But there was a study showing that a total intake for the day of 550 milligrams of magnesium that was associated with brains that appeared younger than their cohorts. Like this, I think magnesium is one of our longevity minerals that we just don't.

talk enough about. I feel like people talk about it for like, cramps, muscle relaxation. maybe they're using magnesium citrate because they have constipation. But I think magnesium glycinate is one of those really incredible ones because it's got that glycinate molecule that really helps with calming the brain. And I don't know about you, but in my patient population, calm is usually the thing that we're chasing most because most people are feeling frazzled, stressed, inundated with just so much of the world. So

You know, those are some of the top things I'd recommend. I talked about L-theanine before. I think that's a fantastic one. apogenin as well. Passion Flour. I love Passion Flour for stimulating GABA and helping you stay asleep through the night. That's an alternative for women who have progesterone intolerance while we're working on that part out, or women who are like, I just don't want to take progesterone, or they're too young for progesterone, but they're feeling that like, no, I'm still getting that night waking like a few days before my period.

Passion flower can be incredibly helpful for that.

Dr. Kay (40:13)
I think that's so interesting. I I love all of those ideas. if if a woman right now is feeling more distracted, more forgetful and overwhelm overwhelmed and kind of emotionally reactive than she did five years ago, what are kind of the first three steps she should take to kind of get centered and get back in her headspace correctly?

Dr. Jolene Brighten (40:34)
Okay, I'll give you three tips, but I would also say let's always like think about thyroid health in women, because a lot of the symptoms of ADHD, it can be thyroid masquerading as ADHD. Symptoms of perimenopause can be hypothyroidism. And I think as perimenopause is having this moment right now. I think everyone's forgetting about the thyroid. And I'm like, please, friends, can we please talk about the thyroid? Because it's so, so critical. And when your thyroid hormone goes low in hypothyroidism,

brain energy metabolism slows and all your neurotransmitters start to decline as well. And so in the book, there's no ADHD thyroid hormone profile. Because if you have hypothyroidism, that is hypothyroidism until until we've cleared that up, we've addressed that. And then we come back and we check the ADHD. But I would never send a patient out to be evaluated for ADHD without checking that they're hypothyroid or not first. So if you're someone who's like

I'm feeling like really distracted. I'm having a hard time paying attention. I think we've like, we've established like a lot of really good things that you can be doing, exercise, you know, getting the good sleep. But one thing I would say is having a notebook where you kind of brain dump during the day. That isn't, you don't even need to return to this notebook. Okay. This is not your to-do list. This is not anything. It is when women have this propensity, and we all do this, to take on other people's problems.

And to take on other stuff and to start thinking, we need to handle things. And what I want you to do is have a little space. And a physical space works really well for that. To just jot it down. That's where it lives now, not in your brain, not taking up your mental energy. Because sometimes what is going on when we feel so distracted, our brain doesn't have enough energy to get through the project that we're doing is because the mental burden is too high. Our mental load is too high. So

There's a lot of ways we can start dumping those things, but that's just something that I would do is just have a notebook, and that's where those thoughts you don't need can go to die. Like make it your graveyard. So you just dump them and go. The other thing that I would say to you is making sure that you are the one who's controlling how your day starts. So when you wake up in the morning, it's not social media first. It's whatever the hell you want to do first. And why I say it's not social media first is because social media is inundated with people.

Who are trying to dictate your day to you? And like you don't need to be told what to do by one more person, myself included. So I want you first thing in the morning to really dictate what makes for your best day. Are you the person who needs to wake up and meditate? Are you the person who needs to wake up and go stand in sunlight? Are you the person who just needs to go to the coffee machine and have five minutes of silence and drink your coffee? Like,

Whatever it is, and I apologize if you have kids because I know they're gonna dictate your life. I got a five-year-old right now, like he he runs the show, but I'm like, I make it work for me because I get my morning kettles in, and that gets my oxytocin up, and I know that drops inflammation. So I'm like, at least like I got this wind coming in. But I need you to figure out like what works for you because we can all have the I can sit here and tell you every one of those things is great for you. Every one of those things is great for you, but only you are gonna know what's the thing you need.

To really get your morning going and get your day started right. And then I would say after that, I need you to get quality protein. And if you do not eat protein at any point in your day except breakfast, you're still ahead of the curve. And the reason is that the research shows the most important meal of the day for us to get protein to stimulate muscle synthesis, which by the way, more muscles, more mitochondria, better brain health is first thing in the morning. So eating.

25, 35 grams of protein first thing in the morning, making sure you have your fiber, making sure you have something to enjoy, by the way, too. I don't think that every meal should feel like an endeavor towards perfection at the expense of deprivation, like feeling deprived. I think we should have pleasure and joy as well. So, you know, whatever that looks like, if you want to have a chocolate square of like dark chocolate in the morning with your breakfast, I ain't mad at you for that. Like you should have things that like

Then make you feel good. I feel like so much of wellness has been like, how do you deprive yourself? And the more deprivation is like you're winning morally, you've got the blue ribbon of life. And it's like we forget that the human experience is about so much more. And so sometimes when we feel like we're slogging through our day, it's also because like our day is not filled with micro pleasures. We're not, I need you to be whimsical. I need you to like, I mean, this is something that like.

Somebody who has spent like a lot of time in France and I've I've lived in Paris that I think everybody talks about what the French do best. Uh-uh. The one thing I think the French do best is they understand how important pleasure is, how important micro pleasures are throughout the day. You take that lunch and you enjoy that lunch. You be with your people and you really be with your people. You're not on your cell phone. You want to have a pastry and go for a walk. You have a pastry and you go for a walk. Like, and it's not to say that like,

open the doors and just like eat pastries all day. No, it's just to say we have to do more to build micro pleasures into our life because I think too much of our life has been completely focused on how do I dodge death? How do I live so long? How do I have the healthiest body? I mean, listen, in a healthcare system where like most people don't have access to providers or insurance, I totally get that. And I totally get that as a healthcare provider as well. But I think,

What we've seen the last 10 years with biohacking and with like the we've gotta be so rigid about everything, has forgotten what the human experience is, has forgotten that we are meant for so much more than pro chasing the perfect protocol.

Dr. Kay (46:27)
Mm. That's such a beautiful thought, honestly. I think a great way to summarize and and bring this conversation to a close because I have learned so much from you. I really did not think of ADHD as a mitochondrial problem. And now I'm gonna rethink all of that. And I honestly think these are powerful tools for women out there who have ADHD and probably even the men will learn something here. So how yeah.

Dr. Jolene Brighten (46:53)
Absolutely. And

if I for all the men, you are breathing too loud if she's in perimenopause, I have to tell

Dr. Kay (46:57)
Ha ha

Dr. Jolene Brighten (46:58)
you. No.

Dr. Kay (47:00)
Yes. Chew your food

with your mouth closed too. Right.

Dr. Jolene Brighten (47:05)
Ha ha ha.

Dr. Kay (47:07)
well, I have really enjoyed this conversation. And Dr. Jillian, where can people find you? I know you have a book launch coming and your book's in pre order. How do they pre order if they're interested?

Dr. Jolene Brighten (47:18)
Well, if you want to get the first chapter as an audiobook, because I know your ears have more time than your eyes, and you want to grab some recipes so you can get started on all of the tasty things I told you about living this kind of life. and you know, you also get access to other bonuses. You can go to drbrighton.com d R B R I G H T N dot com slash adh d n women. That's the pre order page anyway that you pre order. Yes, audiobook counts as well.

And you can grab all those bonuses. The book goes on sale October 6th, and after that week, all the bonuses go away. Wah wah. But that's because you're gonna have the book and you're gonna be all set.

Dr. Kay (47:55)
That is so amazing. What a great accomplishment. So congratulations on that. I got a copy I'm gonna show you guys and I'm gonna mark some paragraphs and read them with you on my Instagram. But love it. Where can people find you on your social handles?

Dr. Jolene Brighten (48:12)
DR Jolene Brayton all over the internet. I literally live everywhere there. So come

Dr. Kay (48:16)
Yeah.

Dr. Jolene Brighten (48:18)
hang out. And of course we have the Dr. Brayton show, which you can catch us weekly. and that lives on YouTube as well.

Dr. Kay (48:25)
Amazing. Okay, I'd I would love to come on your show and talk about all things beauty and longevity of skin. That's a new topic.

Dr. Jolene Brighten (48:32)
Yeah, we should make it happen.

Dr. Kay (48:34)
Definitely. Well, guys, that's it for now. I hope you learned a ton about ADHD. And don't forget to find me on my Instagram. It's Beauty by Dr. K doing amazing things with people's faces. And our website is the same as beauty by drk.com.

And that's where you can find our new peptide skincare launch. And would love you guys to try some of these ideas to nourish your life. I'm going to leave this conversation with the intention to have more micro pleasures throughout the day. That's it for now, guys. Stay beautiful. Yay.