Bonus Episode: Healing ADHD at the UltraWellness Center

Coming up on this episode of the Dr. Hyman Show. Your brain's not working the way you want. It's hard to have the life you want because your brain drives everything and how it functions drives everything in your life. So whether you can, you know, work or function or be in relationships or feel good, depends on how your brain's working. Now, before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for me to do this at scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real-time lab insights. And if you're in need of deepening your knowledge around your health journey, check out my membership community, the Hyman Hive. And if you're looking for curated and trusted supplements and health products for your health journey, visit my website at drhyman.com for my website store for a summary of my favorite and thoroughly tested products. Hey everyone, it's Dr. Mark Hyman here. Today's episode is something a little different from our usual programming. As a special bonus, we're highlighting one of the incredible doctors from my clinic, the Ultra Wellness Center. And over the next few weeks, we're gonna be sharing a short Friday episode each month featuring an Ultra Wellness Center practitioner diving into how functional medicine tackles real world health issues from fatigue to brain fog, to mold toxicity, cancer metabolism, and lots more. Now, this is a limited series for now, but if you find it helpful, we might offer more like it down the road. If you're interested in learning more, or working with the Ultra Wellness Center team in one of our docs, visit ultrawellnesscenter.com Thanks for listening and I hope you enjoy this bonus conversation. Hey everybody, it's Dr. Hyman. I'm excited to present to you a new way of thinking about chronic disease and all sorts of diagnoses that we get labeled with that are just labels. And what functional medicine does is talk about the root cause. And every day, I get emails, texts, can you help me with this? Can you help me with that? And people are really unhappy with the conventional medicine approach to their issues. What I'm really excited to talk to you about today with my colleague, George Papamichaelow, who is one of the physicians at the Ultra Wellness Center, is a very common problem, which is attention deficit disorder or attention deficit hyperactivity disorder. or ADHD, whatever you want to call it. And this is a problem. Now, when I was a kid, there was that one kid in my class, I think his name was Patty Insworth. I don't remember his name. Who was that troublemaker who had, I'm sure had ADHD, and that was it. Now it's increased from 1% of the population when I was born to 11.4% of kids. That's a big problem. 8% of them are on medication. So why are we having this problem? why is it so prevalent? And rather than just saying, let's medicate it and diagnose it, let's talk about why we've seen this increase and then how do we approach it with a new way of thinking, which is really the, the root cause approach of functional medicine. So I want to introduce you George Papamichael, who is one of the physicians at the Ultra Wellness Center. By the way, if you're listening and you're excited to kind of learn more about what we're doing at the Ultra Wellness Center, you can go to ultrawellnesscenter.com and learn how to become a patient and learn about all the resources we have to help you think through complex chronic disease issues that are not dealt with well by traditional medicine. So welcome, George.

Work, it's always a pleasure. Thanks for having me. I'm so excited to talk about the tension deficit hyperactivity disorder with you today.

This is something that a lot of people struggle with. And when you see an increase of 1,000% in a condition like this, probably 1,100%, if you look at the data, something's going on. And the question is, why are we seeing such an increase in the prevalence of this disease? Is it something that we have to endure and take medications for for the rest of our life? Or is there another way of thinking about it that can address the root causes and help people feel better and address some of the symptoms we're having?

I see every week, probably at least, if I see 16 patients a week, two to three of them have ADHD, either as a primary diagnosis or coming to see me for, or it's something they've struggled with, haven't recognized it, or they have recognized it and never done anything about it. If they've never recognized it, sometimes they're hearing about it for the first time in the office as I go through their case, identify it for them. Why are we having so many cases? Why is it occurring so much more? I do think in this case, there's just a lot more awareness. I do think that there's been Increased screening. I do think the new definitions of what ADHD are have broadened the diagnosis. So in this case, I do think that does play a role.

But it doesn't explain everything. It doesn't, I mean, 1100%, maybe even if it was half, half of those cases were new, new criteria that helped us sort of broaden the criteria to diagnose people. Maybe it's half or even a quarter, but even if it's 200 to 500% increase, it's still crazy.

Yeah, we've talked about this before. We, we both agree that, you know, the diagnostic criteria are, you know, don't account for 400%. But with, you know, but what's going on in our world today, there are some fundamental things about the brain that I think we've all maybe need to be reminded of or maybe understand the brain in a different way. And going back to the idea that there's this hunter farmer theory that our brains are really designed to pay attention to a lot of things, which just, so it's a quick aside, I think that the, the, the, designation, attention deficit hyperactivity disorder is the wrong nomenclature. People with ADHD like me just pay attention to way too many things. And it really comes down to being able to organize that information and being able to recall it and use it and assimilate it very quickly. You know, with some ways we can do that really well. But the brain was really designed to be able to be fast screening, high energy, novelty seeking, creative. That's what you needed to do when you were hunting and gathering. You had to pay attention to everything. And then we had the theory that in the tribal nomadic societies, telling stories, having vision, being able to rapidly adapt was highly valued. And so those folks that had that tendency were actually in invaluable. They had ADHD. But what happened when we started the Industrial Revolution and we had a lot of the Titans of Industry involved in the development of Education at the turn of the century in the industrial age, we created a system that was focused, orderly, routine and valued compliance. that is absolutely terrible for the ADHD brain. So then we start to have more and more kids involved in this one size fits all educational system, and they can't fit into that system. They can't sit and get, right? And so they get, they, and it's mostly boys, but get very hyperactive and fidgety, and the school setting just wasn't right for them. So now you add to that we live in a world with 1P47 you're on. It's your phone, it's your computer, it's text, it's X, it's Facebook, it's Instagram. You're constantly being distracted. In some ways, an ADHD person could thrive in that environment, but in other ways, and this is the dichotomy of ADHD, something that's a real strength Also is a weakness and something that can be a disability. And that's where all of this input, this constant input, they can keep up with it. We can keep up with it, but then it's a matter of organizing it, putting the brakes on the information, putting it into sections in our mental library to recall when we need them. And that gets really difficult. So we have historical evolutionary forces at play. The brain's really designed to be a hunter gatherer. Then when we design educational systems to be a one size fit all, look at a blackboard, no visuals and drone on, very difficult. That's why I think we're seeing more cases.

Well, that may be explaining part of it, George, but I think when we think about the spectrum of brain disorders, whether it's autism or ADD or the fact that one in six kids have some neurodevelopmental issue, there's something else going on. And when you look at the brains of these kids, they have a lot of neuroinflammation. meaning their brains are on fire, whether it's autism or ADD. Now, some kind of level of adaptation to hunter-gatherer way of living required us to have sort of be able to shift focus and do a lot of different things. So there was some adaptation. So some might be a normal evolutionary process, but I would say that a lot of what we're seeing today is because the brain is not working properly, that it's disordered, chaotic, dysfunctional, and that there are ways you can figure out what to do about it rather than just medicate it with Ritalin. is that right?

Oh, yeah. I, I would, I agree. We've talked about this before, so of course, of course I agree with you on that. We, that's what we do here at the, at the ultra Wellness Center. And I agree 100. Yeah. The one point I did want to make in that regard was that the brain does have structures and, and we have these networks that are really important and they're disordered in the ADHD brain. So if you have, if you have ADHD, or even if you don't and you're listening to this podcast and you find yourself trying to get a task done, but you're daydreaming at the same time, you're sort of distracted with other thoughts while you're trying to focus on what you're doing, that's actually a problem because that daydreaming network called the default mode network can be turned off. When you're doing a task, it should be your task positive network. It's fitting right into that. So it's a network, it's a system that gets turned on so you can just pay attention to what you're doing and that's it. But in the HD brains, that toggle switch between daydreaming, egocentric, how's the world affecting me, how do I affect the world, peace, that's, that's toggle switch doesn't turn it off. And when you're trying to do a task, you can't keep. from daydreaming a bit. So it makes what you're doing harder and you have to concentrate harder, you get your work done, you just have to work harder at it.

So there's a spectrum of people who have, you know, sort of normal human biology, right? But there's also a lot of these people who suffer from ADHD who have a lot of things wrong with them, a lot of nutritional deficiencies, gut issues, toxins, and brain inflammation.

And I just wanted to make the point, that the reason why these systems may be disordered include why? Inflammation, nutritional deficiencies, you know, single nucleotide polymorphisms, those variations in your genes that impact how your dopamine and your serotonin and your norepinephrine flow. All of that gets disrupted when you have inflammation, when you have trauma, when you have nutritional deficits, 100% agree.

So, so let's go through this case now that you, you know, have seen at the Ultra Wellness Center where we see a lot of this. And, you know, I wrote a book years ago called the Ultra Mind Solution, and we just have a lot of experience with dealing with people with brains that are not working the way they want. And, you know, if your brain's not working the way you want, it's hard to have the life you want because your brain drives everything and how it functions drives everything in your life. So whether you can, you know, work or function or be in relationships or feel good depends on how your brain's working. And the brain is just part of the rest of the body, and it's influenced by so many factors that are ignored by traditional medicine. So Take us through this case and then let's kind of dive into what you did diagnostically and what therapeutically you did. And then we'll sort of zoom out to talk about, you know, how, how someone's struggling with this. What do they need to think about and search for and look for in terms of diagnosis and treatment?

Yeah, this is a great case because I see a lot, not a lot, a disproportionate number of students. We, you know, we're right outside of Boston and I've had at least four or five students in the last two years that have been brought in by their parents because they're in their freshman year or sophomore year and they're anxious and depressed. They're trying to figure out why my kid's going to Harvard, my kid's going to Boston College, why are they suddenly struggling in school? Why are they suddenly anxious and depressed? And this is the case that will illustrate what goes on. Claire is a 20 year old woman and she came to me She had been struggling with focus and emotional regulation, always feeling overwhelmed and stressed for years. It got worse when she went to college. When she was a child, they thought she might have ADHD, but they decided not to pursue it. They finally did, she was put on a medication. She felt terrible on it.

Stimulants, like Adderall or Ritalin or, yeah.

She was, she was put on Adderall. and she did not like it, so she never used it through school. She happens to be very bright, but she really struggled. And at times she got bullied. She got bullied through elementary school, middle school, and she was oftentimes called dumb and slow. And she wasn't any of those things. She just had a really hard time focusing. Organizing was very difficult for her and she created systems, but she had to work really hard at them. And she felt overwhelmed all the time. But there's a very high standard set for her. So she didn't complain. She put her nose down and she worked at it. And one of the things that the parents commented to me was, he's always fatigued. He's always tired. Well, if you had to work as hard as he did, you're going to be tired at the end of your day. And it's going to be even harder to focus when you try to get your work done. so she struggled through these things. And she also struggled with sleep. Mine was always racing, hard time falling asleep. She would wake up in the middle of the night, oftentimes catastrophizing, and she also would find herself drawn to eating lots of carbohydrates and sugars. We found them stimulating and helpful during the day, and she was drinking more coffee than she should. So basically she was using drugs, using.

Drugs like stimulants, like sugar and caffeine, basically. So she was trying to self-medicate through to food and it helped for a little bit, but it would probably have a big downside for her, right?

It creates the neuroinflammation. It creates the nutritional deficits when you're not getting those things that you need, you're just compounding the problem. So she's just pouring gasoline onto the fire. Typically in conventional medicine, this is what happens. She, parents take her to her local physician before they come to see me. and he wants to put her on an antidepressant and even told her to consider taking a stimulant again. And they didn't want to do that. So they decided to bring her to the Ultra Wellness Center to see me. We're going to now take the functional medicine approach. That we're going to dig, we're going to dive deep and we're going to do what we do. We're going to look for the clues in those, those root causes, those deep dive conditions. and we have all the tools to do that. One, I've seen thousands in my career of patients with ADHD. So I know what to look for, I know questions to ask to find out about lifestyle. Because it all starts with lifestyle. You've got to get lifestyle under control. What does that mean? That means you got to be sleeping, you've got to be exercising, you got to be eating correctly. You have to manage your stress well. and you have to make sure you have good, solid connections and relationship with people. It's very important for people with ADHD. Because connections are important for all of us.

Important for everybody, right? For anybody, those things are just foundational. And the question is like, what else goes on with these people? It's not just fixed by having an optimal lifestyle. 'Cause often these people have a great lifestyle, but they still are struggling. So, and let me just before you dive into the sort of the details, I just wanna point out to everybody that, Functional medicine is the medicine of why, not what. What happens is in traditional medicine, you get a diagnosis, ADHD, and then immediately we have the solution, which is a drug. In functional medicine, we don't do that. We don't stop at the diagnosis. We go, okay, well, we have this diagnosis. What's the cause? What's the why? And so then we have a way of assessing people through a medical history, through lab testing, what the underlying things are that are causing the brain to be so chaotic and dysfunctional. and asynchronous that's driving the symptoms. So tell us now, what did you do diagnostically to figure this out? And what did you find in this, in this patient?

So what we do is we always started the gut because there's a very strong gut-brain connection. And if you have an imbalance of that 100 trillion bacteria in your gut called the microbiome, this very important bacteria have to be in balance because they're really good guys of that group. make things for our brain. They're also engaged in modulating some of the things in our brain. So they make our serotonin, 90% of it, up to 90% comes from the gut. Dopamine metabolism can be altered by bacteria in our gut. It can be altered by our immune function in the gut. So that gut-brain connection is really important because if you have neuroinflammation, I mean, if you have gut inflammation where you have leaky gut, that will trigger the immune system into an inflammatory state or even into a state where it's making antibodies against self tissue. That is going to cause neuroinflammation. It's going to, it's going to activate glial cells or microglial cells. And microglial cells, when they're activated by the, by these gut processes, are going to then result in producing cytokines, which are inflammatory. They could also be balanced out and be anti-inflammatory, but oftentimes when we have this disorder of the gut-brain connection, you're having microbial activation and inflammation.

That's like the immune system in the brain. So basically because the gut is out of balance, it's driving inflammation in the body and that creates inflammation in the brain and you get the activation of.

The brain immune system, which creates a whole sort of brain on fire issue. And so we did a stool test and we also tested Claire or Leaky Gut. And the Leaky Gut test that I use also measures histamine levels in the gut and the enzyme that breaks down histamine levels in the gut. And in her case, she had a mild imbalance of her bacteria, but she had an overgrowth of Candida, which is a yeast or a fungus, probably from the fact that she's eating all that sugar. So that lifestyle of nutrition does play an important role in creating inflammation in the gut. Because now you've allowed Candida to grow. Candida is highly immunogenic, highly inflammatory, and will definitely trigger the immune response and your inflammation we just talked about. But she also had an imbalance where she did not have enough of that enzyme to break down histamine. So there's a chance that she's having histamine levels that are too high. and she's eating high histamine foods. And what that means is histamine can actually cross the blood-brain barrier and there's histamine receptors in the brain. And when that histamine interacts with those receptors, it creates excitation, agitation, and it makes it actually worsen your symptoms of ADHD. She had that as well.

It's like almost like an allergy response. You have this inability to break down a lot of histamine and then it creates an immune response that's almost like an allergy and that affects brain inflammation.

Is what you're saying. Exactly. So, so if you eat high histamine foods, avocado, garlic, onions, citrus fruits and the like, if you, if you're eating those and you can have, you know, in the audience, if you're listening, Google, Google histamine foods, make a list of them and see what happens when you eat them. A lot of people with ADHD say, I get worse. My brain just gets fogged out. I get irritable. I get agitated. So she had that going on. So her right there, if I just started working on that with her, improved her nutrition, got her eating cleaner, healthier foods, stopped having to eat sugars, having more fiber, polyphenols, aged foods right there, she's going to begin to feel a huge improvement.

But you also had to treat her gut, right? Didn't you have to treat her gut like you actually fixed the beast overgrowth and heal the leaky gut.

I put her on a candida protocol. We use antifungals. In her case, I used botanical antifungals, and I gave her a probiotic that actually had the ability to limit histamines in the gut. I gave her a enzyme to use if she was going to eat high histamine foods, and I gave her some glutamine to help clear up and fix the leaky gut. So Candida protocol, leaky gut protocol, a little support to help her digest your. And by the way, these are things.

You won't get at a traditional doctor. And that's, you know, that's really what at the Ultra Wellness Center we focus on is how do we, how do we normalize the function of the body? Hence the word functional medicine. And what you're doing is you're just, you're not treating the disease, you're just getting her gut microbiome healthy, you're getting rid of the yeast, your healing leaky gut and you're helping her with histamine issues that she might have. And that in and of itself can help reduce overall inflammation in the body and in the brain. But you didn't stop there. You went on and did other things. So it's more than just that. Sometimes there's other issues. So talk about some of the other issues like the nutrient issues and the mitochondrial issues that are key to the brain health.

So we then do a pretty big deep dive into you're nutrition, neurotransmitter balance, mitochondrial assessment, and all your nutrients. It's usually in one big test. It can be called an OATs test. Other companies have different names for it.

But you're looking at organic acids.

Organic acids that are products of metabolism. And when we look at those, we can see are those organic acids in the right balance? And if they're not, that's an indicator functionally that particular systems and pathways aren't working correctly. And then we combine that with the nutrient assessment. We combine that with the mitochondrial function and we get a picture. And so in Claire's picture, we found that she had an omega index, omega-3 index was very low. So that means the all-important essential fatty acids, the omega-3s, EPA and DHA that are very important for neuronal function. They're very important for getting neurons to fire correctly. She was very low in omega-3s. Yeah, and 60% of your brain is like omega-3 fats.

And if you don't have that, and it comes from breast milk, comes from wild fish, many people who deficient over 90% are, and it's been linked to bipolar disease, to depression, to ADHD, and you're basically providing this incredibly important fatty acid that's involved in regulating immune system function, inflammation, and neurotransmitter function. Just every level of your biology is regulated by these omega-3 fats. And if she's low, her brain's not gonna be working.

And she was very low. So, and there are studies, particularly with ADHD patients and Omega-3s and doses of upward of four grams per day, suggest that in a large number of people with ADHD, they actually start just increasing their Omegas, they start to see a benefit. I mean, you see a reduction in their distractibility and improvement in focus. and also self regulation of mood. So Omega is very important. On top of that, she had a very low vitamin D. She was deficient. And vitamin D is very important. It's a pro hormone that plays a very important role in mood regulation. And also it's a potent anti-inflammatory itself. And so we needed to increase her vitamin D. She was low in magnesium. Magnesium plays a role in about 300 different very important immune reactions in the body, particularly in the brain. It's very important for methylation, which is a basic chemical process that can turn on neurotransmitters, turn off neurotransmitters, and be involved in their metabolism. And if you're low on magnesium, it's going to impact how dopamine is managed. And dopamine is critical in ADHD. It is the molecule in your frontal lobe. that's responsible for learning, cognition, executive function and planning, and so, and mood regulation. So it's very important that magnesium be at an appropriate level. So we needed to correct that as well. And on that particular organic acids test, we look at metabolites of dopamine and norepinephrine versus were out of balance. So now we had a lot of information. We had low magnesium. we have low omegas and we have now this out of balance dopamine system. So now I'm really beginning to understand a lot here. What we need to do, we need to replace, we need to fix the gut. We need to give her the nutrients like the omegas, the vitamin D, the magnesium. But now this dopamine balance becomes really very important because it's out of balance. And here's one of the things we do. You're definitely not going to be getting at your your local doctor anytime soon. And that's the genetic testing that we do.

Before you jump on that, I just want to double down because I think what you're saying is so important around nutritional issues. Many people are walking around with nutritional deficiencies that they don't really know they have. And one of the things we do at the UltraWellness Center is focus on deep nutritional testing. And we're seeing across the population massive deficiencies in Omega-3s and vitamin D and magnesium and even things like zinc and iron. These are really common and all of these affect the brain. and they're commonly found low in people with ADHD and even things like autism, the whole spectrum of sort of neurodevelopmental or cognitive issues. And so you get a lot of information from the Diagnostics, and then you can use treatments to actually fix it. You can give people Omega-3, you can give people vitamin D, you give people magnesium in the right forms of magnesium. You can give people zinc, iron. All these things are critical in order for the brain to work, because basically nutrients are the helpers for all the chemical reactions for every neurotransmitter you need to make. and if you don't have optimal levels of these, your brain's not going to be working and the rest of your body's not going to be working because everything's connected, right? So it's really important that you found these things and they're easily correctable. So it wasn't just her gut or the yeast issue, but she had like a whole complex of things. And this is the point in functional medicine. It's not just one thing. In medicine, in traditional medicine, it's like single diagnosis, single drug. In functional medicine, we look at the connections and patterns and everything. So we can see the tremendous things that are out of balance that are driving whatever problem we're looking at, whatever it is in functional medicine or in, in health issues that you have, we actually are able to identify those dysfunctions. And that's what you did. You really deep dive with this patient into their biology, and you found so much to treat. And in the treating of that, you weren't treating ADHD. You were just treating the imbalances in her system, in her gut, in nutritional status, her mitochondria, that then helped her to actually have a recovery to set abnormal function. So keep going on, on the next step you were going to talk about.

And again, Mark, as you, we've talked about this before, and you've said and written about and used this term, you know, the issue with the brain isn't necessarily the brain, it's the body. And that's what we put into the body that trigger all of these systems or deprive these systems of what they need to function correctly. So that's what we're doing here. We're fixing the body. we're helping it function the way it was designed to function.

What you also did, and you were about to jump in, was genetic testing. And what is really interesting is in your genome, you can see predispositions. And the way we think about is the environment pulls the trigger, the genes load the gun, right? So you might have predispositions, but you can modify your life, your lifestyle, or supplements to actually optimize your gene expression. And that's what you did with this patient. So tell us about the kinds of genetic testing you did and what you found. how that links up to her diagnosis and how it helped your treatment.

Yeah, this is one of my favorite things to do. I order it on all my patients, but I can't wait to get the results back when I see my ADHD patient because oftentimes the genetics line up almost hand in glove with what they're experiencing in their day to day life in terms of concentration, focus, and just regulation, their inability to read social cues. What we do is we look at these, what we call single nucleotide polymorphisms or these I call them gene blueprints. You have gene blueprints. Your genes are just blueprints for making proteins, most of which are enzymes. Some of them are structural proteins, but that's what these are. They're blueprints. And when God made you, he opened up the file for enzyme X. And when he opens it, there's six different blueprints. We don't know which one he gives you until we look. So we found out, it all depends on what mood he was in that day. He may have gotten a really fast enzyme X, a really slow enzyme X, we don't know until we do this test. So now I can find out there's enzymes that break down dopamine in various parts of the brain. There's enzymes that are responsible for serotonin metabolism. So we look at this and there can be patterns that can be associated or predispose somebody to a certain way of thinking or behaving or experiencing the world. In Claire's case, one of the blueprints I look at is called the CompT. So that COMT blueprint is basically responsible for breaking down dopamine in the prefrontal cortex. Dopamine is critical because it is the neurotransmitter responsible, as I said before, her cognition, learning, focus, attention, planning, which you call executive function and self-regulation of emotion. It plays a big role, although there are other parts of the brain and newer transmitters that do that as well. In her case, her gene breaks down dopamine very slowly. So she's predisposed to having a high level of dopamine in her brain at baseline. which is actually a good thing. And then she has another gene, the MAO gene. It also breaks down dopamine and that one was also working very slow. The, the, the role that goes when it's, and those are really high actually at baseline, you're going to be, your superpower will be the ability to focus and hyper focus. The problem is, is that those two are also involved in the stress response and people with a CMT, what we call met met or slow active slope former. They tend to be anxious, they tend more towards depression, and they tend towards having ADHD. Hey, George, I'm just gonna interrupt you for a sec.

Isn't CMT increasing? She's homozygous, isn't she increasing the breakdown of dopamine? So she has less dopamine.

Homozygous GZ. is fast. Homozygous PP is slow. So she's, so she's, she's met met. Met is slow. That's, that's met met is, yeah, met met and AA are the same and that's slow and she's going to build up her dopamine. So I found that she had the slow, slow form of the CMT gene. Dopamine, we think, is great to be at higher levels in the prefrontal cortex than it is. but it's also part of the fight or flight reflex. And dopamine, in particular, patients like Claire, her dopamine receptors also were impacted. And so the dopamine, when she's in her, if everything's good, she can concentrate, but very little things would set her off. She, if, if, you know, she'd have a phone call, somebody's gonna be late. or she over drew her bank account, or she failed a test, that would disrupt her very quickly. She'd go into fight or flight because her dopamine levels and her norepinephrine levels are already high. They're very close to spilling over. So it doesn't take much to throw her into an anxiety state and a state where she can't focus and concentrate. So we're able to balance that out. And there are ways of doing that. One of the important things is making sure her sleep patterns, her circadian rhythm was in place. So I worked with her to establish a good circadian rhythm, a good circadian pattern. I gave her sleep techniques and rituals, things to do to support circadian rhythm and lock it down all day long. Then we use some supplements that can be very helpful. One of them is called Bacopa Monnieri. So we're not exactly sure.

That's an herb. It's an Ayurvedic herb, right?

We're not exactly sure how this this herb works in the brain, but we note some of the effects is to balance out the dopamine. And we think it does that by actually reducing some of the oxidative stress and inflammation and also in increasing the number of neuronal connections and how quickly they can communicate. And so that seems to have an impact on dopamine levels and can balance that out. And people feel the effect of, hey, I'm calmer, I feel better. And with her particular CMT, she also benefits from another supplement called SAMe. SAMe is a methylation supporting compound, and in people with her particular CMT gene, it can be very mood stabilizing. And it doesn't work for everybody, but in her case, she found a right dose and the SAMe was very helpful in stabilizing her mood. In fact, the Bacopa and the SAMe, she said, had a better effect on her brain than the stimulant. That's amazing.

So basically there are natural products out there that work with the body rather than against it and that can have actually better outcomes in terms of how you feel. And so whether it's SAMe, which is basically a methylating nutrient, we can talk about that in a minute, which is a really important part of brain function, which is all the B vitamins, B12, folate, B6. and this herb seemed to help regulate her, her mood. And she's, because of this gene, she's more prone to anxiety, more prone to being, you know, having more difficulties under stress or any environment because she kind of can't clear the dopamine.

Helping her clear that dopamine, helping her balance it out again, just, you know, love to make this point, is it wasn't just me giving the bacopa and the Sami, it really helped. But that was also in conjunction with her going to sleep at the same time, waking up in the morning at the same time, being more aware of her need for exercise. Exercise was something she didn't do. And that is the first prescription I write for any of my ADHD patients. If you look at the literature and exercise's impact on ADHD, it is the best drug for the ADHD brain. So we improved those things and that really balanced out her dopamine. We also did some mitochondrial testing. you know, it showed up on our OATS test, but we do a very specific test called the MitoSwab that actually looks at the, the, the very detailed function of the mitochondria. The organ in the body that requires the most energy is the brain. Mitochondria are in all your cells. They're the, they're the energy making factory inside your cell. And if they're not functioning correctly, You're not going to produce enough energy. Your cells won't work properly. They'll be, and then if they're not working correctly and making the energy, when they make energy, they produce an oxygen molecule that needs to be removed as water. If that's not happening, you have a buildup of oxygen. It's oxidative stress. That oxygen molecule is like a pinball inside your mitochondria, inside your cell. It can even damage your DNA. we found with Claire that she had a mitochondrial dysfunction where her mitochondria were compensating for excessive oxidative stress. And again, that's something that we can really fix in her DNA, which I did mention earlier, she did have some variations in the genes in an oxidative pathway. So she wasn't very good at removing oxygen. So I gave her some antioxidants. First off, I gave her a handout and all the antioxidants foods that she could eat. Cause I always want my patients to get most of everything they need from the food that they eat. And then I supported that with antioxidants. And in her case, I use alpha lipoic acid and glutathione.

Two very, cause those help the mitochondria too. And they're very potent antioxidants as well.

Yeah.

I mean, it's interesting to bring up the mitochondria because, you know, when you, Suzanne goes a, a, pediatric neurologist, you know, at Harvard, Oxford, she's now pioneered a whole new approach to autism. And she found that looking at very sophisticated brain MRI techniques called functional brain MRIs, she was able to see that these kids have very dysfunctional mitochondria with autism, so they can't make energy. So the brain has an energy deficit. And so essentially what you found with Claire, in addition to the gut issues, in addition to the nutritional deficiencies, in addition to the genetics, she had sort of this underlying energy deficit in her mitochondria, which is making the brain not work properly. So optimizing the mitochondria is also part.

Of the treatment protocol. And as you mentioned, it occurs in autism as well. It's actually a bigger deal in autism than it is in people with ADHD, but it occurs in both. There's a fair amount of crossover between ADHD and autism in the brain. helping this mitochondria function better is always a key part of helping people with their ADHD. She did have some toxins. She had some mold toxins, and she also had a slightly elevated mercury level. Both of them were mild, not enough that I, you know, we decided not to make that a first tier issue. We see how she responded to everything else. We don't want to overwhelm her with too much, but that's why I chose the glutathione and the alpha lipoic acid. for antioxidants because they're also both potent detoxification agents. Alpha lipoic acid can bind a lot and glutathione is your master detoxifying compound. So, I had those guys doing double duty and we were managing her toxins. But one of the things I wanted to mention, it's a mold, mycotoxins, and that's on everybody's mind for whatever reason, whether it's social media, whether it's the news, But it says, the parents saw mold mycotoxins. They were very concerned. Well, the mold mycotoxin is very minimally elevated, and they were ochratoxin zero. Those molds are extraordinarily common in foods. And she was eating a lot of foods that are known to be high in mold, peanut butter being one of them. And so I did have them test their house with the kit, they could buy, you know, to that we recommend that their house tested negative. So it's really important to know that there are toxins in our food and mycotoxins are one of them. But we also have glyphosate, which I measured in her and it was on the lower average side. So not a major concern. Bisphenol is another, you know, toxin that we're going to get in our plastics. Just as an aside, I want to remind everybody, when I'm talking about nutrition, I'm talking about you eat, you've got to filter your water, you've got to eat organically, you have to have a detox plan in your life because we live in toxic soup. Our exposome is huge. So that was a little aside I wanted to make about how toxins get in.

So, George, what you said just now is really important. I want to unpack it. You talked about something called the exposome. And the exposome is basically everything that your biology is exposed to throughout your life from day one. and how that affects every system in your body. So it's what you eat, it's your thoughts, it's exercise, it's sleep, it's stress, it's relationships, it's your microbiome, it's toxins. All the things that we have to deal with affect our biology and we can modify those things. And 90% of chronic disease is caused by the exposome, not the genome. So you might have genetic predispositions, but it doesn't mean you're gonna get the problem unless you set yourself up by having a lifestyle or exposures to toxins that are disrupting your, your your biological function and causing problems with your gene expression. So it's, it kind of was interesting when you're talking about this case, it's not just one thing you're dealing with your gut. You're dealing with your nutritional status. You're dealing with, you know, nutrient deficiencies. You're dealing with neurotransmitter problems and genetics that make that difficult. You're dealing with mitochondrial issues and toxins. And there was one other thing you kind of found in her, which I think is common and interesting, which has.

To do with urine peptides that have.

To do with how we eat certain foods that turn into kind of neurotoxins.

This is a really cool test. This is a urine peptide test. And it basically we're able to measure metabolites of milk proteins and the gluten protein that you find in grains. And when you, you know, there's not an immune response. It triggers an immune response, but it's not immune response. It's how particular people, we find that people with ADHD, with autism, how do they do this more? They, when they break down their milk protein and their gluten protein, they break them down into smaller peptides. These are smaller proteins that are then going to be absorbed into the body. Certain peptides will actually cross the blood brain barrier. And when they do, they have an opiate like impact on the brain that can impact and affect cognition, learning, Focus, you become more distractible because when they, when these come into the brain and hit those receptors, that's the impact. So she had both peptides, she had casimorphin and gludiamorphin. So it's not, and once those, so into the brain, they create inflammation, they get these receptors, and on top of that inflammation, they can alter your ability to cognate and make sense of the world around you. So simple fix, gluten free and dairy free.

So those proteins that are toxic come from eating gluten and dairy, which are often things that trigger brain dysfunction. Not for everybody, but for a lot of people who have brain dysfunction, those are sort of fundamental things that we do. And we, in functional medicine, often will do elimination diets or get rid of certain foods that could be potential triggers. And then you see how you're doing and you can add it back if you're doing okay. But if you see a reaction after you add it back, probably means you shouldn't eat it.

And people are, you know, they're always intrigued by this particular test because they, we do another test to look for the immune response to gluten when we do the gut testing. And that's negative. But when I tell them they have to be gluten and dairy free, they say, why? I say, because of this test. And sometimes it doesn't make a difference. There are some people where even if we make them dairy free and gluten free, they're not noticing any difference when they add those foods back in. in regards to, oh, now they've been off them for six weeks, I'm adding them back in. I don't notice any difference. Or they'll say, I added them back in and boy, I had a really bad afternoon. That's how you can tell if that's a problem.

So this is incredible, George. This is like, this is such a perfect functional medicine case. 'Cause we look at things that no one else is looking at, and we find things that no one else is finding, and then we're able to modify that person's lifestyle, treat the fundamental underlying factors, whether it's gut dysfunction or mitochondrial dysfunction or basically neuroinflammation is caused by foods we're eating and get rid of those foods. And you're able to actually get these people to normal, right? So tell us what happened with Claire, what you did, sort of what the plan was and what happened to her.

One thing with Claire, she had a lot of bullying when she was in middle school, elementary school, middle school. she also had parents, lovely parents, but their parenting style was to use a lot of negative reinforcement. If you don't do this, then that's going to happen. If you do this, then that will happen. They were constantly telling her, if you, if you don't, you won't. And that's really, it's really terrible for a person with ADHD. She said to me at one point when I was talking to her alone, that she was generally one or two negative comments away from tears. So she had a real trauma. She was bullied. It was really hard to get through school. You're a toddler, you don't want to ever go back to school because it was just so hard socially and academically. So there is a I diagnose these patients where I tell them your anxiety and depression are actually sort of separate from your ADHD. They're really symptoms, and they're symptoms of your ADHD, but not directly. They're really symptoms of the trauma you experienced from your ADHD. And so Claire would tell me, if certain things happened in her life, if she didn't get invited to a party, if she didn't get a good grade, if somebody said something negative to her, she just starts spiraling. Her default mode network, she starts ruminating over all these negative things. And then when that happens, she has all this negative self-talk. And when you start to go down that negative self-talk, ruminant pathway that's triggered from trauma, what happens? When you have, you go into fight or flight. And when you go into fight or flight, what gets turned off? Your prefrontal cortex. Because when you're running from the lion, you don't have time to have a philosophical thought conversation with yourself of whether it's a good thing to kill the lion or not. You kill it, you got to get away from it. You can't reason. So your prefrontal cortex gets turned off.

So I, that's the executive function and the adult in the room. And then you just go on total reactivity.

I encourage her to seek out a trauma therapist and consider doing something called eye movement desensitization, repolarization, which is a way of rewriting those voices, rewriting those pathways so that you're not constantly going into that fight or flight because she has a superpower. We know genetically if we can keep her calm and get her out of her own way, she can concentrate. She has the capacity. In the end, with Claire, it was a pretty dramatic turnaround. I would say four months is pretty dramatic. and what we found was, is she had improved her sleep patterns. She no longer was having that racing mind that she couldn't control. I started. She started to meditate. She started to have a sleep ritual that helped turn off that racing thought. The thought mode place much better energy during the day. And more, more importantly, she now had energy at the end of the day to do things she really enjoyed, which in and of itself. started to bring her satisfaction, joy, and contentment. Sugar cravings gone, mood stability no longer easily triggered, depression and anxiety no longer there, and she was doing much better in school. Learning was easier because she had all these tools. Was it perfect? No, but she had tools.

So what's so important about this case is to understand is that this is very personalized. so if you saw 10 people with ADHD, there might be some similarities, but you'll often find different things and need to treat them differently. And this is the whole focus of functional medicine. It's personalized medicine based on your unique biology and what your imbalances are. And even though you might have the same diagnosis as somebody else, you might have very different issues. And in this case, Claire, you know, you did sort of, you sort of did a full assessment. You found all these imbalances, you know, who are Her nutritional status was a problem. She had a crappy diet, lots of sugar. She was eating a lot of gluten and dairy that was affecting her brain through these peptides. She had nutritional deficiencies like magnesium and vitamin D and omega-3 fats and others may have zinc or other deficiencies. She had also downstream effects of mitochondrial issues and oxidative stress and genes that predisposed her to all these problems. And she had terrible gut issues with overgrowth of yeast. And you systematically went and optimized all these systems, right? You put her on a low sugar, gluten-free, dairy-free diet. You got her off the, this gluten-free and dairy-free diet. Got her, not all of these peptides that were causing brain dysfunction. You optimize her gut function by giving her antifungals and probiotics and things to help repair the leaky gut. You gave her support for the nutrients that are really important for methylation, the SAMe and B6 and so forth. And you, you helped her mitochondria and you gave her some herbs and things that helped calm her neurotransmitters down. and it wasn't just one thing. You have to do a lot of things. And this is the whole point of functional medicine. It's not just that you deal with one problem with one drug, which is what traditional medicine does. You look at all the dysfunctions in the body and get those optimized. And when you do that, people get better because you're not treating the ADHD, you're treating all these things that are causing the ADHD. And then you get people better. And this is an incredible system of treatment. And we've been doing this for 20 plus years at the Ultra Wellness Center for A lot of us who were at the practice were working together even for almost a decade before that. So we've got like 30 plus years of experience in this and we've got five of us doing this. So I don't know, five times, almost 150 years of experience in helping people navigate complex chronic issues. And, and George, this was such a great case. It's such a great story because it gives people hope. People don't have to suffer. And I, I think my, my view of what functional medicine can do for people is to help them stop suffering needlessly.

Yeah. And, you know, Mark, the Ultra Wellness Center is the Ultra Hope Center. It's so important that people have hope, right? And that people do come. They come with a high level of expectation and hope because they hear these stories. We've done these podcasts before and they come and they, and they do get better. I was thrilled for Claire and she did a, she did a great job. This can be overwhelming, but she put her nose to the grind because she, she, if she had another superpower, here's the reason she was, it's not resilient. She was on tenacious. She's tenacious. And again, when you have ADHD, it's like the dichotomy of, you know what? I can hyper focus. On the other hand, I forget my keys everywhere. I forget my shoes, but I can hyperfocus, get an enormous amount of work done. I can get really passionate about something, right? But on the other hand, I can become very rigid. I can become very, I'm stuck in a way of thinking that default mode network gets you there. ADHD has all these great superpowers, but on the other edge of the sword, they can have a negative impact. And when you can help somebody move over and create an environment for themselves that utilizes all their superpowers, you're going to change their life. And my final piece of advice to Claire was Claire, find your frontal lobe and marry him.

George, thank you for this incredible story. Everybody listening, if you know somebody with this problem or you have other issues, we're here to help you at the Ultra Wellness Center. Just go to ultra wellnesscenter.com, you can learn more about what we're doing, how to become a patient. and hopefully come see us because we're in a beautiful part of the world in western Massachusetts and we'll do everything we can to help you figure out what's going on and help you get better. So George, thanks a lot for joining us and let's-- It was a pleasure. Yeah, let's really remind ourselves that we have a way to get to the root cause of so many problems and that's what we do at the Ulcer Wound Center. So George, thanks for joining us today.

And we'll see you next time. Thank you, Mark.

It was a pleasure. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to the Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health, where I am Chief Medical Medical Officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness Center at ultrawellnesscenter.com, and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public. So I'd like to express gratitude to sponsors that made today's podcast possible.

Thanks so much again for listening.

Don't forget, there's a way to listen completely ad-free. With Hyman Plus on Apple Podcasts, you can enjoy every episode without any breaks. Just open open Apple podcasts and tap try free to start your seven-day free trial.