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ADHD & How Anyone Can Improve Their Focus — Transcript

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0:00- Welcome to the Huberman lab podcast,
0:02where we discuss science and science-based tools
0:04for everyday life.
0:06[upbeat music]
0:09I'm Andrew Huberman,
0:10and I'm a professor of neurobiology and ophthalmology
0:13at Stanford school of medicine.
0:15Today, we are going to talk all about attention deficit,
0:18hyperactivity disorder, or ADHD.
0:21We are also going to talk about normal levels of focus.
0:25What are normal levels of focus and how all of us,
0:28whether or not we have ADHD or not can improve our ability
0:33to focus our ability to rule out distraction.
0:36It turns out those are two separate things,
0:39as well as remember information better.
0:42We are also going to talk about
0:43how we can learn to relax while focusing,
0:46which turns out to be a critical component of learning new
0:50information and for coming up with new creative ideas.
0:54So whether or not you have ADHD or know someone who does,
0:59or if you're somebody who feels that they do not have ADHD,
1:02but would simply like to improve their ability to focus
1:05or to be more creative.
1:07This episode is definitely for you as well.
1:11We are going to talk about drug based tools
1:13that are out there.
1:14We are going to talk about behavioral tools.
1:17We will talk about the role of diet and supplementation,
1:20and we will talk about new emerging
1:22brain machine interface devices,
1:24things like transcranial magnetic stimulation.
1:27If you don't know what that is, don't worry,
1:29I will explain it to you.
1:30These are non-invasive methods for rewiring your brain
1:34in order to make focusing more natural for you
1:38and to teach you how to increase your depth of focus.
1:41Now, just a quick reminder
1:43that any time we discuss a psychiatric disorder,
1:47it's important that we remember
1:49that all of us have the temptation to self-diagnose
1:52or to diagnose others.
1:54So, as I list off some of the symptomology of ADHD,
1:56some of that symptomology might resonate with you.
1:58You might think, oh, maybe I have ADHD
2:00or you might decide that someone you know,
2:02definitely has ADHD.
2:05However, it is very important that you don't self-diagnose
2:08or diagnose somebody else
2:10the clear and real diagnosis of ADHD
2:14really should be carried out by a psychiatrist, a physician,
2:18or a very well-trained clinical psychologist.
2:21There are clear criteria for what constitutes
2:25full-blown ADHD.
2:27However, many of us have constellations of symptoms
2:31that make us somewhat like somebody with ADHD
2:35and if you're struggling with focus nowadays,
2:36as a lot of people are because of stress,
2:40because of smartphone use,
2:42which turns out can induce adult ADHD.
2:44We'll talk about that.
2:46We'll then pay attention to the symptomology.
2:48You may actually require professional treatment
2:51you might not,
2:52equally important is to remember
2:53that some of the terms that we cover,
2:54like impulse control and attention and concentration
2:58are somewhat subjective and they can change over time.
3:01Sometimes we have a better level of attention than others.
3:05Maybe it depends on how we slept
3:06or other events going on in our life
3:08where something that we're entirely unaware of.
3:10The important thing to remember
3:11is that we can all improve our attentional capacity.
3:15We can all rewire the circuits that make heightened levels
3:18of focus, more accessible to us.
3:21We can do that through multiple types of interventions,
3:24and we are going to cover all those interventions today.
3:27Before we march into the material,
3:29I'd like to remind that this podcast is separate
3:31from my teaching and research roles at Stanford.
3:33It is however, part of my desire and effort
3:35to bring zero cost to consumer information about science
3:38and science related tools to the general public.
3:41And keeping with that theme,
3:42I'd like to thank the sponsors of today's podcast.
3:45Our first sponsor is Roka.
3:47Roka makes eyeglasses and sunglasses
3:49that are of the utmost quality.
3:51I've spent a lifetime working on the visual system
3:54and I can tell you that there are many features
3:55built into our visual system
3:57that allows us to see things clearly,
3:59whether or not we are in shade
4:00or bright sunlight, et cetera.
4:02A lot of sunglasses have the problem
4:04that you have to constantly take them off
4:06and put them back on again,
4:07because of changes in background luminance, as we call it,
4:10Roka, sunglasses have solved this problem.
4:12It doesn't matter if you're standing in tree shade
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4:17you can always see things with perfect clarity
4:19and that shows that they really understand
4:21the way that the visual system works
4:23and their eyeglasses are built accordingly.
4:26I wear readers at night,
4:28so I wear eye glasses to read at night,
4:30or when I drive at night and their readers
4:33and eyeglasses are terrific as well.
4:35One thing I like so much about their eyeglasses
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4:56they have a lot of different styles,
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4:59The company was founded by two All-American swimmers
5:01from Stanford and everything about their sunglasses
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5:07If you'd like to try Roca, you can go to roka.com,
5:09that's R-O-K-A.com and enter the code Huberman
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5:15Today's episode is also brought to us by Belcampo.
5:18Belcampo is a regenerative farm in Northern California
5:21that raises organic grass fed
5:23and finished certified humane meat.
5:26I tend to eat meat about once a day.
5:28So typically I'll fast until about noon or one
5:30and then my lunch consists of a small piece of steak
5:33or chicken and some salad
5:34and then I tend to eat my carbohydrates in the evening
5:37before I go to sleep.
5:38Sometimes and especially lately I'm eating my protein
5:41earlier in the day
5:42because I'm playing around with some of the findings
5:44related to protein intake early in the day.
5:46But regardless, I'm eating meat about once a day.
5:49For me, it's extremely important
5:51that any meat that I consume
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6:33Today's episode is also brought to us by Helix sleep.
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7:56So let's talk about ADHD,
7:58Attention Deficit Hyperactivity Disorder.
8:00Let's also talk about focus and attention
8:03and everybody's ability to focus and attend
8:06not just people with ADHD.
8:08We are also going to talk about tools
8:10that would allow anyone,
8:11whether or not they have ADHD or not
8:13to enhance their level of concentration and focus.
8:18Now, ADHD used to be called ADD Attention Deficit Disorder.
8:24We have record of ADD in the medical literature
8:27dating back to as early as 1904.
8:30Now there's nothing special about 1904.
8:32That's just the first time that it showed up
8:34in the standard medical literature.
8:36We have to believe that ADD,
8:39which we now call ADHD existed before 1904
8:43and probably long before 1904, why?
8:47Well, because it has a strong genetic component.
8:50If you have a close relative that has ADHD,
8:53there's a much higher probability that you will have ADHD
8:57and that probability goes up depending on how closely
9:00related to that person you happen to be.
9:02So for instance,
9:02if you're an identical twin and your twin has ADHD,
9:06there's a very high concordance as we say,
9:09a very high probability that you will have ADHD
9:12up to 75% chance.
9:15If you have a fraternal twin with ADHD,
9:17that number goes down a bit in the 50 to 60% range
9:20and so on.
9:21If you have a parent with ADHD,
9:23that number ranges anywhere from 10 to 25% likelihood,
9:26that you will have ADHD if you have two parents
9:28and so on and so on, okay?
9:30So there's a genetic component
9:31that genetic component it turns out,
9:33relates directly to how specific neural circuits
9:36in the brain wire up,
9:37the chemicals they use and the way they use those chemicals,
9:41a topic that we are going to discuss in depth today.
9:45Now, if you have a close relative with ADHD,
9:48that does not mean that you are faded to have ADHD
9:51and if you happen to have ADHD,
9:53there are ways to overcome those symptoms
9:56of lack of attention, impulsivity and so on.
10:00Another important point about ADHD
10:03is that it has nothing to do with intelligence,
10:06whether or not we're talking about intelligence
10:08measured by a standard IQ test
10:10a rather controversial issue as many of you probably know,
10:13there are lots of forms of intelligence
10:15that a standard IQ test just wouldn't pick up
10:18emotional intelligence, musical intelligence,
10:20spatial intelligence, all sorts of intelligences.
10:24None of them are related to ADHD.
10:27Being very high functioning doesn't make you
10:29more likely to have ADHD and being ADHD
10:33doesn't necessarily mean that you have a low IQ.
10:35So there are people with ADHD who have low IQs
10:37people with ADHD with high IQ,
10:39people with ADHD with high emotional IQ or with low IQ
10:43in the emotional scale, it's all over the place.
10:46The important point is that your ability to attend and focus
10:50does not relate to how smart you are or your IQ of any type,
10:55not just a standard IQ.
10:57The renaming of the ADD to ADHD took place
11:00in the mid to late 1980s
11:03when the psychiatric community
11:05and the psychological community
11:06started taking better notice of the fact that
11:10so-called hyperactive kids also had attentional issues.
11:14This might seem obvious,
11:16but there's been extensive and ongoing revision
11:19of the criteria for designating a psychiatric disorder
11:23and this is still an ongoing process even today.
11:27So in the mid eighties,
11:28we started hearing about ADHD
11:30and then gradually that term ADD has been dropped away.
11:33However, just the renaming of ADD to ADHD
11:38has led to much better diagnosis and detection of ADHD.
11:44So right now the current estimates are that
11:46about one in 10 children and probably more have ADHD.
11:53The current estimates are anywhere from 10%, one in 10
11:56to as high as 12%.
11:58Now, fortunately about half of those
12:00will resolve with proper treatment,
12:03but the other half typically don't.
12:05The other thing that we are seeing a lot nowadays
12:08is increased levels of ADHD in adults
12:13and there's some question as to whether or not
12:15those adults had ADHD that went undetected
12:18during their childhood or whether or not
12:21ADHD is now cropping up in adulthood
12:24due to the way that we are interacting with the world
12:26in particular smart phone use,
12:30the combination of email, text, real-world interactions,
12:35multiple apps and streams of media and social media
12:39all coming in at once trying to manage life.
12:42All of the things that are going on
12:44are creating a kind of cloud of poles on our attention
12:49and so there is this question to whether or not
12:51we are creating ADHD in adults that never had ADHD
12:56prior to being an adult.
12:59So let's talk about attention
13:00and first let's just define what we mean by attention
13:03out there in the scientific literature
13:05and in discussions about ADHD,
13:08we will hear things like attention and focus
13:10and concentration and impulse control
13:13for sake of today's discussion,
13:15attention, focus, and concentration
13:17are essentially the same thing, okay?
13:20We could split hairs and the scientific literature
13:22does split hairs about these.
13:23But if we want to understand the biology
13:25and we want to have
13:26a straightforward conversation about ADHD,
13:29if I say attention or focus,
13:31I'm basically referring to the same thing,
13:33unless I specify otherwise, okay?
13:36So people with ADHD have trouble holding their attention.
13:41What is attention?
13:43Well, attention is perception.
13:46It's how we are perceiving the sensory world.
13:50So just a little bit of neurobiology 101,
13:52we are sensing things all the time.
13:54There's information coming into our nervous system
13:56all the time.
13:57For instance, right now you're hearing sound waves.
13:59You are seeing things,
14:00you are sensing things against your skin,
14:02but you're only paying attention to some of those
14:05and the ones that you're paying attention to
14:08are your perceptions.
14:09So if you hear my voice, you are perceiving my voice.
14:12You are not paying attention to your other senses
14:15at the moment, okay?
14:17You might even be outside in a breeze
14:18and until I said that,
14:19you might not be perceiving that breeze,
14:21but your body was sensing it all along.
14:25So attention and focus are more or less the same thing,
14:28but impulse control is something separate because impulse
14:31control requires pushing out or putting the blinders on
14:35to sensory events in our environment.
14:38It means lack of perception,
14:40impulse control is about limiting our perception.
14:44People with ADHD have poor attention
14:47and they have high levels of impulsivity
14:50they're easily distractable.
14:52But the way that shows up is very surprising.
14:55You might think that people with ADHD
14:58just simply can't attend anything.
15:00They really can't focus,
15:01even if they really want to, but that's simply not the case.
15:05People with ADHD yes, they are distractable.
15:09Yes, they are impulsive.
15:12Yes, they are easily annoyed
15:13by things happening in the room.
15:15They sometimes have a high level of emotionality as well.
15:18Not always, but often
15:20however people with ADHD can have a hyper focus
15:24and incredible ability to focus
15:27on things that they really enjoy
15:29or and are intrigued by.
15:31Now, this is a very important point
15:33because typically we think of somebody with ADHD
15:37as being really wild and hyperactive,
15:40or having no ability whatsoever to sit still and attend
15:43and while that phenotype as we call it
15:46that contour of behavior and cognition can exist,
15:52many people, if not all people with ADHD,
15:55if you give them something they really love,
15:57like if the child loves video games
15:59or if a child loves to draw,
16:01or if an adult loves a particular type of movie
16:05or a person very much, they will obtain laser-focus
16:10without any effort.
16:11So that tells us that people with ADHD
16:14have the capacity to attend,
16:16but they can't engage that attention
16:19for things that they don't really, really want to do
16:22and as we all know much of life,
16:24whether or not you're a child or an adult
16:26involves doing a lot of things that we don't want to do,
16:28much of our schooling involves doing things
16:30that we would prefer not to do
16:32and sort of forcing ourselves to do it, to attend,
16:35even though we are not super interested
16:37in what we are attending to.
16:39There are a couple other things
16:40that people with ADHD display quite often.
16:43One is challenges with time perception.
16:47Now time perception is a fascinating aspect
16:50of how our brain works
16:51and later we're going to talk about time perception
16:53and how you can actually get better at time perception.
16:56It's very likely that right now you are doing things
16:58that get in the way of optimal time perception
17:02and I will tell you how to adjust your ability
17:05to measure time with your brain.
17:09People with ADHD often run late.
17:12They often procrastinate,
17:14but what's interesting and surprising
17:15is that if they are given a deadline,
17:17they actually can perceive time very well
17:20and they often can focus very well
17:23if the consequences of not completing a task
17:26or not attending are severe enough.
17:28It's a little bit like the way that people with ADHD
17:31can really focus if they like something.
17:34Well, if they're scared enough about the consequences
17:36of not attending, oftentimes not always,
17:39but oftentimes they can attend.
17:42If they're not really concerned about a deadline
17:44or a consequence,
17:46well, then they tend to lose track of time
17:48and they tend to underestimate how long things will take.
17:52Now many people do that, not just people with ADHD,
17:55but people with ADHD have challenges,
17:58understanding how to line up the activities of their day
18:02in order to meet particular deadlines
18:04even if it's just a simple thing,
18:06like finishing one set of tasks before lunch,
18:10oftentimes they will remember that lunch starts at noon,
18:13but somehow they aren't able to fill the intervening time
18:16in a way that's productive
18:19and they can obsess about
18:20the upcoming deadline for instance,
18:22we will talk about how to remedy this.
18:25In addition,
18:25their spatial organization skills are often subpar,
18:30not always, but often you will find that somebody with ADHD
18:34uses what's called the pile system
18:37in order to organize things,
18:39they will take many belongings
18:41and this could be in the kitchen or in their bedroom
18:43or in their office or in any space
18:46and they will start piling things up
18:48according to a categorization system
18:50that makes sense to them and only them.
18:52It doesn't really have any logical framework.
18:55Now, many people use the pile system
18:57and if you use the pile system,
18:58that doesn't mean that you have ADHD
18:59in fact, if you're unpacking a house
19:01or you've moved recently,
19:03or you've received a lot of presence recently,
19:05the pile system makes perfect sense to organize your space.
19:09But people with ADHD tend to organize things
19:12according to the pile system all the time
19:14and that pile system doesn't work for them.
19:17Okay, so that's the key distinction
19:18that they use a filing system, and it's not really files,
19:21they're piling things up in a way that makes sense to them,
19:24but then it doesn't work for them in terms of what tasks
19:27they actually need to perform.
19:29They can't find things
19:30or if anyone moves one thing then it's very disruptive
19:33to their overall plan because their overall plan
19:35doesn't really work in the first place.
19:38So that's a common phenotype as we call it.
19:41A phenotype by the way,
19:42is just an expression of a particular set of underlying
19:47genetic or psychological components, okay?
19:51So we say the phenotype.
19:52So a phenotype can brown hair and green eyes,
19:55like for me,
19:56a phenotype could also be
19:57that somebody uses the piling system, okay?
20:00The other thing that people with ADHD have real trouble with
20:04is so-called working memory.
20:06Now you might think that people with ADHD
20:08would have really poor memories,
20:09but in fact, that's not the case.
20:11People with ADHD often can have a terrific memory
20:14for past events,
20:16they can remember upcoming events quite well.
20:19Their memory is clearly working.
20:21However, one aspect of memory in particular
20:23that we call working memory is often disrupted.
20:26Working memory is the ability to keep
20:28specific information online,
20:30to recycle it in your brain over and over again,
20:33so that you can use it in the immediate or short term.
20:36A good example of this would be you meet somebody,
20:39they tell you their name,
20:40they give you their phone number verbally,
20:42and you have to walk back to your phone
20:43and enter it into your phone.
20:46People without ADHD might have to put some effort into it,
20:49it might feel like a bit of a struggle,
20:50but typically they will be able to recite that phone number
20:53in their mind over and over, and then put into their phone.
20:55People with ADHD,
20:56tend to lose the ability or lack the ability
21:00to remember things that they just need to keep online for
21:03anywhere from 10 seconds to a minute or two, okay?
21:07So a string of numbers like 6, 4, 3, 7, 8, 1 for most people
21:11would be pretty easy.
21:126, 4, 3, 7, 8, 1, 6, 4, 3, 7, 8, 1,
21:14you could probably remember that a minute from now
21:17without writing it down.
21:18But if you add one more number to that 6, 4, 3, 7, 8, 1, 3,
21:23it gets tougher, okay?
21:25So there's a reason why phone numbers typically have
21:28seven digits in them, of course, there's an area code,
21:31but remembering information that strings out longer
21:35than seven numbers or a sentence or two
21:39that's challenging for most people,
21:41people with ADHD have severe challenges,
21:43even with much smaller batches of information
21:46over even much smaller batches of time.
21:49Deficits in working memory are also
21:51something that we see in people who have
21:52frontotemporal dementia,
21:54so damage to the frontal lobes
21:56or age-related cognitive decline
21:59and so it will come as no surprise that later
22:01when we discuss treatments, supplements,
22:04and other tools for ADHD,
22:07that many of those treatments,
22:08supplements and tools for ADHD are similar to the ones
22:11that work for age-related cognitive decline.
22:15Okay, so we've more or less established
22:19the kind of menu of items that people with ADHD tend to have
22:23some have all of them.
22:24Some have just a subset of them.
22:26Their severity can range from very intense to mild,
22:31but in general,
22:32it's challenges with attention and focus,
22:35challenges with impulse control, they get annoyed easily.
22:38They have kind of an impulsivity,
22:39they can't stay on task.
22:41Time perception can be off,
22:44they use the piling system
22:45or a system that doesn't work well for them
22:48in order to organize their things in physical space
22:52and they have a hard time with anything that's mundane
22:54that they're not really interested in.
22:56But again, I just want to highlight that people with ADHD
22:59are able to obtain heightened levels of focus,
23:02even hyper-focus for things that are exciting to them
23:05and that they really want to engage in.
23:07So now you have the contour of what ADHD is,
23:10and if you're somebody who doesn't have ADHD,
23:12you should also be asking yourself which aspects of ADHD
23:16are similar to things I've experienced before.
23:20Because what we know about the healthy brain
23:24is that there's also a range of abilities to focus.
23:27Some people focus very well on any task.
23:29You give them a task, they can just laser in on that task.
23:33Other people that have to kind of fight an internal battle,
23:36they have to convince themselves
23:37that it's important or interesting.
23:39They have to kind of incentivize themselves internally.
23:42Other people doesn't matter,
23:45they could be bored to tears with the information,
23:47but they can do it just because they are,
23:50"Very disciplined people."
23:51We tend to admire those people
23:53but as you'll see a little bit later,
23:54it's not clear that that's the best way
23:56to run your attentional system.
23:57There might be something to this business
23:59of having heightened levels of attention
24:02for the things that you are
24:03most interested or excited by.
24:07So let's drill into this issue of why people with ADHD
24:10actually can focus very intensely on things that they enjoy
24:14and are curious about.
24:16Now, enjoyment and curiosity are psychological terms,
24:21they're not even really psychological terms.
24:22They're just the way that we describe our human experience
24:25of liking things, wanting to know more about them.
24:28But from a neuro-biological perspective,
24:31they have a very clear identity and signature
24:34and that's dopamine.
24:36Dopamine is released from neurons,
24:38it's what we call a neuromodulator
24:41and as a neuromodulator it changes the activity
24:44of the circuits in the brain,
24:45such that certain circuits are more active than others
24:49and in particular,
24:50dopamine creates a heightened state of focus.
24:54It tends to contract our visual world
24:57and it tends to make us pay attention to things
25:00that are outside and beyond the confines of our skin.
25:04That's what we call exteroception.
25:06Dopamine also tends to put us in a state of motivation
25:10and wanting things outside the confines of our skin.
25:14So whether or not we're pursuing something
25:16physical in our world,
25:17or whether or not we're pursuing information
25:19in our outside world,
25:21dopamine is largely responsible for our ability
25:24and our drive to do that.
25:27But dopamine as a neuromodulator is also involved
25:30in changing the way that we perceive the world.
25:34So, as I mentioned earlier
25:35you have all these senses coming in
25:37and you can only perceive some of them
25:39because you're only paying attention to some of them.
25:41Dopamine when it's released in our brain
25:45tends to turn on areas of our brain
25:47that narrow our visual focus
25:50and our auditory focus,
25:51so it creates a cone of auditory attention,
25:54that's very narrow,
25:55creates a tunnel of visual attention that's very narrow.
25:58Whereas when we have less dopamine,
26:00we tend to view the entire world,
26:02we tend to see the whole scene that we are in,
26:04we tend to hear everything all at once.
26:07So as I describe this,
26:09hopefully you're already starting to see and understand
26:12how having dopamine release can allow a person,
26:17whether or not they have ADHD or not
26:20to direct their attention to particular things
26:22in their environment, all right?
26:24So now what we're doing is we're moving away from attention
26:27as this kind of vague ambiguous term,
26:30and we're giving it a neurochemical identity dopamine,
26:33and we are giving it a neural circuit identity
26:36and just to put a little bit of flavor and detail
26:39on which neurocircuits those are,
26:41I want to discuss two general types of neurocircuits
26:44that dopamine tends to enhance.
26:46So let's talk neurocircuits
26:48and for those of you that love hearing neuroscience,
26:51nomenclature, you're going to eat this part up
26:54and for those of you that don't like a lot of names
26:56of brain areas I invite you to tune out
26:59or just try and grab the top contour of this.
27:01I will describe it in pretty general terms,
27:03but I will give some detail because I know there are
27:06some of you out there who really want to dig deeper into
27:08what the exact structures and connectivities are, okay?
27:12So there are two main types of circuits that
27:15we need to think about with respect to ADHD,
27:17attention and dopamine.
27:19The first one is called the default mode network.
27:22The default mode network is the network of brain areas
27:25in your brain and my brain and in everybody's brain
27:28that is active when we're not doing anything
27:31when we're just sitting there idle at rest.
27:34Now it's very hard to not think about anything,
27:36but when you're not engaged in any type of specific task,
27:39so you're not driving, you're not playing a video game,
27:42you're not trying to study, you're not trying to listen,
27:44you're just sitting there letting your brain
27:46kind of go wherever it wants to go.
27:48Your default mode network underlies that state of mind.
27:54The other set of circuits that we're going to think about
27:56and talk about with respect to ADHD are the task networks,
28:01the networks of the brain that make you goal oriented,
28:04or that are at least trying to make you goal oriented
28:08and those are a completely different set of brain areas.
28:11However, the default mode network
28:14and these tasks networks are communicating with one another
28:18and they're doing that in very interesting ways.
28:21So first I want to describe how these two
28:23sets of brain areas,
28:25the default mode network
28:26and the task networks normally interact, okay?
28:29So little bit of naming here
28:31again feel free to ignore it
28:32if you don't want this level of detail,
28:34but the default mode network includes
28:38an area called the dorsolateral prefrontal cortex,
28:41frontal cortex, no surprises in the front
28:43and you have a dorsal, the top
28:45and side lateral part dorsolateral, prefrontal cortex.
28:49You got one on each side of your brain, right?
28:51And then you have a brain area called
28:52the posterior cingulate cortex
28:54and then you have an area called the lateral parietal lobe.
28:57Again, you don't need to remember these names for,
28:58these are three brain areas that normally
29:01are synchronized in their activity.
29:03So when one of these areas is active in a typical person,
29:06the other areas would be active as well.
29:08So it's a little bit like a symphony or a band
29:10like a three-piece band is like drums, guitar,
29:13and bass they're playing together, okay?
29:16That's how it is in a typical person
29:17and in a person with ADHD,
29:19or even a person who has subclinical ADHD
29:22or in any human being who hasn't slept well,
29:26what you find is the default mode network
29:27is not synchronized.
29:29These brain areas are just not playing well together.
29:32Now the task networks include a different set of structures.
29:37It still involves the prefrontal cortex,
29:39but it's a different part of the prefrontal cortex, okay?
29:42Tends to be the medial prefrontal cortex
29:45and there are some other brain areas
29:47that the medial prefrontal cortex is communicating to
29:49all the time, mainly to suppress impulses.
29:53It's shutting down the desire to stand up
29:56or to scratch the side of your cheek or your nose,
29:58if you're trying not to do that,
29:59anytime you're restricting your behavior,
30:01These task directed networks are very active, okay?
30:06Now normally in a person without ADHD,
30:10the task networks and the default mode networks
30:14are going in kind of Seesaw fashion,
30:15they are actually what we call anti-correlated.
30:18So it's not just that they are not correlated,
30:20they're actually opposing one another
30:22they are anti-correlated.
30:25In a person with ADHD,
30:26the default mode networks and the tasks networks
30:29are actually more coordinated.
30:31That might come a surprising,
30:33I think that we all have this tendency
30:35to kind of jump to conclusion and assume that somebody
30:39who doesn't have an easy time paying attention or has ADHD,
30:42that their brain must be completely incoherent
30:45that it's not working well
30:46and because everything's out of whack,
30:49but there's something interesting about people with ADHD
30:51whereby the task networks and the default mode networks
30:56are actually working together in a way that's correlated
30:59and that is what's abnormal.
31:01So this would be like the guitar bass and the drums
31:05playing together in a way where
31:07the bass isn't keeping the backbeat and the drums,
31:10aren't keeping the backbeat that they're playing together,
31:13they're all playing the melodies and harmonies
31:14in a way that just doesn't sound right.
31:17That's what's going on in the brain of somebody with ADHD
31:21and we can now confidently say
31:23based on brain imaging studies,
31:24that when somebody gets better,
31:26when they're treated for ADHD or when they age out of ADHD,
31:30as sometimes it's the case that the default mode networks
31:34and the task networks tend to become
31:36anti-correlated again, okay?
31:38So that's the underlying neurobiology,
31:41but you'll notice that I didn't mention dopamine at all.
31:44What dopamine is doing in this context
31:47is dopamine is acting like a conductor.
31:50Dopamine is saying this circuit should be active
31:52then that circuit should be active.
31:54It should be default mode network
31:55and then when the default mode network is not active,
31:57then it should be the task network.
31:59So it's really acting as a conductor saying, you go,
32:01now you go, now you go, now you go.
32:03And in ADHD,
32:04there's something about the dopamine system
32:06that is not allowing it to conduct these networks
32:10and make sure that they stay what,
32:13the engineers or physicists or mathematicians would say
32:15out of phase to be anti-correlated, okay?
32:18Out of phase and anti correlate, essentially the same thing,
32:21at least for purposes of this discussion.
32:23So that raises two questions,
32:25could it be that dopamine is not at sufficiently high levels
32:30or could it be that dopamine is just doing it all wrong?
32:33In other words,
32:34is there no conductor or is the conductor playing with like
32:36little tiny toothpicks
32:37and so the instruments can't see
32:39what they're supposed to do.
32:41They can't get the instruction
32:42'cause it's just not loud enough, so to speak,
32:45or could it be that the information is getting out,
32:47but the information that's getting out is wrong,
32:49the conductor's there,
32:50but the conductor is in very good at conducting.
32:54Now we can gain insight into how the system works
32:57and fails and how to treat it
33:00by looking at some of the current
33:01and previous treatments for ADHD,
33:04as well as some of the recreational drugs
33:06that people with ADHD tend to pursue and like
33:09now I'm certainly not a proponent of people with ADHD
33:12taking drugs recreationally,
33:14that's not what this is about,
33:15but if you look at their drug seeking behavior
33:18and you couple that drug seeking behavior
33:21to their desire to remedy their attention deficit,
33:25you start gaining some really interesting insight
33:28into how dopamine is regulating these circuits
33:31in normal circumstances and in people with ADHD.
33:35So what exactly is going on with the dopamine system,
33:38in people with ADHD
33:40and what's going on with the dopamine system
33:42in people that have terrific levels of attention
33:44for any task?
33:46Well, in the year 2015, an important paper came out.
33:51The first author is Spencer,
33:52and it came out in a journal called Biological Psychiatry,
33:55and it formalized the so-called
33:57low dopamine hypothesis of ADHD.
34:01The idea that dopamine was somehow involved
34:04or not at the appropriate levels in people with ADHD
34:07had been around for a pretty long time,
34:09but a formal proposition of the low dopamine hypothesis
34:14led to some really important experiments and understanding
34:17of what goes wrong in ADHD.
34:20It turns out that if dopamine levels are too low
34:24in particular circuits in the brain,
34:27that it leads to unnecessary firing of neurons in the brain
34:31that are unrelated to the task that one is trying to do
34:35and that is unrelated to the information
34:37that one is trying to focus on.
34:39So if you think back before you've got this
34:41default mode network and a task-related network,
34:44and they need to be in this kind of concert of
34:46anti-correlation and an ADHD they're firing together.
34:50Well, the problem seems to be that when dopamine is low,
34:55certain neurons are firing when they shouldn't be,
34:57this is like a band, right?
34:59We'll go back to our band, that's a guitar bass in it,
35:01and the person playing the drums
35:03and it's as if one of those or several of those instruments
35:06are playing notes when they shouldn't be playing, right?
35:09The pauses and music are just as important
35:12as the actual playing of notes.
35:15When dopamine is too low neurons fire,
35:19more than they should in these networks
35:20that govern attention.
35:23This is the so-called low dopamine hypothesis
35:26and if you start looking anecdotally
35:29at what people with ADHD have done for decades,
35:33not just recently since the low dopamine hypothesis
35:36has been proposed,
35:38but what they were doing in the 1950s and then the 1940s
35:41and the 1960s.
35:42What you find is that they tend to use recreational drugs,
35:48or they tend to indulge in non drug stimulants.
35:53So things like drinking, six cups of coffee
35:57or quadruple espressos,
35:59or when it was more prominent
36:01smoking a half a pack of cigarettes
36:03and drinking four cups of coffee a day
36:05or if the person had access to it
36:08using cocaine as a recreational drug
36:10or amphetamine as a recreational drug.
36:12All of those substances that I just described
36:15in particular cocaine and amphetamine,
36:17but also coffee and cigarettes
36:20increase levels of multiple neurotransmitters,
36:23but all have the quality of increasing levels
36:26of dopamine in the brain and in particular,
36:29in the regions of the brain that regulate attention
36:31and these task related and default mode networks okay?
36:35Now young children,
36:36fortunately don't have access to those kinds of stimulants
36:39most of the time
36:41and those stimulants all have high potential
36:44for abuse in adults.
36:46So we will talk about the potential for abuse
36:48in a few minutes.
36:49But if you look at children,
36:51even very young children with ADHD,
36:54they show things like preference for sugary foods,
36:57which also act as dopamine inducing stimulants.
37:01Now, of course, once they get access to soda pop
37:05and coffee and tea,
37:07they start to indulge in those more than other people.
37:10For a long time,
37:10it was thought that children with ADHD
37:12consumed too many sugary foods or drank too much soda
37:15or adults with ADHD
37:18would take recreational drugs like methamphetamine
37:20or cocaine or would drink coffee to excess
37:24or smoke cigarettes to excess
37:25because they had poor levels of attention
37:28and because they couldn't make good decisions,
37:31they were too impulsive and so forth
37:33and while that certainly could be the case,
37:35knowing what we now know about dopamine,
37:37and the fact that having enough dopamine is required
37:41in order to coordinate these neural circuits
37:43that allow for focus and quality decision-making
37:47an equally valid idea is that these children
37:51and these adults are actually trying to self-medicate
37:53by pursuing these compounds, right?
37:56Things like cocaine lead to huge increases in dopamine.
37:59Well, what happens was when somebody with ADHD
38:01takes that drug,
38:03it turns out they actually obtain
38:05heightened levels of focus,
38:07their ability to focus on things
38:08other than things they absolutely care
38:11intensely about goes up,
38:13likewise, children who consume anything
38:16that increases their levels of dopamine,
38:18if those children have ADHD, they tend to be calmer,
38:23they tend to be able to focus more.
38:25Now, this is very different than children
38:28who do not have ADHD.
38:29When they consume too much sugar,
38:30they tend to become super hyperactive.
38:33When they consume any kind of stimulant,
38:34they tend to go wild and run around like crazy.
38:37Actually, I have an anecdote about this
38:38just to illustrate it.
38:40I have a friend,
38:41he has two children that are now in their teens
38:44and twenties, but when they were little,
38:45one time, I brought them some chocolate just as a gift,
38:48when I showed up at their house and within 30 minutes,
38:51the kids were running around like crazy
38:53I mean they were pretty high energy kids,
38:56but they were going bonkers
38:57and that's actually when the mother, my friend at the time,
39:01unfortunately, still now looked at the chocolate,
39:03realized that it was chocolate with espresso beans in it.
39:06It was like dark chocolate with espresso beans
39:07so I was really at fault there,
39:09you don't want to give kids dark chocolate
39:10with espresso beans,
39:11but what you're really seeing that hyperactivity
39:13that is dopamine, okay?
39:15It's the sugar combined with the caffeine in this case,
39:18combined with a few other compounds that exist in chocolate,
39:21that really increase our levels of alertness
39:23and our tendency to want to move around a lot, okay?
39:27So dopamine and low levels of dopamine
39:31apparently are what's wrong in people with ADHD,
39:34that dopamine hypothesis
39:36is what led to the idea that treating people,
39:39children and adults included with dopaminergic compounds
39:44would somehow increase their ability to focus
39:48and if you look at the major drugs that were developed
39:51and now marketed by pharmaceutical companies
39:54for the treatment of ADHD,
39:56those drugs have names like Ritalin.
39:59Nowadays, it's typically things like Adderall, Modafinil
40:04and some of the other derivatives,
40:06they all serve to increase levels of dopamine
40:09in particular dopamine in the networks
40:11that control task directed behavior,
40:13and that coordinate the default mode network
40:16and these task-related networks.
40:18So many of you have probably heard of Ritalin.
40:20Ritalin is a prescription stimulant that is
40:24prescribed for ADHD as well as for narcolepsy.
40:28Narcolepsy is a condition
40:30in which people tend to fall asleep
40:32during the day time, quite a lot,
40:33excessive daytime sleepiness,
40:35not due to lack of sleep at night,
40:37but also tend to fall asleep when they get excited,
40:39if they're really emotionally excited or about to eat
40:42or any other kind of activity that
40:44would normally get somebody really aroused and alert
40:47people with narcolepsy tend to fall asleep,
40:49or they tend to become what's called cataplectic.
40:51They tend to just sort of go limp in the muscles.
40:54So it's this invasion of sleep into the daytime.
40:57It's dysregulated by emotion.
40:59You can imagine why a stimulant,
41:00something that would wake you up, make you very alert,
41:03focused and motivated
41:04would be a good treatment for narcolepsy.
41:07Adderall also is used to treat ADHD and to treat narcolepsy
41:13things like Modafinil
41:15also used to treat ADHD and narcolepsy.
41:18So you're sensing a theme here.
41:19So what are the differences and similarities
41:22between these drugs
41:23and what can that tell us about ADHD?
41:25Well, Ritalin was one of the first-generation drugs
41:29that was prescribed for ADHD in order to deal head on
41:34with this dopamine hypothesis.
41:36This idea that in ADHD, dopamine levels are too low.
41:40Nowadays, Adderall is the more typically prescribed drug
41:43for ADHD that has to do
41:45with some of the so-called pharmacokinetics,
41:47the rate at which those drugs enter the system
41:50and how long they last in the system.
41:52So for instance,
41:53Ritalin was a drug that was packaged
41:56into various time-release formulas.
41:58Whereas initially Adderall was only released in a form that
42:02had a very short life,
42:03So meaning that it wasn't in the bloodstream very long
42:07and didn't affect the brain for very long
42:08and so the dosages could be controlled in a more typical way
42:13without going into a lot of tangential detail.
42:15As you all know, at different times of day,
42:18you tend to be more or less alert.
42:19So a long sustained release drug
42:22while that might sound like a really terrific thing.
42:24If that drug is having an effect
42:26of making you more alert
42:27and it's released across very many hours of your day,
42:31there might be periods of your day
42:32when you feel too alert,
42:34periods of your day,
42:35when you feel just right and periods of your day,
42:37when you wished that you were more alert.
42:39These are some of the pharmacokinetics, kinetics,
42:42meaning movement of the different compounds
42:44within the bloodstream and brain that could,
42:46you could imagine in a very real way,
42:48would impact whether or not someone would feel really good
42:50on one of these drugs or whether or not
42:52they would feel too anxious or too sleepy and so on.
42:56Let's take a step back for a second and just ask,
42:57what are these drugs?
42:59We know they increase dopamine,
43:01but what are they really?
43:03Well, Ritalin also called methylphenidate
43:07is very similar to amphetamine speed,
43:11or what's typically call speed
43:13in the street drug nomenclature.
43:16Adderall, which goes by various other names, okay?
43:20So Adderall, Adderall XR, my dialysis, things like that.
43:28Adderall is basically a combination of
43:29amphetamine and dextroamphetamine.
43:33Now some of you probably realize this,
43:35that Adderall is amphetamine,
43:37but I'm guessing that there a good number of you out there,
43:39perhaps even parents and kids that don't realize that
43:42these drugs like cocaine and amphetamine methamphetamine,
43:45which are incredibly dangerous and incredibly habit forming
43:51and have high potential for abuse.
43:53Well, the pharmaceutical versions of those
43:56are exactly what are used to treat ADHD
43:59and they're not exactly like cocaine or methamphetamine,
44:01but they are structurally and chemically very similar
44:05and their net effect in the brain and body
44:07is essentially the same,
44:08which is to increase dopamine primarily,
44:11but also to increase levels of a neuromodulator
44:14called epinephrin or norepinephrine
44:16also called noradrenaline and adrenaline
44:18those names are the same and to some extent
44:21to increase levels of serotonin in the brain and blood,
44:23but not so much serotonin,
44:25that's just kind of a small smidgen of effect, okay?
44:28So dopamine way up norepinephrine and adrenaline way up.
44:32So that's motivation drive, focus and energy
44:36and to some extent, a little bit of serotonin,
44:40which is really more about feeling calm and relaxed
44:44and you can imagine why that would be
44:46a good balancing effect for dopamine and norepinephrine.
44:52So what I'm essentially saying is that the drugs
44:54that are used to treat ADHD are stimulants,
44:56and they look very much alike.
44:58In fact, nearly identical to
45:00some of the so-called street drugs,
45:02stimulants that we all here are so terrible.
45:05However, I do want to emphasize
45:07that at the appropriate dosages
45:10and working with a quality psychiatrist
45:13or neurologist or family physician
45:16does have to be a board certified MD
45:17that prescribes these things,
45:19many people with ADHD achieve excellent relief
45:23with these drugs, not all of them, but many of them do,
45:26especially if these treatments are started early in life.
45:30So now knowing what these drugs are,
45:32I want to raise the question of why prescribe these drugs?
45:36I mean, everyone has to make a decision for themselves
45:38or for their child as to whether or not
45:39they're going to take these things or not.
45:42I also want to acknowledge that many people out there,
45:46many, many people out there are taking these drugs,
45:49even though they have not been clinically diagnosed
45:52with ADHD when I say these drugs,
45:54I'm specifically referring to Ritalin and Adderall
45:56and Modafinil, but more typically it's Adderall, okay?
46:00People using cocaine and amphetamine
46:02for recreational purposes,
46:03that's a completely different beast
46:05and it is indeed a beast
46:06and it's something that I strongly discourage.
46:10However, I'm aware that up to 25% of college students,
46:15and perhaps as many as 35% of all individuals
46:19between the ages of 17 and 30 are taking Adderall
46:25on a regular or semi-regular basis
46:27in order to work, in order to study
46:30and in order to function and focus in their daily life.
46:33Even though they have not been diagnosed with ADHD,
46:37there's a whole black market for this.
46:38They're getting it from people with prescriptions.
46:40I'm not here to pass judgment.
46:41I just want to emphasize how these drugs work.
46:44Some of the things that they do to enhance cognition
46:48and focus that actually serve the brain well
46:50in certain individuals and how they can be very detrimental
46:54in other individuals.
46:55I sort of blew right past it.
46:57But the fact that in upwards of 25% of young people
47:01are taking things like Adderall,
47:03despite not having a clinical diagnosis of ADHD.
47:07Well, that's a ridiculously high number.
47:11A few years ago,
47:12it was estimated that Adderall use and Ritalin use
47:15without diagnosis of ADHD was second in incident
47:19only to cannabis,
47:21but actually now the consumption of Adderall
47:25without prescription is higher than
47:29the consumption of cannabis in that age group.
47:31So what that means is that there's a lot of stimulant use
47:35in that age group
47:36and there are a lot of adults also
47:39using and abusing stimulants in order to gain focus.
47:42Then we can have a whole discussion about whether or not
47:43life is becoming more demanding,
47:45whether or not the need for focus is excessive
47:48and that's why people are doing that.
47:50But frankly, it's an interesting discussion,
47:51but it's not one that would deliver us to any answers.
47:54Rather, I'd like to focus on the ways that people now
47:57and people have always been self-medicating
47:59to increase, focus, right?
48:02Caffeine, which I can indulge
48:05some, I don't think to access has long been used
48:08as a stimulant to increase dopamine,
48:10increase norepinephrine,
48:11increased focus and energy and in addition to that,
48:15it works through the so-called cyclic amp,
48:16phosphodiesterase pathway, remember anytime you see,
48:20you hear an ASE, that's an enzyme.
48:22Phosphodiesterase is involved in the
48:24conversion of things like cyclic amp into
48:27energy for cells and so forth.
48:28Basically coffee gives you energy it makes you feel good
48:31and it increases focus because of the circuits
48:34that it engages in the brain.
48:37People have been taking caffeine
48:38and continue to take it caffeine for ages.
48:42People also used to smoke cigarettes,
48:45nicotine in order to gain focus.
48:47Nowadays, that's less common because of the concerns,
48:50quite valid concerns about lung cancer from smoking,
48:54but there's a lot of vaping out there.
48:57There are a lot of people now consuming nicotine,
48:59which is the active substance in cigarettes
49:02and in most nicotine vapes that stimulates the brain
49:06to be more focused and more alert.
49:09So the idea of taking stimulants of consuming things
49:12or smoking things in order to increase alertness
49:15is not a new idea.
49:17It's just that in ADHD,
49:20it's surprising that these things would work, right?
49:22I mean, if the problem is
49:23Attention Deficit Hyperactivity Disorder,
49:26what we're really talking about here,
49:28or children that are prescribed a drug
49:31that ought to be a stimulant,
49:33it ought to make them hyper hyperactive
49:35and rather than doing that,
49:36it actually somehow serves to calm them a bit,
49:40or at least allow them to focus.
49:42Here's the reason, children have a brain
49:45that's a very plastic meaning it can remodel itself
49:49and change in response to experience very, very quickly
49:52compared to adults.
49:54Taking stimulants as a child,
49:56if you are a child diagnosed with ADHD
50:00allows that forebrain task related network to come online,
50:04to be active at the appropriate times
50:07and because those children are young,
50:09it allows those children to learn what focus is
50:12and to sort of follow or enter that tunnel of focus.
50:16Now, by taking a drug, it's creating focus artificially,
50:20it's not creating focus because they're super interested
50:23in something it's chemically inducing, a state of focus,
50:27and let's face it a lot of childhood and school
50:30and becoming a functional adult
50:31is about learning how to focus
50:32even though you don't want to do something.
50:34In fact, when I was in college,
50:35I had this little trick that may or may not work
50:37for some of you,
50:38which is if I couldn't focus on the material
50:40I was trying to learn,
50:42I would delude myself into thinking
50:44that it was the most interesting thing in the world.
50:46I would just kind of lie to myself and tell myself,
50:48okay, this, I won't mention the subjects,
50:52I absolutely love this.
50:54I would just, I would tell myself that I loved it
50:56and I noticed that just that selective
50:58or deliberate engagement of that desire to know circuit,
51:03whatever that is in my brain, no doubt involves dopamine,
51:06allowed me to focus and remember the information
51:08and somewhat surprisingly or perhaps not surprisingly,
51:11I would often fall in love with the information.
51:13I find that that was my favorite class.
51:14So it was what I wanted to learn the most.
51:17So that's one way you can do it artificially,
51:19but kids with ADHD, they can't do that, right?
51:22They're told to sit still
51:23and they end up getting up 11 times.
51:25They are told that they can't speak out in class
51:28or that they have to remain in their seats for 10 minutes
51:31and they just, despite their best effort,
51:33they simply cannot do it,
51:35they're highly distractable.
51:37So what are we to make of this whole picture
51:39that we need more dopamine, but these kids with ADHD,
51:42they're getting their dopamine by way of a drug,
51:45which is for all the world amphetamines, right?
51:47It's speed, that's really what it is.
51:50What are the long-term consequences,
51:51where the short-term consequences and what should we make of
51:55people taking these drugs without a clinical need?
51:58What are the consequences there?
52:00Well, in order to get to some of those answers,
52:02I went to one of my colleagues,
52:04this is a colleague that I've actually known
52:05for a very long time, I was their teaching assistant
52:08when they were an undergraduate,
52:10they went on to get an MD, a medical degree,
52:12as well as a PhD and become a pediatric neurologist
52:18that specializes in the treatment of epilepsy
52:21and ADHD in kids of all ages, from age three to 21,
52:25that's the age range,
52:26pretty broad age range and has extensive knowledge in this
52:30and what makes them particularly interesting for sake of
52:34this discussion is that they have a child, a young boy,
52:38who's now showing signs of ADHD
52:40and they are on the threshold of trying to decide
52:43whether or not they will prescribe Adderall
52:47or something similar.
52:49So we had a discussion about this
52:51and prior to learning that their child may have ADHD.
52:56I asked the following questions.
52:57First of all, I asked,
52:58what do you think about giving young kids amphetamine?
53:02And their answer was, on the face of it, it seems crazy,
53:08but provided that the lowest possible dose is used
53:12and that that dosage is modulating as they grow older
53:15and develop those powers of attention,
53:18their observation was that they've seen more kids benefit
53:22than not benefit from that.
53:25Now I'm certainly not saying what people should do.
53:27You obviously have to go to a doctor
53:29because as I always say, I'm not a doctor,
53:31I don't prescribe anything,
53:32I'm a professor so I profess things
53:34and here I'm professing that you talk to your doctor,
53:35if you're considering giving Ritalin or Adderall
53:39or any type of stimulant to your child, of course,
53:41what could be more important than the health of your child.
53:44But it was a very interesting answer because
53:46typically we hear yes, medicator don't medicate.
53:48Rarely do we hear that the medication should be adjusted
53:51across the lifespan and in any particular kind of way.
53:54Now the fact that this person,
53:56this now friend of mine and colleague of mine
53:58has so much expertise in the way that the brain works
54:02and is considering putting their child on such medication.
54:06I said, why wouldn't you wait
54:09until your kid reaches puberty?
54:11I mean, we know that in boys and in girls,
54:14there are increases in testosterone
54:16and estrogen during puberty,
54:17that dramatically change the way that the body appears.
54:21But also that dramatically change
54:23the way that the brain functions in particular we know this,
54:26that puberty triggers the activation of so-called
54:30frontotemporal task related executive functioning.
54:34That's just fancy science speak for being able to focus,
54:37being able to direct your attention,
54:38being able to control your impulses, look at a small child,
54:41or look at a puppy and then look at an older child,
54:44or look at a dog, very different levels,
54:46patterns of spontaneous behavior.
54:47Young children move around a lot they're,
54:49I don't want to say shifty,
54:50cause that makes it sound like they're up to something bad,
54:52which they might be,
54:53but they don't have to be up to something bad,
54:55they fidget a lot.
54:56So to puppies,
54:57everything's a stimulus as animals and humans get older,
55:00they learn how to control their behavior and sit, still,
55:04listen and focus even if they don't want to.
55:07So giving a drug that allows a child to access that
55:12stillness early on it's thought will allow them
55:16to maintain that ability as time goes on.
55:19But I decided to push a little bit further,
55:21I said, well, why would you do it now
55:25as opposed to during puberty or after puberty?
55:28And their answer was very specific
55:30and I think very important, what they said was look,
55:33neuroplasticity is greatest in childhood
55:37and tapers off after about age 25,
55:40but neuroplasticity from age three until age 12 or 13
55:45is exceedingly high and they're right,
55:49when you sit back
55:49and you look at the literature on neuroplasticity,
55:52you'd say childhood plasticity and young adult plasticity
55:54is much greater than adult plasticity,
55:57but that early childhood plasticity is far and away
56:00the period in which you can reshape the brain
56:03at an accelerated rate.
56:05So this lines up really well with the clinical literature.
56:08Not surprisingly,
56:09there are clinician that early treatment is key.
56:13If you have the opportunity to work with a quality physician
56:16and treat these things early,
56:18these drugs can allow these frontal circuits,
56:21these task-related circuits to achieve their appropriate
56:24levels of functioning and for kids to learn how to focus
56:27in a variety of different contexts.
56:30Now, is that the only thing that they should be doing?
56:33Of course not.
56:34So the next question I asked was
56:36what should we make of all this diet related stuff, right?
56:40I've heard before that the so-called elimination diet
56:44or ingesting no sugars or no dairy or no gluten,
56:48that all of these things have been purported
56:51to improve symptoms of ADHD and people and parents with ADHD
56:56go to fanatic lanes to try and find the exact foods
57:00that are causing problems and the exact foods
57:03that the kids can eat in order to try
57:05and get their brain wired up right,
57:07and correctly, and to avoid lifelong ADHD
57:12and their answer was really interesting.
57:14But before I tell you their answer,
57:16I want to tell you the studies and the data
57:18related to this question of whether or not food
57:21and the constellation of foods that one avoids
57:24and will eat has anything to do with our levels of attention
57:28and in particular,
57:29whether or not that can be used as a leverage point
57:31to treat ADHD.
57:33So you can imagine the challenges of exploring the role
57:36of diet and nutrition in any study,
57:39but especially in a study on ADHD, why?
57:41Well, because as I mentioned before, children with ADHD,
57:44and it turns out adults with ADHD
57:46tend to pursue sugary foods or any types of food
57:49that increase their levels of dopamine.
57:51They are naturally drawn to those foods,
57:53whether or not they realize it or not,
57:55presumably as a way to try and treat
57:57their lack of focus and impulsivity.
58:00So in this study that I'm about to share with you,
58:03there was no drug treatment, it was just a study,
58:05manipulating diet and involved 100 children,
58:0950 in the so-called elimination diet group,
58:12the special diet where certain foods were eliminated
58:14and 50 in the so-called control group.
58:16However, being a well-designed randomized controlled trial,
58:21this study also included a crossover,
58:23meaning where the kids would serve as their own control
58:27or control group at a certain portion of the study.
58:30So there'll be in one group
58:30where they eliminated certain foods
58:32and then after a period of time in the study,
58:33they would swap to the other group.
58:35This is a powerful way to design a study
58:37for reasons that you can imagine,
58:38because you start to eliminate changes and effects
58:41due to individual differences.
58:43In any case, 100 children total 50 in each group
58:46at any one period in time
58:48and the effects that they observed were extremely dramatic.
58:51In the world of statistics and analysis of scientific data,
58:55we talk about P-values, probability values.
58:57What's the likelihood that something
58:58could happen according to chance
59:00and typically the cutoff would be
59:01something like P less than 0.05,
59:04that's less than 0.05 chance essentially,
59:08of the effect being due to chance.
59:11However, in this study,
59:13every single one of the effects is P less than 0.0001,
59:17very, very infant decimally small
59:19probability that the effect observed could be due to chance.
59:23So what were these effects?
59:24These effects were enhanced ability to focus,
59:26less impulsivity,
59:28even less tendency to move when trying to sit still.
59:32So everything from mental focus
59:34to the ability to control their bodies improved
59:36when they were in the elimination diet group,
59:38what was eliminated?
59:39Well, the elimination diet in this particular study
59:44was a so-called oligoantigenic diet.
59:47It was a diet in which each kid took a test to determine
59:51which foods they had antibodies for,
59:53meaning that they were mildly allergic to.
59:56Now in this study, it was very important
59:58that the kids not be extremely allergic to any food
1:00:00because as I mentioned before,
1:00:01they actually served as a control at one point in the study
1:00:05where they were eating all sorts of foods,
1:00:06including foods that had mild allergies to.
1:00:08So basically what the study said was that eliminating foods
1:00:14to which children have allergies
1:00:16can dramatically improve their symptoms of ADHD.
1:00:19And this study,
1:00:21not surprisingly because it was published
1:00:22in such a high quality journal Lancet, et cetera,
1:00:25large number of subjects set the world on fire.
1:00:28People were extremely excited about these results
1:00:32because here in the absence of any drug treatment,
1:00:34there was a significant improvement
1:00:36in ADHD symptoms observed and then came the criticisms.
1:00:40So many papers were published after this specifically
1:00:45dealing with re-analysis of these data
1:00:48and I want to be fair in saying that
1:00:51the data in the paper look good,
1:00:53but there are criticisms
1:00:55of the overall structural design of the study.
1:00:57I don't want to go into all the details exactly
1:00:59'cause it gets really nuanced about some of the statistics
1:01:02and the way that one examines these types of data,
1:01:05but there was skepticism
1:01:07and in science, skepticism is healthy,
1:01:09especially when making decisions about
1:01:11whether or not to treat or feed children
1:01:13one food or another, or give them one drug or another.
1:01:17Now I want to return to the story of my friend,
1:01:19who is a pediatric neurologist and treats ADHD
1:01:23and has a child who is on the precipice of
1:01:26perhaps starting to take drugs for the treatment of ADHD.
1:01:29I asked the simple question, do you see an effect of diet?
1:01:33Meaning when parents control the diet of their children,
1:01:37does it make a positive or negative or no difference in
1:01:41terms of the way that the kids respond to ADHD,
1:01:44drugs like Ritalin and Adderall or whether or not
1:01:47it can help them avoid treating with those drugs entirely?
1:01:49And her response was very straightforward, she said,
1:01:53elimination of simple sugars
1:01:54has a dramatic and positive effect.
1:01:56She's observed that over and over and over again
1:01:59in many dozens, if not hundreds of patients, okay?
1:02:03Now that's not a peer reviewed study,
1:02:04that's a statement that I'm conveying to you anecdotally,
1:02:07but it's a highly, highly informed one.
1:02:10I said, what about these elimination diets?
1:02:12She said, and I found other sources to support this,
1:02:15that these oligoantigenic diets are controversial.
1:02:18There are many people who really believe
1:02:21in identifying all the things that you're allergic to
1:02:23and making sure that you
1:02:25and especially your kids avoid those foods.
1:02:27However, there's another camp that's starting to emerge
1:02:30in the peer reviewed scientific literature,
1:02:33showing that when kids are not exposed to certain foods
1:02:37in particular nuts and things of that sort,
1:02:39they develop allergies to those foods
1:02:42and then when exposed to them later,
1:02:44they cause real problems.
1:02:45So there's a whole galaxy of discussion and controversy
1:02:48and outright fighting about allergies
1:02:51and kids and whether or not the oligoantigenic diet
1:02:53is the appropriate one.
1:02:54However, out of the four neurologists and psychiatrists
1:02:58that I spoke to about ADHD in preparation for this,
1:03:01every single one said children with ADHD,
1:03:04as much as possible,
1:03:05should be encouraged to avoid high sugar
1:03:08and simple sugar foods of most kinds
1:03:11and if they can find particular foods
1:03:14that exacerbate their symptoms,
1:03:16obviously eliminating those foods is beneficial
1:03:20and the foods that exacerbate their symptoms
1:03:23change over time.
1:03:25So I don't like giving a complicated answer,
1:03:28but I also don't like giving an incomplete answer.
1:03:31What this tells me is that children,
1:03:34especially young children who have ADHD
1:03:37should probably not eat much sugar
1:03:41in particular simple sugars.
1:03:43In addition to that,
1:03:44exploring whether or not they have existing allergies
1:03:47to foods, they already consume might be a good idea.
1:03:52At least that's what this paper,
1:03:53the Pelsser et. al Lancet paper seems to speak to
1:03:56and I should mention that that paper was published in 2011.
1:03:59Since then there have been many dozens of studies exploring
1:04:03the same thing, as well as meta analysis of all those data
1:04:06and it does appear that diet can have
1:04:09a highly significant role in eliminating
1:04:13or at least reducing the symptoms of ADHD
1:04:15so much so that some of the children
1:04:17are able to not take medication at all,
1:04:19or eventually wean themselves off medication
1:04:23as young adults and as adults.
1:04:25One interesting question is whether or not adults
1:04:28should modify their diet in order to
1:04:31increase their levels of focus,
1:04:32if they're already having normal levels of focus,
1:04:35but we'd like more or would like to reduce
1:04:37existing adult ADHD, that's an interesting,
1:04:42and even more controversial topic,
1:04:44it brings us right into the realm of what are called
1:04:47omega-3 fatty acids.
1:04:48I've talked many times on this podcast about
1:04:50the known benefits of omega-3 fatty acids in particular,
1:04:54getting a one gram 1000 milligrams or more
1:04:58even as much as 2000 milligrams each day of
1:05:01the so-called EPA component of omega-3 fatty acids
1:05:06known to have antidepressant effects,
1:05:08mood elevating effects,
1:05:09known to have important effects
1:05:13protecting the cardiovascular system.
1:05:15I think it's now clear that the immune system also benefits
1:05:18that omega-3 fatty acids that include a gram or more of EPA
1:05:24that are very beneficial typically
1:05:25that's done through fish oil,
1:05:27liquid fish oil is going to be the most cost efficient,
1:05:29but they're capsule forms
1:05:30for those of you that don't like fish oil,
1:05:33you can ingest this through other means
1:05:34you can get it from certain algaes or krill, et cetera.
1:05:36You have to make it compatible with your particular diet,
1:05:40whether or not you're vegan
1:05:41or vegetarian or omnivore, et cetera.
1:05:44Omega-3s have shown,
1:05:45been shown to have all these positive health benefits.
1:05:48Do they have positive effects on focus and attention?
1:05:52And the answer is you can find studies
1:05:55that support that statement and the effects are significant,
1:05:59but the effects are modest.
1:06:02You can also find studies that show no effect,
1:06:06however much like with omega-3s and antidepressants,
1:06:11whereby ingestion of omega-3 fatty acids of a gram or
1:06:17more of EPA per day allows people with major depression
1:06:20to get away with taking lower doses
1:06:21of antidepressant medication.
1:06:23It does seem that ingestion of omega-3 fatty acids in adults
1:06:30that include EPA is of 1000 milligrams or more
1:06:33can allow adults with ADHD
1:06:36or mild attention deficit issues
1:06:38to function well on lower doses of medication
1:06:43and in rare cases to eliminate medication entirely.
1:06:47So what this says is once again,
1:06:49that the omega-3 fatty acids are beneficial,
1:06:51will they cure or eliminate ADHD?
1:06:54I think it's safe to say, no,
1:06:57they are playing a supportive
1:06:58or what we call a modulatory role.
1:07:00Just like good sleep,
1:07:02plays a supportive and modulatory role
1:07:04for essentially everything, your immune system,
1:07:06your ability to think your ability to regulate your emotion,
1:07:08it's modulating that process.
1:07:10This component of modulation
1:07:13is extremely important to highlight
1:07:14and I think I want to spend a moment on it because
1:07:17this is especially important in the context of ADHD
1:07:20and all the information that's out there.
1:07:22There are biological processes that are mediated
1:07:26by particular compounds like dopamine.
1:07:28So for instance, the ability to feel motivated,
1:07:31to attend to focus is mediated by the circuits in the brain
1:07:35that release dopamine.
1:07:38However, attention is also modulating by how rested you are.
1:07:42If you want to eliminate your ability to think well at all,
1:07:45just stay up for two nights and don't sleep at all right?
1:07:48If you do that,
1:07:49you will have modulating the circuits in your brain
1:07:52that respond to various things
1:07:55and you will be highly distractible.
1:07:57You'll be highly emotional.
1:07:58You will feel like garbage,
1:07:59but that doesn't mean that sleep mediates,
1:08:02focus and attention.
1:08:03It modulates it indirectly.
1:08:06Likewise, I think these omega-3 fatty acids
1:08:09in particular the EPA is which are so beneficial for mood
1:08:12and apparently also for attention,
1:08:14they directly mediate attention and mood,
1:08:18what they do is they modulate those circuits,
1:08:20they make dopamine more available.
1:08:23They make whatever dopamine is available,
1:08:25more likely to bind to the various receptors
1:08:28that are present on neurons and so forth
1:08:30and I think this is very important because likewise diet
1:08:33in any discussion about nutrition
1:08:35has to include this framework of is the diet,
1:08:38the elimination diet,
1:08:39or whether or not it's some other diet or esoteric diet,
1:08:42ketogenic diet, is it modulating or mediating a process?
1:08:46And most likely in the context of ADHD,
1:08:48it's modulating that process.
1:08:51So if the ADHD is mild or if it's caught early enough,
1:08:54or if it's in conjunction with pharmacology
1:08:57with a prescription treatment,
1:08:59well, then it might help guide the child or adult
1:09:01to a better place of being able to focus.
1:09:03But it's not going to be the switch that flips everything.
1:09:07Now that does not mean that consuming the wrong foods,
1:09:10sugary foods or foods that you happen to be allergic to
1:09:13is a good idea it will still be detrimental.
1:09:16So I hope that conceptual framework helps
1:09:18because if you go online,
1:09:19if you're somebody with ADHD
1:09:20or not your going to be bombarded with the ADHD diet,
1:09:24the oligoantigenic diet, the elimination this,
1:09:27this supplement that EPA
1:09:29and I think it's very important to understand whether or not
1:09:31you're talking about something mediating a process
1:09:34or modulating a process.
1:09:36Now drugs like Ritalin, drugs like Adderall,
1:09:38they are tapping into the circuitries
1:09:40and the neurochemistries that mediate attention and focus.
1:09:45They are not the only alternatives or the only choices
1:09:48rather for treatment of these circuits
1:09:50and enhancement of the circuits for focus.
1:09:52I'm going to talk about other alternatives
1:09:54and some behavioral alternatives
1:09:56that are not very well known,
1:09:57but are very, very effective in a few minutes.
1:10:00But I really want to make this clear distinction
1:10:03between modulation and mediation,
1:10:05because it's vital for anyone that's trying to modulate
1:10:09or mediate anything within their own brain.
1:10:11If any of you are interested in this oligoantigenic diet,
1:10:14as it relates to ADHD,
1:10:16and you want to explore a more recent study
1:10:19besides that classic 2011 Lancet study,
1:10:22that's rather controversial.
1:10:23There's a paper that was published in frontiers
1:10:25in psychiatry just last year, 2020.
1:10:29The title of the paper is,
1:10:30"Oligoantigenic diet improves children's ADHD
1:10:33rating scale scores reliably in added video rating."
1:10:37The added video rating is just that they're using
1:10:39an additional measure of focus and attention.
1:10:43Again, that's Frontiers in psychiatry, 2020,
1:10:46I'll put a link to it in the caption,
1:10:48and that's a more recent study for you to peruse.
1:10:51So we've talked about the neural circuits of focus
1:10:53and the chemistry of focus,
1:10:55but we haven't talked yet about what would make us better
1:10:59at focusing and what focusing better really is.
1:11:02So let's take a step back and think about
1:11:05how we focus and how to get better at focus
1:11:07and I'm going to share with you a tool for which there are
1:11:11terrific research data
1:11:13that will allow you in a single session
1:11:15to enhance your ability to focus in theory forever.
1:11:22What am I about to read you is from an excellent book
1:11:24that I recommend,
1:11:25if any of you are interested in neuroscience
1:11:27and things like meditation and default mode networks
1:11:30and things of that sort,
1:11:32the book is called, "Altered Traits."
1:11:35Science reveals how meditation changes your mind,
1:11:37brain and body and no, I'm not going to try
1:11:40and convince you to meditate.
1:11:41I'm going to share with you a small passage in the book
1:11:44that relates some research data related to focus
1:11:47that are very important.
1:11:48If you want to meditate, that's your choice.
1:11:50That's a separate matter.
1:11:51This is a book by Daniel Goleman and Richard Davidson
1:11:54and I should just mention that
1:11:55Goleman is a well-known author
1:11:57has written books on emotional intelligence and so forth.
1:12:00Richard Davidson is also a PhD.
1:12:04He's a professor of psychology and psychiatry,
1:12:06and he's at a University of Wisconsin Madison,
1:12:09he's done terrific work on brain states
1:12:12and modulation of brain states and so forth.
1:12:15What we're about to talk about is
1:12:17when attention works and when attention falters
1:12:21and what we are specifically going to talk about
1:12:24are what are called attentional blinks,
1:12:26not actual eye blinks.
1:12:28We're going to talk about that in a few minutes,
1:12:29but we're going to talk about attentional blinks.
1:12:33I'm paraphrasing here because
1:12:36Goleman and Davidson wrote about this so beautifully.
1:12:39I'd rather paraphrase from them than try and just
1:12:41make up a new way to say it
1:12:42that is less interesting or less good,
1:12:45but I want to credit them.
1:12:46Attentional blinks are really easy to understand,
1:12:48if you think about a where's Waldo task,
1:12:50you know this task where's Waldo where,
1:12:53there are a bunch of people and objects
1:12:54and things in a picture
1:12:56and somewhere in there is Waldo
1:12:57with the striped hat and the glasses and go skinny dude,
1:13:00and you have to find Waldo
1:13:02and so it's a visual search
1:13:03and it's visual search for an object
1:13:06that has distinct features,
1:13:07but is embedded in this ocean of other things that
1:13:10could easily be confused as Waldo.
1:13:12So you tend to look, look,
1:13:13look, look, look, look, look, look, look,
1:13:14and then you find Waldo.
1:13:16Kids can do this they enjoy doing this.
1:13:18Adults may or may not enjoy it,
1:13:19but they can do it too.
1:13:21They find Waldo, when you find Waldo
1:13:24or when you search for a target
1:13:26in some other visual search task at that moment,
1:13:29your nervous system celebrates a little bit
1:13:31and it celebrates through the release of neurochemicals
1:13:34that make you feel good, you found it and you pause.
1:13:38Now, the pause is interesting because when you pause,
1:13:41what we know from many experiments is that
1:13:45in that moment of pause and mild celebration,
1:13:48however, mild you are not able to see another Waldo
1:13:54sitting right next to it.
1:13:56So what this means is in attending to something
1:13:59in searching and in identifying a visual target
1:14:03your attention blinked it shut off for a second
1:14:07and there's a more formal and more laboratory type
1:14:10way that we look at this.
1:14:13The more typical way to do this is to give someone
1:14:16a string of letters or a string of numbers
1:14:19and beforehand you tell them be on the lookout for the
1:14:23letters R and Z, okay?
1:14:27You're just going to watch this string of numbers go by
1:14:30and there will be a letter R in there,
1:14:31and there will be a letter Z in there
1:14:33and try and spot them both
1:14:36and what you find is when you present
1:14:38that string of numbers, and then they see the R,
1:14:42they see the R they register it consciously
1:14:45and they tend to miss the Z,
1:14:48just like in the Waldo type example.
1:14:51Now, of course the numbers are going by pretty quickly,
1:14:53but they can spot the R.
1:14:56They could also spot the Z,
1:14:57if you told them beforehand, just spot the Z
1:15:00and the numbers are moving through at the same rate
1:15:02in both conditions.
1:15:03So what that means is that in every case,
1:15:05you are capable of seeing the R or the Z
1:15:10it's when you try and see both that seeing the first one
1:15:13prevents you from seeing the second one,
1:15:16it's what we call an attentional blink.
1:15:19We do this all the time
1:15:21and people with ADHD tend to have many more
1:15:25attentional blinks than people that don't
1:15:27and this is true for children and for adults.
1:15:30This is an important point.
1:15:32So important that I want to emphasize it twice
1:15:34in case you attentionally blinked.
1:15:36If you see something that you're looking for,
1:15:39or you're very interested in something,
1:15:40you are definitely missing other information
1:15:45in part because you're over focusing on something
1:15:47and this leads to a very interesting hypothesis
1:15:50about what might go wrong in ADHD,
1:15:53where we've always thought that they cannot focus
1:15:56and yet we know they can focus on things
1:15:58they care very much about,
1:16:00well, maybe just maybe
1:16:03they are experiencing more attentional blinks
1:16:06than people who do not have ADHD
1:16:09and indeed, there are data now to support the possibility
1:16:12that that's actually what's happening
1:16:14and that should be exciting to anyone that has ADHD.
1:16:16It should also be exciting to anyone that cares about
1:16:18increasing their focus and their ability to attend.
1:16:22What this is saying is that these circuits,
1:16:23that underlie focus in our ability to attend
1:16:26and our ability to eliminate distraction,
1:16:30they aren't just failing to focus.
1:16:32That's just a semantic way of describing the outcome.
1:16:35They are over focusing on certain things
1:16:37and thereby missing other things.
1:16:39And so our distractability or the distractability
1:16:42of somebody with ADHD could exist because
1:16:46they are over focusing on certain elements
1:16:49and there are there for missing
1:16:51other elements that they should be attending to.
1:16:53So what they really need is this property
1:16:57that we call open monitoring.
1:16:59Now open monitoring is something
1:17:00that's described in the book that I just referred to
1:17:02and that typically is associated with people
1:17:05who have done a lot of meditation,
1:17:07so called Vipassana meditation,
1:17:09or have spent a lot of time learning how to
1:17:12do what's called open gaze visual analysis
1:17:15and open gaze thinking.
1:17:16But there's a simpler version of this
1:17:17that allows us to bypass all that.
1:17:19First of all,
1:17:22your visual system has two modes of processing.
1:17:26It can be highly focused, a soda straw view.
1:17:28So looking for the R in this string of numbers
1:17:31in the example that I just gave,
1:17:33or if you're very excited about something
1:17:35you're in that soda straw view of the world,
1:17:36and you're missing other things, okay,
1:17:38that's high levels of attention.
1:17:40However, there's also a property of your visual system
1:17:43that allows you to dilate your gaze,
1:17:45to be in so-called panoramic vision.
1:17:47Panoramic vision is something you can do right now,
1:17:49no matter where you are, and I can do it right now,
1:17:51you won't know that I'm doing it,
1:17:53but even though I'm still looking directly at you,
1:17:56I'm consciously dilating my gaze so that I can see the
1:17:59ceiling, the floor and the walls all around me.
1:18:01That panoramic vision is actually mediated by
1:18:03a separate stream or set of neural circuits
1:18:06going from the eye into the brain
1:18:08and it's a stream or set of circuits
1:18:10that isn't just wide angle view.
1:18:13It also is better at processing things in time.
1:18:16Its frame rate is higher.
1:18:18So you've seen slow motion video,
1:18:20and you've seen standard video,
1:18:21slow motion video gives you that slow motion look,
1:18:26because it's a higher frame rate.
1:18:28You're thin slicing time, okay?
1:18:32You can use panoramic vision to access the state
1:18:35that we call open monitoring.
1:18:36When people do that,
1:18:38they are able to attend to and recognize
1:18:42multiple targets within this string of numbers.
1:18:46They can see the R and they can see the Z
1:18:48and they can see additional things.
1:18:50So this is something that can be trained up
1:18:52and people can practice whether or not
1:18:54they have ADHD or not.
1:18:56What involves is learning
1:18:57how to dilate your gaze consciously,
1:18:59that's actually quite easy for most people,
1:19:01whether or not you wear corrective lenses
1:19:03or contacts or not
1:19:04you can consciously go into open gaze
1:19:06and then you can contract your field of view as well.
1:19:09There have also been studies done
1:19:11where people were taught to think in a particular way
1:19:15for a very short period of time,
1:19:17and that forever changed their ability to limit
1:19:21or reduce the number of these attentional blinks.
1:19:24There are now published accounts in the literature
1:19:26of a simple practice done for about 15 minutes,
1:19:29where subjects were asked to just sit quietly eyes closed
1:19:33and do what is sort of akin to meditation,
1:19:35but to not direct their mind
1:19:36into any particular state or place,
1:19:38but simply to think about their breathing
1:19:40and to focus on their so-called interoception,
1:19:42focus on how their body feels,
1:19:44their mind drifted to bring it back, okay?
1:19:46So it's basically meditation for about 15 minutes.
1:19:50That might not seem like a significant or unusual practice
1:19:53or that it would have any impact at all.
1:19:55But remarkably, just doing that once for 17 minutes,
1:20:01significantly reduced the number of attentional blinks
1:20:05that people would carry out.
1:20:06In other words, their focus got better
1:20:08in a near permanent way without any additional training.
1:20:12There's something about that practice of reducing the amount
1:20:15of visual information coming in
1:20:17and learning to pay attention to one's internal state,
1:20:19what we call interoception that allow them an awareness,
1:20:23such that when they needed to look for visual targets,
1:20:26when they need to focus on multiple things in sequence,
1:20:29they didn't experience
1:20:30the same number of attentional blinks
1:20:32and I should mention not incidentally as people age
1:20:36and their working memory gets worse
1:20:38and their ability to focus gets worse,
1:20:40the number of attentional blinks
1:20:42that they carry out goes up,
1:20:44and there are now studies exploring whether or not
1:20:46the simple meditation like practice of 15 to 20 minutes
1:20:50or so of sitting and just quietly resting
1:20:53and paying attention to one's breathing
1:20:54and internal state can also offset some of that
1:20:57age-related what is called cognitive decline.
1:21:01So what these data tell me is that
1:21:03regardless of whether or not you're a child
1:21:05or you're an adult,
1:21:07whether or not you have ADHD or not,
1:21:09whether or not you're experiencing
1:21:11age-related cognitive decline,
1:21:12or you would simply like to avoid
1:21:14age-related cognitive decline,
1:21:16a simple practice of taking 17 minutes
1:21:20sitting and paying attention to your internal state,
1:21:23just interocepting, registering your breathing,
1:21:27registering the contact of your skin
1:21:29with whatever surface you're on,
1:21:31can forever rewire your brain to be able to attend better
1:21:35and possibly even offset
1:21:37some of that age related attentional drift.
1:21:41Now, I don't expect anyone to start meditating regularly.
1:21:44I don't expect anyone to do anything they don't want to do,
1:21:47but I think most of us could handle
1:21:49one meditation's session of 17 minutes or so
1:21:53and so if ever there was a tool that stood to rewire
1:21:56our attentional circuitry in a powerful way.
1:21:59This seems to be it
1:22:00and in addition, the ability to engage in panoramic vision,
1:22:05to dilate our gaze,
1:22:06the so-called open monitoring that allows the brain
1:22:10to function in a way
1:22:10that it can detect more information faster,
1:22:13that's a powerful tool as well
1:22:14and the beauty of that tool is that it works the first time
1:22:17and it works every time.
1:22:19Now, how exactly it works is a little bit unclear.
1:22:23Is it for instance,
1:22:25orchestrating this synchrony or asynchrony
1:22:29between the default mode network
1:22:30and the task related networks we don't know.
1:22:32Those studies have not yet been carried out.
1:22:35Nonetheless, the effects are significant,
1:22:37they are long lasting and they appear to exist
1:22:40after just one session of this quiet
1:22:4317 minute interoception,
1:22:45which to me makes it seem like
1:22:46a very worthwhile thing to do for everybody.
1:22:49So we just talked about attentional blinks,
1:22:51which are essentially blinks of thinking
1:22:54it's your mind shutting off for a moment
1:22:56and missing information.
1:22:58Now let's talk about actual blinks,
1:23:00the sort that you do with your eyelids.
1:23:03Now, this might come across as somewhat obvious,
1:23:05but you can do fast, what are called spontaneous blinks
1:23:10and they're always coordinated between the two eyes
1:23:12or you can do long blinks
1:23:14like when you go to sleep at night,
1:23:15you do one very long blink, and I'm not being facetious.
1:23:19When you go to sleep at night,
1:23:20you are shutting your eyelids
1:23:23and you are limiting the amount of information coming in
1:23:27and your perception of time starts to drift
1:23:30as you go into sleep.
1:23:31Your perception of time changes from very fast,
1:23:35at one moment to very slow meaning the frame rate
1:23:40at which you are analyzing information dreaming, et cetera,
1:23:44is variable when you were in sleep,
1:23:46sometimes it's very fast.
1:23:48Meaning you experienced things in slow motion.
1:23:49Sometimes it's very fast.
1:23:51In waking to your experience of time
1:23:55can sometimes be very fast sometimes be very slow.
1:23:58Typically the more alert you are, the higher the frame rate,
1:24:01your thin slicing your experience.
1:24:05You've probably had this happen.
1:24:06If you're ever very stressed
1:24:07and you're waiting for something or somebody,
1:24:09it seems like it takes forever because
1:24:12your frame rate is higher
1:24:14you're analyzing time more finely.
1:24:16Conversely, if you are very relaxed or even sleepy,
1:24:21you wake up and you have to think of
1:24:22all the things you have to do.
1:24:23It will seem like the world is going by very, very fast
1:24:25and that you are moving very slow.
1:24:28Time is going at the same rate,
1:24:30but your perception of time is what's changed.
1:24:33Believe it or not.
1:24:35Your perception of time is also changed on a rapid basis.
1:24:39Moment to moment basis by how often you blink.
1:24:44This is a well-established literature
1:24:46in the world of neuroscience that unlike the literature
1:24:51and claims about blinking and sociopathy,
1:24:53which have no basis,
1:24:55the science of blinking as it relates to time perception
1:24:59has some very good data to support it.
1:25:01I want to just emphasize one study in particular,
1:25:03which is quite appropriately titled,
1:25:06"Time dilates after spontaneous blinking."
1:25:09This is a paper that was published in current biology.
1:25:11The first author is Terhune, T-E-R-H-U-N-E.
1:25:15It's a wonderful paper.
1:25:17They examine the relationship between fluctuations in timing
1:25:22and blinking and to make a long story short
1:25:26what they found is that right after blinks,
1:25:29we reset our perception of time, okay?
1:25:33So blinks in that sense are a little bit like
1:25:36the curtain coming down on a scene
1:25:38between scenes in a play
1:25:40or takes in a movie, and they clap the clap thing,
1:25:43they started take in our, what do they say, action
1:25:46and then at the end they do the thing and they click it down
1:25:49and they say, it's a take that's one take
1:25:52when you blink it's a take, okay?
1:25:56Now what's interesting
1:25:58and will immediately make sense to you as to why
1:26:01this is important is that the rate of blinking
1:26:05is controlled by dopamine.
1:26:08So what this means is that dopamine
1:26:10is controlling attention.
1:26:11Blinks relate to attention and focus,
1:26:14and therefore the dopamine and blinking system is one way
1:26:17that you constantly modulate and update
1:26:21your perception of time
1:26:23and fortunately, it's also one that you can control.
1:26:27So the basic takeaway of this study was that blinking
1:26:29controls time perception,
1:26:31but also that levels of dopamine
1:26:33can alter your sense of time and stay with me here,
1:26:38and that blinking and dopamine are inextricably linked.
1:26:42They are working together to control your attention.
1:26:46When dopamine levels go up,
1:26:48people tend to overestimate how long something lasted, why?
1:26:53Because they are processing time more finely
1:26:56it's slow motion mode.
1:26:59When dopamine levels are lower,
1:27:01they tend to underestimate time intervals.
1:27:04Let's remember back to the very beginning of the episode,
1:27:07what's going on in people with ADHD,
1:27:10they are not good at managing their time,
1:27:12they tend to run late, or they are disorganized.
1:27:15They are not just disorganized in space,
1:27:17meaning in that physical space, around them,
1:27:20they're disorganized in time.
1:27:23Their dopamine is low, we know that as well
1:27:26and so they are underestimating time intervals
1:27:29and so it makes perfect sense that they would be late.
1:27:32It makes perfect sense that they would lose track of time
1:27:34or the ability to focus.
1:27:36This is really exciting because what it means is that
1:27:39children with ADHD, adults, with ADHD
1:27:42or people with normal levels of focus
1:27:44that want to improve their ability to focus
1:27:46can do so through a training that involves
1:27:50learning how often to blink and when,
1:27:53and how to keep their visual focus on a given target
1:27:56and it turns out this study has actually been done.
1:27:59There's a study again, I'll link to the study,
1:28:02entitled "Improvement of attention
1:28:04in elementary school students
1:28:06through fixation focused training activity."
1:28:08I won't go through all the details,
1:28:10but what they found was a short period of
1:28:14focusing on a visual target,
1:28:16allowed the school children to greatly enhance
1:28:20their ability to focus on other types of information
1:28:23and a significant component of the effect was due
1:28:26to the way that they were controlling the shutters
1:28:28on their eyes, their eyelids, and controlling their blinks.
1:28:31So what they did in this study is they had these kids
1:28:34focus their visual attention
1:28:35on some object that was relatively close,
1:28:38like their hand for a minute or so,
1:28:40which actually takes some effort if you try and do that,
1:28:42they were allowed to blink.
1:28:44However, it's known from other work
1:28:47that if people can consciously override the desire to blink,
1:28:51at least to the point where they feel like they have to,
1:28:54or else their eyes were dry out,
1:28:55that actually can increase attention even further
1:28:58and they had conditions where they would look at a point
1:29:00further across the room and even further across the room.
1:29:04It only took a few minutes each day to do this
1:29:0730 seconds in one condition, or maybe a minute
1:29:09and then at another station
1:29:11of looking a little bit further out
1:29:12and a little bit further out, however,
1:29:14there was an important feature of this study
1:29:16that is definitely worth mentioning,
1:29:18which is before they did this
1:29:20visual focus, task or training,
1:29:23they did a series of physical movements with the kids
1:29:27so that the kids could sort of eliminate or move out
1:29:30some of their desire to move
1:29:32and would thereby enhance their ability to sit still.
1:29:36Now it's long been known that kids need a recess,
1:29:38they need time to run around and play and roll around,
1:29:41do whatever it is that they do
1:29:42in order to be able to sit still at all.
1:29:44Adults probably need this too, frankly,
1:29:46but kids need it more because the circuits in the brain
1:29:49that control reflexive movements and as we say,
1:29:53kind of rhythmic undulating behavior and things like that,
1:29:57that's an active suppression
1:29:58and kids have less of that circuitry built up
1:30:00until they hit about age 15 or 16.
1:30:03So they had the kids move around a bit
1:30:06and then do this focus training.
1:30:08That brings me to another treatment
1:30:10that's actively used nowadays in schools for kids with ADHD,
1:30:14but also is starting to be used by many kids
1:30:18and by parents in order to keep their kids focusing
1:30:22and not going crazy in the car or not acting out in general
1:30:27and that's the prevalence of these so-called fidgeter toys
1:30:31or things that kids can do actively
1:30:32and repetitively in order to move out
1:30:34some of their underlying reverberatory activity
1:30:37in their nervous system.
1:30:39So what you will find is that some kids with ADHD
1:30:43are now given a rubber band on their desk,
1:30:45literally a rubber band that's attached to their desk
1:30:47and they're able to pull on it,
1:30:49even snap it against the desk,
1:30:50if I had done that when I was a kid,
1:30:51I think my teachers were throw me out of class,
1:30:53but I think it's great that they're allowing them
1:30:54to do this now as a way of moving
1:30:57some of their physical energy out
1:31:00or engage their physical energy, rather,
1:31:03as opposed to trying to sit
1:31:04statue still all the time and attend
1:31:06and it turns out that does enhance these children's ability
1:31:10to focus mentally when they have some physical activity
1:31:12to attend to and it turns out it also can work for adults.
1:31:16I'll share with you I related anecdote
1:31:19because it illustrates the underlying mechanism.
1:31:21I've had the great privilege of being able to do a number of
1:31:25surgeries, brain surgeries during my career.
1:31:28So one thing you find when you do brain surgeries,
1:31:30is that the brain's pretty small
1:31:32regardless of the species that you're working on
1:31:33and you're in there and you're trying to do
1:31:35something very specific and the more you try
1:31:38and hold your hands really steady,
1:31:40the more they want to shake, all right?
1:31:42So it's not natural for any of our limbs
1:31:44to sit perfectly still,
1:31:46depending on how much coffee you had,
1:31:48how well rested you are
1:31:49and your sort of baseline level of autonomic arousal.
1:31:52Some of you may find that you can hold out your hand,
1:31:54absolutely rock solid, others will shake a little bit more.
1:31:58It doesn't mean you're if you're shaking,
1:31:59doesn't mean you're calm if you're still.
1:32:03What it relates to
1:32:04is the amount of what we call premotor activity,
1:32:06the number of commands to move
1:32:08that are being sent through the system
1:32:09and that's what I mean by reverberatory activity
1:32:12and it does seem that kids with ADHD and adults with ADHD
1:32:16have a lot of reverberatory activity
1:32:18in their nervous system
1:32:19and so that's that constant desire to move
1:32:21it's hard for them to sit still
1:32:22and therefore it's hard for them to attend,
1:32:24to harness their attention.
1:32:27When you do a surgery
1:32:29and you find that your hands are shaking,
1:32:32what you learn from your mentors,
1:32:33which I did and what works extremely well,
1:32:36whether or not you're doing a surgery or not,
1:32:37is that you simply tap your foot
1:32:39or you bounce your knee a little bit,
1:32:40which you might think would make your hand shake even more,
1:32:44but provided that it's subtle.
1:32:45What it does is it actually shuttle some of the activity
1:32:49from those premotor circuits to elsewhere in the body
1:32:51and then you're able to sit much more still with your hand,
1:32:55you're able to perform the surgery with much more precision.
1:32:57You are able to write with much better handwriting
1:33:00and for those of you who engage in public speaking,
1:33:03if you ever too nervous,
1:33:04that's why pacing while you public speak helps
1:33:07if you're nervous,
1:33:07that's why bouncing your knee behind the podium
1:33:10works as well.
1:33:10That's why nodding your head and gesticulating can help.
1:33:13It's not a matter of,
1:33:15"Moving energy out of the body."
1:33:17That doesn't actually happen,
1:33:18what it is you're engaging those premotor circuits
1:33:20that are sending through commands.
1:33:22It's like trying to stuff,
1:33:23a bunch of stuff through a funnel,
1:33:25and it creates this tension,
1:33:26so you're giving it an outlet for the neural circuitry
1:33:31to be able to move something
1:33:32so that you can keep other components of your body
1:33:34and your mental attention engaged
1:33:37and locked onto something what we call focus.
1:33:41One thing related to this whole business of blinking
1:33:43and focus and training yourself to focus
1:33:45and not blinking, et cetera, is that most all of the drugs,
1:33:51Ritalin, Adderall, and recreational drugs
1:33:53that increase dopamine,
1:33:55even coffee and tea and other forms of caffeine,
1:33:59they tend to make us blink less
1:34:01and when we get tired, we tend to blink more.
1:34:04Now this is sort of a duh, right?
1:34:07But being wide-eyed with excitement or fear
1:34:10or with your eyes, barely being able to keep them open,
1:34:15now it should make perfect sense that these shutters
1:34:17on the front of your eyes,
1:34:18they aren't just there for winking
1:34:20and they aren't just there for cosmetic purposes.
1:34:22They are there to regulate the amount of information
1:34:26going into your nervous system
1:34:27and they're there to regulate how long
1:34:31you are bringing information into your nervous system
1:34:34and in what bins, how widely or finely
1:34:37you are binning time is set by how often you blink
1:34:40and how widely or specifically
1:34:44you are grabbing attention from the visual world is set
1:34:46by whether or not you're viewing things very specifically
1:34:48like a cross area through a soda straw view like this,
1:34:51or whether or not you were in this panoramic
1:34:54sort of whole environment mode,
1:34:57this kind of fisheye lens or wide angle lens mode
1:35:00and in fairness to the pharmacology and the circuitry,
1:35:04while dopamine and heightened levels of alertness
1:35:07and excitement tend to make us blink less and attend more.
1:35:12There's actually a study that's looked at
1:35:14the other neurochemical systems
1:35:16and drugs and how those relate to blinking
1:35:19and so this will all be obvious by the title of the paper
1:35:22I'm about to share with you.
1:35:23This is a paper entitled,
1:35:25"Decreased spontaneous eyeblink rates
1:35:27in chronic cannabis users,
1:35:29evidence for stride or cannabinoid, dopamine interactions."
1:35:34Okay, I'm not going to go into all the details here,
1:35:36but one thing that is somewhat surprising is that
1:35:40many people with ADHD use or abuse cannabis,
1:35:45you might think, well, why would they do that?
1:35:47Because I thought that a increase in dopamine
1:35:50is actually what's going to lead
1:35:51to heightened levels of attention
1:35:52and that's what these people in children crave.
1:35:55Well, it turns out that cannabis also
1:35:57increases dopamine transmission in the brain,
1:36:00but because of the other chemicals,
1:36:02it increases namely serotonin
1:36:04and some components of the cannabinoid and opioid system,
1:36:07it creates that kind of alert, but mellow feel
1:36:13and again, here I'm not a proponent of this,
1:36:15I personally am not a THC or cannabis user.
1:36:18It's just not my thing
1:36:20and obviously it's illegal some places
1:36:21and so you have to determine that for yourself
1:36:24it does have medical purposes in some places it is legal,
1:36:28but THC increases dopamine and increases neurochemicals
1:36:32that can also create a state of calm.
1:36:34So it's that sort of middle ground
1:36:35and this paper has a beautiful demonstration
1:36:38whereby not just while people are using cannabis,
1:36:42but depending on how long they've been using
1:36:44cannabis across their lifespan,
1:36:46the rates of eye blinking change.
1:36:49So if you look at the number of years
1:36:51that people have been using cannabis on a regular basis,
1:36:54either daily or up to excuse me, weekly, or up to daily,
1:36:58what you find is that for people
1:37:00that have not been using cannabis at all,
1:37:02or have only been using it for about two years,
1:37:05their rates of eye blinks are much higher
1:37:08than people who've been using it chronically for 10 years.
1:37:10In other words, people
1:37:11who may be using cannabis for 10 years,
1:37:13don't blink very often at all.
1:37:15Now cannabis has well known effects in depleting memory,
1:37:19but it does seem to engage the focus
1:37:22and blinking system in a way that increases focus.
1:37:25So basically what I'm saying is
1:37:27marijuana seems to increase people's focus,
1:37:29but then they can't remember what they were focusing on.
1:37:32Something I'd like to discuss just briefly is the so-called
1:37:35interoceptive awareness that's present in people with ADHD,
1:37:39both children and adults.
1:37:40Interoceptive awareness is one sense
1:37:43of one's own internal state heartbeat,
1:37:46breathing contact of skin with a given surface, et cetera.
1:37:50For a long time, there was this hypothesis,
1:37:52this idea that people with ADHD,
1:37:54were just not in touch with how they felt
1:37:57that somehow they weren't registering
1:37:59all the stuff that was going on inside them
1:38:01changes in heart rate and so forth
1:38:02and so they were behaving in a way
1:38:04that was dysregulated or appear dysregulated,
1:38:08and that if they could just learn to attend
1:38:11to their internal state better,
1:38:13that somehow they would function better in the world.
1:38:16Now, before we described a process,
1:38:19literally a 17 minute interoceptive exercise
1:38:23that does seem to lead to improvements
1:38:25in one's ability to focus for a longer period of time.
1:38:29However, it's very unlikely that that was due to
1:38:34increasing interoceptive awareness per se.
1:38:37It probably wasn't because people gain a much heightened
1:38:41or improved ability to understand
1:38:44what's going on internally.
1:38:46In fact, you can imagine how that might actually
1:38:47prevent one's ability to pay attention to things
1:38:49in the outside world.
1:38:51So while there is benefit to just sitting there
1:38:53and being in stillness, as they say,
1:38:55or focusing on one's breathing and internal state
1:38:57for sake of then accessing information
1:39:00in the external world,
1:39:01a really nice study called interoceptive awareness
1:39:06and attention deficit hyperactivity disorder
1:39:08explored whether or not interoceptive awareness
1:39:11was different in people with ADHD or did not have ADHD
1:39:15and the findings were essentially that there's no difference
1:39:20that people with ADHD, children, and adults,
1:39:22they are aware of what's going on inside them
1:39:25just as much as anyone else's
1:39:27and the typical measure of interoceptive awareness
1:39:29is one's ability to count their own heartbeats.
1:39:33This is actually challenging for some individuals
1:39:36and very easy for other individuals,
1:39:37regardless of their attentional capacity.
1:39:39Some people just can really feel their heartbeat
1:39:41without taking their pulse other people cannot
1:39:45and these studies are pretty straightforward to do.
1:39:47You ask people to sit there and to count their heartbeats,
1:39:50and then you are monitoring their heartbeats
1:39:52and you get to gauge how accurate they are.
1:39:55So it's important to understand that people with ADHD
1:39:58are in touch with how they feel.
1:40:01It's really a question of whether or not
1:40:03they can take the demands that are placed upon them
1:40:06and enter a cognitive state of mental state
1:40:09that allows them to access the information
1:40:11they need to access
1:40:12in other words, whether or not they can focus,
1:40:13but it is absolutely wrong to think that
1:40:15the child that's getting up 11 times during a short
1:40:19six minute interaction at the table,
1:40:21or whether or not a child who
1:40:24somehow has to venture off every moment
1:40:26or a coworker of yours
1:40:27who's an adult who's constantly fidgeting
1:40:29or moving things around that somehow they are unaware
1:40:31that they are oblivious,
1:40:32they're not oblivious to how they feel.
1:40:34Chances are they're very challenged in the situations
1:40:36that they're in
1:40:37and they're doing everything they can to try
1:40:38and regulate their attention.
1:40:40So I think it's an important study to highlight
1:40:42because it really underscores the fact that
1:40:44something else is going on
1:40:46and that something else has everything to do
1:40:48with this ability to coordinate
1:40:49these tasks directed networks,
1:40:51and to coordinate that in the proper way
1:40:53with that default mode network
1:40:55and that is a process as you now know,
1:40:58that's regulated exquisitely by certain neurochemicals
1:41:02and in particular the neurochemicals, dopamine,
1:41:04norepinephrine and serotonin,
1:41:07and a fourth one I'd like to throw into the mix,
1:41:09which is acetylcholine,
1:41:10which is very vital for cognitive focus.
1:41:13So now I want to switch back to talking about
1:41:15some of the drugs that are typically used
1:41:17to access those systems, prescription drugs
1:41:19and I want to talk about some of the new and emerging
1:41:22non-prescription approaches
1:41:23to increasing the levels of dopamine,
1:41:25acetylcholine and serotonin in the brain
1:41:28using various supplement type compounds,
1:41:30because several of them are showing
1:41:32really remarkable efficacy
1:41:34in excellent peer reviewed studies.
1:41:36So before moving to some of the newer atypical compounds
1:41:39and things sold over the counter,
1:41:41I'd like to just briefly return to the classic drugs
1:41:46that are used to treat ADHD.
1:41:49These are the ones I mentioned earlier,
1:41:51methylphenidate also called Ritalin,
1:41:54Modafinil or armodafinil is another one and Adderall,
1:42:00again, all of these work by
1:42:02increasing levels of dopamine and norepinephrine.
1:42:05Typically they're taken orally in pill form,
1:42:08or sometimes in capsule form
1:42:11the dosages that are appropriate vary,
1:42:14according to severity of the condition
1:42:17for a given person and the age of the person.
1:42:20This is a complicated landscape for each individual.
1:42:24They have to figure out the pharmacology
1:42:25that's best for them.
1:42:26Some individuals are even layering long
1:42:30or time to release Ritalin with Adderall in smaller doses,
1:42:35it can get quite complex or it can be quite straightforward
1:42:37if you are really interested in these drugs
1:42:40and how they work
1:42:41and you'd like to get a glance at a table of all the results
1:42:46from all the studies of which there are now hundreds,
1:42:49there's an excellent review about these drugs and their use
1:42:54and their comparison to similarly structured drugs
1:42:57in particular MDMA and cocaine and amphetamine,
1:43:01meaning Street Amphetamine
1:43:03to really illustrate the similarities
1:43:05of action and some of the problems associated
1:43:08with long-term use.
1:43:10I don't expect you to read this article in full
1:43:11I'm here so that you don't have to go read these articles,
1:43:14but in case you want a ton of information,
1:43:17the paper is Esposito et al Frontiers and bio-sciences,
1:43:20it's an excellent, excellent
1:43:22review of the entire literature.
1:43:24It is quite long.
1:43:26I can put a link to that study in our caption,
1:43:29and it essentially describes all the studies
1:43:33that have been done, peer reviewed and published,
1:43:35and it refers to these drugs in an interesting way.
1:43:39It doesn't just refer these drugs as for treatment of ADHD.
1:43:42It actually refers to them using language that ordinarily
1:43:45I'm not very fond of, but I'll agree to here,
1:43:48which is so-called smart drugs or nootropics.
1:43:52It also covers caffeine, which again as I mentioned earlier,
1:43:56increases dopamine norepinephrine
1:43:59and to some extent serotonin,
1:44:01but what I like about this review so much is that
1:44:05in putting, these drugs of abuse,
1:44:07methamphetamine, and cocaine, right alongside these drugs,
1:44:09like Ritalin and Adderall and also caffeine,
1:44:12we start to realize that the distinction between
1:44:15drugs of abuse
1:44:15and the distinction between drugs of treatment
1:44:18is actually a very fine and sometimes even a blurry line
1:44:21and in thinking about whether or not one wants to use
1:44:25these prescription, I want to emphasize prescription,
1:44:27not drugs of abuse,
1:44:28but prescription drugs
1:44:29for treatment of one's own attentional capacity.
1:44:33I think it is important to understand
1:44:35the extent to which they all carry
1:44:37more or less the same side effects.
1:44:38The one exception being caffeine caffeine side effects
1:44:41can be anxiety if you ingest too much of it, insomnia,
1:44:44if you drink it too late in the day,
1:44:46but typically it will not cause the major side effects
1:44:49of the other drugs,
1:44:50such as high propensity for addiction and abuse.
1:44:55Amphetamines of any kind as well as cocaine
1:44:58can cause sexual side effects
1:45:00because they're vasoconstrictors.
1:45:02So, men have trouble achieving erection,
1:45:06there can often be the intense desire or libido for sex,
1:45:11but an inability to actually perform.
1:45:14So that's an issue with any kind of stimulant.
1:45:16So these drugs are not without their consequences.
1:45:19In addition, and here I'd lump caffeine back into the mix.
1:45:24In addition, they almost all carry cardiac effects, right?
1:45:27They increase heart rate,
1:45:28but they also have effects on constriction of blood vessels
1:45:32and arteries and veins and so forth in ways
1:45:34that can create cardiovascular problems.
1:45:37Now, caffeine is a bit of a complicated one.
1:45:40I talked about this on a podcast long ago,
1:45:42but I'll just remind you that it turns out
1:45:44that if you are caffeine adapted, in other words,
1:45:47if you are used to drinking caffeine
1:45:49then the ingestion of caffeine,
1:45:51most often will cause vasodilation who actually allow more
1:45:54blood flow through.
1:45:55However, if you are not caffeine adapted,
1:45:57it will cause vasoconstriction
1:45:59due to an increased stress response.
1:46:02So if you're familiar with caffeine,
1:46:04caffeine can actually have a little bit more
1:46:06of a relaxation response
1:46:08although if you drink enough of it,
1:46:08it will make you amped up.
1:46:11These other drugs, almost always lead to vasoconstriction,
1:46:15increased heart rate dilation of the pupils, less blinking,
1:46:18heightened levels of attention,
1:46:19which looks very much like stress
1:46:22and at its extremes looks very much
1:46:23like the effects of street drugs,
1:46:25like cocaine and amphetamine.
1:46:27Because of the large amounts of
1:46:28dopamine that released in the brain.
1:46:30People tend to crave that state over and over
1:46:33and yet with each subsequent use
1:46:36are able to get less and less
1:46:38of that euphoric feeling
1:46:39or that really, really focused feeling.
1:46:41So one thing that's being explored quite extensively now
1:46:43in the treatment of ADHD are drug schedules.
1:46:47Whether or not people should take Adderall every day
1:46:51or every other day,
1:46:52whether or not they should take it
1:46:53only every once in a while,
1:46:55whether or not young children can take it just a few times
1:46:57and engage in behavioral training of the sort
1:47:00that I talked about before, where they're doing,
1:47:02maybe it's a 17 minute meditation type exercise,
1:47:05but more likely it would be the movement
1:47:08followed by the visual focusing,
1:47:10cause that's only done for 20 or 30 or 60 seconds.
1:47:13Why would you do that?
1:47:13Well in a chemically enhanced state,
1:47:16your brain is more plastic.
1:47:17The circuits are able to modify and learn better.
1:47:22That's the optimal time to engage in focus
1:47:25in a very deliberate way.
1:47:27So just taking a drug and expecting
1:47:29focus to just work at any point
1:47:31and being able to turn focus on and off at will,
1:47:35that's an unrealistic expectation, right?
1:47:38More likely the best use of things like Adderall, Modafinil,
1:47:44armodafinil and Ritalin is going to be
1:47:47to combine those treatments with behavioral exercises
1:47:51that actively engage the very circuits
1:47:53that you're trying to train up and enhance
1:47:55and then perhaps I want to highlight perhaps
1:47:58tapering off those drugs
1:47:59so that then one can use those circuits
1:48:01without any need for chemical intervention.
1:48:04So despite any controversy that might be out there,
1:48:07I think it's fair to say that
1:48:09the consumption of omega-3 fatty acids
1:48:12can positively modulate
1:48:14the systems for attention and focus.
1:48:16So then the question becomes how much EPA,
1:48:20how much DHA does that differ for,
1:48:23what's helpful for depression, et cetera
1:48:25and actually it does differ
1:48:27in reviewing the studies for this
1:48:29it appears that a threshold level of 300 milligrams of DHA
1:48:34turns out to be an important inflection point.
1:48:37So typically fish oils or other sources of omega-3s
1:48:41will have DHA and EPA
1:48:43and typically it's the EPA
1:48:45that's harder to get at sufficient levels,
1:48:48meaning you have to take quite a lot of fish oil
1:48:50in order to get above that 1000 milligram
1:48:52or 2000 milligram threshold to improve mood
1:48:55and other functions.
1:48:56But for sake of attention,
1:48:59there are 10 studies that have explored this in detail
1:49:02and while the EPA component is important,
1:49:05the most convincing studies point to the fact that getting
1:49:08above 300 milligrams per day of DHA is really where you
1:49:12start to see the attentional effects.
1:49:14Now, fortunately, if you're getting sufficient EPA
1:49:16for sake of mood and other biological functions,
1:49:20almost without question,
1:49:22you're getting 300 milligrams or more of DHA.
1:49:25So that usually checks that box just fine.
1:49:27What's interesting is that there's another compound
1:49:30phosphatidylserine that has been explored for its capacity
1:49:35to improve the symptoms of ADHD.
1:49:37Again, I don't think this is any direct way,
1:49:39but rather in a modulatory way,
1:49:41but it appears that phosphatidylserine
1:49:44taken for two months for 200 milligrams per day,
1:49:49was able to reduce the symptoms of ADHD in children.
1:49:52It has not been looked at in adults yet as,
1:49:55at least as far as I know,
1:49:57but that this effect was greatly enhanced
1:50:00by the consumption of omega-3 fatty acids.
1:50:03So now we're starting to see synergistic effects
1:50:05of omega-3 fatty acids and phosphatidylserine
1:50:08again that was 200 milligrams per day.
1:50:11This is something that sold
1:50:12over the counter in capsule form, at least in the U.S.
1:50:15there were two studies,
1:50:16both were double-blind studies.
1:50:18I carried out for anywhere from one to six months on both
1:50:21boys and girls and it really was boys and girls,
1:50:23not men and women.
1:50:24This was kids age one to six or seven to 12,
1:50:28and it was a fairly large number of subjects.
1:50:32So 147 subjects in one case in 36 in the other,
1:50:35the takeaway is that getting sufficient levels of EPA
1:50:39and particularly there's 300 milligram threshold of DHA,
1:50:42plus, if you are interested in it and it's right for you,
1:50:46200 milligrams of phosphatidylserine
1:50:48can be an important augment
1:50:50for improving the symptoms of ADHD.
1:50:53You'll also find literature out there
1:50:55and many claims about so-called Ginkgo Biloba,
1:50:59which has been shown to have minor effects
1:51:01in improving the symptoms of ADHD,
1:51:04not nearly as effective as Ritalin and Adderall.
1:51:08Ginkgo Biloba is not appropriate for many people.
1:51:12I am one such person, I don't have ADHD,
1:51:15but when I'd taken Gingko, even at very low doses,
1:51:19I get absolutely splitting headaches.
1:51:21Some people do not experience those headaches,
1:51:23but it's known to have very potent vasoconstrictive
1:51:25and vasodilating properties that vary depending on
1:51:29when you took the compound.
1:51:32So for those of you that are exploring Ginkgo Biloba,
1:51:35and you will see a lot of claims about Ginkgo Biloba
1:51:38for attention in ADHD definitely take the vasodilation
1:51:41vasoconstriction headache issue into consideration.
1:51:46So I'd like to talk about the drug Modafinil
1:51:48and the closely related drug armodafinil
1:51:50that's AR Modafinil.
1:51:53Because Modafinil and armodafinil
1:51:55are gaining popularity out there,
1:51:57both for treatment of ADHD and narcolepsy,
1:52:00but also for communities of people
1:52:03that are trying to stay awake long periods of time.
1:52:05So it's actively used in the military by first responders,
1:52:10it's gaining popularity on college campuses
1:52:13and people are using it more and more as an alternative
1:52:15to Adderall and Ritalin and excessive amounts of coffee.
1:52:20It does increase focus and to a dramatic extent,
1:52:24Modafinil typically was very expensive,
1:52:28I don't know if it's still this expensive,
1:52:30but when one has a prescription for it,
1:52:32it could still cost as much as eight or $900
1:52:35even $1000 a month.
1:52:37Armodafinil is a far less expensive version,
1:52:41that's chemically slightly different than Modafinil.
1:52:44Regardless of price
1:52:45people are taking Modafinil and armodafinil.
1:52:48Want to emphasize that unlike Ritalin and Adderall,
1:52:52Modafinil and armodafinil are weak dopamine
1:52:56re-uptake inhibitors,
1:52:57and that's how they lead to increases in dopamine.
1:53:00So, whereas Ritalin and Adderall, amphetamine,
1:53:02and cocaine lead to big increases in dopamine
1:53:05also through re-uptake mechanisms and so forth
1:53:07Modafinil is a weaker dopamine re-uptake stimulator
1:53:12and so what that means is that it leaves
1:53:15more dopamine around to be active at the synopsis,
1:53:17the gaps between neurons,
1:53:19however, it also activates other systems.
1:53:22It acts on the orexin system,
1:53:24which is actually a peptide that we talked about
1:53:26in the episode on hunger,
1:53:28because it regulates hunger and appetite,
1:53:31and it regulates sleepiness and feelings of sleepiness.
1:53:34In fact, the, excuse me, orexin
1:53:36also called hypocretin system,
1:53:37the orexin hypocretin system
1:53:39is what's disrupted in narcolepsy.
1:53:42That was the important discovery of my colleagues,
1:53:44Emmanuel Mignot and Seiji Nishino
1:53:46at Stanford some years ago,
1:53:48they identified the biological basis of narcolepsy
1:53:50and it's a disruption in the so orexin hypocretin system
1:53:54and Modafinil is one of the
1:53:56primary treatments for narcolepsy.
1:53:58It also has these other effects on the dopamine system
1:54:01and on the norepinephrine system,
1:54:03even though it doesn't lead to quite as intense levels
1:54:08of dopamine and arousal and focus,
1:54:11it does have the property of raising levels of attention
1:54:14and focus, and that's why people are using it.
1:54:16So it's a somewhat milder form of Adderall.
1:54:19Armodafinil for some people works as well as Modafinil
1:54:22and as I mentioned before,
1:54:23it's much lower cost for other people it doesn't.
1:54:26I have an experience,
1:54:27meaning I do have an experience
1:54:30that I'll share with you with armodafinil.
1:54:32A few years ago,
1:54:33I was suffering from jet lag, really terribly
1:54:36and I was traveling overseas.
1:54:38I went to a meeting to give a talk,
1:54:40I took half of the prescribed dose of armodafinil.
1:54:45It was prescribed to me.
1:54:47I took that half dose and I gave my lecture
1:54:51and then I stayed around to answer questions
1:54:53and then four hours later,
1:54:56a friend of mine came up to me and said,
1:54:58you've been talking for four and a half hours,
1:55:01and they're only a few people still here.
1:55:03Luckily there were still a few people be a lot weirder,
1:55:05if the room was completely empty,
1:55:07'cause it wasn't being recorded.
1:55:09So I have firsthand knowledge
1:55:10of the sorts of cognitive effects that it can create.
1:55:14I personally would not want to be in that state
1:55:16for sake of studying or learning
1:55:18or for doing this podcast, for instance
1:55:21and I can honestly say that today,
1:55:23all I've adjusted is some coffee
1:55:25and some Yerba latte tea and some water.
1:55:27I'm not on any of the compounds that I've described during
1:55:30the course of today's episode.
1:55:32You might ask why I took half the recommended dose
1:55:36of armodafinil and the reason is that I'm somebody who's
1:55:40fairly hypersensitive to medication of any kind,
1:55:44what you find if you look in the literature,
1:55:46is that about 5% of people
1:55:48are hyper hyper sensitive to medication.
1:55:50They require far lower doses of any medication
1:55:53than other people in order to experience the same effects.
1:55:56I'm somebody that I think has,
1:55:57or modest a hyper if that sort of oxymoronic statement,
1:56:02but a modest hypersensitivity to medication.
1:56:05So I've almost always been able to get by,
1:56:07on taking less of whatever was prescribed for me
1:56:10and feel just fine
1:56:11or in this case to feel like it was still too much,
1:56:13it turned out that the right dose of armodafinil for me
1:56:17was zero milligrams.
1:56:19Now you may notice that
1:56:20I haven't talked much about acetylcholine.
1:56:22Acetylcholine is a neurotransmitter
1:56:24that at the neuron to muscle connections,
1:56:27the so called neuromuscular junctions
1:56:28is involved in generating muscular contractions
1:56:30of all kinds for all movements.
1:56:34Acetylcholine is also released from two sites in the brain.
1:56:37So a little bit of nomenclature here again,
1:56:38feel free to ignore the nomenclature,
1:56:41but there is a collection of neurons in your brain stem
1:56:43that send projections forward,
1:56:45kind of like a sprinkler system
1:56:46that's very diffuse to release acetylcholine
1:56:50and those neurons reside in an area or a structure
1:56:53that's called the pedunculopontine nucleus, the PPN
1:56:57and then there's a separate collection of neurons
1:56:59in the basal forebrain called
1:57:02unimaginatively nucleus basalis the nucleus at the base
1:57:05and they also hose the brain with acetylcholine,
1:57:09but in a much more specific way.
1:57:11So one is sort of like a sprinkler system
1:57:13and the other one is more like a fire hose
1:57:15to a particular location
1:57:16and those two sources of acetylcholine,
1:57:19collaborate to activate particular locations in the brain,
1:57:23and really bring about a tremendous degree of focus
1:57:26to whatever is happening at those particular synapses.
1:57:29So it could be a focus on visual information
1:57:32or auditory information,
1:57:33if you're listening closely to what I'm saying right now,
1:57:35and you just heard closely
1:57:37step out from the rest of my sentence,
1:57:39no doubt there was acetylcholine
1:57:41released at the sites in your brain
1:57:43where the neurons that represent your recognition
1:57:46of the word closely occurred, okay?
1:57:49So now you have an example and you have an understanding
1:57:51and hopefully a picture in your mind
1:57:52of how all this is working,
1:57:54not surprisingly then drugs that increase cholinergic
1:57:58or acetycholine transmission
1:57:59will increase focus and cognition.
1:58:03One such compound is so-called alpha GPC,
1:58:06which is a form of choline and increases acetycholine
1:58:09transmission dosages as high as 1200 milligrams per day,
1:58:14which has a very high dosage spread out,
1:58:16typically it's 300 or 400 milligrams spread out
1:58:19throughout the day have been shown to offset
1:58:23some of the effects of age-related cognitive decline,
1:58:26improved cognitive functioning
1:58:27people that don't have age-related cognitive decline
1:58:29that's a very high dose.
1:58:30Typically when people are using alpha-GPC to study
1:58:34or to enhance learning of any kind,
1:58:36they will take somewhere between 300 and 600 milligrams
1:58:40that's more typical.
1:58:41Again, you have to check with your doctor,
1:58:43you have to decide if the safety margins
1:58:45are appropriate for you
1:58:47obviously you'll want to check that out,
1:58:49but alpha-GPC is effective in creating
1:58:52more focused by way of this cholinergic system,
1:58:54It stimulates acetylcholine release
1:58:56from both of those locations,
1:58:58the PPN in the back of the brain and nucleus basalis
1:59:01in the front of the brain.
1:59:04There are two other over the counter compounds
1:59:07that are in active use out there for treatment of ADHD
1:59:11and in use for simply trying to improve focus
1:59:15and the first one is L-Tyrosine
1:59:17it's an amino acid that acts as a precursor
1:59:20to the neuromodulator dopamine
1:59:22and now knowing everything you know about
1:59:23dopamine, attention and the circuits involved,
1:59:25it should come as no surprise as to why
1:59:27people are exploring the use of L-tyrosine for that purpose.
1:59:31L-tyrosine does lead to increases in dopamine.
1:59:35They are fairly long lived and L-tyrosine can improve
1:59:40one's ability to focus, however,
1:59:42the dosaging can be very tricky to dial in.
1:59:46Sometimes it makes people feel too euphoric
1:59:48or too jittery or too alert that they are then
1:59:51unable to focus well.
1:59:52So the dosage ranges are huge,
1:59:56you see evidence for 100 milligrams
1:59:58all the way up to 1200 milligrams.
2:00:00It's something that really
2:00:01should be approached with caution,
2:00:02especially for people that have any kind
2:00:04of underlying psychiatric or mood disorder,
2:00:07because dysregulation of the dopamine system is
2:00:11central to many of the mood disorders such as depression,
2:00:15but also especially mania bipolar disorder,
2:00:19schizophrenia, things of that sort.
2:00:21So it's something that really should be approached
2:00:22with caution, nonetheless, in exploring what's out there
2:00:25and even some studies online
2:00:28that were done in either animal studies or human studies,
2:00:32it's clear that L-tyrosine is being explored for that
2:00:35purpose as is PEA and Phenethylamine,
2:00:39which is a essentially PEA, but some related compounds.
2:00:43So there's a whole class of dopaminergic
2:00:46or dopamine stimulating supplements
2:00:48that people are using to try
2:00:49and get their dopamine levels up and again,
2:00:52it's kind of a fine line between too little enough
2:00:56and too much.
2:00:57If you want to get the literature on
2:00:59those two compounds there, I will refer you to
2:01:02this great website at examine.com just as it sounds
2:01:07and you can put in L-tyrosine or PEA,
2:01:09and you can get the details on that.
2:01:11But I highly recommend also going to their section on ADHD
2:01:14to see how those particular comment OENs relate specifically
2:01:17to ADHD and cognitive focus.
2:01:20And last but not least
2:01:22in terms of these different compounds,
2:01:24I do want to mention the Racetams.
2:01:27These are somewhat esoteric
2:01:30and probably most of you haven't heard about them,
2:01:32but some of you probably know a lot about them
2:01:35and they are becoming more popular.
2:01:36They go by names like New pepped and things of that sort.
2:01:40The Racetams. are illegal in certain countries.
2:01:43They are gray market in other countries,
2:01:45and they are sold over the counter in this country,
2:01:48in the U.S. so they have different margins for safety
2:01:54you definitely need to consult your doctor,
2:01:56especially if you have ADHD,
2:01:58but new pepped has been shown when taken,
2:02:02at 10 milligrams, twice daily can be more effective
2:02:06than some of the other Racetams.
2:02:07What is Noopept? Noopept taps into the cholinergic system,
2:02:11the acetylcholine system in ways, very similar to alpha-GPC,
2:02:14but seems to have a slightly higher affinity for some of the
2:02:18receptors involved and can lead to those heightened states
2:02:22of cognitive capacity
2:02:23and there are these studies one in particular,
2:02:26comparative studies of new pepped,
2:02:28Racetams in the treatment of patients
2:02:29with mild cognitive disorders
2:02:31and brain diseases of vascular and traumatic origin.
2:02:34That's a mouthful.
2:02:35What this study basically points to
2:02:37is the fact that people who are experiencing some degree
2:02:40of inability to focus due to prior concussion
2:02:44or some vascular event, a stroke or a schemey of any kind,
2:02:47because neurons need blood,
2:02:49when the blood supply is cut off to neurons,
2:02:50or when there's a bleed in the brain.
2:02:52Subsequent to that, often
2:02:54there are challenges in maintaining focus.
2:02:56This is very common for people who have done sports,
2:02:59where there's a lot of running into each other
2:03:00with your head like rugby football, hockey, and so forth,
2:03:04but also people who have experienced head blows
2:03:06or often overlooked is the fact that
2:03:08most traumatic head injury is not actually from sports,
2:03:11even football it's from things like construction work
2:03:14from high-impact work of that kind.
2:03:16So there does seem to be some efficacy
2:03:18of new Pepped and Racetams. and things like it.
2:03:22It's an emerging area and as I mentioned in the U.S.
2:03:25these things are sold over the counter.
2:03:27Again, you have to figure out if it's right for you,
2:03:29but they are beginning to show some promise,
2:03:32and I'm intrigued by them because of the way
2:03:35that they tap into the cholinergic system,
2:03:37which is both directly involved in focus,
2:03:40and the ability to focus,
2:03:42but is also important for things related
2:03:45to age-related cognitive decline.
2:03:47So a decline in cholinergic transmission or acetylcholine
2:03:51as we call it in the brain is one of the things
2:03:54associated with cognitive decline
2:03:55and it does seem that increasing cholinergic transmission
2:03:58can offset some of that cognitive decline
2:04:00and perhaps even more so in conditions
2:04:03such as vascular damage or concussion to the brain.
2:04:06If you're interested in atypical treatments for ADHD
2:04:10compounds or improve focus and related themes,
2:04:13and you like reading about this stuff,
2:04:14there's an excellent review article
2:04:16that I can refer you to it's
2:04:18by Ahn et al, AHN it was published in 2016
2:04:22so it's a little bit behind the times,
2:04:25although it's surprisingly comprehensive given that,
2:04:27which lines up all the various drugs that I've discussed,
2:04:32Racetams., and Adderall and Ritalin,
2:04:34and various forms of dopaminergic agents
2:04:38and cholinergic agents spells out whether or not
2:04:40they are sold over the counter by prescription,
2:04:43and really lines them up in all their effects,
2:04:45their drawbacks, et cetera.
2:04:48I'll refer you to that study.
2:04:49It's available in its full length form online for free
2:04:52it's Hen et al the journal is neuro plasticity,
2:04:56neural plasticity, 2016
2:04:58should be very easy to find if you put those keywords in,
2:05:01and while it is a review,
2:05:02it is a very comprehensive review
2:05:04and if you're really into this stuff,
2:05:06and you also want to learn a thing or two about
2:05:08how these things interact with neurofeedback, et cetera,
2:05:11there's some information in there as well.
2:05:13I know I've already covered a lot of information,
2:05:15but there is one more category of technology
2:05:18for the treatment of ADHD and for enhancement of focus
2:05:22in anyone that I would like to emphasize
2:05:26and that's transcranial magnetic stimulation.
2:05:28Transcranial magnetic stimulation also called TMS
2:05:31is achieving increasing popularity nowadays
2:05:34for the treatment of all sorts of neurologic conditions
2:05:38and psychiatric conditions.
2:05:40It is a non-invasive tool,
2:05:41it involves taking a coil it's a device with a coil
2:05:45that's placed over particular locations in the brain,
2:05:48and then sends magnetic stimulation into the brain
2:05:53and it can actually pass through the skull
2:05:54without having to drill through the skull
2:05:56and nowadays can be used to both
2:05:59lower the amount of activity
2:06:00or increase the amount of activity
2:06:02in specific brain areas.
2:06:04It's spatial, precision is not remarkable.
2:06:09That doesn't mean it's not of use,
2:06:11but it is not a super fine green tool, okay?
2:06:16It's not a canon, but it's also not a needle.
2:06:19It is somewhere in between.
2:06:21It can direct the activity of particular brain regions
2:06:23at particular depths and as I mentioned,
2:06:26it can increase or decrease that activity.
2:06:28So for instance,
2:06:29I've had a TMS coil placed on my head,
2:06:31not for therapeutic purposes, even it was,
2:06:33I wouldn't tell you, but rather just for,
2:06:36well, I'm a neuroscientist
2:06:37and I worked in a lab with one for entertainment,
2:06:40exploratory purposes, please don't do this at home.
2:06:44It was placed over my motor cortex,
2:06:46which generates voluntary action
2:06:49and it was a coil that at that time
2:06:52could only inhibit neurons
2:06:54and so what I was doing as I was moving objects
2:06:56around on a table, just like I am now,
2:06:58it was actually a pencil, not a pen
2:07:00and I was tapping the pencil
2:07:01and then the TMS coil was turned on and for the life of me,
2:07:05I could not move that pencil, okay?
2:07:08Because it was inhibiting my upper motor neurons
2:07:11in the portion of my cortex
2:07:12that controls voluntary activity.
2:07:15As soon as the coil was turned off,
2:07:16I could return to tapping the pencil again,
2:07:19nowadays it's possible to stimulate motor cortex
2:07:23or any area of the brain with some degree of precision
2:07:26that could create the impulse to move
2:07:29without actually making the decision to move.
2:07:31So you can literally engage certain neural circuits
2:07:34and therefore behaviors and certain thought
2:07:36and emotional patterns
2:07:38by way of transcranial magnetic stimulation.
2:07:40This has far reaching and vast implications,
2:07:43as you can probably imagine
2:07:47in discussing ADHD with a colleague that uses TMS,
2:07:50what they are doing is they are taking the TMS coil
2:07:55to children and adults that have ADHD,
2:07:59and they're using it to stimulate the portions
2:08:01of the prefrontal cortex that we talked about earlier
2:08:04that engage task directed focused states.
2:08:08So rather than using a drug
2:08:09that generally increases dopamine,
2:08:11and some of the other chemicals involved
2:08:13there you using directed TMS stimulation of the circuits
2:08:17and fortunately, I was quite relieved to hear this,
2:08:20they are combining that with a focused learning task.
2:08:24So they're literally teaching the brain to learn
2:08:25in a noninvasive way, no drug at all
2:08:28and right now there are experiments clinical trials
2:08:31going on, comparing TMS of this sort
2:08:34to the drug treatments of the sort that we described earlier
2:08:37that engaged these circuits
2:08:38through pharmacologic mechanisms.
2:08:40So very exciting times for TMS,
2:08:42very exciting times for pharmacology related to ADHD
2:08:48and for enhancing focus in general
2:08:49and when I say very exciting times,
2:08:51I mean, no drug is perfect,
2:08:53but the constellation of drugs that's out there
2:08:57is getting much larger,
2:08:58but because they tap into different aspects
2:09:01of their circuitry,
2:09:02I do think that we are well on our way
2:09:04to identifying the ideal combinations of drug treatments,
2:09:06technological treatments,
2:09:08and behavioral paradigms for increasing focus in both
2:09:11children and adults with ADHD.
2:09:14And as a final final point,
2:09:16I also want to mention something about technologies
2:09:18that are making it harder for all of us to focus,
2:09:22regardless of whether or not
2:09:23we have pre-existing ADHD or not.
2:09:25You can probably guess where this is going.
2:09:28Everybody nowadays seems to have a smartphone.
2:09:31I'm sure there are a few individuals out there
2:09:33that don't have a smartphone.
2:09:35Nonetheless, most people have them.
2:09:37Most kids want one, as soon as they can get them
2:09:40and they are small, they grab our attention entirely.
2:09:45But within that small box of attention,
2:09:48there are millions of attentional windows
2:09:51scrolling by, right?
2:09:53So just because it's one device that we look at
2:09:55does not mean that we are focused,
2:09:56we are focused on our phone,
2:09:58but because of the way,
2:10:00in which context switches up so fast within the phone,
2:10:03it's thought that the brain is struggling now
2:10:06to leave that rapid turnover of context, right?
2:10:09Many, many shows, many, many Instagram pages,
2:10:12many, many Twitter feeds many, many websites.
2:10:14Basically the whole world,
2:10:16at least in virtual format is available
2:10:18within that small box.
2:10:20Unlike any other technology
2:10:21humans have ever dealt with before,
2:10:23even though there are trillions
2:10:25infinite number of bits of information
2:10:27in the actual physical world,
2:10:29your attentional window,
2:10:30that aperture of constriction
2:10:32and dilating that visual window
2:10:34is the way in which you cope with all that
2:10:36overwhelming information typically.
2:10:39Well within the phone,
2:10:40your visual aperture is set to a given width
2:10:44it's about this big,
2:10:45typically the phone seem to be getting bigger,
2:10:46but nonetheless, it's about that big
2:10:48and within there,
2:10:51your attentional window is grabbing it near infinite
2:10:54number of bits of information, colors, movies.
2:10:57If a picture is worth 1000 words,
2:10:59a movie is worth a billion pictures,
2:11:01the brain loves visual motion
2:11:03and so the question is,
2:11:07does that sort of interaction on a regular basis
2:11:09lead to deficits in the types of attention
2:11:12that we need in order to perform well
2:11:13in work, in school, relationships, et cetera
2:11:15and the short answer is yes, it does appear so
2:11:19we are inducing a sort of ADHD
2:11:22and while the studies on this are ongoing because prominent
2:11:25use of smartphones really took off right around 2010
2:11:27and we're only in 2021 longstanding studies take time,
2:11:33which is essentially to say the same thing as long standing.
2:11:36There are some studies and one in particular
2:11:39that I'd like to highlight
2:11:39one was actually carried out pretty early in 2014.
2:11:42This is a study that explored smartphone use
2:11:46at the time they called it mobile phone use,
2:11:47but smartphone use and inattention,
2:11:50difficulties in attending in 7,102 adolescents
2:11:56that's a huge study,
2:11:58a population based cross-sectional study
2:12:01and you will be probably surprised and somewhat dismayed
2:12:06to hear that in order to avoid this decrease
2:12:10in attentional capacity,
2:12:12adolescents needed to use their smartphone
2:12:16for less than 60 minutes per day,
2:12:19in order to stay focused and centered on their other tasks.
2:12:23Otherwise they started to really run
2:12:24into significant issues.
2:12:26So 60 minutes is not much,
2:12:28I've a feeling that most young people
2:12:31are using their phone more than 60 minutes per day,
2:12:33I know I am.
2:12:35I think for adults,
2:12:36the number's probably higher meaning if you're an adult,
2:12:40I'm going to just extrapolate from what I read in this study.
2:12:43It seems that probably two hours a day on the phone
2:12:47would be the upper limit beyond which
2:12:49you would probably experience
2:12:51pretty severe attentional deficits.
2:12:54I'm a big fan of Cal Newport who wrote the book "Deep work."
2:12:57He's also written an excellent book,
2:12:59"A world without Email."
2:13:00I've never met him, but I'm a huge admirer of his work
2:13:02and I will paraphrase something that he said
2:13:05far more eloquently than I ever could,
2:13:07which is that the brain does not do well with constant
2:13:12context switching, meaning it can do it,
2:13:15but it diminishes our capacity to do meaningful work
2:13:18of any other kind.
2:13:20And so Cal, as I understand is very
2:13:24he's our computer science professor
2:13:25at Georgetown, by the way,
2:13:26is very structured and very disciplined
2:13:29in his avoidance of cell phone use.
2:13:33I think we're all striving to do that.
2:13:34I'm not here to tell you what to do,
2:13:36but I think whether or not you have ADHD or not,
2:13:39if you're an adolescent limiting your smartphone use
2:13:42to 60 minutes per day or less
2:13:45and if you are an adult to two hours per day or less
2:13:49is going to be among the very best ways to maintain,
2:13:54just to maintain your ability to focus
2:13:56at whatever level you can now and as I always say,
2:14:01most of the things that we get recognized
2:14:03for in life success in life, in every endeavor,
2:14:05whether or not it's school relationships, sport,
2:14:08creative works of any kind are always proportional
2:14:12to the amount of focus that we can bring that activity.
2:14:16It is important to rest of course, to get proper sleep.
2:14:18But I stand behind that statement
2:14:20and I leave you with that study about attention
2:14:23and cell phones and how cell phones are indeed eroding
2:14:26our attentional capacities.
2:14:28So I realized I covered a lot of information about ADHD
2:14:31and the biology of focus and how to get better at focusing.
2:14:35We talked about the behavioral
2:14:37and psychological phenotypes of ADHD.
2:14:40We talked about the underlying neural circuitry.
2:14:43We also talked about the neurochemistry
2:14:45and we talked about the various prescription
2:14:47drug treatments that are aimed at that neurochemistry
2:14:51and aimed at increasing focus in children
2:14:53and adults with ADHD.
2:14:55We also talked about over the counter compounds,
2:14:58the role of particular types of diets and elimination diets
2:15:01and we talked about interactions between these various
2:15:04features in dictating outcomes for ADHD
2:15:08and enhancing focus in general,
2:15:10we also talked a little bit about emerging neurotechnologies
2:15:13and how certain technologies like the smartphone
2:15:15are no doubt hindering our ability to focus
2:15:18and put us at greater risk of developing ADHD at all ages.
2:15:23I do acknowledge the irony and somewhat the contradiction
2:15:27of doing a two hour plus episode on ADHD
2:15:30If indeed, people who are watching this
2:15:32have challenges with attention,
2:15:34I want to emphasize that this podcast,
2:15:36like all of our podcast episodes
2:15:38are timestamped for a specific reason.
2:15:41They are designed to be digested
2:15:42in whatever batch one chooses, right?
2:15:45You don't have to watch or listen to the entire thing
2:15:47all at once however,
2:15:48if you've gotten to this point in the podcast,
2:15:51I want to thank you.
2:15:52I do hope that you've learned a lot about this condition.
2:15:55I hope you've also learned a lot
2:15:57about your own capacity to focus
2:15:58and things that you can do to enhance your focus.
2:16:00We even talked about a tool that takes just
2:16:02one 17 minute session to enhance your ability to focus
2:16:06thereafter, presumably forever.
2:16:08If you're enjoying this podcast and you're learning from it,
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2:17:00at any level that you like.
2:17:01During today's episode we talked a lot about
2:17:03supplement based compounds.
2:17:05If you're interested in supplements
2:17:07and you want to see the supplements that I personally take,
2:17:09you can go to Thorn that's T-H-O-R-N-E slash the letter U
2:17:14slash Huberman and you can see everything that I take
2:17:17and you can get 20% off any of those supplements
2:17:20or if you navigate into the Thorn site through that portal,
2:17:23you can get 20% off any of the supplements that Thorn makes,
2:17:27supplements aren't for everybody,
2:17:28you by no means have to take supplements.
2:17:30But if you are going to take supplements,
2:17:32it's important that you take supplements
2:17:33from a source that's reputable
2:17:35and which the ingredients are very high quality
2:17:38and in which the amount of the ingredients
2:17:40that listed on the bottle
2:17:41actually matches what's in the bottle.
2:17:43That's why we partnered with Thorn
2:17:44because they have the highest levels of stringency
2:17:46in terms of quality and specificity of the ingredients.
2:17:50And finally,
2:17:50I want to thank you for your time and your attention,
2:17:53and as always thank you for your interest in science.
2:17:56[upbeat music]

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