ADHD & How Anyone Can Improve Their Focus

- Welcome to the Huberman lab podcast, where we discuss science

and science-based tools for everyday life. [upbeat music] I'm Andrew Huberman, and I'm a professor of

neurobiology and ophthalmology at Stanford school of medicine. Today, we are going to talk

all about attention deficit, hyperactivity disorder, or ADHD. We are also going to talk

about normal levels of focus. What are normal levels of

focus and how all of us, whether or not we have ADHD

or not can improve our ability to focus our ability to

rule out distraction. It turns out those are

two separate things, as well as remember information better. We are also going to talk about how we can learn to relax while focusing, which turns out to be a critical

component of learning new information and for coming

up with new creative ideas. So whether or not you have

ADHD or know someone who does, or if you're somebody who feels

that they do not have ADHD, but would simply like to

improve their ability to focus or to be more creative. This episode is definitely

for you as well. We are going to talk

about drug based tools that are out there. We are going to talk

about behavioral tools. We will talk about the role

of diet and supplementation, and we will talk about new emerging brain machine interface devices, things like transcranial

magnetic stimulation. If you don't know what

that is, don't worry, I will explain it to you. These are non-invasive methods

for rewiring your brain in order to make focusing

more natural for you and to teach you how to

increase your depth of focus. Now, just a quick reminder that any time we discuss

a psychiatric disorder, it's important that we remember that all of us have the

temptation to self-diagnose or to diagnose others. So, as I list off some of

the symptomology of ADHD, some of that symptomology

might resonate with you. You might think, oh, maybe I have ADHD or you might decide that someone you know, definitely has ADHD. However, it is very important

that you don't self-diagnose or diagnose somebody else the clear and real diagnosis of ADHD really should be carried out

by a psychiatrist, a physician, or a very well-trained

clinical psychologist. There are clear criteria

for what constitutes full-blown ADHD. However, many of us have

constellations of symptoms that make us somewhat

like somebody with ADHD and if you're struggling

with focus nowadays, as a lot of people are because of stress, because of smartphone use, which turns out can induce adult ADHD. We'll talk about that. We'll then pay attention

to the symptomology. You may actually require

professional treatment you might not, equally important is to remember that some of the terms that we cover, like impulse control and

attention and concentration are somewhat subjective and

they can change over time. Sometimes we have a better

level of attention than others. Maybe it depends on how we slept or other events going on in our life where something that

we're entirely unaware of. The important thing to remember is that we can all improve

our attentional capacity. We can all rewire the circuits

that make heightened levels of focus, more accessible to us. We can do that through multiple

types of interventions, and we are going to cover all

those interventions today. Before we march into the material, I'd like to remind that

this podcast is separate from my teaching and

research roles at Stanford. It is however, part of

my desire and effort to bring zero cost to consumer

information about science and science related tools

to the general public. And keeping with that theme, I'd like to thank the

sponsors of today's podcast. Our first sponsor is Roka. Roka makes eyeglasses and sunglasses that are of the utmost quality. I've spent a lifetime

working on the visual system and I can tell you that

there are many features built into our visual system that allows us to see things clearly, whether or not we are in shade or bright sunlight, et cetera. A lot of sunglasses have the problem that you have to constantly take them off and put them back on again, because of changes in background

luminance, as we call it, Roka, sunglasses have solved this problem. It doesn't matter if you're

standing in tree shade or a bright light, or what have you, you can always see things

with perfect clarity and that shows that they really understand the way that the visual system works and their eyeglasses

are built accordingly. I wear readers at night, so I wear eye glasses to read at night, or when I drive at night and their readers and eyeglasses are terrific as well. One thing I like so much

about their eyeglasses and their sunglasses

is that despite being, "Performance glasses" mean

you can wear them on running or swimming or biking, they

don't fall off your face, even if you get sweaty,

they're very lightweight. You don't even notice that they're on is that the aesthetic is really good. A lot of performance glasses, they look kind of ridiculous, frankly, they make people look like cyborgs, but their aesthetics are terrific, they have a lot of different styles, you can select from. The company was founded by

two All-American swimmers from Stanford and everything

about their sunglasses and eyeglasses were designed

with optical clarity and performance in mind. If you'd like to try Roca,

you can go to roka.com, that's R-O-K-A.com and

enter the code Huberman to save 20% off your first order. Today's episode is also

brought to us by Belcampo. Belcampo is a regenerative

farm in Northern California that raises organic grass fed and finished certified humane meat. I tend to eat meat about once a day. So typically I'll fast

until about noon or one and then my lunch consists

of a small piece of steak or chicken and some salad and then I tend to eat my

carbohydrates in the evening before I go to sleep. Sometimes and especially

lately I'm eating my protein earlier in the day because I'm playing around

with some of the findings related to protein

intake early in the day. But regardless, I'm eating

meat about once a day. For me, it's extremely important that any meat that I consume come from humanely raised animals and that the meat be of

the very highest quality. So with Belcampo meets the

animals graze on open pastures and seasonal grasses,

which results in meats, that's much higher in

nutrients and healthy fats, including omega-3s, which I've talked a lot

about on this podcast, the importance of

omega-3s for heart health, for brain health, for mood, et cetera. Personally, I love their rib eye steaks, their New York steaks,

their chicken is terrific and I also liked the organic meatballs. All the elk meat is organic and grass fed, and grass-finished, if

you'd like to try Belcampo, first time customers can get 20% off by going to belcampo.com/Huberman and using the code Huberman at checkout. Today's episode is also

brought to us by Helix sleep. Helix sleep makes mattresses and pillows that are absolutely second to none. I started sleeping on a

Helix mattress about eight, nine months ago, and I've

never slept better in my life. If you go to the Helix site, they have a short two minute quiz, and that quiz asks you questions like, do you sleep on your back? Do you sleep on your side? Do you sleep on your stomach? Do you tend to run hot or cold

in the middle of the night? Maybe you don't know and they actually have an

option to select, I don't know and Helix will match you to a mattress that specific to your sleep needs. It turns out to be really important. Some people have the tendency to run hot and sleep on their stomach. Other people lie on their back and they're waking up cold

in the middle of the night. So you really need a mattress that's matched to your sleep needs. I did that and I matched to

the dusk mattress, D-U-S-K and it turns out to be perfect

for me and my sleep needs as well their pillows are really terrific. So if you're interested in

upgrading your mattress, go to helixsleep.com/huberman, take their two minutes sleep quiz, and they'll match you

to a customized mattress and you'll get up to $200

off any of their mattresses and you'll get two free

pillows with your order. They have a 10 year warranty. You have to try it out

for 100 nights risk-free it's more than three months and if you don't like it, they'll pick it up for you

and they'll take it away and you get all your money back. So if you're interested, go

to helixsleep.com/huberman for up to $200 off your

mattress and two free pillows. So let's talk about ADHD, Attention Deficit Hyperactivity Disorder. Let's also talk about focus and attention and everybody's ability

to focus and attend not just people with ADHD. We are also going to talk about tools that would allow anyone, whether or not they have ADHD or not to enhance their level of

concentration and focus. Now, ADHD used to be called

ADD Attention Deficit Disorder. We have record of ADD in

the medical literature dating back to as early as 1904. Now there's nothing special about 1904. That's just the first

time that it showed up in the standard medical literature. We have to believe that ADD, which we now call ADHD existed before 1904 and probably long before 1904, why? Well, because it has a

strong genetic component. If you have a close

relative that has ADHD, there's a much higher probability

that you will have ADHD and that probability goes

up depending on how closely related to that person you happen to be. So for instance, if you're an identical twin

and your twin has ADHD, there's a very high concordance as we say, a very high probability

that you will have ADHD up to 75% chance. If you have a fraternal twin with ADHD, that number goes down a

bit in the 50 to 60% range and so on. If you have a parent with ADHD, that number ranges anywhere

from 10 to 25% likelihood, that you will have ADHD

if you have two parents and so on and so on, okay? So there's a genetic component that genetic component it turns out, relates directly to how

specific neural circuits in the brain wire up, the chemicals they use and the

way they use those chemicals, a topic that we are going

to discuss in depth today. Now, if you have a close

relative with ADHD, that does not mean that

you are faded to have ADHD and if you happen to have ADHD, there are ways to overcome those symptoms of lack of attention,

impulsivity and so on. Another important point about ADHD is that it has nothing

to do with intelligence, whether or not we're

talking about intelligence measured by a standard IQ test a rather controversial issue

as many of you probably know, there are lots of forms of intelligence that a standard IQ test

just wouldn't pick up emotional intelligence,

musical intelligence, spatial intelligence, all

sorts of intelligences. None of them are related to ADHD. Being very high functioning

doesn't make you more likely to have ADHD and being ADHD doesn't necessarily mean

that you have a low IQ. So there are people with

ADHD who have low IQs people with ADHD with high IQ, people with ADHD with high

emotional IQ or with low IQ in the emotional scale,

it's all over the place. The important point is that

your ability to attend and focus does not relate to how smart

you are or your IQ of any type, not just a standard IQ. The renaming of the ADD to ADHD took place in the mid to late 1980s when the psychiatric community and the psychological community started taking better

notice of the fact that so-called hyperactive kids

also had attentional issues. This might seem obvious, but there's been extensive

and ongoing revision of the criteria for designating

a psychiatric disorder and this is still an

ongoing process even today. So in the mid eighties, we started hearing about ADHD and then gradually that term

ADD has been dropped away. However, just the renaming of ADD to ADHD has led to much better

diagnosis and detection of ADHD. So right now the current

estimates are that about one in 10 children

and probably more have ADHD. The current estimates are

anywhere from 10%, one in 10 to as high as 12%. Now, fortunately about half of those will resolve with proper treatment, but the other half typically don't. The other thing that we

are seeing a lot nowadays is increased levels of ADHD in adults and there's some question

as to whether or not those adults had ADHD that went undetected during their childhood or whether or not ADHD is now cropping up in adulthood due to the way that we are

interacting with the world in particular smart phone use, the combination of email,

text, real-world interactions, multiple apps and streams

of media and social media all coming in at once

trying to manage life. All of the things that are going on are creating a kind of cloud

of poles on our attention and so there is this

question to whether or not we are creating ADHD in

adults that never had ADHD prior to being an adult. So let's talk about attention and first let's just define

what we mean by attention out there in the scientific literature and in discussions about ADHD, we will hear things

like attention and focus and concentration and impulse control for sake of today's discussion, attention, focus, and concentration are essentially the same thing, okay? We could split hairs and

the scientific literature does split hairs about these. But if we want to understand the biology and we want to have a straightforward conversation about ADHD, if I say attention or focus, I'm basically referring to the same thing, unless I specify otherwise, okay? So people with ADHD have

trouble holding their attention. What is attention? Well, attention is perception. It's how we are perceiving

the sensory world. So just a little bit of neurobiology 101, we are sensing things all the time. There's information coming

into our nervous system all the time. For instance, right now

you're hearing sound waves. You are seeing things, you are sensing things against your skin, but you're only paying

attention to some of those and the ones that you're

paying attention to are your perceptions. So if you hear my voice,

you are perceiving my voice. You are not paying attention

to your other senses at the moment, okay? You might even be outside in a breeze and until I said that, you might not be perceiving that breeze, but your body was sensing it all along. So attention and focus are

more or less the same thing, but impulse control is something

separate because impulse control requires pushing out

or putting the blinders on to sensory events in our environment. It means lack of perception, impulse control is about

limiting our perception. People with ADHD have poor attention and they have high levels of impulsivity they're easily distractable. But the way that shows

up is very surprising. You might think that people with ADHD just simply can't attend anything. They really can't focus, even if they really want to,

but that's simply not the case. People with ADHD yes,

they are distractable. Yes, they are impulsive. Yes, they are easily annoyed by things happening in the room. They sometimes have a high

level of emotionality as well. Not always, but often however people with ADHD

can have a hyper focus and incredible ability to focus on things that they really enjoy or and are intrigued by. Now, this is a very important point because typically we think

of somebody with ADHD as being really wild and hyperactive, or having no ability whatsoever

to sit still and attend and while that phenotype as we call it that contour of behavior

and cognition can exist, many people, if not all people with ADHD, if you give them something

they really love, like if the child loves video games or if a child loves to draw, or if an adult loves a

particular type of movie or a person very much, they

will obtain laser-focus without any effort. So that tells us that people with ADHD have the capacity to attend, but they can't engage that attention for things that they don't

really, really want to do and as we all know much of life, whether or not you're a child or an adult involves doing a lot of things

that we don't want to do, much of our schooling

involves doing things that we would prefer not to do and sort of forcing ourselves

to do it, to attend, even though we are not super interested in what we are attending to. There are a couple other things that people with ADHD display quite often. One is challenges with time perception. Now time perception is

a fascinating aspect of how our brain works and later we're going to

talk about time perception and how you can actually get

better at time perception. It's very likely that right

now you are doing things that get in the way of

optimal time perception and I will tell you how

to adjust your ability to measure time with your brain. People with ADHD often run late. They often procrastinate, but what's interesting and surprising is that if they are given a deadline, they actually can perceive time very well and they often can focus very well if the consequences of

not completing a task or not attending are severe enough. It's a little bit like the

way that people with ADHD can really focus if they like something. Well, if they're scared

enough about the consequences of not attending, oftentimes not always, but oftentimes they can attend. If they're not really

concerned about a deadline or a consequence, well, then they tend to lose track of time and they tend to underestimate

how long things will take. Now many people do that,

not just people with ADHD, but people with ADHD have challenges, understanding how to line up

the activities of their day in order to meet particular deadlines even if it's just a simple thing, like finishing one set

of tasks before lunch, oftentimes they will remember

that lunch starts at noon, but somehow they aren't able

to fill the intervening time in a way that's productive and they can obsess about the upcoming deadline for instance, we will talk about how to remedy this. In addition, their spatial organization

skills are often subpar, not always, but often you will

find that somebody with ADHD uses what's called the pile system in order to organize things, they will take many belongings and this could be in the

kitchen or in their bedroom or in their office or in any space and they will start piling things up according to a categorization system that makes sense to them and only them. It doesn't really have

any logical framework. Now, many people use the pile system and if you use the pile system, that doesn't mean that you have ADHD in fact, if you're unpacking a house or you've moved recently, or you've received a lot

of presence recently, the pile system makes perfect

sense to organize your space. But people with ADHD

tend to organize things according to the pile system all the time and that pile system

doesn't work for them. Okay, so that's the key distinction that they use a filing system,

and it's not really files, they're piling things up in a

way that makes sense to them, but then it doesn't work for

them in terms of what tasks they actually need to perform. They can't find things or if anyone moves one thing

then it's very disruptive to their overall plan

because their overall plan doesn't really work in the first place. So that's a common

phenotype as we call it. A phenotype by the way, is just an expression of a

particular set of underlying genetic or psychological components, okay? So we say the phenotype. So a phenotype can brown

hair and green eyes, like for me, a phenotype could also be that somebody uses the

piling system, okay? The other thing that people

with ADHD have real trouble with is so-called working memory. Now you might think that people with ADHD would have really poor memories, but in fact, that's not the case. People with ADHD often

can have a terrific memory for past events, they can remember upcoming

events quite well. Their memory is clearly working. However, one aspect of

memory in particular that we call working

memory is often disrupted. Working memory is the ability to keep specific information online, to recycle it in your

brain over and over again, so that you can use it in

the immediate or short term. A good example of this

would be you meet somebody, they tell you their name, they give you their phone number verbally, and you have to walk back to your phone and enter it into your phone. People without ADHD might have

to put some effort into it, it might feel like a bit of a struggle, but typically they will be able

to recite that phone number in their mind over and over,

and then put into their phone. People with ADHD, tend to lose the ability

or lack the ability to remember things that they

just need to keep online for anywhere from 10 seconds

to a minute or two, okay? So a string of numbers like 6,

4, 3, 7, 8, 1 for most people would be pretty easy. 6, 4, 3, 7, 8, 1, 6, 4, 3, 7, 8, 1, you could probably remember

that a minute from now without writing it down. But if you add one more number

to that 6, 4, 3, 7, 8, 1, 3, it gets tougher, okay? So there's a reason why

phone numbers typically have seven digits in them, of

course, there's an area code, but remembering information

that strings out longer than seven numbers or a sentence or two that's challenging for most people, people with ADHD have severe challenges, even with much smaller

batches of information over even much smaller batches of time. Deficits in working memory are also something that we see in people who have frontotemporal dementia, so damage to the frontal lobes or age-related cognitive decline and so it will come as

no surprise that later when we discuss treatments, supplements, and other tools for ADHD, that many of those treatments, supplements and tools for

ADHD are similar to the ones that work for age-related

cognitive decline. Okay, so we've more or less established the kind of menu of items that

people with ADHD tend to have some have all of them. Some have just a subset of them. Their severity can range

from very intense to mild, but in general, it's challenges with attention and focus, challenges with impulse control,

they get annoyed easily. They have kind of an impulsivity, they can't stay on task. Time perception can be off, they use the piling system or a system that doesn't

work well for them in order to organize their

things in physical space and they have a hard time

with anything that's mundane that they're not really interested in. But again, I just want to

highlight that people with ADHD are able to obtain

heightened levels of focus, even hyper-focus for things

that are exciting to them and that they really want to engage in. So now you have the

contour of what ADHD is, and if you're somebody

who doesn't have ADHD, you should also be asking

yourself which aspects of ADHD are similar to things

I've experienced before. Because what we know

about the healthy brain is that there's also a

range of abilities to focus. Some people focus very well on any task. You give them a task, they can

just laser in on that task. Other people that have to kind

of fight an internal battle, they have to convince themselves that it's important or interesting. They have to kind of incentivize

themselves internally. Other people doesn't matter, they could be bored to

tears with the information, but they can do it just because they are, "Very disciplined people." We tend to admire those people but as you'll see a little bit later, it's not clear that that's the best way to run your attentional system. There might be something to this business of having heightened levels of attention for the things that you are most interested or excited by. So let's drill into this

issue of why people with ADHD actually can focus very intensely

on things that they enjoy and are curious about. Now, enjoyment and curiosity

are psychological terms, they're not even really

psychological terms. They're just the way that we

describe our human experience of liking things, wanting

to know more about them. But from a neuro-biological perspective, they have a very clear

identity and signature and that's dopamine. Dopamine is released from neurons, it's what we call a neuromodulator and as a neuromodulator

it changes the activity of the circuits in the brain, such that certain circuits

are more active than others and in particular, dopamine creates a

heightened state of focus. It tends to contract our visual world and it tends to make us

pay attention to things that are outside and beyond

the confines of our skin. That's what we call exteroception. Dopamine also tends to put

us in a state of motivation and wanting things outside

the confines of our skin. So whether or not we're pursuing something physical in our world, or whether or not we're

pursuing information in our outside world, dopamine is largely

responsible for our ability and our drive to do that. But dopamine as a

neuromodulator is also involved in changing the way that

we perceive the world. So, as I mentioned earlier you have all these senses coming in and you can only perceive some of them because you're only paying

attention to some of them. Dopamine when it's released in our brain tends to turn on areas of our brain that narrow our visual focus and our auditory focus, so it creates a cone

of auditory attention, that's very narrow, creates a tunnel of visual

attention that's very narrow. Whereas when we have less dopamine, we tend to view the entire world, we tend to see the whole

scene that we are in, we tend to hear everything all at once. So as I describe this, hopefully you're already

starting to see and understand how having dopamine

release can allow a person, whether or not they have ADHD or not to direct their attention

to particular things in their environment, all right? So now what we're doing is

we're moving away from attention as this kind of vague ambiguous term, and we're giving it a

neurochemical identity dopamine, and we are giving it a

neural circuit identity and just to put a little

bit of flavor and detail on which neurocircuits those are, I want to discuss two general

types of neurocircuits that dopamine tends to enhance. So let's talk neurocircuits and for those of you that

love hearing neuroscience, nomenclature, you're

going to eat this part up and for those of you that

don't like a lot of names of brain areas I invite you to tune out or just try and grab

the top contour of this. I will describe it in

pretty general terms, but I will give some detail

because I know there are some of you out there who

really want to dig deeper into what the exact structures

and connectivities are, okay? So there are two main

types of circuits that we need to think about

with respect to ADHD, attention and dopamine. The first one is called

the default mode network. The default mode network is

the network of brain areas in your brain and my brain

and in everybody's brain that is active when

we're not doing anything when we're just sitting

there idle at rest. Now it's very hard to

not think about anything, but when you're not engaged

in any type of specific task, so you're not driving, you're

not playing a video game, you're not trying to study,

you're not trying to listen, you're just sitting

there letting your brain kind of go wherever it wants to go. Your default mode network

underlies that state of mind. The other set of circuits that

we're going to think about and talk about with respect

to ADHD are the task networks, the networks of the brain

that make you goal oriented, or that are at least trying

to make you goal oriented and those are a completely

different set of brain areas. However, the default mode network and these tasks networks are

communicating with one another and they're doing that

in very interesting ways. So first I want to describe how these two sets of brain areas, the default mode network and the task networks

normally interact, okay? So little bit of naming here again feel free to ignore it if you don't want this level of detail, but the default mode network includes an area called the

dorsolateral prefrontal cortex, frontal cortex, no surprises in the front and you have a dorsal, the top and side lateral part

dorsolateral, prefrontal cortex. You got one on each side

of your brain, right? And then you have a brain area called the posterior cingulate cortex and then you have an area called

the lateral parietal lobe. Again, you don't need to

remember these names for, these are three brain areas that normally are synchronized in their activity. So when one of these areas is

active in a typical person, the other areas would be active as well. So it's a little bit

like a symphony or a band like a three-piece band

is like drums, guitar, and bass they're playing together, okay? That's how it is in a typical person and in a person with ADHD, or even a person who has subclinical ADHD or in any human being

who hasn't slept well, what you find is the default mode network is not synchronized. These brain areas are just

not playing well together. Now the task networks include

a different set of structures. It still involves the prefrontal cortex, but it's a different part of

the prefrontal cortex, okay? Tends to be the medial prefrontal cortex and there are some other brain areas that the medial prefrontal

cortex is communicating to all the time, mainly to suppress impulses. It's shutting down the desire to stand up or to scratch the side of

your cheek or your nose, if you're trying not to do that, anytime you're restricting your behavior, These task directed networks

are very active, okay? Now normally in a person without ADHD, the task networks and

the default mode networks are going in kind of Seesaw fashion, they are actually what

we call anti-correlated. So it's not just that

they are not correlated, they're actually opposing one another they are anti-correlated. In a person with ADHD, the default mode networks

and the tasks networks are actually more coordinated. That might come a surprising, I think that we all have this tendency to kind of jump to conclusion

and assume that somebody who doesn't have an easy time

paying attention or has ADHD, that their brain must

be completely incoherent that it's not working well and because everything's out of whack, but there's something interesting

about people with ADHD whereby the task networks

and the default mode networks are actually working together

in a way that's correlated and that is what's abnormal. So this would be like the

guitar bass and the drums playing together in a way where the bass isn't keeping the

backbeat and the drums, aren't keeping the backbeat

that they're playing together, they're all playing the

melodies and harmonies in a way that just doesn't sound right. That's what's going on in the

brain of somebody with ADHD and we can now confidently say based on brain imaging studies, that when somebody gets better, when they're treated for ADHD

or when they age out of ADHD, as sometimes it's the case

that the default mode networks and the task networks tend to become anti-correlated again, okay? So that's the underlying neurobiology, but you'll notice that I

didn't mention dopamine at all. What dopamine is doing in this context is dopamine is acting like a conductor. Dopamine is saying this

circuit should be active then that circuit should be active. It should be default mode network and then when the default

mode network is not active, then it should be the task network. So it's really acting as a

conductor saying, you go, now you go, now you go, now you go. And in ADHD, there's something about

the dopamine system that is not allowing it

to conduct these networks and make sure that they stay what, the engineers or physicists

or mathematicians would say out of phase to be anti-correlated, okay? Out of phase and anti correlate,

essentially the same thing, at least for purposes of this discussion. So that raises two questions, could it be that dopamine is

not at sufficiently high levels or could it be that dopamine

is just doing it all wrong? In other words, is there no conductor or is

the conductor playing with like little tiny toothpicks and so the instruments can't see what they're supposed to do. They can't get the instruction 'cause it's just not

loud enough, so to speak, or could it be that the

information is getting out, but the information that's

getting out is wrong, the conductor's there, but the conductor is in

very good at conducting. Now we can gain insight

into how the system works and fails and how to treat it by looking at some of the current and previous treatments for ADHD, as well as some of the recreational drugs that people with ADHD

tend to pursue and like now I'm certainly not a

proponent of people with ADHD taking drugs recreationally, that's not what this is about, but if you look at their

drug seeking behavior and you couple that drug seeking behavior to their desire to remedy

their attention deficit, you start gaining some

really interesting insight into how dopamine is

regulating these circuits in normal circumstances

and in people with ADHD. So what exactly is going on

with the dopamine system, in people with ADHD and what's going on

with the dopamine system in people that have

terrific levels of attention for any task? Well, in the year 2015, an

important paper came out. The first author is Spencer, and it came out in a journal

called Biological Psychiatry, and it formalized the so-called low dopamine hypothesis of ADHD. The idea that dopamine

was somehow involved or not at the appropriate

levels in people with ADHD had been around for a pretty long time, but a formal proposition of

the low dopamine hypothesis led to some really important

experiments and understanding of what goes wrong in ADHD. It turns out that if

dopamine levels are too low in particular circuits in the brain, that it leads to unnecessary

firing of neurons in the brain that are unrelated to the

task that one is trying to do and that is unrelated to the information that one is trying to focus on. So if you think back

before you've got this default mode network and

a task-related network, and they need to be in

this kind of concert of anti-correlation and an ADHD

they're firing together. Well, the problem seems to

be that when dopamine is low, certain neurons are firing

when they shouldn't be, this is like a band, right? We'll go back to our band,

that's a guitar bass in it, and the person playing the drums and it's as if one of those or

several of those instruments are playing notes when they

shouldn't be playing, right? The pauses and music are just as important as the actual playing of notes. When dopamine is too low neurons fire, more than they should in these networks that govern attention. This is the so-called

low dopamine hypothesis and if you start looking anecdotally at what people with ADHD

have done for decades, not just recently since

the low dopamine hypothesis has been proposed, but what they were doing in

the 1950s and then the 1940s and the 1960s. What you find is that they

tend to use recreational drugs, or they tend to indulge

in non drug stimulants. So things like drinking,

six cups of coffee or quadruple espressos, or when it was more prominent smoking a half a pack of cigarettes and drinking four cups of coffee a day or if the person had access to it using cocaine as a recreational drug or amphetamine as a recreational drug. All of those substances

that I just described in particular cocaine and amphetamine, but also coffee and cigarettes increase levels of

multiple neurotransmitters, but all have the quality

of increasing levels of dopamine in the

brain and in particular, in the regions of the brain

that regulate attention and these task related and

default mode networks okay? Now young children, fortunately don't have access

to those kinds of stimulants most of the time and those stimulants

all have high potential for abuse in adults. So we will talk about

the potential for abuse in a few minutes. But if you look at children, even very young children with ADHD, they show things like

preference for sugary foods, which also act as dopamine

inducing stimulants. Now, of course, once they

get access to soda pop and coffee and tea, they start to indulge in

those more than other people. For a long time, it was thought that children with ADHD consumed too many sugary

foods or drank too much soda or adults with ADHD would take recreational

drugs like methamphetamine or cocaine or would drink coffee to excess or smoke cigarettes to excess because they had poor levels of attention and because they couldn't

make good decisions, they were too impulsive and so forth and while that certainly

could be the case, knowing what we now know about dopamine, and the fact that having

enough dopamine is required in order to coordinate

these neural circuits that allow for focus and

quality decision-making an equally valid idea

is that these children and these adults are actually

trying to self-medicate by pursuing these compounds, right? Things like cocaine lead to

huge increases in dopamine. Well, what happens was

when somebody with ADHD takes that drug, it turns out they actually obtain heightened levels of focus, their ability to focus on things other than things they absolutely care intensely about goes up, likewise, children who consume anything that increases their levels of dopamine, if those children have ADHD,

they tend to be calmer, they tend to be able to focus more. Now, this is very different than children who do not have ADHD. When they consume too much sugar, they tend to become super hyperactive. When they consume any kind of stimulant, they tend to go wild and

run around like crazy. Actually, I have an anecdote about this just to illustrate it. I have a friend, he has two children that

are now in their teens and twenties, but when they were little, one time, I brought them some

chocolate just as a gift, when I showed up at their

house and within 30 minutes, the kids were running around like crazy I mean they were pretty high energy kids, but they were going bonkers and that's actually when the

mother, my friend at the time, unfortunately, still now

looked at the chocolate, realized that it was chocolate

with espresso beans in it. It was like dark chocolate

with espresso beans so I was really at fault there, you don't want to give kids dark chocolate with espresso beans, but what you're really

seeing that hyperactivity that is dopamine, okay? It's the sugar combined with

the caffeine in this case, combined with a few other

compounds that exist in chocolate, that really increase

our levels of alertness and our tendency to want

to move around a lot, okay? So dopamine and low levels of dopamine apparently are what's

wrong in people with ADHD, that dopamine hypothesis is what led to the idea

that treating people, children and adults included

with dopaminergic compounds would somehow increase

their ability to focus and if you look at the major

drugs that were developed and now marketed by

pharmaceutical companies for the treatment of ADHD, those drugs have names like Ritalin. Nowadays, it's typically

things like Adderall, Modafinil and some of the other derivatives, they all serve to increase

levels of dopamine in particular dopamine in the networks that control task directed behavior, and that coordinate the

default mode network and these task-related networks. So many of you have

probably heard of Ritalin. Ritalin is a prescription

stimulant that is prescribed for ADHD as

well as for narcolepsy. Narcolepsy is a condition in which people tend to fall asleep during the day time, quite a lot, excessive daytime sleepiness, not due to lack of sleep at night, but also tend to fall asleep

when they get excited, if they're really emotionally

excited or about to eat or any other kind of activity that would normally get somebody

really aroused and alert people with narcolepsy

tend to fall asleep, or they tend to become

what's called cataplectic. They tend to just sort of

go limp in the muscles. So it's this invasion of

sleep into the daytime. It's dysregulated by emotion. You can imagine why a stimulant, something that would wake

you up, make you very alert, focused and motivated would be a good treatment for narcolepsy. Adderall also is used to treat

ADHD and to treat narcolepsy things like Modafinil also used to treat ADHD and narcolepsy. So you're sensing a theme here. So what are the differences

and similarities between these drugs and what can that tell us about ADHD? Well, Ritalin was one of

the first-generation drugs that was prescribed for ADHD

in order to deal head on with this dopamine hypothesis. This idea that in ADHD,

dopamine levels are too low. Nowadays, Adderall is the

more typically prescribed drug for ADHD that has to do with some of the so-called

pharmacokinetics, the rate at which those

drugs enter the system and how long they last in the system. So for instance, Ritalin was a drug that was packaged into various time-release formulas. Whereas initially Adderall was

only released in a form that had a very short life, So meaning that it wasn't

in the bloodstream very long and didn't affect the brain for very long and so the dosages could be

controlled in a more typical way without going into a lot

of tangential detail. As you all know, at

different times of day, you tend to be more or less alert. So a long sustained release drug while that might sound like

a really terrific thing. If that drug is having an effect of making you more alert and it's released across

very many hours of your day, there might be periods of your day when you feel too alert, periods of your day, when you feel just right

and periods of your day, when you wished that you were more alert. These are some of the

pharmacokinetics, kinetics, meaning movement of

the different compounds within the bloodstream

and brain that could, you could imagine in a very real way, would impact whether or not

someone would feel really good on one of these drugs or whether or not they would feel too anxious

or too sleepy and so on. Let's take a step back

for a second and just ask, what are these drugs? We know they increase dopamine, but what are they really? Well, Ritalin also called methylphenidate is very similar to amphetamine speed, or what's typically call speed in the street drug nomenclature. Adderall, which goes by

various other names, okay? So Adderall, Adderall XR, my

dialysis, things like that. Adderall is basically a combination of amphetamine and dextroamphetamine. Now some of you probably realize this, that Adderall is amphetamine, but I'm guessing that there a

good number of you out there, perhaps even parents and

kids that don't realize that these drugs like cocaine and

amphetamine methamphetamine, which are incredibly dangerous

and incredibly habit forming and have high potential for abuse. Well, the pharmaceutical versions of those are exactly what are used to treat ADHD and they're not exactly like

cocaine or methamphetamine, but they are structurally

and chemically very similar and their net effect in the brain and body is essentially the same, which is to increase dopamine primarily, but also to increase

levels of a neuromodulator called epinephrin or norepinephrine also called noradrenaline and adrenaline those names are the

same and to some extent to increase levels of serotonin

in the brain and blood, but not so much serotonin, that's just kind of a small

smidgen of effect, okay? So dopamine way up norepinephrine

and adrenaline way up. So that's motivation

drive, focus and energy and to some extent, a

little bit of serotonin, which is really more about

feeling calm and relaxed and you can imagine why that would be a good balancing effect for

dopamine and norepinephrine. So what I'm essentially

saying is that the drugs that are used to treat

ADHD are stimulants, and they look very much alike. In fact, nearly identical to some of the so-called street drugs, stimulants that we all

here are so terrible. However, I do want to emphasize that at the appropriate dosages and working with a quality psychiatrist or neurologist or family physician does have to be a board certified MD that prescribes these things, many people with ADHD

achieve excellent relief with these drugs, not all of

them, but many of them do, especially if these treatments

are started early in life. So now knowing what these drugs are, I want to raise the question

of why prescribe these drugs? I mean, everyone has to make

a decision for themselves or for their child as to whether or not they're going to take these things or not. I also want to acknowledge

that many people out there, many, many people out there

are taking these drugs, even though they have not

been clinically diagnosed with ADHD when I say these drugs, I'm specifically referring

to Ritalin and Adderall and Modafinil, but more

typically it's Adderall, okay? People using cocaine and amphetamine for recreational purposes, that's a completely different beast and it is indeed a beast and it's something that

I strongly discourage. However, I'm aware that up

to 25% of college students, and perhaps as many as

35% of all individuals between the ages of 17

and 30 are taking Adderall on a regular or semi-regular basis in order to work, in order to study and in order to function and

focus in their daily life. Even though they have not

been diagnosed with ADHD, there's a whole black market for this. They're getting it from

people with prescriptions. I'm not here to pass judgment. I just want to emphasize

how these drugs work. Some of the things that

they do to enhance cognition and focus that actually

serve the brain well in certain individuals and how

they can be very detrimental in other individuals. I sort of blew right past it. But the fact that in upwards

of 25% of young people are taking things like Adderall, despite not having a

clinical diagnosis of ADHD. Well, that's a ridiculously high number. A few years ago, it was estimated that

Adderall use and Ritalin use without diagnosis of ADHD

was second in incident only to cannabis, but actually now the

consumption of Adderall without prescription is higher than the consumption of

cannabis in that age group. So what that means is that

there's a lot of stimulant use in that age group and there are a lot of adults also using and abusing stimulants

in order to gain focus. Then we can have a whole

discussion about whether or not life is becoming more demanding, whether or not the need

for focus is excessive and that's why people are doing that. But frankly, it's an

interesting discussion, but it's not one that would

deliver us to any answers. Rather, I'd like to focus

on the ways that people now and people have always

been self-medicating to increase, focus, right? Caffeine, which I can indulge some, I don't think to

access has long been used as a stimulant to increase dopamine, increase norepinephrine, increased focus and energy

and in addition to that, it works through the so-called cyclic amp, phosphodiesterase pathway,

remember anytime you see, you hear an ASE, that's an enzyme. Phosphodiesterase is involved in the conversion of things like cyclic amp into energy for cells and so forth. Basically coffee gives you

energy it makes you feel good and it increases focus

because of the circuits that it engages in the brain. People have been taking caffeine and continue to take it caffeine for ages. People also used to smoke cigarettes, nicotine in order to gain focus. Nowadays, that's less common

because of the concerns, quite valid concerns about

lung cancer from smoking, but there's a lot of vaping out there. There are a lot of people

now consuming nicotine, which is the active

substance in cigarettes and in most nicotine vapes

that stimulates the brain to be more focused and more alert. So the idea of taking

stimulants of consuming things or smoking things in order

to increase alertness is not a new idea. It's just that in ADHD, it's surprising that these

things would work, right? I mean, if the problem is Attention Deficit Hyperactivity Disorder, what we're really talking about here, or children that are prescribed a drug that ought to be a stimulant, it ought to make them hyper hyperactive and rather than doing that, it actually somehow

serves to calm them a bit, or at least allow them to focus. Here's the reason, children have a brain that's a very plastic

meaning it can remodel itself and change in response to

experience very, very quickly compared to adults. Taking stimulants as a child, if you are a child diagnosed with ADHD allows that forebrain task

related network to come online, to be active at the appropriate times and because those children are young, it allows those children

to learn what focus is and to sort of follow or

enter that tunnel of focus. Now, by taking a drug, it's

creating focus artificially, it's not creating focus because

they're super interested in something it's chemically

inducing, a state of focus, and let's face it a lot

of childhood and school and becoming a functional adult is about learning how to focus even though you don't

want to do something. In fact, when I was in college, I had this little trick

that may or may not work for some of you, which is if I couldn't

focus on the material I was trying to learn, I would delude myself into thinking that it was the most

interesting thing in the world. I would just kind of lie

to myself and tell myself, okay, this, I won't mention the subjects, I absolutely love this. I would just, I would tell

myself that I loved it and I noticed that just that selective or deliberate engagement of

that desire to know circuit, whatever that is in my brain,

no doubt involves dopamine, allowed me to focus and

remember the information and somewhat surprisingly

or perhaps not surprisingly, I would often fall in

love with the information. I find that that was my favorite class. So it was what I wanted to learn the most. So that's one way you

can do it artificially, but kids with ADHD, they

can't do that, right? They're told to sit still and they end up getting up 11 times. They are told that they

can't speak out in class or that they have to remain

in their seats for 10 minutes and they just, despite their best effort, they simply cannot do it, they're highly distractable. So what are we to make

of this whole picture that we need more dopamine,

but these kids with ADHD, they're getting their

dopamine by way of a drug, which is for all the

world amphetamines, right? It's speed, that's really what it is. What are the long-term consequences, where the short-term consequences

and what should we make of people taking these drugs

without a clinical need? What are the consequences there? Well, in order to get to

some of those answers, I went to one of my colleagues, this is a colleague

that I've actually known for a very long time, I was

their teaching assistant when they were an undergraduate, they went on to get an

MD, a medical degree, as well as a PhD and become

a pediatric neurologist that specializes in the

treatment of epilepsy and ADHD in kids of all

ages, from age three to 21, that's the age range, pretty broad age range and has

extensive knowledge in this and what makes them particularly

interesting for sake of this discussion is that they

have a child, a young boy, who's now showing signs of ADHD and they are on the

threshold of trying to decide whether or not they

will prescribe Adderall or something similar. So we had a discussion about this and prior to learning that

their child may have ADHD. I asked the following questions. First of all, I asked, what do you think about

giving young kids amphetamine? And their answer was, on the

face of it, it seems crazy, but provided that the

lowest possible dose is used and that that dosage is

modulating as they grow older and develop those powers of attention, their observation was that

they've seen more kids benefit than not benefit from that. Now I'm certainly not saying

what people should do. You obviously have to go to a doctor because as I always say, I'm not a doctor, I don't prescribe anything, I'm a professor so I profess things and here I'm professing that

you talk to your doctor, if you're considering

giving Ritalin or Adderall or any type of stimulant

to your child, of course, what could be more important

than the health of your child. But it was a very

interesting answer because typically we hear yes,

medicator don't medicate. Rarely do we hear that the

medication should be adjusted across the lifespan and in

any particular kind of way. Now the fact that this person, this now friend of mine

and colleague of mine has so much expertise in

the way that the brain works and is considering putting

their child on such medication. I said, why wouldn't you wait until your kid reaches puberty? I mean, we know that in boys and in girls, there are increases in testosterone and estrogen during puberty, that dramatically change the

way that the body appears. But also that dramatically change the way that the brain functions

in particular we know this, that puberty triggers the

activation of so-called frontotemporal task related

executive functioning. That's just fancy science

speak for being able to focus, being able to direct your attention, being able to control your

impulses, look at a small child, or look at a puppy and then

look at an older child, or look at a dog, very different levels, patterns of spontaneous behavior. Young children move around a lot they're, I don't want to say shifty, cause that makes it sound like

they're up to something bad, which they might be, but they don't have to

be up to something bad, they fidget a lot. So to puppies, everything's a stimulus as

animals and humans get older, they learn how to control

their behavior and sit, still, listen and focus even

if they don't want to. So giving a drug that allows

a child to access that stillness early on it's

thought will allow them to maintain that ability as time goes on. But I decided to push

a little bit further, I said, well, why would you do it now as opposed to during

puberty or after puberty? And their answer was very specific and I think very important,

what they said was look, neuroplasticity is greatest in childhood and tapers off after about age 25, but neuroplasticity from

age three until age 12 or 13 is exceedingly high and they're right, when you sit back and you look at the

literature on neuroplasticity, you'd say childhood plasticity

and young adult plasticity is much greater than adult plasticity, but that early childhood

plasticity is far and away the period in which you

can reshape the brain at an accelerated rate. So this lines up really well

with the clinical literature. Not surprisingly, there are clinician that

early treatment is key. If you have the opportunity to

work with a quality physician and treat these things early, these drugs can allow

these frontal circuits, these task-related circuits

to achieve their appropriate levels of functioning and for

kids to learn how to focus in a variety of different contexts. Now, is that the only thing

that they should be doing? Of course not. So the next question I asked was what should we make of all

this diet related stuff, right? I've heard before that the

so-called elimination diet or ingesting no sugars

or no dairy or no gluten, that all of these things

have been purported to improve symptoms of ADHD and

people and parents with ADHD go to fanatic lanes to try

and find the exact foods that are causing problems

and the exact foods that the kids can eat in order to try and get their brain wired up right, and correctly, and to avoid lifelong ADHD and their answer was really interesting. But before I tell you their answer, I want to tell you the

studies and the data related to this question

of whether or not food and the constellation

of foods that one avoids and will eat has anything to

do with our levels of attention and in particular, whether or not that can be

used as a leverage point to treat ADHD. So you can imagine the

challenges of exploring the role of diet and nutrition in any study, but especially in a study on ADHD, why? Well, because as I mentioned

before, children with ADHD, and it turns out adults with ADHD tend to pursue sugary

foods or any types of food that increase their levels of dopamine. They are naturally drawn to those foods, whether or not they realize it or not, presumably as a way to try and treat their lack of focus and impulsivity. So in this study that I'm

about to share with you, there was no drug treatment,

it was just a study, manipulating diet and

involved 100 children, 50 in the so-called

elimination diet group, the special diet where

certain foods were eliminated and 50 in the so-called control group. However, being a well-designed

randomized controlled trial, this study also included a crossover, meaning where the kids would

serve as their own control or control group at a

certain portion of the study. So there'll be in one group where they eliminated certain foods and then after a period

of time in the study, they would swap to the other group. This is a powerful way to design a study for reasons that you can imagine, because you start to

eliminate changes and effects due to individual differences. In any case, 100 children

total 50 in each group at any one period in time and the effects that they

observed were extremely dramatic. In the world of statistics and

analysis of scientific data, we talk about P-values,

probability values. What's the likelihood that something could happen according to chance and typically the cutoff would be something like P less than 0.05, that's less than 0.05 chance essentially, of the effect being due to chance. However, in this study, every single one of the

effects is P less than 0.0001, very, very infant decimally small probability that the effect

observed could be due to chance. So what were these effects? These effects were

enhanced ability to focus, less impulsivity, even less tendency to move

when trying to sit still. So everything from mental focus to the ability to control

their bodies improved when they were in the

elimination diet group, what was eliminated? Well, the elimination diet

in this particular study was a so-called oligoantigenic diet. It was a diet in which each

kid took a test to determine which foods they had antibodies for, meaning that they were mildly allergic to. Now in this study, it was very important that the kids not be

extremely allergic to any food because as I mentioned before, they actually served as a

control at one point in the study where they were eating all sorts of foods, including foods that

had mild allergies to. So basically what the study

said was that eliminating foods to which children have allergies can dramatically improve

their symptoms of ADHD. And this study, not surprisingly because it was published in such a high quality

journal Lancet, et cetera, large number of subjects

set the world on fire. People were extremely

excited about these results because here in the absence

of any drug treatment, there was a significant improvement in ADHD symptoms observed

and then came the criticisms. So many papers were published

after this specifically dealing with re-analysis of these data and I want to be fair in saying that the data in the paper look good, but there are criticisms of the overall structural

design of the study. I don't want to go into

all the details exactly 'cause it gets really nuanced

about some of the statistics and the way that one

examines these types of data, but there was skepticism and in science, skepticism is healthy, especially when making decisions about whether or not to treat or feed children one food or another, or give

them one drug or another. Now I want to return to

the story of my friend, who is a pediatric

neurologist and treats ADHD and has a child who is on the precipice of perhaps starting to take drugs

for the treatment of ADHD. I asked the simple question,

do you see an effect of diet? Meaning when parents control

the diet of their children, does it make a positive or

negative or no difference in terms of the way that

the kids respond to ADHD, drugs like Ritalin and

Adderall or whether or not it can help them avoid treating

with those drugs entirely? And her response was very

straightforward, she said, elimination of simple sugars has a dramatic and positive effect. She's observed that over

and over and over again in many dozens, if not

hundreds of patients, okay? Now that's not a peer reviewed study, that's a statement that I'm

conveying to you anecdotally, but it's a highly, highly informed one. I said, what about

these elimination diets? She said, and I found other

sources to support this, that these oligoantigenic

diets are controversial. There are many people who really believe in identifying all the things

that you're allergic to and making sure that you and especially your

kids avoid those foods. However, there's another camp

that's starting to emerge in the peer reviewed

scientific literature, showing that when kids are

not exposed to certain foods in particular nuts and

things of that sort, they develop allergies to those foods and then when exposed to them later, they cause real problems. So there's a whole galaxy of

discussion and controversy and outright fighting about allergies and kids and whether or

not the oligoantigenic diet is the appropriate one. However, out of the four

neurologists and psychiatrists that I spoke to about ADHD

in preparation for this, every single one said children with ADHD, as much as possible, should be encouraged to avoid high sugar and simple sugar foods of most kinds and if they can find particular foods that exacerbate their symptoms, obviously eliminating

those foods is beneficial and the foods that

exacerbate their symptoms change over time. So I don't like giving

a complicated answer, but I also don't like

giving an incomplete answer. What this tells me is that children, especially young children who have ADHD should probably not eat much sugar in particular simple sugars. In addition to that, exploring whether or not

they have existing allergies to foods, they already

consume might be a good idea. At least that's what this paper, the Pelsser et. al Lancet

paper seems to speak to and I should mention that that

paper was published in 2011. Since then there have been many

dozens of studies exploring the same thing, as well as

meta analysis of all those data and it does appear that diet can have a highly significant role in eliminating or at least reducing the symptoms of ADHD so much so that some of the children are able to not take medication at all, or eventually wean

themselves off medication as young adults and as adults. One interesting question

is whether or not adults should modify their diet in order to increase their levels of focus, if they're already having

normal levels of focus, but we'd like more or would like to reduce existing adult ADHD,

that's an interesting, and even more controversial topic, it brings us right into the

realm of what are called omega-3 fatty acids. I've talked many times

on this podcast about the known benefits of omega-3

fatty acids in particular, getting a one gram 1000 milligrams or more even as much as 2000

milligrams each day of the so-called EPA component

of omega-3 fatty acids known to have antidepressant effects, mood elevating effects, known to have important effects protecting the cardiovascular system. I think it's now clear that

the immune system also benefits that omega-3 fatty acids that

include a gram or more of EPA that are very beneficial typically that's done through fish oil, liquid fish oil is going to

be the most cost efficient, but they're capsule forms for those of you that don't like fish oil, you can ingest this through other means you can get it from certain

algaes or krill, et cetera. You have to make it compatible

with your particular diet, whether or not you're vegan or vegetarian or omnivore, et cetera. Omega-3s have shown, been shown to have all these

positive health benefits. Do they have positive effects

on focus and attention? And the answer is you can find studies that support that statement and

the effects are significant, but the effects are modest. You can also find studies

that show no effect, however much like with

omega-3s and antidepressants, whereby ingestion of omega-3

fatty acids of a gram or more of EPA per day allows

people with major depression to get away with taking lower doses of antidepressant medication. It does seem that ingestion of

omega-3 fatty acids in adults that include EPA is of

1000 milligrams or more can allow adults with ADHD or mild attention deficit issues to function well on

lower doses of medication and in rare cases to

eliminate medication entirely. So what this says is once again, that the omega-3 fatty

acids are beneficial, will they cure or eliminate ADHD? I think it's safe to say, no, they are playing a supportive or what we call a modulatory role. Just like good sleep, plays a supportive and modulatory role for essentially everything,

your immune system, your ability to think your

ability to regulate your emotion, it's modulating that process. This component of modulation is extremely important to highlight and I think I want to spend

a moment on it because this is especially important

in the context of ADHD and all the information that's out there. There are biological

processes that are mediated by particular compounds like dopamine. So for instance, the

ability to feel motivated, to attend to focus is mediated

by the circuits in the brain that release dopamine. However, attention is also

modulating by how rested you are. If you want to eliminate your

ability to think well at all, just stay up for two nights

and don't sleep at all right? If you do that, you will have modulating

the circuits in your brain that respond to various things and you will be highly distractible. You'll be highly emotional. You will feel like garbage, but that doesn't mean that sleep mediates, focus and attention. It modulates it indirectly. Likewise, I think these

omega-3 fatty acids in particular the EPA is which

are so beneficial for mood and apparently also for attention, they directly mediate attention and mood, what they do is they

modulate those circuits, they make dopamine more available. They make whatever dopamine is available, more likely to bind to

the various receptors that are present on neurons and so forth and I think this is very

important because likewise diet in any discussion about nutrition has to include this

framework of is the diet, the elimination diet, or whether or not it's some

other diet or esoteric diet, ketogenic diet, is it modulating

or mediating a process? And most likely in the context of ADHD, it's modulating that process. So if the ADHD is mild or

if it's caught early enough, or if it's in conjunction

with pharmacology with a prescription treatment, well, then it might help

guide the child or adult to a better place of being able to focus. But it's not going to be the

switch that flips everything. Now that does not mean that

consuming the wrong foods, sugary foods or foods that

you happen to be allergic to is a good idea it will

still be detrimental. So I hope that conceptual framework helps because if you go online, if you're somebody with ADHD or not your going to be

bombarded with the ADHD diet, the oligoantigenic diet,

the elimination this, this supplement that EPA and I think it's very important

to understand whether or not you're talking about

something mediating a process or modulating a process. Now drugs like Ritalin,

drugs like Adderall, they are tapping into the circuitries and the neurochemistries that

mediate attention and focus. They are not the only

alternatives or the only choices rather for treatment of these circuits and enhancement of the circuits for focus. I'm going to talk about other alternatives and some behavioral alternatives that are not very well known, but are very, very

effective in a few minutes. But I really want to make

this clear distinction between modulation and mediation, because it's vital for anyone

that's trying to modulate or mediate anything

within their own brain. If any of you are interested

in this oligoantigenic diet, as it relates to ADHD, and you want to explore

a more recent study besides that classic 2011 Lancet study, that's rather controversial. There's a paper that was

published in frontiers in psychiatry just last year, 2020. The title of the paper is, "Oligoantigenic diet

improves children's ADHD rating scale scores reliably

in added video rating." The added video rating is

just that they're using an additional measure

of focus and attention. Again, that's Frontiers

in psychiatry, 2020, I'll put a link to it in the caption, and that's a more recent

study for you to peruse. So we've talked about the

neural circuits of focus and the chemistry of focus, but we haven't talked yet

about what would make us better at focusing and what

focusing better really is. So let's take a step back and think about how we focus and how

to get better at focus and I'm going to share with

you a tool for which there are terrific research data that will allow you in a single session to enhance your ability to

focus in theory forever. What am I about to read you

is from an excellent book that I recommend, if any of you are

interested in neuroscience and things like meditation

and default mode networks and things of that sort, the book is called, "Altered Traits." Science reveals how

meditation changes your mind, brain and body and no,

I'm not going to try and convince you to meditate. I'm going to share with you

a small passage in the book that relates some research

data related to focus that are very important. If you want to meditate,

that's your choice. That's a separate matter. This is a book by Daniel

Goleman and Richard Davidson and I should just mention that Goleman is a well-known author has written books on emotional

intelligence and so forth. Richard Davidson is also a PhD. He's a professor of

psychology and psychiatry, and he's at a University

of Wisconsin Madison, he's done terrific work on brain states and modulation of brain

states and so forth. What we're about to talk about is when attention works and

when attention falters and what we are specifically

going to talk about are what are called attentional blinks, not actual eye blinks. We're going to talk about

that in a few minutes, but we're going to talk

about attentional blinks. I'm paraphrasing here because Goleman and Davidson wrote

about this so beautifully. I'd rather paraphrase from

them than try and just make up a new way to say it that is less interesting or less good, but I want to credit them. Attentional blinks are

really easy to understand, if you think about a where's Waldo task, you know this task where's Waldo where, there are a bunch of people and objects and things in a picture and somewhere in there is Waldo with the striped hat and the

glasses and go skinny dude, and you have to find Waldo and so it's a visual search and it's visual search for an object that has distinct features, but is embedded in this

ocean of other things that could easily be confused as Waldo. So you tend to look, look, look, look, look, look, look, look, look, and then you find Waldo. Kids can do this they enjoy doing this. Adults may or may not enjoy it, but they can do it too. They find Waldo, when you find Waldo or when you search for a target in some other visual

search task at that moment, your nervous system

celebrates a little bit and it celebrates through

the release of neurochemicals that make you feel good,

you found it and you pause. Now, the pause is interesting

because when you pause, what we know from many experiments is that in that moment of pause

and mild celebration, however, mild you are not

able to see another Waldo sitting right next to it. So what this means is in

attending to something in searching and in

identifying a visual target your attention blinked

it shut off for a second and there's a more formal

and more laboratory type way that we look at this. The more typical way to

do this is to give someone a string of letters or a string of numbers and beforehand you tell them

be on the lookout for the letters R and Z, okay? You're just going to watch

this string of numbers go by and there will be a letter R in there, and there will be a letter Z in there and try and spot them both and what you find is when you present that string of numbers,

and then they see the R, they see the R they

register it consciously and they tend to miss the Z, just like in the Waldo type example. Now, of course the numbers

are going by pretty quickly, but they can spot the R. They could also spot the Z, if you told them

beforehand, just spot the Z and the numbers are moving

through at the same rate in both conditions. So what that means is that in every case, you are capable of seeing the R or the Z it's when you try and see

both that seeing the first one prevents you from seeing the second one, it's what we call an attentional blink. We do this all the time and people with ADHD

tend to have many more attentional blinks than people that don't and this is true for

children and for adults. This is an important point. So important that I want

to emphasize it twice in case you attentionally blinked. If you see something

that you're looking for, or you're very interested in something, you are definitely

missing other information in part because you're

over focusing on something and this leads to a very

interesting hypothesis about what might go wrong in ADHD, where we've always thought

that they cannot focus and yet we know they can focus on things they care very much about, well, maybe just maybe they are experiencing

more attentional blinks than people who do not have ADHD and indeed, there are data

now to support the possibility that that's actually what's happening and that should be exciting

to anyone that has ADHD. It should also be exciting

to anyone that cares about increasing their focus and

their ability to attend. What this is saying is

that these circuits, that underlie focus in

our ability to attend and our ability to eliminate distraction, they aren't just failing to focus. That's just a semantic way

of describing the outcome. They are over focusing on certain things and thereby missing other things. And so our distractability

or the distractability of somebody with ADHD could exist because they are over focusing on certain elements and there are there for missing other elements that they

should be attending to. So what they really need is this property that we call open monitoring. Now open monitoring is something that's described in the

book that I just referred to and that typically is

associated with people who have done a lot of meditation, so called Vipassana meditation, or have spent a lot of

time learning how to do what's called open gaze visual analysis and open gaze thinking. But there's a simpler version of this that allows us to bypass all that. First of all, your visual system has

two modes of processing. It can be highly focused,

a soda straw view. So looking for the R in

this string of numbers in the example that I just gave, or if you're very excited about something you're in that soda

straw view of the world, and you're missing other things, okay, that's high levels of attention. However, there's also a

property of your visual system that allows you to dilate your gaze, to be in so-called panoramic vision. Panoramic vision is something

you can do right now, no matter where you are,

and I can do it right now, you won't know that I'm doing it, but even though I'm still

looking directly at you, I'm consciously dilating my

gaze so that I can see the ceiling, the floor and

the walls all around me. That panoramic vision

is actually mediated by a separate stream or

set of neural circuits going from the eye into the brain and it's a stream or set of circuits that isn't just wide angle view. It also is better at

processing things in time. Its frame rate is higher. So you've seen slow motion video, and you've seen standard video, slow motion video gives

you that slow motion look, because it's a higher frame rate. You're thin slicing time, okay? You can use panoramic

vision to access the state that we call open monitoring. When people do that, they are able to attend to and recognize multiple targets within

this string of numbers. They can see the R and they can see the Z and they can see additional things. So this is something

that can be trained up and people can practice whether or not they have ADHD or not. What involves is learning how to dilate your gaze consciously, that's actually quite

easy for most people, whether or not you wear corrective lenses or contacts or not you can consciously go into open gaze and then you can contract

your field of view as well. There have also been studies done where people were taught to

think in a particular way for a very short period of time, and that forever changed

their ability to limit or reduce the number of

these attentional blinks. There are now published

accounts in the literature of a simple practice done

for about 15 minutes, where subjects were asked to

just sit quietly eyes closed and do what is sort of akin to meditation, but to not direct their mind into any particular state or place, but simply to think about their breathing and to focus on their

so-called interoception, focus on how their body feels, their mind drifted to bring it back, okay? So it's basically meditation

for about 15 minutes. That might not seem like a

significant or unusual practice or that it would have any impact at all. But remarkably, just doing

that once for 17 minutes, significantly reduced the

number of attentional blinks that people would carry out. In other words, their focus got better in a near permanent way without

any additional training. There's something about that

practice of reducing the amount of visual information coming in and learning to pay attention

to one's internal state, what we call interoception

that allow them an awareness, such that when they needed

to look for visual targets, when they need to focus on

multiple things in sequence, they didn't experience the same number of attentional blinks and I should mention not

incidentally as people age and their working memory gets worse and their ability to focus gets worse, the number of attentional blinks that they carry out goes up, and there are now studies

exploring whether or not the simple meditation like

practice of 15 to 20 minutes or so of sitting and just quietly resting and paying attention to one's breathing and internal state can

also offset some of that age-related what is

called cognitive decline. So what these data tell me is that regardless of whether

or not you're a child or you're an adult, whether or not you have ADHD or not, whether or not you're experiencing age-related cognitive decline, or you would simply like to avoid age-related cognitive decline, a simple practice of taking 17 minutes sitting and paying attention

to your internal state, just interocepting,

registering your breathing, registering the contact of your skin with whatever surface you're on, can forever rewire your brain

to be able to attend better and possibly even offset some of that age related

attentional drift. Now, I don't expect anyone to

start meditating regularly. I don't expect anyone to do

anything they don't want to do, but I think most of us could handle one meditation's session

of 17 minutes or so and so if ever there was a

tool that stood to rewire our attentional circuitry

in a powerful way. This seems to be it and in addition, the ability

to engage in panoramic vision, to dilate our gaze, the so-called open monitoring

that allows the brain to function in a way that it can detect more

information faster, that's a powerful tool as well and the beauty of that tool is

that it works the first time and it works every time. Now, how exactly it works

is a little bit unclear. Is it for instance, orchestrating this synchrony or asynchrony between the default mode network and the task related

networks we don't know. Those studies have not

yet been carried out. Nonetheless, the effects are significant, they are long lasting

and they appear to exist after just one session of this quiet 17 minute interoception, which to me makes it seem like a very worthwhile thing

to do for everybody. So we just talked about

attentional blinks, which are essentially blinks of thinking it's your mind shutting off for a moment and missing information. Now let's talk about actual blinks, the sort that you do with your eyelids. Now, this might come

across as somewhat obvious, but you can do fast, what

are called spontaneous blinks and they're always coordinated

between the two eyes or you can do long blinks like when you go to sleep at night, you do one very long blink,

and I'm not being facetious. When you go to sleep at night, you are shutting your eyelids and you are limiting the

amount of information coming in and your perception of

time starts to drift as you go into sleep. Your perception of time

changes from very fast, at one moment to very slow

meaning the frame rate at which you are analyzing

information dreaming, et cetera, is variable when you were in sleep, sometimes it's very fast. Meaning you experienced

things in slow motion. Sometimes it's very fast. In waking to your experience of time can sometimes be very fast

sometimes be very slow. Typically the more alert you

are, the higher the frame rate, your thin slicing your experience. You've probably had this happen. If you're ever very stressed and you're waiting for

something or somebody, it seems like it takes forever because your frame rate is higher you're analyzing time more finely. Conversely, if you are very

relaxed or even sleepy, you wake up and you have to think of all the things you have to do. It will seem like the world

is going by very, very fast and that you are moving very slow. Time is going at the same rate, but your perception of

time is what's changed. Believe it or not. Your perception of time is

also changed on a rapid basis. Moment to moment basis

by how often you blink. This is a well-established literature in the world of neuroscience

that unlike the literature and claims about blinking and sociopathy, which have no basis, the science of blinking as

it relates to time perception has some very good data to support it. I want to just emphasize

one study in particular, which is quite appropriately titled, "Time dilates after spontaneous blinking." This is a paper that was

published in current biology. The first author is

Terhune, T-E-R-H-U-N-E. It's a wonderful paper. They examine the relationship

between fluctuations in timing and blinking and to

make a long story short what they found is that

right after blinks, we reset our perception of time, okay? So blinks in that sense

are a little bit like the curtain coming down on a scene between scenes in a play or takes in a movie, and

they clap the clap thing, they started take in our,

what do they say, action and then at the end they do the

thing and they click it down and they say, it's a take that's one take when you blink it's a take, okay? Now what's interesting and will immediately make

sense to you as to why this is important is

that the rate of blinking is controlled by dopamine. So what this means is that dopamine is controlling attention. Blinks relate to attention and focus, and therefore the dopamine

and blinking system is one way that you constantly modulate and update your perception of time and fortunately, it's also

one that you can control. So the basic takeaway of

this study was that blinking controls time perception, but also that levels of dopamine can alter your sense of

time and stay with me here, and that blinking and dopamine

are inextricably linked. They are working together

to control your attention. When dopamine levels go up, people tend to overestimate

how long something lasted, why? Because they are

processing time more finely it's slow motion mode. When dopamine levels are lower, they tend to underestimate time intervals. Let's remember back to the

very beginning of the episode, what's going on in people with ADHD, they are not good at managing their time, they tend to run late,

or they are disorganized. They are not just disorganized in space, meaning in that physical

space, around them, they're disorganized in time. Their dopamine is low,

we know that as well and so they are

underestimating time intervals and so it makes perfect sense

that they would be late. It makes perfect sense that

they would lose track of time or the ability to focus. This is really exciting

because what it means is that children with ADHD, adults, with ADHD or people with normal levels of focus that want to improve

their ability to focus can do so through a training that involves learning how often to blink and when, and how to keep their visual

focus on a given target and it turns out this study

has actually been done. There's a study again,

I'll link to the study, entitled "Improvement of attention in elementary school students through fixation focused

training activity." I won't go through all the details, but what they found was a short period of focusing on a visual target, allowed the school

children to greatly enhance their ability to focus on

other types of information and a significant component

of the effect was due to the way that they were

controlling the shutters on their eyes, their eyelids,

and controlling their blinks. So what they did in this

study is they had these kids focus their visual attention on some object that was relatively close, like their hand for a minute or so, which actually takes some

effort if you try and do that, they were allowed to blink. However, it's known from other work that if people can consciously

override the desire to blink, at least to the point where

they feel like they have to, or else their eyes were dry out, that actually can increase

attention even further and they had conditions where

they would look at a point further across the room and

even further across the room. It only took a few minutes

each day to do this 30 seconds in one

condition, or maybe a minute and then at another station of looking a little bit further out and a little bit further out, however, there was an important

feature of this study that is definitely worth mentioning, which is before they did this visual focus, task or training, they did a series of physical

movements with the kids so that the kids could sort

of eliminate or move out some of their desire to move and would thereby enhance

their ability to sit still. Now it's long been known

that kids need a recess, they need time to run around

and play and roll around, do whatever it is that they do in order to be able to sit still at all. Adults probably need this too, frankly, but kids need it more because

the circuits in the brain that control reflexive

movements and as we say, kind of rhythmic undulating

behavior and things like that, that's an active suppression and kids have less of

that circuitry built up until they hit about age 15 or 16. So they had the kids move around a bit and then do this focus training. That brings me to another treatment that's actively used nowadays

in schools for kids with ADHD, but also is starting

to be used by many kids and by parents in order to

keep their kids focusing and not going crazy in the car

or not acting out in general and that's the prevalence of

these so-called fidgeter toys or things that kids can do actively and repetitively in order to move out some of their underlying

reverberatory activity in their nervous system. So what you will find is

that some kids with ADHD are now given a rubber band on their desk, literally a rubber band

that's attached to their desk and they're able to pull on it, even snap it against the desk, if I had done that when I was a kid, I think my teachers were

throw me out of class, but I think it's great

that they're allowing them to do this now as a way of moving some of their physical energy out or engage their physical energy, rather, as opposed to trying to sit statue still all the time and attend and it turns out that does

enhance these children's ability to focus mentally when they

have some physical activity to attend to and it turns out

it also can work for adults. I'll share with you I related anecdote because it illustrates

the underlying mechanism. I've had the great privilege

of being able to do a number of surgeries, brain surgeries

during my career. So one thing you find when

you do brain surgeries, is that the brain's pretty small regardless of the species

that you're working on and you're in there

and you're trying to do something very specific

and the more you try and hold your hands really steady, the more they want to shake, all right? So it's not natural for any of our limbs to sit perfectly still, depending on how much coffee you had, how well rested you are and your sort of baseline

level of autonomic arousal. Some of you may find that

you can hold out your hand, absolutely rock solid, others

will shake a little bit more. It doesn't mean you're if you're shaking, doesn't mean you're calm if you're still. What it relates to is the amount of what we

call premotor activity, the number of commands to move that are being sent through the system and that's what I mean

by reverberatory activity and it does seem that kids

with ADHD and adults with ADHD have a lot of reverberatory activity in their nervous system and so that's that constant desire to move it's hard for them to sit still and therefore it's hard

for them to attend, to harness their attention. When you do a surgery and you find that your hands are shaking, what you learn from your mentors, which I did and what works extremely well, whether or not you're

doing a surgery or not, is that you simply tap your foot or you bounce your knee a little bit, which you might think would

make your hand shake even more, but provided that it's subtle. What it does is it actually

shuttle some of the activity from those premotor circuits

to elsewhere in the body and then you're able to sit

much more still with your hand, you're able to perform the

surgery with much more precision. You are able to write with

much better handwriting and for those of you who

engage in public speaking, if you ever too nervous, that's why pacing while

you public speak helps if you're nervous, that's why bouncing your

knee behind the podium works as well. That's why nodding your head

and gesticulating can help. It's not a matter of, "Moving energy out of the body." That doesn't actually happen, what it is you're engaging

those premotor circuits that are sending through commands. It's like trying to stuff, a bunch of stuff through a funnel, and it creates this tension, so you're giving it an outlet

for the neural circuitry to be able to move something so that you can keep other

components of your body and your mental attention engaged and locked onto something

what we call focus. One thing related to this

whole business of blinking and focus and training yourself to focus and not blinking, et cetera,

is that most all of the drugs, Ritalin, Adderall, and recreational drugs that increase dopamine, even coffee and tea and

other forms of caffeine, they tend to make us blink less and when we get tired,

we tend to blink more. Now this is sort of a duh, right? But being wide-eyed

with excitement or fear or with your eyes, barely

being able to keep them open, now it should make perfect

sense that these shutters on the front of your eyes, they aren't just there for winking and they aren't just there

for cosmetic purposes. They are there to regulate

the amount of information going into your nervous system and they're there to regulate how long you are bringing information

into your nervous system and in what bins, how widely or finely you are binning time is

set by how often you blink and how widely or specifically you are grabbing attention

from the visual world is set by whether or not you're

viewing things very specifically like a cross area through a

soda straw view like this, or whether or not you

were in this panoramic sort of whole environment mode, this kind of fisheye lens

or wide angle lens mode and in fairness to the

pharmacology and the circuitry, while dopamine and heightened

levels of alertness and excitement tend to make

us blink less and attend more. There's actually a study that's looked at the other neurochemical systems and drugs and how those relate to blinking and so this will all be obvious

by the title of the paper I'm about to share with you. This is a paper entitled, "Decreased spontaneous eyeblink rates in chronic cannabis users, evidence for stride or cannabinoid,

dopamine interactions." Okay, I'm not going to go

into all the details here, but one thing that is

somewhat surprising is that many people with ADHD

use or abuse cannabis, you might think, well,

why would they do that? Because I thought that

a increase in dopamine is actually what's going to lead to heightened levels of attention and that's what these

people in children crave. Well, it turns out that cannabis also increases dopamine

transmission in the brain, but because of the other chemicals, it increases namely serotonin and some components of the

cannabinoid and opioid system, it creates that kind of

alert, but mellow feel and again, here I'm not

a proponent of this, I personally am not a

THC or cannabis user. It's just not my thing and obviously it's illegal some places and so you have to

determine that for yourself it does have medical purposes

in some places it is legal, but THC increases dopamine

and increases neurochemicals that can also create a state of calm. So it's that sort of middle ground and this paper has a

beautiful demonstration whereby not just while

people are using cannabis, but depending on how

long they've been using cannabis across their lifespan, the rates of eye blinking change. So if you look at the number of years that people have been using

cannabis on a regular basis, either daily or up to excuse

me, weekly, or up to daily, what you find is that for people that have not been using cannabis at all, or have only been using

it for about two years, their rates of eye blinks are much higher than people who've been using

it chronically for 10 years. In other words, people who may be using cannabis for 10 years, don't blink very often at all. Now cannabis has well known

effects in depleting memory, but it does seem to engage the focus and blinking system in a

way that increases focus. So basically what I'm saying is marijuana seems to

increase people's focus, but then they can't remember

what they were focusing on. Something I'd like to discuss

just briefly is the so-called interoceptive awareness that's

present in people with ADHD, both children and adults. Interoceptive awareness is one sense of one's own internal state heartbeat, breathing contact of skin with

a given surface, et cetera. For a long time, there

was this hypothesis, this idea that people with ADHD, were just not in touch with how they felt that somehow they weren't registering all the stuff that was

going on inside them changes in heart rate and so forth and so they were behaving in a way that was dysregulated

or appear dysregulated, and that if they could

just learn to attend to their internal state better, that somehow they would

function better in the world. Now, before we described a process, literally a 17 minute

interoceptive exercise that does seem to lead to improvements in one's ability to focus

for a longer period of time. However, it's very unlikely

that that was due to increasing interoceptive awareness per se. It probably wasn't because

people gain a much heightened or improved ability to understand what's going on internally. In fact, you can imagine

how that might actually prevent one's ability to

pay attention to things in the outside world. So while there is benefit

to just sitting there and being in stillness, as they say, or focusing on one's

breathing and internal state for sake of then accessing information in the external world, a really nice study called

interoceptive awareness and attention deficit

hyperactivity disorder explored whether or not

interoceptive awareness was different in people with

ADHD or did not have ADHD and the findings were essentially

that there's no difference that people with ADHD,

children, and adults, they are aware of what's

going on inside them just as much as anyone else's and the typical measure

of interoceptive awareness is one's ability to count

their own heartbeats. This is actually challenging

for some individuals and very easy for other individuals, regardless of their attentional capacity. Some people just can

really feel their heartbeat without taking their

pulse other people cannot and these studies are pretty

straightforward to do. You ask people to sit there

and to count their heartbeats, and then you are

monitoring their heartbeats and you get to gauge

how accurate they are. So it's important to understand

that people with ADHD are in touch with how they feel. It's really a question of whether or not they can take the demands

that are placed upon them and enter a cognitive

state of mental state that allows them to access the information they need to access in other words, whether

or not they can focus, but it is absolutely wrong to think that the child that's getting

up 11 times during a short six minute interaction at the table, or whether or not a child who somehow has to venture off every moment or a coworker of yours who's an adult who's constantly fidgeting or moving things around that

somehow they are unaware that they are oblivious, they're not oblivious to how they feel. Chances are they're very

challenged in the situations that they're in and they're doing

everything they can to try and regulate their attention. So I think it's an

important study to highlight because it really

underscores the fact that something else is going on and that something else

has everything to do with this ability to coordinate these tasks directed networks, and to coordinate that in the proper way with that default mode network and that is a process as you now know, that's regulated exquisitely

by certain neurochemicals and in particular the

neurochemicals, dopamine, norepinephrine and serotonin, and a fourth one I'd like

to throw into the mix, which is acetylcholine, which is very vital for cognitive focus. So now I want to switch

back to talking about some of the drugs that are typically used to access those systems,

prescription drugs and I want to talk about

some of the new and emerging non-prescription approaches to increasing the levels of dopamine, acetylcholine and serotonin in the brain using various supplement type compounds, because several of them are showing really remarkable efficacy in excellent peer reviewed studies. So before moving to some of

the newer atypical compounds and things sold over the counter, I'd like to just briefly

return to the classic drugs that are used to treat ADHD. These are the ones I mentioned earlier, methylphenidate also called Ritalin, Modafinil or armodafinil is

another one and Adderall, again, all of these work by increasing levels of

dopamine and norepinephrine. Typically they're taken

orally in pill form, or sometimes in capsule form the dosages that are appropriate vary, according to severity of the condition for a given person and

the age of the person. This is a complicated

landscape for each individual. They have to figure out the pharmacology that's best for them. Some individuals are even layering long or time to release Ritalin

with Adderall in smaller doses, it can get quite complex or it

can be quite straightforward if you are really

interested in these drugs and how they work and you'd like to get a glance

at a table of all the results from all the studies of

which there are now hundreds, there's an excellent review

about these drugs and their use and their comparison to

similarly structured drugs in particular MDMA and

cocaine and amphetamine, meaning Street Amphetamine to really illustrate the similarities of action and some of

the problems associated with long-term use. I don't expect you to

read this article in full I'm here so that you don't

have to go read these articles, but in case you want a ton of information, the paper is Esposito et al

Frontiers and bio-sciences, it's an excellent, excellent review of the entire literature. It is quite long. I can put a link to that

study in our caption, and it essentially

describes all the studies that have been done, peer

reviewed and published, and it refers to these

drugs in an interesting way. It doesn't just refer these

drugs as for treatment of ADHD. It actually refers to them

using language that ordinarily I'm not very fond of,

but I'll agree to here, which is so-called smart

drugs or nootropics. It also covers caffeine, which

again as I mentioned earlier, increases dopamine norepinephrine and to some extent serotonin, but what I like about this

review so much is that in putting, these drugs of abuse, methamphetamine, and cocaine,

right alongside these drugs, like Ritalin and Adderall

and also caffeine, we start to realize that

the distinction between drugs of abuse and the distinction

between drugs of treatment is actually a very fine and

sometimes even a blurry line and in thinking about whether

or not one wants to use these prescription, I want

to emphasize prescription, not drugs of abuse, but prescription drugs for treatment of one's

own attentional capacity. I think it is important to understand the extent to which they all carry more or less the same side effects. The one exception being

caffeine caffeine side effects can be anxiety if you ingest

too much of it, insomnia, if you drink it too late in the day, but typically it will not

cause the major side effects of the other drugs, such as high propensity

for addiction and abuse. Amphetamines of any

kind as well as cocaine can cause sexual side effects because they're vasoconstrictors. So, men have trouble achieving erection, there can often be the intense

desire or libido for sex, but an inability to actually perform. So that's an issue with

any kind of stimulant. So these drugs are not

without their consequences. In addition, and here I'd lump

caffeine back into the mix. In addition, they almost all

carry cardiac effects, right? They increase heart rate, but they also have effects on

constriction of blood vessels and arteries and veins

and so forth in ways that can create cardiovascular problems. Now, caffeine is a bit

of a complicated one. I talked about this on a podcast long ago, but I'll just remind you that it turns out that if you are caffeine

adapted, in other words, if you are used to drinking caffeine then the ingestion of caffeine, most often will cause vasodilation

who actually allow more blood flow through. However, if you are not caffeine adapted, it will cause vasoconstriction due to an increased stress response. So if you're familiar with caffeine, caffeine can actually

have a little bit more of a relaxation response although if you drink enough of it, it will make you amped up. These other drugs, almost

always lead to vasoconstriction, increased heart rate dilation

of the pupils, less blinking, heightened levels of attention, which looks very much like stress and at its extremes looks very much like the effects of street drugs, like cocaine and amphetamine. Because of the large amounts of dopamine that released in the brain. People tend to crave

that state over and over and yet with each subsequent use are able to get less and less of that euphoric feeling or that really, really focused feeling. So one thing that's being

explored quite extensively now in the treatment of

ADHD are drug schedules. Whether or not people should

take Adderall every day or every other day, whether or not they should take it only every once in a while, whether or not young children

can take it just a few times and engage in behavioral

training of the sort that I talked about before,

where they're doing, maybe it's a 17 minute

meditation type exercise, but more likely it would be the movement followed by the visual focusing, cause that's only done for

20 or 30 or 60 seconds. Why would you do that? Well in a chemically enhanced state, your brain is more plastic. The circuits are able to

modify and learn better. That's the optimal time to engage in focus in a very deliberate way. So just taking a drug and expecting focus to just work at any point and being able to turn

focus on and off at will, that's an unrealistic expectation, right? More likely the best use of

things like Adderall, Modafinil, armodafinil and Ritalin is going to be to combine those treatments

with behavioral exercises that actively engage the very circuits that you're trying to train up and enhance and then perhaps I want

to highlight perhaps tapering off those drugs so that then one can use those circuits without any need for

chemical intervention. So despite any controversy

that might be out there, I think it's fair to say that the consumption of omega-3 fatty acids can positively modulate the systems for attention and focus. So then the question becomes how much EPA, how much DHA does that differ for, what's helpful for depression, et cetera and actually it does differ in reviewing the studies for this it appears that a threshold

level of 300 milligrams of DHA turns out to be an

important inflection point. So typically fish oils or

other sources of omega-3s will have DHA and EPA and typically it's the EPA that's harder to get at sufficient levels, meaning you have to take

quite a lot of fish oil in order to get above that 1000 milligram or 2000 milligram

threshold to improve mood and other functions. But for sake of attention, there are 10 studies that

have explored this in detail and while the EPA component is important, the most convincing studies

point to the fact that getting above 300 milligrams per day

of DHA is really where you start to see the attentional effects. Now, fortunately, if you're

getting sufficient EPA for sake of mood and other

biological functions, almost without question, you're getting 300

milligrams or more of DHA. So that usually checks that box just fine. What's interesting is that

there's another compound phosphatidylserine that has

been explored for its capacity to improve the symptoms of ADHD. Again, I don't think

this is any direct way, but rather in a modulatory way, but it appears that phosphatidylserine taken for two months for

200 milligrams per day, was able to reduce the

symptoms of ADHD in children. It has not been looked

at in adults yet as, at least as far as I know, but that this effect was greatly enhanced by the consumption of omega-3 fatty acids. So now we're starting to

see synergistic effects of omega-3 fatty acids

and phosphatidylserine again that was 200 milligrams per day. This is something that sold over the counter in capsule

form, at least in the U.S. there were two studies, both were double-blind studies. I carried out for anywhere

from one to six months on both boys and girls and it

really was boys and girls, not men and women. This was kids age one

to six or seven to 12, and it was a fairly

large number of subjects. So 147 subjects in one

case in 36 in the other, the takeaway is that getting

sufficient levels of EPA and particularly there's 300

milligram threshold of DHA, plus, if you are interested

in it and it's right for you, 200 milligrams of phosphatidylserine can be an important augment for improving the symptoms of ADHD. You'll also find literature out there and many claims about

so-called Ginkgo Biloba, which has been shown to have minor effects in improving the symptoms of ADHD, not nearly as effective

as Ritalin and Adderall. Ginkgo Biloba is not

appropriate for many people. I am one such person, I don't have ADHD, but when I'd taken Gingko,

even at very low doses, I get absolutely splitting headaches. Some people do not

experience those headaches, but it's known to have very

potent vasoconstrictive and vasodilating properties

that vary depending on when you took the compound. So for those of you that

are exploring Ginkgo Biloba, and you will see a lot of

claims about Ginkgo Biloba for attention in ADHD

definitely take the vasodilation vasoconstriction headache

issue into consideration. So I'd like to talk

about the drug Modafinil and the closely related drug armodafinil that's AR Modafinil. Because Modafinil and armodafinil are gaining popularity out there, both for treatment of ADHD and narcolepsy, but also for communities of people that are trying to stay

awake long periods of time. So it's actively used in the

military by first responders, it's gaining popularity

on college campuses and people are using it more

and more as an alternative to Adderall and Ritalin and

excessive amounts of coffee. It does increase focus

and to a dramatic extent, Modafinil typically was very expensive, I don't know if it's still this expensive, but when one has a prescription for it, it could still cost as

much as eight or $900 even $1000 a month. Armodafinil is a far

less expensive version, that's chemically slightly

different than Modafinil. Regardless of price people are taking

Modafinil and armodafinil. Want to emphasize that

unlike Ritalin and Adderall, Modafinil and armodafinil

are weak dopamine re-uptake inhibitors, and that's how they lead

to increases in dopamine. So, whereas Ritalin and

Adderall, amphetamine, and cocaine lead to big

increases in dopamine also through re-uptake

mechanisms and so forth Modafinil is a weaker

dopamine re-uptake stimulator and so what that means is that it leaves more dopamine around to

be active at the synopsis, the gaps between neurons, however, it also activates other systems. It acts on the orexin system, which is actually a peptide

that we talked about in the episode on hunger, because it regulates hunger and appetite, and it regulates sleepiness

and feelings of sleepiness. In fact, the, excuse me, orexin also called hypocretin system, the orexin hypocretin system is what's disrupted in narcolepsy. That was the important

discovery of my colleagues, Emmanuel Mignot and Seiji Nishino at Stanford some years ago, they identified the

biological basis of narcolepsy and it's a disruption in the

so orexin hypocretin system and Modafinil is one of the primary treatments for narcolepsy. It also has these other

effects on the dopamine system and on the norepinephrine system, even though it doesn't lead

to quite as intense levels of dopamine and arousal and focus, it does have the property of

raising levels of attention and focus, and that's

why people are using it. So it's a somewhat

milder form of Adderall. Armodafinil for some people

works as well as Modafinil and as I mentioned before, it's much lower cost for

other people it doesn't. I have an experience, meaning I do have an experience that I'll share with you with armodafinil. A few years ago, I was suffering from

jet lag, really terribly and I was traveling overseas. I went to a meeting to give a talk, I took half of the prescribed

dose of armodafinil. It was prescribed to me. I took that half dose

and I gave my lecture and then I stayed around

to answer questions and then four hours later, a friend of mine came up to me and said, you've been talking for

four and a half hours, and they're only a few people still here. Luckily there were still a

few people be a lot weirder, if the room was completely empty, 'cause it wasn't being recorded. So I have firsthand knowledge of the sorts of cognitive

effects that it can create. I personally would not

want to be in that state for sake of studying or learning or for doing this podcast, for instance and I can honestly say that today, all I've adjusted is some coffee and some Yerba latte tea and some water. I'm not on any of the compounds

that I've described during the course of today's episode. You might ask why I took

half the recommended dose of armodafinil and the reason

is that I'm somebody who's fairly hypersensitive to

medication of any kind, what you find if you

look in the literature, is that about 5% of people are hyper hyper sensitive to medication. They require far lower

doses of any medication than other people in order to

experience the same effects. I'm somebody that I think has, or modest a hyper if that

sort of oxymoronic statement, but a modest hypersensitivity

to medication. So I've almost always been able to get by, on taking less of whatever

was prescribed for me and feel just fine or in this case to feel

like it was still too much, it turned out that the right

dose of armodafinil for me was zero milligrams. Now you may notice that I haven't talked much about acetylcholine. Acetylcholine is a neurotransmitter that at the neuron to muscle connections, the so called neuromuscular junctions is involved in generating

muscular contractions of all kinds for all movements. Acetylcholine is also released

from two sites in the brain. So a little bit of

nomenclature here again, feel free to ignore the nomenclature, but there is a collection of

neurons in your brain stem that send projections forward, kind of like a sprinkler system that's very diffuse to

release acetylcholine and those neurons reside

in an area or a structure that's called the

pedunculopontine nucleus, the PPN and then there's a separate

collection of neurons in the basal forebrain called unimaginatively nucleus

basalis the nucleus at the base and they also hose the

brain with acetylcholine, but in a much more specific way. So one is sort of like a sprinkler system and the other one is more like a fire hose to a particular location and those two sources of acetylcholine, collaborate to activate

particular locations in the brain, and really bring about a

tremendous degree of focus to whatever is happening at

those particular synapses. So it could be a focus

on visual information or auditory information, if you're listening closely

to what I'm saying right now, and you just heard closely step out from the rest of my sentence, no doubt there was acetylcholine released at the sites in your brain where the neurons that

represent your recognition of the word closely occurred, okay? So now you have an example

and you have an understanding and hopefully a picture in your mind of how all this is working, not surprisingly then drugs

that increase cholinergic or acetycholine transmission will increase focus and cognition. One such compound is so-called alpha GPC, which is a form of choline

and increases acetycholine transmission dosages as high

as 1200 milligrams per day, which has a very high dosage spread out, typically it's 300 or

400 milligrams spread out throughout the day have

been shown to offset some of the effects of

age-related cognitive decline, improved cognitive functioning people that don't have

age-related cognitive decline that's a very high dose. Typically when people are

using alpha-GPC to study or to enhance learning of any kind, they will take somewhere

between 300 and 600 milligrams that's more typical. Again, you have to check with your doctor, you have to decide if the safety margins are appropriate for you obviously you'll want to check that out, but alpha-GPC is effective in creating more focused by way of

this cholinergic system, It stimulates acetylcholine release from both of those locations, the PPN in the back of the

brain and nucleus basalis in the front of the brain. There are two other over

the counter compounds that are in active use out

there for treatment of ADHD and in use for simply

trying to improve focus and the first one is L-Tyrosine it's an amino acid that

acts as a precursor to the neuromodulator dopamine and now knowing everything you know about dopamine, attention and

the circuits involved, it should come as no surprise as to why people are exploring the use

of L-tyrosine for that purpose. L-tyrosine does lead to

increases in dopamine. They are fairly long lived

and L-tyrosine can improve one's ability to focus, however, the dosaging can be

very tricky to dial in. Sometimes it makes

people feel too euphoric or too jittery or too

alert that they are then unable to focus well. So the dosage ranges are huge, you see evidence for 100 milligrams all the way up to 1200 milligrams. It's something that really should be approached with caution, especially for people that have any kind of underlying psychiatric

or mood disorder, because dysregulation of

the dopamine system is central to many of the mood

disorders such as depression, but also especially

mania bipolar disorder, schizophrenia, things of that sort. So it's something that

really should be approached with caution, nonetheless,

in exploring what's out there and even some studies online that were done in either animal

studies or human studies, it's clear that L-tyrosine

is being explored for that purpose as is PEA and Phenethylamine, which is a essentially PEA,

but some related compounds. So there's a whole class of dopaminergic or dopamine stimulating supplements that people are using to try and get their dopamine

levels up and again, it's kind of a fine line

between too little enough and too much. If you want to get the literature on those two compounds

there, I will refer you to this great website at

examine.com just as it sounds and you can put in L-tyrosine or PEA, and you can get the details on that. But I highly recommend also

going to their section on ADHD to see how those particular

comment OENs relate specifically to ADHD and cognitive focus. And last but not least in terms of these different compounds, I do want to mention the Racetams. These are somewhat esoteric and probably most of you

haven't heard about them, but some of you probably

know a lot about them and they are becoming more popular. They go by names like New

pepped and things of that sort. The Racetams. are illegal

in certain countries. They are gray market in other countries, and they are sold over the

counter in this country, in the U.S. so they have

different margins for safety you definitely need to

consult your doctor, especially if you have ADHD, but new pepped has been shown when taken, at 10 milligrams, twice

daily can be more effective than some of the other Racetams. What is Noopept? Noopept taps

into the cholinergic system, the acetylcholine system in

ways, very similar to alpha-GPC, but seems to have a slightly

higher affinity for some of the receptors involved and can

lead to those heightened states of cognitive capacity and there are these

studies one in particular, comparative studies of new pepped, Racetams in the treatment of patients with mild cognitive disorders and brain diseases of

vascular and traumatic origin. That's a mouthful. What this study basically points to is the fact that people who

are experiencing some degree of inability to focus

due to prior concussion or some vascular event, a

stroke or a schemey of any kind, because neurons need blood, when the blood supply

is cut off to neurons, or when there's a bleed in the brain. Subsequent to that, often there are challenges in maintaining focus. This is very common for

people who have done sports, where there's a lot of

running into each other with your head like rugby

football, hockey, and so forth, but also people who have

experienced head blows or often overlooked is the fact that most traumatic head injury

is not actually from sports, even football it's from

things like construction work from high-impact work of that kind. So there does seem to be some efficacy of new Pepped and Racetams.

and things like it. It's an emerging area and

as I mentioned in the U.S. these things are sold over the counter. Again, you have to figure

out if it's right for you, but they are beginning

to show some promise, and I'm intrigued by

them because of the way that they tap into the cholinergic system, which is both directly involved in focus, and the ability to focus, but is also important for things related to age-related cognitive decline. So a decline in cholinergic

transmission or acetylcholine as we call it in the

brain is one of the things associated with cognitive decline and it does seem that increasing

cholinergic transmission can offset some of that cognitive decline and perhaps even more so in conditions such as vascular damage or

concussion to the brain. If you're interested in

atypical treatments for ADHD compounds or improve

focus and related themes, and you like reading about this stuff, there's an excellent review article that I can refer you to it's by Ahn et al, AHN it was published in 2016 so it's a little bit behind the times, although it's surprisingly

comprehensive given that, which lines up all the various

drugs that I've discussed, Racetams., and Adderall and Ritalin, and various forms of dopaminergic agents and cholinergic agents

spells out whether or not they are sold over the

counter by prescription, and really lines them

up in all their effects, their drawbacks, et cetera. I'll refer you to that study. It's available in its full

length form online for free it's Hen et al the journal

is neuro plasticity, neural plasticity, 2016 should be very easy to find

if you put those keywords in, and while it is a review, it is a very comprehensive review and if you're really into this stuff, and you also want to

learn a thing or two about how these things interact

with neurofeedback, et cetera, there's some information in there as well. I know I've already covered

a lot of information, but there is one more

category of technology for the treatment of ADHD

and for enhancement of focus in anyone that I would like to emphasize and that's transcranial

magnetic stimulation. Transcranial magnetic

stimulation also called TMS is achieving increasing

popularity nowadays for the treatment of all

sorts of neurologic conditions and psychiatric conditions. It is a non-invasive tool, it involves taking a coil

it's a device with a coil that's placed over particular

locations in the brain, and then sends magnetic

stimulation into the brain and it can actually pass through the skull without having to drill through the skull and nowadays can be used to both lower the amount of activity or increase the amount of activity in specific brain areas. It's spatial, precision is not remarkable. That doesn't mean it's not of use, but it is not a super

fine green tool, okay? It's not a canon, but

it's also not a needle. It is somewhere in between. It can direct the activity

of particular brain regions at particular depths and as I mentioned, it can increase or decrease that activity. So for instance, I've had a TMS coil placed on my head, not for therapeutic purposes, even it was, I wouldn't tell you, but rather just for, well, I'm a neuroscientist and I worked in a lab with

one for entertainment, exploratory purposes, please

don't do this at home. It was placed over my motor cortex, which generates voluntary action and it was a coil that at that time could only inhibit neurons and so what I was doing

as I was moving objects around on a table, just like I am now, it was actually a pencil, not a pen and I was tapping the pencil and then the TMS coil was turned

on and for the life of me, I could not move that pencil, okay? Because it was inhibiting

my upper motor neurons in the portion of my cortex that controls voluntary activity. As soon as the coil was turned off, I could return to

tapping the pencil again, nowadays it's possible

to stimulate motor cortex or any area of the brain

with some degree of precision that could create the impulse to move without actually making

the decision to move. So you can literally engage

certain neural circuits and therefore behaviors

and certain thought and emotional patterns by way of transcranial

magnetic stimulation. This has far reaching

and vast implications, as you can probably imagine in discussing ADHD with a

colleague that uses TMS, what they are doing is they

are taking the TMS coil to children and adults that have ADHD, and they're using it to

stimulate the portions of the prefrontal cortex

that we talked about earlier that engage task directed focused states. So rather than using a drug that generally increases dopamine, and some of the other chemicals involved there you using directed TMS

stimulation of the circuits and fortunately, I was

quite relieved to hear this, they are combining that with

a focused learning task. So they're literally

teaching the brain to learn in a noninvasive way, no drug at all and right now there are

experiments clinical trials going on, comparing TMS of this sort to the drug treatments of the

sort that we described earlier that engaged these circuits through pharmacologic mechanisms. So very exciting times for TMS, very exciting times for

pharmacology related to ADHD and for enhancing focus in general and when I say very exciting times, I mean, no drug is perfect, but the constellation of

drugs that's out there is getting much larger, but because they tap

into different aspects of their circuitry, I do think that we are well on our way to identifying the ideal

combinations of drug treatments, technological treatments, and behavioral paradigms

for increasing focus in both children and adults with ADHD. And as a final final point, I also want to mention

something about technologies that are making it harder

for all of us to focus, regardless of whether or not we have pre-existing ADHD or not. You can probably guess

where this is going. Everybody nowadays seems

to have a smartphone. I'm sure there are a few

individuals out there that don't have a smartphone. Nonetheless, most people have them. Most kids want one, as

soon as they can get them and they are small, they

grab our attention entirely. But within that small box of attention, there are millions of attentional windows scrolling by, right? So just because it's one

device that we look at does not mean that we are focused, we are focused on our phone, but because of the way, in which context switches

up so fast within the phone, it's thought that the

brain is struggling now to leave that rapid

turnover of context, right? Many, many shows, many,

many Instagram pages, many, many Twitter feeds

many, many websites. Basically the whole world, at least in virtual format is available within that small box. Unlike any other technology humans have ever dealt with before, even though there are trillions infinite number of bits of information in the actual physical world, your attentional window, that aperture of constriction and dilating that visual window is the way in which you cope with all that overwhelming information typically. Well within the phone, your visual aperture

is set to a given width it's about this big, typically the phone seem

to be getting bigger, but nonetheless, it's about that big and within there, your attentional window is

grabbing it near infinite number of bits of

information, colors, movies. If a picture is worth 1000 words, a movie is worth a billion pictures, the brain loves visual motion and so the question is, does that sort of interaction

on a regular basis lead to deficits in the types of attention that we need in order to perform well in work, in school,

relationships, et cetera and the short answer is

yes, it does appear so we are inducing a sort of ADHD and while the studies on this

are ongoing because prominent use of smartphones really

took off right around 2010 and we're only in 2021

longstanding studies take time, which is essentially to say the

same thing as long standing. There are some studies

and one in particular that I'd like to highlight one was actually carried

out pretty early in 2014. This is a study that

explored smartphone use at the time they called

it mobile phone use, but smartphone use and inattention, difficulties in attending

in 7,102 adolescents that's a huge study, a population based cross-sectional study and you will be probably

surprised and somewhat dismayed to hear that in order

to avoid this decrease in attentional capacity, adolescents needed to use their smartphone for less than 60 minutes per day, in order to stay focused and

centered on their other tasks. Otherwise they started to really run into significant issues. So 60 minutes is not much, I've a feeling that most young people are using their phone more

than 60 minutes per day, I know I am. I think for adults, the number's probably higher

meaning if you're an adult, I'm going to just extrapolate

from what I read in this study. It seems that probably two

hours a day on the phone would be the upper limit beyond which you would probably experience pretty severe attentional deficits. I'm a big fan of Cal Newport

who wrote the book "Deep work." He's also written an excellent book, "A world without Email." I've never met him, but I'm

a huge admirer of his work and I will paraphrase

something that he said far more eloquently than I ever could, which is that the brain does

not do well with constant context switching, meaning it can do it, but it diminishes our

capacity to do meaningful work of any other kind. And so Cal, as I understand is very he's our computer science professor at Georgetown, by the way, is very structured and very disciplined in his avoidance of cell phone use. I think we're all striving to do that. I'm not here to tell you what to do, but I think whether or

not you have ADHD or not, if you're an adolescent

limiting your smartphone use to 60 minutes per day or less and if you are an adult to

two hours per day or less is going to be among the

very best ways to maintain, just to maintain your ability to focus at whatever level you can

now and as I always say, most of the things that we get recognized for in life success in

life, in every endeavor, whether or not it's school

relationships, sport, creative works of any kind

are always proportional to the amount of focus that

we can bring that activity. It is important to rest of

course, to get proper sleep. But I stand behind that statement and I leave you with that

study about attention and cell phones and how cell

phones are indeed eroding our attentional capacities. So I realized I covered a

lot of information about ADHD and the biology of focus and

how to get better at focusing. We talked about the behavioral and psychological phenotypes of ADHD. We talked about the

underlying neural circuitry. We also talked about the neurochemistry and we talked about the

various prescription drug treatments that are

aimed at that neurochemistry and aimed at increasing focus in children and adults with ADHD. We also talked about over

the counter compounds, the role of particular types

of diets and elimination diets and we talked about interactions

between these various features in dictating outcomes for ADHD and enhancing focus in general, we also talked a little bit

about emerging neurotechnologies and how certain technologies

like the smartphone are no doubt hindering

our ability to focus and put us at greater risk of

developing ADHD at all ages. I do acknowledge the irony

and somewhat the contradiction of doing a two hour plus episode on ADHD If indeed, people who are watching this have challenges with attention, I want to emphasize that this podcast, like all of our podcast episodes are timestamped for a specific reason. They are designed to be digested in whatever batch one chooses, right? You don't have to watch or

listen to the entire thing all at once however, if you've gotten to this

point in the podcast, I want to thank you. I do hope that you've learned

a lot about this condition. I hope you've also learned a lot about your own capacity to focus and things that you can

do to enhance your focus. We even talked about

a tool that takes just one 17 minute session to

enhance your ability to focus thereafter, presumably forever. If you're enjoying this podcast

and you're learning from it, please subscribe to our YouTube channel that really helps us. In addition, in the

comment section on YouTube, you can leave a suggestions

for future podcast guests and suggestions for future podcast topics that we may have not covered, or that you'd like to see

covered in the future. In addition, please

subscribe to the podcast on Apple and Spotify and on Apple, you have the

opportunity to leave us a comment and up to a five-star review. In addition, please check

out the sponsors mentioned at the beginning of the podcast, that's a terrific way to support us and for those of you that

would like to support research on stress, neurobiology

and human performance, you can go to hubermanlab.stanford.edu, and there you can make a

tax deductible donation for research on neurobiology

in my laboratory. In addition, we have a Patreon it's patreon.com/andrewhuberman. There you can support the podcast at any level that you like. During today's episode

we talked a lot about supplement based compounds. If you're interested in supplements and you want to see the

supplements that I personally take, you can go to Thorn that's

T-H-O-R-N-E slash the letter U slash Huberman and you can

see everything that I take and you can get 20% off

any of those supplements or if you navigate into the

Thorn site through that portal, you can get 20% off any of the

supplements that Thorn makes, supplements aren't for everybody, you by no means have to take supplements. But if you are going to take supplements, it's important that you take supplements from a source that's reputable and which the ingredients

are very high quality and in which the amount of the ingredients that listed on the bottle actually matches what's in the bottle. That's why we partnered with Thorn because they have the

highest levels of stringency in terms of quality and

specificity of the ingredients. And finally, I want to thank you for your

time and your attention, and as always thank you for

your interest in science. [upbeat music]