The Truth About ADHD and Hypermobility

Speaker 0:00 ADHD people are no different to anybody else. We've got everything we need, but there's a balance. You've got to balance what you need at the right time. And the problem for ADHD is we can do all of that. We just can't regulate it, so we don't find that balance. Lots of different subtypes of ADHD, and I think we should be careful of that. And we can't just say that because somebody's just a bit overvigilant and a bit this and a bit of a worrier, that they've got ADHD. We've got so obsessed with cognition, the brain, how clever we are, et cetera, is that we've forgotten that we are an embodied brain.

Alex Partridge 0:24 Dr. Nick Potter is an ADHD and hypermobility specialist.

Speaker 0:27 World-renowned author with three decades of medical experience. Nick is behind pioneering research into how our ADHD mind can drastically impact our physical body. So there's a dissonance, a mismatch between what your vision's telling you and what your body's telling you. That's what we call prediction error. If you're on the plains, which is, uh, where our brains really are manufactured to be, that meant you got eaten. So we've still got that mechanism, and it sets off fear, and it sets us to move. That's why we fidget. It means also that we're constantly very often being drawn into the periphery to know what things could take us out. We just don't know we're doing it.

Alex Partridge 0:58 Quick one before I get distracted. I just wanted to say a very brief thank you to all of my listeners. Thank you for tuning in, and thank you for subscribing and following the podcast. It really, really helps. At ADHD Chatter, my mission is to ask the world-leading experts the hard questions to give you access to the most pioneering advice the world has to offer, and with an aim to help you feel seen. Following and subscribing helps me on my mission to book these incredibly insightful guests and to give you these incredibly insightful interviews. Remember, you're not broken, just different, and you have always been enough. Nick, thank you so much for joining us.

Speaker 1:36 Absolute pleasure. It's lovely to be here.

Alex Partridge 1:38 It blew my mind when I learned about hypermobility and the links to ADHD. Um, but just to set the foundation,

Alex Partridge 1:46 Nick, what would you say your mission is in the world of ADHD and hypermobility?

Speaker 1:51 It's a great question. I think for me, it started with hypermobility, and I, as I was saying earlier, that the, um... I worked in primary care down in Fulham, actually, so we were seeing families and these. And it was conspicuous to me how much of the po- how many of the population were hypermobile, particularly I am myself, and actually also its connection to other conditions, problems we were seeing. And I did flag it up to the GPs, who were very receptive actually, and sort of grew. But I think that as with so many, medicine's a funny, funny institution. It takes probably 15 years to change, uh, consciousness around certain concepts. And I think certainly rheumatologists who were seeing these patients were like, "Oh, blimey, there's a whole new thing coming, and we don't really know what to do with it," you know? Um, and then it was, "Oh, everybody's hypermobile." And it's actually, well, not really. And then, then, then the consciousness developed. But I also just noticed that increasingly they did have a neurotype, you know, a body type was producing a way of... Th- they fidgeted more. They twisted their ankles all the time. You know, it's a classic question I say to patients is, you know, "Did you always twist your ankles as a kid?" And they go, "Yeah. Yeah, I did. A lot," you know?

Alex Partridge 2:47 [laughs]

Speaker 2:48 And of course, once you keep- we've done it once-

Alex Partridge 2:49 Mm

Speaker 2:49 ... you keep doing it. But that's very important because proprioception, which is what we use, um, our feet for a lot, which is to tell where we are in space, relies on ligaments, and if those ligaments are damaged and they can't... If they don't rehabilitate them properly, then they keep doing it. So then they get into a vicious cycle. Um, but I think my mission is awareness. Um, I'm very lucky I have a busy practice, so I don't necessarily need more patients. But I'm very passionate that I actually wrote a book in 2018 on pain, uh, in which I included hypermobility, and realized looking at data that if you look at the, um, pain society data, that 43% of the population have pain, chronic pain. The NHS is unfortunately unable to really provide any for it other than medication, which doesn't work very long, and that's 23 million people. That's an awful lot of people. Um, and some of those people couldn't afford to either come and see me, they're too far away. I see a lot of international patients. That's how desperate some of them are. Um, and I thought I'd like to put something back to a certain extent. Um, it's, it's not a financially driven thing. It's purely, uh, awareness and education. And I think I found a bit of a talent, uh, for being able to explain it, and I do it every day to my patients. Um, but to explain it simply 'cause it's quite complex. It's multifactorial. Um, and, um, it was at the heart of a lot of pain syndromes, and it's at the heart, I think we know now, very, very connected to the ADHD domain.

Alex Partridge 4:08 Do you think we're seeing a similar movement in awareness towards hypermobility as we've seen towards ADHD? It feels like over the last 15 years in the ADHD space-

Speaker 4:18 Yeah

Alex Partridge 4:18 ... what people thought it was is very different to what they think it is today. Um-

Speaker 4:23 Yeah. I think that's not... I think the more awareness you get, the more the people involved are kicked into doing it. So in, in the academic world, and it's, you know, a lot of the trusts within the NHS are attached to hospitals, but they're also attached to universities, and so the, you get the PhD students suddenly looking at this stuff, and so we now start getting a plethora of data. You've gotta be careful that that data's good. They've gotta be properly done studies. Um, it's difficult to do because it's so multifactorial, and generally research doesn't lend itself very well to the human organism because by the time you've reduced something down to a tiny, a tiny amount, um, it's very useless. It doesn't tell you the relevant to anything else.

Alex Partridge 4:56 Mm.

Speaker 4:56 So I think, um, I would say hypermobility's taken longer. Um, I think in the occupational therapy world are very aware of it. I don't... One of the things I'm passionate about and why I want partly to come today is I want these tests done more on children in all schools. They're incredibly simple. They cost nothing. Even a teacher can do it. If you can flag hypermobility up, then you can say to the parents, and I would do it to all children, so that you're not isolating anybody, and it's not an academic test. It's not educational psychology. It's just a physical test. And if you flag it up and you say, "Look," to the parents, "just to let you know, we know that hypermobility is more commonly linked to certain neurodevelopmental disorders. And if we could get him, uh, doing very specific exercise to integrate himself better, et cetera, um, we would... It is now proven that it would reduce the chances of loss of those neurodevelopmental problems coming on." Well, you know, it's much better to produce a resilient kid than it is to have to fix a, a damaged

Speaker 5:51 adult.

Alex Partridge 5:52 What would that test look like? For someone listening, someone watching, how could they test?

Speaker 5:55 Really simple, and you can Google it immediately. It's called the Beighton score. There is one called the Brighton score, which is slightly different. And as you, your, uh, my colleague, Jess Eccles, who's a dear colleague, uh, they sort of developed that. Brighton and Sussex have been leaders in this. But the Beighton score is a nine-point score-And, uh, it's very easy to do. It involves, uh, things like having very extensible fingers, uh, on both sides, so that's two. Uh, and then, uh, whether or not you can get your thumb pretty close to your wrist. I mean, I, I really can't. That's something I don't particularly do well, but it's a lot more than most. Most people get-

Alex Partridge 6:25 Mm

Speaker 6:25 ... won't get past there. Uh, extensible elbows. So if you can go extend your elbows past about 10 or 15 degrees, then we would consider that hyper-mobile, okay? Which means your joints can go further than they should do.

Alex Partridge 6:36 Okay.

Speaker 6:37 And then the same with your knees. Uh, and then the other one is that you can, you can pretty much early in the morning, no matter how stiff you may feel, you can get pretty close to touching your toes. And if you c- if you're very hyper-mobile, you'll just go straight flat on the floor. The one that I'm particularly interested in, which isn't in the test, um, and is difficult to validate, which is what we're trying to do at the moment, is that you have what we call extensible skin. So you do it at the neck and on the back of the hand. And even quite young people, obviously, as you get older, it tends to happen, but even quite young people can extend their skin a, a lot longer off the surface of their body. And that's very interesting because skin is a multi-sensory tissue, and so it gives us a lot of feedback about the world, and if that's very flexible or overly flexible, it moves in relation to the body, so we get impaired proprioception through it. So that's something I'm looking at at the moment. But then I have to get the dermatologist involved with that.

Alex Partridge 7:24 Right. [laughs]

Speaker 7:24 So there's lots of ologists, uh, who I have to talk to, but they're actually really open to it 'cause they're all sitting in silos, and they all kind of know it. But it just needed someone like me to come and say, "Dudes-

Alex Partridge 7:33 Mm

Speaker 7:33 ... I think we need to have a dinner at least," and got talking, and that's what we did with the ADHD hypermobility group, and then I will factor in those other, other elements. But they, they love it. They all, they all wanna do something new and exciting, you know. We all get a bit bored of doing the same thing every day.

Alex Partridge 7:46 [laughs] How does this... So how common is hypermobility in ADHD? Because you think of ADHD, right, and you don't necessarily think joints.

Speaker 7:54 Yeah.

Alex Partridge 7:54 How, how common is it?

Speaker 7:56 It's a really good question. I mean, really big studies, i- if you're gonna do prove this stuff, you've got to do sort of 20,000 patients and then correlate it, et cetera. But in real terms, we're looking at probably the general population, about 20% upwards. In the ADHD study done by Jess, uh, at Sussex, it looked like it was about 40% of the ADHD group. But interestingly, about 75% of the female group, which is interesting, so it was higher, and that's certainly anecdotally in my own practice, you see more hi- female-

Alex Partridge 8:24 Mm

Speaker 8:24 ... hyper-mobile patients. Um, so, uh, and then tie in with their what we call psycho or neuro type, um, and the fact that they, they have less bodily awareness and so on, then it produces a form of anxiety. Um, but so my passion is that these are not neurotic females. You know, these are people with an internal system that is constantly hypervigilant, and that ultimately turns, which is a fear response, and fear turns into anxiety.

Alex Partridge 8:49 If, if s- so you, it is more common in women, hypermobility?

Speaker 8:51 Yeah, 100%.

Alex Partridge 8:52 And if... W- what are the sort of consequences, physiological, emotional consequences of, of living with hypermobility, um, and ADHD, but not knowing?

Speaker 9:03 So again, as we were saying earlier, I think all these... There, there are sub- lots of different subtypes of ADHD, and I think we should be, you know, we need to be careful of that. And we can't just say that because somebody's just a bit over, overvigilant and a bit this and, and a bit of a worrier, that they've got ADHD. There's lots of other reasons. There's childhood reasons and so on. I think maybe to wind back a little bit, and without getting too technical, the way I try and explain it to patients is our brain spends two-thirds of its capacity on visual information. We're very big on eyes, okay? So we have the most developed o- o- um, ocular system in the world, and way more than hawks and everything else. And, and we use our peripheral vision to tell us about new information coming in from the periphery, so we orientate towards it. You know, Bambi in the headlights, she looks across when she hears, you know, and then they freeze, and they hold their breath, right? So but we integrate that with what our body's telling us. And my big zit is that we've got so obsessed with cognition, the brain, how clever we are, et cetera, is that we've forgotten that we are an embodied brain, okay? We can't, we cannot build models of the world unless we have a body, because you have multi-sensory information, and it's a phenomenal piece of kit. That's why I don't believe we'll make a, a robot that's sentient for literally years, because it can't be made of metal. It's got to be made of tissue. So, um, what we rely on is those five senses coming in, one of which, the most important ones, is proprioception that doesn't get talked about, which is stretch receptors in our body that are... There are millions of them. They're nano-sized, and they're particularly in your joints. They're particularly in the capsules and ligaments of your joints. They feed back to your brain about where you are in space, because if you can't tell where you are, you don't know everything relative to anything else. It all gets quite metaphysical, but it's, that's the point. The problem for hypermobility is that we have a collagen disorder. We lack a particular type of collagen. That collagen binds us together. So we have tissues that are like marshmallow instead of chewing gum. We don't have a sticky, agile form of t- soft tissue. Those receptors are just mechanoreceptors. They just measure movement, and they're a propeller shape. They're called piezoreceptors. And interestingly, we actually have them in moving organs. So it's anything that moves, these receptors. So we've got the heart that moves, the chest that moves. Even your bowel moves to a certain extent. So they're in both of those, and they correlate with each other where they are, and your brain is m- is, is, is monitoring that at very high resolution. You just can't possibly know about it because you couldn't be thinking about it all the time. It literally knows what your big toenail's doing right now and is processing that for you. But it only makes you aware of what you need to do something about. The problem for us is if you have a, a movement, the soft tissues will not pick up that movement, these receptors, as high resolution as normal. So there's a dissonance, a mismatch between what your vision's telling you and what your body's telling you. That's what we call prediction error, which I know Jess Eccles talked about a little bit-

Alex Partridge 11:43 Mm

Speaker 11:43 ... which is that my perception of the world is off. Now, that's great in our safe world. That's relatively easy in, in the modern days. But if you're on the plains, which is, uh, where our brains really are manufactured to be, um, that meant you got eaten. Because if you tripped up a tree stump, over a tree stump when you were being chased, uh, you were toast. So we've still got that mechanism, and it sets off fear, and it sets us to move. That's why we fidget, because we're trying to find... We're constantly taking little parameters, little, little soundings about where we are, and it means also that we're constantly very often being drawn into the periphery.Okay, because we're constantly seeking to know what, what things could take us out. We just don't know we're doing it. So if there's a mismatch, the brain's co- has to take many more flashes of the world. Uh, we burn much more neural energy. Again, we don't know we're doing it, and then, um, we can crash much quicker. So it is a Ferrari brain that has its advantages. The way you can integrate that is actually physical exercise, and that's what these people don't like doing because they're clumsy. So girls are particularly susceptible to being sh- to feeling shame. So the classic thing in the playground is, or if they're doing PE, is they just don't get it as quickly when their other friends are, so they actually just tend to give up, and then they don't do it. Whereas actually if you said to them, "Look, you just need to do 10 times what somebody does five, but you will get it," then you'll start integrating your body. So you're just knocking out that error by practicing.

Alex Partridge 13:02 Hmm.

Speaker 13:03 It's what any sport's about. The more you practice it, the more you get. The problem for us is we have to b- spend a bit longer doing it, but then we get bored, or we find everyone else is doing it. "I'm crap. I'll walk away." And girls, I've seen it with my own daughter and family, you know, they're much more aware of who saw me fluff it, who saw me get it wrong. Boys tend to be actually in those situations more competitive, more focused, so they will just drill it harder. The problem is then you don't get into the sporty group, sporty group's often sometimes the cool group, and then they feel more isolated, and that's where the kind of social anxiety I think begins to, to develop, and it's quite an early age.

Alex Partridge 13:35 Hmm. It's, it's so interesting. Shame seems to be such a, such a common characteristic of the ADH- ADHD-

Speaker 13:42 Hmm

Alex Partridge 13:42 ... experience. Is it quite easy to look at the executive functioning challenges of ADHD-

Speaker 13:47 Yeah

Alex Partridge 13:47 ... and think disorganization and forgetfulness, but I think the emotional aspects of it are so much more significant-

Speaker 13:53 Yeah

Alex Partridge 13:53 ... and impacting.

Alex Partridge 13:54 How would you describe ADHD to an alien, for example?

Speaker 13:58 Okay. Um, ADHD people generally, I mean, without getting into sort of the, the learning disorders of executive function, et cetera, in general terms, ADHD people are no different to anybody else. We've got everything we need, but there's a balance between... The yin and yang sign that you see, and the ancients really knew it, right? For every, every action there was a reaction, whether it's in your chemistry, in your movements, or your behavior. You've got to balance what you need at the right time, and the problem for ADHD is we can do all that. We just can't regulate it, so we don't find that balance, and I think that starts early in childhood for lots of reasons. Uh, it can be parental, familial, uh, tho- those things, traumatic, all those sort of things which just knock you, and, and if you don't recover from it properly, then, um, you go forward in the world. And the problem is if you, and I've done this with traders, when we stress them deliberately looking at volatility, what we didn't realize was that within less than two days, if they were feeling... They wouldn't know they were stressed, but they were feeling it through their physiology. They would actually change what we call the search algorithm, so they would actually see the world in a different way.

Alex Partridge 14:56 When you say traders?

Speaker 14:57 These are traders on a, on a, on a, a financial floor.

Alex Partridge 14:59 Right.

Speaker 15:00 So they're trading masses of data.

Alex Partridge 15:01 Sure.

Speaker 15:02 That's why they're all ADHD.

Alex Partridge 15:02 Yeah. [laughs]

Speaker 15:03 They need to be at least that because that, that's their superpower, right? They can, they can see mo- market movements way before. I have an anesthetist colleague, and it's fascinating. He can tell before the computers whether the patient's gonna do something weird.

Alex Partridge 15:15 Wow.

Speaker 15:15 And he'll suddenly say, "Oh, hold on a minute," and he'll sort of inject something into the body, and then I said, "How did you know?" He said, "Oh, I can just..." 'Cause just from millions of patients, he knows that lots of parameters are d- happening, and from learned experience. And I said, "What happens if you don't do it?" He said, "Well, I don't. There you go." And then suddenly the computer went bing, bing, bing, and it was picking it up. So he was actually quicker than the p- he was, he was seeing it quicker than the computer was.

Alex Partridge 15:33 Pattern recognition.

Speaker 15:34 Pattern recognition, exactly, and we're very good at that.

Alex Partridge 15:36 Hmm.

Speaker 15:36 So it, it is a talent, and we see it in medicine, and we see it in, you know, um, surgeons are quite similar. Um, they have to do very focused, intens- tens- intense operations, but most of the time they're, you know, they're also having to take in an awful lot of other stuff going on in the, in the room, and I don't think you could do that if you didn't have that superpower.

Alex Partridge 15:53 Hmm.

Speaker 15:53 So I think, you know, I think it's, a lot of it's about finding what we're good at, um, rather than feeling judged by because we're slightly irritating in a classroom.

Alex Partridge 16:00 You mentioned earlier, Nick, that women are more likely to have hypermobility.

Speaker 16:03 Hmm.

Alex Partridge 16:04 Do- does that mean that therefore women are more likely to have ADHD?

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Speaker 17:08 Very good question. This is where we have to have caveats. But I think, um, I would certainly say in my experience, yes, certainly in all my other colleagues' experience, yes. The data studies have got to be really big to be able to say that categorically, and certainly for NICE and people like that to, to, to buy into it, they've gotta say. And obviously we get into what we call the correlation causation trap, which is just because two things coexist doesn't mean they cause each other. But if you look at the neuroscience, and this is something I found that I just had a bit of a talent, and I think is the talent of ADHD with, is the seeing the interconnectedness of things. You know, you don't need to be too much a rocket scientist to see these, why these things would happen. If you know some neuroscience and you know some psychology, you can actually say, "Well, the, it's obvious that this causes that." Um, and actually maybe here I would mention the work of Karl Friston at UCL, who, which has been seminal, and he actually wrote a, an equation for how it is the brain thinks. And I contacted him and said, "Could you rewrite it for me?" 'Cause it's way above my pay grade to know the physics.

Alex Partridge 17:59 [laughs]

Speaker 18:00 Um, could you rewrite it-

Alex Partridge 18:01 Hmm

Speaker 18:01 ... with, um, the arm that is pro- perception and say that there's a mismatch? And so we are actually writing an equation for, uh, hypermobility, which would ultimately be probably really what ADHD is. It's, it's an equation, and it's quite nice to be able to prove it mathematically. Um, and I think that, uh, certainly Jess Eccles's studies, Professor Critchley, uh, uh-... Gar, um, Garfinkel, um, they, they have certainly seen in their experience that the ADHD people they're coming seeing through psychiatry, who they can simply do a Beighton score, there's a huge amount of overlap. And I've done it with s- a very nice educational psychologist friend of mine. I said, rang her up and said, "Could you possibly just, um, give all your ADHD kids a Beighton score?" And she rang me about three weeks later and said, "Jesus, they all are." I went, "Yeah."

Alex Partridge 18:45 Mm.

Speaker 18:45 You know, so I think it's probably that, that one causes the, not causes the other, but is interrelated.

Alex Partridge 18:50 Sure.

Speaker 18:51 Uh, it's a, it's a problem of perception, so, so, and you have body perception as well as cognitive.

Alex Partridge 18:56 I remember Dr. Jess Eccles, when she came on and did her brilliant interview, she said, "If you're hyper-mobile, you probably have been told that you've got a great party trick of-

Speaker 19:06 Yeah

Alex Partridge 19:06 ... for example, being able to bend your thumb back-

Speaker 19:08 Or the freak, yeah

Alex Partridge 19:08 ... and touch [laughs] yeah, or the freak.

Speaker 19:09 Well, it is a party trick. Or, I mean, you see some of these guys who can do it, and you, I mean, look at, look at these, um, the, the circuses and, uh, Cirque du Soleil.

Alex Partridge 19:16 Mm.

Speaker 19:16 You know, these poor, these poor kids, and Malaysians are very, very hyper-mobile, so they come in and they're stretched 'cause of course their parents see an opportunity. But I mean, they can get themselves through a tennis racket, you know? So it is amazing, but it's also ugh, isn't it? You know, so it's a bit freaky. So I'm not sure. I think it's a party trick, but I think you're also, at least you can laugh at yourself maybe.

Alex Partridge 19:33 Mm.

Speaker 19:33 But I mean, I, I think to a certain extent it's also you're a bit weird, which we're quite used to being told

Speaker 19:38 probably.

Alex Partridge 19:39 O- I mean, on the flip side, what, what problems do you think having a body like that could cause?

Speaker 19:43 Well, this is, this is where I come in with the sort of body stuff. I think that the problem is having too much movement isn't just a neurological feedback thing. It's also that unfortunately joints rely on a reciprocal relationship between picking up tension and stiffness to support your joints. So we tend to fatigue quite quickly. Um, just we get tired, we fidget, we fidget, we're constantly shifting. You know, the classic is, do you know, do you shift all the time in the cinema? Do you twist your ankles? Um, uh, can you flex your joints? But more importantly, you know, do you constantly get neck pain, back pain? Yes, if I'm working the laptop, all those sorts of things, they're gonna get it, they're gonna fatigue earlier, and they're gonna get much more bodily pain, which again, makes them feel like there's something wrong with them. But once they... A lot of, a lot of my treatment is education. I mean, it's just they go, "Wow, finally somebody's told me why I'm like I am."

Alex Partridge 20:25 Mm.

Speaker 20:25 And that's, um, that is the treatment really. Um, but it's, it's integrated with pain. Um, and if you don't understand it, then your brain starts saying, "What's wrong with me?" And then you build that into a fear. Makes... And you actually stop moving because mo- not moving's easier and moving hurts, when it's actually the exact opposite of what you need to do.

Alex Partridge 20:45 With the pain thing, I mean, are there any real-life examples that someone with hypermobility might avoid because they are more susceptible to feeling pain in that situation?

Speaker 20:54 Absolutely. I mean, it, it makes you retract. If you know something, it's like migraine, migraineurs will begin to retract from the community because they tend to get it in social environments, from stimulated environments. So they, they just don't do it, right? They, they go back into a hole.

Alex Partridge 21:06 Mm.

Speaker 21:06 So the same thing is, you know, if you, if you've got a sore hip, you'll start limping and then you'll accommodate it, then that becomes tiring, so you, you walk less and, you know. And we see this in the elderly. Once they get injured, they deteriorate very quickly because they can't move. And you need... Your, well, brains are designed to move, not to think, and that's what people forget. Every affect, every feeling that we have involves a movement. If I'm thirsty, I drink. If I'm hungry, I eat. Sex, horniness, that, you know, you couldn't tell me what horniness was, but you just know what it is, right? And is it a com- a compulsion to do the sexual act. They're all affects. That's why I tend to call them affects. They're feelings, they're not emotions.

Alex Partridge 21:40 Mm.

Speaker 21:41 Then you have the other emo- they're the survival ones, and then you have the other emotions which are socially based and parentally based, so fear, sadness, despondency, rejection, et cetera. They're much more subtle. But even crying, if you think about it, if you're upset, there is no function to crying physiologically. Producing tears doesn't do anything for you other than to show to the group that you're upset. And if your sensitivity's higher, your tolerance for doing that's lower, so you are a more sensitive person. But that means you have a lower... Hypermobile people don't like being told. They say, "Oh, well, Nick, I think I've got quite a high pain threshold." By definition, if you've told me that, you haven't, because you're feeling the pain. So we can measure that, and they do tend to have lower pain thresholds, but that's because they see the world as a fearful place. So your, as like an alarm system, your brain makes everything more sensitive. So they don't... You, you can't see it.

Alex Partridge 22:24 Mm.

Speaker 22:24 There's nothing you can go and measure other than ouch or tickle. They generally don't like being touched much. They don't like being tickled. They don't like being poked. And they get very claustrophobic. You know, do it to a child. Tickle a child who's, who's hypermobile, they really don't like it. They don't really giggle. They go, "Get off," you know?

Alex Partridge 22:39 Mm.

Speaker 22:39 So it's a, a generalized sensitivity.

Alex Partridge 22:42 And does that apply to emotional pain too?

Speaker 22:45 Yeah. You're go- you're going down, go- going down another hole. Yeah, I wouldn't separate the two. I mean, when we call what we call nociception, which is if I just prod you with a needle, which is that the tension receptors will tell you that they're being so stimulated that it's dangerous. There i- there are no... Look, the freaky truth is there are no pain fibers anywhere in the body. There are no pain nerves. And everybody rejects that, but it's completely true. There's nowhere in your body that specifically fires pain. It's when a particular receptor is so overstimulated, heat, you know, you can put your finger on a hot plate and as it's getting ho- hotter, you'll go, "Ouch," right? That's just a, that's just a, a tolerance at which your brain says, "No, you're gonna get damaged." Okay? If I s- if I start with a pen on your knee and I keep pressing it in slower and slower and slower, and then, "Oh, ouch," right? All you're feeling is summation. So that's what we call nociception. That's very different. If you go on to feel chronic pain, which is you can't get out of that pain, that's a very different... That's when the, the information coming in, what we call somatosensory information coming in, turns, it flips into the emotional circuit. So that's when it's gone deeper into the brain. It's gone, it's stopped being here and in the spinal cord. It's been sent up to the top.

Alex Partridge 23:46 Mm.

Speaker 23:46 And in my book, I likened it to the CIA. This is where, you know, your bureau, the bureau out in Hong Kong's picking up a lot of noise. It's then got to start reporting it back to Langley, and then Langley makes a response.

Alex Partridge 23:56 [laughs]

Speaker 23:56 Okay? So it's a, it's a similar concept, but it's... So emotional pain, yeah, is, is, it hurt, you know, emotional pain hurts. We know what hurt is. We, it's very difficult to describe, but something can have a physical hurt, and it can be, you know, if you lose a loved one or you find out your girlfriend's, um, two-timing you, that is a physical hurt because your narrative, which is I'm in a relationship, I'm happy, I'm loved, et cetera, suddenly is catastrophically broken. So you could say that pain is-... I- is the, is the felt sensation of a neurological network, which could just be story, relationship, or it could be leg broken. Um, those circuits are broken, and the brain's saying they need to be-

Alex Partridge 24:37 Hmm

Speaker 24:37 ... tended to and fixed.

Alex Partridge 24:39 It's fascinating. So the, the, the brain-to-body connection is so strong. I mean, I, I don't know, is there research to suggest that heartbreak might be more painful for someone with ADHD hypermobility?

Speaker 24:51 Well, you just said it. We have, we have language. No other animal has language. Why? Because it means you and me can communicate, but we have to have an understanding, a mutual understanding of what we're talking about is, and it's endemic. That's why being articulate is really important because if I say on the... I was on the BBC once, and I said to a whole lot of pain patients, I said, "Look, you've got to understand that pain is not in your head, it's not in your mind, but it is in, in your s- nervous system, okay, and your brain." And it's weird. They will go, "Okay." If you say it's in their head, it implies malingering. It's all your fault. Again, it's, it's a shame thing. As soon as you say it's a nervous system disorder, they go, "Okay. Right. Okay, I feel validated. I'm, I'm listening now," you know? And you see them in chat rooms. They're quite a- they've got angry emojis. You know, they're, they're pissed off. They're in their room too much, and they hurt, right? So if they, "Who's this guy telling me that it's all in my head?" N- I agree with them.

Alex Partridge 25:36 Mm-hmm.

Speaker 25:36 But if you say it's in your nervous system, and then you take... And once you've hooked them, you can then take them down this pathway saying, "Well, look, actually the only place that hurts is your brain." It's just taking in information. But, um, so you have a representation of your body on the surface of your brain, and when people can't... I know when somebody's dissociated from an injury because they'll say to me, "Hey, Doc, it's the knee, not my knee." And that's very important because it means he's seeing it as something other.

Alex Partridge 26:00 Hmm.

Speaker 26:01 And that's part of rehabilitation. You have to say to them, "No, no, it's your knee, and we're gonna fix it." And then you... The rehabilitation is reintegrating a model on the surface of your brain.

Alex Partridge 26:08 Hmm. Well, what you just said is probably enough to, to make someone instantly not feel crazy [laughs] -

Speaker 26:13 Yeah, absolutely

Alex Partridge 26:13 ... to instantly feel validated.

Speaker 26:15 Absolutely. Pain is a... I mean, I was... I'm very passionate about, I teach quite a lot, and I'm very passionate about teaching students how to be with patients.

Alex Partridge 26:22 Hmm.

Speaker 26:22 You know, be honestly. Amazing, I d- I went to go and speak at a, a quite a big, um, conference recently, and I just asked them all, "What does, where does the word patient come from?" And very few hands went up. A couple went up, and so a young, keen chap said, um, "Oh, it's 'cause like they're like, they're patient. They're waiting in the room." I said, "No, it comes from patior, which is to suffer."

Alex Partridge 26:44 Right.

Speaker 26:44 Patiens is the participle. They're suffering. So we're very mindful to remember that, right? These people are giving us the privilege of them coming to us saying, "I can't cope anymore," that's why they're here, "and that I'm suffering at whatever level." And my role is to find out what, what's causing that and try and help them with it, but it's about empowering them. Whereas I think now, you know, you go into some of the areas of the NHS who are o- over busy and demoralized, but they actually see patients as irritants. So when somebody comes in and says, "I'm giddy," it's like, "Oh, it's either something or nothing," you know? "I'm in pain." "Oh, okay. Wow." And they've only got seven minutes. So what are they gonna do? They're gonna give you medication. I think a lot of my doctors know what they should be doing, but my doctor colleagues, but they just haven't got the time, and they're inundated with it. And the problem is, medicine has gone into a reductionist point of view, which means that we, you know, you see your cardiologist, and this... So hyper-mobile patients invariably will have seen a cardiologist, a neurologist, a rheumatologist, a psychologist, a psychiatrist, and none of them independently have given them the answer. Why? Because these patients sit at the intersection between all of those. That's why they get missed. So they get sent round this sea of endless practitioners but never get an answer.

Alex Partridge 27:50 Hmm.

Speaker 27:51 And that's why I have them crying of joy in my room saying... You know, my, my nurses when I first joined the King Edward, they said, they said, "They're all crying there." I said, "Yeah, but they're actually happy because they just said, 'Fuck, somebody has told me why I'm like I am.'" And then that's where it starts, and then you can give them all the little things, and they actually fix themselves just by understanding, not being afraid, saying, "Look, this isn't actually broken anymore. It's healed, but your brain's got a representation that it is. So we've got to change your perspective, give you the, give you the things to do." And they, and it happens quite quickly.

Alex Partridge 28:20 Hmm. Seven minutes appointment is, I mean, it's terrible, isn't it?

Speaker 28:22 Seven to 10 minutes is the average, yeah.

Alex Partridge 28:24 Seven... I mean, if they were longer, would that be more time for the doctor to maybe-

Speaker 28:28 Well, look at the private sector. I mean, the reason I can't do what I do in the NHS is 'cause I simply, I take an hour with my patients to start with, and they're at half an hour to 40 minutes. I'm always running over, right? 'Cause you don't know what you're gonna bump into. And it, and it's a, it's a wonderful ride 'cause a human isn't, isn't a sort of an organism, right? Somebody coming in with back pain is, is you. It's Alex with back pain. It's not just back pain, and Alex will manifest that pain in a completely different way, and his perception of it. So I've got to know what makes up Alex, right from childhood right through to that. So people are, I think, a bit, sometimes a bit surprised by what they get from me 'cause they think, "Oh, you're an osteopath. You're a back cracker." It's like, no, that's not what osteopathic medicine's about. And, um, but also I've worked in rehab medicine in Germany and whatever, you know, you, you formulate, and you have to know the neuroscience. Then you start thinking, "God, this is very limited what we're doing."

Alex Partridge 29:10 Okay.

Speaker 29:10 And you get a bit disappointed.

Alex Partridge 29:12 And with that knowledge of the brain and, and the body connection, I mean, are there other physical conditions that are linked to ADHD?

Speaker 29:20 I would slightly change that by saying, are there other conditions that are, are a, are a manifestation of neural state? If that doesn't sound too complicated. But yes, and in fact, I could... I've got a nice little slide, in fact, of about 11. And gastric reflux, for example, 90% of it is stress. You secrete much more gastric acid, but they'll just give you an antacid for it. They're not interested in why you're stressed, okay? Could be emotional, could be work, could be any number of things. Um, and if you are, uh, migraine is centered in the brain, so, and a lot of it's related to stress, a lot of it's backgrounds and so on. But they're not gonna do that. They're just gonna give you Imigran. They're gonna give you something to... A triptan, which also zonks you out and also works for a bit. Everything works for a bit with pain, unless you get to the root of it. So, um, I, again, I'll probably be shouted down for it, but I would say that M- uh, CFS, chronic fatigue syndrome, fibromyalgia, and ME are effectively the same thing, just manifesting in a different way. So why do we keep calling them three different things?

Alex Partridge 30:17 Hmm.

Speaker 30:18 Because the people with each one say, "Well, no, that's not the case for me. I get this." Yes, yes, you do, but it's just your brain is inhibiting you, either through brain fog, fatigue, or pain.They're the, they're the three horsemen of those conditions

Alex Partridge 30:32 And surely those three horsemen perpetuate this ADHD burnout cycle if you're giving so much energy to something that-

Speaker 30:38 Understood. So going back to what we were saying about how you've, you've got to take many more f- samples of the world, we call it sampling rate, if you'll g- if you've got much more error in the system. So you keep taking more flashes, right? You need more resolution, so you're taking more flashes. You don't know you're doing it, but that means you're burning a lot of neural energy. You're only given 20% of the body's energy every day, and it won't give you any more. This is something that, again, Friston's labs, they discovered, is that you get a certain amount of energy as a packet, and you've got that for the day, and you can't have any more, sir

Alex Partridge 31:04 Where does the other 80%, go?

Speaker 31:05 Body. But 20% of your body is... And the other, uh, God, certainly 20, 30% of it is muscles. Muscles are very heavy on energy. It's just chemical energy. We're not talking wagga wagga m- m- energy. This is, this is real energy. You're burning about... You're sitting there burning the heat of about a 60 watt light bulb right now. That's a lot of energy. And in the old days, that was very expensive 'cause you then had to go and find food, and if you had to find food, you were at the behest of the, of the predator. Now, in a world of abundance, that's not a problem to us. What we don't realize is just taking more food doesn't give the brain more energy. So if you are ADHD, you're, you're a Ferrari brain, and you find it difficult to put... I think somebody I listened to, and they said it very nicely, it's a Ferrari brain with bicycle brakes, right?

Alex Partridge 31:43 Mm.

Speaker 31:43 But if you go down to Cornwall driving with a Ford Escort and a Ferrari, a Ferrari might actually not get there, 'cause he'll go off at 180 miles an hour thinking, "Oh, I'll beat you down there." But he runs out of fuel. It's like a crash.

Alex Partridge 31:53 So the ADHD brain and the neurotypical brain, let's say, they both get 20%, it's just the ADHD brain is less efficient-

Speaker 31:57 Absolutely right. Yeah

Alex Partridge 31:58 ... with the 20%.

Speaker 31:59 You're just burning the nitro in your, in your souped-up brain much quicker than somebody else's.

Alex Partridge 32:03 Mm.

Speaker 32:03 So it's, it's regulated, right? So just, that's why the impulsivity, "Oh, am I gonna do this?" It's like, whoa, just, is that good for me? Is that a good idea? And I was saying to one of your colleagues earlier, I mean, I would say to a lot of people, don't... If you're ADHD, don't go and do a lot of exerci- physical exercise in the morning. Certainly do movement, so do some yoga poses, move, get stretched. Um, but don't actually go and burn, 'cause most of us need that energy between 5:00 and 10:00 in the morn... You know, when you go to work, that's when you really need it. But if you're already going depleted, and then you're going to a multi-sensory environment in your office... Open plan offices are an anachronism of the '80s. On the trading floors, these guys are all neurodiverse. They're constantly bothered by this chat, this noise. They've all got their noise-canceling earphones in. Some of them I've found in, in telephone pods with no air conditioning, wondering why they're feeling a bit faint. But it's just, it's just better than listening to all that noise. So, you know, if we could accommodate this, you could have office spaces-

Alex Partridge 32:53 Mm

Speaker 32:53 ... that certainly would accommodate this. But you'd get a lot better work out of them, and they would be your superheroes anyway.

Alex Partridge 32:58 What do you think an optimal morning routine looks like to sort of really make the most of that 20%?

Speaker 33:04 Well, so going b- With the hypermobility, and you were asking about whether things, other, other problems, there's a thing called POTS. It's very important, this. So postural orthostatic tachycardia syndrome. Not everybody gets it if they're hyper-mobile, but they can do. Everybody, when you stand up, gravity drops onto your, your, your, the blood in your system. So your bo- your heart and your breathing rate have to go up momentarily in order to stop that gain, otherwise you'd faint. So, but in hyper-mobile people, because of the lack of collagen in our blood vessels, they're, they're a little slacker, so they're less reactive, they're less quick. A bit like our agility, we're just a little bit less quick and less gawky. The problem is, therefore, there's a delay. So the gravity presses down on the venous system, which there, where there's no pressure, and then they sh- they should feel that stretch, and the stretch receptors respond by shutting. But they don't, there's a delay. And so the pulse rate doesn't go up as quickly as it should do, and they perceive that as a drop in blood pressure. Well, they, they have a drop in blood pressure, and that's what makes them feel dizzy. And it's very disconcerting. It's like a pre-faint. They normally won't faint, because it will pick up, but that's why in the heat at the moment, a lot of my hypermobile patients say, "I really hate the heat." I actually pretty much feel unwell all the time, because when you open up your blood vessels to lose heat, you drop your blood pressure. So we tell them to eat, uh, to, to, to drink a lot more, and they're the few people who really need salt. They should have much more salt in their food, um, because they will generally have lower blood pressure, and they can help regulate it. Um, keep your, keep your, um, meals constant. You know, a lot of women, for example, just avoid breakfast. Uh, uh, this, this, they're the few group that I don't think that fasting is a good idea, because you're, you have such big drops in your blood sugar, your internal state rep- feels that, and then you feel unwell. So we're very sensitive to our internal state-

Alex Partridge 34:41 Mm

Speaker 34:41 ... what we call interoception, and that's really important. But with POTS, there are ways of getting around. There's a, there's a fabulous neurologist I work with called, um, uh, Ali Parry, and she came up with a great answer for her POTS patients, which is, uh, which she calls duvet dancing, and I love this. So what she does, and it helps with the ADHD, you set your alarm clock on your phone to have a, uh, series of dance music. So it might be some techno, whatever, right? Which is pretty intense in the morning. But it goes off, and so boom, right? You've got high dopamine. You're awake, okay? You're not procrastinating about getting up. But if you get up quickly, you're gonna feel that drop, and then you're gonna feel unwell, and then you're gonna... So what she says is you, you dance to it, but in bed. So you literally just lie there in bed dancing to the music. 'Cause subliminally what happens is that puts your blood pressure up, 'cause your pulse rate goes up. So when they stand up, they don't feel dizzy. So those little hacks-

Alex Partridge 35:27 Mm

Speaker 35:27 ... are just... But it helps the ADHD as well as the POTS. So what you're doing is you're just down-regulating all that fear all the time, so then they don't approach the world in a fearful state. And as I said to you about the traders, if you're in a fearful state, you literally see... You're only looking for the things that can take you out. You don't see opportunity, and that, of course, is the beginnings of a sort of depressive state. I can't get out this hole 'cause everything's fearful to me, so it's safer to say, stay where I am. And that's why slowly they go down that hole. But give them those, the, the capacity to change it, and then they get into exercise, and then they increase their blood pressure, they get less variance, they don't feel as dizzy, and they feel in more control.

Alex Partridge 36:02 If someone's listening, Nick, and they, they relate to a l- a lot, a lot of what you've said, and they haven't quite got to the stage yet where they've recognized that hack to put techno music on-

Speaker 36:11 Yeah

Alex Partridge 36:11 ... in the morning. Mine would've been Beyoncé, by the way. [laughs]

Speaker 36:13 Amazing. Amazing. Me too.

Alex Partridge 36:15 And they've gone to the doctor, and they've said they stand up, they're feeling lightheaded. Uh, could it, could that person be accused of just having hypochondria and not be believed?

Speaker 36:24 Absolutely. They just, they just sort of think... It is just, they just accuse it of being sort of neurosis. Oh, you're just feeling, oh, you know. 'Cause they don't, they don't necessarily understand what's going on. Because don't forget, if somebody takes your blood pressure and it's relatively, they go, "Oh, it's great. You've got great blood pressure." Well, not past a certain point. And if you actually took it when they're lying down and stood up-

Alex Partridge 36:39 Mm

Speaker 36:39 ... which I do, and you see the pulse rate delay, that's, it's as, it's as easy as that to diagnose. You don't need special kit. Um, then you go, there we go.And now, oh yeah, that's it, now I'm feeling, I'm feeling faint. Because the blood, the pulse rate didn't go up.

Alex Partridge 36:51 Mm.

Speaker 36:52 And then it did. But in that delay, that's lack of oxygen to the brain, so you feel a bit, woo. And in the heat... So if you've been lying on a sunbed in Majorca or whatever, and you get up quickly, and you're a bit dehydrated, you've been lying there for a while, you will get... I certainly, I have to hold on a minute, and then it passes, then I'll get in the pool. And it's why t- even temperature can be stressful. That's why I get them to do cold showering. And, and all this stuff about deep cold is utter rubbish. You just need delta, you just need a difference, 'cause that's what the brain doesn't like. It doesn't like rapid change. So if you're just having a shower, wash your hair, wash your body, and then just flip it for 30 seconds to cold. But you get them to breathe through that.

Alex Partridge 37:28 Mm.

Speaker 37:28 It's a bit like Wim Hof's breathing, but you have to be careful with his stuff, 'cause they tend to hyperventilate. But if you just get them to breathe through it, and you calm the fear response, then you're adjusting your sympathetic nervous system. The dysautonomia, as we call it. So they sweat less, they don't get sympathetic sweating. They just, they're just much better at their res- oh, I can control my response. I control, control myself. I can make this go away. That's empowerment. They get better. And at th- third or fifth time, they won't even go... You know, the first time it's, "My God, it's freezing." S- second or third time, they don't even feel it. You've just watched resilience developing. Fear response-

Alex Partridge 38:01 Mm

Speaker 38:01 ... has just re-toned itself. And that's, you know, those are the sort of things we teach them. But once they do it and it works, you know,

Speaker 38:09 they're set.

Alex Partridge 38:10 Do you think the medical community is getting better at recognizing hypermobility? And, and when women particularly, a community that how, ha- have been used to going to their doctors and being misdiagnosed and not feeling heard.

Speaker 38:22 Mm.

Alex Partridge 38:23 Is the medical community getting better at recognizing it now, so when these women do go, they get validation?

Speaker 38:28 I think they're better at recognizing it. Whether they're better about actually doing anything about it, I don't... They might say, "Oh, you know, you're hyper-mobile." And then, but not the meaning of that and these. And of course, it takes time, right? I have to explain why they should wear compressive garments, why they, like, their Lululemon leggings are good for them, right? Because again, it compresses their venous system, they don't get as much dumping. Why having core stability is good is because you're gonna get that dumping into the abdomen. So post, post-um, pregnancy ladies, they're gonna have this much more because they've lost their abdominal tone. They're dumping the, the venous blood into their abdomen. So they're losing pressure. We find on tilt table tests that most people will dump about 300 milliliters of blood into their legs. But in these patients, it can be up to 800, over double. And that's just a drop with gravity. And that makes you feel unwell.

Alex Partridge 39:12 What about lifespan? Because the, the, there's some scary statistics about ADHD can shorten life by 20 years, um, through lifestyle factors, impulsive decisions. Can hypermobility shorten lifespan?

Speaker 39:24 Um, no. I mean, I can't see anything that would be... I mean, if you let your body go to completely to, to flop, and we do see those. But a lot of the EDS patients have been so disabled for so long that, you know, their bones get thin and whatever. But I mean, that's kind of just disuse. That's gonna happen to anybody to a certain extent. So will it shorten your life? Possibly. There are extreme versions of, of hypermobility, which is where they have a lot of collagen. They can have heart valve disease and that sort of thing. But they're, they're rare. They're on the far end. Marfan's disease, Stickler's disease, serious high-level EDS. But they're really rare, actually. And I think the trouble is they'll Google it and go, "Oh my God, I could have a heart valve problem." It's like, no, no, but only if you're right down there. Um, the ADD thing actually is an attention problem. So I think could you say that the hypermobility leads to the ADHD leads to a shortened life? Possibly, but not because it's bad for them, but because they're like, more likely to be impulsive. They're gonna go and do a bungee jump. They're gonna go and do something stupid in a car. There is some evidence that driving, um, is in inattention, you're gonna have more accidents. So indirectly, but I, you know, again, I wanna just... I think we've gotta calm all this, this anxiety down around it. Is, are there people out there who have died? I mean, I, I am appalled still how I see people looking at their phones in cars.

Alex Partridge 40:31 Mm.

Speaker 40:31 That just seems to have been allowed now, you know? And if you're ADD, you're gonna look at it for a bit too long, right? 'Cause you've got no temporal reference. So suddenly it's whoop, bang, accident. So I would certainly say to anybody with ADHD, just don't look at your phone. Try and use your, you know, your Waze as little as possible 'cause you are gonna get distracted. Uh, I think digital screens are dangerous. In the old day, you had a knob. You knew where it was, your reference, or you were still looking at things. Now you've gotta go and look at the menu. And I'm amazed digital screens are allowed. If you're ADD-

Alex Partridge 40:57 Mm

Speaker 40:57 ... because you're gonna go and attend it, and you might even get distracted by something. It could be a message. My wife's car brings up messages on the screen. So, um, yeah, I think distraction is the problem. But distraction in a dangerous situation, if you're in Formula 1, you'll die. But, you know, it's, um, they learn to control it, hopefully. They might have one experience that teaches them not to do it again.

Alex Partridge 41:20 Driving's interesting. I'm sure whether it's ADHD or just a particular type of focus, like I'm, I'm sure that it makes me a very good driver. Um, and maybe that's the anomaly because particularly if there's a, a song playing-

Speaker 41:33 Mm

Alex Partridge 41:33 ... and I can focus on that, like I, I know exactly what's going on half a mile in front of me. I know exactly what's going on half a mile behind me.

Speaker 41:40 100%.

Alex Partridge 41:40 I'm so focused on the road. Um, I think my insurance company should give me a discount. [laughs]

Speaker 41:45 I agree. I agree. No, I think it does if... And I, feel like if I was driving to Cornwall the other day, I am actually neurally, not physically, but I'm neurally very exhausted. I'm quite zombified when I get there. And I think it's just because I'm just using, you know, uh, and I actually ride a motorbike, and I think that makes you more aware 'cause you just know that everything that comes up is gonna kill you-

Alex Partridge 42:01 Mm

Speaker 42:01 ... instantly, if you haven't got the cocoon of the car. So I think, no, I think you're hyper-aware, and I think you do see things coming from left and right. You know, I think pilots probably as well. You know, so fighter pilots certainly would have to be because they can't process at that speed normally. Um, but if you're in that, you know, the youngsters with the ADHD, if they're in their cars with their mates-

Alex Partridge 42:19 Mm

Speaker 42:19 ... where the distraction, the signal of being cool with your mates is higher than the signal of missing the guy on the zebra crossing, that's where you're gonna be in trouble.

Alex Partridge 42:26 That's the caveat.

Speaker 42:27 Yeah.

Alex Partridge 42:27 Don't talk to me, and I've probably just missed my exit. [laughs]

Speaker 42:30 Exactly. Shut up. I'm not talking to you. I just need to get there.

Alex Partridge 42:33 [laughs]

Speaker 42:34 Okay. You know, oh, you're weird, yeah. You know.

Alex Partridge 42:36 Yeah.

Speaker 42:36 So it's, I don't know, it's a constant balance. But I think, yeah, it's all about the signal.

Alex Partridge 42:39 Mm.

Speaker 42:39 So I think, yeah, the, the danger is you've got the, you've got the music pumping, you've got your mates in the car, you're talking about the girls you're gonna meet, whatever, and then you just missed the motorcyclist.You know, it's just don't be distracted. But yeah, when you're in hyper-focus-

Alex Partridge 42:52 Mm

Speaker 42:52 ... you'll, you'll see a hedgehog move, you know?

Alex Partridge 42:54 Truly fascinating, Nick.

Speaker 42:55 Good. I hope so.

Alex Partridge 42:56 I feel like I could talk to you for another hour. We'll have, have you back.

Speaker 42:59 Oh, it'd be lo- lovely. I enj- I, I loved... So I find like it's made me a lot calmer doing some of this stuff simply because when you know it all and you wanna share it, you know, you do get, you get agitated and probably quite intense-

Alex Partridge 43:08 Right [laughs]

Speaker 43:08 ... most of the time. But, but actually it's been, I was saying to my son that it's, um, it's been very nice just airing it and explaining it to people-

Alex Partridge 43:14 Mm

Speaker 43:14 ... because if you've got a lot, if you've got the knowledge, it's quite fun to share it and, um, and it helps people, so.

Alex Partridge 43:19 We're very grateful for your time and your wisdom.

Speaker 43:21 Pleasure.

Alex Partridge 43:22 I wanna move attention to your ADHD item, which has-

Speaker 43:24 Yes

Alex Partridge 43:24 ... been patiently waiting underlay- underneath that cloth in front of us this entire interview. I'm gonna reveal it now, Nick.

Speaker 43:33 Ah, the golf balls.

Alex Partridge 43:35 Golf balls. Now, why do golf balls represent ADHD?

Speaker 43:39 Well, I, only this week, I was in Cornwall and I was playing golf with my son, my, uh, daughter's boyfriend and father-in-law, and, um, we hack, we don't really play golf. And, um, I certainly sliced about six into the rough and realized, and I've always had this weird talent, and I think it is just my sampling rate, is that I can always find people's golf balls. And I think it was a good example of doesn't matter where you are in the rough. And my father-in-law actually said, "Could you come and find my ball?" And it's funny, become a thing. And it is just, you know, you're just taking a higher resolution, multiple pictures of where you just see the difference in the, in, in the environment, and suddenly there's the ball. Uh, and actually found a couple of other ones that had been left behind. So I think it was just a nice example of these funny little talents you find that you have that-

Alex Partridge 44:22 Mm

Speaker 44:22 ... are a bit weird, but, um, actually-

Alex Partridge 44:24 Fascinating

Speaker 44:24 ... can be quite useful.

Alex Partridge 44:25 I've always been very good at spotting Wally in Where's Wally?

Speaker 44:29 Oh, in Wally, Where's Wally? I... There you go.

Alex Partridge 44:30 I'm always the-

Speaker 44:30 Yeah

Alex Partridge 44:30 ... the first one. Like, there he is. There he is.

Speaker 44:32 Well, another example, my daughter wanted to go, went to Zara and, um, she wants to buy a green blouse. And she said, "Dad, you know, will you trip to go?" So off we went, and I'd got green in my head. So we went through the store, and she finally found the blouse, and then she said, "I wonder if I should get a pair of trousers." And I said, "Well, there was one over there, one over there, one over there." And I'd realized that I'd just set my head to, to, to, to, to see green, you know? And so, as I said, I, I'm like a bit like Dr. Halliwell. I think that we've got to focus more on the, the upsides of what we can do and find our talents, and actually people who may be career masters at schools and things should actually be saying to us, "Look, you, you, you're not gonna be a corporate bod." You know, why do you think they're all entrepreneurs, right? High signal, impulsiveness, drivenness, passion, drive. Um, and maybe this could be guided better, but I think that it's, um... Yeah, and also I'd gone through Zara and was, you know, neurally exhausted, uh, shopping, but it was just interesting. I'd suddenly realized I'd just seen everything that was green subliminally-

Alex Partridge 45:27 Mm

Speaker 45:27 ... and was able to direct her-

Alex Partridge 45:28 [laughs]

Speaker 45:28 ... to where they were, you know. So it's, um, it's a weird one. And at 55, I've just, maybe I've learnt to manage it a bit better and focus into something I love, which I'm lucky. But I think that's what I'd say to anybody in HD is, is find what really gives you the signal-

Alex Partridge 45:41 Mm

Speaker 45:41 ... and just go for it. So maybe it's your passion, maybe it's your, you know. But, but don't let other people tell you that you can't do it, and question everything. That's the other thing I, in education is, you know, we're taught not to question things, and we're questioners. We like truth, which isn't always a, you know, it can be awkward for people, but it's usually the right way to go, and so we see it, and I would say go for it. But always ask questions. But in an education world, you're taught really what to think most of the time, and that bores us because we wanna say, "But why?"

Alex Partridge 46:08 Do you think your ability to spot things like the golf balls coupled with a, an ability to pattern recognition means you're able to spot or read someone's character-

Speaker 46:19 Yeah

Alex Partridge 46:19 ... exceptionally well?

Speaker 46:20 It's definitely an advantage in my clinical life because you spot those little moments when you say, um, "How's your marriage?" And then bing, that little-

Alex Partridge 46:27 Mm

Speaker 46:27 ... you know, that little tense moment and yeah, you definitely see that. Uh, and I think it gives you an, a, an ab- ability to observe very definitely. Um, it-

Alex Partridge 46:36 Would it make you a good negotiator?

Speaker 46:38 Uh, yeah, although I'm a people pleaser probably at heart, you know, so again, you don't, you don't, wouldn't be necessarily as, quite as aggressive and you might get rolled over. But I think, um, no, I mean, certainly I would say to students, you know, the diagnosis starts in the waiting room. I will go out and get a patient because I'll watch how they get up. If it, "Ugh," or is it, "Ha," you know? Are they better? You know very quickly 'cause in some ways you wanna observe them when they're not thinking about it.

Alex Partridge 46:58 Mm.

Speaker 46:59 'Cause patients want validation, so, you know, if you say, "How are the pins and needles?" You know, they'll say, "Oh, yeah, I'm still getting it, but I'm not... But yeah." "But are you getting it all the time?" "No, I'm only getting it once a week." "Oh, okay, so we've seen an improvement." You know, so you have to play that game. Um, but it's, yeah, it's just looking at the way some foot isn't moving properly. They're carrying a hip. Um, their eyes did something funny when they turned their head. Oh, better look for that, you know. And it defines what you're gonna assess.

Alex Partridge 47:24 I suppose you can learn a lot from reading someone in those micro moments before the mask gets put on.

Speaker 47:30 Absolutely. And you've got to judge whether you're gonna go after it. You know, if it was, if it... You could act- Sometimes you can see people, it's all, they almost, they engulf around what you've just asked them, and you can just see like, whoa, that's wrapped up in something really big. So you might go around the corner to it, or you might just say, "Oh, tell me about that," you know. "How's that going? How's work?" And it's just the three parts of their life, but y- you'll usually find one where there's an imbalance.

Alex Partridge 47:53 Mm.

Speaker 47:53 For example, in the traders, it's quite interesting when they come in, it's very rarely the trading that's stressing them. They've done that before. They've lost money. They've made money. But it will be something going on at home. They generally don't manage emotional stuff very well, and that can be a bit more sort of autistic tendency. But they're struggling with the relationship. They're not really seeing what their daughter is trying to tell them empathically, et cetera, and it, it agitates them. So that's when they come in and they... And that's what makes them tense and stressed, and so they come in with pain very often. It's quite interesting. So it does, there's a lot of counseling-

Alex Partridge 48:22 Mm

Speaker 48:22 ... as well in the job, but I think it's, it's seeing, getting a feel for where's, wh- in all the different parts of their life, where, where, where's the problem lie?

Alex Partridge 48:31 Fascinating. Fascinating. I wonder if that ability makes people maybe good at poker. You sort of read-

Speaker 48:38 Yeah

Alex Partridge 48:38 ... you can see someone's reaction to their cards as they look at them and see through.

Speaker 48:41 Absolutely right. I mean, I think the, um, yeah, the ability to sort of... 'Cause to a certain extent, they'll be counting cards without realizing it, and actually one of the... selection profiles we used to do for traders was just one of the questions was, do you like poker? Do you bet on the GG's? 'Cause it's a, a trade is a bet. It's, it's a sort of a hypothesis that you bet on it and hopefully-

Alex Partridge 48:59 Mm

Speaker 48:59 ... you're right. But, um, yeah, no, and I think, and then you've got the tell, so they of course they'll pick the tell. Um, and, um, and then they probably know their own one and try to mask it, so they're good at bluffing.

Alex Partridge 49:10 Mm-hmm.

Speaker 49:10 But yeah, they like risk, and that's the impulsiveness. But it's, if it's gambling and it goes down the wrong way, you've lost balance. It's like alcohol, it's vape, it's whatever, you know? If you don't-

Alex Partridge 49:19 Mm

Speaker 49:19 ... if you lose your relationship with it, you're in trouble. Regulation.

Alex Partridge 49:23 Fascinating, Nick. Um, time for my favorite part-

Speaker 49:26 Right

Alex Partridge 49:26 ... of the show-

Speaker 49:27 Okay

Alex Partridge 49:27 ... which is the ADHD agony aunt section, where a-

Speaker 49:29 Yeah

Alex Partridge 49:29 ... member of the audience writes in with a question, and the a- the, the section's actually called the washing machine of woes-

Speaker 49:35 Oh, okay

Alex Partridge 49:35 ... because the washing machine is my item. It represents short-term memory loss-

Speaker 49:39 [laughs]

Alex Partridge 49:39 ... 'cause I always forget my clothes in the machine after I, uh, after the cycle's finished, and I ask everyone-

Speaker 49:44 Right

Alex Partridge 49:44 ... do you relate to that struggle?

Speaker 49:46 Yeah. Oh, yeah.

Alex Partridge 49:47 [laughs]

Speaker 49:47 I mean, you're so busy doing the multitasking, then you forget the row that you do. Ab-

Alex Partridge 49:50 Yeah

Speaker 49:50 ... absolutely. I think my wife would relate to it more.

Alex Partridge 49:52 Okay. [laughs] I have been using the Tiimo app, which is, uh-

Speaker 49:56 Yeah

Alex Partridge 49:56 ... and they, they give me a little-

Speaker 49:57 Great

Alex Partridge 49:57 ... they're very good at reminding me to, to, if I can find the woe. There we go. This week, Nick, in the washing machine of w- woes, someone's written in and asked, "I get so many injuries. I have ADHD, and with that I'm very impulsive, and then add my hypermobility onto that. Is this a combo that sets me up for disaster?"

Speaker 50:16 I hope not disaster, but yeah. I mean, I think we've possibly answered quite most of that question, but I think, yeah, so very quickly, the inattention, these are, you know, clumsiness and things and is, is the hypermobility, so you're not picking up the world quite as quickly, the twisting of the ankles and so on. So I would say if you're gonna take up something new, if particularly if it's a sport, then train for it. You know, just do a few things that get you ready for doing it. Because if you go straight into tennis, you're gonna go all over the court, you're gonna be gawky all over the place, you know, and you're gonna get demoralized. So just train for it, be careful, regulate your impulsivity. Um, but also the inattention problem is the issue. So if you're, if you're unable to put your body in a certain space at a certain time i- in the right order, then you're more likely to twist an ankle and injure yourself, et cetera. Um, if you're attending things, it's the classic, you know, I knock over the glass of the wine on the way to picking up the salt cellar. Um, that's fine, but if you, if you knock over something on award and knock out somebody's, you know-

Alex Partridge 51:09 Yeah, slightly more problematic

Speaker 51:11 ... bottle, you're in trouble. So I, it's, it's meaning, but I think it's, um, yeah, I mean, it, it's not gonna set you up for disaster, but I think understanding it and therefore saying, "Well, look, do some training." You know, don't, don't play sport to get fit. Get pl- fit to play sport was the old adage, and it's particularly for the, for the hyper-mobiles. Once you've got those motor patterns organized, you're much less likely to then hurt yourself doing it. So I would just say try and do, you know... And that's why generally in schools, I'm so rabidly, um, pro doing exercise, and we're taking more and more exercise out of schools because that practice, that orientation, and it's highly connected to intellectual capacity too, so, you know, but we seem to be doing less. So just give them more lessons, you know?

Alex Partridge 51:50 Mm-hmm.

Speaker 51:51 And to an ADHD brain, that's just brutal, right? Because they're gonna get exhausted, and then they fidget, hey ho, you know? I just... It's all a bit bonkers. So I think the system doesn't fit us rather than we... That doesn't mean we need to be accommodated. It just means to me that the system has thrown us out, I think, as being more obvious because we sit on the edge of the bell curve, and we're not the middle 65%. I think that's an advantage, but you've learned to manage it.

Alex Partridge 52:12 It's a big topic we could go into.

Speaker 52:13 Yeah.

Alex Partridge 52:13 I mean, we'll have to have you back for [laughs]

Speaker 52:15 Different, uh, different day.

Alex Partridge 52:16 Nick, thank you so much.

Speaker 52:17 Thank you. It's been really, really

Speaker 52:19 great being here.

Alex Partridge 52:19 Just finally, Nick, I want to deliver you a letter that was written by the previous guest.

Speaker 52:23 Yeah.

Alex Partridge 52:23 In fact, I think you know the previous guest.

Speaker 52:25 Yeah. Dr. Hassan.

Alex Partridge 52:26 And he's written his three rules to live by.

Speaker 52:28 All right. Three rules to live by. Read it with passion, Potter.

Alex Partridge 52:32 [laughs]

Speaker 52:33 If there was only one thing you do to manage your ADHD, fix your sleep or manage your gut health. Second, find purpose. This will change and evolve as time goes on, something you are interested in, good at, and above all, passionate about. Well, that's very similar to what I was saying. Grievances and holding onto injustices is something that fuels your RSD. Let it go. Forgiveness is key. Be kind to yourself.

Alex Partridge 52:58 The first point, like, [laughs] so it's, it's opening up a whole topic, isn't it? I mean, how, how does one start to fix their gut health?

Speaker 53:06 Um, I, I'm, quickly, I'm slightly at loggerheads with the gut biome thing. I think that, uh, it's not that it's not true, but I think that what, to reverse it, I think that our gut calls to the bacteria that it needs to represent its neural health. So what I mean by that, if you take a stressed person, you probably notice this, you like carbs. You tend to go towards because it's, it's, it's, it's energy, right? So it's a call to action, I wanna move. What we know is that the receptors in the bowel will switch on and form a relationship. They literally hook onto the bacteria that will digest carbohydrate. So, and it's exactly what trees do. So during the down season, they need to, they need to store, so they will grow their roots out towards the thing that they're gonna build with, and that's where the bacteria are, and then they will build a se- separate set when they need to be respiring and, and flowering and all that sort of thing, and I, I think we do exactly the same. And I have actually put this past a gut biome person at Oxford, and she's actually said, "I'm inclined to agree with you." So I think it's a... But I don't think we're ever gonna know what the gut biome really is or what the national average is. You need some of all of it, and then your brain calls to it through the gut to absorb what you need. So for example, if you give acidophilus to somebody who is very stressed, they'll actually poo their pants. They get diarrhea because they're not in the right state to be absorbing protein, which is what it does. So I would say the gut health to me is be nice to yourself and kind to yourself. When you're impulsive, tired, and intolerant, you're gonna eat crap. Don't eat crap. You know, don't do the chips, the crisps, et cetera, et cetera, you know? And eat meat. I'm very pro eating meat. You don't need to eat too much, but you need it, and girls particularly need it, red meat, need it for their B12 and, and lots of other things. Um, but just don't overdo it, you know? Um, I think, and the vegetables, you know, you are what you eat, so be nice to yourself and eat well, uh, rather than anything specific. But also keep it consistent. If you're ADHD, you have low blood pressure, and you're hyper-mobile, you need a consistent level of, of sugar, and that just means food coming into the system. But don't use sugar because it doesn't work.It makes you spike, dopamine spike, and then you get cravings, and then you get overweight. It's that simple

Alex Partridge 55:04 I'm smiling because we were gonna do a whole episode on ADHD and nutrition, and I think you just did a very ADHD-friendly answer to that in, like, a minute

Speaker 55:10 Hope so [laughs]

Alex Partridge 55:12 [laughs] Uh, just finally, Nick, the se- the second point, find your... Like, how, how does some- how does someone find their passion, find their purpose?

Speaker 55:18 Well, it goes back to what I was saying about, you know, that I can find golf balls. I mean, look, if, if, if it all goes to shit, I can go and get a job on a golf course and make-

Alex Partridge 55:25 Mm

Speaker 55:25 ... a pound a ball maybe. But I think it's, um, the whole of the West Coast of America, these high-tech geeks, right, they're, they're gonna be ADHD, right? And it's a kind of genius, but they also didn't really grow up, right? [laughs] They all, they all sit there eating too much. They don't really know how to behave, et cetera. So, so they need to be mature as well. You know, Elon Musk is a good example. Let him go and run Tesla and everything, but don't let him run the world. It's a disaster. But I think that you can also argue that what he's done is some of the greatest stuff we're ever gonna see. You know, he's done what Henry J. Ford did four times over. So he, he, he deserves some credit. But he's got to learn to regulate, and, and his impulsivity has kind of got a bit dictatorial. I think, you know, you've just gotta regulate it. But, um, brother, like, you know, you found this, you know. I don't know what else you were interested in doing at university, but maybe when you founded all your other podcast channels, et cetera, you know, you just suddenly said, "I love linking people. I love hearing stuff. I love absorbing it. I see the interconnectedness of things, um, and maybe I can make money from that," you know? And clearly you've done really well, but it's also helping people, you know. Millions of people are listening to this podcast, so it must be getting an audience, and they don't seem to be, um, canceling you or trolling you too often, so there must be something with resonating. Um, so I just say to people, um, you know, if you are ADHD, you're probably not gonna do that well in the corporate environment unless it's a small, creative, structured environment where you can also be creative and you can have more roles maybe, 'cause you'll get very frustrated being stuck in one silo. Um, so I think it's not just about your passion, but also maybe about what, what you're good at and you can do well in, and then move forward. You've also gotta have a family. You've gotta provide. You've gotta do f- you know, you've gotta, you gotta have babies. You gotta do all those things. So it's not just about your career. But you have gotta provide and support. So, um, sometimes your passion might not be the best thing to do, but maybe the thing that you're really good at. But just keep nailing it, and just keep doing it. Just keep knocking at doors-

Alex Partridge 57:12 Mm-hmm

Speaker 57:12 ... because it's not gonna come easily, but nothing ever great ever was really.

Alex Partridge 57:17 Incredibly insightful. And Nick, thank you once again.

Speaker 57:19 My pleasure.

Alex Partridge 57:20 Um, cheers. Thank you so much.

Speaker 57:21 My pleasure. [upbeat music]