ADHD & How Anyone Can Improve Their Focus

1. 0:00 – 3:27

   Introduction & Note About Diagnosis

   1. AHAndrew Huberman0:00

      (mellow music) Welcome to the Huberman Lab Podcast, where we discuss science and science-based tools for everyday life. 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, 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 symptomatology of ADHD, some of that symptomatology 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 w- 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, well then pay attention to the symptomatology. 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, or 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.

2. 3:27 – 7:56

   Sponsors

   1. AHAndrew Huberman3:27

      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. In 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 eyeglasses to read at night, uh, 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, quote-unquote, "performance glasses," meaning you can wear them while 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. You know, a lot of performance glasses, they look kind of ridiculous frankly. They l- 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 ROKA, you can go to roka.com. That's R-O-K-A dot-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 'cause 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 meats, 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 like the organic meatballs. All, all the 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 a, an option to select I don't know, and Helix will match you to a mattress that's specific to your sleep needs. This 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-minute 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 get to try it out for 100 nights risk-free, that'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.

3. 7:56 – 13:00

   ADHD vs. ADD: Genetics, IQ, Rates in Kids & Adults

   1. AHAndrew Huberman7:56

      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 fated 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 IQs, 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 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-'80s, 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 ten children, and probably more, have ADHD. The current estimates are anywhere from 10%, one in ten, 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, smartphone 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 pulls 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

4. 13:00 – 14:57

   Attention & Focus, Impulse Control

   1. AHAndrew Huberman13:00

      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 are hearing sound waves, you are seeing things, you are sensing things against your skin, but you are 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 are easily distractible, but the way that shows up is very surprising. You might think that people with ADHD

5. 14:57 – 16:45

   Hyper-focus

   1. AHAndrew Huberman14:58

      just simply can't attend to 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 distractible. 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, an incredible ability to focus on things that they really enjoy or in- 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

6. 16:45 – 18:25

   Time Perception

   1. AHAndrew Huberman16:45

      with time perception. 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.

7. 18:25 – 20:00

   The Pile System

   1. AHAndrew Huberman18:25

      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 presents 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 task they actually need to perform. They can't find things, or if anyone moves one thing, then it, 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 could be brown hair and, uh, green eyes, like for me. A phenotype could also be that somebody uses the piling system, okay?

8. 20:00 – 24:10

   Working Memory

   1. AHAndrew Huberman20:00

      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 would be able to recite that phone number in their mind over and over and then put it 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 643-781 for most people would be pretty easy, 643-781-643-781, you could probably remember that a minute from now without writing it down. But if you add one more number to that, 643-7813, 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 d- 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, 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 hyperfocus, 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, they 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, quote-unquote, "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

9. 24:10 – 26:40

   Hyper-Focus & Dopamine

   1. AHAndrew Huberman24:10

      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 neurobiological 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. It'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, uh, 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 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 p- a person, whether or not they have ADHD or not, to direct their attention to particular things in their environment, 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

10. 26:40 – 32:57

    Neural Circuits In ADHD: Default Mode Network & Task-Related Networks

    1. AHAndrew Huberman26:40

       which neural circuits those are, I want to discuss two general types of neural circuits that dopamine tends to enhance. So let's talk neural circuits, 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 conductivities 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, in 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 task 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 surprise, is 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, but 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. It's like drums, guitar, and bass, they're playing together, okay? That's how it is in a typical person. 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. Any time 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 see-saw fashion. They are actually what we call anti-correlated. So it's not just that they are not correlated, they are actually opposing one another, they are anti-correlated. In a person with ADHD, the default mode networks and the task networks are actually more coordinated. That might come as 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 back beat and the drums aren't keeping the back beat, 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 is 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, you know, the engineers, or physicists, or mathematicians would say out of phase to be anti-correlated. Okay? Out of phase and anti-correlated, 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 is there, but the conductor isn't very good at conducting. Now we can gain insight into how this system

11. 32:57 – 37:10

    Low Dopamine in ADHD & Stimulant Use & Abuse

    1. AHAndrew Huberman32:57

       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 getting 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 in 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, a bass, and a, and a 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 in 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 in 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, increased 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.

12. 37:10 – 47:00

    Sugar, Ritalin, Adderall, Modafinil & Armodafinil

    1. AHAndrew Huberman37:10

       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. I actually have an anecdote about this just to illustrate it. I have a friend, he has two children that are now in their teens and 20s, 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, we- the kids were running around like crazy. I mean, I- they were pretty high-energy kids, but they were going bonkers, and that's actually when the mother, my friend at the time and fortunately still now, looked at the chocolate and realized that it was chocolate with espresso beans in it, and it was like dark chocolate espresso beans. So I, I was really at fault there. You don't want to give kids dark chocolate with espresso beans, but what you're really seeing in 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 daytime quite a lot, i- 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, uh, 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, uh, 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 called speed in the street drug, uh, nomenclature. Adderall, which goes by various other names, okay, so Adderall, Adderall XR, Myda- Mydas- Mydiasus, uh, 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 are 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. Now 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 epinephrine 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, 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 like, in fact, nearly identical to some of the so-called street drug stimulants that we all hear 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 h- 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 am 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 you know, upwards of 25%

13. 47:00 – 49:18

    Non-Prescribed Adderall, Caffeine, Nicotine

    1. AHAndrew Huberman47:00

       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. And we could 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. Frankly, it's, 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 en- indulge some, I don't think to excess, has long been used as a stimulant to increase dopamine, increase norepinephrine, increase 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 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 e-... most nicotine vapes that stimulates the brain to be more focused and more alert. So this, 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,

14. 49:18 – 52:00

    How Stimulants “Teach” the Brains of ADHD Children to Focus

    1. AHAndrew Huberman49:20

       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 are children that are prescribed a drug that ought to be a stimulant. It might, 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 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. Um, "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 it 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'd find that that was my favorite class, it was the, 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. You know, they are told that they can't speak out in class, or that, uh, 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? What are the short-term consequences? And what should we make of people taking these drugs without a clinical need? What are the consequences there?

15. 52:00 – 56:35

    When To Medicate: A Highly Informed (Anecdotal) Case Study

    1. AHAndrew Huberman52:00

       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 have 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, "You know, on the face of it, it seems crazy, but provided that the lowest possible dose is used and that that dosage is modulated 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 medicate," or, "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, "You know, 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 shi- 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 do 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, they're a 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

16. 56:35 – 1:04:46

    Elimination Diets & Allergies In ADHD

    1. AHAndrew Huberman56:35

       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 lengths 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, the study also included a crossover, meaning where the, the kids would serve as their own control or control group at a certain portion of the study. So they would 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 .05. That's, uh, less than .05 chance, essentially, of the effect being due to chance. However, in this study, every single one of the effects is P less than .0001, very, very infinitesimally small probability that the effects 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 they had mild allergies to. So basically what this 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, m-many papers f- 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 in 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 in 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 Pelser 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-analyses 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 would like more, or would like to reduce existing adult ADHD. That's an interesting and even more controversial topic. It brings us right into

17. 1:04:46 – 1:07:00

    Omega-3 Fatty Acids: EPAs & DHAs

    1. AHAndrew Huberman1:04:46

       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 p- fatty acids, in particular, i- getting a one gram, 1,000 milligrams or more, even as much as 2,000 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 EPAs are very beneficial. Typically that's done through fish oil, liquid fish oil is going to be the most cost efficient, but there are capsule forms for those of you who don't like fish oil. You can ingest this through other means, you can get from certain algaes or krill, et cetera. You have to make, uh, 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 EPAs of 1,000 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

18. 1:07:00 – 1:10:50

    Modulation vs Mediation of Biological Processes

    1. AHAndrew Huberman1:07:00

       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 and to attend, to focus is mediated by the circuits in the brain that release dopamine. However, attention is also modulated 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 modulated the circuits in your brain that respond to various things. And you will be highly distractable. You will 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 EPAs which are so beneficial for mood and apparently also for attention, they don't 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 and 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 'cause if you go online, if you're somebody with ADHD or not, you are going to be bombarded with the ADHD diet, the oligoantigenic diet, the elimination this, the-this supplement, that EPA, and y- 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. Uh, 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

19. 1:10:50 – 1:16:56

    Attentional Blinks

    1. AHAndrew Huberman1:10:50

       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 I'm 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, uh, Goleman is a well-known author. Uh, he's written books on emotional intelligence and so forth. Um, Richard Davidson is a also a PhD. Uh, he's a professor of psychology and psychiatry and, uh, he's at, uh, University of Wisconsin-Madison. He's done terrific work on brain states, uh, 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, you know, there are a bunch of people and objects and things in a, in a picture and somewhere in there is Waldo with the striped hat and the glasses and kind of a 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. 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 on 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 distractibility or the distractibility of somebody with ADHD could exist because they are over-focusing on certain elements and they are therefore missing other elements that they should be attending to. So what they really need is this

20. 1:16:56 – 1:22:50

    Open Monitoring & 17 minute Focus Enhancement

    1. AHAndrew Huberman1:16:56

       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 per- 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 it 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, if 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 this 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

21. 1:22:50 – 1:30:10

    Blinking, Dopamine & Time Perception; & Focus Training

    1. AHAndrew Huberman1:22:50

       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 are 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. Y- 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 are in sleep. Sometimes it's very fast, meaning you experience things in slow motion. Sometimes it's very fast. In waking too, your experience of time can sometimes be very fast, sometimes be very slow. Typically, the more alert you are, the higher the frame rate, you're 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 about 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. You know, when they clap, the clap thing, they start it, "Take." You know, what do they say? Um, "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. Unfortunately, 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 the physical space around them, they are 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

Episode duration: 2:18:00