If you have suffered from ongoing pain, hormonal issues, fatigue or immune system challenges for most of your life alongside your long undiagnosed ADHD, today's FASCINATING episode is a MUST listen with leading Consultant Psychiatrist Dr James Kustow.

Kate and Dr. James Kustow, highly regarded expert in adult ADHD, explore the fascinating connection between ADHD, hypermobility, and many different physical health conditions.

Dr. Kustow sheds light on how ADHD is more than a neurodevelopmental condition, often accompanied by physical symptoms like chronic pain and immune dysfunction.

Dr Kustow is also a member of UKAAN's Executive Board (UKAAN is the main professional organisation for Adult ADHD in the UK). He is UKAAN’s Director of Education and was instrumental in developing the national training programme for psychiatrists.

He is the author of a new bestselling book on adult ADHD, ‘How to Thrive with Adult ADHD – 7 Pillars for Focus, productivity and Balance’, published by Penguin in October 2024.

He is a recognised national and international speaker on adult ADHD, and the winner of the ‘Genius Award’ at the 2021 Celebrating Neurodiversity Awards (run by the social enterprise group, Genius Within) for the ground-breaking ‘Lifeskills’ adult ADHD group programme he established in the NHS about 5 years ago.

During this ground-breaking episode, Dr. Kustow introduces us to his innovative approach to mental health care, which integrates traditional psychiatric methods with body-oriented therapies. He underscores the importance of treating the brain and the entire body, advocating for lifestyle changes encompassing nutrition, exercise, and emotional regulation techniques. By drawing attention to the role of inflammation and the autonomic nervous system in mental health, he challenges conventional notions about ADHD, urging a more inclusive understanding that recognises the complexity of these disorders.

What You’ll Learn:

✨ The link between ADHD and hypermobility affects nearly 50% of individuals with ADHD and often manifests as a cluster of symptoms.

✨ How hormonal fluctuations and misdiagnoses uniquely impact women with ADHD

✨ Chronic inflammation may play a significant role in ADHD and related conditions

✨ Why a holistic approach, including lifestyle changes and self-care, is vital for managing symptoms

✨ Insights from Dr. Kustow’s 3S model, which connects physical and mental health for better well-being

Timestamps:

• 13:10 - Exploring the connection between ADHD and physical health
• 18:12 - Understanding dysautonomia and mental health
• 25:18 - Understanding ADHD: A new perspective on diagnosis and hormonal influence
• 34:54 - Understanding the 3S model: The somatic super syndrome
• 52:21 - The crisis of medical understanding
• 54:33 - The intersection of mind and body in healthcare

Find out more about Dr James Kustow and his work via Instagram, @thegrovepracticeempowered or his website, www.thegrovepractice.com

Have a look at some of Kate's workshops and free resources here: https://www.adhdwomenswellbeing.co.uk

Kate Moryoussef is a women’s ADHD Lifestyle and wellbeing coach and EFT practitioner who helps overwhelmed and unfulfilled newly diagnosed ADHD women find more calm, balance, hope, health, compassion, creativity, and clarity. 

Follow the podcast on Instagram here: https://www.instagram.com/adhd_womenswellbeing_pod/

Follow Kate on Instagram here: https://www.instagram.com/kate_moryoussef/

Find Kate's resources on ADDitude magazine here: https://www.additudemag.com/?s=kate+moryoussef

Welcome to the ADHD Women's Wellbeing Podcast.

I'm Kate Moore Youssef and I'm a wellbeing and lifestyle coach, EFT practitioner, mum to four kids and passionate about helping more women to understand and accept their amazing ADHD brains.

After speaking to many women just like me and probably you, I know there is a need for more health and lifestyle support for women newly diagnosed with adhd.

In these conversations, you'll learn from insightful guests, hear new findings and discover powerful perspectives and lifestyle tools to enable you to live your most fulfilled, calm and purposeful life wherever you are on your ADHD journey.

Here's today's episode.

Hi everyone.

Today I'm absolutely delighted to welcome a guest who I've been waiting for a really long time to have on the podcast.

It's Dr.

James Cousteau.

If you don't know about Dr.

Cousteau, he is the author of how to Thrive with adult the seven pillars for focus, productivity and balance.

Dr.

Cousteau is a London based consultant psychiatrist and a trained integrative psychotherapist and he works in specialist NHS adult ADHD services as well as his own private practice.

Also based in London.

He is a specialist and has a very particular interest in the overlap between ADHD and hypermobility and related disorders.

And he believes this characteristic cluster of syndromes may provide vital clues to understanding the physiological underpinnings of ADHD and other neuropsychiatric presentations.

And we're going to be delving deep into this on today's podcast.

So I'm so delighted to welcome you here.

Dr.

James Custo.

Thank you very much, Kate.

It's a pleasure to be here.

Honestly, it's been really, really looking forward to having you here and being able to validate so many of the different presentations of ADHD that many people have experienced their whole lives but have never had that, that medical kind of assurance, or I would say validation of, yes, this is connected to your undiagnosed ADHD autism or the combined.

And your book how to Thrive with Adult ADHD is, I would say it's a modern day bible to understanding your adhd, understanding how it presents, what it could look like, but also incredible, amazing tools, practical strategies to help you no longer sort of just survive in this state of like what is going on, but to actually move forwards and actually enjoy your life.

So thank you so much for that.

What I'd love to hear, you're a psychiatrist, are you a neuropsychiatrist?

Is that, am I right to call you that?

No, no, I'm not a neuropsychiatrist, but I am.

My original training was, but was in general adult psychiatry, so working across the board with adults.

But right from the beginning I specialized particularly in something called liaison psychiatry and liaison psychiatry, known as consultation.

Liaison psychiatry in America is the psychiatry specialization that is interested in the interface between mind and body, between physical and mental health.

And it's a fascinating interface and liaison psychiatrists are basically spend their time looking at that.

So rather than being based in a mental health hospital or unit, the liaison psychiatrist is based in the general hospital.

So going into the respiratory, the cardiovascular, the neurology, all the different overlaps with all the different specialities and also the psychiatrist that covers the A and E department.

So dealing with emergency presentation.

So quite an interesting body orientated focus right from the very beginning.

Yeah, that is interesting.

And I've never heard of that terminology before.

So would you say it sort of stems in America and it's slowly filtering now into the uk?

Has it always been been here in the uk?

I mean relatively speaking, liaison psychiatry is a newish speciality.

It's, it's definitely took root in America and has come here subsequently, but it's been around for a very long time and it's a very, one of the very few specialties of medicine that looks at the big picture.

So we've lost the looking at patterns and connections and systems and we've prioritized becoming experts at our individual parts, whether we're a.

Previously we might have been a general surgeon and now people are a sub specialist of a thumb rather than even a hand surgeon, for example.

And so I think there's the GP was always traditionally one of the doctors who retains that overview, that big picture look.

But we know that gps are completely and utterly overloaded and so the idea of broadening out in that seven minute consultation is not that straightforward.

But liaison psychiatry has managed to retain that big picture view.

And I spent many years before going anywhere near ADHD working in that environment, setting up an NHS team, doing that and really getting to understand this interface in a little bit more depth.

But my focus shifted, not shifted, but I was in parallel very interested in trauma, psychological trauma and how when you have a traumatic event take place, it can lodge its, leave its, its charge in your system.

And it's a very body orientated issue.

Trauma is extremely body.

So that fitted very nicely.

But when I became interested in ADHD down the line, I never thought for a moment that the, my interest in the body would transition across into adhd.

I thought this is very much a brain thing, isn't it?

It's a neuro developmental problem is brain and how wrong I was.

Yeah, amazing.

And it's so interesting to hear you kind of make that discovery.

I mean, what's so fascinating from someone who isn't a medical expert, but from working in this field now for, you know, nearly four and a half, five years and speaking to so many people that we understand, especially in women, that the physical symptoms are almost the same amount as the mental symptoms.

We've never really been able to have someone turn around from the medical industry and say yes, all these clusters are connected and this is what so many people need to hear.

And when you talk about trauma, ADHD and trauma are so intrinsically linked because if we've never understood ourselves and we felt blocked and defeated and held back and we've had all these criticisms and there's been dysfunction and chaos and addiction, like all of this together is created in a very non medical term shitstorm of symptoms and you know, trials and tribulations of our life.

To know that this is, is real and that we've not been imagining it is very, very powerful.

So perhaps you could maybe help validate people today that are listening and they can maybe you could explain a little bit about the brain body connection, these somatic comorbidities and maybe, you know, I've just named a few of them but maybe just sort of like put your stamp of approval of what you are seeing, what is real.

Well, that's possibly the biggest question I.

Like to ask loaded questions on this podcast.

I think it's great.

Okay, so I think even before any discussion about adhd, we have, our whole medical, Western medical system is set up in quite a divisive way really.

The, the mind and mental health issues and neurodevelopmental issues are on one side and the body and the physical health problems are on another.

And even the specialities are completely separate.

The medics sort of don't give much weight to psychiatry and psychiatry doesn't necessarily think about the body as much as it should.

So there's this gap and it goes back a long way and the idea that the two systems are not one.

I was going to say connected, but even more so that you know, it's an integrated system.

So.

And lots of the research and the studies in ADHD have reinforced that ADHD is a very brain condition.

We haven't traditionally been looking at physical health, comorbidity.

Now when I say comorbidity, I Mean conditions that cluster together with in this case ADHD at a higher rate than you would expect in the non ADHD population, in the general population.

So we haven't really looked at what physical health problems cluster together in adhd.

So if you have adhd, what problems are you more likely to have?

We just simply haven't been looking at it until recently.

Now before this, the data even started looking at this in detail maybe 15 years ago, given the fact that I'd come from a liaison psychiatry background and that I was very interested in the physical body and that I had unknowingly at the time, adhd and I was also quite perfectionist and, and, and I, you know, I hyper focused and went into detail and things very, from very early on I would always take a very detailed physical health history from my patients with ADHD.

Someone would come in, I think I might have ADHD.

Dr.

This is more going on.

I would then after exploring all of that stuff I would then so okay, can tell me about your physical health issues, Any, anything that you have now when you ask a very open question, do you have any physical health problems?

Quite often the answer comes back oh no, no, no, not really, I'm fine, I'm fine.

But when you dig down and you go system by system and you ask questions about the respiratory system, the cardiovascular system and the skin and all of these different areas in some detail, you really start to uncover more stuff.

Oh yes, I've got that.

Oh yes, I did have those weird allergies and that strange post viral, post infection exhaustion.

Oh yes.

And I did have, I reacted to food.

So it's about how deep you dig.

And I was digging deeply and I started to notice a couple of patterns.

The first thing I noticed, which was really intriguing actually was that more of my patients seem to have hypermobility.

That hypermobility is basically a connective tissue issue where your connective tissues, the tissues that hold your body together, have a different or an abnormality in their structure or function.

So the main protein, structural protein of the body is collagen.

And collagen in people with hypermobility is lax.

It's floppy, it bends more and so on.

And collagen is present in your ligaments and your tendons.

So it's not surprising that people with this connective tissue issue and lacks collagen have joints that bend more than they should, that they were more lax.

Okay, so that's not so much of a surprise.

But what I didn't realize at the time was that mapped around people with Lax joints is a whole network of very characteristic physical and mental health problems.

And the reason that's the case is that it's not just ligaments and tendons where there's collagen.

But collagen is present all over the body.

It's present in the skin, it's present in the muscles, it's present in the eyes, it's present wrapped around the blood vessels and it's responsible for tightening up the.

Helping tighten up the blood vessels so you can.

The way you move blood around the body is by pumping the heart faster or tightening in certain places and loosening in other places.

You can direct blood around the body.

And collagen is also wrapped around the gut so it helps with that peristaltic movement through the gut.

So every system in the body is impacted when you have connective tissue that's lacks.

Now there were various other problems that I was picking up in my patients, but pain was one of them actually.

And quite naively early on I thought, okay, people with hypermobility, they're going to get injured, they're going to injure their joints a bit more, they're going to have a bit more pain.

As I dug a bit deeper because I just was seeing this, this connection with ADHD that was really much stronger.

I was getting about 35, 40% of my patients in the gap between me making this like, wow, this is crazy what's going on here?

Why is this connection so strong?

There have been a couple of research studies looking at this really good quality research studies and one of them demonstrated that people with ADHD.

About 50% of people with ADHD are hypermobile, which is a shockingly high amount, shockingly high number.

Half the people with ADHD have this system wide connective tissue issue with characteristic physical health problems piggybacking off it.

And the more I dug and the more I uncovered, the more I realized that actually looking at ADHD from this broader distance, looking at the physical health stuff and all this hypermobility stuff, it's as if ADHD is just one component of a much bigger map that at least in some people.

I mean I'm not at 50% of people don't have hypermobility who have ADHD.

So I'm not suggesting that what we understand to be ADHD is purely this, but there is this very large group within the ADHD community and it's more women than men actually, because hypermobility affects women more than men, but that have a very characteristic cluster of problems that seem to be very much to do with their connective tissue and their and their immune system.

These patterns basically align.

The ADHD comorbidities and the hypermobility comorbidities strongly overlap.

And over the last few years there has been more and more evidence showing that ADHD is linked to pain disorders to, so fibromyalgia, to chronic fatigue syndrome.

There's a massive increase in allergies and autoimmunity in the ADHD population.

There are studies looking at inflammatory mediators, inflammatory chemicals in the bloodstream, and they're much higher rates in ADHD and even higher rates in autism, actually.

So we are seeing this picture that ADHD is a quite an inflammatory presentation and that it has these strong relationships with a variety of physical health problems.

And until now, as far as I know, there's been no story or weaving together of these things that makes sense and brings everything together in a picture.

But I feel like over the last few years that's all I've been concentrating on.

And I think I found some very, very interesting things.

And I've called the model that I that maps this out the somatic super syndrome and its neuropsychiatric expression or sequelae.

It's basically saying that all of the mental health problems, many of the mental health problems and neurodevelopmental problems we know today, including issues around pain and sensitivity and fatigue, which are more neurological than psychiatric, are linked to this cluster of physical health problems and in all likelihood driven by inflammation and impaired blood supply to the brain.

Now, this is the key point, I'm sorry, it's taken me quite a long time to get here because it's not straightforward.

But when we think of ADHD and autism and depression and anxiety disorders, we think about brain, we think about neurotransmitters, brain chemicals, we think there's too little serotonin or we think there's too much dopamine or not enough dopamine or.

And of course this is an important expression of it.

But it's like looking at a problem that has multiple entry points, multiple views of it, but looking at it from one view and saying this is the problem, this is the issue.

Whereas actually, if you look at it from a different angle from maybe the body or from the immune system, you see a different picture, but it's the same thing you're looking at.

It's like you're looking at different parts of an elephant but, you know, fascinated by the feet, but in fact there's a whole elephant there with different angles to look at it.

And because these things can actually drive neuropsychiatric symptoms without any need for brain chemistry changes.

Because what happens when you get inflamed and the inflammation goes to the brain?

What is that?

That looks like anxiety and irritability.

Irritability, by the way, is one of the strongest inflammatory neuropsychiatric symptoms.

I went to a very impressive talk that recently that said that irritability is quite a strong inflammatory symptom.

So it's basically saying we can, we can explain a lot of mental health and some neurodevelopmental things without needing to talk about neurotransmitters, talking about not enough blood to the brain.

Because one of the clusters in this group is actually something called dysautonomia.

And this is where your autonomic nervous system is not working properly.

One of the main conditions in dysautonomia is pots.

Many of your viewers will know what POTS is.

It's called postural orthostatic tachycardia syndrome.

And basically you stand up and then you get symptoms.

You're getting symptoms.

You get heart racing very fast, you get dizzy and lightheaded.

You're getting symptoms because there's not enough blood supply going to your brain.

And if there's not enough blood supply going to your brain, there's not enough oxygen going to your brain.

And why are you getting a heart racing?

Because your heart's trying to compensate and get more blood to your brain.

But those symptoms you get when you have a POTS attack, or the people who stand up and get dizzy and light headed regularly, you know, that's a very obvious, acute, dramatic presentation of not enough blood to the brain.

What if you dial it down a bit and there's not quite enough blood going to the brain?

What does that look like?

It looks like anxiety and depression and irritability and sleep problems and mood problems.

And, you know, what's the.

Which one is it, Is it not enough blood to the brain or inflammation going into the brain?

Or is it what we traditionally understand to be adhd?

So what's really interesting just made me think of something.

A few weeks ago, it was Remembrance Day, the beginning of November, and my kids school typically do this two hour assembly and they came home and they said, every year the same thing happens.

About five kids faint or have to leave because they feel really sick because they've been stood up for so long.

And the teachers are on standby because they know that because the kids are stood up for so long, there's going to be like a percentage of kids that can't hack it and they just like wheel them out like, you know, like on stretches almost.

It's not funny, but it's just making me think.

We're thinking at least one in five kids on your divergent.

That's a hell of a lot of kids stood in an assembly probably with some form of, you know, pots, not understanding why they are dizzy, lightheaded, feeling sick, heart palpitating.

Now, interestingly, I have what I've always been told is low blood pressure.

If I do anything with yoga or anything and I have to do like the head thing and I always get really dizzy and sort of like have to hold on.

It's just making me think I'm definitely hypermobile.

I've been in and out of all sorts of different physiotherapy therapists and osteopaths and all sorts of things that you know, I've had going on over the, over the years.

Thankfully I manage it through movement, yoga, pilates.

I know my osteopath really well, she knows me, so she kind of knows what's normal.

But this is because you have to.

Work hard at it.

You have to work hard at it.

And it's, it's money, it's time, it's privilege, all of that.

And I wonder if I didn't do this podcast and work in what I do, what I'd be doing, I don't know, popping pills, taking lots of opiate based medication to help with my pain, which unfortunately I know has happened in my family because the hypermobility and this, what you're, you're discussing is being rife in my family.

Chronic pain, back, back problems.

ADHD as you know, is a highly genetic condition.

It's how genetic something is, is, is captured by its heritability, a percentage score and ADHD's heritability is 70 to 80%.

That tells us it's, we know it's a combination of genes and environment but we, we know that there's a heavy genetic loading.

We've always thought that those genes are just coding for brain differences, whereas I think those genes are coding for multi system problems.

But amongst them are brain differences.

And we've been looking for the brain differences differences and so hypermobility and the complex.

So hypermobility.

Let's just be really clear first of all that not everyone who has lax joints has problems.

There's asymptomatic or uncomplicated hypermobility and it's, if you live with it and you have no problems, you might do gymnastics More likely than other people.

And as long as you don't get injured or you don't get ill down the line then that hypermobility is just, you know, normal variant stuff.

However, quite a large proportion of the hypermobility world will at some point develop characteristic cluster of problems and they typically include problems linked to pain.

Like I said before, pain due to injury, overstretching joints and getting injured and getting deconditioned and then that spiraling.

But there are other non injury related complications, this characteristic picture I'm talking about that include dysautonomia and immune over activation.

So this is the triad, the hypermobility syndrome which is known as Ehlers Danlos syndrome when it gets pathological, when there's a problem linked to it or hypermobility spectrum disorder.

These are two clusters.

The Ehlers Danlos syndrome is the more severe end of the spectrum.

But don't be mistaken, Hypermobility spectrum disorder or HSD can be extremely serious.

But it's basically this group of people are people with hypermobility and other problems.

They typically have dysautonomia, immune over activation and over time they're more likely to get gut related problems for a variety of reasons and autoimmune related illness over time because think about it, the immune system is reacting excessively, something's triggering it and it's reacting and it's reacting chronically excessively producing lots of inflammation.

Which I by the way is, is how you generate the ADHD or the anxiety etc those symptoms.

And when a system is firing too much, it's excessively firing.

It's not a big jump for it to start making mistakes and instead of attacking the bacteria or the virus that it starts attacking aspects of the cell.

And that's what autoimmunity is.

So this, this is, this is the pattern immune over activation and autoimmunity dysautonomia like dysfunction of the autonomic nervous system, which interestingly is the stress system as well as being the how do you move blood around the body system, the autonomic this, the parasympathetic and the sympathetic, the this balancing thing.

And so you get this cluster with hypermobility, dysautonomia, immuno overactivation and gastrointestinal problems and all of those things in slightly different ways actively physically drives mental health symptoms.

And that's why people with hypermobility have way higher rates of most mental health problems.

But particularly adhd.

Anxiety is probably top of the list.

Yeah, but so this is not just adhd we're talking about, this is a bigger picture and I don't know how many people with adhd, their ADHD is explained by these drivers.

That's not been really studied, but I suspect it's a large percentage.

And the, this is slightly different, I think, from, from, from the more brain chemistry, brain dysfunction, adhd.

So I see ADHD as the final common pathway from different mechanisms and I think there's a group that won't have any of these physical health problems, but it's still ADHD because it still meets the criteria, making a diagnosis of adhd.

And that's a critical point as well.

If you, you mustn't forget that all of these diagnoses are essentially, do you have X number of these symptoms?

Do you have impairment linked to the symptoms?

Tick, tick.

And if you meet these criteria, then you get the diagnosis.

It's not saying we're going to do a scan and we're going to look for this, we're going to do a blood test.

It's, it's a descriptive thing, it's a cluster, it's a, it's not telling you anything about the cause.

We don't know anything about the cause when we make a diagnosis of adhd.

Unless of course, someone had a head injury when they were six years old and developed ADHD afterwards, which is again another pathway to adhd, because if you have a big knock on the frontal part of your brain, you develop an ADHD like syndrome, but it's referred to as secondary adhd.

What I'm trying to say is I think there's a lot of secondary ADHD out there, but more subtle in its presentation than the head injury.

So are you of the school of thought?

Is secondary ADHD related to trauma?

There is an argument that says if something goes right back to a source like early, early days, you sort of consider it more as part of the adhd.

You know, if it's.

But if it happens later on in life, in adolescence or adulthood, you're more likely to label it secondary adhd.

What I'm trying to say is if you have early adversity and you develop into an ADHD child, it's difficult to know whether it was the early adversity or just the genetics that led you into that ADHD picture.

Whereas if you had it later on and it was quite clear cut that you had no problems up to the age of 16 and then you got this head injury and you've got adhd, it's a slight, we consider it a slightly different entity and we call the latter secondary adhd, but cluster the former in with the rest of the neurodevelopmental adhd.

So there wouldn't be a differentiation for someone who's been hypermobile, had dysautonomia at low levels and immune dysfunction, pumping inflammation around, not getting enough blood to their brain, having chronic brain fog that looks like adhd.

And in this sort of long term picture, there's no difference in the present, well, subtle difference in the presentation between an individual that doesn't have that cluster but still has that inattention and I suppose more of a traditional picture of what we understand to be adhd.

Okay, it's a very important point here, is that we know that the ADHD that we understand from all the studies, from many of the studies, is a genetic problem that has been around since Paleolithic times.

The genetics goes back far, far, far, 150,000 years back.

And we know that that gene pool, that ADHD is actually decreasing over time.

Wow, decreases.

Yet we are seeing more and more people presenting with, in quotes, adhd.

And we're also seeing, and this is very divisive and controversial, but we're seeing studies, more than one study, showing that there may be an adult onset form of adhd.

That is, you don't need to develop it in childhood, you can start getting it in adulthood.

And that completely obliterates our understanding, our model of adhd, which is a neurodevelopmental.

Problem that could go back.

I'm just thinking the adult onset.

We've talked about lots of other things, but obviously for women especially, we've got our hormones which are playing a big part in all of this.

And the fluctuations, you know, throughout our life, puberty, you know, pregnancy, postnatally, perimenopause, post menopause.

So we're having these fluctuations, but at the same time we've got all the external stressors.

So we could have had ADHD from birth.

Puberty, everything's, you know, the typical sort of puberty, ups and downs, maybe postnatally, all of that, but then something catastrophic can happen later on in life.

Grief, divorce, financial problems, addiction, all sorts of terrible, dysfunctional, chaotic things can happen.

And that ADHD that's been lying dormant, but maybe presenting in more sort of easy to manage ways, you know, I'll get a cleaner, I'll get a pa, I'll get someone to help me with this.

And all of a sudden, and I'm hearing this a lot, your life just blows up because of these sort of big moments in Your life.

So could that be an answer to why secondary ADHD or adult ADHD presents itself?

Because again, we're seeing it with the hormonal kind of ups and downs of perimenopause.

Yeah, yeah, no, absolutely, definitely could be one aspect explaining it.

So a woman goes along and basically we're all, everyone with ADHD is to some degree compensated.

They set up their life to minimize the impact.

And so it's quite possible and it's going to be people who have traits of adhd, but because they've set their life up in a certain way, they don't get impaired by it and therefore they don't hit the impairment criteria and they don't get a diagnosis of ADHD.

So they're not meeting criteria.

20s, 30s, 40s, the hormonal landscape starts changing a bit.

The estrogen starts going down.

And what people don't often know is that estrogen is very correlated with dopamine.

So the dopamine baseline dopamine level starts going down and essentially there's an unmasking of what was there before.

Probably like it had the potential to be there.

But the fine balance that was established is now unsettled and the symptoms are more prominent and they carry on getting more prominent.

And then I see many women coming to me in their mid to late 40s and getting diagnosed with ADHD for the first time.

And what's also very interesting there is that as well as the hormones being linked to other hormones, estrogen interacts with the immune system as well.

So there's receptors on the mast cells of the immune system that will register that lower estrogen state and cause some destabilization in the immune system.

And so these stories all link together.

People who have jumpy immune systems tend to have more heavier periods, more painful periods and more dramatic menopausal symptoms as well.

But this is all new.

This is all new stuff that's emerging.

The role of the immune system is absolutely critical to understanding everything in the body and how the immune system works.

Because you know that on guard feeling that people with ADHD often report and the hyper vigilant, that sort of low level threat state.

I'm looking at danger, that's really a sign that your whole system's pivoted towards threat.

And we know that the autonomic nervous system sympathetic and we all talk about, don't we fight or flight and stress response and the calming effect of the parasympathetic nervous system or the vagus nerve.

So we're used to talking about this Threat model for thinking about the autonomic nervous system.

This is the thing that gets disordered in ADHD and hypermobility.

But also the immune system can be thought of as the innate immune system, which means the immune system that's not using, not mem, it's not using memory.

It's the immune system that will mop up any danger that comes our way.

It's called the innate, the first responders.

This is what we're talking about here.

The immune system, when it perceives that there's a threat, either something in our environment is triggering, whether it's an allergy or a toxin, or our internal states changing, the hormones are changing, our immune system registers a threat.

If there's an injury and it rallies and it starts releasing chemicals to neutralize the threat.

And so when you see people with overactive immunity immune systems over a long period of time, jumpy immune systems, more allergies, it's likely they're responding to something in the environment.

But in the process of that low level response, a lot of inflammation is being pumped into the bloodstream, causing problems.

So when we think of threats and stress systems, we mustn't forget the role of the immune system.

And the immune system I think is starting to decompensate because we are straining it with all of the attacks in our environment.

Tell people you've got the 3S model.

Can you explain what this is?

So the 3S model is the somatic super syndrome.

So somatic means physical health super syndrome.

A syndrome is a cluster of features in different systems of the body.

So a syndrome might mean you've got this mental health thing and you've got this gut thing and you've got this skin thing.

So it's a syndrome, it's multiple.

And what I'm saying is there is a cluster of syndromes.

Ella's Danlos syndrome is one of them.

Mast cell activation syndrome or disease is another one of them.

Dysautonomia quotes Syndrome is another.

We have a cluster of syndromes.

Each of them have their multiple multi system expressions and they're coming together in a, in a, in a coexistent interactive way and through various mechanisms.

I've mentioned two of them.

Inflammation and impaired perfusion or blood supply to the brain.

When you don't get enough blood supply to an organ, you don't get enough oxygen to the organ and the organ fails.

You don't give the liver or the kidneys enough blood, enough oxygen, it will fail.

You get liver failure, you get kidney failure.

We know what the symptoms of that are, what I'm saying is brain failure is another thing.

If you don't get enough blood to the brain, it doesn't work properly.

So you're getting these cluster of syndromes, the somatic super syndrome, super multiple syndromes and the focus is on its neuropsychiatric manifestations.

So we could look at the syndrome and say what are the gut manifestations or what is the skin manifestation?

I'm saying let's just look at the brain and the mind and let's have a look at what this cluster causes.

What we know this cluster causes in terms of neuropsych and what it causes is anxiety and a dysregulated stress response.

This low level threat state, hyper vigilant stuff, mood disturbance and sleep disturbance.

It causes an autism picture.

And autism is extremely inflammatory and it is going up.

It is.

There's questions as to whether ADHD is actually going up or it's just being more recognized.

But autism is going up.

Anyone will tell you that.

Now as well as these sort of mental health and neurospraxia is another one of the neurodevelopmental presentations.

There's also the sensory issues, that's heightened sensitivity, sensory processing issues, the pain issues and a variety of other neurological symptoms.

And that neuropsychiatric list is being driven by the somatic syndromes, the Ellers downloss, the dysautonomia and the immune dysfunction.

And the gut stuff is driving these symptoms through inflammation.

That is what the 3s, Somatic Super Syndrome, 3s's in a row and is really saying this is what the cluster is.

And I think that the cluster explains a lot more mental health and neurodevelopmental problems and fatigue and pain syndromes than we currently think.

And we should start thinking more body rather than mind and brain.

Yeah, no, absolutely.

This.

So again you, you said that we're only just understanding all of these connections, but what I hear is that these women have been experiencing all of this forever, but we've never had any explanations.

And I've got someone very specific in mind and family member who unfortunately around the time of, of perimenopause, menopause, also had a family breakdown, divorce, very traumatic.

Her mental health.

We know she's got adhd, but then she had a prolapse and it was just continue one thing, one immune problem after the other, thyroid issues.

And it was just, she's this category, she's.

She's exactly what I'm talking about.

Everything, it was like thyroid stuff.

Is likely to be autoimmune and the prolapse is likely to be to do with weak connective tissue, all of these out pouching and diverticular and hernias and, and hemorrhoids, all because the tissues are weak and lacks.

So what you're describing is exactly the cluster and you would not believe how many people in our networks have this cluster.

I can see, I can almost feel your listeners just going, wow, yeah, this is, and this is what happens when I take these detailed histories.

I will literally every question I ask.

Yes, yes.

How, how do you know that, Dr.

That's exactly how it goes.

And this is just unbelievable.

To just have something which perhaps was there for a long time but never the connections were never made between the things suddenly emerge is quite phenomenal because it, one, it gives you an explanation of how it all fits together and two, it gives you many more areas that you can intervene because you can, you can manage all of these individual things and bring down the inflammation and bring, improve the blood supply to the brain.

And you're not even getting anywhere near ADHD meds at this stage.

So it's the revolution in the way that we're understanding adhd, but it will meet with lots of resistance.

It will.

So I am all for the awareness, I'm all for making sure that we have all this information that people are empowered and yes, it can feel really scary and it can feel, feel like, oh my God, I'm doomed.

And I know with our hyper vigilant brains and our anxious brains we're thinking, oh my God, what are we going to do here?

And I don't want people to think that this is the end of the road.

What I.

Far from it.

It's the beginning.

Exactly.

And I think what's so powerful about what you're saying is that we're having this, this validation.

We're looking back at the generations behind us, we're seeing all the different things that have gone on.

I can see, see it throughout my whole family tree.

And then we're able to say, right, okay, and you're talking about inflammation and our immune system.

And I know that your book, and what I love about it is that you are a medical, you know, psychiatrist, that you've been trained by the nhs, you've been embedded in that system, but you're so open minded to all the kind of the somatic work, the calming, the regulating the nervous system system.

You talk about things like eft, which is what I'm a practitioner in.

You talk about the solar soma method, you're talking about relaxation, meditation.

And this is what I've been talking about for many, many years on the podcast when I decided that I needed to find well being and lifestyle tools and practices that don't include medication that we can integrate into our lifestyle so we can start.

Because all I know is that I operated on palpitations, hyper vigilance, anxiety, worry, neurosis, pain, gut problems.

And I did not want to carry on like that.

I wanted to be able to live life without thinking what if, like everything's going to be a catastrophe.

And you know, we've talked about the cardiovascular system.

This is all connected.

And I had Dr.

Sandra Coy on the podcast a few months ago, friend.

Of mine, by the way, she's wonderful, credible, incredible.

And that podcast like the figures just went through the roof because people were saying, oh my God, yes, I've got cardiovascular issues, my mum had it.

You know, I had family members die in their 50s from heart attacks and I've suffered with palpitations.

I don't want to go down that road.

So, you know, you can see how, how impactful this is just by my reaction.

And I want people to know that this is not a sentence, this isn't a life sentence because as a psychiatrist you are prescribing calming, regulating methods that we can reduce this inflammation that negates the world that we live in, which is all about hyper productivity, not switching off online, overworking this fixation with like doing everything all the time and never having any time out.

So first of all, I would love you to read your poem.

You have the most amazing poem and I think people from, you know, we can use this as a bit of a punctuation point in the conversation because that really affirms everything we've been saying.

And then let's move to some of the things that we can do to help move from this place of oh my God, to we have got options and things are going to be okay.

Absolutely.

No, I think just to pick up on a couple of points, I'm happy to read the poem if you like that whenever I make a diagnosis of adhd, forget all this extra stuff.

By the way, I call this ADHD plus because the plus represents the broader picture, the bigger picture, but it also represents plus represents looking to, to take positive psychology.

It's the plus of don't just try and take away the negative, negative you've got to build in the positive.

So I see.

I've sort of moved from thinking about ADHD as the old style of adhd.

And I think about it ADHD plus to encompass all of these new perspectives, the strength space model, the physical comorbidity and the much more holistic, rounded approach.

So the second thing to say is I just wanted to pick up, you mentioned this goes back to past generations, etc.

Etc.

That we just haven't seen these connections before.

I think that's true to a large degree, but I think we are seeing a change in the sorts of presentations in Western world particularly, I think we are seeing many new illnesses presenting over recent times.

We have seen some changes in the sorts of presentations that are presenting to us.

We have in a bigger picture over the last hundred years, we've seen a big reduction in infections and illness and death through infection.

Become very good at treating infections and they've come right down.

Used to be the main cause of illness and death right down massively.

We're good at surgery and all of this stuff.

So we've basically reduced that in parallel over the last 50 to 100 years.

We've seen this ramping up of allergies, autoimmunity, anaphylaxis and a whole host of new presentations that the medical system hasn't got their head around yet and therefore has stigmatized people for having them.

Because we don't understand what causes it.

We never learned about it in medical school and it's not in our textbooks and we don't really understand it.

Then I'm afraid there's nothing wrong with you.

Yep.

And it's the disgrace.

It's gaslighting.

It's a disgrace.

And people with fibromyalgia and chronic fatigue and other forms of chronic pain and, and chronic migraines and reactivity and heightened sensitivity to their environment.

You know, they're getting disregarded and, and invalidated and it's, it's, it's awful.

We just need to catch up.

Yeah.

And thank you for that.

Thank you so much as a doctor for validating that to so many women who sadly have gone to other doctors and have been told to go home and take some paracetamol and just deal with the pain, deal with the discomfort.

Change something.

It's obviously something you're doing and there's a huge amount of shame there for a lot of women who've not been able to sort out themselves because they then think, is this something that they've been doing wrong?

And especially when it comes to women's health issues as well, Heavy periods, painful periods, all sorts of things like that.

Pmdd.

And I think it's so powerful to hear that from you.

So, so thank you, thank you, thank you.

Let's listen to the poem because it's.

It's wonderful and I think people will really appreciate it.

The poem's called Systemic Toxicity.

First people started experiencing more allergic reactions, but you paid little attention as you're not the sensitive type.

Then came a steady flow of fatigue and fibro but you didn't give it much thought because you aren't that sort.

And then flowed the waves of foggy brains and irritable bowels and restless minds and although this time you could relate, you chose not to state it as you didn't want to be labeled and hated but then hit the insults you hadn't expected, the fallout from which has been so destructive it could be infection, injury or exposure or a psychological trauma that you just couldn't get over.

It knocked you for six and unlike the past, things deteriorated quick.

The dust has now settled and as far as you can tell it's left you quite unwell.

Low energy, dizziness and sensitivities too.

So many new symptoms, it just doesn't sound true.

What's causing this chaos?

You desperately ask then feel so alone as the doctors you trust appear not to grasp that the symptoms are real.

Yes, I'm inflamed and yes, I'm in pain and no, it's not just secondary gain.

You search hard for answers for hours on end with other people's stories resonating true, so desperate for guidance.

Anything work well for you?

So what is to blame?

I hear you exclaim.

Well, how one describes it depends on your frame, but here's my best guess based on my reading, dissecting and weeding.

It clearly needs more study, but the field is now moving and the patients I'm treating are clearly improving, reinforcing the notion that we may be getting closer.

I suspect it's the mast cells that have become hyperactive with inflammation unleashed, every system collapsing, the body so tired and mind strangely wired, sleep interfered with and gut function slowed, reacting to everything and now petrified of your home, your brain has stopped working and everything's hurting.

But how can one tiny blood cell wreck so much havoc?

Evolutionarily complex and intelligent too, with hundreds of chemicals released into tissue with subtly different effects that can respond to a wide range of threats.

And I've come to appreciate that histamine is critical, but it's still only one little bit of it all old injuries awoken by the inflammatory state.

Lumens are swollen all over the place, but one may not See this just by looking at your face and over time we often find that autoimmunity climbs into the mix and that's it then you're in the shit so much harder to fix.

Why now I hear you cry out well, I'll share my current theory it's perfectly sound it may build with more knowledge but it's compelling and profound Our lives have become so hideously toxic Lounging around in chemical boxes where the air is so stagnant and mould growth rampant WI fi and Bluetooth and smart meters too invading our airwaves, penetrating through our food manufactured with nutrition lambasted and nature collapsing and all in the name of financially maxing the careless spraying of crops and de fleeing of dogs the plastics and vox and polygod knows what's the flame retardants that may be worse than the fire as they've gassed off around you since you were a vulnerable child, innocent, stealth, degrading your health the chemical sweeteners and preservatives too, the rancid air fresheners that slowly suffocate you the antibiotics prescribed for mild flu not to mention those that get into our food the experts we trust tell us it's fine don't make a fuss, there's nothing to fear the science is clear so please adhere but my body and instinct are powerful tools that tell me I must not trust in these ignorant fools that the science is distorted and all logic thwarted with agendas confused it's just not to be trusted, I suspect I regret that what we are facing is immune decompensation across entire nations with COVID 19 as the final straw, a closing door where did we go wrong?

I hear you sob.

Isn't our medical know how up to the job?

But with so many afflicted in a system outdated and heavily berated with such little focus on the wider shape of things, I just feel there's no hope, that there's too much to change that it's out of our range and in the place of hope sits resigned acceptance that so many who suffer will continue to be neglected and so severely affected, let down by the structures that were meant to protect them.

So what can we do when faced with this mess?

I know not the answers, I really must confess.

But let's take a step back, notice the patterns, ask the right questions and then make connections.

A system's perspective is what is suggested and what might you discover?

A cluster of syndromes that journey together, so common yet hidden from all but a few who often themselves are suffering too A cluster with lax joints right at its core.

But with it there often comes a whole lot more.

A cluster so toxic, inflaming the brain and draining the mind of the joy and the drive that keeps us alive.

So where do we start, I hear you ask.

As it feels so impossible to piece it apart, we first need to cease all the generating of shame and pointless self blame in the millions who come with this thing with no name.

The stigma and judging must now come to an end, replaced with compassion and love like a friend.

The 3S model of neuropsychiatric disorder.

A desperate attempt to bring a semblance of order and remind us that physical and mental are really the same and probably should be captured under one name.

And perhaps this could foster a shift from the smaller into the broader, where problems connect and most definitely intersect, at least from afar.

It may better reflect where things presently are.

With so many ailing and then judged to be failing, how are we going to change this prevailing but clearly aging healthcare system of ours?

A system that sees body and mind not as intertwined and aligned, but separate, discreet and conveniently neat.

A delusion on a scale untold behold.

It's true, we have lost our direction and we're in need of a radical correction.

I'm certainly not expecting a welcome reception from all those who read these challenging reflections, especially those who are presently fine or metaphorically blind or in some way invested in the current paradigm.

But what the hell, it needs to be said.

The voice of the many who often feel better off dead.

Wow, that's the second time I've heard it.

And it's just as impactful and chilling and incredibly brave, I think, for you to, like you say, you know, it has to be said and there's going to be pushback and there's going to be an old school medical mentality that just won't and can't accept it because maybe the research and the evidence that isn't quite there, even though we know it's emerging.

We know that you and a lot of your amazing colleagues are working hard to get this out there.

Unfortunately, it is worrying that it's going to trickle through maybe a little bit too late for some people.

But I think what's so powerful and important about this conversation and what you're saying is that we can learn to advocate for, for ourselves.

So we can go and we can say to our doctor, listen, I've got X, Y and Z and I've got this.

I believe that I need this help or this referral and we can Start coming from a more empowered, knowledgeable place as opposed to putting all our expectations on a doctor.

And I know doctors don't want to be told by, you know, what, what to do, but sometimes we know ourselves, we know, you know, especially women, very intuitive, we know ourselves cycles.

We know those very kind of nuanced symptoms that very, you know, we know when that migraine's brewing because we're premenstrual or we know that irritability is brewing because we're ovulating and all these little things.

So, so thank you.

Let's just.

On the point of this point, I think that any new big discoveries or breakthroughs in the way that we practice in medicine always takes time to filter through like big changes in the way that we do things usually take about a 20 year period from the first person talking about it till it's integrated into new practice.

And during that time quite a lot of people who see the light, you see the connections, see the new thing, are stigmatized themselves, like there's not enough evidence for this.

And of course there's going to be things where the evidence is emerging.

And what we need to do in this new world of evidence based medicine is recognize that just because something doesn't have loads of evidence behind it yet doesn't mean that it's rubbish.

It just means that it hasn't been studied enough yet.

There's so much judgment about things that may well hold value, but there's not the X number of high quality studies yet to prove it.

Evidence based medicine is clearly the way forward, but paired with a humility and an understanding that we don't know all the answers and that sometimes things that look a bit strange, like tapping on acupuncture points, actually work.

And we need to be less negative and judgmental, more open, still rigorous about the science and still rigorous about being clear what is very evidence based and what is not.

But I think we're 10 years into this 20 year journey with this cluster now just in terms of exposure to the ADHD world three years ago, and it brings back Sandra Coy, who three years ago I took a gamble at a big international ADHD conference.

I was invited to do two talks and I brought all this material out.

There's conference difference for the first time ever.

It's never been presented this sort of stuff around mast cell activation and diving in deeply into the hypermobility question.

Jessica Eccles is a psychiatrist who's doing some research on it and she's great.

Hasn't permeated through in a Big way.

And a lot of how it all connects together is, is new.

I presented it at this conference and three of the leading figures in the ADHD world, Sandra Coy, Margaret Vice, who, the Vice Impairment Scale, many people will know that, and Iris Manor were there at the talk and they came up to me afterwards and said, you're onto something really important here.

And we've collaborated over the last few years in many symposium, there's another one coming up.

So the message is getting out there.

But I have a big thank you towards my three colleagues who are top of their game because they, they saw it, they realized how important it was and with their support the message is going filtering into the ADHD world right now in a big way.

Somatic comorbidity, physical health, comorbidity and hypermobility and its surroundings are 100% on the map now.

And it's now a matter of time to unpick and understand how all these things link to together.

And I think it's going to change the way we think about adhd.

In fact, I think it's going to change the way we think about mental health and neurodevelopmental presentations, full stop.

And it's exciting to be in that.

It's very exciting.

And I, and I'm really happy to use my platform to use this podcast which goes out globally to as many people as possible.

And we're going to spread the message really, really rigorously with this, with this conversation to get it out there because this is what it needs.

It needs to come from the patients to the doctors and the doctors can hear this and then they can, you know, with the training and all the symposiums, everything.

And I think your book is great because you explain all of this, but then you offer these pillars of focusing on nutrition, the gut health, movement, exercise, sleep, hydration, so we can actively reduce this inflammation.

Because what we don't have control over, very sadly is we don't have control over the ultra processed foods.

That is just like mass consumption that, you know, we don't know what our kids are eating when they're not with us.

We don't know what's being pumped into the house, you know, if we're in a hotel, through the air conditioning, cleaning products like you say, if people like air fresheners, we don't know what the 5G, the wifi is all everything and it's just everywhere.

And as an anxious person, I could very easily spiral worrying about all the things that I can't control.

But what we have to keep coming back to is like, what can we control?

Dr.

James Kisso, thank you so, so much.

As you can tell, I've really enjoyed this conversation because it reinforces everything I've been saying in layman's words.

Like I, I just kind of say what I experience with regards to how it's shown up for me and how I see it, show it for my community.

And then I just try and transfer what I need for me and what I've learned through all my different trainings and give that to my community.

But to have it validated and affirmed by someone like yourself is really, I would say, encouraging.

So I just say one thing about that.

I've been sort of looking at what you've been doing and what you've been chatting about and you've definitely on the right track with all the themes that we're coming up today.

And without a doubt the themes that are included in my book and the pillars are coming through in your podcast.

You're right on the mark and it's very, very exciting to see that, you know, people naturally find their way to these important themes.

I want to, just before we end, just want to flag up the solo SOMA thing because I'm super excited about this.

I just want to tell your listeners what it is because it's original and it's different and it's just about to be launched like made available.

So I always struggled to meditate in this sort of traditional listening to some sort of meditation script or sitting still on just breathing.

I just find it really difficult and I'm definitely not alone in that respect.

I also spent the last 20 years learning about the best emotional regulation and trauma processing and techniques that involve the body.

Because of my interest in the body, my interest in trauma, my interest in emotional regulation, for example, I developed a six day diploma course on advanced emotional regulation skills which much of the book is infused with that.

So what I decided to do many years ago now was try and pull the most powerful or potent elements of some of the most established and best therapeutic approaches, trauma processing approaches, vagal nerve stimulate like a whole host of 14 different, different existing therapeutic modalities.

I pulled what I thought was the most important bit and integrated it, weaved it into a 20 minute movement meditation that that encompasses eye movements and tapping and breath work and a variety of physiological things and cognitive things like intention and gratitude, rhythmical stimulation, like hypnotic stuff like everything I could think to get in here is in.

And I do it every morning and have done for years and about five years ago I started teaching it to my colleagues and my patients and manualizing it.

And I've just come to the end of, of creating a really lovely video of it that guides people through how to do it.

And one of my extremely talented musician friends who writes music for films and big, big stuff has written the music for it to be extremely healing and powerful.

And it's about to go live.

Just wanted to flag it will be on the grovepractice.

I'll make sure the links will be linking everything to the book, to that course, to everything you do.

Have you got any last words of support to anyone that's listened to this this and maybe feels a little bit like overwhelmed, but kind of doesn't wants to believe there's, there's going to be positivity from this?

Is that you got anything you could say to them?

Yeah, two things.

First is the more, you know, like when you get the diagnosis of ADHD or when you say you have ADHD and you've got all these other things and suddenly today you're going, wow, light bulb moment.

I'm so overwhelmed with all of this.

I've got this and this.

And I said, I don't know where to start.

Yeah, you're definitely in a better place than you were before you got the diagnosis or before you learn these connections.

You're overwhelmed because it's resonating, it's making sense.

And so it usually represents the beginning of a much better trajectory.

When you get a diagnosis or when you have a light bulb moment, it might mean you tuck challenges on you to go and investigate and read and learn and connect.

It might take you many years to find the path really well, but that's okay.

Because actually, the way to live successfully and to thrive with this thing called ADHD is actually to commit to lifelong self care, self compassion and a nurturing focus on self development, on clearing trauma, on optimizing, on incrementally improving your life so that your ADHD impairs you less.

And it's not a quick fix.

It's a lifelong journey.

Your podcast is brilliant for that because it's ongoing and it's an ongoing process of self development.

Don't give up.

You just got to get your head around the idea this is a lifelong thing.

It's not a battle, it's a lifelong journey.

And it will have ups and downs.

There's no doubt about it.

You're going to have ups and downs with adhd, but expect them and don't beat yourself up about it, because ADHD is in general riddled with shame.

And it's one of the biggest problems we have to learn to shed the chains of shame, as I call them.

And that's why Pillar one is about mindset.

It's nurture a growth oriented mindset.

Because if you start this whole journey and you hate yourself and you're beating yourself up every other second second saying, oh, idiot, there I go again.

Yeah, then you're not going to do very well.

So you've got to learn how to shed that.

And part of shedding that is learning about ADHD and realizing it's a very, very biological, very genetic thing.

And this is not a matter of just trying a bit harder.

It's a proper thing.

It's a proper brain and body thing that is going to take work to stabilize.

But without a doubt there's a lot you can do.

And I think my books are starting.

Amazing.

Thank you so, so much.

My pleasure.

Nice to talk to you.

I really hope you enjoyed this week's episode.

If you did and it resonated with you, I would absolutely love it if you could share on your platforms or maybe leave a review and a rating wherever you listen to your podcast.

And please do check out my website, adhdwomenswellbeing.co.uk for lots of free resources and paid for workshops.

I'm uploading new things all the time and I would absolutely love to see you there.

Take care and see you for the next episode.