The Link Between ADHD & Obesity

Summary

This script delves into the intricate connection between ADHD and obesity, highlighting how altered reward processing in ADHD can intensify food cravings but reduce satisfaction, potentially leading to obesity. It explores the hormonal activity of fat cells, which can exacerbate ADHD symptoms. The speaker suggests that by managing emotions and cravings through mindful eating, avoiding impulse purchases of unhealthy food, and daily emotional regulation, individuals with ADHD can mitigate both conditions. The script also underscores the importance of understanding these interconnected neurological mechanisms to develop effective treatment strategies.

Takeaways

• 🧠 ADHD and obesity are interconnected conditions influenced by the mind-body connection, with each condition potentially exacerbating the other.
• 🔄 ADHD's altered reward processing can lead to increased food cravings and a higher likelihood of obesity due to a potent dopamine release from food.
• 🚫 The satisfaction derived from food is lower in individuals with ADHD, which can lead to overeating in an attempt to achieve the same level of satisfaction as neurotypical individuals.
• 💉 Adipose (fat) cells are hormonally active and can produce chemicals that worsen ADHD symptoms, such as by interfering with brain-derived neurotrophic factor (BDNF).
• 🏭 In ADHD, the prefrontal cortex is altered, leading to increased food cravings but a decreased reward from food consumption.
• 🏋️‍♂️ Impulse control difficulties in ADHD mean that the gap between the idea of eating and the act of eating is smaller, making it harder to resist food cravings.
• 😖 Emotional dysregulation in ADHD can amplify sensitivity to dopamine, leading to increased cravings for food as a means of emotional relief.
• 🍽️ Savoring food and avoiding distractions during meals can help increase the reward from food and counteract the reward processing deficit in ADHD.
• 🚫 Limiting the availability of unhealthy, packaged foods can help manage impulse eating behaviors in individuals with ADHD.
• 💪 Daily emotional management is crucial for individuals with ADHD and obesity, as it can naturally reduce the drive to eat unhealthy food.
• 🏃‍♂️ Exercise can help combat insulin resistance and improve overall physiology, which is beneficial for individuals struggling with ADHD and obesity.

Q & A

What is the connection between ADHD and obesity as discussed in the script?

The script suggests that ADHD and obesity are tightly connected due to altered reward processing in ADHD, leading to increased food cravings and a higher likelihood of obesity. Additionally, fat cells are hormonally active and can produce chemicals that worsen ADHD symptoms.

How does the dopamine release from food affect individuals with ADHD differently?

In individuals with ADHD, the dopamine release from food is more potent, leading to increased cravings. However, there is a dichotomy where the satisfaction derived from food is actually lower, requiring more intake to achieve the same level of satisfaction as a neurotypical individual.

What is the role of brain-derived neurotrophic factor (BDNF) in ADHD and obesity?

BDNF is a chemical that stimulates neuron growth and is associated with a lower likelihood of developing ADHD in children. However, the size of adipocytes (fat cells) in obesity can interfere with BDNF function, potentially worsening ADHD symptoms.

How does the prefrontal cortex (PFC) in ADHD affect food cravings and satisfaction?

The PFC in individuals with ADHD is altered, leading to increased food cravings (anticipation signals). However, the actual satisfaction derived from eating is decreased, creating a cycle of intense cravings and lower satisfaction.

What is the impact of altered inhibitory control in ADHD on impulse control related to food?

Altered inhibitory control in ADHD makes it difficult for individuals to restrain impulses to eat, especially when the idea of food enters their mind. This gap between idea and action is smaller in ADHD, leading to immediate action on food cravings.

How does emotional regulation in ADHD affect eating habits?

Emotional dysregulation in ADHD can intensify the experience of negative emotions, which can, in turn, amplify sensitivity to dopamine and food cravings. This can lead to overeating as a means to manage emotions, contributing to obesity.

What strategies are suggested in the script to counteract the neurological mechanisms linking ADHD and obesity?

The script suggests savoring food without distractions, avoiding the purchase of unhealthy pre-packaged food, and managing emotions daily through activities like journaling, therapy, or meditation.

How can savoring food help individuals with ADHD improve their food reward?

Savoring food with full attention and intention can increase the food reward in individuals with ADHD. This practice can counteract the decreased satisfaction from food by enhancing the experience and appreciation of eating.

What is the significance of the hormonal activity of adipocytes in the context of ADHD and obesity?

Adipocytes are hormonally active and can produce chemicals that affect the brain and behavior. In obesity, these cells can increase inflammation and affect insulin metabolism, which can worsen ADHD symptoms and contribute to a cycle of overeating.

How does the script relate the concept of dissociation to emotional dysregulation and eating behaviors in ADHD?

The script suggests that dissociation, a lack of awareness of one's emotional state, can lead to emotional dysregulation in ADHD. This, in turn, can drive overeating as a means to cope with unrecognized negative emotions.

What is the role of exercise in managing both ADHD and obesity as discussed in the script?

Exercise can help counteract insulin resistance and improve overall physiology, which is beneficial for weight management. Additionally, it can have positive effects on brain function and emotional regulation, aiding in the management of ADHD symptoms.

Outlines

00:00

🧠 Mind-Body Connection Between ADHD and Obesity

The paragraph discusses the correlation between ADHD and obesity, highlighting the mind-body connection. It explains that the severity of ADHD symptoms in childhood can predict the likelihood of obesity in adolescence. The altered reward processing in ADHD, which leads to increased sensitivity to the pleasure derived from food, is a significant factor. Additionally, the paragraph delves into how hormones from fat cells can exacerbate ADHD symptoms, particularly mentioning the role of brain-derived neurotrophic factor (BDNF) and its interference by adipocytes.

05:01

🍪 ADHD and the Struggle with Food Cravings and Reward

This section explores the unique challenges individuals with ADHD face regarding food cravings and reward processing. It contrasts the intense cravings for food in ADHD with the diminished satisfaction derived from eating, leading to overconsumption. The paragraph also touches on the role of the prefrontal cortex (PFC) in ADHD and how it contributes to increased anticipatory signals for food cravings, but a reduced dopaminergic response upon eating, creating a dichotomy between desire and fulfillment.

10:02

🏃‍♂️ Impulse Control and Emotional Regulation in ADHD

The paragraph examines the difficulties in impulse control and emotional regulation associated with ADHD, particularly in the context of obesity management. It describes how the gap between the idea of eating and the act of eating is smaller for individuals with ADHD, leading to immediate action on food impulses. Furthermore, it discusses the amplified sensitivity to negative emotions in ADHD and how these emotions can intensify cravings and the desire for dopaminergic reinforcement from food.

15:03

🚫 Strategies for Managing ADHD and Obesity

This section presents strategies to counteract the neurological mechanisms linking ADHD and obesity. It emphasizes the importance of savoring food to increase the reward of eating, avoiding distractions during meals, and managing impulse control by eliminating easily accessible unhealthy food options. The paragraph suggests that making unhealthy food preparation labor-intensive can help control impulsive eating behaviors in individuals with ADHD.

20:03

🧘‍♂️ Emotional Regulation as a Key to ADHD and Obesity Management

The paragraph underscores the importance of daily emotional management for individuals with ADHD and obesity. It points out that emotional regulation skills, awareness of negative emotions, and the tendency to dissociate during emotional experiences are interconnected with eating behaviors. The speaker recommends integrating emotional processing activities into daily routines to reduce cravings and improve impulse control related to food.

25:04

🤖 Hormonal Impact of Adipocytes on ADHD

This section delves into the hormonal activity of adipocytes, explaining that they are not merely storage cells but endocrine cells that produce hormones affecting ADHD. It discusses how inflammation caused by adipocytes can decrease BDNF levels, affecting brain function and potentially worsening ADHD symptoms. The paragraph also explains the role of insulin resistance in obesity and its impact on nutrient signaling and satiety.

30:06

🌱 Anti-Inflammatory and High-Fiber Diet for ADHD and Obesity

The final paragraph suggests dietary and lifestyle changes to address the intertwined issues of ADHD and obesity. It recommends consuming anti-inflammatory foods and those that positively affect insulin metabolism, such as green tea and ginger. The paragraph also advocates for high-fiber, high-volume foods to leverage gastric stretch and induce feelings of fullness, as well as regular exercise to combat insulin resistance and improve overall health.

Keywords

💡ADHD

ADHD, or Attention Deficit Hyperactivity Disorder, is a neurodevelopmental disorder characterized by inattention, impulsivity, and hyperactivity. In the video, ADHD is linked to obesity due to shared neurological and behavioral factors. The script discusses how ADHD affects reward processing and impulse control, which can influence eating behaviors and contribute to obesity.

💡Obesity

Obesity is a medical condition involving excessive body fat to the extent that health may be negatively affected. The video script explores the connection between ADHD and obesity, suggesting that the hormonal activity of adipose (fat) cells can exacerbate ADHD symptoms, and that individuals with ADHD may be more prone to obesity due to altered reward processing and impulse control related to food.

💡Mind-Body Connection

The mind-body connection refers to the interaction between mental and physical processes in the body, affecting health and well-being. The video emphasizes this concept by discussing how psychological factors in ADHD can influence physical health outcomes like obesity, and vice versa.

💡Dopamine

Dopamine is a neurotransmitter associated with reward, pleasure, and motivation. The script explains that in individuals with ADHD, the dopaminergic circuitry is altered, leading to increased cravings for food but a decreased sense of satisfaction after eating, which can contribute to overeating and obesity.

💡Reward Processing

Reward processing is the brain's way of responding to rewarding stimuli, such as food. The video describes how people with ADHD have an altered reward processing system, making them more sensitive to food cravings but less satisfied by the consumption of food, which can lead to overeating behaviors.

💡Impulse Control

Impulse control refers to the ability to resist urges or impulses to act in certain ways. The script discusses how individuals with ADHD often struggle with impulse control, particularly in relation to food, making it difficult for them to resist the urge to eat when faced with tempting food options.

💡Emotional Regulation

Emotional regulation is the ability to manage and control one's emotions effectively. The video script explains that individuals with ADHD may have difficulties with emotional regulation, which can lead to increased cravings for food as a means of emotional coping, further contributing to obesity.

💡Brain-Derived Neurotrophic Factor (BDNF)

BDNF is a protein that supports the growth and survival of neurons in the brain. The script mentions that BDNF levels are lower in children who later develop ADHD, and that the size of adipocytes (fat cells) can interfere with BDNF function, potentially worsening ADHD symptoms.

💡Inflammatory Markers

Inflammatory markers, such as IL-6, are proteins that indicate the presence of inflammation in the body. The video explains that adipocytes can produce inflammatory markers, which can decrease BDNF levels and contribute to mood problems and anxiety, exacerbating ADHD symptoms.

💡Insulin Resistance

Insulin resistance is a condition in which the body's cells do not respond properly to the hormone insulin, leading to high blood sugar levels. The script discusses how obesity can cause insulin resistance, which impairs the body's ability to signal fullness, potentially leading to overeating and further weight gain.

💡Gastric Stretch

Gastric stretch refers to the sensation of fullness that occurs when the stomach is physically stretched by food. The video suggests that utilizing the gastric stretch mechanism, such as by eating high-volume, high-fiber foods, can help individuals with ADHD and obesity feel full and manage their eating behaviors.

Highlights

ADHD and obesity are interconnected conditions influenced by altered reward processing and hormonal activity of fat cells.

Children with more ADHD symptoms at a young age are more likely to be obese in their teenage years.

ADHD is associated with increased food cravings due to altered dopamine release, but decreased satisfaction from food.

Fat cells produce chemical signals that can exacerbate ADHD symptoms, such as reducing brain-derived neurotrophic factor (BDNF).

Neuroscience reveals differences in the brain of individuals with ADHD, affecting reward processing and impulse control.

People with ADHD have a harder time restraining impulses to eat due to a smaller gap between idea and action.

Emotional dysregulation in ADHD can amplify sensitivity to dopamine, increasing cravings for comfort food.

ADHD and obesity can be managed by savoring food and avoiding distractions during meals to increase food reward.

Eliminating easily available unhealthy packaged food can help control impulsive eating in ADHD.

Daily emotional management is crucial for individuals with ADHD and obesity to reduce cravings and improve impulse control.

Fat cells' hormonal activity can negatively impact brain function and contribute to ADHD symptoms.

Inflammation caused by adipocytes can decrease BDNF levels, affecting brain development and ADHD severity.

Insulin resistance due to obesity can impair satiety signals, leading to overeating in individuals with ADHD.

Exercise can improve insulin sensitivity and counteract the negative effects of a sedentary lifestyle on ADHD and obesity.

Eating high-fiber, high-volume foods can create a feeling of fullness and aid in weight management for those with ADHD.

Professional guidance is recommended for adopting an anti-inflammatory diet to support ADHD and obesity management.

Improving ADHD management can lead to better weight control, and vice versa, indicating a synergistic relationship.

Current clinical trials often exclude individuals with ADHD, leading to interventions that do not address both conditions effectively.

Understanding the neuroatypical mechanisms at play allows for targeted approaches to manage both ADHD and obesity.

Transcripts

today we're going to talk a little bit

about ADHD and

[Music]

obesity now generally speaking we think

of these two diseases is unlined but the

more that we're learning about medicine

the more we're realizing that there is a

Mind Body Connection and what we're

seeing sort of really speaks to the

connection between these two diseases or

conditions so just as an example the

worse your ADHD is at the age of let's

say six or seven the more symptoms of

ADHD you have the more likely you are to

be obese at the age of 16 so it turns

out that these two conditions are very

tightly connected because in ADHD we

have altered reward processing which

means that the dopamine release that we

get from food is much more potent and is

much more likely to lead to obesity on

the flip side we tend to think of fat

cells or adipocytes as cells that are

just storage but they're not storage

they're actually hormonally active and

it turns out that fat cells

actually produce certain chemical

signals that will worsen ADHD as a

simple example of this there's this

chemical called brain derived

neurotrophic factor which is something

that literally stimulates growth of

neurons and what we know is that kids

who have low bdnf are more likely to

develop ADHD and it turns out that the

more fat cells you have the larger your

adipocytes actually are the more that

they interfere or stop the uction of

bdnf so let's dive a little bit into the

Neuroscience because the Neuroscience

will show us how the brain of someone

with ADHD is a little bit different and

give us new options for things to do

that we don't even bother with in

neurotypical individuals because they

don't have the ADHD deficits so let's

start with some features of ADHD number

one is reward processing so we know that

the dopaminergic circuitry in people

with ADHD is different it's more

sensitive in some ways and specifically

when it comes to food we discover one

really interesting thing so anticipation

signals I.E cravings for food is

increased okay so this comes from the

PFC so the PFC is altered this is a

prefrontal cortex in people with ADHD

and now this would be fine this isn't

that big of a deal but this is where

kids with ADHD really get screwed so the

food reward is actually decreased okay

so this is something that's very very

fascinating this is very different from

what most people expect so most people

assume and this is true in some ways

okay that if I eat some unhealthy food

since my dopaminergic circuitry is more

sensitive I get more dopamine that's

true and we'll get to that in a second

but there's one really interesting

dichotomy in ADHD which is that the

Cravings that you get are more intense

but the satisfaction you get from food

is actually lower so let's say that I'm

a neurotypical person so I see I don't

know like a cookie and so when I see the

cookie I get a craving score of five

five and then I eat the cookie and I get

a satisfaction score of five so this is

good right I want to eat the cookie the

cookie looks really good I eat it I

really get satisfied everything is great

now if we look at someone who has ADHD

and they see a cookie this is what

happens their craving score becomes a 10

but their satisfaction score becomes a

2.5 so what are the implications of this

the first implication is that you want

food more but food is less satisfying so

if we look at the brain of someone who

has ADHD what does the brain of ADHD

want so in this case we just need one

cookie to satisfy our anticipation or

craving but if you really look in the

brain of someone who has ADHD we need

four cookies to satisfy this very

intense craving so literally the reward

that you get from food is reduced so the

way that I kind of understand this is

this is a little bit like a skeleton

who's eating food so I remember I saw a

cartoon many many years ago of a

skeleton who is very hungry and what

they keep doing is they keep on putting

food in their mouth but there's no

stomach there's no digestion there's no

satisfaction so no matter how much they

eat they never really feel full or get

the benefit of eating and this is

literally what we see due to alterations

in the PFC in ADHD increased Cravings

lower dopaminergic response from receip

of food hey y'all if you're interested

in applying some of the principles that

we share to actually create change in

your life check out Dr K's guide to

mental health it combines over two

decades of my experience of both being a

a monk and a psychiatrist and distills

all of the most important things I've

learned into a Choose Your Own Adventure

format so check out the link in the bio

and start your journey today the second

thing that we see is altered inhibitory

control so this we kind of understand

right so one of the problems in ADHD is

that people have impulse control

difficulties so if I get an Impulse

let's say I I see some kind of food it's

very difficult if I get the impulse if I

get the thought of eating it it is very

hard for me to restrain this impulse and

so part of the challenge if you're doing

like obesity management is we can sort

of tell people hey like you know the you

should eat healthy like make sure like

you know you you don't eat as much

unhealthy food and then the neurotypical

brain is able to restrain their impulses

more so in ADHD we have a slight problem

because the second that the impulse

enters your mind if the idea of food

enters your mind then you will eat the

food the gap between idea and action for

people who have ADHD is way smaller so

if we look at the neurotypical person we

have the idea of food and then the act

of eating is further away okay so this

means that they have more ability to

restrain their impulses the second

problem that we have the third problem

that we have is altered emotional

regulation okay so we need a little bit

of Neuroscience for this so we have this

part of our brain called the amydala and

the amydala is connected more broadly to

something called the lyic system so this

is where we feel negative emotions okay

then over here we have the nucleus

accumbent which gives us dopamine and

reinforcement anticipation okay so let's

just understand dopamine circuitry real

quick so let's say I have a stimulus if

the stimulus activates the nucleus

succumbent we get a dopamine release and

dopamine then goes to other parts of our

brain and does three things the first is

it makes us feel pleasure the second is

it increases Cravings of whatever the

stimulus is so this makes sense right so

if I eat a cookie for the first time oh

my God the cookie was so delicious what

does that make me do the next time I see

a cookie I will have a craving for it

the next thing that'll happen is that

it'll increase behavioral reinforcement

so this is kind of related to the cookie

so not only will I want the cookie but

it is more likely that I will eat a

cookie next time okay so this is the

dopam energic circuitry basically how it

works now what we also know in people

with ADHD So This is highly sensitive in

ADHD which means that the dopamine

signal the anticipation and the

reinforcement that we get is Amplified

so there's another problem in ADHD which

is emotional disregulation so what does

this mean so people who have ADHD feel

negative emotions more intensely so

literally like if something happens

let's say someone cuts me off when I'm

driving let's say this normally leads to

a in a neurotypical person this leads to

five units of anger in someone with ADHD

this will lead to 7.5 units of anger

okay so we literally know that these

parts of the brain are more jittery and

are easier to activate there's another

problem so not only do we feel things

more intensely we also feel the emotion

for a longer duration okay so not only

am I angry at units of 7.5 but I'm angry

for the next hour so we sort of know is

that this emotional disregulation has

even been hypothesized as a subtype of

ad DHD so for some people this is

actually their primary symptom now this

creates a specific challenge in food

because these two circuits in ADHD are

not unlined in fact they're synergistic

so what this means is that people who

have ADHD in their brains anytime they

have negative emotions this actually

amplifies their sensitivity to dopamine

so what does this mean on a practical

sense so let's take a look at what this

practically means the first is I have my

ner typical kid okay then I have my kid

with ADHD who is happy and then I have

my kid with ADHD who is sad so in

scenario number one kid sees a cookie

neurotypical kid kid eats cookie kid

gets five units of dopamine okay five

units of craving all right and five

units of dopamine now let's take our

happy kid so happy kid sees a cookie

this is 8hd Happy Kid okay so CES a

cookie gets 10 units of craving and gets

2.5 units of of dopamine from eating it

so already I have to eat four times more

cookie than a neurotypical kid now let's

take an angry kid or sad kid so now what

happens is if I've got negative emotions

this is going to amplify this effect

twofold so what this means is when I've

got negative emotions I need something

to make me feel better so I will get 20

units of craving so now this anger this

negative emotion needs some kind of

relief so crave this cookie even more

because as soon as I activate my

dopaminergic circuitry it will help me

feel better so I may still get only 2.5

units of dopamine but my craving is now

induced so now what happens is anytime

I'm angry or sad or have some kind of

negative emotion I need to eat eight

cookies in order to not only give myself

some amount of pleasure but since I have

so much more craving so much more

negativity I sort of have to treat that

negativity using this dopaminergic

stimulus and this is in a nutshell why

kids with ADHD are four times as likely

to be obese compared with typically

developing kids what happens is our

brain is designed in this way where it

becomes sensitive to negative emotions

which we have difficulty controlling we

are more sensitive to Cravings we get

less receip of food so we have to eat

more and so this is a basic basic

problem now before you think oh my God

Dr K does that mean I am screwed I am

no there's good news so let's

look at a couple of things that we can

do because there are new interventions

that we can use that will counteract

these neurological mechanisms so number

one is the problem is that food reward

is actually decreased okay so what can

we do there are two reasons for this so

what we need to do is Savor our food

huge huge huge huge huge important thing

the more that you intend intentionally

and attentionally Savor your food this

food reward will get increased so if you

look at people with ADHD what do they

love to do while they're eating not just

people with ADHD everybody right

everybody loves to watch YouTube listen

to a podcast oh we're being efficient

we're being so efficient I can't waste

my time eating oh my God that's 30

minutes where I'm not learning Spanish

or learning to code or having fun I'm

going to work after I'm done eating so

let me have my break let me watch a

little bit of Sports while I have my

meal right this is what we think so as

we watch this kind of stuff as we have

some kind of dopaminergic stimulus or

some kind of distraction it decreases

our attention and if it decreases our

attention on eating we are going to

decrease our food reward when you go to

the movie theater they give you a

bucket of popcorn with like 128

o of soda these gigantic jugs of stuff

and you sit there because the movie is

so damn good and you don't get any

receipt of your food reward so there are

two things that you need to do which

will help a lot the first is Savor your

food really sit there and enjoy it taste

it notice the food as much as you can

simply noticing will increase the

receipt of the food signal second thing

that you can do is do not distract

yourself don't do anything while you eat

because then your brain is so

distractable to begin with it's not

going to pay attention to anything that

you're eating so if you want to counter

this reward processing deficit or change

in ADH Savor your food and don't eat

anything don't do anything else while

you're eating second thing altered

inhibitory control okay what this means

is that the idea and the action are

going to be way closer in ADHD so what

we really need to do is space those out

so practically what I tell my patients

with ADHD is no

unhealthy available

packaged food okay so what does this

mean this means that if you buy it and

it is sitting in your pantry you will

eat it without realizing you will eat it

on an Impulse you cannot control whether

you eat it on an Impulse or not so what

I tell all of my patients and what works

really well for them at the very

beginning I was saying don't you know

stop eating cookies and that didn't work

and then we discovered something really

cool you can Absolut absolutely eat

cookies but don't buy cookies make

cookies so if you want to eat something

unhealthy unhealthy food requires work

this is the key thing we're not cutting

out unhealthy food because that's that's

mean it's cruel oh you poor kid who's

obese with ADHD no more cookies

for you no bro girl go ahead and have

cookies but just make them bake them

from scratch buy the flour buy the brown

sugar buy the chocolate chips we want to

increase the gap between an impulse and

a reward and what I find when I work

like this with my patients is they are

actually totally fine it's like awesome

like okay it's Friday evening I've had

dinner I feel like having a cookie so

what I'm going to do is bake a

batch of cookies that takes 30 or 45

minutes it's way healthier there's none

of this processed crap in it we'll get

to that a little bit but this actually

works really well so do not buy packaged

unhealthy food that is easily available

the only packaged stuff that you are

allowed to buy or the only stuff that is

easily available for you is healthy

things all of your unhealthy food should

be made so even if you want to make

fried chicken don't buy Frozen nuggies

don't buy Frozen tendies chop up

that chicken breast make your egg wash

grab your breadcrumbs and fry that

up man like have it and it's going to be

delicious it's going to be good it's

going to be way healthier anyway okay

this is critical you cannot win this

battle when you are fighting it this

battle is won logistically before you

even show up on the field of battle it's

one through Logistics ahead of time

third thing altered emotional regulation

what can we do to fix this we need to

move this way so this is a prime example

of one of the biggest problems that I

see with endocrinologists treating

obesity I'm not trying to dog on them

they're doing a fantastic job they have

great outcomes whatever right so I'm not

saying they're doing a bad job this is

just a weakness of our field of medicine

where we've over specialized in bread

and weakness so if you're trying to

control your food impulses what you

really need to do is control your

emotions so if we look at studies on

people who are binge eaters what we

discover is Three core changes when it

comes to emotions the first is that they

have poor emotional ulation skills okay

the second is that they are almic so

they are not aware that they are even

feeling negative emotions you don't even

know exactly what's going on you're kind

of like your mind is wandering all over

the place this is sort of why I see with

my patients with ADHD they're like mind

is all over the place they have so many

things to take care of they feel like

they need to they're under a lot of

pressure right that's what they really

describe they don't describe sadness or

shame or fear or anxiety they're like I

have a ton of to do that's what

their subjective experience is and what

is that that's some kind of negative

emotion it's fear of the consequences if

I don't do it right it's anxiety it's

even perspective shame if I don't do

this right oh my God I'm going to feel

so bad everyone is going to think I'm

pathetic everyone is going to hate me no

one's going to want to be my friend all

of these emotions are going on they're

not aware of it what do they feel they

feel pressure more than anything else so

they are unaware of their internal

emotional state and then what happens is

their brain their amydala knows that

there is shame there's fear there's

anxiety there's Panic there's even some

amount of anger right oh my God how did

I get into this situation why do I

always do this to myself right you feel

all these negative emotions but you're

not aware of it all you feel is pressure

and so then the brain of the ADHD person

realizes okay we have all this negative

emotion we need to get this under

control boom let's go to the nucleus

cumbin baby let's go let's get some of

those cookies let's manage that emotion

CU we need to manage that emotion we

have to do we can't afford not to

eat unhealthy today because we have so

much things to do so we literally find

three features in the brains of people

luing poor emotional regulation skills

Alexia which is emotional colar

blindness we have a whole lecture on

that we've got guides on that it's

really really important third thing is

really fascinating these people

literally dissociate oh interesting so

when you dissociate let's see oh

fascinating we are not aware of the food

reward so interesting right so what

happened is 30 years ago people did

brain scans on people who binge and like

wow these people are dissociating we

didn't understand the mechanism now we

understand the mechanism there is a lack

of attention literally that's what

dissociation is is to not be aware in

experiencing what is going on in your

life so what do we need to do to correct

this problem what we need to do to

correct this problem is manage our

emotions so what I recommend in my

patients who are ADHD and obese because

they don't see the problem as emotions

right they see the problem as impulse

behaviors they see the problem as

willpower they see the problem as

attentional deficits emotions aren't

even on their radar right so i' I've

heard of very few endocrinologists who

when someone comes in who's overweight

first of all they may not even do an

ADHD evaluation right because we're here

for weight management and secondly

they're not going to say like okay

what's your emotional regulation uh

Management on a daily basis how do you

manage your emotions every single day

that's not a part of obesity treatment

and I'm not dogging on the

endocrinologist because these people

studied for like 3 years in fellowship

and went to some weight management

clinic it's not a standardized part of

our treatment because that's Psychiatry

it's over there so what we need to do if

we have ADHD and obesity is daily

emotional management right I don't care

if you Journal I don't care if you go to

therapy I don't care if you meditate I

don't care if you go for a walk I don't

care if you take your dog out for a walk

or you cuddle your cat or whatever but

everyone who is struggling with ADHD and

obesity must must have some kind of

daily emotional processing cleaning that

stuff out it'll make it'll reduce this

craving literally neuroscientifically

it'll make it easier for you to eat okay

and it's not even that once again is a

battle that we're going to win The

Battle Before we ever show up on the

battlefield as you regulate and take

care of your emotions your drive to eat

unhealthy will naturally go down the

reinforcement of that behavior will

actually decrease if you manage your

emotions what that means is that your

Cravings will decrease the pleasure that

you get from the unhealthy food will

decrease all by managing your emotions

okay there's a lot of good stuff that we

can do hey y' I want to take a second to

talk about star Forge PCS so I am in

love with these Game Machines because I

love gaming the problem is that I

started building PCS when I was 12 and I

just don't have the time for it anymore

and if you really think about it like

sure you can keep up with all the trends

and stuff but chances are especially if

you're a healthy gamer you may have

better things to do with your time so if

you're like a college student I love

that they have the horizon line which is

like more economical really solid gaming

PC and instead of like spending 15 hours

following trends like you know study

your for your final and like get a

better grade and then get a better GPA

then get a better job and then go live

your life so if you're like me and

you're like a professional and you want

a really solid gaming PC because you're

a gamer but you also don't want to waste

the time to figure out what's good and

what's not I highly recommend star Forge

all of their PCS are built in Austin by

Gamers who really know what they're

doing and if you're like me like you

build a PC once every 3 years and you

screw up the gel on the heat sink if you

know what I'm talking about you know

what I'm talking about all this kind of

crap you don't have to worry about

they're going to do everything for you

it'll be a solid PC it'll run your games

and this is the crazy thing every single

one of their PCS I've ever used also run

Zoom at top specs so check out star

Forge I absolutely love

him now we're not done we're just

halfway and this may be way too long but

hey this is like important to understand

so now let's talk about obesity all

right so the first thing to understand

about obesity is that adipocytes are not

fat storage cells this is what we used

to think we think oh my God your fat is

just energy storage it's just sitting

there no no no we have a whole video

about this fascinating adipocytes are

hormonally active oh my goodness so I

want you to think about it this way

adipocytes are Endocrine cells what are

your other endocrine organs of the body

your testes your ovaries so what this

means is that when we have someone who

is obese they're eposides they usually

don't have more adipocytes the

adipocytes just grow so if we double the

volume of adipocytes it's like doubling

your ovaries doubling your testes we see

spikes in hormonal production and all of

these hormones will affect the ADHD so

let's start with a couple of core

mechanisms okay the first is increased

inflammation okay so what we literally

know is that adipocytes produce

something called il6 so il6 along with

il1 il10 t tumor necrosis fa Factor

Alpha there are all these so inter

lucans are chemical signals that

activate immune cells okay that's what

these are so these will activate your

immune system in increase inflammation

what is inflammation it's activation of

your immune system but specifically we

know that adipocytes will create il6 now

il6 does something really problematic it

decreases

bdnf now what is bdnf brain derived

neurotropic Factor so something that is

neurotropic is something that causes

neurons to grow a stimulant for the

brain now I don't mean stimulant the way

that like methyl idate or arerol or not

those kinds of stimulants these are

growth factors so they promote the

growth and development of your brain if

you look at children and you measure

their bdnf the lower the bdnf in the

child during development the more likely

they will develop ADHD later in life so

literally the this is a chemical

chemical compound hormonal compound that

triggers brain growth and development

and it is low in levels of in people

with ADHD so there are some very small

trials that are sort of hypothesizing

that stimulating B bdnf will improve

symptoms of ADHD it may be one of the

mechanisms through which um ADHD

treatments work on some way that really

that stuff hasn't really been sorted out

but we certainly know that fat cells

increase il6 and il6 decreases bdnf so

how does that work let's understand this

see our body has two modes it has

fighting mode and it has building mode

so our our our brain is just like any

kind of RTS right so let's think about

Starcraft or Warcraft I know no one

plays RTS anymore we kind of have our

economy right we're going to build

things up we're going to acquire more

minerals we're going to build more

pylons and then we make a lot of units

and then we send those units into war

and when we are building up our economy

we're not making like zealots or Marines

or whatever like either we're building

peons and pylons or we're building like

zealots and drons I know this is a

reference that y'all Gamers

aren't going to understand so either

we're investing our in our economy or we

are investing in like wartime unit units

so our brain and body are the same way

either we are fighting off an infection

or we are building things and the

problem is that since adipocytes

increase our inflammation they put our

body into combat mode and then it stops

building things it literally reduces

bdnf which results in problems in our

brain reduces the function of our brain

makes our ADHD worse second thing that

adipocytes do is mess with our insulin

okay now we're going to have to learn

more complex physiology this is the most

complex thing I'm going to teach yall

today so let's understand this here is

me I eat food food makes glucose in my

bloodstream glucose triggers insulin

okay insulin causes the absorption of

glucose into cells so now my cell is

full of glucose okay so insulin is

triggered any time we eat something so

what does insulin end up doing insulin

signals to our brain and our body that

we have nutrients check nutrients

acquired okay so it kind of travels to

our brain and it triggers things like

leptin and gin we're not going to get

into too much detail but it kind of

makes sense right so when I'm hungry I

will have glucagon levels that are high

glucagon is the opposite of insulin so

glucagon tells us oh crap we're running

low on energy we're hungry and glucagon

will stimulate hunger and then we eat

something we get glucose insulin shows

up puts the glucose into cells and

Insulin goes here and tells our brain

hey nutrients acquired you don't need to

feel hungry anymore there's another

issue at play which is that the more fat

cells we have or the larger our fat

cells are the more we have insulin

resistance this is why people who are

diabetics type 2 diabetics who are often

times overweight or obese require

insulin we have to literally inject

extra insulin because their cells are

resistant to insulin I want to ask

youall a question if I have a resistance

to insulin what do you think it will do

to my nutrients acquired signal it

decreases it right so the insulin is

what tells our brain hey we have enough

nutrients you can stop feeling hungry

now and as I increase my adipocytes ocy

mass my insulin resistance increases

which means that my body brain cannot

detect the signal of fullness it is

literally neurologically impaired so

people even when they eat they do not

feel full and this is mediated by

adipocytes the last thing that I'm going

to touch on I kind of forgot this is

that il6 works by two mechanisms one is

bdnf but then the other thing is that we

know that inflammation increases mood

problems and anxiety so there are some

theories of inflammatory hypotheses of

the brain so if you sort of think about

this if you get the flu what happens to

your mood it goes into the pitter right

so this is something that's very

important to understand anytime we have

inflammation in the brain we will feel

more depressed we will feel more

anxious now we see where everything is

coming together because if y'all have

been paying attention why does this hurt

more for people who have ADHD compared

to the neurotypical person inflammation

from adipocytes right so here's the

sequence epoy increase in obesity Isle

six mood goes down anxiety goes up and

what happens in the brains of people

with ADHD did y'all pay attention did

y'all remember amygdala hypers

sensitivity so now what we're going to

do do y all remember do y all remember

do you all remember we're going go up to

this column where is it here it is you

guys remember this Dr K didn't doesn't

have enough space so now what we're

going to do remember this one where

emotional remember we have the sad kid

who's got ADHD so now we're going to add

a fourth column I'm sad and now I'm

obese so if I'm obese it doubles the

sadness if I double the sadness I get 40

units of craving and now 2.5 units of

satisfaction which means I need to eat

16 cookies and oh that's right as I'm

eating these 16 cookies what would

normally stop us from eating 16 cookies

in one sitting that's right because

every cookie that I eat releases insulin

and tells my brain hey bro we've had

enough but if I have insulin resistance

from a large amount of adipocytes I do

not receive a satiety signal from all of

the cookies I'm eating which is

how I eat a whole package of cookies in

one sitting if I have ADHD and obesity

everything comes together so does this

mean we are screwed no this just means

we have been mistargeting the mechanisms

so the first thing is as we increase

emotional regulation techniques we will

actually fix this problem automatically

the other thing that we're going to do

is recruit a couple of other interesting

things so now we're going to use kind of

anti-obesity mechanisms so our body has

multiple ways of detecting the food that

we eat one is through this insulin and

glucose metabolism thing but then we

also have this thing called gastric

stretch which is that we literally have

stretch receptors in our stomach so as

our food as our stomach fills with

volume we get a completely different

pathway right so you can't eat like this

much food in terms of volume why not

because what happens is I is I eat a

large not quantity not nutrient density

but literally large volume of food my

stomach stretches out it expands I feel

full and I'm bloated oh my God I've got

a food baby in my belly once I have a

food baby it's a completely different

pathway it is a physiologic stretch

pathway and this will help us feel full

this has nothing to do with dopamine

nothing to do with emotions this is a

completely separate pathway and this is

what we need to utilize so what I

recommend to all of my patients who are

struggling with weight loss and ADHD is

that you eat foods that are going to

make your belly stretch make that belly

stretch that is usually high fiber foods

high volume Foods so if you look at

something like broccoli you have to eat

like a large volume of broccoli to

equate the calories of a single Twinkie

the problem with a Twinkie is that most

neurotypical brains if I eat a Twinkie I

will feel somewhat satisfied because

those sugar receptors the insulin

receptors are all kind of in working

well so I get this nutrient load right

and then my brain is like okay we've had

enough because this is like 400 calories

no big deal I'm done that doesn't work

in people who have ADHD and obesity so

we need to use gastric stretch so eat as

much high fiber food as you can have it

easily available this will stretch your

belly and will make you feel full next

thing we want to really start exercising

so the more that we exercise the more it

fixes this whole insulin resistance

thing so we know that for example even

type 1 diabetics to a certain degree I

think is type one definitely type two so

the more that you exercise it kind of

counteracts all of this physiologic

stuff and all this sedentary lifestyle

is half the reason why ADHD and obesity

are getting worse so the more you can

exercise the better it will be for your

stomach and your physiology and stuff

like that it'll even help your brain we

want to also eat anti-inflammatory food

so this is where I would strongly

recommend that you seek a professional

so someone like a dietitian or an

endocrinologist or medical doctor and

try to really start eating

anti-inflammatory foods and also foods

that affect insulin metabolism so in my

practice I'll use things like margam in

you know urtic medicine we'll use bitter

melon a lot uh coffee green tea

chamomile Ginger these are these all of

these foods have had some evidence that

they will affect our sugar metabolism

and our inflammation so if you start to

eat these things you can start to

counteract some of these principles so

just in summary so we're seeing a rise

of ADHD and we're seeing a rise of

obesity there's another problem that we

have which is that if you have ADHD

often times we don't consider the impact

of obesity on your brain and on the flip

side if we're trying to treat obesity we

do not consider the impact of your ADHD

emotional regulation reward processing

brain in terms of resisting food so what

ends up happening is that we use all of

these interventions which are designed

from clinical trials but as part of

those clinical trials because they're

very controlled we start excluding

people who have problems like ADHD and

so what we're seeing is a rise of ADHD

and obesity partially because our

interventions don't account for both of

them and there are certainly there's

certainly a synergistic effect of obes

on ADHD it makes our brain more

vulnerable and there is a synergistic

effect of ADHD on eating and so this is

why a lot of people lose hope but the

good news is that if we understand the

mechanisms at play we can Target these

neuroatypical mechanisms and hopefully

get a handle on both ADHD and obesity

and this is what I've seen as a

clinician this seems like a a battle

that's really hard to win because one

screws over the other but the good news

is that if you start moving in the

positive direction with one if I have a

patient who has ADHD and their weight

gets under control their ADHD improves

if I have a patient who is obese and I

get their ADHD under control their

weight improves so both of these things

it's kind of they combine together to

screw you over but you can also actually

improve both of them two birds with one

stone you can get kind of a nice fatty

crit in there and hit both of them at

the same time so definitely try some of

the stuff that we're talking about today

if you're someone who has a clinician

that you're working with right now I

strongly recommend that you talk to them

about these kinds of mechanisms and see

if there's something you can do about it

the last thing is if yall are really

interested in this stuff and you like

these kind of mechanisms and stuff like

that we have a awesome guide to ADHD

where we dive into a lot of Neuroscience

and give youall a lot of interesting

techniques so check that out too hey Dr

K how do I get my kid to put down the

game without it being a fight every

single time the problem with gaming is

that it tricks our brain into being a

substitute for Life once we start to get

our psychological needs met through the

game that's when we become addicted how

to raise a healthy gamer combines the

latest in Neuroscience research along

with a decade of clinical practice check

it out anywhere books are

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