⚠️If you want all my tried & true options for mental clarity✨ on demand, pick up Finally Focused: http://christabiegler.com/focus

On this episode of the Less Stressed Life, we’re continuing ADHD month with returning guest Dr. Jolene Brighten to talk about the hidden signs of ADHD in women and why so many go undiagnosed for years. We get into masking, people pleasing, overachieving, and what ADHD can look like when someone seems to have it all together on the outside but is struggling to keep up behind the scenes.

We also unpack the connection between ADHD and perimenopause, including why hormonal changes can make existing symptoms worse or create symptoms that look like ADHD. Jolene explains why thyroid health matters when evaluating ADHD symptoms and how inflammation, gut health, sleep, and movement can influence brain function. Plus, we discuss what an ADHD diagnosis actually involves and when getting one may be helpful.

📖 Get Dr. Jolene Brighten’s new book, ADHD and Women, here: https://drbrighten.com/books/adhd-and-women/

✅ Check out Dr. Jolene Brighten's previous episode, #294 Is This Normal? Libido, Night Sweats, and BC Alternatives

KEY TAKEAWAYS:

🧠 Why ADHD often goes undiagnosed in women
🎭 Masking, people pleasing, and overachieving
🔍 How ADHD can show up beyond the typical stereotypes
🌸 Why perimenopause can amplify ADHD symptoms
🦋 How thyroid and hormone changes can mimic ADHD
🔥 The connection between inflammation, gut health, and brain function
💤 How sleep and movement support focus and executive function
🧩 When an ADHD diagnosis may be helpful

ABOUT GUEST:
Dr. Jolene Brighten is an internationally recognized hormone expert, nutrition scientist, and founder of Dr. Brighten Essentials, a supplement company creating science-backed solutions for women’s health. Board-certified in naturopathic endocrinology, a certified menopause specialist, and sex counselor, she’s the bestselling author of Beyond the Pill, Is This Normal, and the forthcoming ADHD and Women—empowering women to optimize their hormones and enhance sexual wellness. A passionate advocate for uncovering the root causes of hormonal imbalances, Dr. Brighten combines clinical expertise with evidence-based education to empower women to optimize their hormones, brain health, and sexual wellness. Through her writing, speaking engagements, and global educational platforms, she has inspired millions of women to better understand their bodies and reclaim vitality.

WHERE TO FIND GUEST:
Website: https://drbrighten.com/
Instagram: https://www.instagram.com/drjolenebrighten/
Podcast: The Dr. Brighten Show - https://drbrighten.com/podcast/

SPONSOR:
Thank you to Jigsaw Health for being such a great sponsor. 💛 I’m sharing some pretty cool health pearls 💎 about vitamin K2, a misunderstood nutrient that goes way beyond 🦴 bone health, including its role in helping calcium get where it needs to go, ❤️ cardiovascular health, 🥾 performance and more. Save 10% on any Jigsaw Health order with code LESSSTRESSED10.

NUTRITION PHILOSOPHY OF LESS STRESSED LIFE:
🍽️ Over restriction is dead
🥑 Whole food is soul food and fed is best
🔄 Sustainable, synergistic nutrition is in (the opposite of whack-a-mole supplementation & supplement graveyards)
🤝 You don’t have to figure it out alone
❤️ Do your best and leave the rest

WHERE TO FIND CHRISTA:
Website: https://www.christabiegler.com/
Instagram: @anti.inflammatory.nutritionist
Podcast Instagram: @lessstressedlife
YouTube: https://www.youtube.com/@lessstressedlife
Quick Links: https://www.christabiegler.com/links
Cortisol Shop: https://christabiegler.com/cortisol-shop

✨Grab Cortisol Reset here: https://christabiegler.com/cortisol-a

❓Questions for Christa? Submit them here: https://www.christabiegler.com/questions

TRANSCRIPT:

[00:00:00] Dr. Jolene Brighten: you can manage your husband, your children, all of these schedules, and hold it all together, but you can't make your own appointments and hold together your own life.

[00:00:10] Dr. Jolene Brighten: You feel like you are putting every ounce of energy to seeming put completely together while you're screaming and drowning on the inside. 

[00:00:18] Christa Biegler, RD: Welcome to the Less Stressed Life podcast. I'm your host, Christa Biegler, and we're in the ninth year of this show, and I just want to say thank you so much for being here. I'm personally in a season of wanting to pay it forward, to share everything I have learned from our clients over the last decade so that I can share it with as many people as possible in the next years, in the next decade.

[00:00:43] Christa Biegler, RD: I'd love to hear from you about what you want more of in the future, in the coming months of this podcast. Feel free to drop me a line at https://christabiegler.com/questions.

ADHD Month and Guest Intro

[00:00:53] Christa Biegler, RD: Now, this month our theme is ADHD. I've become pretty interested in this topic in the last couple of years because I'm probably undiagnosed ADHD myself, so I set out to gather strategies on motivation, ADHD in women, conversations with therapists to bump up against the status quo, so to speak, diagnosing, improving executive function, and of course, one of my favorite topics, ADHD and nutrients.

[00:01:18] Christa Biegler, RD: I want incredible mental focus too, and I've found that when I'm supporting my body in the correct ways, I almost don't have some of those symptoms that usually come along with ADHD. I even created a small mini program on this called Finally Focused: Mental Clarity on Demand, because that's what I want when I need to focus.

[00:01:38] Christa Biegler, RD: Usually, you can only get it after you buy the Cortisol Reset, but it's on sale on its own for a limited time. The link is in the show notes. I thought it was only appropriate for ADHD month. You can get it at https://christabiegler.com/focus. Now, onto the show.

[00:01:53] Christa Biegler, RD: All right, today on the Less Stressed Life we have back return guest for a very exciting topic, the topic of the whole month, ADHD. So Dr. Jolene Brighten is an internationally recognized hormone expert, nutrition scientist, and founder of Dr. Brighten Essentials, a supplement company creating science-backed solutions for women's health.

[00:02:11] Christa Biegler, RD: Board certified in naturopathic endocrinology, a certified menopause specialist and sex counselor, she's the bestselling author of Beyond the Pill: Is This Normal? And the forthcoming ADHD and Women, that comes out at the end of October, empowering women to optimize their hormones and enhance sexual wellness.

[00:02:29] Christa Biegler, RD: A passionate advocate for uncovering the root causes of hormone imbalances, Dr. Brighten combines clinical expertise with evidence-based education to empower women to optimize their hormones, brain health, and sexual wellness. Through her writing, speaking engagements, and global education platforms, she's inspired millions of women to better understand their bodies and reclaim vitality.

[00:02:48] Christa Biegler, RD: Welcome back, Dr. Brighten. 

[00:02:50] Dr. Jolene Brighten: Yeah, thanks so much for having me, and this'll be exciting. It's October 6th the book comes out. Oh, wonderful. So not the end of October. Halloween would've been fun, but no. We're giving it to you early. 

[00:03:01] Christa Biegler, RD: We don't need any more scary things at that time. So it's, not October yet when we're recording this, and I was able to get an advance copy of the book, and for the people looking at the video, it is a beast. When we met on Zoom, I said, "This must have taken literally forever." But what I wanted to say is that it's the most interesting and engaging health book I've picked up in a long time. I usually get very bored very quickly in health books and not finish a book, which might be because of my ADHD tendencies in general.

[00:03:31] Christa Biegler, RD: But you made this fun. I mean, You knew your audience. You made this fun. You summarized well at the end if you didn't wanna read the chapter right away, or if you wanted to see, there's bullet points at the end of every chapter. It's summarized in tables. So I wanted to commend you 'cause I thought it was impressive.

[00:03:46] Christa Biegler, RD: And- I appreciate that ... it was probably a labor of love. When did you start this project? And why did we need this book? Why did we need a book about ADHD in women specifically? 

Why ADHD in Women Matters

[00:03:57] Dr. Jolene Brighten: I started this project a year before I ever mentioned it to my agent and ever even took it to publishers, and then it was another year of refining that.

[00:04:09] Dr. Jolene Brighten: But prior to that, it was all researching. It just occurred to me I was researching ADHD because it was my journey. Late diagnosed ADHD in my 40s, ADHD, then endometriosis, then autism diagnosis, and I'm like, "This is weird. This is weird to be in your 40s and be discovering all of these things."

[00:04:29] Dr. Jolene Brighten: And so really, I started researching this, years ago, and I started just putting together what is changing for me? What is happening for me? How do I prevent what's coming down the road ahead? Because I've witnessed so much in my patients. And, instead of keeping this selfish protocol, in my computer for myself, I was like, "Let's put it into a book, and let's share this," because one I have experienced is what most women have experienced.

[00:04:55] Dr. Jolene Brighten: We are dismissed. We're misdiagnosed as anxious. I was told for years that I just had anxiety. As it turns out, no, it's not anxiety. It is neurodivergent traits. And on top of that, no one has really done the research extensively into what does it look like to be a woman with ADHD, and also the experience of that.

[00:05:19] Dr. Jolene Brighten: So much of this is pulled out of my personal experience, my clinical experience, and then the emerging research we've only gotten in the last five years. And then what I did, because this is what my neurodivergent brain does, is I hyper-focus on all of this. I became obsessed with it, and I started making all of the connections and just spending- too much time in PubMed, my husband would say. Our, A, our relationship for every night he wanted to watch a movie, and I'm like, "I just wanna read studies about, ADHD and the connection to endometriosis,

[00:05:49] Dr. Jolene Brighten: ADHD and the connection- ... to PMOS, ADHD and the connection to PMDD, ADHD and the connection to your gut health."

[00:05:57] Dr. Jolene Brighten: And so just looking at all of the ways that research has really captured this, but it's never been put in one place. And- ... for people listening, I teach clinicians this. So I'll actually be at several conferences this year teaching clinicians how to work with women's hormones, how to manage perimenopause, specifically for ADHD, autistic, and other neurodivergent women.

[00:06:19] Dr. Jolene Brighten: But this book, you're like, "It's so dense," because it is both a user manual to the ADHD experience and your operating system, and also a clinical guide. And so I wrote it for anyone who has ADHD or loves someone with ADHD, and anybody who might treat a woman with ADHD, which is a lot of clinicians. And my hope is that if your clinician doesn't pick it up, you bring them this book because I very much believe that people get into medicine because they wanna help people, and that they do wanna uplevel their care and get patients satisfied, happy, living a full life.

[00:06:58] Dr. Jolene Brighten: And I think together, I wrote the book, but I won't be the one to change medicine. It'll be very much the women who take this information and advocate for themselves with their providers. 

[00:07:08] Christa Biegler, RD: Yeah. I can't wait to talk about late-diagnosed ADHD, which was your experience. Not the same words as late-onset.

[00:07:15] Christa Biegler, RD: I'll come right back to that because first I want to differentiate between how we stereotypically sometimes think of ADHD because of, years, decades of how we've looked at hyperactive disorder in boys. But ADHD looks different in women versus men or boys versus girls. Can talk a little bit about that before we go into women the rest of this time?

How ADHD Shows Up in Women

[00:07:39] Dr. Jolene Brighten: Absolutely. If you were a woman that, as a girl, you were in school, and you ever got a report card that said, "Oh, she's really smart, but she talks too much. She's really smart, but..." Dot. These are ways that ADHD shows up for women. They are hypervigilant. They learn, and it happens once we go through puberty, to internalize everything, to internalize the struggle, to hide the struggle, to never let it be known, and to people-please, to overachieve, to be, the gifted one, right?

[00:08:11] Dr. Jolene Brighten: So we actually show up, a lot of times, excelling in certain areas of our life, especially areas where we care, especially areas where we wanna put our attention, because we don't lack attention. We lack the ability to regulate our attention. Now, when we get older and things start to become more adult, what that l- can look like is that you can manage your husband, your children, all of these schedules, and hold it all together, but you can't make your own appointments and hold together your own life.

[00:08:44] Dr. Jolene Brighten: You feel like you are putting every ounce of energy to seeming put completely together while you're screaming and drowning on the inside. You're maybe the person where the downstairs of the house, the shameful area we might call it, that means people come into your house, and you would feel great shame about if they saw the mess and the chaos, that's clean.

[00:09:05] Dr. Jolene Brighten: That's organized. That's minimal, maybe. Maybe you have this minimal aesthetic. And then in your own living space, there's doom piles of laundry. There is piles of papers, things that you can just never get to. I remember when I was in college, my office was like a war zone, like, where I studied in, and there would literally be, like, books everywhere and papers everywhere.

[00:09:27] Dr. Jolene Brighten: And, people would normalize that and be like, "Oh, you're like that brilliant professor, right? Who has all of this chaos everywhere." And it's yeah, brilliant professors tend to be neurodivergent, too, where they have all of this chaos. But the other thing with female ADHD is it can show up as hyperactive but not in the way you think, not in the, "I can't sit still.

[00:09:48] Dr. Jolene Brighten: I'm always fidgeting." Which, by the way, there's a really good reason why ADHD-ers fidget and why we should let them, so we can talk about that. But it is more internal. So maybe you're the person who's going to bed at night and your brain won't shut up. And maybe you engaged in what you believe was TMI earlier in the day because you were trying to sound relatable, trying to cultivate this relationship.

[00:10:10] Dr. Jolene Brighten: Maybe you were impulsively interrupting people in conversation, and now you're going to bed at night and the hyperactivity is consuming you because you're replaying everything you think you did wrong in the day and hating on yourself for it. So these are not things that show up classically in the DSM for diagnosis of ADHD.

[00:10:31] Dr. Jolene Brighten: For diagnosis of ADHD, it's like we've got the hyperactive or the inattentive type or the mixed type. But at the core of ADHD, if you're like everyone experience these things?" Everyone can experience executive dysfunction to some degree. Depending on how you split it up, there's 8 to 15 buckets of executive function.

[00:10:51] Dr. Jolene Brighten: That's being run from the prefrontal cortex. This is how we manage our life. This is how we stay afloat in terms of having a career, paying our bills. Executive dysfunction for the ADHDer is so disruptive that it actually disrupts every aspect of their life, and it can feel debilitating at times. And it's not just this one-off of for example, I struggle with time blindness.

[00:11:16] Dr. Jolene Brighten: It's not something where you're like, "I'm just someone who's bad with time, but everything else seems fine." We see with ADHDers, there is dysfunction of executive functions across all executive functions, but to different degrees. So if I had a bar graph, it would be like, for me, it's like my time blindness is like the lowest.

[00:11:34] Dr. Jolene Brighten: I have no ability to manage time or work backwards with time if I'm in my luteal phase. But I'm a little bit better at organizing, praise the autism, because it has to have its rigid routine and organization. And so that's a little bit, better for me. That's like more of a strength.

[00:11:50] Dr. Jolene Brighten: And so we look at those executive functions across ADHD, and we find that there are some struggles in every single area. But we don't ask, "Do you struggle?" We ask, "How much does it impact your life?" And this is where people say, "I have difficulty remaining in relationships with people. I have difficulty keeping jobs."

[00:12:09] Dr. Jolene Brighten: So many of us are entrepreneurs 'cause- ... the quiet part that no one says out loud is that many of us are unemployable. We just can't be employed because the rigidity of the schedule, the demands, or the fact that our brain is so creative that we can see better ways of doing things that are not always welcome.

[00:12:27] Dr. Jolene Brighten: So I think that's an important thing to understand, and you can have very much similar experiences to the male ADHD experience. But because of society's influences and then the influences of hormones, which we'll get into, ADHD can look very different for women 

[00:12:42] Christa Biegler, RD: Yeah. I was almost going to ask about business.

[00:12:44] Christa Biegler, RD: I'm glad you just touched on it lightly there, which is a whole topic that a lot of business owners have ADHD. You just talked about in your own story being diagnosed in your 40s, so I wanna talk a little bit about, sometimes a topic starts to feel trendy, but at the same time we're bringing light to it.

[00:13:01] Christa Biegler, RD: And you covered some of the question marks that I already had in the answer to your last question, which was, doesn't everyone feel this way to some extent? And you have a really lovely chart on executive function and how that works in the book. So you said everyone can struggle with parts of this, it's just a matter of how much it impacts you overall, not does it impact you.

[00:13:19] Christa Biegler, RD: So we should all resonate with this conversation at least a bit. 

Late Diagnosis vs Perimenopause

[00:13:23] Christa Biegler, RD: Let's talk just a bit about late diagnosed ADHD, not the same as late onset ADHD. Looking like, there's a conversation, I think you have some diagnostic criteria in the book as well, and one of the things I consider a little bit is diagnosing ADHD with symptoms versus anything else.

[00:13:41] Christa Biegler, RD: What else are we using to maybe diagnose ADHD? The genetic susceptibility is a very large genetic c- component, et cetera. So late diagnosed ADHD, not the same as late onset. You say that very clearly in the book. It's unlikely that you have late onset ADHD. Why is that?

[00:13:58] Christa Biegler, RD: Allow me to interrupt this episode to share about a misunderstood nutrient that has given me some really cool results, and that's vitamin K2. Now, most people only know about vitamin K1 because of its blood clotting abilities, but vitamin K2 is a totally different animal. Vitamin K2 is known for bone health, but there's also a number of studies that show how useful it is in cardiovascular health and improving cardiac output in athletes, so in other words, performance.

[00:14:23] Christa Biegler, RD: With those mechanisms in mind, I started vitamin K2 before a high elevation hiking trip and had zero altitude sickness. The other thing I've used it for is sluggish thyroid. For years, I've seen calcium stuck in the tissue on hair tissue mineral analysis testing with sluggish thyroid clients, including myself.

[00:14:40] Christa Biegler, RD: Vitamin K2 is one of the most important nutrients to help calcium get where it needs to go instead of impairing thyroid function. This is a very mineral-specific nuance that can make a big difference if you don't wanna have relapsing gut issues from the sluggish motility that comes along with this subclinical sluggish thyroid issue situation that is very rampant, very common.

[00:15:01] Christa Biegler, RD: Jigsaw Health has a vitamin K2 plus E complex marketed for bone health, but that vitamin E will support the cell membrane so the nutrients can get into the cell. So it's a very nice two-for-one product, but I would also do two caps of this product, as a lot of the health benefits associated with vitamin K2 are for 100 micrograms.

[00:15:20] Christa Biegler, RD: So two caps of Jigsaw's vitamin K2 plus E is gonna get you there. You can get 10% off of any order at jigsawhealth.com with the code LESSSTRESSED10. Any time, any place, repeat orders, code LESSSTRESSED10.

[00:15:35] Dr. Jolene Brighten: This is so important, and it is what too many clinicians out there who don't truly understand ADHD are getting wrong.

[00:15:42] Dr. Jolene Brighten: You're right. It is trendy. It is very trendy right now, which is why we're seeing practitioners step into this acting like they have expertise. And what I take issue with is I think you can be an expert and not have a condition, right? Lots of oncologists have never gone through cancer, but when you talk over someone who has the experience, especially when you lack so much research and so much data, and clearly clinical experience from the way you talk about this, I think that becomes really problematic.

[00:16:10] Dr. Jolene Brighten: So what is this idea of late onset ADHD? JAMA actually came out and said, no, this is not a thing. What it is is that you either were misdiagnosed, it was missed altogether, or you had these ADHD traits that were, like, sub-threshold. Basically, you could mask it so that your practitioner couldn't catch it.

[00:16:31] Dr. Jolene Brighten: Catch me two days before ovulation and nobody knows. They're never- ... gonna know. And I have so many friends too that are like, "I would have never known you have ADHD. I would have never known that you had autism." And I'm like, oh man. Like, when you go through this diagnosis, you have to have people who knew you from childhood, if you have access to that, write a narrative about you.

[00:16:55] Dr. Jolene Brighten: Oh my gosh, did I have my eyes opened. My family writing a narrative, my husband's experience of me, and then when I was diagnosed he also has ADHD, and so of course we have children with ADHD, which is how I got diagnosed. So when I got diagnosed was so funny 'cause the ADHD, he was like, "Yeah, I can kinda see that."

[00:17:14] Dr. Jolene Brighten: I'm like, "Dude, I wanna deny the ADHD, but when I'm in my luteal phase, there's no denying. It's so obvious. It's so painfully obvious. And then, the autism, when I got that diagnosis, he was like, "This makes the most sense of everything." And I was like, "Thanks, guy." much sense to you?"

[00:17:30] Dr. Jolene Brighten: 'Cause I'm like, "Wait, what?" Although I will say it did very much resonate with me. From some of these clinicians' perspective, I'm a late onset because, I was, from the outside, seemingly very successful, had it all together. Then I enter these perimenopausal years, and now I get diagnosed.

[00:17:47] Dr. Jolene Brighten: But what it is that what came up with it was my son's provider. I was arguing, not because I thought she was wrong, but because I was like, "No, it's totally normal if you melt down because the seams of your socks are so disgusting and they make your skin crawl. And of course people struggle with emotional dysregulation, and yeah I don't make eye contact either," and like all of this stuff.

[00:18:07] Dr. Jolene Brighten: And she's like, "Yeah, that's not I just hate to break it to you not normal. We should have a discussion." These things were all coming out of my childhood experience relating to my son, okay? And what my childhood experience was. I also still have sensory sensitivity. I think it's really important for people to understand that the idea of late onset is that you just developed this.

[00:18:29] Dr. Jolene Brighten: Now, here's what I differentiate in the book that I need everybody to understand. A woman in perimenopause can absolutely have ADHD-like symptoms that she never experienced before. She does not have late onset ADHD. She has temporary executive dysfunction. And why is it temporary? Because we know from the research about one and a half, two years post-menopause, your brain is gonna come back.

[00:18:54] Dr. Jolene Brighten: It's gonna come back. You're not gonna struggle with these deficits. You're not gonna be dropping words mid-sentence. You are not going to have those struggles. This is temporary. This is not ADHD. This is not warrant an ADHD diagnosis. This is a perimenopause conversation, maybe a hypothyroidism conversation.

[00:19:10] Dr. Jolene Brighten: What we know about the ADHD experience, you had these symptoms since childhood. Your hormones came online. You were like, "I can mask it. I can fake it till I make it." "I'm exhausted. I'm burning out." "I'm having all these, struggles, but I can seem put together on the outside." Perimenopause for an ADHD woman comes about 10 years earlier with twice the symptom severity.

[00:19:32] Dr. Jolene Brighten: Not just the ADHD symptoms, but twice the symptom severity of perimenopause symptoms. 25% of those women who get big struggle with ADHD as we do in perimenopause, 25% do not recover post-menopause. 25% will remain with severe ADHD symptoms. This is a public health crisis in my opinion, because these are the people who will not get their medical screenings.

[00:19:57] Dr. Jolene Brighten: These are people who may not pay their mortgage payment on time. They may lose their car. They, may not be getting necessary medical treatments or be able to meet these follow-up visits. And so I think, this is one of the things I think is most important, is that we have to treat these two individuals differently And in addition to that, if we just call something late onset ADHD, that is very like disrespectful of the true ADHD experience.

[00:20:22] Dr. Jolene Brighten: But a bigger problem is, that you actually miss potentially other issues. Could this be early onset neurode- degenerative disease? Could this be hypothyroidism? Could this just be perimenopause? Like it could be that simple, but perimenopause is one of those things that is also very trendy to talk about now, that I'm like, not everything is just perimenopause.

[00:20:42] Dr. Jolene Brighten: Yeah. And it can be peri- perimenopause and something else. But we're also seeing that reductionistic thinking of "Oh, it's just late onset ADHD. Oh, it's just perimenopause." It's never just. The body is super complicated in that way. So for everybody listening, the only time that we would see a later onset ADHD is when we've had a brain injury.

[00:21:02] Dr. Jolene Brighten: You can acquire ADHD, and that is a different scenario altogether. And I would also say we don't just call that ADHD. If you had a traumatic brain injury, I wanna make sure you're in rehab. I wanna make sure you're with a neurologist. And so my point here is we don't wanna just call everything ADHD, and at the same time we have to understand and honor the unique experience that is ADHD.

[00:21:25] Dr. Jolene Brighten: 'Cause as you were saying, there's the genetic component. What gene? It's a cluster of genes, and that's the unfortunate reality that puts you at higher risk for autoimmune disease, for, potentially eating disorders, mental health conditions, endometriosis, connective tissue disorders.

[00:21:41] Dr. Jolene Brighten: So we see these clusters of genes that ride together, and that is what's making up ADHD. But there's more to ADHD than just the genes, which is why I think most of my book is a love letter to epigenetics and what you can do to actually influence your genes in a positive way. 

[00:22:00] Christa Biegler, RD: Yeah, I think at the end of the day, even though there's a lot to it, it does boil down to we've gotta support the system.

[00:22:08] Christa Biegler, RD: So I wanna highlight a couple of things you said, that if we glaze over something and call it perimenopause, which is such an umbrella. It's like, do people even know what's really happening in perimenopause? And so we'll go there next, what's happening that would exacerbate ADHD symptoms. But we don't wanna miss

[00:22:23] Christa Biegler, RD: One of the things that happens with the decline of sex hormones is we are at an increase of neurodegeneration in general, right? 20 years later. And so we don't wanna miss anything that is more significant earlier on. I've struggled with this concept for a while, or I've wrestled with it in my brain because I would've told you

[00:22:42] Christa Biegler, RD: Just like you said with cycles, and I think that's where a lot of this gets missed, is because if you change throughout your cycle, I'm sure you would agree. I think it's one of the most underrated things we could do is look at how we change throughout the month.

[00:22:55] Christa Biegler, RD: Because sometimes we're like, "I don't understand why my skin is worse right now." I'm like, "Is it your ovulation or right before your period? Have you considered that?" They're like, "I don't understand why I'm hungry at 5:00 PM right now." I'm like, "Is it a few days before your menstrual cycle?" All of those things would be acceptable.

[00:23:10] Christa Biegler, RD: But anyway, I've been wrestling with this a little bit because I would've said without a doubt, "Oh, I have very ADHD tendencies," until I started supporting my thyroid. And then of course, like every topic, our diagnostics for thyroid I think are really underwhelming until everything's a mess. I think we don't really

[00:23:28] Christa Biegler, RD: And then I think we have to always have be considering our adrenals, which we don't do anything about. So to my point, it's really your point, it's, we wanna make sure we're evaluating for everything else as well because we don't wanna just say, "Oh, you're just getting old." The biggest disservice to anyone is to say, "Oh, you're just getting older."

[00:23:45] Christa Biegler, RD: People look incredible at any age. This is a preservation of brain function at least, right? At a core component. But it's also preservation or improvement of imbalance of other systems. And so we have this life transition that lasts potentially eight years, and you were just talking about this health crisis of some women, 25% of women will not recover from severe ADHD symptoms after perimenopause.

[00:24:12] Christa Biegler, RD: And as you were describing that, I was thinking, who would wanna wait? eight or 10 years. It's unfortunate, right? Yeah. People feel like they don't have options. But when I look at this book or this conversation as a whole, I think there's a lot of opportunity. So let's talk about what hormone changes are happening as perimenopause starts that are exacerbating ADHD symptoms and allowing women to say, "Oh my gosh, I am dropping these words mid-sentence.

[00:24:39] Christa Biegler, RD: What is going on?" What is happening hormonally, whether quickly or slowly? I'm curious about that part. There was one title in your book where it said, "Progesterone plummeting," and what's been interesting for me as I discern this is I feel like my progesterone's not plummeting.

[00:24:54] Christa Biegler, RD: I feel like it's just very slowly changing, and sometimes I see the results of it.

[00:24:59] Dr. Jolene Brighten: I just- Yeah, go ahead. I'm obsessed with alliteration, so erratic estrogen, progesterone plummeting, tanking testosterone. It's just... It's, I just wanna- 

[00:25:08] Christa Biegler, RD: I knew it was a title. 

[00:25:10] Dr. Jolene Brighten: Yeah.

[00:25:10] Dr. Jolene Brighten: Title. It's just also the I just love titles like that. You'll see that theme throughout all of my books. Yeah. Okay, so first I wanna talk about thyroid. I think this- please ... you brought up a really important point. In the book, I have these ADHD hormone profiles for you to understand- what hormones are influencing your ADHD. Thyroid is not one of them. for anyone listening, if you right away are like, "Wait, what? That's such a huge hormone," you are right to ask that, and you are very smart. But here's the thing. Before I would ever diagnose a patient with ADHD or send them out to be diagnosed, I would make sure their thyroid is optimized, because thyroid can masquerade as ADHD when it is low.

[00:25:50] Dr. Jolene Brighten: So h- hypothyroidism pulls every neurotransmitter down with it. What is happening in ADHD is not just neurotransmitter related, it's also about glucose utilization in the brain. And from the jump, since you were in utero, your brain, if it is ADHD programmed, has struggled with energy utilization. This is gonna be very important as we talk about estrogen.

[00:26:13] Dr. Jolene Brighten: When you're hypothyroid, you drop all metabolism, including brain metabolism, and your neurotransmitters, acetylcholine, dopamine, norepinephrine, serotonin, they all come down with it as well. You will look ADHD, you will act ADHD. If I give you levothyroxine, Armour, Cytomel, something like that, and your symptoms go away because you had an elevated TSH, low T3, then we know this was hypothyroidism, not true ADHD, and that is something that should be ruled out before you are diagnosed with ADHD.

[00:26:49] Dr. Jolene Brighten: That is also something that should be ruled out before we just say you're in perimenopause. Just because perimenopause can start at 35 do you wanna know what else starts at age 35? The increased risk of hypothyroidism, specifically Hashimoto's thyroiditis, which is an autoimmune thyroid condition.

[00:27:04] Dr. Jolene Brighten: So this is something that's missing from the perimenopause conversation as well, and too many doctors out there are just all about the estrogen. Now they're all going with testosterone now. You can watch this trend of the doctors who were not trained to prescribe these hormones just discovering them, usually for themselves, and then they're like, "Oh my God, everybody, we have to talk about this."

[00:27:22] Dr. Jolene Brighten: As someone who's been prescribing hormones for 15 years, and this was part of my core training let me tell you, hormones, it is an entire symphony, and I have to be the orchestrator who makes sure that every single one is in fine tune, and not just chasing one or the other Now, what is happening in perimenopause other than the thyroid?

[00:27:42] Dr. Jolene Brighten: So we know that the first hormone to go in perimenopause is progesterone. Okay? Estrogen, she gets all the airplay, but let me tell you about progesterone. So progesterone is made only following ovulation via a temporary endocrine structure known as the corpus luteum. That corpus luteum becomes weak at first.

[00:28:00] Dr. Jolene Brighten: Okay? It's not... It's like you still ovulate. I'm 45, I'm still ovulating, but it'll become weak, and how you'll notice that weakness is it'll be a day or two before your period. Maybe you have emotional dysregulation as it is, and now it's really amplified. So emotional dysregulation is not in the DSM to diagnose ADHD, but it is common enough of experience b- among ADHDers, and it is absolutely an executive function ran by the prefrontal cortex that we can recognize it as a symptom for it.

[00:28:30] Dr. Jolene Brighten: So maybe that's what you start experiencing, and you're not sleeping, and then over time things get a lot worse. Now, the tricky thing about ADHD, as I explain in the book, is that you can have progesterone sensitivity or you can have not enough progesterone, and I help you differentiate those, but they show up very similar in terms of the ADHD experience, and that is where I just want people to understand, if you're like, "Wait, that sounds complicated," this is where women shouldn't be expected to DIY everything and practitioners should step it up to be able to support them.

[00:28:59] Dr. Jolene Brighten: Now, as progesterone begins its decline, estrogen is now unchallenged. So for the ADHDer, there may be times where you're like, "Oh, my brain is on it's just firing on all cylinders." And then you might be like, "Oh, but now my brain's on fire," because maybe it's exacerbating histamine issues that you have a propensity towards.

[00:29:17] Dr. Jolene Brighten: If you have concomitant endometriosis, we expect that you're gonna have these cyclical flu-like symptoms. You're gonna be raging. You're gonna be waking 2:00 to 4:00 AM related to that histamine. As things progress, the ovaries finally call it quits. They're like, "I'm not gonna ovulate for you anymore."

[00:29:33] Dr. Jolene Brighten: Periods are getting irregular. And estrogen, So it's like maybe a third of us does it slowly decline, all nice and lovely. Most of us, it's like rock and roll. Like it's just it's like a heavy metal concert. Like one minute you got... You're, like rocking so hard, the next you got the love ballad going on, and it's like, what am I gonna get?

[00:29:49] Dr. Jolene Brighten: I just don't know. Russian roulette of estrogen. And so with that, it becomes very unpredictable. Your brain becomes very unpredictable Progesterone is related to the GABA system in the brain. So that's our chill, our calm. At least it should be, unless you have progesterone sensitivity or intolerance.

[00:30:06] Dr. Jolene Brighten: Estrogen is gonna be pulling more on your serotonin, your dopamine, your acetylcholine, your norepinephrine. Whenever anyone thinks ADHD, they think dopamine. Sure, dopamine is important. It's wa- it's what tells us this is relevant and worth doing, and let's do more of it. But we need serotonin there to help with the neuroplasticities to say reinforce the good behavior, reinforce the things that get us what we want.

[00:30:29] Dr. Jolene Brighten: Serotonin also plays a role in mood, but not just because of serotonin alone, but also because of the neural inflammation that can arise out of low estrogen and the immune dysfunction that comes on. Then we've got acetylcholine. If you can't, remember where you put your keys, you're dropping words mid-sentence say hello to acetylcholine, or goodbye actually, because acetylcholine is all about that memory as well.

[00:30:55] Dr. Jolene Brighten: And then norepinephrine is playing a similar role as dopamine in all of this. And so what is important to understand though is that when I started talking about this like six years ago, and I talked about estrogen, how important it is, now everybody only wants to talk about estrogen and ADHD.

[00:31:10] Dr. Jolene Brighten: And I'm like, if you wanna make an ADHD woman feel like super bad, just give her estrogen somewhere in that perimenopause phase, and don't worry about her progesterone or her testosterone or her cortisol or her thyroid. The answer is not always just give more estrogen. Sometimes it's get the detox system right.

[00:31:27] Dr. Jolene Brighten: Sometimes it's support the gut health. Sometimes it is bring in just a tad bit of estrogen, but make sure we have progesterone to balance that so histamine doesn't get out of control. And so if you're a woman, especially with ADHD, and you're like, "I started estrogen, things didn't get better," what I talk about in the book is this model that I've put together for understanding this, which is the brain hormone immune triad.

[00:31:49] Dr. Jolene Brighten: And it's important to understand that as your hormones shifted, so did inflammation, and that inflammation could have affected your brain. And unfortunately, it's not enough just to give you estrogen. If neuroinflammation is set in, you... Maybe we give you estrogen, your serotonin starts to come back up. Oh, but sorry, the pathway is actually altered because of inflammation.

[00:32:09] Dr. Jolene Brighten: You're making more neurotoxic metabolites now. You're not actually getting into that serotonin, melatonin pathway. And so it become- it's so much more complex and nuanced than I think the majority of menopause influencers out there are making it. And these influencers, what's tricky is that they are licensed medical providers, but for all intents and purposes they only started prescribing hormone therapy in the last three to five years.

[00:32:32] Dr. Jolene Brighten: It is so much more nuanced. And just clinical pearl here for anyone who's like, "How do I find a provider who can work with me, who understands this nuance?" Ask them if they've ever worked with a compounding pharmacy. If they tell you, "I will never work with a compounding pharmacy," I can guarantee they've never worked with a hormone-sensitive brain like the ADHD or autistic brain tends to be, and they've never had somebody that has required way more nuance and intensive, because the standard run-of-the-mill, for example, 100, 200 milligrams promethium might make someone rage, be hysterical, right?

[00:33:10] Dr. Jolene Brighten: That's what you would be classified as, but it's really... it could make you suicidal. We have to be a lot more cautious with hormone-sensitive brains, and it's only been in the last handful of years that research has come out saying some people have hormone sensitivity. Their brain does not respond the same way.

[00:33:28] Dr. Jolene Brighten: The cookie cutter approach of just put an estradiol patch on and take some promethium doesn't work for everyone, and that doesn't mean the person it doesn't work for is broken, can't have hormones, or is just sometime- just too difficult of a patient. It means that you either have to step up your game or you need to refer.

[00:33:47] Christa Biegler, RD: Yeah. What I am hearing come out, and I was seeing in the book to summarize in a different way of some of what you were saying, is your ovaries might be checking out. They might be saying, "Oh, I'm not gonna make these sex hormones anymore," and estrogen might be declining and exacerbating symptoms for sure.

[00:34:03] Christa Biegler, RD: But if the basic systems that were always there, the detox and drainage, the gut digesting protein and making amino acid, which makes neurotransmitters, or if it has dysbiosis, creates endotoxins. If these basic systems, and there's more, adrenals, et cetera. If these systems are already not operating optimally or functioning optimally, it seems that when you add on hormone replacement therapy, which is a big topic, if you add on hormone replacement therapy, you may have a little bit of a Wild West experience.

[00:34:37] Christa Biegler, RD: And I think what you just said is really important because So often we get a stereotype around certain thing, like any word, right? So if you say, hey If the standard is 200 milligrams of Prometrium and someone tries that, and then they consider that as trying progesterone, then they probably are missing out as on optimizing those doses.

[00:35:01] Christa Biegler, RD: If they tried an estradiol patch and they didn't have luck, or if their detox sucked and it was a bad experience, they're maybe not getting the opportunity to understand how that potentially could be life-changing for them, right? Because I think no matter what, the bottom line that I take away is that you still have to support all systems.

[00:35:21] Christa Biegler, RD: All these systems matter, right? They all need... It's just a conversation of optimizing systems, and as I continue to discern perimenopause myself, what I see is that if things are a little bit off before perimenopause, then perimenopause just simply unmasks that. It just amplifies it. It just exacerbates it.

[00:35:40] Christa Biegler, RD: And I don't mean just. It's a big deal, right? It just complicates it, right? And so it makes the conversation a little bit harder And I'm not an HRT professional. I don't have those skills whatsoever, and I'm happy to not have those skills. I'm happy for someone else to do that.

[00:35:54] Christa Biegler, RD: I like to work in all those other areas, like getting the other systems optimized. But that's what I keep coming back to is there's not gonna be a time where we get, we typically get to skip over supporting the rest of our body. But when we're looking at the ADHD conversation, there's some things that come out especially true.

[00:36:11] Christa Biegler, RD: You talked about for sure ruling out thyroid. The one that rings most true is brain function, brain inflammation, and you say in the book, I thought this was super important, you say... And this is just another stereotype, right? ADHD is not a psychiatric condition. It's a neuroendocrine immune condition.

[00:36:30] Christa Biegler, RD: And you've been talking about that, but that's a big worded way of, I think, saying some of what I'm saying. It's like the brain is huge because the brain is the thing that tells your body to make hormones in the first place, right? And then the entire endocrine system is involved.

[00:36:45] Christa Biegler, RD: So what do you wanna say about, you've talked a little bit about it, but if you were talking about, hey, ADHD is not just, you're going on meds, you're hyperactive, right? If we're trying to reverse stereotypes around this, how is ADHD this broader thing, this broader systems-based approach that we need to look at?

[00:37:03] Dr. Jolene Brighten: ADHD is a full body condition. I think that is super important for medicine to get the memo on, but for people living with it to understand, because medicine has siloed this into a psychiatric condition and said that what lives in your head, stays in your head, right? Medicine loves to do that, and I think I'm just too old for the make believe anymore of telling people that their experiences aren't real.

[00:37:27] Dr. Jolene Brighten: So the neuroendocrine immune condition, what I need everybody to understand is that the collateral is the mitochondria. Mitochondria, powerhouse of your cell, right? Kick it back to when we were 12. Produces all this energy. Estrogen, as it declines in perimenopause, so does the function of the mitochondria.

Mitochondria and Brain Fog

[00:37:47] Dr. Jolene Brighten: But it's not just the function in energy production. We do see a decline in energy production, so remember everyone I said before The, the fact that you've always struggled with energy production in your brain is really important, especially as estrogen declines now in perimenopause. We can also see this postpartum.

[00:38:03] Dr. Jolene Brighten: Postpartum is basically the preview. It's the m- it's the movie trailer to what might be coming in perimenopause. And yes- ... you might not have a baby screaming at you, but you definitely will have other people who are very demanding in your life as a result of just getting older as a human on this planet.

[00:38:19] Dr. Jolene Brighten: So when I say the mitochondria are the collateral, when we have the hormones shift of perimenopause, when we have the immune system dysregulation that's happening, then what we see within the brain is that the mitochondria become dysfunctional. Now, we see more free radicals being produced. Reactive oxygen species get upregulated.

[00:38:40] Dr. Jolene Brighten: Now, what is so lame about these mitochondria is that they see that happening and they're like, "Cool, is that what we're doing? I will also make free radicals. I will also make things to damage and rip apart your cells." No, mitochondria, that's not your job. That's not what we want you to do. And so this is where it's more than just brain fog.

[00:39:00] Dr. Jolene Brighten: You feel like you're losing your mind. You have all this inflammation. When you have neuroinflammation, it is the same as inflammation anywhere in the body with your hormones. They cannot dock to the receptors. So you might have the right amount of hormones, but they can't get on the receptor.

[00:39:16] Dr. Jolene Brighten: You might have the right amount of neurotransmitters, they can't get on the receptor. 

Inflammation Blocks Signaling

[00:39:19] Dr. Jolene Brighten: So it's not often super helpful to just chase just the hormones, just the neurotransmitters, if you're not also addressing the inflammation. Now, spoiler, we are absolutely garbage at this point in time of being able to quantify neuroinflammation via blood testing.

[00:39:37] Dr. Jolene Brighten: We just don't have the capacity. There are some labs out there that do some sophisticated testing. They are not cheap, but they are better than nothing if you are someone who's like, "I have to know." I think we can look at things like do you have C-reactive protein elevation? I don't like doing cytokine panels on people. There's sometimes patients who want them, but they're expensive. They're not typically covered by insurance. We can also look at things like do you have diabetes? Do you have polyendocrine metabolic ovarian syndrome, formerly PCOS? Do you have endometriosis or adenomyosis?

[00:40:10] Dr. Jolene Brighten: If you have these other conditions, I already know you have inflammation. Those conditions by definition are, in terms of, like, how they operate in your body- Are highly inflammatory. You will have neuroinflammation. And so we have to be addressing that component. But it's not just the neuroinflammation,

[00:40:26] Dr. Jolene Brighten: My book is not just about the behavior, and it sure as hell is not about how do I get you to be more productive in society. I really take issue with this pathologizing the female experience and being like, how do you biohack your luteal phase so that you're more productive? Maybe you're not supposed to be.

[00:40:43] Dr. Jolene Brighten: In the book I say the Luna, like she shines bright for the full moon. The moon has its full moon moment, and then it dips out for a couple days in the new moon, and nobody's mad at her. Nobody's like, "Oh, what the hell? Why can't you shine every day?" We're following roughly similar to the lunar cycle.

[00:40:57] Dr. Jolene Brighten: Why can't we have a few days where not everyone expects us to be everything to everyone? Like, why? So I want women to understand that, yes, ADHD may be showing up and the way we- we're gonna quantify that in medicine and, we're gonna go through a whole checklist and be like, "What are your executive dysfunctions?"

[00:41:14] Dr. Jolene Brighten: But you can also be having, these concomitant co-occurring conditions. So you can have connective tissue disorder. There's a whole chapter on sleep. Why? 'Cause 70% or more with ADHD struggle with sleep. Oh, hi, perimenopause. Almost everybody struggles with sleep then. So of course we're gonna expect things to get worse.

ADHD Tools Sleep Food Movement

[00:41:35] Dr. Jolene Brighten: And rather than telling everybody... there's a lot in this book that I think people are gonna be like, "Oh, yeah I know I should be exercising. I know I should be sleeping." Or you mentioned protein. You may not be aware of the research that came out last couple years showing that ADHDers probably need more protein, and they probably need higher omega3 fatty acids because they have altered metabolism of these nutrients.

[00:41:58] Dr. Jolene Brighten: This is the tip of the iceberg. I'm like, what else are, do we not know about this condition- ... and about how we should be supporting it? But I think what's important to understand is that, while I'm saying, sleep is important, exercise is important, it's not enough to tell an ADHD-er those things.

[00:42:14] Dr. Jolene Brighten: A lot of us know what we should be doing, what we need to be doing, and what I did different in the book is I actually went through like, why are you not doing these things? So within the sleep chapter, it's very specific. Maybe there's nothing wrong with your sleep, but your default mode network needs time to process your day, and I give you tips on how to do that.

[00:42:35] Dr. Jolene Brighten: And then I'm like, maybe it is a progesterone problem. Maybe it is a histamine problem. Maybe it's something else. How do we address that? Same with exercise. Yes, we all know we should exercise, but for some ADHD-ers, it's the sensory sensitivity, it's the executive dysfunction, it is the emotional dysregulation that comes up because of lived gym trauma of like whatever happened in the gym in the past.

[00:42:56] Dr. Jolene Brighten: And so we have to solve these problems from the ADHD perspective, and that's what I think medicine has gotten so wrong, is that they have said it's really just, here's the neurotypical male. It's not even like, here's the neurotypical woman. And it is, how do you fit in this box?

[00:43:10] Dr. Jolene Brighten: And if you don't fit in this box, you're broken. You're the problem. Figure it out yourself. And that's what I'm like, I wanna push back against. We need to approach this differently. We need to give them different tools, and we need to recognize that like some of this stuff we're asking them to do is so boring.

[00:43:26] Dr. Jolene Brighten: And when the ADHD brain is bored to death, it can literally shut down and fall asleep, and that is not something that it's like, oh, this person's lazy. They didn't get enough sleep last night. It is because their, all of their neurotransmitters drop, GABA rises and is just "Go to bed, 'cause this is so bad, I don't even wanna be present for this anymore."

[00:43:45] Dr. Jolene Brighten: So how do we address this person differently? 

[00:43:49] Christa Biegler, RD: Yeah. There's just a lot that we could unpack here, and we don't have time to go into all of your types of ADHD, but you go into so many, estrogen-driven, progesterone sensitivity, cortisol dysregulation, insulin dysregulation, androgen dysregulation, and you just touched on some of that , in how you responded to that as well.

[00:44:05] Christa Biegler, RD: You were just talking quite a bit about inflammation, and so I do wanna touch on why inflammation is rising in general in perimenopause. And then I wanna answer that question you started with, which is why is a... Which is a separate question, but why should ADHDers fidget? 

[00:44:21] Dr. Jolene Brighten: Oh, yes.

Gut Shifts Drive Inflammation

[00:44:22] Dr. Jolene Brighten: Okay let's start with why is inflammation rising? So it's hormones, but hormones are not operating in a vacuum container, right? They're shifting and they are changing, and I literally do lecture on this for two to three hours sometimes, so the one thing I would have people take away from this is, as your hormones shift and change in perimenopause, so does your microbial diversity.

[00:44:43] Dr. Jolene Brighten: And as your microbial diversity diminishes, we see that not only are you susceptible to infections and dysbiosis, but there is a propensity towards intestinal hyperpermeability, what the layperson calls leaky gut, which is honestly a really good term for it. With, Proteins, undigested food microorganisms, they start to get through.

[00:45:05] Dr. Jolene Brighten: The immune system's not having that. The immune system has a job: sound the alarm. But that alarm is constantly going off. Then we couple that with the fact that there's a lot of HPA axis dysregulation, so how the adrenal glands are operating with the brain. If that happens in perimenopause, that further lends itself to gut dysbiosis, to leaky gut.

[00:45:26] Dr. Jolene Brighten: So your gut relies on these hormones significantly, and what we know from the research is that when your estrogen is gone, you have the microbial diversity of a man. Now, you're never supposed to have that low of microbial diversity, because what mama passes on to baby isn't just genetics, isn't just maternal mitochondrial DNA.

[00:45:46] Dr. Jolene Brighten: It is also the microbiome, and that plethora of organisms that exist in your gut are really important. It also serves as a primary reservoir for lactobacillus, which is what the vagina and the reproductive tract should be 90% or more of, and when they get skewed, they have to pull from the gut and borrow, and we don't have that source anymore.

[00:46:05] Dr. Jolene Brighten: So that's what I would, say, and that is why there are two chapters dedicated to gut health in the book. One of them's like, "Let me break it down for you, and let me help you heal your gut." And then another that's like, "How do you feed your gut?" Because already having ADHD, we know from the research, which is mostly done in children, right?

[00:46:23] Dr. Jolene Brighten: Because that's where they wanna do dietary interventions. We know that there is altered microbial diversity. There's not a ADHD-type gut, although I think we may find in the future that there becomes a pattern that we see, but as of right now, it's just microbial diversity is just not there in the same way.

[00:46:40] Dr. Jolene Brighten: Part of it may be what you got from your mom Part of it may be just your operating system, but a big part is likely how you've also been feeding yourself. Because feeding yourself is hard, and just because we're supposed to do it three times a day, we take it for granted, but it is hard. Now, to your point, why should ADHDers fidget?

[00:46:57] Dr. Jolene Brighten: So if your mitochondria is the main power supply to your house, your cell, I want you to think about movement as the crank generator. You literally gotta go crank it if you want energy. It's a backup supply. So the brain can use lactate or lactic acid, so the soreness in your muscles, that's lactic acid buildup.

[00:47:17] Dr. Jolene Brighten: The brain will use that for energy. So this is a brain, if you have ADHD, that's already struggling with g- glucose utilization and producing enough energy. The brain is like, "Fidget, move, generate more energy," because we need this lactate buildup so that we can use that for energy. This is why whenever people are like, "What is the one thing you recommend for ADHD?"

[00:47:41] Dr. Jolene Brighten: And then they're always surprised, 'cause I have a supplement company. I have a great supplement called Radiant Mind that I do love, but I'm like, "If there was one thing, it would be exercise." Because if you can put in 20 minutes of physical activity, that can buy you two to three hours of focus and improved attention.

[00:47:57] Dr. Jolene Brighten: That's huge. And for some people, that's better than what ADHD medications are getting them. And it has no side effects. The side effect is you start lowering cancer risk, right? You lower visceral adiposity. You gra- You gain muscle mass. You support myokine production.

[00:48:12] Dr. Jolene Brighten: You modulate inflammation, right? You help with insulin sensitivity. Wow. Yeah. Those are some pretty tough side effects there for exercise. Yeah. So this is why... okay I will say for women in perimenopause, your husband fidgeting is the worst thing in the world. I hate when my husband's and he's a musician, so he's like, "Oh, yeah, I'm just gonna do air drums on," or not air drums, but, "drums on my stomach or my legs." And it drives me nuts, but I always have to be like, "This is how his brain is generating energy. He needs this." I'm someone that if I feel the need that I'm like, "Oh, gosh, I feel like I gotta..."

[00:48:42] Dr. Jolene Brighten: I do talk with my hands. So let me just say Latina being from a- Mexican American culture I do have an up of it's normal for me to talk with my hands, and yeah, I should own that. That's my own kind of my- 

[00:48:53] Christa Biegler, RD: Your own fidget ... 

[00:48:54] Dr. Jolene Brighten: but I do, before this, I was like, "I have to exercise."

[00:48:56] Dr. Jolene Brighten: I have to make sure that I get my movement in. And this is something in the book I think is just really important for women to also understand, is that when you're in perimenopause and your estrogen declines, you will shift your fat deposition to being packed around your organs. And I cite that visceral adiposity as a source of inflammation that is hijacking your brain. And then I give ... my publishers were just like, "This is, like you're just everything. You're like, 'Oh, here's all the solutions.' Do they really need that many solutions?" And I'm like, "I'm telling you, you're accumulating this deep visceral adiposity, this belly fat that's like trying to take you out before your time that is gonna make you past tense like very early."

[00:49:36] Dr. Jolene Brighten: And you guys are like, "Yeah, but they can just wait to get to the exercise chapter." I'm like, " Do you know ADHD? You cannot tell them, 'Oh, okay, and now read another 200 pages.'" 

[00:49:47] Christa Biegler, RD: I feel that. I was also trying to solve for every problem in my book, and the publisher said, "This is supposed to be a cookbook.

[00:49:55] Christa Biegler, RD: Go ahead and cut out 10,000 words related to this." But I love everything you just said, and what I wanna highlight around it is whether we like it or not, life is a developing skills and learning skills, and you get to use those skills more than once. And I mention this here and there on the podcast is that so often when we have something that's not working, we wanna fix it, we wanna outsource that, we wanna, we want someone else to fix it.

[00:50:17] Christa Biegler, RD: Some way we want it fixed so we don't have to wanna think about it again, right? 'Cause we just we're demanded in many ways in life. But when you were just talking about the importance of gut health, amplifying in perimenopause and HPA dysfunction amplifying, I agree. If your cortisol was not in a great place before you started transitioning to perimenopause, it will probably not be a beautiful transition necessarily, right?

[00:50:39] Christa Biegler, RD: You're going to have the opportunity to develop and harness and reuse these skills. And I think we can all use, I know I do, I can always use more motivation for exercise. You can be told that a million times, right? But it's always good. I'm a questioner, so I'm like why?"

[00:50:55] Christa Biegler, RD: And I love hearing all of the reasons because that was also a skill, right? It's not like you just came out of the womb... you did sorta come out of the womb and knew how to move at that point, but as we age, it is still a skill, right? It's a skill to figure out what is working for us no matter what.

[00:51:08] Christa Biegler, RD: It's a skill to be able to become attuned to exercise and realize how we feel in our body afterward, right? That's a skill- Yeah ... that a lot of people don't even employ. 

[00:51:20] Dr. Jolene Brighten: I wanna ask you 'cause you've been online for a long time. I have made this observation, I'm wondering if you've seen it too, that we've moved away from diet wars and now we're in exercise wars.

[00:51:31] Dr. Jolene Brighten: And so it's like the Pilates versus who's lifting weights crew. It's the, hot girl walks versus the are you a- doing your HIIT training? And we're seeing like... So we saw like there was like... I feel when it was paleo, right? So like this is 10 years ago.

[00:51:47] Dr. Jolene Brighten: And it was like paleo versus vegan versus this. And now I feel like I'm seeing the exercise of "Oh, I lift weights, and walking is not exercise." And then the people who are like, "Oh, but like I walk, and like there's no reason to also lift weights." And then there's the Pilates, like people hating on Pilates.

[00:52:03] Dr. Jolene Brighten: And I'm like- 

[00:52:03] Dr. Jolene Brighten: Why can't people just enjoy themselves? 

[00:52:07] Christa Biegler, RD: Yeah, 

[00:52:07] Dr. Jolene Brighten: no Why can't you just be like, "This is my jam. Oh, that's yours? Cool." But it has to be so polarizing, and , the camps have become this us versus them when it comes to exercise. And I'm like, I'm gonna tell you, the only exercise people are going to ever be successful with is the exercise they actually like doing.

[00:52:25] Christa Biegler, RD: Yeah. My bigger issue for a long time was not wanting to exercise and dealing with the ident- I worked with a coach. I'm like, "Why do I not wanna do this thing," right? Anyway, and so we talked about identity, et cetera. And so my point is, yes, if you don't want to do it, if it's not entertaining for you

[00:52:39] Christa Biegler, RD: And actually for my ADHD tendency brain, I had to try a lot of different programs before I found one that was entertaining enough to operate through. And I was like, "This is the best app in the world for ADHD. I love it so much." But to your point about exercise wars, I hadn't thought about it before quite like that.

[00:52:56] Christa Biegler, RD: Obviously, I feel really front row, and I'm excited for diet trends, over restriction to diet. That's been my whole career. A lot of it is the detriment of that. But I saw that sort of cascade. I think when carnivore sorta took over, it also came with this muscle man mentality, and I thought it was a war a little bit between the biohackers and the people that are like, "Can we be a little bit softer and nicer," right?

[00:53:18] Christa Biegler, RD: The masculine versus feminine. As you were describing it, yeah, I do see it a little bit. I hadn't really thought about it, 'cause I'm over here just trying to get my own exercise done- ... and not worrying about, whether or not I'm ... if I wanna wear a weighted vest, great. If I don't want to, great.

[00:53:32] Christa Biegler, RD: I don't need to be polarizing about it. Yeah. That was 

[00:53:33] Dr. Jolene Brighten: something that became controversial, too. So I was a group fitness instructor in college, and I taught this senior fitness program. And just was trying to get senior citizens to lift weights. And this is why I get really mad when anyone's like, "Oh, what are you picking up, those three to five pound pink weights?"

[00:53:50] Dr. Jolene Brighten: I'm like, "Yeah. Do you know how many, like, 70-year-olds I got to pick up three to five pound pink weights and actually start doing something at that age?" But they all would wear a weighted vest, and they were like, "We're doing it," like, all of their bone doctors were like, "You gotta wear a weighted, weighted vest."

[00:54:06] Dr. Jolene Brighten: So I was like I'm wearing a weighted vest then." Okay, I'm in my 20s, and I'm like, "If you guys are wearing weighted vests, then I'm wearing a weighted vest." Because if you're doing that to prevent osteoporosis, like I don't wanna get that either. And so when weighted vests had its moment, I was like cool."

[00:54:20] Dr. Jolene Brighten: I think it's a great thing to add a little more resistance or especially there's certain exercises where maybe you can't hold as heavy of weights and you put on this weighted vest. And then we see all these people being like, "There's no research to support wearing a weighted vest."

[00:54:34] Dr. Jolene Brighten: And I was like, did she go walk though? She put on the weighted vest, and then she went and walked, and she felt stronger for it, and she was motivated, so shut up about that. Yeah. Let her do her thing. Just- Yeah ... people are happy right now. The biohacker thing, when you were saying people wanna soften, I think it is because biohacking took all of the research that was done only on men, and then because the primary consumer of health content, h- supplements, everything are women, they just said same," and they weren't honest about it.

[00:55:06] Dr. Jolene Brighten: They never said, "Oh, all of this research was done on men." They just said, "Oh, this research applies to you." And I think that's the pushback now is women being like We're not the same. We're not the same. I detail in the book just how absolute garbage research really is in women's health, not just women's health conditions, but, everybody cites like, "Oh, it wasn't until 1993 that, women were had to be included in drug trials."

[00:55:30] Dr. Jolene Brighten: And I'm like, "They're not." I hate to break it to you, but you're not reading the research because nothing has changed. What do they do? Animal model is a female? Castrate it. Okay, how is that the same as me? Oh, an- the model is a human? Okay, let's measure her during this very, very finite window when her hormones are more closely matched to a man, and we don't wanna deal with progesterone, so do not measure her in her luteal phase.

[00:55:57] Dr. Jolene Brighten: They have not really included us in drug trials, in any of these trials, in the way we actually exist in the world, and this is why women have twice the side effect rate when it comes to drugs, twice the adverse side effects compared to men, because they have never actually studied us. They have only said, "You have to include them," but the people who make the laws don't understand the science, don't understand the research, and I need everybody to calm down online being like, "We're now included."

[00:56:27] Dr. Jolene Brighten: We are not, okay? In the way that we actually exist, we are not actually included. Until they actually track a woman throughout her entire cycle, which they're not gonna do that, it's way too expensive, and also, they can't put you on the pill because that's gonna mess with cortisol, and they know that putting you on the pill can mess with inflammation, mess with insulin, mess with all of these things and truly measure things.

[00:56:49] Dr. Jolene Brighten: Although sometimes they will. They'll put you on the pill and then be like, "Oh, you're in this trial," and we measured it against women's hormones. No, you actually didn't. That's not true either. But what happens after we ovulate? We're possibly pregnant, and if there's a risk of pregnancy, nobody wants you in a drug trial.

[00:57:06] Dr. Jolene Brighten: Nobody wants to- ... experiment on a non-consenting human in the womb. Nobody wants to do that. So- Yeah ... I can be fair and give science and, drug manufacturers there are limitations, and I can- ... understand that, but I need all of us to understand that we haven't truly been measured.

[00:57:23] Christa Biegler, RD: Yeah. It's a slow, glacial process to change that, and so- I feel like knowing having the N of one of yourself is the best defense you can possibly have in this age, in this day, and educating yourself and understanding and learning these skills. Okay one last thing. 

Diagnosis Pros Cons and Wrap

[00:57:43] Christa Biegler, RD: So there's some things I really love in the back of the book, and specifically one of the things you talk about is how to use this book with your doctor, and bring this to your appointment and be specific, and you give, like, one-sentence scripts.

[00:57:57] Christa Biegler, RD: It's the best version I've seen in writing of this in a book, so I loved this. And this is also, I think, where you give the diagnostic, the traditional diagnostic criteria of ADHD I already shared a little bit with you about how optimizing thyroid was pretty dramatic for my brain function and focus at once upon a time.

[00:58:18] Christa Biegler, RD: And this is a, ADHD a very popular topic. I actually unsubscribed to lots of content around it a few years ago. But I've never felt drawn to getting a diagnosis for ADHD because I didn't feel ... So often we think the diagnosis is going to change everything- ... and it's just some information.

[00:58:35] Christa Biegler, RD: But as I review this book, I'm synthesizing all the opportunities overall. I think that the, there's always opportunities to meet your body where it is. My question to you is, how would you challenge my neutrality or avoidance around getting a diagnosis or anyone who would say, "I don't wanna get a diagnosis"?

[00:58:52] Christa Biegler, RD: And I might be the weirdo. I feel like people love diagnoses, that they love a test that will just tell them that something is wrong. But really they're typically using symptoms and less brain scans for diagnosis. Is that correct most of the time? 

[00:59:06] Dr. Jolene Brighten: Yeah. There's no evidence that we can use a brain scan and diagnose ADHD at this time.

[00:59:11] Dr. Jolene Brighten: I wish there was something that was really hard science, right? But it's not. It's soft science. It's an intake form and, a screening exam and conversations. And I think what's important for people to understand is that the majority of healthcare practitioners when asked in surveys, like, "Do you feel confident diagnosing ADHD in adults or treating it?"

[00:59:34] Dr. Jolene Brighten: They do not. 

[00:59:35] Christa Biegler, RD: Yeah, 

[00:59:35] Dr. Jolene Brighten: that makes sense. So it's really hard. So I'm actually gonna make a case of why not to get a diagnosis first. Firstly, it's expensive. Secondly, you don't know how many practitioners you'll have to actually see until you feel like you got a real true fair evaluation. Thirdly, I do think that clinicians are more comfortable diagnosing someone with ADHD than they are with autism, and now we're starting to understand- this hybrid AuDHD, is what it's called, autism and ADHD. There's a high- ... co-occurrence between these. It sh- it has to be treated differently. We haven't even studied it, but I see time and again that stimulants don't work for people. If you know you don't want to try stimulants, which, in the book I do talk about how it helps with mitochondrial function, it helps with inflammation- Mm-hmm but only if you actually have ADHD. If you do not, all the tech bros in Silicon Valley, you are jacking up your brain in the worst of ways. It is not a good medication to take. But there's also alternatives, i'm someone who has I don't say this because I wanna sway anybody any way or say that one way is better than the other, but I have multiple drug sensitivities, drug allergies.

[01:00:38] Dr. Jolene Brighten: I am the person if you're gonna have a side effect, it's gonna be me, and I hate it. So I'm like, I'm not even gonna try stimulants. I make things work with like- there's good research on saffron, there's good research on memory with citicoline, there's good research for ADHD with bacopa. There's other things that I also use for my ADHD that help my endometriosis, help my PMDD, which is N-acetylcysteine.

[01:01:02] Dr. Jolene Brighten: So there's those things, but those are all on top of my lifestyle. Those are all on top of making sure I feed those gut bugs, making sure I keep inflammation down, making sure I'm moving my body, making sure I get good sleep, which I should have said this with the exercise piece. You build up lactate, oh, you'll use it for brain energy.

[01:01:19] Dr. Jolene Brighten: If you don't sleep at night, your glymphatic system doesn't flush it, and your brain doesn't work the next day. So it's super lame. You gotta, like you- ... you wanna build it up, but you also gotta sleep, friends. What I wanna say is that if you're like, "I don't need accommodations, I work for myself.

[01:01:33] Dr. Jolene Brighten: I don't wanna be on a medication." Then you wanna ask why would you get the diagnosis? In some places, you're $5,000 out of pocket. Maybe at the least you're $3,000 out of pocket. What... insurance these days is just absolute garbage. It's a criminal network, honestly. I'm just like, "This is absolutely a cartel."

[01:01:52] Dr. Jolene Brighten: And I will go on record saying that. They... there's no knowing if they'll cover it. So for all those reasons, I don't know that a diagnosis is necessary. I think it's enough to be like, "This is the ways that my brain struggles, and I want to support it." And that's really... I wrote the book.

[01:02:09] Dr. Jolene Brighten: I do explain in there that if you're in that perimenopause phase where you're like, "My brain just isn't working," everything in here will work for you. It will help you. And then good news you've got a couple years afterwards. But also everything is also helping prevent dementia, for which we're like- two-thirds of that population, so that's great. That's the things to consider. Now, why might you wanna pursue a diagnosis? Could it be something else? Maybe you're wrong, 'cause you're not a clinician, and understanding your symptoms and diagnosing it when it's you is like reading a book that's too close to your face.

[01:02:38] Dr. Jolene Brighten: You have all the words, but you just can't see 'em. You can't make 'em out. So what if this is bipolar? What if this is hypothyroidism? What if this is something else, right? And so that's when I think it's worth pursuing a diagnosis. What if you need work accommodations? What if, your, the things you struggle with is travel, and you travel for work?

[01:02:59] Dr. Jolene Brighten: If there are accommodations that you need, then yeah, you're gonna have to get a diagnosis in order to have those accommodations. If you feel like you're becoming debilitated by this, yeah, you should pursue getting this worked up and making sure that nothing else is there. I talk in the book that I do think self-diagnosis- is imperfectly valid.

[01:03:21] Dr. Jolene Brighten: So it's imperfect, all right? And I get really cautious about it because as a clinician, I don't want you to miss anything. But if you say- Yeah ... "I think I have ADHD," not I do have ADHD, therefore I do need these things," and you're just like, "I want to change my life. I wanna start working with my brain," I think that's a totally valid thing for somebody to do.

[01:03:41] Dr. Jolene Brighten: I think, a lot of pushback happens online from people who have access, right? People who have had access to get a diagnosis and they don't wanna share the space with people, or because some people are, they are totally just asses, where they're out there being like, "I have quirk. I'm so quirky.

[01:03:56] Dr. Jolene Brighten: Look at my little ADHD thing." And you're like, if you only knew, like, how debilitating this can be. Like, this is a disability. It's, a lot of times people will say "Oh, they're superpowers." And I'm like, I can absolutely honor superpowers I have. A superpower I have is that I can plan like no one else, and I can put down, I can put together a plan, an itinerary, and have, like, all of this put together.

[01:04:19] Dr. Jolene Brighten: And then you wanna know my kryptonite? If we deviate from the plan, my nervous system thinks I'm dying. And I have to accommodate that. So I'm like, for everything as a superpower, it's usually because there's this need to compensate, to control, to do things so that you can be well-regulated.

[01:04:35] Dr. Jolene Brighten: I didn't make a case, I think, for anybody going out and getting this diagnosis. And I think if somebody's like- I suspect this is me. I resonate with all of this. I think it is me. I wanna do things to support myself." Valid. Do that. If you're like, "I'm being debilitated in some way", please make sure it's not something else, because the truth about ADHD is it's rarely riding solo.

[01:05:00] Dr. Jolene Brighten: ADHD is associated with a much higher risk of major depressive disorder, of PMDD, which is way more severe than PMS, and people have suicidal thoughts, so it's a very serious condition. It's very common to have, like I said, ADHD and autism, connective tissue disorders, autoimmune disease, hypothyroidism.

[01:05:21] Dr. Jolene Brighten: Hashimoto's is very common with ADHD. So I just wouldn't want someone to say, "This is just ADHD," the same I don't want someone to say, "This is just perimenopause," and not- ... make sure it gets worked up. And the unfortunate reality is that healthcare access in the United States is making it so difficult for people to do that.

[01:05:39] Dr. Jolene Brighten: So for everyone listening, I think the choice is ultimately up to you, and you really have to consider, what will this diagnosis do for you? For me, I will just own that I have a propensity to gaslight myself. I think after... When you go 29 years of menstruating and then finally get a diagnosis of endometriosis, I had to really come to terms with, like, how much gaslighting was done to me, but also how much I integrated that.

[01:06:03] Dr. Jolene Brighten: And my mom was also very good at gaslighting me and being like, "Oh, yeah, your period, it doesn't hurt that bad. You just need to drink water." I'm like, "I vomited every period." No, when I came to a doctor. I was like, "Not normal. Not normal." But that was the other thing, is that I was like, "No, you're imagining this.

[01:06:21] Dr. Jolene Brighten: Maybe it wasn't that bad." And I was, like, diminishing a lot of things. But then I also was like, "I need to know what I'm working with here, because I'm also- ... a mom, and my kids need to have this as part of their health history." When you go in and they say, "What conditions does your mom have?"

[01:06:36] Dr. Jolene Brighten: They need to know that information- Yeah ... going forward. Because as we study this more, I think we're gonna see that if someone has ADHD or autism and they have painful periods, that's endometriosis until proven otherwise. If someone has ADHD or autism and the, seven to 10 days before their period is the worst of their life, they have PMDD until proven otherwise.

[01:06:57] Dr. Jolene Brighten: We're gonna start seeing that because you got this certain operating system, that there are diseases that we immediately say, "Okay, because of this, you have a risk factor for this," and we identify it. And so personally, I don't know if that helps anyone, but that was personally for me, is that I'm like, my children need to have this data as they move forward.

[01:07:15] Dr. Jolene Brighten: Because unfortunately, I cannot be here forever, and at one point in their life when I am no longer here, they're gonna need to know what this was. When it comes to my grandma, they were, like, so secretive about their health- ... that I'm like, I don't know. I don't really know what was going on.

[01:07:29] Dr. Jolene Brighten: And I look back- ... at things my mom went through, like- Being in bed for months on end, and she wasn't able to get up, and she was so fatigued, and her- she was losing her hair. And I was like, "Oh." My mom had Hashimoto's. I was in high school, and I remember this, and only now am I like, she had Hashimoto's, but she didn't talk about it.

[01:07:45] Dr. Jolene Brighten: We don't talk about it. Yeah. I'm like, that would've been good for me to know. That would've been really good for me to know because I developed Hashimoto's, and I would've known I was at risk for this. 

[01:07:54] Christa Biegler, RD: Yeah. Lots of good points. Lots of opportunity. One thing I hear from you saying there is that no matter what your decision is it's okay to just have your own back on either side of it, depending on what's the right decision for you in general.

[01:08:07] Christa Biegler, RD: And related to when you make the plan and it doesn't go that way, I was giggling because I like to train my prefrontal cortex, into phrases that are more helpful. And so I like to say I'm just a product of inertia." So if we get off track around it, it's like I was already barreling toward that plan overall.

[01:08:24] Christa Biegler, RD: So much we could cover. So many opportunities for you to cover more in the future. We didn't really touch on ADHD and autism, which I would've liked to. We didn't touch on you ... One thing I was impressed by, and I think this is just the age that we're in now, is you touched on GLP-1s in the book, which I think was important because so often, and I tell this to my very intelligent clients, I'm like, the amount of times I need to just talk to highly intelligent women about eating and sleeping.

[01:08:50] Christa Biegler, RD: Just like, that we have to just check ourselves, right? 'Cause we'll just keep working, right? Right through lunch, and then we're like, why can't I function anymore? 'Cause my brain needed some energy, right? But you talk about that as a consequence, and so we need to consider those things when this kind of thing is coming into the picture.

[01:09:05] Christa Biegler, RD: And then I think there's just a whole, conversation. You touched a little bit on some of those nutraceuticals. People will continue to use probably ... I think we'll probably see peptides staying. They've been around forever anyway, right? But I think we'll continue to have those conversations ongoing, so I thought it was useful you put that in the book.

[01:09:22] Christa Biegler, RD: I think we covered a lot And we barely scratched the surface at the same time. Where can people find you online and get the book? 

[01:09:31] Dr. Jolene Brighten: So you can find me at drbrighten.com, D-R-B-R-I-G-H-T-E-N.com. That is my main hub. And if you go there, /adhdandwomen, there are bonuses that you can grab that are gonna be up until the week the book comes out, and then they go away.

[01:09:48] Dr. Jolene Brighten: So- ... if you're listening to this, go grab them now. And then you can find me all over social media at drjolenebrighten. And I also have the Dr. Brighten Show, which I need to have you on as a guest as well. 

[01:09:59] Christa Biegler, RD: Perfect. I can't wait. So thank you so much for coming on today. 

[01:10:03] Dr. Jolene Brighten: Yeah, thanks for having me.

[01:10:04] Christa Biegler, RD: Thanks for listening to this week's show. For all the links mentioned in this episode, from submitting your questions and comments to picking up The Cortisol Reset or Finally Focused: Mental Clarity on Demand, you can find all of those links in the show notes below this episode. See you next week