Nourishing the Neurodiverse Child

In this episode I have a fascinating chat with Lucinda Miller, Naturopath and Functional Medicine Practitioner who specialises in health approaches to help neurodiverse kids. Lucinda is the founder and clinical lead of Nature Doc, a UK wide team if Naturopaths, Nutritionists and Nutritional Therapists. 

Lucinda talks about how she got into this area as a result of her experience with her own children. The crucial role of diet in neurodiverse children is discussed at length. This episode provides invaluable information and golden nuggets of easily actionable steps to support parents with neurodiverse children. 


We hope you enjoy this episode. 

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Transcript

Peter Williams  0:02  
So welcome everyone to the new podcast. I've got Lucinda Miller, who I'm going to be interviewing today, and meaning Lucinda have only known each other for in glancing, I would say over the last couple of years, I've heard of your name, of course, for quite a long time because you've been in the nutritional world space. I'm not going to say you're sort of one of the older people in the space, but you've been in for a long time. And I think you've actually been doing that longer than I have so and I've been in it for 25 years. So Lucinda, you have a you've created a very specialist niche that I'm getting more and more interested in, simply because I think there are some traits that I see in particularly one of my kids, but also I think there's lots of traits that we see, and we'll get onto that in regards to a lot of my patients. And I think again, as a clinician in practice, there are so many, so many things that you need to be able to be good as a clinician. And one of them is understanding how people see the world and the way they do things, which leads into your specialist area, which I'll probably define as, and you can, of course, we'll introduce you, but it's is a sort of a specialist in understanding neurodivergent patients and understanding how they may have different health challenges than than what's the word when? When we're normal, neurotypical, neurotypical. Sorry, yeah, exactly. So look, I think you've been in a game a very long time, which is great. You've got three books, and we'll plug your new one, brilliant brain brilliance, which is your third book. And again, we can discuss that. But why don't you give us your background, how you started, how you got into this specialized area? And I think we can, we can sort of start getting into some terminology after that as well. That'd be great.

Lucinda Miller  2:02  
Well, great. Thank you so much for inviting me on. Pete, it's pleasure to see you. So yes, I basically spent the latter part of my time at school and university half asleep. And I put that down to a sort of chronic fatigue kind of state, and it's why I sought out help from a naturopath. And actually it was life trance, just like life changing seeing the naturopath in terms of my energy levels and so forth. But I don't think I'd associated it specifically with neurodivergence, but now knowing that I have ADHD, and I was diagnosed at 31 and I'm now in my mid 50s, I think that a lot of it was because, you know, when you are neurodivergent, you have to your brain you need to use so intensely to be able to get through a typical day. And equally, at, you know, university, that focus and concentration for trying to get an essay done. I just, I think that's why I got so tired, and so I think it was part of the picture. So it what I didn't really know about neuro divergence, specifically, I knew my aunt couldn't spell and things like that, but I think we didn't really have diagnoses in those days. So much.

Peter Williams  3:19  
I've just been out with the dog, and I was walking back thinking about, what were some of the questions I was going to ask, and one of them was, we just never heard about this 20/30, years ago. So is that because, number one, it was there, but it just hasn't been recognized, or number two, it really wasn't there in the levels that we're seeing now.

Lucinda Miller  3:37  
It's a really good question, and it's one of those ones that could be debated over and over, but I would say that kids of my age, when they were kids, they probably might have got a diagnosis of dyslexia, if they were, say, two to three years behind in their learning. So it was a big red flag, there's something going on and but, and then I don't think ADHD or autism was ever spoken about. And then I think I became sort of aware of the ADHD space, probably from my mid 20s onwards. So A, exploring myself, but B, kind of understanding, you know, and it was becoming, I think everyone was thinking it was these hyperactive little boys, and they weren't thinking of all the other subtypes of ADHD. So women tend to mask things more easily. Girls, again, mask things more easily. There's often this inattentive type, where they tend to be the Day Dreamers, and so there's lots of different types of ADHD. And then, you know, I mean, some people would say the first time they'd heard of autism was Rain Man. Whether that's a good representation or not, it's a debate, but it. Again, it's opened up people's understanding of what it could be or seem to be. And I think more and more people are saying, hey, well, actually, I'm really struggling with this and struggling with that. So I think there were lots of people that have struggled over the years, but they've been very silent about it, and now they're able to express what's going on. But equally, we know that from research, genetics do not always give all the answers. So I have ADHD. My husband has ADHD. So guess what? Two of our kids have ADHD too, but that so I know there is a very strong genetic element. However, it's how you cope with that ADHD and how much it can derail you is something that can be changed.

Peter Williams  5:53  
So therefore, the old, the old adage of genes load your gun, but your lifestyle determines whether the bullet is fired. Is, I think, is what you're trying to say on that side,

Lucinda Miller  6:02  
absolutely. So the whole kind of genomic side of thing is so important to understand how important that, you know, you can have. I think the ADHD brain, in its purest form as such, is an incredible brain. It can think out of the box. It's adaptable. You know, ADHDers tend to be incredibly good friends, very loyal. I don't think I could do my job that well if I didn't have my ADHD brain. Because I'm able to pull someone's whole health history together and all the nuances of what they can and can't achieve, or like or don't like, or all those factors can come together, almost like a puzzle in my brain, and come together and go, Okay, this is what we need to do. And a lot of practitioners really struggle with that. They find it very hard to bring they kind of can't bring it all together. And then I find it super easy. So there are really big skills with having an ADHD brain. The trouble is, what comes alongside it is, as I said, there's a lot more, with neurodivergent,  across the board, there's a lot more fatigue, there's a lot more kind of chronic pain, there's a lot more hypermobility, so there's a lot more autoimmunity, there's higher risk of type one, type two, type two diabetes, and a lot of that, I think, is managing brain energy. Okay, so I think, for instance, I've personally found, and also amongst our client base, that many people with ADHD or similar neurodivergence crave sugar, carbs, etc, because it gives them that immediate energy boost to get their brain through that difficult task at that point. Now, it may not do them that many favors in terms of their metabolic health, but because they need their brain to work at that point in the day, and it's just not. And you know, medications don't always help, you know, so sometimes you need you you're at work, you're at school, something has to help you get through. But obviously, if you can get the nutrition really right, as in, you have a much better breakfast, so you have more sustainable energy. That's better to do, but it's very easy to default to the easy, you know, the easy snack, or the easy win. So these, in turn, can mean that metabolic health can go out of sync, and therefore there's more inflammation. There's likelihood of, you know, other things, as I said, the chronic pain, the autoimmune diseases, you know, mental health challenges that are all inflammatory based, for instance, you

Peter Williams  8:43  
said that you were diagnosed around about 31 years of age, and you're obviously in a, in a, you're you're thinking, you're obviously in the health sphere. So, I mean, you have a, really quite a expansive and successful consultancy, I suppose, is the way, the way to talk about it, which has a lot of all practitioners who have been trained by you working in this neurodivergent space. Can you, and obviously you've wrote three books. So can you sort of take us through historically how that all sort of gained momentum, and give us an indication of just some of the patients, because I sort of know you as you're the person to send kids that may be having health issues and areneurodivergent that was the way I would that's the sort of, that's what comes into my mind when, when I think about you. So can you tell us about that journey to get to that point where you are now? Yes,

Lucinda Miller  9:40  
like all these things, it tends to be a personal journey. So as I said, two of our children have diagnosis with ADHD, but it was the elder one that was really struggling from quite a young age, the middle one, really, everything became much more apparent after school, actually, sort of university was a real challenge for her. But with the with the older one, it was very obvious that he was finding it very, very hard. His executive function was very poor. So he's very disorganized, and he was very much head in the clouds. He had a tick. He had gut issues. You know, there were lots of things going on, and I just felt he was very out of kilter, and I wanted to do as much as possible. He was being bullied at school, you know. I could just see things weren't right, you know. And I wanted to, you know, build up his confidence, his self esteem. I wanted to help him with his educational journey. And school was sort of like, oh, well, you know, we have to wait till he's sort of seven or eight before we can do assessments, and then we'll put in provisions and things at school and I'm thinking, well, you know, what about now? He's five, you know, I want to do something now. So I'd always known that nutrition played a very important role, and we'd always given him a very good diet. I'd always worked on his gut microbiome, and I'd done fish oils and everything, but it wasn't, it didn't seem to be quite enough. And we were, I was at that point, using some functional tests within my clinic, but very limited. And I thought I actually went to an autism conference, and I knew he wasn't autistic, but I knew that I would learn something from it. And there were some incredible doctors from America, sort of the functional medicine kind of crew, and they were changing children's lives. I mean, the trajectory was outstanding in terms of speech development, you know, proper sleep, eating, well, growing, well, happier. You know, school achievements, all these things. You know, it was just great to see. And I thought, well, if they can do it for those kids, I can do it for my son. So I went back and I ran the key tests, organic acids, amino acids, stool test, hair test, etc, some Bloods, and yeah, we found some really interesting things that we were able to work on. So there was a lot of gut stuff to work on, some toxicity to work on. And I kid you not, within three days of changing things around and getting super focused on exactly what he needed rather than guessing. He woke up and he said, My My brain's not playing hide and seek anymore. I can concentrate. And he just, I mean, it wasn't perfect at that point, but you know, he was so much more together, and he could just feel that his brain was working better, and that gave him motivation, too, that his brain, I don't like this word, but he, I think he probably felt his brain felt a bit broken, you know, because he was always kind of, he was always sort of disengaged and disorganized and, you know, just, you know, there was always something, always in trouble anyway. Suddenly he was making friends. His tic went away, you know, his tummy was so much better. And I thought, well, this is absolutely incredible. So I started learning as much as I can, you know, I went to as many conferences as I could, online conferences, books, whatever I could garner, really. And then I was seeing a few neuro divergent kids and say, Well, okay, I'd like to go a little bit more in depth on them and try this test or that test, and see what's going on and look for patterns. Go, oh my God, that's what they were saying in the lecture. That's the same thing. And let's try this, you know, learning more and more and more. And I was just very lucky because I actually went back to the same conference. I think it was two years later, and I was asked to speak at it, which was crazy. And there was this parent there who I'd been working with, and his daughter had gone from eating two foods, had to be carried, chronically constipated and zero speech, and had never interacted with anybody outside the family circle. So she'd only interacted with mum, dad and sister, and within a month, she was eating like three meals a day. She was starting to socialize. She was able to go to, like, play groups. It was just incredible. And slowly, slowly, slowly, you know, we got her better and better. And she's now 17, actually, and she's at mainstream school. She's got some good GCSE, she's got lots of mates, and she doesn't stop talking. She's also an incredible runner. So she's a phenomenal young lady. And so he came on stage and basically said, you know, this is the changes in my daughter. And my husband tapped me on the shoulder and said, Have you seen the queue? And suddenly there were all these parents queuing up wanting to see me. I was like, Oh my goodness. So I took deep breath. Six months of learning, the steepest learning curve I've ever had. I felt I cried every night. I was so emotional with the stories I was hearing of repeated seizures, you know, just the violence, the self harm, you know, the trauma that was going on within these families. And I thought, I've got to do more and more. And it just, you know, it just built and built and built. And then about eight years ago, my husband said, your waiting list is far too long. What are you going to do about it? And. And I said, I don't know, he goes well in, you know, should we build a team? So that's what we did. And slowly, one by one, we've built in this incredible team. We do women's health, we do men's health, we do children. We do lots of neurodivergence. But I would say that a lot of people that come to see us probably suspect they have adult ADHD, or they say I'm dyslexic, and, you know, I've also got rheumatoid arthritis, or whatever it might be. So we sort of see this, sort of often, the combination. And they're all phenomenal. So we're 23 now, practitioners dotted around the country, couple abroad as well, and they are phenomenal, and they see so many people and are able to do the same work as me, but you know, with more people, which is very exciting, and so very luckily, you know, a publisher approached me a few years back. So I've written three books. The first book I didn't write on neurodivergence, but very much, if you read it, it's very much about nourishing the brain and talking about the immune system, how the immune system can affect the brain and how the gut can affect the brain. So I was very much talking about all these areas, and then I did a baby book called I can't believe it's baby food, and that is a weaning book, because I suddenly realized that I was often getting to the parents too late and their kids, well, not too late, but the kids were so fixed on pizza and nuggets, sure, whereas obviously the babies, you can help with the weaning and so forth. So I wrote that book. And then, you know, my new book, brain brilliance, is basically my passion. It's everything about neurodivergence, and it's been received so well. And I think there are so many people who now believe they are neurodivergent, have had a formal diagnosis or waiting for a diagnosis, that it's a really lovely tool kit to basically help to provide them with some foundational support, because there's very little support out there. So at the moment,

Peter Williams  10:38  
isn't that really interesting? Because obviously in our spheres, in that Systems Thinking world is that it's almost like, yeah, you go, you need to go and see so and so. But I think in the conventional world it, and I strongly believe that from the conventional side, it's just a question of they, they just not taught to look at it in a systems thinking way, so, so that your choices are small whereas I think in our world, it's like, yeah, you just need to go and see so and so, or someone who's at least a systems thinker would have an idea, a much better idea of how to maybe amalgamate it better. I mean, is that what you see? And I'm assuming that's why you've got all these patients and all these parents queuing up to see you and see your team.

Lucinda Miller  17:17  
So first of all, just the volume of people now realizing that they're likely to be a neurodivergent is incredibly high. So for example, in Kent alone, which is one county in the UK, there are 28,000 people waiting for an autism or ADHD assessment, and that's just one county out of the whole of the British Isles. I mean, it's a huge number. So some are getting, you know, 10/15, year waiting lists, you know, and that's just too late. So first of all, what can they provide? Well, I think it's very reassuring to understand your brain better. So it's really good to know that. And there are strategies to understand how to, you know, talk to or interact with or behave with, or whatever it is, or live with, someone with ADHD, someone with autism, etc. You know, these are really helpful, but you can read those in books, right? There are some early bird courses when your child's first been diagnosed with autism, you can be in a parent group, and they'll teach you some basics of how to sort of manage it at home a bit better, because especially when there are extreme meltdowns and, you know, things like that, that can be really tough on everybody, or no sleep for instance. With ADHD, you've got the medications. Some suit them incredibly well. Some don't suit them very well, but there's also a very short supply. And as I said, the waiting lists are very long, so a lot of people are waiting three years just to get a prescription. But what's interesting is so many more psychiatrists are now realizing that you've got to look at the diet. You've got to look at some baseline supplements too, but not everybody, you know, it's a handful will be doing that at the moment, but it's more and more are

Peter Williams  19:53  
Can we jump in? And I would love to get get some basics, because there's a couple of things that you talked about. You talked. About deeper testing, like amino acids, like looking at the gut, like looking at what might be stimulate, hyper, stimulating the immune system. But could we sort of start almost like the basics with regards to basic nutrition and what we've got to get right for Neuro divergent kids and people? And then can we also get into the problems with Ultra processed foods and how that can affect mood and mind as well. I mean, that would be a really good thing, because, you know, the key thing is here is that the food does really influence humans to a level that we, you know, we never thought that it did, but it clearly does, and it clearly does in your field. So can you give us an idea of what we need to think about how we need to do it, and what we might expect to see?

Lucinda Miller  20:50  
Yes. So first of all, the neurodivergent brain tends to be a very sensitive brain, a very sensitive system overall. So there's something like 84% of autistic people or autistic kids have some kind of gut issue, whether it's reflux, constipation, gut allergies, etc,

Peter Williams  21:09  
that's a big number, isn't it? 

Lucinda Miller  21:11  
It's a really big number. So imagine you've got children who are really, really struggling with how their gut feels, and this can really influence how what they will and won't eat, because I always say to people, if you've just had a tummy bug, would you eat a Sunday roast? And they go, No, I couldn't handle it. Be too rich, right? I just want toast and yogurt and banana. Okay, what does your child eat every single day? Toast, banana and yogurt? Ah, okay, so they've got this chronic, you know, and they're constipated, or they've got reflux, so they're basically sort of self medicating as such, yeah? So one of the biggest problems is the highly selective eating, yeah? So I just want to caveat that, to say that we work, as I mentioned earlier, with so many families where the child literally eats two foods. And the beauty of the supplements, which I call scaffolding, is that those can enable to turn on things like the gastric juices. So things like digestive enzymes, zinc, probiotics, B vitamins, can also can all sort of help to calm down the neurological system, help with the gas gastric function, so that the food tastes better, smells better, feels better, is better digested and better absorbed. So those are the things we do, but to go. But so that aside, because the fussy eating is such a big thing, the ideal food that that people with neuro divergence should be consuming is a high protein, high healthy fat diet. They can eat carbs, and they will eat carbs because it's very difficult being neuro divergent and not eating any carbs. But hopefully these are going to be more the slow release, high fiber versions, rather than the ultra processed versions, which we'll talk about in a minute. And so the thing that can be the biggest game changer is to have a high protein, savory breakfast. So most kids would love to have a big bowl of Cheerios. Very often they're dairy intolerant, or for whatever reason, they're not having milk so often. They're having Cheerios with oat milk, which is an incredibly sweet, high GI hit, kind of breakfast. And so their brain becomes very hyper, very quickly. It works incredibly fast. They start talking very fast. They might become quite hyperactive. They might become quite disruptive, find their sort of find it hard to be in control, quite impulsive. And then 45 minutes to an hour later, the blood sugar has gone crashing down, and that's where they become zoned out, unfocused, grumpy, naughty, as if they've got a sort of hypoglycemia, sort of low blood sugar state. And often that's when they get I'm hungry again, and they're sort of scratching around for snacks. And of course, they're going to go for an instant snack. I know whether it's fruit, rice cake, bread sticks, raisins, all these things that are just carb and then again, the blood sugars go shooting up again, and then they go crashing down just before lunch. And then they can't face eating the healthy bit of the lunch, so they end up eating the pudding and the bread. And then it goes on. So the day goes on. So starting off with a healthy protein, rich, savory breakfast, whether it's eggs and feta, whether it's pancakes, whether it's waffles, whether it's eggs and bacon, that's okay, you know, to start, even if it's a cheese sandwich, it's better than nothing or peanut butter on toast. Just got some sort of good quality protein and fat in there that's going to suddenly blunt that blood sugar spike. So. Suddenly everything's going to be much more even over the day, and so their mood, their focus, their behavior, is going to be more even. And this means that when you pick them up from school at the end of the day, they're less burnt out, they're less overwhelmed, they're able to do the same, you know, be a fun child to have around, rather than a really dysregulated child.

Peter Williams  25:20  
So what you're saying, which I think is just a really, it's almost like a crucial point is you're saying that if you get the breakfast right, you really do stabilize these kids for most of the day, or you've got a much better chance of stabilizing mood and energy levels determined by more protein and more fat in that breakfast. Absolutely.

Lucinda Miller  25:40  
Absolutely. And if they're not, yeah, and if they're not hungry in the morning, which lot of teenagers aren't, you know, they're like, I'm going to skip breakfast, just going to have a coffee, you know, and then, you know, I have something later. But of course, school lunch tends to not be that great. The offerings, and the healthy version tends to be quite expensive, and they often, you know, will opt for the donut and the piece of pizza rather than, you know, I know the curry or the Bolognaise or whatever's there, so that can set up. So then they binge eat later on, honestly,

Peter Williams  26:12  
sounds like our house we've talked about in the last in the last 10 minutes, sounds like our house to a tea. It's unbelievable, okay,

Lucinda Miller  26:21  
but what's very interesting is one of the most important things for morning appetite is zinc. So zinc helps with making gastric juices. It helps on setting up sense of smell and taste. And therefore, sometimes a zinc supplement, just for a couple of months, two three months can make a massive difference to that early morning hunger, and it's something that teenagers specifically need, because when they're going through puberty, they their body steals a lot of zinc to to do the puberty thing. So yes, zinc's really important for that. And often, kids are on ADHD medications, and as soon as they take the medication, their appetite goes for the hours the medications active, so they're not getting lunch. And so some of them, you know, these boys, they're like 14 years old, but they look as if they're 11, you know, and they're just not going through puberty and not growing the girls obviously go through puberty a little bit earlier. And you know, this sounds awful, but there's less pressure on their growth than it is for boys. The boys feel much more like want to be tall and strong and girls, but, you know, girls are so much healthier, if they are, you know, of a fairly average height and weight. So, yeah, so it's, you know, so I'd say that protein at breakfast is key. And then in terms of the ultra processed foods, there are lots of studies on the link with Ultra processed foods, and, you know, obesity, cardiovascular disease, diabetes, risk, all of that. But most parents are going. You know what? That's not going to affect my child. They're not overweight, they're not at risk of autoimmune disease, you know, blahdy blah or you don't know a child's going to have type one diabetes until it happens. You know, it can happen literally within a week of the child. You know, it's one of those instant things, so it's very difficult. You can say whether they're slim. Why would I want to change things? And the research is emerging on the brain. It's not as robust because the focus has been on kind of metabolic health. But there's a piece of research that was done about Ultra processed foods and the volume of ultra processed foods of a young child consuming and their IQ at eight. And they found that the children who had the healthy home cooked food, lots of fruits and vegetables, meats, eggs, etc, even though. And they adjusted all of this for the socio economic factors and genetic factors, they found that they had a slightly higher IQ at eight versus those had more Ultra processed foods, you know, as a toddler, and considering the average UK toddler is having about two thirds Ultra processed foods in their diet, you know, it's a big factor. Secondly, there's another study that was done looking at the volume of ultra processed foods consumed and physical activity and locomotor skills, and you as you the practitioner you are, you very much focus in on Exercise and Sport and so forth. And we know that things like hopping, skipping, jumping are really important for not just physical activity, but also cognitive mobility as well, and things like fine motor skills as well as gross motor skills, to be able to do activities, both at school and educational activities and so forth, as well as hobbies. So all of these things are really important to mature the brain to be able to do that. Yeah, and, you know, it's difficult to tell, you know, do the ultra processed foods make you feel kind of less it make you feel a bit apathetic and less likely to want to exercise, because so often people will eat, say, a big pizza and feel very, very sleepy afterwards. You know, could it be that? Could it because these ultra processed foods do not have enough nutrients in them. They're just not full of those brain nutrients. They're not full of zinc or iron or omega three or even calcium for the bones, there's very little in there. So these things are really important as well. There's been a question over whether the ultra processed ingredients contain, you know, inflammatory properties. You know, some of the sweeteners, some of the emulsifiers, are these disrupting the gut microbiome? Are these just causing an inflammatory cascade in the gut? Is this disrupting the ability to absorb the nutrients efficiently?

Peter Williams  31:01  
In your opinion, I mean, there's, there's extrapolation of the literature, and that's what you see in practice. So my assumption is on this is that you probably see a population group that has a disturbed microbiome and more likely to have a increase in testable permeability. Is that what you see?

Speaker 1  31:22  
I mean, yes, what's very difficult is, with all these studies, they're looking at one data point, one intervention, what changes? That's basically how studies are done. It's incredibly hard to do a diet study or a microbiome study and look at diet because diet is so flexible. I mean, yes, some kids only eat the same pizza and the same nuggets every single day, but that most kids would have a diverse diet. You know, even at school, they'd have a different lunch each day. Even if they ate similar foods, it would still be diverse. So the studies are very difficult to look at and really get the full information. But because we've seen about 10,000 clients through our doors over the last nearly 30 years, I'd say we've seen patterns, and yes, most of the people we see have got some sort of neuro divergent skew. So again, that's filtering it down again. So I think when we're looking at these mass population studies, they're not necessarily taking on board the neurodivergence or not as well, but for what we can see. So what do we see? We see a very high level of people with very low lactobacillus in their gut. Interesting, and lactobacillus not only helps with digesting milk and helping dial down inflammation and helping with immunity, but it also helps to make GABA Yeah. And GABA helps with anxiety and sleep and risk taking. Lactobacillus also helps to make acetylcholine, and acetylcholine helps with learning, memory, emotional regulation, self regulation. So again, these are big challenges that many neurodivergent people have. Equally. You can find in the gut microbiome, when we do stool tests, that there can be inflammatory bacteria in there too. So there are the three. You can call them 3c. Stroke K is basically Klebsiella, clostridia and Citrobacter. These are three very common bacteria that come up over and over again in the literature and also in our clinic. And the more that the child has, the more likely they're going to have more challenges with their neurodivergence. So because they're very pro inflammatory and neurotoxic, if they're sitting in the gut all the time, that's going to potentially lead to a lot of dysregulation and inflammation, which can lead to aggression and mood swings, and all the things that the parents see in their kids, you know? So it's like these behaviors are very much an expression of probably what's going on in the gut. As I said, we're still learning and like you, where do we get our evidence from? We get our evidence from the scientific literature. We get it from our test results, and then we get it from our clients. So we piece that all together, but we're not doing, you know, a, you know, peer reviewed study of x, y and said together, well,

Peter Williams  34:41  
I think the reality of that, like everything that we do in systems thinking, is that no one you Is there evidence that maybe this makes sense in a literature? Yes. And then you've got to dig that literature down to an individual patient, and then you've got to use your clinical experience and intuition to think that this is the right thing to do based on what we see in front of. Us whether it works or not, I just don't think you can ever take regardless of how good the literature is, take that down and have that as gospel for an individual, I usually look at the most important whether it's RCTs, whether it's Mendelian analysis, as far as the top of the tree, as far as information, and that's your that's just your starting point. And it's a question, well, how does this? How does this work for the patient? It's really interesting. Again, that you see this is the key thing. 10,000 patients, 30 years, you're going to start seeing some patterns on there that make sense, and then you become just more intuitive, don't you, the longer you are that. Here's what I think we should do, and here's why I think we should do that, and

Speaker 1  35:48  
it's why, yes, you can write a book like brain brilliance, because, because, you know, you've been able to, over the years, bring all these pieces together. But not everybody has the bandwidth, time, finances, or whatever it is, to explore everything in depth. So they're looking for the take home things that they can do at home, because at the end of the day, we're feeding our kids at least three times a day, and so we have that ability to adapt the diet where possible, to be able to enhance it with nutrition, yeah? And then use some simple supplements, as I said, as scaffolding in the short term, just to get through whatever that block might be,

Peter Williams  36:31  
yeah? Talk about the supplements. I always I've got a bug with, with, with Tim Spector, who he says, supplements don't work. And it's like, mate, I don't know what field you're working in, but, you know, I think most of the decent people who are in nutrition can tell you time and time again that well targeted, good quality supplements. You know, it's a no brainer that they work, so I'm not quite sure why he says that. I mean, I don't know whether,

Speaker 1  36:54  
yeah, my hunch is, My hunch is he's talking about supermarket multivitamins, maybe,

Peter Williams  37:01  
maybe. But he needs clarity on that, and talking to supplementation. Should we talk about, certainly, one of my favorites, which is omega three fatty acids, and it's important in this area. Yes,

Speaker 1  37:12  
absolutely. So there's been a huge amount of research on omega three and neurodivergence across the board, whether it's dyslexia, dyspraxia, ADHD, autism, and all the other neuro divergence. You know, you've got to think about things like Down syndrome, cerebral palsy, etc. And most of that's been done in out of a Oxford University. It's called FAB research, or food and Behavior Research, run by Dr Alex Richardson, and she's written a brilliant book, too, on it all. And then there's an amazing guy called Professor Michael Crawford, who's in his early 90s, and I think he's still working. He's at Imperial and this has been their sort of lifelong work. And essentially omega three fatty acids, which you get from oily fish. So whether it's salmon, mackerel, sardines, etc, but some seafood as well, like prawns, you know, are helpful as well. These all help to with eye development and brain development overall. But what's interesting in the slightly sort of older child, you know, the teen and tween is so often it's that prefrontal and frontal cortex that hasn't developed that well. And especially if you're neurodivergent, you tend to be quite behind with that, which is things like, you know, risk taking, organization skills, executive function, etc. And that's why they can be scatty. They can, you know, make poor decisions, etc, and find it difficult to apply to, I know, a job, or university, whatever, they just find these big blocks, and it's often because their frontal and prefrontal cortex is not developed. Now, there are many factors for that, but one of the things that helps to feed that part of the brain is omega three. So it's really important not I think lot of people read about Omega 3 and think it's just for little ones. Up until they're about six, they sort of see it's about brain development and it's about eye development, but they forget that the teenagers need it just as much. And I'd say neurodivergent adults also, because it's anti inflammatory, etc. And my rule of thumb is the which you've probably discussed on other podcasts, is that there's something called DHA, which is the sort of most dominant Omega three in the brain. Yeah, this is the crucial one for that early years. So it's when you're before you're pregnant, when you're pregnant, and then breastfeeding, and for your baby, once they've weaned on to solids, you know, going forward until they're sort of six or seven, DHA is really important, and then the EPA becomes more important. And this is more anti inflammatory kind of type of Omega three. So. Um, but I sometimes caveat that that by saying that if the child is delayed in their maturity, so say, they're a six year old, but they're functioning as a three year old, you might want to continue with that slightly higher balance of DHA for a little bit longer, so that they it helps them catch up. So I always see DHA as the sort of catch up. It helps the brain get faster. So it's for that sort of but the child that's behind with their skills, whereas EPA tends to be more for someone who's got a very fast brain working too fast, and it needs to slow down a bit. So with ADHD, very often people's brains work too fast, so their brain jumps ahead and they haven't done the working memory bit or the processing bit, so they miss very crucial parts or Yeah, so they don't sort of see the nuances of things. They often, just as I said, they see or they tend to interrupt because they don't want to lose that information out of their brain, because they know it's just going to drop unless they say it. And so that helps with that sort of aspect. So the DHA, as I said, is for speeding up the brain, and EPA is sort of slowing, slowing things down a bit and helping with inflammation. But the reality is, if you eat a piece of good quality oily fish, or even grass fed meat, good quality eggs, you know, all of these do have omegas in them. It's just the balance. Yeah, and you will get a balance of both in these foods naturally. So it's really only the supplements where you're kind of, you're getting a different ratio. So

Peter Williams  41:51  
is this sort of, is there sort of like a baseline that you're happy to give out without testing? And how often would you be testing with patients. I mean, and I know that depends on a lot of stuff, how much money people have got, etc. Do you feel as though you need it? But is this sort of somewhere you're, you're, you're working to a certain level, or is it that you're just happy with giving a certain amount on a daily basis for a period of time?

Lucinda Miller  42:17  
So the trouble with Omega three is it does need to be tested through blood, and that can be a real barrier for many parents. Yeah, you know, the very high, anxious child is not going to be happy with that, yeah, and it's a FAF, and you've got to find a good nurse who understands neurodivergent children, etc. So I find that a bit of a barrier. So basically, we tend to think, have they got very dry skin, for instance, are they tending towards eczema and asthma and those sort of inflammatory things, or do they need to wear glasses? Have they got a bit of a squint? Do they not have very good eye contact? So we look at symptoms,

Peter Williams  43:01  
clinical intuition, I would say, yeah, yeah.

Speaker 1  43:05  
And I think you just don't go too high, because at the end of the day, these supplement companies are incredible, you know, in terms of, you know, the getting the strength, the quality, the purity, you know, go for good brand, yeah. And you know that if it says, you know, your child needs two mil, then go with two mil. And then we could guide them, obviously, in clinic, whether they go in with a little bit more or so forth. But it's very hard to overdo it, isn't it? It

Peter Williams  43:35  
is. I just think the same thing is, is that, again, you've got to balance the situation of the stress put on a kid that, you know, realizes you're going to stick a needle into them. And you know, a lot of the time, you know that's just not going to happen. And you've got to be able to have momentum in any strategy, and you don't want that momentum being, you know, being interfered with, because you've got to wait three or four months before they decide to do the blood test. Can I ask? Can I ask about, I'm going to slightly veer off here about how infections may influence certain neurodivergent patients. I'm thinking OCD. I'm thinking patients who more prone to anxiety are the infections that we need to take into account for

Speaker 1  44:22  
yes, 100% so there's a very interesting condition known as PANDA, which is pediatric, acute neuro psychiatric condition associated with strep. Okay, so

Peter Williams  44:41  
I only, I only heard of pandas about 10 years ago, and it was completely new to me. And I don't think many people know about it, but it's, it's very significant if you've got a child who has that diagnosis, because it changes their life quite significantly 

Speaker 1  44:55  
Absolutely, strep, strep. That is streptococcus. It can be a very, very sore throat. It can be associated with tonsillitis, Scarlet Fever, but also there's anal strep and other sort of strep issues. And most of the time, if the child gets a strep infection, which is bacterial infection, antibiotics will knock it on the head, and the child will be absolutely fine. However, if the child's immune system is in auto immune mode, and you may not know that at that point, then sometimes what will happen is that the immune system will not fight that strep infection effectively, and then you get a misdirected auto immune response, which affects something called the basal ganglia, which is in the back of the brain. And this is a really key part of the brain that involves movement. It's, you know, mood, etc, and learning. So, for instance, a typical person with basal ganglia encephalitis or inflammation of the basal ganglia or autoimmune response to those ganglia, will probably develop tics, anxiety, they may regress in their skills. So they may start talking in say, baby speech, sort of as if they were much younger than they really are. Their writing or drawing may suddenly regress, so, going from beautiful cursive writing to suddenly 10, back, back to front. 10p pieces or their drawing get turns into from a beautiful like drawing my family to a big squiggle. They often need to go to the loo very often. So there was one boy who came to see me, and I think he went to for a wee 11 times in one consultation, they often develop body dysmorphia. So he again, kept on looking at his beautiful like six pack tummy, going, I'm fat, I'm fat, I'm fat. He couldn't he just couldn't see his body as it was. And there tends to be violence, mood swings, but also OCD, and it's something that is thought to affect around one in 200 children, so it's a very high prevalence these days. Only about 10% of GPS know about it, yeah. So it's slightly potluck. If you go and see your GP, if your child has developed changes in them, this the sort of hallmark of pandas. So the pans bit is, when it's not strep, it's to do with another infection. So it could be COVID, it could be mycoplasma, it could be Lyme, it could be mould, even can trigger some of these things as well, similar kind of presentation, but the trigger is different. But the doctor, very few doctors will understand this and but the hallmark is that usually it happens almost overnight. So what will happen is, you think my child was absolutely, perfectly fine at school, you know, in the cricket team, I know, playing football, doing quite well. Lots of friends, suddenly they're in their room. They've got this awful OCD, they're super anxious that, you know, whatever you know, everything's changed. But what's very interesting is that that's usually the neurotypical child that wasn't neuro divergent in the first place, that has changed. But what we find with the neuro divergent kids is it's a bit more subtle. So it can be that they don't necessarily have an infection that's obvious, so maybe a sibling gets the tonsillitis, or mum's carrying strep, but the child's mood changes, but it's really difficult to pinpoint, because they weren't sick beforehand, and they're thinking, Well, you know, they can be a bit of a pickle. They can be a bit of a challenge at home anyway, but this is just worse now, and they've just, yeah, we've all been ill. So there's a family, actually I spoke to just this week, and the whole family had had COVID, except the one child had no symptoms, so they assumed he had got away with not getting COVID, but his mood has exploded. He's actually been refusing to go to school. He's super highly anxious. Developed a tic, developed very high OCD around certain things. And you know, I think if we we're going to do some tests, but I think if we drill down, it will be COVID is probably the trigger. But because he wasn't sick, it's very hard to see that. And the background is, you know, the dyslexia and some ADHD So, but not, not particularly marked, you know, just a sort of a baseline of struggling a bit at school. Yeah, so

Peter Williams  50:00  
actually it's probably for my interest. Now I just want to sort of try and work through if that was your patient, and you think COVID is, that is the trigger. Would you treat that from a point of view of how you would sort of treat COVID, or what would be, what would be the potential strategy on that.

Speaker 1  50:21  
So actually, there's been quite a lot of studies at Exeter university, and there's a test that they developed looking at viral persistence in long COVID Kids and long COVID adults. And I think that would be a very interesting test to do to see whether this was a viral persistence thing. But because you often don't have the time, you've got to get the child back to baseline as quickly as possible, I've always assumed that it is persistent viral load, and therefore, yes, I have done exactly that. I've probably put in elderberry or olive leaf extract. I've probably put in zinc, vitamin D, vitamin C, to try and help the body fight that virus. But then, because it's an inflammatory condition, I'm also looking at something to dial down the inflammation. So probably Omega three. We use a lot of PEA and turmeric, yeah, and those things as well are really, really good at getting them back to baseline quite quickly, interesting. And then you can say, hey, that's helped. So maybe it would be good idea to go and see a doctor and get some more tests done. Or maybe we can run some panels to see what is in the system. And sometimes, as I said, it's often strep, which is bacterial, but it's COVID. Seems to be a big, big thing. Epstein Barr is another big, big trigger, and that, as we know, can trigger autoimmunity. Sure. So it's something that I think is a really big piece in the puzzle. And I think the most important message is for any parents or professionals listening to this and thinking, I think this is my child is. Think if you go to CAMS, they will not take this into consideration. They'll just say it's anxiety. They'll treat us as a mental health problem, whereas, if it's sudden onset, or this wasn't my child six months ago, or they were not that, they were okay, we were trotting along, okay. But now this is wild. This is really difficult to deal with, and they're really, really struggling, then there may be something going on, and it's worth just going down the track of thinking, I'm going to look after their immune system, I'm going to look after their inflammation, and it could make a massive difference. And if it does change, then you know that it's likely to be that.

Peter Williams  53:00  
Yeah, really interesting. My God, we're nearly an hour in. I would look, if you can, because I was looking at one of the questions I was going to ask, because I just think it's super interesting and super interesting, because I do see quite a lot of this with regards to referrals that I get from physiotherapists where part and parcel of and these are physiotherapists who in the sense of systems thinkers, so they always send them to me. And of course, these are patients with significant GI symptoms. And of course, they've got hypermobility, whether that's whether that is a joint Hypermobility syndrome or whether it's something like Ehlers Danlos Syndrome as well, and I see it time and time again, this association with hypermobility disorders and gut dysfunction and maybe immune dysregulation. So what I also see with that, which is perfect for you, is that it seems that more the most of the people I see in this who come as patients, seem to have a higher proportion of neuro divergence. So I don't know whether that's what we'd expect to see and that's what you see, but I just find that the hyper mobility question relationship with neuro divergence, I would love you to maybe explain that a little bit more, and whether there's actually anything in that scientifically,

Speaker 1  54:29  
yes. So there's an amazing researcher called Dr Jessica Eccles, and she's based at Brighton University, and she's published a number of papers over the last few years, and one is linking is basically saying, if you're hyper mobile,

Peter Williams  54:51  
She's what, Brighton University, yeah, okay, brilliant, brilliant,

Speaker 1  54:55  
and yeah, if you're hyper mobile, i. You're more likely to be like neuro divergent, and vice versa. So if you're neuro divergent, you're more likely to be hyper mobile, I think, sort of double the chance, right? Wow. Okay. Secondly, they found that hypermobility is very, very strongly with anxiety, and it seems to be differences in the amygdala in these cases. And then the third thing that she's published relatively recently is about how very high proportion of neurodivergent people end up with chronic fatigue and or pain by the time they're 18. So there's a very big link with fibromyalgia, chronic pain because of the hypermobility, and it seems to be very, very high in the neurodivergent population. So she's a bit of hero in my mind, because she's bringing the data together, something that I've been looking at for 30 years. You've seen in your clinic, too, and so and so fascinating to think there are differences in the brain, which is, you know, shared with, you know, neurodiversity and hypermobility. You know, is this all to do with something else? And she actually calls her account, I think it's on Twitter, something called bendy brains. So she's about bendy bodies and bendy brains and how these can all be associated. And it's something we screen every child for is hypermobility through our clinic. And equally, I think that anyone that is hypermobile, you know, you can have a soft conversation about, you know, focus, concentration, you know, sociability, whatever it might be and or were they diagnosed with dyslexia as a child? And so often they are, and a lot of them, again, are the ones that go on. So again, studies have been found, found that hypermobility is very, very linked with long COVID. And a lot of neurodivergent people have been affected by COVID more than others. So my hunch is there's a systemic thing going on that is making this very sensitive body and brain. It's hypermobile, much more sensitive to mast cell activation, pots chronic fatigue, pain, etc, and so I think it's why so many neurodivergent people come to functional medicine practitioners, naturopaths, nutritional therapists, etc, for support, because the system's not working for them, yeah, in terms of food, in terms of lifestyle, you know, very often they need that extra input because they're fed up with being in pain, tired, whatever it might be, overwhelmed, and so that's why I think you know you're seeing it. We're seeing it is because there are cohort of people that need that extra input.

Peter Williams  58:04  
Fascinating. Let's, let's summarize this up what would be the the four most important things that you would tell a parent of a child that might be suffering with health issues and has a neurodivergent presentation. What would you say on the foods? And because I know these are going to be really simple and practical, but I think that's the key is, what would simple and practical, apart from buy your books, which are excellent, and we'll, we'll, we'll list all of those on the on the show notes. Of course.

Lucinda Miller  58:40  
Great. So Pete, what I would say is, first of all, cook from scratch wherever possible, brilliant Yeah. So if your child likes waffles, make them yourself. If they like pesto, make it yourself. So do the best you can. Now, I know some parents are really, really time poor and overwhelmed, and their child is highly selective, but if you can, that's great. Then you can choose the ingredients. You can boost up the food that they're eating. Secondly to, as I said, right at the beginning, prioritize a high protein, good quality fat breakfast where possible. And again, it's amazing how you can sneak an egg into porridge. You can put nut butter into porridges. You can put loads of things, and they can loads of things into waffles, muffins, pancakes, and the kids are happy, smoothies can be boosted up too. So there's a whole load of things that kids often will take. I think Omega three is a very, very key nutrient to consider for your child. And if they've got very dry skin or dry hair or very seen inflamed, as in, eczema, asthma, etc, as well. This would be a very, very helpful thing to try or if they've got problems with their eyesight, etc. So I think opening three is really, really important too, and where possible. Switch out from ultra processed foods to nutrient dense foods. So a lot of parents are really freaking out that their kids won't eat their greens. I would much prefer the children to be eating the best quality eggs, the best quality dairy, the best quality fish, the best quality meats. And if you could get the veg into that's great, because those foods are going to contain the choline, the iron, the zinc, the omegas, all those really key brain foods. And then, of course, we want to feed the gut microbiome, but you can get those in in small amounts, as I said, in the smoothies, in the ice lollies, etc, to begin with, grating them into the porridge, grating them into the pancake mix or whatever, so you can get those in but to prioritize those nutrient dense foods first, over and above, trying to push them to eat a bit of broccoli at the end of each meal. Okay, listen,

Peter Williams  1:00:56  
really, fantastic. I really appreciate your time. So on behalf of me and all the viewers, thank you so much for your time.

Lucinda Miller  1:01:04  
Pete, thank you so much. It's been fantastic to chat to you. Pleasure.

Transcribed by https://otter.ai