ADHD or Perimenopause? The Signs Every Woman Needs to Know | Dr. Jolene Brighten, NMD

Many women spend decades believing they're simply overwhelmed, anxious, disorganized, or "bad at keeping up."

But what if the real issue is ADHD?

Women's health expert Dr. Jolene Brighten explains why ADHD is often missed in women, why symptoms become dramatically worse during perimenopause and how hormones, inflammation, gut health, sleep, and brain energy all play a role.

We discuss:

✔ Why ADHD often goes undiagnosed until midlife
 ✔ The connection between estrogen, progesterone, testosterone and brain function
 ✔ ADHD vs normal perimenopause symptoms
 ✔ Exercise as a powerful brain-health intervention
 ✔ GLP-1 medications and neuroinflammation
 ✔ Functional medicine strategies for women with ADHD
 ✔ Sleep, gut health and hormone optimization

🔗 Dr. Alex Carrasco, MD

https://nourishmedicine.com

https://www.instagram.com/dralexcarrasco

🔗 Dr. Jolene Brighten, NMD

https://drbrighten.com

https://www.instagram.com/drjolenebrighten

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Transcript

0:09

Thanks for joining us, Doctor Brighton. I'm so happy to see you. I know we go way back, but we've never recorded a podcast before. We do go way back. At least ten years. Probably more. Yeah. I think every now and again I, like, have my Apple memories pop up and I send you a photo of like, remember when? And we look like such babies. Yeah. And our babies were babies. I was gone by. And here we are. But you are coming out with a new book. And I think it is just such a pressing topic right now. And now that I'm in my mid 40s I wonder often do I have ADHD? And tell me more about it, because I just think it's something that most women haven't talked about and haven't learned about. But I think a lot of women in prayer are feeling like, hey, something's different with my brain. Yeah, and I don't know if it's just the hormones or if it's like something that's been masked for decades. Well, that's definitely a basket we can sort because there's ADHD like symptoms. And then there is you have ADHD friends. So what we know about ADHD is that it is extreme executive dysfunction. Every single human on this planet struggles with executive function in some capacity. So that might be like you're like, I'm just the person who can never run on time, or I'm just the person. I can't plan anything. I cannot be in charge of the bake sale moms because it ain't me. I'm not the person who can do that. So we all have a deficit to some degree, but with ADHD, it's a deficit in multiple areas that impacts your life so severely that your relationships get interrupted. You know, it's interesting. There was a survey that said it was like 97% of spouses said their ADHD spouses symptoms interfered with their relationship. Yeah. That's huge. We also know it can impact school. It can impact your work life. But with women it looks a lot different because we are people pleasers, we are overachievers and usually the ADHD woman. She looks completely put together on the outside, but she is screaming and fighting her hardest to look put together. And on the inside it feels like chaos. It feels like a struggle. And she knows she's working harder than anyone else. So when it comes to ADHD, this has been with you your whole life. But because society shaped your experience as a woman, you presented differently and you had your hormone allies. And we can talk about all the hormones that are involved. But estrogens, the one everyone likes to talk about first. And I think it is important because if you imagine having ADHD, you're constantly surveying yourself, surveying the environment, asking yourself, what's the most important thing I should say next? Make sure I don't interrupt this person. Hold that thought there. Am I smiling right? Did I laugh at the right time? Like. And you're running all of these efforts and energy expending, you know, tasks in your brain. You enter perimenopause, you no longer have estrogen. Your mitochondria decrease in their ability to create energy. And so at that point, you no longer have the energy to keep up what's called masking or camouflaging. And so that's really the point where the ADHD woman is like, okay, wait a minute, something's going on, or it's my my child's getting diagnosed and you're telling me all of this is not normal? Like what I've been doing my whole life? Yeah, I think that it can be really tricky because maybe and up until a point you've you've been able to cope, you've been able to kind of get all the things done, check all the boxes off and then you can't or it's harder. Right? Yeah. I like to say to you that like perimenopause for the non ADHD woman is like ADHD light like it's not full strength like beer my friends. It's the light version. But basically you know, you go through this neuroendocrine transition and in that transition you can start to struggle more. So your acetylcholine is more problematic. So we have more word finding struggles going on. You have less dopamine. Plus it hurts when you go to the gym and you work out because maybe you have musculoskeletal syndrome of menopause. So now motivation is filling a lot lower to do the things that you know you should do. But the good news is for every non ADHD woman listening is you'll experience these ADHD like symptoms about two years. Post menopause. Your brain recovers. It comes back online. Unfortunately for the ADHD woman, she enters perimenopause on average ten years sooner, twice the symptom severity, and then 25% of those women will have severe ADHD symptoms post menopause for the rest of their life. So it's a very different conversation. I think when you hear it in that way, you can understand why ADHD women get so angry when someone says, oh, we're all just a little ADHD and you're like, oh, we're not all, in fact, just a little HD. But we all, in fact, do have a little bit of executive dysfunction, which is that experience. And because of the brain changes that happen in perimenopause, you can feel like you have ADHD. And within the book, I put together this model that I call the brain immune hormone triad because it's more than just hormones. It's more than just this, this brain change happening. We also have this inflammatory burden that gets upregulated. And for the non ADHD woman, she's getting a preview in what it's like to be an ADHD woman because she starts experiencing that neuroinflammation. But ADHD women have struggled with neuroinflammation their entire life. So this set of genes that ride with ADHD, they also are the same set of genes that can have crossovers with things like endometriosis. You're twice as likely to have endo. If you have ADHD, highly inflammatory systemic disease, they are more likely to have autoimmune disease. They are more likely to have connective tissue disorders like Ala Stanley's syndrome. So there's all these genes that ride together in this highly inheritable condition, which is ADHD. And so you're often also struggling with other co-occurring conditions. Yeah. And I think that that can make that can make someone really feel lost in the middle of it. I think, I want to touch on just your own path and your own story because you're kind of a giant in in the world of women's health. You've just done so many amazing things. You're you're definitely a pioneer. So can you kind of share your journey? And then also, what made you write this book? I want to hear all of it. I'm not, in fact, a giant. I'm only about five. Four know so well. The funny thing about my story is that coming to this like landing on ADHD, my child was, as you know, diagnosed with pandas, which is an autoimmune condition of the brain. And as we rolled out of that, we then revealed, okay, there's an ADHD diagnosis. And I was sitting on the porch and I'll never forget this, like kind of arguing with his psychologist, but not like arguing like she was wrong. Just more like know everything you're explaining about him. I did too, so of course it's normal. Like, how is this not normal? And and it wasn't even that. I was just like, who doesn't melt down by the scenes of their socks? Like, of course it's the worst thing. And like, the big lie overhead, you're telling me for real people like that, there's no way. And she was like, we got to have our own session. And so he gets diagnosed with ADHD. I get diagnosed with ADHD, but then we're like, there's something else here, and it's not the end of the story. And as it turns out, I get a code of autism as well, which I think when you explain when you describe me as like, oh, a pioneer at the forefront of things, it's like, oh my God, this like clicked for me. And I remember crying like when I got the diagnosis because I was like, oh my God. Like, this actually explained so much about my life. I mean, you know, I speak on stages all over the world. I remember talking to you and Vincent at an IFM Vincent, Padre, for people who don't know. And if I remember talking to you guys and being like, yeah, you know, like how you're out with people and you speak and then like, you just like crashed and you have to spend six hours in your room, like you stack all the covers on your child yourself. And you guys are like, no. What are you talking about? And I was like, and I'm like, wait a minute, you guys don't get like, super dysregulated and then have to, like, recalibrate. And, you know, it was little things like that where I was like, I was kind of was like, you're a little bit different. But then I was like, well, you put out more energy and you do it. You know, you start to like, negotiate like the things with yourself. So, you know, it was interesting though, because it was this it's a really weird thing. I write about this in the book. It's really weird to be in your 40s and be like, I have an ADHD diagnosis. Oh, and I have endometriosis. Oh, and then an autism diagnosis. And to be like, okay, so I had this idea of who I was and who I've always been, has been who I've been compensating for and not really recognizing, like what's been going on. But, you know, it was it was before my diagnosis that I got really interested in this because the first patients that I started to notice this with, they were the PCOS patients. Now PMOs, we've changed the name poly endocrine metabolic ovarian syndrome for everybody who's treating women. And that's the new conditions name. Well, it's not a new condition, but it's a new name. New name. So but it was seeing these women and how often they had symptoms of ADHD and constantly getting evaluated the other. And then I started making the pattern connection of like PMDD women. And why are all my PMDD women telling me, like, you know, that 10 to 14 days dark cloud moves in worst time of their life, but also like, well, the cloud lifts, things don't necessarily get totally easier. And then sending them out for psychiatric evaluation ADHD or autism is coming up and I'm like, This is so interesting. And, you know, that's when I just started going into the research and trying to understand further, like what is going on with women's hormones, because the way they're expressing is so different. I don't know how it was when you were in mud school. When I was in school, we were told that only little boys had autism and that ADHD was like, you just bounce off the walls. And it was typically boys as well. Yeah, it wasn't ever really on my radar for women. Totally. And if you. Yeah. And when you look at the research, it's very interesting because all of the mental health workers that have been in survey after survey after survey say the same thing. They don't really know how to diagnose women. They don't really know what to do with women once they diagnose them. And that was a big reason for me writing this book, because I'm like, there's actually so much you can do. And because I'm autistic, it became my special interest. And so it was like, all I want. And that's the other thing, let me tell you, because people would be like, oh, well, I've never heard you talk about trains, right? Like making these jokes to me. And I'm like, oh, but have you heard me talk about hormones or nutrition? Because I talk about all the different rabbit holes. Yeah. I'm like, I mean, do you remember that time we were in a hotel room together

and it was like 4: 11:09

00 in the morning, and I'm still going through, like, steroid pathways with you? Yes. Yeah. And so it's like it's, you know, the stereotypical special interests of like, oh, are you into trains with girls? It's usually like horses. And I'm like, mine was nutrition. And when I look back at like how, you know, I was nine getting medical textbooks and wanting to read those, like, that's not normal. Let me just say like. And I thought it was normal. I was like, of course, like kids get really, really into stuff. And then now I'm realizing like, no, no, that was a you thing, special superpower. Yeah. Here you are. Like, you connected all these thoughts that other people haven't been able to do. So what do you do? Like, what do you do? Yeah. Oh my god. Golden question. Right. So in the book I actually came up with a quiz that is an ADHD hormone profile where we go through a set of questions. This is not diagnostic. And I'm very clear about that in the book, because I don't want anyone to be like, I've made this mistake in the past of like how I present things and people are like, oh, this is a diagnosis and this is fact. I'm like, oh, wait a minute. Like, this is a this is like basically a way I've come up with for you to understand yourself and also for clinicians to identify, because certain hormones are really taking the lead and how you express. And so that's the first thing we've got to unpack with women. So typically what we see like more classically reproductive years we will see progesterone issues. And so what I call the progesterone sensitivity profile because it could be too low of progesterone. Or it could be that your Gaba receptors are too sensitive to progesterone. So this is what we see from the research from PMDD is that women get exposed to from that gets converted to allow pregnenolone. Pregnenolone being a neurosurgery metabolite affects the Gabba receptor. Should make it work better. Say chill, calm. Everything's great. Like filter your mouth. As Doctor Carrie Jones says. Well, what happens is that what it appears to be is that women who are neurodivergent, their brain cannot adopt as quickly. And it makes sense when you consider that there's not as much synaptic pruning that's happened. So there's a lot more connections happening. And so their brain can adapt as quickly. So there's hindrance of neuroplasticity. And so when you understand that you might be like, oh, more progesterone is not actually always the case. It's usually decrease inflammation and find the source of inflammation, which a lot of times can be things like endometriosis, fibroids, PCOS, OS I'm going to use them interchangeably until like it's been a year I think probably. So we have to look at what's going on there. And so we see that classically in reproductive years when women get about in their 30s, because I said, you know, perimenopause is coming sooner. So women are peaking perimenopause symptoms 35 to 39 if know if they have a diagnosis of ADHD, general population is not going to happen until their 40s. And what we see is far less symptom severity. So for everyone listening, if you're in perimenopause and you think it's hell, okay, maybe we want to track if you're in a virgin, or maybe it's not as bad as, like, you know, it could possibly be, you know, because you're not having to struggle with other things. So I don't want people to be like, oh, this means I must be ADHD or something. So but we thought we typically see that low estrogen profile in the late phase prairie menopause. So in the it could happen with ADHD women in their 30s that we start to see that low estrogen profile. But we also commonly see cortisol dysregulation, insulin resistance. And we also see issues with testosterone. And people don't often think about testosterone and ADHD. I mean, every time you see, I started talking about ADHD and estrogen like six years ago, and now everyone's like ADHD and estrogen. This is the thing, you just need estrogen. I'm like, okay, I kind of messed that up. I probably should have talked to you guys about testosterone, because if you don't have testosterone, you will not run your dopamine correctly. You don't wake up with energy, vigor, ability to get going. You feel really flat. If something is your special interest, you're probably not going to be that interested in if you don't have enough testosterone. Cortisol is one where I think people can understand that, okay, any kind of stress disruption can disrupt the brain, but I don't think people understand that acutely. This is why your ADHD ers will wait until like the night before the term papers do, to get it done. Acutely, cortisol will actually increase dopamine. Chronic exposure means the receptors no longer are not going to respond to dopamine, and you're going to clear dopamine faster. So you can have that chronic HPA axis dysregulation coming up. And then we're going to see okay, you're you're not actually able to utilize dopamine even if you are able to make it. And so that's the first thing you're like what do we do. Figure out what's going on with the hormones. Yeah. So I do go through that in the book because that's the other thing is people are like, just give estrogen. Why is it not working? Why are things going worse? And I'm like, well, because like Comt and dopamine and estrogen, they're all going to. And so if you're flooding the system with estrogen now we might get dopamine problems with that. Or I think the biggest problem is we wait too long to start. Women on hormones. Neuroinflammation sets in. You can't out estrogen your way out of that. And that's the whole idea of like, oh, we'll give estrogen because that's why you have immune system dysregulation. But we then also have to walk back of like what's going on with the mitochondria. So within that triad I was talking about the sits in the middle. So this brain immune hormone triad mitochondria in the middle. The thing that sucks about the mitochondria like I love them. We're friends. But when you get increased reactive oxygen species the mitochondria little followers, they're like, oh, that's what we're doing. Now I'm going to make some of those two. Here's some reactive oxygen species. And then the brain feels really like there's a lot of static a lot of dysregulation. So we also have to look at things of how to care for the mitochondria. One tip I always give people and they're always people will be like, you own a supplement company. What's the one thing I can take for ADHD? And I'm always like, exercise. And they're like, what? I thought, like there could be a thing. I'm like, the thing is exercise. So if your mitochondria or like the generator powering your house, like if they're the main primary source, then I want you to think about exercise is like a crank generator. And you have to move to get your lactate up. So the lactic acid that everyone's like, I don't want that makes me saw. Yes. And it's a backup energy source for the brain. So this works well if you're in menopause in general. But this is a tool. This is why we see the hyperactivity. This is why we see the ADHD or that can't like sit still. Their legs always moving. Things are always moving. They're trying to generate that brain energy. Because there is an issue with glucose metabolism in the brain of a neurodivergent individual. So neurodivergent being a really big umbrella here we're talking specifically ADHD. I mentioned autism that can also be tics. It can be OCD, it can be, you know, anything that fits into a learning disability. Exactly. And a lot of these individuals, they have a hard time generating energy from glucose alone. And this is why movement becomes so powerful. So exercise is amazing. Why okay. So I want you to think about exercise. You know, I do talk about visceral adiposity in the book. I talk about all these important metabolic cardiometabolic benefits. But the thing about exercises is that 20 minutes of physical activity, usually zone two, is going to get you 2 to 3 hours of focus and attention. So I'm like, you do this before you have a big meeting. I do it before parent teacher conferences if I like, because I'm like, if you were if you were an ADHD kid in school, like that is like reliving your own trauma every single time, you're like, oh God, I got to go to the teacher's office like, oh, no. But the other thing is that as you lose estrogen, you lose blood perfusion to the brain and you also start losing neuroplasticity. So we need these hormones, especially estrogen and progesterone for neuroplasticity. There is nothing that beats exercise really for bumping BT and F which is the miracle grow of your brain. So that's the first thing I usually talk to people about. Although in the book it comes, it's actually like chapter seven exercises. But like, you know, practitioners will get it. Like starting with food is such an important place. So, you know, the first part of the book is it's very heavy in science. I hope ADHD people don't hate me for it. And then we go right into like, okay, we're going to talk about how to change your diet because ADHD ers have less microbial diversity than the average person. Well, what happens when we go into menopause? Goodbye, goodbye. Microbial diversity is estrogen declines. So we've got to talk about the food component. We also know that the gut is a major source of inflammation for some people. If we're not working on those aspects like I can get you to exercise, but without getting you adequate fiber, that's not really going to shift visceral adiposity. And for people listening, visceral adiposity, the deep abdominal fat packs around your organs and why we care about it. Yes. Heart disease. Yes. Diabetes. In the context of ADHD, this is the source of inflammation. This is a source of inflammation disrupting your brain. So even if I give you astro and you may need estrogen so that you can exercise and not feel in pain and, and be able to control your cravings, but it's not going to be enough. So what are your thoughts about when a woman is imperium and a cause? She's got visceral adiposity and maybe a little muffin top that she does not want. Can't get rid of it, and she's trying to change her diet. And then there's the kind of the siren call of the GLP ones. Yeah. Well, one thing I'll say about GOP ones is I do think they they're great tool, but we are seeing from the research that they really only benefit women in middle age when they're also receiving HRT. So you need to have that on top of it. Because like if we go back and peel back the layers of like, why are you ending up with insulin resistance? Why are you ending up with visceral adiposity? Because you've lost your estrogen, and estrogen regulates fat storage. And so estrogens like pocket in the hips and thighs, you lose your estrogen. And it's like, let's do what these, like our guy pals have been doing all these years. And let's just like, put it, you know, in the center. And so, you know, does she need a GOP one? Like maybe. But I think we have to start having a conversation first of like, what's your nutrition? What's your lifestyle? And then what are your hormones at? And why that's so important is because anytime we lose weight, we lose muscle. And you cannot afford to lose muscle when you are in your middle age like you just can't, you're just losing way too much. I mean, we lose such a significant amount of muscle. Not everybody. Yeah. Everybody talks about what happens, you know, post menopause in the first five years. And I'm like, why are we not talking about perimenopause? Because it's also we're we're deleting we're deleting, we're deleting. And then there's this big deletion event. And so you know before we go GLP one route we want to talk about okay what are the foundations and how are we going to make sure we have a strategy for you to hold on to your muscle mass. And then I think like there is a time and a place for it. I definitely had patients who are successful who are like, I just want to use a low dose for a short period of time and like something to give me a little bit of an edge. The tricky thing with ADHD, so we don't have research on it, but people are reporting the brain works better. I've heard that too. Why does their brain work better? What do you do? Yeah, they drop inflammation. It's the same reason we see endometriosis. Patients are like things are better. Well, GLP ones are dropping inflammation. They help with regulating the immune system. So we see the macrophages stop misbehaving in endometriosis. They work better. Women with endometriosis tend to have lower levels of GLP one. So this may actually be supplementing what they're deficient in. And so when we and when I bring up endometriosis, because it's just so common to see co-occurring with these conditions that, you know, it could be what's disrupting the brain altogether. But the double edged sword is going to talk about is that a lot of ADHD ers lock introspection. They don't know when they're hungry. They don't know when they're thirsty. They're already ignoring their body. Or maybe they hyper focus and they don't eat. You know, people always ask like how do you write books? And like you're just able to do that. And I'm like, you should see like how nasty I am at hyperfocus. Like when my husband is just setting food and water to me in front of me, or being like, I need you to shower. Exactly. I know, and it's like, one thing I'll say is not I do take a break to like, be with my kids and be like that be because priority wise, that's really up there for me. But you know, so that's the tricky thing with GOP ones, is that if somebody's already not feeding themselves and then you're like, well, this GLP one might help your ADHD, it might help your peri menopause, it might help festival adiposity, but you haven't set the foundation so that they do feed themselves, which can be sometimes as simple as like setting alarm, which sounds so cliche. And ADHD ers will be like, oh, you know son, everyone says it, but sometimes you set five alarms of like counting down to like when you're going to feed yourself. So I actually have a quiz in the book about the different things that naked. So it's hard to feed ourselves because for everyone it can look a little different. Sometimes it's like, I just don't recognize I'm hungry. Other times it's that I open up the fridge, I experience overwhelm, there's too much. Yeah. Or there's the email prepped yesterday and that took everything I had in me. And now I don't want to eat any of that because now you like. And so there's all of these reasons that really. Yeah I do I made the sausage. So you know, with that though, I think that's where working with a registered dietitian, certified nutrition specialist, someone who is neuro affirming. I think that's really important takeaway for clinicians, because there are people who will say, oh, I work with ADHD, and their way to work with ADHD is to say, you're broken. I need to fix you like you do bad things. That's not neuro affirming and for the ADHD or that will actually backfire. So most ADHD ers will have something within the emotional dysregulation realm. So that's one of the executive functions that I think every woman loses a handle on from time to time. Thanks for just run. But with that. So it might be something like pathological demand avoidance which is like if you tell them what to do, they're going to do the opposite. They're not going to do what you tell them to do. It could be rejection sensitivity. And that's that's not a diagnosis. We need more research in that. But that's a phenomenon where people feel pain when they feel like you're judging them, whether it's real or perceived. And so, you know, it can be really delicate line to walk your synthetic nervous system in that, you know. Absolutely. Because they can, you know, some ADHD are still rejection so deeply that it's like they're under threat, like they're dying. And that can throw that HPA axis off. And you're absolutely right about that. Okay. So I have a couple of questions. Number one, I guess because you were trained in the natural pathway tradition, like what is the fix? How do we reverse engineer all of this, you know, from that perspective? Yeah. Also, I guess what is the Doctor Brighton kind of things? Yeah. Maybe it's the same thing. Maybe it's different things. But yeah, because Doctor Brighton loves her some science. So, you know, with I want to say, firstly, we're not fixing anyone's ADHD brain. I, you know, like to say that you've got a different operating system, right? We got all these Apple users. They got the iPhone, right. We got all these Android users. It's just different systems that you're working with. And so you know what I honor in the book is that so first place is I want to talk about your gut health. And I want to start you on a nutrient dense diet. If you don't have iron, you're not going to make dopamine, you know. And how many women are walking around with iron deficiency anemia because they've got heavy periods which they're told are totally normal. And then, you know, maybe what's the specialty diet of the year that we're all doing right, that we're all following? Maybe they're not getting enough iron. You know, things that we, you know, proteins having its heyday, thank goodness because we're all getting enough tryptophan now. Right. But looking at how do we actually optimize our fiber intake the turkey diet. Yeah. Yeah that would be awesome. So the other thing is like looking at how do we optimize the microbiome to produce short chain fatty acids for us. So you know butyrate is something I use in the recipes in the book because it's one of the food sources of our computer. Eight G is one of the few food sources of butyrate. I'm getting ahead of myself. So excited about butyrate. But butyrate can help with intestinal permeability and brain permeability. So some people who are experiencing severe ADHD symptoms, you know, we'll see a lot in functional medicine where people are like, if you just get the inflammation down, you won't have ADHD. And like you'll always have ADHD, just in the same way you always have PMOs, you always have. You always name the chronic condition. You always have it. But we can manage it really well. And I think that's an important message because people also need to know they didn't cause their ADHD, they didn't cause their child's ADHD because their child decided that they were going to only eat beige food. Like, that's a very common thing for for children to fall into. So we want to look at diversity of fiber, getting the microbiome to work for you. Make those short chain fatty acids because that can help so much with gut health. The other thing that we want to be looking at is how is your sleep. So we haven't even touched on that. But like 70% of those it's 70% or more with ADHD have sleep issues. And so there's something called delayed sleep phase syndrome where your melatonin doesn't rise until midnight. Like everybody's like, oh, go to bed at night, you know, do your screen thing, go to the screens off dark room. And the ADHD is like, no, but I do my best work at nine. May I just have to share my copy editor? I was like, writing in my book and I'm a sleeper. Just for the record, people, I love my sleep. But I had like such a tight deadline. And one of the things I was talking about is like wearing blue light blocking glasses. If you're on your computer in bed and my copy editors, like people are not on their computers in bed. And I was like, tell me you don't know ADHD without telling me.

But also, it's literally 9: 29:54

00 right now, and I'm writing this comment back to you. That's a real phenomenon. And so we have to sometimes you need cognitive behavioral therapy for insomnia to really do the work with this. But I do think sleep hygiene goes a long way. And working with people on walking back that bedtime and then waking at the same time every day. And that's the key thing. If we want to, we want to get bedtime right. You got to wake at the same time every day. How boring, right? Like ADHD is like, no, like if I if my body wants to sleep in, I want to do what I want. But that's one of the big things that we have to change. And so but the thing you know, this comes back to is hormones. Again, if you have insulin dysregulation, well, you might be waking up hungry. If your estrogen is doing perimenopausal, it likes to do spiking and dropping and spiking. Sometimes you might be waking up and we're like, oh, is it protest drone? No, it's histamine. It's because a lot of people with ADHD struggle with histamine. So you're waking it to 4 a.m.. This is where, you know, for practitioners, sometimes it's like you need to work on their gut. Right? That's the every time people are like, should I do low histamine diet? I'm like, I cringe. Maybe you need to for a short period of time, but I think that's such a miserable way to live that I'm like, I don't want you to do that. Also, I know you already have problems with getting enough nutrition. So, you know, the other aspect of having that ADHD operating system, they need more omega fatty acids. They actually need more protein. They don't metabolize it in the same way that the non ADHD system does. And this is like new emerging information coming out showing us that ADHD ers this the research is so not good on omega threes and ADHD. It's like well does it or doesn't it. Maybe I don't know. It's here. So many supplements because the brain is rich in Dar. That's what they focus on. So that's what they try to give ADHD ers. Well it turns out it's actually EPA. We need the EPA and we need higher amounts. So the standard like 1 to 2000mg may not be enough. It may be double that that somebody needs because they're not metabolizing it in the same way. So you know I got a little off track there with like the hormones and talking about the nutrition. But it's all to say that like you may have people with paradoxical effects, but we also have to be looking at the hormone component of all of this, because if the hormones are not optimized, it's going to be harder to sleep. It's going to be harder to get results. When you exercise, it's going to be harder to heal the gut without, you know, these hormones. So, you know, everyone talks about the estrogen. But progesterone is very, very crucial for having the intestinal lining be protected to have its integrity. And that's the first hormone we see go. When that starts to go, that's when gut dysfunction starts. But it isn't until estrogen drops. And really it's the straw that breaks the camel's back that now you have new food sensitivities, IBS like symptoms. You're noticing that you're, you know, belching or everything feels like it's setting you off and that you're reacting to it. You know, your stools are changing, which, by the way, we want to Colonel, if you're over 45, don't be like, oh, doctor, Brighton said estrogen like colonoscopy friends. And so, you know, it's I haven't answered probably. Yeah. I mean, you know, testosterone is one of those ones that's interesting because not everybody does it go low in. There's going to be a woman who's going to be like, yeah, dude, I'm fine. Like I'm going strong. But also, you know, some women, their testosterone is totally fine, but then their estrogen goes and then they're like, well, now I have chin hair, oily skin. The thing that's interesting about testosterone, too, I'll share a little clinical pearl for people is that you may have the right dose of testosterone, but if you start an ADHD woman on testosterone, I always tell them hydro credit cards for two weeks because the impulsivity is so bad. The impulsivity. I almost got a puppy when I started testosterone, I instead bought two pairs of sequined pants. I don't wear those, but I should. I should wear them for an interview at least once or something. But I had a I had a knee surgery. I don't know if you know this, but I was losing muscle and I couldn't get discharged because he's my orthopedic surgeons. Like, you're losing muscle like this is not right. And we're doing all kinds of things like, you know. Oh, yeah, hook me up to electrical, restrict the oxygen, do all the things. And then I was like, wait a minute, I'm going to test my testosterone. Okay. Progesterone. Great. Oh it was it was worse than that. So progesterone is great. Estrogen is great. I'm like, there's no way I get to my testosterone. Total testosterone in the single digits. I've never seen free testosterone below one. Like just like so abysmal. I mean, I have seen it, but this was just so bad in myself. I've never seen it. And so I had to start testosterone because I was like, I can't. I was at the point where I was like, oh, I know, I could probably like surgery was stressful. I could get this up naturally. And I was like, you're in your 40s, you do not have time for this. You don't have time for two years. Can I get my testosterone? You just have to use testosterone. And then the impulsivity was so bad, and my husband and I were laughing about it so much because he's like, you talk about this all the time, and you talk about this all the time, and you say, oh, you know, I warn patients like, hide your credit cards and then I catch you in the mall wandering into the pet store, being like, I think I should get a puppy. And he's like, who are you? Do you want to be up at night? Which is like the deal breaker for me. Like, do you want to not sleep? Oh, God, no. Like, what was I thinking? But, you know, I just think that's an important thing to, you know, I think it's an important story to just illustrate that, you know, you can have a woman some in my mid 40s, my. I'm still ovulating regularly. Estrogen, progesterone look perfectly normal. But that testosterone and my sex hormone binding globulin is like as normal as it comes. And I was like, you're just not making it. You're just not making it at all. And then when I started it, yeah, the impulsivity. But I've seen that so many times with patients. And that is the male expression of ADHD. Right. The super impulsive, super hyperactive. It's also what we see in PMOs. So he's question when the research is like PMOs and then they have higher incidences of ADHD. And I'm like is it that or is it that we catch it easier because other women are going to be more internal. So the research shows that in puberty that's when we become anxious. We start to internalize things. We start to struggle significantly internally. And the hyperactivity is there, but it's in our mind we can't fall asleep at night. We're replaying like, if you've ever been the person who's like, I shared way too much, that was way too much tme, and then you go to bed at night and you have like this TMI hangover, and then you replay everything you did wrong in your day. That's that hyperactive mind. It also is something where people are like, you can't have ADHD because you always run on time. And it's like this woman's always an hour early. That is a compensation that is being hypervigilant. Can you imagine how stressed out she is? But I feel like I haven't, like, completely answered your question yet of like, what do we do about this? But I've said like a lot of things. So we're where do you where you fall based on like medication, you know. Yeah, a lot of people sometimes want to take meds. What do you think about that? Well, that's the really interesting thing. So if you know any silicon rose and you're listening and they like to pop like they're riddling at night to work harder, tune in right now. Okay, so methylphenidate reelin has actually been shown in animal studies to lower reactive oxygen species. Lower inflammation in the brain, make the mitochondria work better, but only in the ADHD brain. The other thing they were able to do is they induced inflammation in this rodent model. And then the methylphenidate helps with that as well. So this is why we think that even if you're a non ADHD woman, but you're in perimenopause that these ADHD stimulant medications help you because they're helping with the inflammation. But if you don't have a PhD, you don't have neuroinflammation, you don't have reactive oxygen species. It makes it worse. And so this is where everyone will say, oh, railings destroying your brain. Yeah. If you don't have ADHD is upregulated inflammation. It is causing mitochondrial dysfunction. So that can definitely be a slippery slope. I definitely think medication has the time and place many women they notice before their period or in perimenopause stops working well. Why? Because we rely on our hormones for these neurotransmitters to work right? And without those, then you're only going to get so far with the medication. Additionally, the sleep. If you're not getting good sleep, then how far can these medications really take you? And so in the right patient population, they can be tremendously helpful. But just giving them out, you know in medicine we don't do that right. Like the DEA would be all over us. But we do see people that do abuse these medications. And for them that's going to be detrimental to their brain. And so the other thing I'll say is the concomitant autism and ADHD, they don't tend to do well on these stimulant medications. So this is something that's starting to be explored because there's a lot of people living with this experience saying, I don't fit in to the medication treatments of ADHD. There is no real medication treatment of autism. There's things for like if you have anxiety, sleep disorders like that, treat like, you know, co-occurring conditions. But you know, they experience that. Like I'm too amped up. I'm too feeling like the environment becomes too intense for me. My sensory sensitivity has become extreme. We're now starting to understand ADHD. ERS also have sensory sensitivities, not likely to the degree that autistic individuals have, but I think that's just an important thing to know, because if you try medication and you're like, I've never felt worse in my life, like I was completely on edge. And you, you go through and you take the rads, you take like an online assessment for autism. And that's coming up high. That's worth exploring and seeing. Like what are your other options available? Do you have a favorite kind of I don't know stack for neuroinflammation beyond high dose omegas. Well I think yeah we want to eat our cold water fish. Right. Because you're also going to get your selenium your iodine. We haven't even talked about thyroid and ADHD yet. But the other thing I really love is saffron. So I am such a fan. I'm like such a fan of my on saffron. I'm like, if there was anything that like leave me on a deserted island, I think it's saffron right now because saffron is just so powerful. It has, you know, it's been in trials with SSRIs and with methylphenidate, and it's been shown to be effective, interestingly, in children, when railings not quite getting you there, rather than upping the dose. There is some studies to suggest that maybe bring saffron on in addition, and that's what I love about saffron is because it can be used on its own or it can be used in conjunction with these medications. And so for practitioners, you know, you don't always have to pick and choose. And so like with SSRIs, which are very common in perimenopause, most women are getting diagnosed with depression before ADHD. SSRIs can cause an orgasm, a low libido. You can bring on saffron, it can actually help with that. The other thing I really love is cysteine. I mean, who doesn't, right. It's so fantastic. But anesthetic cysteine has also been shown to be beneficial for ADHD. Also co-occurring PMDD. You can use saffron and NAC together, but Copa is one that's a great antioxidant for the brain. That's got great ADHD research to back it. And then. Yeah. Yeah. And then but I still exercise people. I was like still. But the other one is which is a form of choline. I mean, when you look at the trials for people with memory deficits, the elderly population, and you just see the I mean, they blow my mind to see the outcomes of that. And then you take a population that's always struggled with memory issues, and then they're going into perimenopause and it's like, where's my acetylcholine at? That I think is just so powerful. And so those are some of the things I like. The other thing I would say is creating is having its moment. And it's one of the most evidence based supplements that we have. Any time someone says, like supplements have no research whatsoever, I'm like, create scenes on the phone, who wants to have a conversation with you? And so creatine can be really powerful. And this is something that sometimes women with ADHD, they'll be on 3 to 5mg daily. And then during their luteal phase, maybe 5 or 7 days before their period, they kick that up to like 7 to 10g a day. And that can really help with their brain energy metabolism. So what we think is happening is that creatine helps the mitochondria actually produce energy. There is concern right now because I brought up endometriosis. I do want to note there have been rodent studies, and I just want to be really clear about this because people say they supplemented rodents with creatine and their endometriosis got worse. And I'm like, Fred, they injected their peritoneum straight into their tummy. We ain't doing that okay. You're taking it. And so there is some research to show that like women with and Dimitrios, they might have higher creatine levels. And that may be interfering with their immune system's ability to handle the endometriosis. However, I'm like, it's there's so much about medical care, right? That is like risk versus benefit. I've not as someone that I've not seen compelling research that would make me give up creatine at this point. And at the same time, and like I am a mom, I run a company. I have all this stuff to do writing a book. I'm talking to you like I have to have things to support my brain. And I think the slippery slope is that too often medicine sees endometriosis as only endometriosis, and they forget that we have a whole body. And I'm like, well, why are we compromising her brain or her heart or her bones just to treat endometriosis like there is? There's so much more to this conversation. Yeah, yeah, it really is. And that's I mean, when you look at endometriosis, this is what's really concerning for me. So we've got ADHD higher cardiometabolic risk. We've got some studies. It's like anywhere to 40 to 60% higher risk of stroke and heart attack under the age of 40, under the age of 40 because of the systemic inflammation. And then you have, you know, you start looking at co-occurring conditions that all have this inflammation. I'm like, you're got better be right your whole life. Like like we got to get that right. And then we've got to make sure that, you know, it's definitely not going to be I'm making a joke here. Right. Because like, you should travel and you're going to get you're going to get food poisoning when you travel at some point actually you rolling the dice, but the stakes are high. And I think, you know, we have to start looking at the entire individual and we need to start asking questions. So it's always that nutrition. And Lisa, I'm a big fan of like what doesn't need a prescription? Because that's what keeps you out of the doctor's office. And then when you need the prescription, let's make sure we're not withholding that from a person just because we have a stigma about, you know, GOP ones are we have a stigma about HRT. We have a stigma about stimulant or non stimulant ADHD medications because there is and I just really challenge people to check their bias because I think, you know, all of us have some degree of bias. And a lot of times that bias has been due to our medical education or the science that that predated, you know, our current moment. Exactly. And so we have to always be willing to be humble and to recognize that, like, we need the buffet, right, of tools and to choose whatever's best for that person. Yeah, I think it's important to stay curious. And it's kind of like, you know, science is always evolving, and we're always supposed to be asking questions and figuring out, you know, if tools that maybe we thought couldn't help, maybe they do help, or maybe we need to pull these stigmas back. So I do agree with you there. That's fascinating about saffron. I was going to ask you, do you have a like the studies are showing 30. Is it 30mg a day? That can be 28 to 30. Yeah. It was a very, very tiny. Yeah. That's the randomized control trials are all done on that. I think that's a great clinical trial. And I always thought it's really interesting. Like for example, I think right now Spain is having the moment is being the happiest country in the world. And I think they're very, very high saffron food in their daily saffron food. They also have period leave. Yeah, they have period leave. Yeah. They eat a lot of seafood depending on the region of Spain. I don't want to lump Spain into all of that. Yeah. I you know, it's funny because you see all of all of those things and I'm like, you know, you don't catch the US topping that list. And I think that's a moment for us to just really reflect on like, what could we be doing better here for sure. Okay. So now let's bring in thyroid. Yeah. So this is one we always want to rule out when we're thinking could this be ADHD. So I said at the beginning we're going to unpack the bucket. So there's the you have ADHD because you have had these problems like your whole life. But you managed you manage really well. Then your hormones change. So whether it was postpartum to the five P's is what I call it postpartum period. So luteal phase pill coming on or off the pill can change things. And then perimenopause and post menopause and then and post-menopausal. As you can imagine you're not coming back from that right. You're not going to come. It's not like postpartum where like six months later you're like, oh, wait, I kind of recognize me. And then two years later you're like, that's me. Okay. Like we're back. And so, you know, we have to identify like where you're at in your life phase. But when it comes to thyroid health, this can be masquerading as ADHD. So it is not one of my hormone profiles that I have. And if anyone was going to question that you're really smart and I really like yes, you can always sit at my table. But the reason it isn't is because if you have low thyroid hormone, you may not have ADHD, but everybody will feel like they have ADHD like symptoms because low thyroid hormone. Now we don't have the brain energy metabolism. We are not able to synthesize dopamine or our other neurotransmitters and utilize them. And literally everything starts slowing down. So thyroid masquerades as ADHD. And that's why, you know, before I'll send someone to see a psychiatrist or a psychologist, like whoever's going to diagnose ADHD, I want a full thyroid panel. And I want to see because if you're you have hypothyroidism, I don't want to send you out yet. I first want to correct the hypothyroidism. And then when you're like, okay, things are getting better. Labs are optimal, symptoms are optimal. Then we send you out and get you evaluated because otherwise I'm sending you out and I know you're going to you're going to get a diagnosis of some kind because you're deficient in this hormone. And so I think that's a really important thing for people to check, especially if the if it's low T3 alone. So sometimes you won't see the is elevated, but you're having this conversion issue happening. Maybe someone has a chronic infection. Maybe they're chronically stressed out. There's something going on. They've got that low T3, they can start having ADHD like symptoms. And so, you know, if you have someone and they're having ADHD like symptoms. So they're like my time blindness is horrible. So what that means is that you have to be somewhere at 11. You can't work your way backwards to figure out how to get there by 11. Or you don't know you've been working on something and you didn't even know how long you'd been working on it for. You're planning your execution, your emotional regulation. Like you're starting to have all these symptoms, but you're also gaining weight, losing hair lateral third of your eyebrows is going away. You've got dry skin going on your you're really cold. Your digestion is really sluggish. Like if you've got that symptom picture, that's enough for you to run the labs and start working on that piece. They can also have ADHD. It can be both. Well, Hashimoto's is very, very common to see with ADHD. Yeah, there's like, you know, a subset of autoimmune diseases that are you know, the researchers like these are most common with ADHD. They happen to be the most common autoimmune diseases only. Are they more common with ADHD, or is it just the fact that these are the most common ones? But we know that Hashimoto's autoimmune condition of the thyroid disproportionately affects women with, you know, in general. So when with ADHD, we would definitely expect to see that as well. Yeah, feel really overwhelming for the patient but also for clinicians. So like in our audience, a lot of our audience is the clinician audience. And some of them are just starting to declare toe into functional medicine or integrative medicine. So you know, when you when you have a patient like this that shows up, you know, what do you do. Where do you start? And I think probably you start in the gut, but you know, how do you unravel it? Do you have for them? Yeah. So we want to do a thorough history, and we want to understand not just who they are today, but who they have been. So I talk about a lot of patient cases in the book and going through, you know, there was this one patient that, you know, she was called a moody teen. You know, you're just a moody teen. Then postpartum, she's having these crash outs and she's going through this whole history. I'm like, you've had PMDD your whole life and you've had this ADHD, you know, issue that's been riding along, you know, basically trying to drag you down your whole life. And no one's been addressing it. You know, I think the first thing we have to do is unpack their story and what's their experience been, and that you start to unravel things and you start to see there's been a pattern here. So that's the first thing. Then you see from that story where it leads you. So where are there their prominent symptoms coming up. So like we just listed off all the hypothyroid symptoms. If that's where it is we definitely want to test that. So we want to do a thorough history you know physical exam when we're talking about ADHD it's like that's not as helpful. You know for something that's a psychiatric condition. But for you know, other co-occurring conditions it can certainly be helpful. And then we want to work them up with lab testing. So, you know, we want to think about things like nutrient deficiency. So get their ferritin a CBC. We want to also get a vitamin D low vitamin D that's going to that's going to aggravate ADHD. We have to correct that. Mean what doesn't it aggravate right. Like there's nothing in health that isn't made worse by a low vitamin D. So you know we want to look at those basics. We want to look at like a continental panel. So if you have a perimenopausal woman and she's like I don't know. Should I shouldn't I with estrogen and yeah, my brain's not working and her cholesterol is going up like that. That's a conversation where it's like, okay, I'm going to have to refer you. They're going to say statin. Do you want to try estrogen first? Right. And then you know. Yeah. Oh absolutely. Right. So we want to have that thyroid panel as well. I think getting an SKP is helpful if you suspect that somebody has neuroinflammation. I think the neural zoomer is probably the best test out there. I think, you know, there's other labs that can help you with antibody mediated neuroinflammation. But we don't have we are guessing at neuroinflammation otherwise because we're like I see a high CRP. We know cytokines can bump up against the blood brain barrier and cause the brain to actually increase its own inflammation, but sometimes they can cross it to. And then once we get inflammation in the brain, that's a very hard thing to calm down. So you want to get the lab testing and really see what you're working with. You know, if you have someone who, you know, here's the other tricky thing is like maybe they have had painful periods. Maybe they pain with urination, pain with bowel movements, pain with sex. You start thinking endometriosis. That's easy. But actually the top symptoms of endometriosis are fatigue and anxiety. This is what that's like everything right now. They've struggled with infertility or they have a family member had painful periods, or they had painful periods when they were younger and then they changed their diet and things got better. So we want to try to unpack the layers. That's not going to happen in one visit. So I mean, good news for like patient retention. You're going to be at this for like, you know, several years of unpacking those layers and figuring out. But you've got to let the patients priority really lead things. And I think the other thing is that as you start to dabble into functional medicine, I have always been a fan of symptom relief long game. And I think the mistake that practitioners make is they want to root cause everything, and the long game takes too long. It just takes too long for someone to feel better and some, you know. So sometimes practitioners are like this person, a CBU. We want to treat the Sibo, but they're also hypothyroid. So we'll maybe we'll treat the Sibo, see if their thyroid gets better. No, we usually have to do both because they won't have gut motility. See what will come right back. So we have to actually address what is going on with our thyroid at the same time as the gut. And the thing the goal should be, how do we make the patient feel as good as possible as soon as possible? And then how do I address the long term of what this is? And I think also having that conversation with them because like oftentimes patients who come to us, they don't want to be on any medications. They're like, I don't want to be on thyroid medication. Okay, here's my reasoning for it. This is why I want to do it also like let's just try it and maybe we work on everything else. And then we are able to bring you off and that sometimes happens. But also I read is not a negotiable like and nobody would ever be like, oh I don't make insulin. I don't want to be on a medication. Like people get that. And with thyroid medication, you know, I'm like, yeah, your is 18 friend. Like you can't live without this. And like maybe you've been getting by but like systems will start breaking down. So you know as a practitioner I'd say full history. Get your lab panel. Their symptoms will guide you on the labs. But I do think the the basics of nutrient status, understanding what their, you know, metabolic cardiometabolic profile is their inflammation profile. I think going through those basics and then just asking yourself in that moment was the first step they need to take so that they can feel better. And the thing that, you know, is different when we're talking in the context of ADHD, more neuroinflammation, more immune system dysregulation, more mitochondrial dysfunction, more brain energy metabolism issues. So this is someone that you got to start thinking right away. How do we get them to sleep. How do I get them to move if they're not sleeping. That system doesn't move. I call it the dishwasher. Like you've been loading it all day. You've got to run it. Because the thing about the exercise and the lactic acid, I was like, oh, it's so great, is it'll work against you if you don't get quality sleep because you won't clear that out. So as simple as it sounds, and I also know that, like every time I talk about this stuff, there's always someone who's like, she didn't say anything new. I hate to break it to you, but everything your mama said was right and what it takes to have, like, longevity. It's like what you see with the Longevity Bros doing. It's not very sexy kind of doing, doing the right thing over and over and over and over. Yeah, but it's also understanding. I mean, this is where you as the clinician, you understand what lever to pull first. And that's, you know, because sometimes your patients will be like, oh, you're just telling me to eat well and you're telling me to exercise and sleep, and that's so boring. But when you can actually explain to them, like if you can explain to them that like the biggest way to drop your brain energy and to ensure fatigue is to be dehydrated in your day. This is why I'm asking you to drink water. It's also why I explained exercise the way I did. I mean, so often what women here is like, you need to exercise because you need to be an optimal weight. Well, that's all well and good. Can we talk about myocytes? Can we talk about every time you contract your muscles how those are positively influencing your brain function? Can we talk about BDNF? Can we talk about all these other aspects that exercise is doing? And it was interesting because I was having that conversation with a patient the other day, and she's like, I've never been convinced to exercise until I heard this. She's like, because I've always thought it was because doctors just wanted to shrink me. And I was like, fair enough. Fair enough. Because a lot of them do. They're like BMI smaller, better. Yay! And that's not a positive message for women. It's way, you know, I teach it medical conferences and I'm so I just am in their face with like eat less and move more is not the earth shattering advice you think it is for a Perry amount of puzzle women? Does the physics work out? Sure. But when her estrogen goes down, she can't put on muscle. She can't exercise because it hurts so bad and she can't control her appetite. When her testosterone is too low, she can't put on muscle mass when her body is literally deleting muscle cells. Well, it was simultaneously infiltrating her abdomen with with fat cells like these addictions, like going out and causing a heyday in her system. Like this is not earth shattering advice to her. You have to you have to position things in a different way for patients to understand. Like, I'm not just scared of your cardiovascular health. It's not just about like, you know, you getting dementia. It's like I want you to function optimally. And then here's how we get there. I am just so excited for your book. And I feel like we could talk for like six more hours, but I think we have to wrap up. So can you share with everyone you know how to find you? And I think everyone should preorder your book now and your book comes out in the fall, I believe. Yeah, it comes out October 6th. You can definitely order it. You can get bonuses that come with that as well. Like I have PMDD workshop. I have like hormone ADHD workshops, like because there's an ADHD audience, I'm like, we can't order a book and then wait. Like although it will say the best part about ADHD is you order a book, you forget about it, then it's a surprise. You're like, oh, I gifted my future self this, you know? And for clinicians, I know clinicians read my book. And I actually got my publisher's been great. But they did push back where they were like, there are so many labs. There's reference ranges. Why are we putting dosages for hormones in here? Why is there like this is so clinical compared to like our average books? And I'm like because did you not read the section in the back that says how to use this with the clinician? So when I, you know, when I want clinicians to know, yes, you can preorder my book, but I can't see everybody. You can't see everybody. You need to be the clinician who is neuro affirming, who can help these women, because this is a huge subset of the population looking for help with this. And I wrote this book in a way so that you can pick it up and you can be like, I know what to do with this patient. I know how to order labs for this patient. I know what right steps to take based on everything that's going on, but also what I'm hoping is that the patient will go through the book, do what they can on their own, which is like so amazing when you get a patient like that, like that, right where you're like, oh wow, you've already like you hit the ground running. So now when you come with me, the results are going to be like ten x, like it's so fantastic. And so that's also my hope is that when to be able to get this book into patients hands and connect them with practitioners who are going to be able to help them, because, you know, the book takes you through every single stage that a woman goes through. But when you get to menopause, you absolutely cannot do that alone. I'd also say postpartum. You should not be doing that alone. And that's absolutely where they need a clinical ally. Yeah that's awesome. All right. And then people can also find you on Instagram. Oh yeah I'm everywhere. Doctor. Jolene Brighton. Yeah. You can join me on the Doctor Brighton show. I also have a podcast where I talk a lot. Well, thank you so much for joining us. Yeah, thanks for having me. If you're a practitioner interested in exploring advanced biomarkers from vibrant, you can learn more about testing options at Vibrant Wellness. And remember to follow us on Instagram at Vibrant Wellness to hear more.