So today on my podcast I've got Jack Sotheby who is founder of Podcast House and also runs Distracted Podcast.

We talk about ADHD, what it's like to have ADHD, how it could be diagnosed and how we can manage it.

And we also talk quite a lot about the brain and how it works.

All works differently for certain people.

It's a great conversation and I hope you learn a lot from it.

So Jack, I am in your sitting room.

This is your.

Studio I know.

And I love it.

It's it's just such a sanctuary.

It's great.

Now, I've been on lots of other people's podcasts, including yours, talking about ADHD, but it's something I was never taught about at medical school.

We hear it, my children talk about it, patients talk about it.

When people say I've got ADHD, you can see other people looking is what is it, what's going on?

And I, I just thought it'd be really useful just to unpick it.

Like what is it?

Is everyone with ADHD the same?

Do they all need treatment?

Like there's so much.

I just thought I'll ask you.

But before I launch into too many questions, just tell us a bit about your back still.

I found out at ADHD like a couple of years ago.

I've, I was in a relationship and it was like the first time that myself was fully reflected back.

I saw not just the good bits, the bad bits as well.

And I was like, why am I not listening all the time?

And like, why am I getting distracting showing up late and all of these bits?

And suddenly I had someone who was actually getting annoyed by it instead of just my family or whatever, you know, where I just like, oh, whatever.

And so I was like, it was over lockdown and it was sort of an explosion of like mental health, especially ADHD.

And so I was like, oh, maybe it's this, maybe I can pin it to this.

And I did, I was in the barbers and I did like an online test and it was just through the roof.

And I did it again with my mom and she found it hilarious because it was basically just taking off.

Every question was like designed for me.

And then I did the test, went privately, did the test and got ADHD and then became since then I just sort of had this 1st for wanting to know more about it.

A year or so ago I started a podcast called Distracted where we get on a bunch of guests and talk about all things ADHD and.

People are talking about it more, aren't they?

But you know, when I was at medical school many years ago in the 80s and early 90s, there was a little bit about ADHD.

It was always naughty boys that can sit still but it was always boys not not men and it was it was if they ate too many sweets or you know.

Well, you're 4 times more likely to be diagnosed with ADHD if you're a bloke.

Yeah, but you're just as likely to have ADHD if you're a woman.

Yeah, because part, you know, 50% chance of getting it from your parents.

So it's just boys are hyperactive, we're loud and it gets spotted at school because it's more problematic in the classroom.

Whereas a woman it a girl, it typically comes out as masking or it's in your head and anxiety.

It sounds like a lot of a lot worse deal in many respects because it's all internal.

You've got that hyperactivity, but it's it's inside your head.

Yeah, and then you can't see it.

Yeah, so no one knows and and you don't even know.

It's so foundational they and, and because you're masking so much, you're getting treated for anxiety or depression, you'll be much more likely to have all of these things if you've got ADHD as well.

And, and so you're getting treated for these symptoms when actually sometimes it's, you've got to sort the ADHD and, or even just understand it because that's, that's basically the, the big take away that I've had over the last few years.

A from being diagnosed, but also from starting the podcast is a lot of it, it really goes back to shame.

And like feeling shame for these these bad qualities and just recognizing that you have it and understanding it goes so far to, yeah, stopping yourself from feeling so guilty or rubbish about yourself and not being great at, you know, doing the bloody washing or whatever.

It, but it is.

It's the guilt, isn't it?

And I think it's the lack of self belief that there is something that's not quite right, but what is right anyway.

That's a whole different conversation.

But it's, you know, in medicine I was always taught you listen to the patient, you understand them, you try and help them.

And then you might make a diagnosis and treatment is really at the bottom.

And if you look at complaints for doctors, the most common complaint is not being listened to, not being believed.

And I see this a lot, obviously in my work with hormones.

But people who've had ADHD for many years, don't you say they've been gas lit really.

They've been told they've got anxiety, depression, which they might have, but they're worried because they're always late, they're letting down their friends, they're not putting the washing on or whatever.

But once they realise what's going on, it's it's quite a relief for people, isn't?

It yeah, a lot of people that come on the podcast say that they almost grieve their past life because it for all those years where they've blamed themselves or knocked themselves or just masked pretended to be someone they're not in so many different environments.

It really weighs heavy.

It's like putting on lots of different cloaks.

You put so many on it, really, you know, it can feel a lot, but.

There is this thing they're trying to conform, isn't there?

That, you know, a school is really difficult for people, a lot of people for all sorts of reasons, whether you know, physically or mentally or often both, because they're trying to conform, aren't they?

And it's a very tip box.

But even out in society, people expect people to behave in certain ways or do certain things.

But I'm very interested in the brain.

I'm really, really interested in neurophysiology, neuroanatomy, neuropharmacology, neuropathology.

So everything related to the brain, when it works well and when it doesn't work well, and all these amazing neurotransmitters, these chemicals and hormones that work in our brain.

So we we still don't know much really about ADHD in a very molecular way, do we?

What from what we know, really it's about a lack of dopamine in the brain.

And it's not really a lack.

It's more just we we don't, we're not managing it well.

We're effectively searching for more dopamine that makes us more impulsive.

We can't stay focused as much.

That's what a lot of the medication does it like Ritalin it, it gives you more dopamine so you have a base level so you're not constantly task switching or.

But dopamine is a reward hormone, isn't it really?

It's that, you know, when people do something pleasurable, they feel good about it.

But if you don't have that, you don't feel quite as good doing the same thing that you've done before.

But there's also, you don't want too much dopamine either.

It's the, the, the neurotransmitters.

It's a fine balance.

It's like a seesaw, isn't it?

Yeah, but they also dopamine changing will have an effect on neurodrenaline or cortisol or serotonin, all the other hormones and neurotransmitters in the brain.

It's amazing how closely they all work.

Yeah.

I mean, for me, it's like, I love it.

I actually like the imbalance.

I mean, sometimes it's not great, but I can hyper focus on something when I find something I love.

And I'm lucky enough to, you know, do podcasting and run this space.

So I get to do what I want to do all the time.

And so I, I find it much easier to fall into that hyper focus state where I can just go in for 6-7 hours and get so much done and it feels amazing.

So I'm lucky because I, I figured out what I liked very early on.

But for some people, I mean, I got fired from 4 jobs.

Did you before?

Yeah, I was constantly getting fired because I was just, if I wasn't didn't like it, I was rubbish.

I was really not engaged, scatty, not turning up on time, just all of the, the classics.

And I used to think I remember when I was like 1918, I was like, why am I always getting fired?

Is this normal?

Does everyone get and then, you know, kept doing podcasting was like, oh, I'm not getting fired from this.

Maybe this is what?

I want.

To do.

Yeah.

And I do think it's also like a bit of a misnomer because it's attention deficit hyperactivity disorder, Yeah, which is quite a long.

Like, what does that really mean?

But you've already said that you've got ADHD, but you don't really have an attention deficit if it's something you're enjoying.

Yeah.

So that makes it really confusing for people, doesn't it?

Just.

Those words, we need to almost update, update it.

It's so broad as well.

It's such a broad.

We could start making subcategories.

It's like having a like a a category called action or just like horror.

You know you can you we can start making the sub categories now and I think it would help people.

As a doctor, I only want to make a diagnosis if it's going to change treatment or outcomes for a person.

And like you say, for lots of people, knowledge is such a power and that having that knowledge is really important.

But our brains are changing all the time.

They're evolving and they they change depending on what we eat, what our lifestyle is, what our sleep is, what our social interaction.

Everything is changing.

So I sort of sometimes worry a bit for two reasons.

Firstly, there is a lot of money to be made with ADHD at the minute, but there's also the medicalisation side that you've already said the red drugs.

And you know, I'm a, I'm a medical doctor.

I prescribe all sorts of drugs and drugs can be very important for the right person for the right reasons.

And often drugs we give short term, not always long term.

And I worry about medicalising too many people.

Is it good that people are just being labeled without really understanding the brain and how it changes?

And you might think you're fine as a woman, and then suddenly your hormones change and that's gonna play havocs to your ADHD.

And who's helping people with that, you know?

Yeah, I think everyone, This is why it's, I got so popular on TikTok and Instagrams because everyone can relate to all the symptoms.

Everyone's turned up late for stuff and everyone's not bothered by things they don't like.

Like, yeah, it's when it's it's a disorder, Yeah.

When it's actually impacting your life to the point where it's disrupting it, yes.

I think for me, getting the diagnosis was really to tell other people that I had it with certainty, almost.

I knew I had it in my bones.

And everyone else I've spoken to who hasn't had the diagnosis, who also really feels it, they, they just know you don't have to get sort of.

And for my, for me anyway, it felt like just sort of a stranger over a zoom call for 60 minutes, less probably 45.

He asked me a bunch of questions, which was effectively, do you have ADHD or not?

And then at the end of it, they were like, right, great.

Do you want, do you want the drugs then?

And it did feel like it was funneling me to just take the drugs instead of like, OK, how do we set up a a system where you can better help yourself in these areas where you're struggling instead of just like, here's some meds.

Yeah.

And, and look, that was my experience.

And that was the one, the one, the private place I went to.

Yeah.

And so it's all going to be different depending where you go and.

Absolutely.

And for some people, you know, they have the most amazing experience.

But I, I also feel in medicine things are really siloed more than they were.

You know, I had a very general training.

My psychiatry training was very general.

My medicine training was very general.

But now everyone is special, specialized in psychiatry.

You have people that only deal with ADHD or only deal with schizophrenia or whatever.

But it's almost like having physio for one part of you instead of having an osteopath to look at the whole picture.

Absolutely.

Yeah, yeah.

It's like if you know you've had a heart attack and not, not look at your blood pressure and not look at, you know, your nutrition and everything else as well, it just feels really in Congress with how medical training should be.

And I think also what you want to do is be able to have this longer term relationship with people as well.

So they really understand.

And, you know, my oldest daughter's always late and she drives us mad.

And she's always just lost her keys.

And it's yeah, yeah, yeah.

But when she said, oh, I've read or seen on TikTok that people ADHD are more likely to be late.

They're less likely to unload the washing machine or whatever.

It's like, oh OK, that's made her feel less bad, if you see what I mean.

Also, what it does is when you kind of accept it, you're like, right, OK, I've got these things.

I'm not, I'm, I can't just fix myself like I'm just going to be better at like keeping my keys and my you just got.

No, no, I'm actually, I'm going to be bad at doing that probably forever.

So let's set up some sort of system.

So I have like a really bright phone case that's red with a zip pocket to put my keys in so I can call my keys if I ever lose them, you know, so I, I always have every like really basic baby stuff, but it's helps and it and it stops you from going, Oh, I'm just, I'm just like this.

I need to, you know, it cuts out that noise and.

That it is the noise and life is really busy anyway.

And then if you've got people that don't understand and then are blaming you the whole time.

But I do worry if people don't get this holistic care.

It's a very different way your brain works.

And I find it so interesting the brain, how it's it we can remould it, we can we rewire it, we can get all this new, you know, changes in the brain.

You know, the brain can grow and develop all the time, and these new neural pathways can can.

It's like a tree.

Do you know what I mean?

Right.

So if you it's like building up habits, basically when you start building up a habit of or always keeping my key in my right pocket.

It's Taus.

It's that muscle memory.

You know, the more you like you do a yoga practice.

It's just a second nature, isn't it?

That or or whatever.

Yeah, and it and it is this when I was learned at Tauset medical school, the brain like moulds and and develops and then as a teenager and then it settles down and then the brain cells just die with time, right.

But it's it's not.

We're constantly getting new brain cells, these new, it's like, but you want to prune those branches and then just get the tree to grow better so you can.

Still grow through your whole life.

Throughout your whole life, it's really important and we've got these sort of these growth factors these in in the brain and they can change according to the environment.

So if you have a very inflammatory diet, you have more inflammation, you're going to have less growth factors.

So your tree will not be more like weeds.

Whereas if you have an anti-inflammatory diet, you know, you eat better, you exercise, hormones can stimulate these these growth factors as well.

Then you can see if your brain is more organised, the cells work better and that helps with all your sort of brain memory and everything else as well.

So.

But you can feel it after you just have a healthy meal.

Course you can.

You just feel, yeah, like more alive.

I had a pizza last night because I came home late and this, this whole morning I've been feeling like sluggish and weird.

And that's just a like a micro example.

Yeah, but you can see that.

But if you're not getting help and a lot of people with ADHD won't get help and then they might turn to drugs and then they're drinking more alcohol and then they're eating worse.

And then everything feels well.

And it's this sort of spiral.

And then your brain is like, Oh my God, chaos, chaos.

And that's where I feel like going back to the basics is really important so we can understand.

And of course, you know, if you've just had an argument with your partner and I, of course I'm going to eat worse.

So my diet was a lot worse then I wasn't doing yoga every morning because I had the children's, you know, And so it's this downward spiral.

But I think the conversation is great, isn't it?

People must be learning, you know, from, from your podcast.

But there's there's so much more out there, isn't there for people to understand.

Especially for women, I think as well, it's really exploding.

I mean, probably across the whole health industry, it's exploding for women.

My girlfriend is an osteopath and she's constantly like, is this right?

Is this right?

Because it's, there's so much new information all the time now.

But for ADHD, especially women, like we said, it's it's less diagnosed and there's way less tests on women.

So yeah, it's kind of like a revolution.

And the more conversation, the better.

You know, this, everyone always says, oh, everyone's ADHD now.

And I just think it's so silly.

Why would you not want to empower people and give them an opportunity to learn about themselves?

I think it's also, it is can be a superpower for lots of people if they find the right, right, right.

Well, career, job, you know, just just lifestyle, everything else as well.

And I think it's similar in some ways to dyslexia.

My middle daughter was diagnosed.

I knew she was, but she was diagnosed with dyslexia.

And actually that just meant she had extra time in exams, took the pressure off.

I mean, she can explain to people and she's got a very visual mind, you know, very visual.

And it's, it's in some ways she doesn't need treatment, but it explains to people.

And I think it's, it's all about explaining to people what it means.

And I think we're sort of getting there with ADHD, but people still don't quite because of the disorder bit it sounds almost is it a disease?

And I think that's where people can be misjudged, actually.

Interesting.

I would say it's, I would say actually for younger generations, it's a different conversation.

Yeah.

I think it's more kind of accepted in younger generations now, especially like 20s seven below.

Yeah, I feel like it's kind of OK, We get it.

That's great because I feel I see a lot of women in their 40s who have been diagnosed.

Often it's symptoms have got worse because their hormones have changed.

And they then say I wish I'd known this 20 years ago.

I wish that that now I've understand how I've behaved and how things have been, and especially this hormonal variation.

Yeah.

I mean, you, you mentioned PM, sorry to cut you off.

You mentioned PMDD.

Yeah.

I mean, from the studies I've seen, it affects about 4% of women.

And but with ADH, well, it's probably many undiagnosed, but with ADHD, it's 40%.

Yeah, so you're far more likely to get it with ADHD.

And imagine not knowing you had ADHD and just having these extreme sort of hormonal changes every month and then realizing you have it in your 50s, sixties, going through menopause.

It's really scary.

I was talking to someone yesterday who just listened to one of my podcasts and he's remarried, he's divorced.

I knew that, but then he said that's why we had such a bad time.

I had no idea because it was once a month, a few days.

Behaviour was awful, drinking was awful and just shouting was terrible.

Self total self sabotage.

It is and the self sabotage is really common actually, isn't it?

People want to look after themselves, but it's almost you have this can have this downward spiral as well.

It's.

Weird, I I get it sometimes like it's almost for me.

It's like when it when it passes a point, I I just like if my room gets past a point of messiness, I just completely sacrificed the room.

I'm, I'm not, I don't, it's done now.

It's nothing.

Because my daughter is.

Like that and my I was, I cleaned it up the other week and I've managed to maintain it.

It's fine because it's like, well, it's clean now.

I can keep it clean.

But it's a it's a weird psychological like point that you can't break otherwise it goes into chaos.

But that's where you need other people to help you.

Yeah, it's, it's interesting because my two daughters are living together at the minute.

One's incredibly tidy.

And the other one likes it to be tidy, but she's quite messy.

And it was just interesting.

One of them was saying to the other, when you've eaten, see putting the plate in the dishwasher as an extension of your meal.

And Jessica was like, oh, no, I see it as something different.

I see it as I eat and then I clear up later.

She said, no, no, no, you can't do that.

I can't live with you if you do that because I can't have the The Dirty plates on the side.

So Jessica was then like, oh, I get that.

OK, I'm going to do that.

It's it's very simple.

It's just interesting.

But that's where the brain I think is, it's so magical because it can be changed, but I think the way it can be changed and other influences of so important people to understand.

And I know I help on a lot about hormones, but obviously you've got the beneficial hormones that we give to people, but then you've also got contraception.

I know we've spoken about this before, these synthetic hormones that are blocking our natural hormones working.

So although people don't get this variation.

They often then find things very difficult, their mood can go down, their concentration can be less good, they can be less motivated, and if they're also then on drugs for ADHD, you've got a double whammy actually.

Yeah, I hadn't thought about that.

Do you prescribe hormones to men as well?

I don't, but I'm very interested in hormones to men.

I often diagnosed because actually testosterone is a male and a female hormone.

But a lot of I'm in a in a group with a lot of doctors who do specialized in ADHD and men as well as women.

And like I do with women, they notice with men testosterone is makes a massive difference.

It's very sort of coming on the brain.

It makes it very a lot easier to think when people take testosterone as well.

And testosterone is made in the brain.

It's a really important neurosteroid and and when you've got good levels of testosterone, you're going to have better levels of dopamine, serotonin and everything else as.

Well, is that why I feel so sharp like after a gym session?

Because I would have produced so.

Much.

Yeah, probably because your muscles produce testosterone as well.

And that's why exercising is really important because our muscles and our bones are metabolically active.

You know those hormones going, the blood going to the brain massive and that you know, you get this endorphin hits as well, don't you?

Oh yeah, I mean, I think exercise, it's like such an obvious one, but for people with ADHD specifically, it's like huge it's.

Huge.

Yeah, just to get that hyperactivity out.

Yeah, yeah, yeah, just.

To get it out and I just feel, I just feel like I can focus better after doing.

Some exercise, you know, if we could prescribe it, it would be the best drug ever.

Yeah, like it, but it's just underrated.

But it's so important.

It's like 1 of it's like one of the most important things anyone, everyone needs to do it.

Like if you can, you need to be.

Able to do something doing exercise.

It's sort of hard to ask people to do it because it's seen as a bit offensive I think.

Yeah, but we need to do it more.

Yeah, so it's not so much we need to just know more, understand more, but I'm really grateful that you've been so open.

And I think just get people to think differently hopefully, and think about the brain, think about how we need to look after our brain.

But three take home tips.

So no question, you know, it's coming.

So if someone's thinking they might have ADHD and they're just a bit confused, what are the three simple things that you would say?

You can just take an online test which is like a nice gateway into something external going.

Yes, yes, yes.

It takes like 10 minutes.

I did a bunch of different ones and the questions are similar but that can really help.

Also, just if you're watching videos on social media, follow a few like ADHD related pages and if it really feels like it's connecting with you, there's a reason for that.

There's probably a reason for that.

When I, when I first found out and I saw content online, God, I just went obsessive.

I was watching so much because it was so Lafartic, Lafartic, Lafartic, cathartic, cathartic.

I just felt so heard and there was a community there which was similar to me.

And again, it was like that first step in removing the shame.

So that's what I'd say.

Binge social stuff and do some online tests and speak to family and friends because it it then it doesn't feel like a big thing in your head.

Absolutely.

You'll also find probably that if you've got ADHD, some of your mates will as well you you tend to attract each other.

Yeah, so sharing is most important and sharing knowledge as well, which is great.

So.

Oh, thanks Jack.

It's been great.

It's O'Neal.