Good Life Project - Escaping Survival Mode: Rewiring Stress & Overwhelm | Spotlight Convo

Episode Date: October 31, 2024

Are you stuck in an endless cycle of stress and burnout, constantly chasing new goals but never feeling fulfilled? Or do you struggle with focus, restlessness, and emotional intensity - perhaps signs of neurodivergence? In this powerful episode, our guests Romie Mushtaq, Aviva Romm, and Sasha Hamdani provide candid insights into breaking free from the "stress success cycle," managing overwhelm and survival mode, and embracing the unique wiring of ADHD. Prepare for an honest, hopeful discussion packed with practical strategies to rewire your busy brain, repair your body's stress response systems, and start living with more presence and inner peace.Episode TranscriptYou can find Dr. Romie at: Website | Instagram | Listen to Our Full-Length Convo with RomieYou can find Dr. Aviva at: Website | Instagram | Listen to Our Full-Length Convo with AvivaYou can find Dr. Sasha at: Focus Genie App | Instagram | Listen to Our Full-Length Convo with SashaCheck out our offerings & partners: Join My New Writing Project: Awake at the WheelVisit Our Sponsor Page For Great Resources & Discount Codes Hosted on Acast. See acast.com/privacy for more information.

So SOS stands for survival overdrive syndrome, and it was just sort of an accidental term. It's not a real medical term, but as I had so many women in my practice sitting across from me or women emailing me and writing to me on Facebook, I kept hearing this theme, and it was actually a theme of repeated words. Dr. Rahm, Dr. Aviva, Aviva, I feel like I'm chronically stuck in survival mode. I feel like I'm always in the on position. I feel like I'm chronically stuck in survival mode. I feel like I'm always in the on position. I feel like I'm always just trying to keep up, you know, I'm like just trying to stay afloat. And it was this sense of really, truly, like life survival being on the line, not in terms of necessarily having enough food, but feeling that the stress response in them was so over activated and they couldn't keep up.

So here's my question. Are you stuck in an endless cycle of stress or burnout or maybe constantly chasing new goals, but actually never feeling like you're coming close to them or feeling fulfilled? Or maybe you struggle with focus or restlessness or emotional intensity, perhaps signs of neurodivergence. In this powerful spotlight episode, we've got three incredible guests who provide candid insights into breaking free from the stress success cycle, managing overwhelm and survival mode, and embracing the unique wiring of ADHD. So my guests today are pioneering a revolution, really, in how we approach well-being amidst the incessant demands of a fast-paced world. First, Dr. Romi Mushtaq, an award-winning neurologist, integrated medicine expert, and mindfulness teacher, shares her deeply personal journey out of the stress-success cycle and into a sustainable model for peak performance. And her innovative eight-week protocol provides a true roadmap for rewiring your busy brain,

taming anxiety, and restoring restorative sleep. And then we'll explore what Dr. Aviv Aram calls survival overdrive syndrome, that chronic state of stress and overwhelm that so many of us have come to accept as normal. And as a Yale-trained physician bridging wisdom from traditional and integrative medicine, chronic state of stress and overwhelm that so many of us have come to accept as normal. And as a Yale-trained physician bridging wisdom from traditional and integrative medicine, she offers compassionate and science-backed strategies for reclaiming your vitality from burnout's grip. And then finally, Dr. Sasha Hamdani, a psychiatrist and ADHD specialist living with the condition herself, provides a really unvarnished look at navigating our frenetic world with a neurodivergent brain. And her toolkit of self-compassion practices really invites you to celebrate your unique wiring while customizing sustainable structures

for focus and thriving. So whether you're wrestling with anxiety or imbalances internally, or the intense emotional rollercoaster of modern life, these pioneers really offer pathways towards balance and well-being and a renewal of hope. So join in as we kind of reimagine a world where genuine success and inner peace harmoniously coexist. Yes, it is possible. So excited to share this conversation with you. I'm Jonathan Fields, and this is Good Life Project. exist. Yes, it is possible. So excited to share this conversation with you. I'm Jonathan Fields, and you is? You're going to die. Don't shoot him. We need him.

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award-winning speaker working with Fortune 500 companies and global associations, Dr. Romi's BrainShift program improves mental well-being and also builds cultures of wellness more broadly. And her expertise is featured extensively in national media outlets from NPR to NBC, TED Talks, Forbes. She's also the author of the book, The Busy Brain Cure, The Eight-Week Plan to Find Focus, Tame Anxiety, and Sleep Again. And in this part of the conversation, she shares her personal journey of burnout and how it led her to develop this eight-week protocol to rewire the brain and break free from the cycles of stress, anxiety, and insomnia that plague so many high achievers. With a whole lot of empathy and practical wisdom, she offers

kind of a roadmap for finding balance, focus, and a renewed sense of hope in a relentlessly demanding world. Here's Dr. Bromi. I want to start in a way that maybe your typical guests don't start and that I'm here on behalf of all fellow type A, success-driven, high-achieving professionals. We don't want to be told to slow down, Jonathan. This is one great life we have. And especially if you're living a life on purpose, if somebody else tells us to go with the flow, eat berries and breathe, we'll probably run over you with our wearable tech and our designer shoes.

But I learned the hard way, and we're gonna unpack that in an honest way, that sometimes we get stuck on what I've been calling the stress success cycle, like yourself meeting thousands of high achieving professionals through keynote speaking, executive coaching, all the programs we run, that there's this wiring and process in our brain that somehow we've been taught. And you and I come from the cassette

tape era. And somewhere in that generation, we learned this awful mantra that became an embodiment, fake it till you make it. In today's world, it still exists. It's not real unless you have social proof and that social media proof is filtered and shot from the right angle and captioned at the right way and you get enough likes, that fake reality. And I want to backtrack and say, we can succeed in a goal that is truly in alignment with what we desire and hope for personally and professionally, but we don't have to stress ourselves out. So we set goal. We use smart goals or whatever systems we've been taught at this high achieving level. And there's a stress that's pushing us to achieve the micro steps until said goal or achievement is achieved in our personal or professional life, buying your first home, getting a promotion, submitting a

research grant, both of us releasing a new book, whatever that is. And that somehow we're forced to keep pushing to that edge of stress or burnout, because if we do, we get that false dopamine high, we feel good, like I'm striving towards success. And guess what, we get that false dopamine high and we feel good. Like I'm striving towards success. And guess what? We get that success and there isn't true joy, a peace of mind because we're falling off that dopamine high. And we look around and be like, what's missing? I thought that was the goal. What's my next goal? And we start to stress all over again, the stress success cycle. I'm really here to say that when you heal a busy brain, we come back to a place I want everyone to live. And that is one of having hope and being someone

else's hope holder. And when you're in that place, we succeed without living on the edge of burnout, without stressing ourselves out. Yeah. You've used the phrase busy brain. What do you mean when you use that phrase? Yeah. Jonathan, it was a term that I coined, an unofficial medical term, but something that I noticed about myself first before I hit the physical symptoms of burnout and ended up in life-saving surgery. I literally felt, Jonathan, that some days someone else had a remote control to my brain. Why was it that some days I was focused and executed my days and other days my schedule was in control of me? Well, it turns out as I started to research in the pandemic and post-pandemic world, the impact of chronic stress and burnout in working high achieving

professionals, that a few things stood true. There's a particular pattern of neuroinflammation that happens when we're under chronic stress that affects the hypothalamus, to be exact, the SCN nucleus, and disrupts our circadian rhythm. Now, this pattern of neuroinflammation is not something new and groundbreaking. I entered neurology in the 1990s. We knew different patterns of neuroinflammation in different parts of the brain cause diseases like MS or Alzheimer's or Parkinson's. But in the last seven years, cutting edge science with advanced neuroimaging showing us that this area in the hypothalamus involved, to the lay person, I call it our airport traffic control tower. Well, when we are on a path to burnout, three symptoms occur. And I'm here so boldly to tell you, Jonathan, that we in the neurology, psychiatry, neuropsychology field got it wrong. Anxiety, adult onset ADHD, and insomnia in the traditional

world of medicine are treated as three separate diseases. And treating one can often make the others worse. It actually turns out this pattern of neuroinflammation that you and I will unpack in a second leads to all three simultaneously happening. So it is something like regardless of the 24-hour news cycle or how many emails are waiting in your inbox, you wake up and you're low energy. Don't get me started. My personality is not here without a stimulant like caffeine or Ritalin. And you need that to energize.

And then you're feeling low-key anxious or panicked all day. Multiple digital devices open in front of you and in your brain, this adult onset ADHD, or just maybe inability to focus. You try to go and unwind and the skills that we all are taught to have some semblance of a pause in our workday and focus on a personal life. And you can't turn it off. You need a sedative like alcohol to take the edge off. And when you put your head down on the pillow, because we know how important sleep is, you've done so many podcasts on it.

There's 72 warning conversations going on in your brain. And the negative, most inconsequential thought is the loudest. And after that, you wake up somewhere between two and four in the morning. You're wide awake. You fooled yourself to think, I don't need the sleep. Let me wake up somewhere between two and four in the morning, you're wide awake, you fooled yourself to think, I don't need the sleep. Let me wake up at 2.57am, knock out a few emails, and ding, at 3.01am, you've woken up everybody else on your team because you hit reply

all. That is a busy brain. It's interesting. As you're describing this, I'm thinking, this has been me on and off? And in the not too distant past, it's funny how you can hear so many of these things, how you can nod along and say, well, yes, this makes so much sense, right? And then you can tell yourself, I'm going to do this. I'm going to do that. I'm going to change. I'm going to say yes to these practices, skills, behaviors, tools, and then life happens. It does. And then you just start to say, oh, I'm back there again. You have some really interesting strategies and tools and a whole process to sort of like

say, like, let's get underneath this and see if we can do some rewiring. Take me into its role. Yeah, I really want to unpack that. Thank you so much for asking. You know, how we came up with this is we took a validated neuropsychology test that has been in existence since the 1970s that measures the direct impact of stress on cognition, mood, and physical health. And we relabeled it, the busy brain test, so I could take it into corporate America. 17,000 people took that in our 24-month research period. And that gave me an incredible insight into,

well, what is stress in this modern day world and burnout doing to us? But also, let's heal the root cause of burnout. Because these superficial tips, to your point, eat berries and breathe, they're no longer serving us. And a lot of outdated paradigms that talk about acute stress management. So as I was looking at the root cause, we broke it down into five key areas. S is sleep or your circadian rhythm. So as we alluded to it earlier here in the podcast is when that neuroinflammation happens, it actually surprisingly in the chronic stress targets this hypothalamus and our circadian rhythm, we see increased inflammatory markers like IL-1 elevated. And with that, a disruption of our circadian rhythm. So one of the most important or obvious functions of our circadian rhythm and an easy way

to treat that is moderating our sleep-wake cycle. Well, it's a chicken and the egg phenomenon in the busy brain, Jonathan, isn't it? Because we may be addicted on the stimulant sedative cycle. Both of them are going to disrupt our circadian rhythm and our sleep patterns. So that's an external behavior. But internally inflammatory, think of it as the airport traffic control tower is malfunctioning. The typical things of sleep when the lights and the sunlight go down and wake up as the sun is rising, our brains are no longer in harmony with that, and we actually need to reset that. There are serious other ramifications of that S,

or the circadian rhythm being off, that affect other key areas that kind of build into the rest of the protocol. But they account for symptoms. To break it down into simple terms for the listeners is, you could easily be listening to Jonathan and I and saying, look, Romy and Jonathan are easily admitting that they've had periods of busy brain or stress. So am I. You're stressed. I'm stressed. Who isn't? But then all of a sudden you go to the primary care doctor's office and they tell you, you've got pretty severe hypertension. You've got type two diabetes. Your autoimmune disease is now in relapse. All of a sudden your menstrual cycles became irregular. And you're wondering, is it infertility, early menopause, or PCOS disease? And it has serious ramifications under that S or the circadian rhythm. And so that is kind of

the core starting point of everything else we'll discuss. And I will backtrack to step one in the entire protocol, which is please get your busy brain test score. It's this moment. It's here in the United States. I know you have a global audience. We have something known as our credit score or credit worthiness. If you're in any phase of your life, wanting a new business credit card, opening a new business, getting a new car, another mortgage, whatever it may be, you need to know your credit score. Most people do. Yet we don't know our brain score. We don't pay attention. So sometimes I want to backtrack to this, Jonathan, which is this idea that if I now know my brain score and I have a self-realization that some

of the symptoms that are hindering me from living a good life, a life on purpose is related to my brain performance, all of a sudden, I have hope to fix the sleep. And so it's dispelled this woe is me and this negative wiring of nothing is going to help now. So step one is actually self-awareness and healing that self-judgment. Step two is let's get practical. And that's why in week seven of the protocol, but we actually send people right away. Jonathan, I actually check labs. I want to look for markers of inflammation. We recommend scientifically studied supplements that can actually number one, help bring some calm to the neuroinflammation or the hyperactivity of the neuronal state that's keeping us wired despite us feeling physically tired, and also really help to reset the circadian

rhythm. And so between checking the labs and looking for imbalances that may be feeding into it, and number two, some supplements. When we ran over 1,000 executives through this eight-week protocol in our test period, people that said, I'll never fall asleep. There's too much going on at work. We run global teams, with the exception of new parents who had young children that wake up for feeding in the middle of the night. Or if you're a caregiver to elderly loved ones who have middle-of-the-night arousal, things you can't control, people actually were falling asleep. When we looked at our research data, sleep was the one area that had the most improvement in performance, like a 40% improvement over baseline.

Now that makes so much sense. I want to circle back to the eight-week protocol that you've developed, but let's move through these five different elements first. So we start out with sleep. Next up, the H in that word represents hormones. Take me there. You know, hormones is a loaded word and the listener is casually, and most people, if we say hormones, have a negative connotation around your sex hormones, unless you're in a good relationship with your estrogen, progesterone, testosterone levels. That's actually not what I'm primarily talking about. That same hypothalamus is connected to the hypothalamic

pituitary thyroid adrenal axis. The hypothalamus also governs a total of 50 neurohormones and hormones that circulate through the brain and the entire body, Jonathan, that govern every organ function in our body, from our immune system to our GI system, to our respiratory, to our digestion, et cetera. The key things that we found looking at the research that we enumerate, which was eye-opening to me, and it shouldn't have been because this was my problem as well. You could have had your full hormones panel checked and you were feeling fine. If you have symptoms of a busy brain, your score is now trending above a 40, which we start to see trends towards having a busy brain or there's neuroinflammation. My biggest concern, shockingly, was the thyroid hormone levels in both men and women. I want to

be clear. The data in thyroid disease in men is a little esoteric still because there's so much focus on a male's testosterone levels or giving them human growth hormone around sexuality and weight loss or doing a disservice to men. I think larger research studies are underway. on a male's testosterone levels or giving them human growth hormone around sexuality and weight loss. We're doing a disservice to men. I think larger research studies are underway. But the research actually shows traditional endocrinology literature that one in eight women in the US has subclinical thyroid disease, either an underactive or overactive thyroid disease. So I'm on the stress success cycle. I have a busy brain on the path to burnout. That hypothalamus is now negatively impacting my thyroid disease. And the worst part is,

is that we often with a traditional one medical screening test of the thyroid stimulating hormone TSH are missing the thyroid. It's why it is so important. I discuss in the book from men and women to get a full thyroid panel so that we're not missing subclinical thyroid, autoimmune thyroid disease. It's fascinating. Yeah. I mean, these are fairly straightforward tests. I'm curious why you think they're not so typical. I personally grapple with this. I know we're supposed to be having a scientific discussion here. I don't know why I find myself getting emotional, Jonathan, at this point. And I share the story in the book. Remember when I told you I was doing research in my early career as a neurologist? There was a big gap at

that time, still is, but at that time, looking at women's hormones as it related to brain health, specifically migraines and epilepsy. I was reading about thyroid and I was like, God, this sounds like me. My hair is falling out in chunks, that remote control feeling of my brain. And by this time, I had never had a regular menstrual cycle in my life. I went to male endocrinologist saying, could you check my entire thyroid? I really intuitively feel like something is wrong here. And fertility at this age is important to me. This was before I got sick and ended up in surgery. And they missed it. They just checked the TSH, that standard protocol, very old protocol in traditional medicine that needs to be updated that I think

those of us in integrative functional medicine are fighting for and why it's important we have this conversation. They're covered by US insurances. They're part of standard lab testing globally. And it wasn't until I got sick and recovered and found an integrative medicine doctor that that doctor listened, number one, did the full panel. Turns out at age 39, I get diagnosed with Hashimoto's thyroiditis, get put on the correct prescription medication by an MD, licensed MD. And for the first time in my life, had a regular period. And I hear this story over and over again. And by the way, the story is similar in men. They can't understand why in their 20s or 30s, they're feeling pretty anxious or irritable compared to the typical man

they work with. Maybe a doctor checked their testosterone level. They're getting pumped full of testosterone and even more anxious. And a thyroid hormone panel was missed. And it turns out why this is so important in a busy brain, leaving testosterone fertility out of it, is that for men and women, when you look at 40% of those that have a subclinical thyroid disease, what are the symptoms? Non-specific mental health symptoms, feeling anxious and I can't focus. Which could be misdiagnosed or missed, which translates to so many different things without even ever looking at that. And you get put on

an anti-anxiety medicine, you get put on Ritalin or Vyvanse and the thyroid disease is missed and only becomes worse. I mean, it's so interesting. And earlier in our conversation, you mentioned anxiety, ADHD. There was one other that you mentioned that are often seen as these three distinct different things. We are seeing, and I'm curious whether data supports this, anecdotally, what it looks like. I'm seeing more people as adults in their 40s and 50s being diagnosed with ADHD. Is that accurate? Do you know the data on that? Okay. I do. Absolutely. Let's break it down. And it's in the book, in chapter nine of my book, and we break it down in detail. When I first went into neurology and was doing my psychiatry rotations, Jonathan, there was

no such thing as adult onset ADHD. If you diagnosed it for the first time in an adult, you could typically backtrack if someone had that ability to look back in childhood or talk to, you know, family members and see that it was missed. We now know, looking at the last decade, as we've transitioned into primarily digital society as adults for our both work and our personal use, that multi-digital device use is actually, quote unquote, to use a layperson's phrase, rewiring our brains, the structure and the function of our brains. That repeated dopamine stimulation of touching a screen.

How many likes did I get? Let me check my email. Let me thumb back a response really quickly. Being on multiple screens at once. How many people are binge watching something on Netflix and they have their phone open at the same time or an iPad, right? A very similar thing. So the data is there and robust, number one. Number two, we see that not all of these adults

were missed in childhood, typically women more than men, because in certain generations, if you were born in the 1960s, 70s, early 1980s, it was boys that were considered impulsive and the inattentive type of ADHD was missed, which is typically in women. So sure, there's a subsegment of that, but we actually know that adult onset ADHD is a real phenomenon. Now, my concern, Jonathan, is that we as doctors are over-prescribing stimulants such as the Ritalin Adderall Vyvanse. 85% of these stimulant prescriptions are taken here in the United States. And so I do think we're missing the underlying root cause, the disruption of the circadian rhythm sleep being one of them, the second one being hormones, and we're going to unpack the rest of them.

And there's a movement in medicine, right? I loathed this term subclinical because what it's alluding to by traditional doctors is your case isn't as severe enough to land you in the hospital with an abnormal heart rate or metabolic syndromes. Okay, if your hair is falling out, your period's not regular, it's okay, you know? And men and women are getting dismissed like that. And so there is this movement now. And one of my hopes as I brain shift myself is this lab slip. We designed it, Jonathan, in a way, I wanted to say this was important to me. So you go to the other extreme, which is being able to work with a board certified integrative functional medicine doctor. Those labs are extraordinarily expensive. So I knew I was

working with a certain type of clientele that are still privileged to have health insurance. What were the labs that could give us the answers we needed that are covered by most traditional US insurance systems? And that was how we designed this so that we didn't want people to feel they were left out of pocket. And we wanted a primary care doctor to look at this lab set and say, I could do this. This makes sense. Yeah. I mean, access is such a huge part of this conversation. You know, because like you just described, there are a whole bunch of tests that are available to you through functional medicine, integrative medicine that can provide a whole tremendous additional value and insight,

but most of them still to this day, many of them at least are not covered and they can be almost obscenely expensive. Thousands of dollars, thousands of dollars for the labs, not to mention the fee for the doctor. And this is one of the things I will tell you, I'm genuinely proud of that we figured out in the book. Yeah, that's fantastic. That brings us to the I in the model here, which is inflammation. And you started out earlier in our conversation talking about using this phrase neuroinflammation.

More broadly, what are we actually talking about when we're talking about inflammation? You know, inflammation is a process that should occur naturally with checks and balances in the brain and the body. It's how we maintain homeostasis. Neuroinflammation in the brain, however, unchecked is not healthy. It will lead to disease. Again, we know the genetic and lifestyle

things that can lead to diseases like multiple sclerosis, Alzheimer's, etc. But what was chronic stress doing that literally causing this neuroinflammation? Well, Dr. Romi, do I have neuroinflammation? We can't just biopsy the brain and look for that. It doesn't work that way. So we needed other measures or clues. One is your symptoms. Two, okay, we can do this neuropsychology test that we have labeled the busy brain test. But now I'm a doctor. In addition to that brain score, I want to quantify things. What were other peripheral labs that in combination could give me a picture? One that talks to us about inflammation in the body and the brain is your high sensitivity

C-reactive protein. But again, that could point to inflammation in many areas of your body, digestion, your immune system, your brain. I really was looking for two key things that I know, one, we needed to fix, two, are heavily related to the functioning of your brain properly. Your vitamin D is in dog D3 levels. It sounds a little off base when you hear the word vitamin.

I think we mismarketed vitamin D3. It really needs to be the super hormone superhero of your brain. It plays an integral structural part of all 50 hormones of your brain and your body and structure and function of many chemicals in the brain and processes. And by the way, I'm not giving you anything groundbreaking and neuroscience here. It was in the 1990s. I started in neurology and we knew our MS patients, low vitamin D3 level, schizophrenia. And yet nobody was saying, well, how about if you've got run-of-the-mill depression? How about if you want to be a peak performer in your brain?

What do we do with your vitamin D3 levels? Now we have that data. That is probably one of the most common abnormalities we screen for and find, even if you're living in a sunshine state or country with chronic inflammation and stress in the body, the mechanisms of you having exposure to sunlight and that metabolizing to the correct form of vitamin D3 is stunted, not to mention the skin exposure needed in sunlight without sunblock is not recommended because of skin cancer risks in anybody. So vitamin D3 was one of them. And the second one, and then we can unpack this, is your fasting insulin levels and your fasting blood sugar levels are really important. We have

insulin receptors in the brain. We know that we can see a blunted or elevated fasting insulin levels and blood sugar levels when there is stress in the brain. So this combination of a vitamin D3 level, your fasting insulin, blood glucose levels, hemoglobin A1C and high sensitivity C-reactive protein kind of point me to, hey, we're looking at a paleocephalus of neuroinflammation in the brain. And I want to be clear, my research busy brain is around the adult brain. Pediatric brain and development is in the anxiety, ADHD in children is something different. It's like talking apples and dragons. Yeah, it makes so much sense.

It feels like a good place for us to come full circle in our conversation as well. So as I always ask at the end of every conversation here in this container of good life project, if I offer up the phrase to live a good life, what comes up? Two weeks before the day we recorded this podcast, I turned 50. And when I was in my early 30s sitting sitting in the surgeon's office, and they were telling me, do you have disability insurance? Jonathan, I didn't know what even that meant. The rug had been lifted out from underneath my entire life and hope departed my soul. And today, by living through the suffering and understanding what worked for me and researching a protocol and service to others who don't feel hope in their lives at this moment because of a

busy brain and burnout. I'm cognitively sharper today than I was at 25 when I graduated from medical school. And so when you ask me what is a good life, it is humbly to have been in that dark place devoid of hope and knowing that there were people that held hope for me when other busy brains that are out there to say, I will hold hope for you and your healing and your best version of dreams of success for yourself as you brain shift. That is what's living a good life is to be that hope holders for others. Thank you. And we'll be right back after a word from our sponsors. Apple Watch, getting you eight hours of charge in just 15 minutes. The Apple Watch Series X, available for the first time in glossy jet black aluminum. Compared to previous generations, iPhone XS or later required. Charge time and actual results will vary. Mayday, mayday, we've been compromised.

The pilot's a hitman. I knew you were going to be fun. On January 24th. Tell me how to fly this thing. Mark Wahlberg. You know what the difference between me and you is? You're going to die. Don't shoot him, we need him. Y'all need a pilot. So I love how she provides such an empathetic yet practical approach to breaking free from often toxic cycles of stress and burnout that entrap so many of us. And her eight-week protocol just offers a powerful roadmap for rewiring our busy brains and rediscovering that

sense of balance and focus and genuine fulfillment. And my next guest is Dr. Aviva Ram, who also happens to be a dear friend of mine. Referred to as the face of natural medicine, the 21st century by Prevention Magazine, she's a midwife, herbalist, and Yale-trained physician, and she's dedicated her career to bridging traditional and integrative medicine approaches. She's an avid environmental health advocate researching the impact of toxins on everything from fertility to pregnancy and chronic illnesses, and a leader in botanical medicine as well, and the author of several books, including The Adrenal Thyroid Revolution, A Proven Four-Week Program to Rescue Your Metabolism, Hormones, Mind, and Mood, and a number of other giant sellers. In this part of the conversation, she offers a compassionate yet practical roadmap for reclaiming your vitality from survival mode.

Drawing from decades of clinical experience, Aviva guides us through the hidden factors that may be driving our burnout and providing actionable steps to begin restoring balance to our body's fundamental systems. And you'll discover how small shifts in your daily habits can really unlock transformative healing when it comes to energy and hormones and overall well-being. Here's Aviva. There's a phrase that you've coined, the acronym for it is SOS, which I think so speaks to the state of the sort of Western human condition these days. Breakdown, what does it actually stand for? So SOS stands for survival overdrive syndrome.

And it was just sort of an accidental term. It's not a real medical term. But as I had so many women in my practice sitting across from me, or women emailing me and writing to me on Facebook, I kept hearing this theme. And it was actually a theme of repeated words. Dr. Ram, Dr. Aviva, Aviva, I feel like I'm chronically stuck in survival mode. I feel like I'm always in the on position. I feel like I'm always just trying to keep up, you know, I'm like, just trying to stay afloat. And it was this sense of really, truly, like life survival being on the line, not in terms of necessarily having enough food, but feeling that the stress response in them was so over activated, and they couldn't

keep up. So I was sharing that with a woman one day. And she said, Yeah, you know, it sounds like survival overdrive is a syndrome. And I was like, huh. And the way my mind plays with words, it was all of a sudden, I saw the SOS. And what I also really loved about SOS is that a lot of us, you know, men and women, when we feel like we're struggling, I think we're super hard on ourselves. Like we see Facebook and everyone else looks like they have their perfect life together. We watch TV and it's like the perfect life. And we don't, none of us have that. Those are like moments and snapshots. And so I think for most of us, we live in such an achievement

oriented culture, such an obtaining oriented culture, like everything is status and what you do and money and how much you have. And I think that we get really, we beat ourselves up when we feel like we're not living up to that standard. And so part of this idea of SOS is that when we feel overwhelmed, when we feel like we're stuck in this survival mode, and we'll talk about what happens in the body, that's so important, That SOS is kind of a reminder to not get angry and beat ourselves up, but to turn on that self-compassion and try to have a context of understanding why we feel that way. It's not that we're not doing enough or being enough or achieving enough or having enough. It's that we are really, we're not victims of,

but we're living in a culture that creates these expectations that are impossible to live up to and affect our health when we do try to live up to them. I think, too, we live in a society where we have like a pill for every ill. We have like a medical solution for every symptom that we have. And I think we tend to be also really hard on ourselves, especially for high kind of performing people or high achieving people like listen to your show and hang out with me. When we are feeling that vulnerability, or when we're having symptoms that are slowing us down, like fatigue, or overwhelm that keeps us sort of procrastinating or actual physical medical symptoms, we tend to think our bodies are betraying us. Or even then, we're not good enough. Our body's not good. We're not strong enough. We're not healthy enough. We need to do

another detox cleanse or whatever, as opposed to actually seeing those symptoms also as those signals, right? If you think about inflammation, it's little fires that are burning in your body. It's like a signal flare from your body saying, please listen to me, I'm here, you know, and I need a little love and I need a little attention. So I don't have to keep sending you these messages louder and louder and louder until they're big symptoms and big medical condition.

Yeah. So, all right, so deconstruct this a little bit. You point to, from what I remember, I think there are five major contributors. Yeah. So, all right. So deconstruct this a little bit. You point to, from what I remember, I think there are five major contributors. Yeah. I'd love to talk about each one of them a little bit. Yeah. So the big underlying kind of mother of root causes, if you will, that I found has a touchstone in every cell of our body, quite literally, is what's called the hypothalamic pituitary adrenal axis.

Big fancy word for a stress response system. It starts in your brain, and its job is to perceive everything going on in your world that may not be safe for you. That can be anything from a real danger. You know, we're biologically hardwired. When we see fire, that fire, somewhere fire should not be like the trash can in the corner of your office. That's a problem. We need to react and respond.

But similarly, it could be somebody had a parent who was emotionally unstable and that parent made certain kinds of facial expressions, even if it has nothing to do with you, that may trigger you to react internally, because in a very primitive way in your brain, that's now cataloged as danger. But there are also a lot of other triggers that happen in our world that get that same stress system activated. Because that stress system is activated, not just to sort of like fight or flight, which is what it controls, but also to keep down your inflammation, to activate your immune system so that if there's a foreign invader in the form of a virus or a bacteria or a parasite, it responds. So everything that triggers your body to say something's going on that needs a survival reaction is going to get activated. So things like foods that we eat that may be not great for us individually. So, you know, an extreme example would be somebody who's really gluten intolerant, and they're eating gluten, it's causing certain changes in their

gut that cause inflammation. And that inflammation triggers the brain to say, Oh, something's not right in here, we need to send out the fire department to put out this fire of inflammation. And that activates that stress response. It can be actual toxins in our food that our body doesn't recognize because we have not evolved. We've evolved over millions of years, but these toxins have only been in our environment for like the last 50 years. And there are 80,000 of them. There are 80,000 known toxins.

That doesn't even include the combinations those make in the environment in our bodies. So our bodies are trying to keep up with this detoxification. And when it reaches overload, that sends out that same sort of alarm signal that gets the body activated, hidden infections that a lot of us get exposed to, or that get reactivated when we're under a lot of stress. So kind of the overall picture of the book is there are a lot of things that can overwhelm our body systems, because we're living in what's called an evolutionary mismatch, right? In the past 50 years, everything from technology to food, to environmental toxins has shifted to an extreme

exposure rate for us, but we weren't prepared for that. And it's the same with our 24-7 lifestyle. So all these different five factors are what I talk about in the book that get this survival overdrive syndrome rolling and what you can do to kind of dial it back so you can get back to your own inner peace, but also physical calm, like inflammatory calm, get all that in control. I love science because science just geeks me out on how perfect the design really is. And we have this enormous capacity to adapt. It's stunning. It's just really, really stunning how we have so many systems within us that keep us safe and keep us alive. I think the problem is,

is when we just keep pushing that adaptability a little bit too far. And I think a lot of us know in our lives when we're doing that, like, like you and I have talked about this, we know that we've talked about sort of like the 10% that we feel like if we have to push our lives to an unhealthy level where we're not having time to breathe or time to eat well or time with our spouses, that we don't need to be in like whatever that top 10% of success is, if it means that the other kind of successes are like happening in our life, right? Like, so where are we pushing ourselves past our adaptability? And most of us have the ability to push past that adaptability for short periods of time. It's when we keep doing it. And we're like constantly pushing and we never take the time to replenish and restore. If we do that as human beings, if we push and then replenish and restore, push and replenish and restore, we actually can adapt. And it's the same thing with toxins in the environment in New York, right? We have kind of like a, I don't know what the expression would be like, like a triple threat, but not in a good

way, right? We're not getting enough rest. We need rest to detoxify. Most of us are not getting just the basic amount of fruits and vegetables or nutrients we need and phytochemicals, these chemicals that are in plants that aren't vitamins and minerals, but that actually help support our natural detoxification systems, which our ancestors got. They ate wild plants. They ate green vegetables. They ate things that had a little bit of a bitter principle to them that made our bodies detoxify.

So not only are we getting the exposures that we have a little bit of control of, you know, or no control over basically, but we're also not doing the healthy habits that allow us to adapt. So you can't make a bus not belch out what a bus is going to belch out. I mean, as a society, we can make demands, right? That's how we got lead out of gasoline. That's how we got catalytic converters on cars. So we actually can do things socially. Buton-one, those exposures every day are happening. So I think about it, you know, what can we control? The average woman, before she leaves her house in the morning for work, has already put on like 15 different body products on her skin and hair. Each of those 15 products may have as many as 15 or 30 or more unpronounceable synthetic ingredients. So we do have control over that. We have control over what we eat, the quality of what we eat. And we have control over getting enough of the nutrients and phytochemicals that do support that detoxification and sleep. I mean, how many of us just get five or six hours of sleep a night and think we're just fine. And but you can't, you can't

indefinitely hack your life on bulletproof or Red Bull, you actually do have to get sleep. And sleep is like the biggest detoxifier we have. So the book is about finding the things that we can do that break that cycle. And it may be different for different people. So for me, it may be just remembering to stop and do some deep breathing because I already have like I kind of already lived the diet lifestyle and the non toxin lifestyle. But for me, the toxin actually might be my own stress habits. But for someone else, it may actually be they have a lot of changes in their gut microbiome because they had 20 years of antibiotics five times a year, which is very common for Americans.

And now their gut microbiome is actually sending chemical toxin messages to their brain. Something's not right. So for that person, fixing the microbiome might be the first step and maybe easier than fixing those old stress patterns. Yeah, this is actually an area that I'm deeply fascinated by. And it sounds like the research is still really early here, but I know that you've been geeking out on this a lot too. So the idea that you have critters in your intestine, you know, that, you know, the microbiome, you know, the gut biome, it's kind of becoming this really hot topic these days of exploration and how it can, you know, cause so much within our body physiologically and biologically,

you know, it can lead to inflammation and pain and disease and all of this stuff. And that the makeup of the bacteria in your intestine actually, you know, like have a huge effect on that stuff. The leap that I find really fascinating that it seems like the, you know, there's research going on around now is the leap that the makeup of the bacteria in your gut can actually control your behavior, your state of mind, your mood. That is a much bigger leap, I think, for folks to think that, okay, you know, so this is actually controlling my thoughts and my feelings. Like what's happening in my intestines is controlling my thoughts, my feelings, my behavior, my emotions. It's so amazing.

So if you think about it as like critters and we kind of sort of anthropomorphize those critters, like we sort of start to imagine them as little cartoon critters or bugs in there that are somehow controlling us like with puppet strings, it starts to feel really far-fetched. You're like, that is so not happening. But if you think about it this way. I should change my visual because I kind of like it. I actually want to get. Sitting around tables, smoking cigars, playing cards. I want to get t-shirts that say my microbiome made me do it or my microbiome made me eat

it. But what's happening is a couple of things. One is most of our nervous system or a very large part of our nervous system is actually centered in the gut lining. So the gut has now started to be called the second brain, not because there's some sort of like magical, weird connection, but literally our nervous system is so deeply wired in there. And whatever is happening in your nervous system in your gut is getting transmitted to your nervous system in your brain through this giant nerve that passes

through our body called the vagus nerve. And it's just like this amazing connection that happens. And what's happening is a couple of things. In your gut, you have 3 trillion different organisms, bacteria, gut, bacteria, viruses, yeast, all kinds of things. And they, just like we all do, produce gases and chemicals. And those gases and chemicals that are produced by different organisms in your gut send signals. They're chemicals that are actually binding to the nervous system receptors, and they're sending a literal electrical impulse or a literal chemical signal up to your brain. So let's say you eat tons of processed food and tons of sugar in your diet.

That is going to cause certain microorganisms to grow because they like that. Anyone who's made bread knows to make yeast rise, you have to feed it sugar. So certain organisms grow on certain foods. Different organisms grow, for example, if you're a vegetarian and or eat tons of vegetables. This has been really well studied. So what we eat just, for example, determines what grows in there. And then different organisms actually speak different chemical languages. So let's say you eat tons of sugar and you have lots of yeast overgrowing in your intestinal system. That yeast is in there actually when it gets hungry, sending out chemical messages. I'm a little hangry in here and I'm going to make you crave that muffin.

It's literally sending a message to your brain that makes you want more sugar. And it makes the taste of sugar become more palatable to you. So it's like this whole neural network that's happening. Also, different organisms produce chemicals that can kind of cause local irritation. And that local irritation can cause different proteins and molecules that are supposed to stay in your intestine that are supposed to be eliminated actually cross over into your immune system also. And then your immune system starts to produce other toxins and other chemicals. So for example, before you've gotten the flu or a cold, you have a few days where you feel kind of maybe blue or emotional or tired, and you don't know why. And then you get sick and you're like,

that explains it all. It's those chemicals that your body's producing that actually get across your brain barrier into your brain and can start to make you feel depressed or anxious or irritable or tired. That's all connected. It's very cool and fun. You have kind of a really nice distillation, what you call your five hours. Can we go through those in a little more detail? So I wanted to create a program, first of all, for people that were overwhelmed, which meant you had to keep it simple. We don't need to add complexity.

Oh, yeah. It's like, oh, so you want me to do more. Right. And at the same time, you know, I want to acknowledge that making lifestyle changes is not the easiest thing to do. I mean, you and I just talked about how we know, and sometimes we keep banging our head against that same wall, right? So I created a program based around these sort of five R concepts is essentially what I do in my medical practice. The first one is to reframe. And reframe is simply a mind simply, but it's a mindset change. And it's around everything from sleep and making sure we're getting more sleep to actually starting to look at what some of the negative self-talk we have. I mean, just to give you an example, 90% of all women in the United States have one I hate my body thought every single day.

And those aren't women with eating disorders. Those are average women. And when you have an eating disorder, you can multiply that by about 400 times. So the thoughts that we have, how do we start to become cognizant of them so that they're not, like we're not feeding ourselves toxic thoughts all day, the things that we do have control over. Again, I mentioned sleep, learning how to sleep, how to get better sleep when your sleep is disturbed, but also how much sleep we need. We can't skimp on that. Now that makes a lot of sense. I want to make sure we covered the five. Oh, the five R's.

The first one is reframe. Right. And that's the mind-body-emotional connection. And it's also looking at some of the habits that we have that we self-impose that really drive us crazy and push us too far as women. The ones I touch on most in the book are perfectionism and how we can get stuck in that pattern of saying yes to too many things. And all of a sudden we've got a million things on our plate that we're trying to do better and better and better all the time. And we're overwhelmed and exhausted or fear of missing out.

FOMO, the great acronym I learned from my kids and being a good girl and all these ways that these patterns can cause us to get into emotional or psychological overwhelm. The next is the reboot. And the reboot is about, you know, when your computer, like you've got too many programs open, and it goes into a spin, and you just have to shut it down and reboot it to get it like, do your will anymore. The reboot is about food. And when we have too much information coming in from our food, whether it's foods that we're intolerant of toxins, etc, that can be going on with our food, whether it's foods that we're intolerant of, toxins, etc, that can be going on with our food, how do we sort of hit the pause button on that, take out the things that might be triggers for us

so that we can quiet down that information overload and reboot on a really simple diet. And for me, I am big on non-restricting. One of the things about restricting is it is exactly what drives survival mode. We're primitively hardwired to be highly aware of any risk of famine. So the minute we start restricting our food, restricting our calories, that survival mode that we're trying to quiet down goes in a red alert. And so this is about how do you actually work with what your body is supposed to sort of be doing biologically, evolutionarily. So the next step is to repair. And this is when we're actually looking at the physical symptoms and physical systems that we have that can get disrupted when we get stuck in this survival overdrive syndrome.

So what I have in the book is a set of questionnaires that you can do so that you can figure out which of your systems are most disrupted. Or I honestly just recommend going through the whole program because that's the easiest way to do it. And most of us can use a little bit of tweaking in each of our different systems. But the ones that get most out of order are usually our gut, our immune system, and our detoxification systems. So that's what we work on here through what foods can nourish those systems,

what foods might be disrupting those systems, what little lifestyle tweaks that we can make to get those systems back on track, and then the herbs and supplements that really have the best evidence of effectiveness and safety behind them that can help reset those systems. Then from there, we go into recharging. And that's where we focus specifically on the adrenals and the thyroid, which are organs that basically are controlling our energy and our metabolism and that are taking a huge hit for a lot of women right now. So we know that at least 30 million women in the United States are diagnosed with a thyroid problem, and at least 50% more have one that don't know it.

It's a lot of people out there. And the adrenals in the book are really a metaphor for what I'm talking about, this overwhelm. It's not just the adrenals, but it's that whole stress response system. So I talk about what testing is really appropriate, how to do this without testing if you can, but for the thyroid, we definitely need some specific tests. If you think you have a thyroid problem going on, there are questionnaires in the book to help you sort through that. And then what to do if you do actually have a thyroid problem? Do you need medication or do you not?

And then for adrenals, what can we do? And by the time you've gotten to that part of the book, you've kind of already been doing all the resets. So now we're doing the fine tuning with the herbs, supplements, and if you need them for thyroid hormone supplement. And then the fifth stage is replenish. And that's really how do we live with this going forward. And again, that's the difference between what's therapeutic, like what gets you well, and then what keeps you well. And so the replenish is really a philosophy on how to live life so that we're mostly keeping our energy level

above the empty line on the gas tank. I mean, so many of us are so busy, kind of like putting on everyone else's oxygen mask first. And women are especially notorious for doing that without taking ourselves taking care of ourselves as well. So it's kind of elevating this idea that it's actually not only okay to take care of yourself, but better for everyone around you and the world if you do too. Yeah. I'm behind all that. For women and men. But yeah, it's interesting because there are – it's interesting that – and we've had conversations about this – that there are – and I've become much more aware over the years, that there is a, women and men are not the same. Obviously, I've been aware of that for a long time.

But the program works for men just as well. Yeah. And that is a bigger- For women, because that's what I do. But the biggest question I get from women is, can this work for my partner too? Right, right. And that is, my sense is that I think women have tended to be, tend to be much more open to sort of conversations

around a lot more inputs and soft inputs into the state of their well-being and their, you know, like mental and emotional and physical well-being or lack thereof

where my experience has been guys tend to be a little more blunt force oriented. And maybe that's a big generalization. I'm not that person. It's so funny because I'm a little more blunt force and my husband is so gentle. It's so funny.

Yeah. But I agree with you on the whole. Yeah. But the bigger idea is really that there's nothing that we've talked about. I mean, there may be certain very specific storylines that I know have been researched and tend to spin more in the heads of different genders. But there is going to be a different yet equivalent storyline spinning in each person's head, which has the same detrimental effect. You know, when I came— The process is equally effective.

It's totally equally effective. And couples doing it together, whatever your gender are, really, you know, that expression, if we want to go fast, go alone. If you want it far, go together. And if you do it together and do the plan, you can go fast and far. But when I taught at your Camp GLP, I couldn't believe it. It was like an audience of 350 people. And as many men came up

to me after and wrote to me and have even stayed in touch and said, wow, that is exactly me. I'm in survival overdrive. I'm really constantly overwhelmed and not taking care of myself. The real reason I wrote the book oriented toward women is that a lot of the conditions that we have as human beings, chronic fatigue syndrome, fibromyalgia, adrenal problems, thyroid problems, anything that's really related to fatigue, overwhelm, depression, weight, and autoimmunity tend to be much more dismissed by the medical establishment when they occur in women. Just to give you sort of an extreme example, 5,000 more women die a year of a heart attack in the hospital than men. And a couple of the symptoms of heart attack, other than just overt chest pain, are overwhelming

fatigue, not feeling that well, little nausea, some anxiety. And so when women report those symptoms, we tend to be dismissed as it's the modern way of saying it's all in our heads is depression, anxiety, you're just under stress because you're a mom, you know, you've got kids, whatever it is, whereas men actually tend to get a cardiac workup for it. So there are gender biases that are operating in the medical establishment right now that have actually led women, for example, on average to be dismissed or not identified as having an autoimmune disease for as long as five years. So women are going around exhausted, not feeling well, knowing something's wrong, going to the doctor and literally being told,

oh, it's just stress. It's just because you have little kids, just because you're juggling a lot at one time and get disproportionately diagnosed as having anxiety and depression than really looking at what's the underlying cause. And that is why I wrote this book as a voice for women because it's in this area, particularly, it's very underrepresented. Yeah. And that's, I think think so needed and so powerful. It's,

it's like a tool almost to take and say, this is real. It is. And I can start to take some control over it. And also maybe, you know, if I, if you start to say,

well, and I need help with it, say no, like this is not, let's, we need to push this further. Yes, exactly.

And that, that I need, you know, the joke is that men don't ask for directions. Women equally, if that's even true, but women equally have a really hard time asking for help. You know, we're expected to sort of keep it all together, have it all together, have it together at work, have it together at home, have it together as mothers. And saying I don't have it all together is not so easy for us. And there's even a lot of mommy judging going on, woman judging going on amongst ourselves.

And so a lot of this is being able to say, I do need help. I'm not getting the help in my doctor's office because my doctor really has no clue because my doctor probably wasn't actually. It's not your doctor is an awful person who's just controlled by the pharmaceutical industry. Your doctor really didn't learn this in medical school. This is stuff I learned as a midwife, as an herbalist, as a geek who reads psychoneuroimmunology journals, and then was able to piece it together with what I learned in medical school. But it's not what doctors are taught. And at the same time, as women, especially, we're so taught from the time we're teeny little girls to be nice, not question authority, play nice, you know, don't make waves. And so you're sitting there in the doctor's office, you know, you don't feel well, your doctor

who may be a man or maybe a woman has no idea what's going on. They're overworked and overstressed because they're seeing 40 patients a day. And then says to you, your labs look fine, you're fine. It's probably just anxiety or depression. And then you don't know how to say, but actually, no, this is new. And I know myself. And this isn't just anxiety or stress or depression. Instead, we internalize it, we take the prescription, we go home, either we don't fill the prescription and live with that confusion of, well, maybe this is just stress. Maybe I do need to just breathe more. Or we take the prescription. And those can have unintended consequences and side effects. And the syndrome is definitely affecting men as much as it is women. We're all, I think, a little overwhelmed. Yeah. No. So we're hanging out. think, a little overwhelmed. Yeah.

So, we're hanging out. I love hanging out. Good life project. Went out for that phrase, to live a good life. What comes up? You know, you asked me this question a few years ago. Did you go back and look at the video? No.

I was trying to remember because in the beginning I wasn't asking it and I couldn't remember whether I'd actually been back to look at the video. I didn't know that you were going to ask me that today but I do remember what I said and you know what it has not changed for me it's the same exact thing it's presence and you know I can even take that deeper now because for me presence means I am here with you looking at you in the eyes, and we're reaching all these people together. And I'm not worrying about yesterday.

I'm not worrying about later or tomorrow. I'm like here, comfortable, feeling my body right at this moment in this chair. And if I can be present in my own life, if I can be present with the people around me, man, that's a good life to me. You know, that's a really good life because we're just like, this moment is so good and so juicy. And yeah, so presence is it. If I can be present with my kids when I'm with them, if I can be present with my partner, with my patients, if I'm just like right there sharing the moment and connecting with you, or when I'm alone, if I'm right there dialing into what's going on in my body, in my world, the birds singing around me.

It's all good. Thank you. And we'll be right back after a word from our sponsors. The Apple Watch Series 10 is here. It has the biggest display ever. It's also the thinnest Apple Watch ever, making it even more comfortable on your wrist, whether you're running, swimming, or sleeping. And it's the fastest-charging Apple Watch,

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Flight risk. So I so appreciate Aviva's wisdom. I love how she combines a profound understanding of the biological drivers of stress and burnout with heartfelt compassion for those struggling to break free. And her practical whole person approach provides just a powerful roadmap for escaping the relentless treadmill of survival overdrive and rediscovering a state of vibrant well-being. to de-stigmatize mental health topics and make this knowledge accessible to all. She's also the author of the book, Self-Care for People with ADHD, 100 Plus Ways to Recharge, De-Stress, and Prioritize You. And she's the creator of the Focus Genie mobile app for ADHD education and productivity. In this part of the conversation, she draws from her professional experience and personal experience also to offer a truly

unvarnished look at what it means to live with ADHD. To gain deeper insight into the neurobiology underlying this condition and how stress and trauma and societal pressures can exacerbate the challenges. But beyond understanding, Dr. Hamdani also provides a toolkit of self-compassion practices and practical applications to really approach your ADHD brain with more grace and self-acceptance. Here people too. So I want to dive into all of it. But I think it's helpful to take a little bit of a step back in time. Your psychiatrist focus, not just on ADHD, but like a substantial focus on that in your practice. So much of what you've been sharing in a very public way all over the internet and social media, your new book really does focus in on diversity and ADHD.

And I'm always fascinated because when somebody goes that deep into it and then turns around and says, I need to be of service to the world in this context too, often it's personal. And for you, this is personal too. Yes, very much so. I think that's an astute observation. I think that as I was going through medical school and, you know, really for the first time struggling academically and socially and everything, because when I was younger, school wasn't was exceedingly difficult. I think in order for me to understand my own brain, I had to deep dive into that. And then once I did that, once I kind of got into psychiatry and continued that work with psychiatrists and therapists and everybody around me that was helping me with that kind of like educational arc, it seemed like too good of information to gatekeep. And so I wanted to share it. Were you aware of the fact that you sort of experienced the world differently from others at a young age? Or was this something where it really started to come together when you're older

academically? So I think that's an interesting question because I was originally diagnosed in fourth grade after I just presented as a very disruptive kid. I was originally diagnosed in fourth grade after like I just presented as a very disruptive kid. I was getting in trouble a lot and I was hyperactive. Like I was smart in school, but it was very selective. It would only be in things that I was naturally inclined towards or interested in. And so when it became problematic in classroom, it was brought up to my parents. My parents got me assessed. And actually, I was started on medication at that time. But I think because of that heavy stigma around ADHD, it wasn't talked about openly. And so I wasn't, I didn't know I had ADHD.

I was given medication, but like, I didn't really know what it was. It was like, this is going to help you focus. But I didn't know, hey, this is a pharmaceutical medication that's going to help you focus. I feel like I had two diagnoses. I had that one. And then in medical school, when things were difficult for me, and I actually started seeking out knowledge about this, that was my second diagnosis. So I think at a young age, I knew that my brain operated differently. And it was very much, I felt like it was a worse than thing.

Like I was getting in trouble a lot. And I felt like my brain was, I remember very distinctly telling my mom in fourth grade that I was like, there's something wrong. I don't work like the other kids do. And it's not that I'm not trying. It's just like I will go to school every day to try and it just everything gets derailed. And then I remember in medical school, I remember feeling like, okay, I remember all of this stuff about feeling different. And I remember all the stuff about like comparing myself to my neurotypical peers and looking at that vast and stark difference

and actually feeling validated that, oh, there's an explanation and there is a reason. And it's just that I'm wired a little bit differently. And if I just tweak some things, maybe I can optimize what I'm doing. I love the term neurodiverse because it's indicating that there's unique wiring. But I also think that we also need to encapsulate and not shy away from the word disorder, because I think that's an important term in that it's not just. And again, why it's a disorder. Some people argue that it's a systemic thing and it's you know, it wouldn't be a disorder if systems had changed. But I think a disorder is indicating that it causes you substantial dysfunction and distress. And I feel like that's something that it needs to be included in that name, because it does. Otherwise, without that, I think that people just minimize ADHD and think everybody has it. It's not that big of a deal. Everybody can't focus. It's our phones. So it gets diminished and the severity gets taken away. I guess a big question for me also is when we're talking about something like ADHD, what are we actually talking about?

So ADHD is a neurodevelopmental condition and it is categorized by three different things. It's categorized by inattention, hyperactivity, and impulsivity. And you don't necessarily need to have all of those things, but you'll see that there's varied presentations of those within each presentation. So the typical three presentations is an inattentive type, a hyperactive type, and then a combined type, which is obviously the grouping of both. And so this is something that typically, typically presents even at birth and it's genetically passed down. And as you grow and evolve, there's a chance that it could get better. There's a chance it could continue into adulthood. There's a chance it could evolve and adapt and you could just hide it better. So it's something that not generally something that just presents out of nowhere.

You're seeing it pervasively before age 12. And generally, if you look back into family lineage, there's signs of it as well. Oh, that's so interesting. Do we have an understanding of what's actually happening in the brain that would lead to these symptoms? There's a lot of good hypotheses about that. I think that brain is always a very difficult thing to study in actuality because the best way to study the brain is when it's out of your head, which nobody wants. So it makes it a difficult thing to study. I mean, there's, there are, you know, some people ascribe to using scans and things like that to assess like PET scans and fMRIs to kind of assess for glucose uptake and,

and how active certain areas of the brain are. But the fact is that just the science hasn't caught up with that. And we're not there yet. It doesn't actually, it's a really pretty picture, but it doesn't actually give us the information we need. So when you're looking at the ADHD, like from a neurobiological perspective, there's a couple of areas that we do know are impacted. Number one is just that frontal lobe. So directly under your forehead is that big part of your brain in charge of personality and decision making and impulsivity. And so when you're actually looking at anatomical changes, that's actually a little bit smaller, and it develops a little

bit later. So if you're thinking about just kind of changes as we progress into our preteen and teen and adult years, you know, everybody talks about how difficult teenage years are. But you know, with ADHD, you can have this like even delayed onset from that where you have like this delayed social maturity. So you're having prolonged problems even throughout teenage years, and it kind of escalates from there. You can have changes in the amygdala, which is that emotional cortex of your brain where it's a little bit bigger and a little bit more hyperactive. You can see that in a lot of different areas of the brain, but that's another area that can be impacted. You can have difficulty in areas like the reticular activating system, which is kind of like this post office where all that chemical messaging happens through. So there's lots of different things, but it's still kind of incompletely understood. I mean, that makes sense to me.

So if we don't diagnose it that way, how does it get diagnosed these days? It really is diagnosed clinically. You base it on your history and symptoms. And what I tell people is, even though you're doing this clinical assessment and you're asking the right questions, it really hinges on a complete understanding of everything else as well. So you have to have a good understanding of what is this person's underlying medical condition?

What is this person's underlying psychiatric condition? Because those things can look a lot like ADHD. Because, you know, if someone is coming in, and they're presenting with focus as the main problem, that tells me nothing. That tells me nothing. That could be depression, that could be anxiety, that could be a thyroid disorder, that could be ADHD, that could be a brain tumor, that could be, you know, it could be so many, so many, so many different things. And so it's just a very nonspecific thing. You have to look at everything in its entirety and tie together that picture, which is why going to a trained mental health professional that can like

piece together all those things is really important. Yeah. I mean, that makes a lot of sense. I wonder then because it can show up as different things, because it can potentially show up as anxiety or some overlap with symptoms of depression, do you feel like ADHD is often either underdiagnosed or misdiagnosed often? It's a complicated question. And the reason for that is it really depends on like the patient population. Because I think there's certain populations where it is grossly underdiagnosed. I think women get diagnosed later. I think they're more likely to get misdiagnosed. I think usually they're coming in like the difference between diagnostic rates for men versus women, boys get diagnosed around six or seven. Women typically median age or mean age of diagnosis is like in their thirties. So there's such a huge discrepancy based on age and gender and things like that. I think they're socioeconomic kind of things. There's a huge, huge discrepancy when you look at certain patient

populations that are completely flying under the radar and being diagnosed with like conduct disorder or oppositional defiant disorder or different behavioral issues are more likely to be diagnosed with bipolar or schizophrenia when really it's ADHD and in, you know, more affluent societies where they have more access to care and they're not going in kind of emergently, they're getting diagnosed and getting that frontline treatment. Yeah. That makes a lot of sense to me. So it's complicated at the end of the day. Very complicated. What would be some signs? So if you're a parent or a caregiver and you're looking at a kid or

a teacher and you're looking at a student, or if it's you, if you've just been, you know, you're in your thirties or forties or fifties, and there's just been this stuff that's been going on for literally for as long as you can remember. And you've never been diagnosed. You never saw a diagnosis. What are some sort of common signs that would let you know, like, maybe I should actually talk to somebody about this and see if there's something else going on. So typically what you're looking for, like, for example, with the inattentive type, you're looking for difficulty initiating tasks. You're having a hard time initiating tasks. You're having a hard time sustaining focus for tasks. You're having a hard time organizing things. You're having a hard time looking forward into goal-oriented tasks. Like if there's something really big coming up, it's hard to plan for that. And so you like avoid it or you push it off or you dread it.

You look for things like you lose things frequently, being forgetful in daily routine, like walking out of the house and being like, did I brush my teeth? Did I not? So things like that are more of this inattentive picture. And if you were to like, just kind of group that and look at something just like a trope that you were thinking about, it's your daydreamer, right? Someone who's just like kind of spacing out, right? And then you have this hyperactive type, which is stuff where you think more about like this verbal and physical impulsivity. So they're blurting out answers, they're interrupting, they're hyper talkative. They're also very fidgety, hard to stay in their seat, difficult to keeping their hands to themselves. You see kind of a blending of those two pictures with the combined type.

So if you are later in life, and you're just hearing like, oh, I just thought I was forgetful, or I just thought I was always a little anxious, or I just thought I was like, I'm a fidgeter. And then you're hearing like, well, what, all these things are going on, but I feel like I've developed mechanisms, practices, coping things where I'm pretty much okay. Is that the type of person where it still makes sense to say like, well, should I go and see if this is actually what's going on and get a diagnosis? Or at that point, is it just kind of like, I've gotten to a place where whatever's going on with me, I'm actually, I feel like I'm good. I'm comfortable. I'm living a good life. And that there wouldn't really be a whole lot of purpose behind saying, let's go down the path of like going through whatever the diagnostic process is. So I think therein lies that, that hinging word of the disorder,

right? If you're getting through this and you're like, I'm actually okay. It doesn't actually disrupt my life. I'm a little spacey. I look like I kind of meet criteria, but it's not bothering me. It's not bothering anybody else. I'm like, fine. I don't think that's a disorder. You're a little spacey, whatever. That's not causing significant dysfunction. And so I think there's that. Now, what I would say is if you do feel, if you're in a situation where you're hearing these symptoms and you're like, that sounds like me, that does cause dysfunction. People often ask me, like, what's the point of getting diagnosed if I'm functioning to some degree? I've developed the things that I need to. I'm in my 50s.

I'm in my 60s. Like, is it too late? I don't know. The way that ADHD made sense to me is once I understood my brain, and then it was like the world opened up. I started to understand the motives behind what I had done. I gave myself grace in these kind of things. So I think from just an understanding standpoint, I don't think that's ever you're ever too late for that. But keep in mind that that's also having that mindset is a privilege, right? I mean, access to care is such

a problem and it's not widely available for many, many people. So I think it depends on a multitude of factors. That makes a lot of sense to me. And what you bring up about, maybe it actually helps you with self-compassion and really just understanding yourself better and self-forgiveness, you know, like in addition to that for like just certain things, the way you move through the world, that alone probably, it really makes a difference just in the way that you experience each day. I wonder also, you know, because we live in a world where there's a lot going on and there are a lot of stressors. How does stress interact with ADHD with any of the ways that it presents? So I think that stress is a unique thing because there's a certain level of stress that kind of motivates you and accelerates kind of action because there's a sense of urgency behind

it. So for an ADHD brain, you might need a little bit of stress because it kind of keeps you going and keeps you kind of on the straight and narrow and gives you this urgency to get things done. But in a more global sense, I think that people with ADHD have because of this dysregulation with focus and attention and emotional stuff, I think stress can be really destabilizing and it can be hard to get on top of adequately. I think we're ill-equipped for stress, but we also need a little stress to function. So it's just, it's finding a good balance and a workable balance. And I think that's something that I know that I struggle with on a pretty solidly daily basis. Yeah. So it sounds like

what you're saying is for most people, there's a sweet spot, whether you're experiencing ADHD or not. And maybe it just makes more sense to really try and understand if this is the way that you're wired, like where does your sweet spot lie? So you can be a little bit more intentional about trying to sort of like operate within it rather than push the extremes on each end. Does that make sense? Yeah. The other thing that I'm curious about, and maybe it's almost like the extension of stress, right? Is that we also live in a world where stress

rises to the level of trauma. Yeah. And sometimes it's trauma bundled with grief. Does this affect somebody with ADHD in a meaningful way that's different than somebody who'd be more neurotypical? I think that it does. And I'll tell you my specific reasoning for that. I think trauma is a really complicating factor in anybody's life. I mean, it adds so many new dimensions and so many new variables. With ADHD, I think one, you are already at high risk of getting overwhelmed. And then two, the part that people don't talk about with ADHD, rarely, if ever, is the emotional component that comes with it. It's not part of the DSM. So people never really lump it in with ADHD, which is part of

the reason why it gets misdiagnosed as mood disorders. But the emotional dysregulation is a huge part of ADHD. You get a lot of mood fluctuation. So if you're having these sizable triggers with trauma, I think you can get caught in these big spikes of emotional activity, big highs, big lows, which can be really destabilizing to everything else. So if you're already having a hard time getting your things done and focusing and managing your day-to-day life, and then you're being just absolutely rocked by this trauma at the same time, I think you're going to have a much harder time coping. Yeah, no, that makes a lot of sense. One of the other

things that you talk about under this sort of bucket is also the notion of leaving the ADHD superpower rhetoric behind. And as I'm watching you, people who can't see the video right now, I just saw what you did with your eyes. That was a legitimate eye roll. So clearly, this is a thing for you. Oh my God, I hate it so much. I think why I'm so averse to that, to that trope is that number one, I've never experienced that. Like there's some things that I think my ADHD has helped me with. But like overwhelmingly, I would rather not have ADHD. That is just like the hard and fast of it. I would just rather not have it. I think my life would be easier. That being said, I value that people are trying to celebrate their brain and bring about, like showcase the positive. There is value in that for sure. I just feel like when you

move so far into this, like almost like delusional toxic positivity, that it's so marginalizing to the other people that struggle and actually squashes their the validity of their claims. So like, I remember when I was hearing that for the first time, and like when my dad and I were kind of re exploring ADHD, when I was in medical school, he was trying, he initially was the first culprit who was trying to like pull this on me. And I was like, No, man, we both know that's not true. And so I think that I remember telling him, when you tell me that, you make me feel like it's my fault

for not being able to harness this. And I think that's where it boils down to. This isn't a volitional thing. There are times where people can hyper fixate and hyper focus, and it's amazing. You can get a lot of work done. You can get a high quality of work done. You can get a high quality of work done. You can do all of these incredible things in a time span that people

couldn't dream of. Is it the right stuff you're doing? I don't know. Is it stuff that can be replicated in the future? I don't know. Like it's just very erratic and it's hard to rely on that as a superpower. Yeah. And it's almost like you described if you're telling everyone, well, it is, and your personal, your lived experiences for me, or at least at this moment, it is absolutely not. Then you're effectively invalidating their experience, which is almost like a form. It almost becomes a form of gaslighting in a weird way. Truly feels like that. And I have the same visceral reaction as I did when I was 19. It still bothers me. And I think I see that it's become so, so pushed on the internet as kind of like this thing where it's like, I've seen it on a shirt

before. And I was like, Oh my God, what? There are positives of adhd there are things that actually i think are really incredible that adhd you have and there are certain successes of mine that i've had that are solely due to my adhd but it's not a superpower at all at all i think there's things that you can like enjoy and cultivate and work on and celebrate but I don't think that's enough to hinge your entire lifestyle on. And I don't think it's enough so that you can say it as a blanket statement and kind of crush everybody else. No, that rings really true. There's also a reset in expectations that you sort of explore, which is certainly whether you experience ADHD or not, the prevalence of perfectionism, so many people have talked about it and how a really devastating effect. But then if you're

holding yourselves to a standard of perfectionism that you feel like is being almost superimposed on you in a particular office culture or setting or team culture, I would imagine that just creates this compounding effect where it just makes things harder than they even really need to be. Totally. I think that a lot of that stems from yourself creating that structure, right? I mean, if within you, you have the standard of work that you hold yourself to a certain standard and you are unwilling to budge from that, well, there's a huge problem in that because if you're already struggling with productivity,

you're gonna potentially be dealing with some difficulty with completing and having that executive function to sustain a task. So I think that if you're, you know, what is that? What do people always say about perfection? Like the greatest enemy of, what is it? Now I'm blanking on what the phrase is also. There's something and it's very profound.

Good is the enemy of great or something like that. Something like that. It's just like, you know, what I've told myself and what I've told my patients, if you're holding your standard to something being absolutely perfect, I think you're losing track of what the greater scheme of things should be. You want net progress. There's going to be ups, there's going to be downs. And with a neurodivergent brain, you're also working against an architecture that wasn't built for your brain. So you're pushing against a lot of different constraints. And so at the end of the day, you might just be shooting yourself in the foot and the only one you're impacting is you. So being able to kind of understand like, what's the end game here? If I want to get done with if my end goal is this,

and there's 10 steps to there, maybe I just need to get done with the steps. And then that'll get me there. And obviously, our energy should be put towards making a great product and doing what we're supposed to be doing. But getting stuck in these obsessive perfectionistic and then subsequently shame spirals with it is just not productive. Yeah. So much of what you're doing is you're sort of like you're turning out to the world and saying, Hey, listen, your brain may be wired in a very particular way, which may have certain benefits, but also may make it really challenging in certain moments or entire seasons of your life. Anything you can do to bring a little bit more grace into the experience of each day, let's try and do that. And here are just a ton of different ideas.

Try them on. I don't know what's going to work for you, but maybe some of these will help and you can put together your own practice and then just keep trying and running experiments over time. I mean, that's so much of what it feels like the way that you're showing up and offering yourself and your ideas and your insight and your experience. At the end of the day, I think that's my hope. And finding that for some know, for some people that, you know, don't like having to go through information through a book form. I mean, that's kind of why learn a lot from the community on social media, and it's been just like this eye-opening experience learning from that group of people, and not only what their unique needs are, but what their unique solutions are. I think it's felt very collaborative. Yeah, no, that's super cool.

So it feels like a good place for us to come full circle as well. So in this container of good life project, if I offer up the phrase to live a good life, what comes up? To live a good life is to serve others. I think that's probably my dad speaking out of my mouth, but I feel like when my life has been really chaotic and difficult, and I've had like a hard time managing my own internal environment, being able to step away out of that and kind of work on helping others or doing things, it's built me up as well. And it raises my self-esteem and it helps me feel more whole and it helps me. And with those experiences, I think it just helps keep society moving. So I think that's a good life. Thank you.

So appreciate the insights from all of our guests today. It's just an inspiring and illuminating journey we've been on together through the realms of well-being and balance and peak performance from Dr. Romi Mushtaq's compassionate roadmap for breaking free of the toxic stress success cycle to Dr. Aviva Ram's wisdom for reclaiming vitality from survival overdrive and Dr. Sasha Hamdani's toolkit for self-acceptance among neurodivergents. We have gained powerful strategies for thriving in our sometimes relentless world. So I hope their insights invite you to really start to forge your own path towards harmonizing achievement with deep self-care and true renewal. And if you love this episode, be sure to catch the full conversation

with today's guests. You can find a link to those episodes in the show notes. This episode of Good Life Project was produced by executive producers, Lindsay Fox and me, Jonathan Fields, editing help by Alejandro Ramirez, Christopher Carter, Crafted Era Theme Music, and special thanks to Shelley Adele for her research on this episode. And of course, if you haven't already done so, please go ahead and follow Good Life Project in your favorite listening app. And if you found this conversation interesting or inspiring or valuable, and chances are you did since you're still listening here, would you do me a personal favor, a seven second favor and share it maybe on social or by text or by email, even just with one person.

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