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E3. Eating and ADHD

Today we're going to tackle a complicated subject, but a really important one: how ADHD impacts our relationship with food and eating. Now, this ends up being a topic that comes up all of the time. It comes up in the ADHD forums that I'm a part of, it comes up with my clients, and it's come up for me personally. This is something that people don't really seem to be talking about, but it's absolutely an issue for people with ADHD. Oftentimes, people with ADHD struggle with their relationship with food.

ADHD increases the risk of disordered eating...signficantly

There's a Harvard study that indicated that people with ADHD were four times more likely than the non ADHD group to have an eating disorder. There was another study that looked at a group of women and 11% of the women who were diagnosed with ADHD, had a diagnosis of bulimia (compared to only 1% of the group that did not). There's some information out there, measurable studies, that's showing us this link.

But even without that, when you speak to a large enough group of people with ADHD, this is clearly a common theme. What is it about the ADHD brain that might make us more vulnerable to having a less peaceful relationship with food? I think that gets to the heart of it and includes people that may not think of themselves as included in an eating disorder group. I think all of us want to have ease and peace with how we take care of ourselves and that definitely includes food. That comes up daily for most of us.

What ADHD challenges impact our relationship with food?

I have a few thoughts. I'm not citing studies in the rest of this talk, so the information that I'm going to present is more information that I've seen working with clients, in my own life, and knowing what I know about the ADHD brain. I don't know as much as I would like to know and hopefully I'm just going to keep learning more about this. But this that I'm bringing today- this is what I've gathered so far.

I've kind of classified these factors as body-based and thought based/cognitive factors (that affect our relationship with food). In this first part, I'm going to talk about our body sense. There are three different things impact the way our bodies are experiencing the world and our relationship with eating.

Emotional Regulation: The first one is emotional regulation. I've spoken about this before, but I can't speak about this enough. This is a huge issue for people with ADHD. What is emotional regulation? It's our ability to experience our emotions without being overwhelmed by them. It's being able to process emotions, respond to emotions, tolerate emotions, without getting to the place where it's just too much to function. And I know for me, this has always been a huge factor of how ADHD shows up in my life.

My sister (who has always been very generous, sweet person) once described me as someone who "burned bright". I think was her sweet way of saying I was really intense. And the thing about emotional regulation is that it's not just I have really huge emotions in terms of what we might classify as a negative emotion like sadness or anger, even joy or excitement can just be overwhelming for someone with ADHD that's dealing with emotional regulation. ADHD is a neurodevelopmental disorder, this is showing up in childhood. Kids don't tend to have an arsenal of tools to draw from to help them regulate. We get more of this, have more access to this as we get older .

One self regulation tool that is out out there for all of us, especially when you're young and you don't have access to a lot, is often food. Food can be a huge regulator. It's comforting and it also gives us a lot of sensory input. Later on, I'm gonna be talking about sensory information and how our bodies deal with sensory information, which is also often impacted with ADHD.

The whole process of eating can be calming, this is this is some rudimentary stuff. This goes back to infancy and it's doesn't make us abnormal to find comfort in that, but obviously, if that is the only tool or the main tool for self regulation for somebody who's often dysregulated, then that makes relationship with food kind of complicated. It's probably not meant to be a primary tool for regukation. So (the ADHD/ emotional eating link) makes total sense to me. Number one, emotional regulation.

Interoception/ body attunement: Another factor for those of us with ADHD is interoception and body attunement. Interoception is impacted with ADHD, what is that? It's your body's registration and interpretation of internal states. Things like your heart rate, temperature, or hunger/satiety. This feedback isn't always reliable for people with ADHD, so this is an area that can be impacted.Body attunement is something a little bit different, similar but different.

Body attunement involves interoception. It involves these signals from our body, but it's also how (and if) Mwe're paying attention or tuning in to those signals. For a lot of people with ADHD, these signals are already a little bit faulty or unreliable. Am I paying attention to the signals that my body is giving me? There are a few factors with ADHD brains that can put this in jeopardy. Impulsivity, is one do we get this information and tune into it? Or do we follow the pull elsewhere?

Are we actually paying attention to these signals, which might sound strange to someone who doesn't have a brain like this. If you're somebody with ADHD, and you're hyper focused and your attention is super focused on something it's not uncommon forus to forget to use the restroom, forget to drink, forget to eat, and then suddenly our body signal gets so extreme,that we can't possibly ignore them.

We feel sick, we might and we may have really low energy. Whether we missed the information in the first place beause of poor interoception, or whether we didn't tune into our bodies, the results are the same. We didn't respond to our body's signals and there are some consequences from that.

That has a pretty big impact on how we relate to food and how we relate to hunger.I'm a big believer in intuitive eating, but this is an extra layer for people with ADHD who are trying to use this way of eating. We have to adpat inuitive eating for our brains and that's a whole process that I do with some of my clients. We're not necessarily starting at the same starting place as a lot of people who are practicing intuitive eating. We need some little tweaks for the things that are true with our brains.

Sensory Processing: Number three (number one was emotional regulation number two is the interoception/body attunement combo) is sensory processing. For those of you who don't know, I have an occupational therapy background. I have a lot of background in how different bodies deal with sensory information, (working with) people that can be extremely sensitive and over reactive to sensory information and those who can be under reactive and under registering sensory information. Both of these things impact our relationship with food.

Obviously, if you are super defensive and sensory information is coming into your body like an assault, then that's going to limit what you take in for food and what you're able to tolerate. What does that look like? Well, it depends. You know, for a lot of people, it means there are not a lot of textures and tastes and smells that they tolerate well, and so that impacts their peace with food.What it looks like specifically, in terms of what they're consuming depends, but it definitely complicates their relationship with food.

Then you have those who are unresponsive. When you're unresponsive to sensory information, this complicates your relationship with eating in a different way. Of course, you satisfy physical hunger when you eat, but you also have sensory input that you're receiving and processing that's a part of satisfaction with food like chewing, textures, swallowing and the feeling of fullness.

There's this idea that ( I think the dietitians out there and people who are pros in this subject could talk about this a lot more in depth than than I can), there's a "sensory specific satiety", a sensory specific satisfaction with eating. So you get less satisfaction, a declining sense of satisfaction, the more you consume a certain type of food. If you're not getting all of that sensory information, it makes sense that you wouldn't really reach that point of satisfaction from that standpoint, as early or even be tuned into it.

We don't just eat with the sense of taste; you see, hear, smell, and touch food. Things that impact how that's experienced in our body complicates our relationship with food. What that looks like is as varied as people are varied, but I do think it's something to consider when you're looking at ADHDand peace/ease with food.

What can we do to have more ease with food? I've just talked about three different areas of our body experience that impact our relationship with food. If you have ADHD and you know, that this is true for you, you'r probably like, "Well, so what? How am I supposed to change or help help myself with this?" and there are several different techniques (that help).

I'm not going to go into everything because I don't have room in this podcast, but I am going to mention one that some of us with ADHD really kind of shy away from, which is mindfulness practices. I do feel like there's a collective cringe because if you have ADHD, you (probably like me) might have this impression that you're not good at mindfulness. I've always said, that I might be the least "in the moment" person that I know. Truly, I'm almost always operating three, four or five steps ahead.

The thought of just sitting there on a meditation cushion and being focused in the moment always just sounded like pure torture to me. I knew I'd be bad at it, right? It was not natural for me. A lot of the things that I do for myself and with my clients it's mindfulness adjusted for our brains.

You do not need to be still to be mindful. You do not need to be technically meditating to be focusing on the moment and focusing on your body. I don't really have time today, but I will probably do an episode that's just about mindfulness and kind of ADHD.

One of the things that can be helpful in connecting us with our bodies is this whole idea of mindfulness practices that's adapted for our brains, we can actually learn to do this, I promise. If I can do this, you can definitely do it. and we can do it in a way that fits us. We can experience more connection (with our bodies).

This might still be an area that's impacted for you and is not typical, maybe it doesn't look like a typical brain and that's okay. We can improve, we can get more connection and more feedback about what's going on in our body and learn how to tolerate and be aware of some of this. So I'm going to move away now from these body experiences. I'm going to go to number four.

Sleep deprivation can impact our hunger and fullness.Number four reason that ADHD brains experience a complicated relationship with food is sleep. Guys, nobody wants to hear this. I think a lot of us deal with impacted sleep related to ADHD. We have difficulties going to sleep, we have difficulties falling asleep, and a lot of times our sleep cycles are really different than the norm. So sleep is a tricky area for us. I'm not going to go into all of that.

But,what I will say is sleep deprivation, which a lot of us deal with, impacts your relationship with food. There's the obvious fact that if you'e tired/ exhausted, you don't have the kind of bandwidth for making decisions that are intentional that you would have if you were well rested. So there's that.


But there's also hormonal differences that happen when we are sleep deprived. There are a few hormones that regulate your satisfaction and your hunger, and those go awry. When you're not sleeping well your body produces more ghrelin, (I had to look that up, because there's actually an H between the G and the ER for some reason, but it's ghrelin). It produces more of that hormone, which actually increases your appetite.

Your body produces less leptin, which is a hormone that suppresses your appetite when you've had enough to eat. Your body also produces more cortisol, which is a stress hormone, and that also increases your appetite. This is no good. This is no good for us when we're trying yo get in sync with what our body actually needs. If we always have disrupted sleep, this kind of hijacks our hunger and satisfaction feelings. So what's the answer? Well, we control what we can control. We can't necessarily control all the ways ADHD impacts our sleep, but we can prioritize sleep. We can decide that it's important and do what's within our control.

One of the things that I'm going to mention today (I'm also going to give a complete disclaimer to say this is one of the hardest things for me that I'm frequently having to return to) is signing off from screens. If you can do it an hour, 45 minutes before you're trying to gear down, it's is a great idea for a couple reasons.

1) It helps us shift into a more passive gear than this really high stimulation of whatever we're doing on a phone computer, before bed. 2)The other factor is that the blue light that we're getting disrupts melatonin production and this impacts our sleep cycles. I think blue light glasses can also help with that.For me, I've found that there's a difference in the kind of sleep that I'm going to get if I'm totally off devices for an hour or so before bed versus no. Like I said, this is super hard for me to do probably one of the hardest things out of all of the sleep stuff for me to do.

Another thing that people have success with is certain supplements that help with sleep. For me, magnesium is really important,and a lot of us are deficient in magnesium and I've always found helpful to supplement for sleep. Some people take melatonin because that can support your sleep cycles. Obviously, if you're taking things like supplements, I'm not the person to give you advice and you need to work with a doctor/professional because only a professional working with you knows what else is going on with your body, what medicines you're taking, and how those all interact together.


But I definitely have had clients who have had success with that and it had helped with me and my kids as well. I've also noticed that having some kind of like calming sensory input usually helps me down shift and be able to fall asleep easier. It depends on what you like and what's calming. You could be a bath person, I tend to like to do stretching and myofascial massage.


I have these really cool therapy balls, that kind you can use to do self massage. Whatever it is, you can experiment with things that help you bring your nervous system level down. Knowing that this is already going to be kind of a hard thing for a lot of ADHD brains bring able to gear down to sleep and prioritize sleep. Sorry, I've talked too long about sleep, we're moving on.


The stuff that I've talked about so far has been a little bit more about how ADHD affects our body sense and sleep. But now I'm going to shift over into brain talk/ mind talk, thought talk. Obviously, ADHD impacts us in not just our bodies and in the way our brain operates as well. So we're going to talk about some executive functioning skills.


The first one I'm going to mention this is our number five reason that ADHD complicates relationships, our relationships with food, is that sometimes we struggle with an executive functioning skill called cognitive flexibility. What does that mean?


It means just what it sounds like: the ability to look at things in more than one way, it's the opposite of rigidity. Sometimes that means we're able to solve a problem by attacking it from different angles without becoming totally frustrated. Or it could mean that we're flexible in our thought, we can see that things can have some nuance and that there are multiple ways to think about something. Very often when I'm talking to somebody who is really struggling having peace around food, whether they have ADHD or not, they often have really rigid thinking about their food, their bodies, all kinds of things. Having peace around food and how you're nourishing yourself requires flexibility, because life requires flexibility.


You're not making food decisions in a vacuum. And oftentimes that rigidity and requiring that someone only eats a certain way, or is really strict about quantities, or really strict about ingredients- it can really jam you up. Because once you get really rigid, there's always a fallout in that. Now, I'm not talking about somebody that has to restrict for for something specific, like an allergy or even an intolerance. I'm talking about those rigid food rules that come along with dieting, and not being okay with our body, and just trying to muscle down on changing our eating.


When they are rigid and extreme, they almost always have a pendulum effect in our lives. Since with an ADHD brain, a lot of us already lean towards being somewhat inflexible cognitively at times, (I'm not saying it's everybody all the time but this is a this is an issue that's often documented with ADHD) we might be particularly vulnerable to the really rigid rules and extremes trends that pop up around food.


That does not tend to give us peace around food. But it also doe ( and this is so true for people with ADHD about a lot of things) is it removes us from this place of authority in our own lives. We really second guess ourselves and we really lean on something that's super structured and super rigid to guide us instead of being able to trust own bodies.


We've already talked about some of that, because we don't always get reliable information from our bodies. But then you add on some of this cognitive inflexibility, and it can become a challenging relationship with food.


What can we do about inflexibility cognitively? I don't have time to do it justice today but I will say that one of the things that was super helpful for me was cognitive behavioral therapy. There are amazing specialists that can help you use those tools and there are definitely resources online,access a lot of that. It's basically the process of recognizing these thoughts and noticing when they crop up, trying to bend them a little bit, and trying to get flexible with them. And eventually it's about replacing them with the thoughts that actually do serve you. This can be an involved process, but it's really a valuable process. It's the kind of tool that you're going to be able to use forever.That is one things that I recommend digging deeper into on your own, if you can. That's a really good tool to use withrigid thinking.


Okay, the number six reason that ADHD can complicate our relationship with food is impulsivity. Very often with ADHD, we don't have the "pause" between impulse and action that a lot of typical brains might have. A lot happens in that pause. Everyone has impulses, all the brains have impulses. The difference between a lot of our brains and the majority of brains is that they tend to pause longer. In that pause, there's time. It could be a very short pause, but there's time to consider, "Okay, what's going on here? What are the likely outcomes? If I do this thing? What do I not want to happen? What do I want to happen?". There's just space in there to make a decision, and a lot of us don't regularly have that space.


So we may have impulse-reaction, rather than impulse-pause-assess-choose an action. That pause can also mean going backwards and looking at what happened before the impulse and saying, "Oh, is that how this person meant me to take that? What else could be going on that caused this thing that caused my impulse?", it's just a moment for taking stock. Many of us don't do this as regularly as other people. That impacts how we make decisions and it impacts our relationship with food. It impacts our relationship with everything.


So what can we do here? Well, this is kind of that combo of the mindfulness, where we're just noticingthat we have the impulse, and we're noticing what happened before that and how we interpreted it and what that's causing in you. Mindfulness can be a big tool in starting to create more of a pause. CBT can be a tool in helping to go from that impulse (that's very often triggered by a thought) and looking at the thought that came before the impulse. How else can I think about this? This is all is not all going to happen and be covered adequately in one 30 minute podcast, this is work. This is work that's ongoing. These are tools that you have to build, skills you have to develop,but they are skills and tools that help manage what can be a challenging relationship with food/ eating.


The last thing I'm going to talk about (my number seven) is the RSD and diet culture combo. For those of you who are not familiar with RSD it stands for rejection sensitivity dysphoria and this is an experience that a lot of people with ADHD have in which they they have a really overwhelming response to the perception of being rejected (whether or not they are actually being rejected ) and this can be derailing this can be for them.


This seems to tie in pretty closely to the emotional regulation piece- not being able to handle/manage the emtional intensity that comes the perception of rejection. That combined with another unfortunate factor, which is diet culture, can be brutal. This might be where I lose some of you, and that's okay because we're all in different places with this, but diet culture this prevailing idea that only attractive bodies are worthy bodies and only thin bodies are attractive bodies.


So this is pretty loaded for a lot of us and it's so prevalent in our culture. We don't even recognize all the ways it shows up. When you combine this really heightened feeling or experience of being rejected, with some cultural factors that are going to pretty much reject the majority of bodies, then you have a lot of added complication with your relationship with food and your body. Let me just say this, the diet culture phenomenon impacts all people. This is not something that's primarily an ADHD thing, but it becomes kind of a one two punch when combined with the RSD. So what do we do about these things?


Well, we've already talked about the tools for emotional regulation in mindfulness, where we're realizing what's happening with our bodies. We've talked about using the tool of CBT, in which we're taking rigid thoughts like the ones that are perpetuated with diet culture and we're helping dismantle them.


The final thing that's been really helpful for me, (and some people are interested in doing this, and some people are not, and that's okay, you are where you are) is really being aware and coming against diet culture when I see it showing up in my life; I have three teenage daughters and I've noticed that they're growing up in a world that's a lot more accepting of different brains, different bodies, different skin colors, they're growing up in a world that's starting to kind of wake up to the fact that there's beauty and value in lots of different packages.


So I do have a lot of hope when I hear them talk about something that for them is just a given and for me growing up in a really different time was something I had to battle to believe. There are a lot of good changes happening, but if you're my age- a little older or even a little younger, you might have to do some of that footwork on your own to reprogram the way you think about your own body and the way you think about the bodies around you.


And that brings us to the conclusion of this episode,I had a lot that I jammed in here. This is an issue that's really close to my heart and one that I feel passionate about- helping people with this and getting information out. There can be a lot of shame already with ADHD and for those who are dealing with the added shame of disordered eating, or just lack of peace with their body and food, this can also be shaming. So there's this this one-two shame punch that keeps people isolated and somehow just feeling like it's only them and it's definitely not. (If you deal with this), you are not alone and this is somethingthat a lot of people with ADHD run into.


There are definitely ways that you can support yourself, and there's things that you can learn that are going to make this easier for you.There's no reason to feel like you're alone or that this is something that you just have to accept and deal with on your own because that's not true either. So that's it- I know today was kind of a heavy one, but this is a really important message. I promise you I can be a lot more fun, but not today:)


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