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Hello, everyone. Welcome back on the Eat Brain Sleep podcast. Today, I have a guest who is fabulous and whom I've known since 02/2007. Nick Potter is a renowned osteopath, and I've met him when I wanted to use him for my own benefit as a patient, as a client. And today, I have him here in the studio.

We're gonna be talking about the link between ADD or ADHD and gut health, sensitivity to pain, and hypermobility. Many people don't know what hypermobility is. We're gonna dive into this topic and understand how neurological issue or how a physical disorder can cause a neurological issue. Nick is gonna cover all of this for us now. Nick, thank you so much for being here with us today.

Absolute pleasure. It's lovely to be back with you again. You're doing such great work, and it's lovely to be involved. So I hope we can do some explanation of quite a complex subject, but we'll we'll do our best. Very complex subject.

And every time I go and see Nick, and he realigns me, we spend the whole session talking about so many concepts. I'm like, hold on. I need to get you into the studio. We need to record these conversations. We can't just have them in your practice.

So I'm gonna give you a little bit of background about Nick. I mean, he's done so much, but I've tried to reduce his bio as much as possible. I invite you to go on his website and read more about all the work he's done. I will link, of course, his website, his Instagram handle, his clinic, everything with the podcast so you can go and reach him. So Nick Potter is a consultant osteopath at King Edward the Seventh Hospital in London, Marylebone, and he has consulted to Brevin Howard Asset Management for eleven years.

Brevin Howard is a hedge fund with many traders who are obviously working on the financial markets, and he is head of health and well-being there. And apart from managing the employee's musculoskeletal problems, he has pioneered the use of interception to manage the traders' stress levels. The reason why Nick is working with all these traders is your stress levels can highly impact your risk appetite. And for a trader, that has a huge impact on their p and l profit and losses, so basically on their performance. So there's a very strong link between the body, the brain, the cortisol levels, and performance at work, particularly in a highly stressed environment like a trading floor when you're working for a hedge fund.

Nick specializes in chronic pain and pain syndrome in general, chronic fatigue, brain fog, and so much more. He runs a regular BBC Radio health surgery on chronic pain, and his book, The Meaning of Pain, published in 2018, is now available in six languages. He runs a special program for chronic pain and pioneers the treatment of elderly with multiple pain sites as well as the effect of menopause, so really relevant for all women. Nick is fondly known as Nick the neck by his colleagues due to his specialization in cervical spine injuries and particularly the upper cervical syndrome as well as head, neck, and facial pain syndromes. He's currently doing research on hypermobility and the links to ADHD and anxiety disorders and recently convened a working group to link the related specialties and neuroscience.

So that's what we're gonna be talking about today. Nick qualified in '93 from the British School of Osteopathy. He also has a diploma in medical acupuncture. Nick splits his clinical time and with his consulting with health and well-being and performance role at Brevin Howard, utilizing his background in sports performance, Formula one, elite rugby, golf, Steve Ballesteros, and tennis and UK athletics, 400 meters. He has spent fifteen years studying the nature and effects of stress on decision making and risk aversion and their relevance in financial markets and trading as I was mentioning earlier, as well as formulating strategies to combat those effects.

Through his links with Brevin Howard, he has worked with John Coats, the hour between dog and wolf, and doctor Danny Kahneman, thinking fast and slow, to study stress responses universal to us all and which are independent of personality type. Nick is also a really keen sportsman. Marathons, triathlons, playing rugby in The UK and New Zealand, all of these very inflammatory activities as you know. Nick still enjoys running and tennis. He played rugby himself to a high level and coached with the Junior Rugby Academy at Henley Rugby Club for seven years.

Currently, he's a governor of Rupert House School in The UK. He's married and has two children. Wow. Thank you. That's you, Nick.

And there is so much more I have omitted. That's very kind of you. Well, look. Where would you like me to start? I think we should, start perhaps with where well, I'm doing with the hypermobility work.

Yeah. So first, I would love you to explain what hypermobility is. No problem. I am myself, so I come from my own self experience. I'm not only hypermobile.

I'm definitely probably on the ADHD spectrum. I just never been formally diagnosed, but I it didn't take too much rocket science for me to work it out. Hopefully, by my age, I've learned to regulate it a bit. Basically, hypermobility is a collagen problem. It's a definite it's a genetic deficiency.

It comes on a spectrum. You can be mildly hypermobile down one end and then you can be down the very far end where there are two main conditions called Ehlers Danlos syndrome and also Marfan syndrome. They tend to be very tall spiky people, very long limbs, long fingers. And the problem is that the stiffening agent that binds your, tissues and joints together, which is collagen, comes in various different forms. There's also one called fibrin.

Sadly, can be genetically deleted from certain. And it is very ethnic, actually. The Middle Eastern countries are particularly hypermobile. The most hypomobile in the world I've ever discovered are actually Sri Lankans. And in fact, the gene was isolated onto the fact they're on an island, so it's been propagated with it.

But the their dancing actually factors in the amazing flexibility of their fingers and so on. The Jewish community are also quite, quite hypermobile. So why is it relevant? Your tissues that stiffen you basically hold you up. They bind your muscles together.

This is the sort of wonderful web of fascia, which is the membrane that binds you together, as well as your tissues, your tendons, your joint capsules, and so on. And they all have within them special receptors. But the problem for us, hypermobiles versus the normal population, is that the little receptors that pick up movement are actually buried in marshmallow instead of chewing gum. That's the way I explain it to patients. So they're buried in this very spongy material instead of being in something that is quite tight and sticky.

And so the problem for that is that these receptors, which we've recently discovered, actually two clever ladies in 2014 got the Nobel Prize for it. And I don't think they've been properly really realized how important they are, called Piezo one and Piezo two receptors. And they're called that because they're mechanoreceptors. All they do is they're, propeller shaped and they're buried in your tissues. We're talking at a nano level.

These are very, very small molecular receptors. But the reason they're important is that the two types that exist, one is in your tends to be in your musculoskeletal system. So it's your your muscles, tendons, and and joints. And then the other ones, which are almost more interesting, are in moving organs. So your heart, your lungs, because obviously they're pumping, they're moving.

Kidneys, things that have flow through them, etcetera. And so they measure vessel movement and so on. And these are the ones that I'm finding most interesting because if you have a collagen deficiency, there is slackness in the system. So you need to have a greater deflection of movement. The the tissue needs to move more for these receptors to pick up movement.

So there's a delay. Now in hypermobility, the reason this is a problem, if we go back to how we process the world, our brain uses two thirds of its capacity to process visual information. So we're very heavy on our visual system and we rely on that very heavily. We then reinforce our sense of reality with our five perception systems. So taste, smell, hearing, temperature, touch.

And the the fifth, which is the most important actually, is proprioception. Where am I in space? If I don't know where I am, I don't know where I'm moving to. I don't know where Yalda is relative to me. So it's a it's a kind of reality enforcer.

So you formulate these patterns of the world, which from which it they're actually patterns which we see and then we build meaning for them. So we don't actually see objects. We actually see patterns from which we infer meaning. And it can get very complicated and it goes off down a sort of neuroscience, tunnel if you like. But the important thing is is that if the the information you're receiving from your body is slightly off compared to what your vision is seeing you telling you, You're you're clumsy.

So all the hypermobile patients out there who will know that they generally it's much more common in women. It's about four to one in women. They'll notice that they're just a little bit clumsy. It's not necessarily dyspraxia. They can hit a tennis ball.

As long as they're tracking things and hitting things, they're okay. But what they'll notice is they very often twist their ankles. They'll also, oh my god, at school I just never stopped twisting my ankles. And because they're they're finding it difficult to judge where they are. And also, they tend to just knock into things.

So we tend to be the putzes at the at the dinner table. We'll hit the we'll hit the salt cellar on the way to the wine glass, you know. And your dad said, oh, God. You've done it again, you know. So but that makes us quite stressed.

So it's it's not in it's not insignificant that that that hyper mode problem occurs. It also tends to make you a little bit less agile. I I noticed it in my rugby career that I was just never quite as quick as everybody else. When I was doing weights, I noticed I had to do three or four reps before I felt solid and strong, and that was because the proprioceptors were were locking into it and engaging. So there's a differential between what we're seeing and what we're feeling, And that's also the same for our organs.

So for example, if you have low stretchability in your or in your blood vessels, then when your blood pressure changes, particularly in relation to gravity, so as you get up, a lot of hypnoble patients will feel dizzy. And it's very disconcerting. It's quite they feel like they're going to faint. And if that goes on for long enough, they can go into a thing called POTS, which is a very glorified word, postural orthostatic tachycardia. They actually suddenly feel their pulse rate go up, and they can feel like they're having palpitations.

So it's a very very anxious making state to be in. So these poor patients are actually internally disrupted. Their internal state is disrupted, but also so is their ability to negotiate the world. And that manifests as anxiety because what it does is creates what we call surprise. It's a term used in neuroscience, which means that if my map of the world doesn't correlate with what I thought it was going to, and when I upgrade them, they they they they there's a there's a dissonance between the two.

That's a fear state for me. Because you remember that our nervous systems are still back on the planes. Three hundred years of civilization hasn't changed that. We're still thinking like Cro Magnon or Homo sapiens. And so if you had a nervous system that meant that if you were running away from the saber tooth tiger, and you couldn't rely on yourself to not trip up over the tree stump that was in for you at dinner.

You were just toast. Right? So that's a stressful state to be in. So when I say to these doctors, I was speaking recently at the International Doctors Forum, and the psychiatrists actually were particularly interested because because I was linking the sciences between psychology, neural neurobiology, and, and sort of neural state. If you are seeing the world as a dangerous place, that manifests as affect.

The brain feeds forward to your conscious brain as, neurosis, we call it in in psychology. But actually, it's just me. It's just anxiety because you can't trust the world. So So these poor girls who come to see me sometimes in their early twenties, who are really having a lot of problems with multiple symptoms that's not being linked for them, they are in a state of uncertainty. And uncertainty means that that that you can potentially have an an infinite number of possibilities.

And that's that the brain doesn't like that. That's what they call entropy. It's they don't like chaos. You wanna grasp something. We talk about grasping an idea.

We talk about grasping, a structure. We love to be able to orientate around it and control it because that tells us where we are, who we are, and where we are in space. So it gets kind of a bit metaphysical if you go down that route. But I think with the relationships between what they're doing at UCL in in neuroscience and robots, actually, how you put a how do you put a an AI into a sentient body, that's actually forced us to use mathematics to work out what is consciousness, how do we process the world. So I've been amazingly lucky to be influenced by Carl Friston and various people down there who are doing amazing science into this.

What I find is that no one's linking it, And I just found a bit of a talent for doing that, is that I could see the links between these things. You don't have to do extensive research to prove this stuff. It's just really obvious. If if if a system's doing this, it's likely this is gonna manifest. And then what I do with with with the at the fund is use those principles, and then I try to put them into my clinical work with my patients.

And we and we experiment. I have a great relationship with my patients, and we say, look, I don't know if this is gonna work, but it makes sense. Should we give it a go? And they do. And sometimes it works, and sometimes it doesn't.

But it's, it's a fascinating field, and it's probably explaining an awful lot of symptoms that these patients are experiencing. You can down regulate their anxiety over it very quickly by just explaining it. Half the treatment is just the education. But also they end up in the sea of endless practitioners. Some of my patients would have seen five or six different specialties, cardiologists, neurologists, rheumatologists, orthopedic surgeons because they're getting back pain, neck pain, leg pain.

They're in this in this but nobody rarely gives them the answer because when they're scanned, you can't scan it. There's nothing to see. There's no blood test for it. And of course, coming back to your specialty of the gut, it manifests in your digestive system. Because if your nervous system is constantly stressed and you don't know it, it's just a normal state for you, then then you actually shut down your bowel.

Go back to the plains again. If you had a sensation that the saber tooth tiger was in the hedgerow last week and you're in this heightened state of arousal, you used to shut down your bowel. It wasn't time to digest. It was time to prepare for running. Yep.

And I think that in modern society and particularly with these conditions, that that state is what we're in all of the time. It doesn't set us up to feel safe. And that's what a lot of in of IBS is about. It's not rarely a condition. It's a neural state.

Because you're eating when you're not ready to eat. So I'm gonna interrupt you there Yeah. Because you're talking about so many interesting things. I'm gonna break it down slowly. The first thing that you've just described is what hypermobility is.

I'm gonna talk as someone who's hypermobile, and you're the person who diagnosed me. I remember as a teenager, whenever I walked and I have a little bit of a hill, my right or left ankle would just I would just trip over in the street. Yeah. And it happened so often. I was like, what's wrong with me?

I can't walk. I hadn't realized that I needed shoes that were slightly tighter around the ankle Mhmm. If I had a little bit of a heel on. Absolutely. And even now as an adult, there are some trainers I can't wear because it's too low when the ankle is not supported.

Mhmm. And that part of my hypermobility, I haven't managed to fix. The other thing which you have just mentioned, I didn't know was typical to hypermobile people. I definitely feel dizzy, bump into everything. I always have bruises on the legs.

That's right. And you do bruise easier as well. Yeah. Yeah. And people make fun of me saying you have no spatial awareness, but if I focus and I wanna catch something, I'm excellent.

That's absolutely right. Which is why it gets missed at school because they think it's a kind of dyspraxia, but then when they're tested, they're absolutely fine. Absolutely. And the other thing that I had recently is the harsh rate go up. Mhmm.

And I had to have an ECG, and everything checked, and everything came back normal. That's right. And up to right now, I hadn't explained it. I was like, what why did my heart go crazy? Well, if you want to touch on that quickly, what what actually happens is if you go from lying down to standing up, what happens is there's a there's a fundamental relationship between breathing rate, pulse rate, and blood pressure.

And And the reason for that is that when you take a breath in, there has to be a momentary increase in your pulse rate so that you don't drop your blood pressure and then you faint. So they just love it. We call it respiratory sinus arrhythmia. It's a very big grown up word, but it's unnecessary. But in fact, the Chinese medics knew this.

They actually when they look the tongue, they look at the pulse, and they look at your nervous system. They knew about this thing. It was a perfect relationship between those three things. It's a mathematical one, which ensures the maximum amount of oxygen around the body for the fewest number of pulse beats. So what happens is if you go you get up quickly.

Gravity is not our friend. Hypermobile people don't like gravity. We'd be quite happy to be in a swimming pool most of the time or actually on Mars or in a you know, without gravity. Because what happens as soon as you go out, your blood literally drops down into your legs. So So that's that's the venous blood, not the arterial blood.

That's got a pressure on it. But the blood in your veins drops down. Now what should happen is your blood vessels in response should contract. But because they're slack, they are late in doing so. So you get a bigger drop in blood pressure, and we now know it's actually into the pelvis as well and into the legs.

And you can do a thing called a tilt table test, which I do with doctor Boone Lim, and it's fascinating. We wire everybody on there. We literally quickly tilt them. And you we watch that some of you you should only drop about three hundred milliliters. Some of these ladies are dropping eight to nine hundred milligram Wow.

Milliliters. So no wonder they're feeling dizzy because they are in a pre feint. What they then feel is that the body does pick that up, which it responds to a little bit late. So you get the dizziness. But then you get a sudden increase in pulse rate to can maintain the pressure again.

It's going, my god, I've gotta get my pressure back up. That is so interesting. I'll tell you what's happened this morning. Yeah. It's time for a little break.

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So at rest, I have a very, you know, low heart rate. I'm at 65, 60 something at rest. Now, we're in a world where we measure everything and honestly, it's anxiety inducing. Which makes sense. My scale in the morning gives me my heart rate.

And if I'm resting in my bed, on my Apple Watch should be 65 Yeah. I stand up, I go and weigh myself in the morning, I'll read a hundred and five. Yeah. So what you're witnessing is that delay. So in fact, the distance it's taking you to go to the bed, if you timed it, it's probably about ten, you know, ten or fifteen seconds.

In fact, the definition of POTS, as we call it, is that you get, within a you know, you you within ten seconds, if you get an increase in pulse rate of 30 beats per second, then that's the diagnosis. It varies. But there's so many things you can do. You don't need to take medication necessarily. A lot of patients end up with medication, but simply by maintaining hydration.

What I found behaviorally is a lot of women particularly with with the eradication of facilities in the high street, literally, you think about it. There are no there are no lose anymore. So now you're thinking when you go out, I've had it with my own wife. Oh, I better not have the extra coffee in case I need a wee. Well, actually that fluid would help you.

So then what happens is they're not they're not taking enough food. They drop the volume of blood in their in their body because they're dehydrated. And so you get this this problem fluctuates more. Maintaining your blood sugar, vitally important. Never miss breakfast.

Have something at eleven and four. Complex little carbohydrate could be a banana, but just that little pickup will maintain your blood sugar. So if you maintain your internal homostatic mechanism, you won't get these fluctuations and you won't feel unwell. And once you have that control, you stop being so anxious because you know what it is. It's really important.

Yeah. I completely fade if I'm dehydrated. I literally disappear. My blood pressure drops and I'm like, oh god. But sometimes I'd see salt in my water just to keep my electrolytes Yeah.

Stable and that does the trick. There we are the few group in the population who should eat more salt. Yeah. So literally put more salt on your food because that will just keep your blood pressure a little bit higher, and it will pump the kidney. Because if you also over hydrate and you're not taking electrolytes, then you leach it from your system.

So then you're in this So there's this constant need for maintaining balance. And your brain, people you don't realize your brain, the hypothalamus monitors internal state at very high resolution. It knows what's going in your big toe right now. It just doesn't bother you with it because unless there's a problem, it doesn't alert your need to it. But it can only speak to you through what we call affect, which is feeling.

You know what first is but you'd find it difficult to describe, it's just a thing. Okay? You know what, hunger is. You know what feeling horny is, right? It's difficult to describe, it's just this imminent need to do something.

And all affect is usually maintained is finished, if you like, with motor outcome. We were never designed to think. We were designed to move. And that's why the ADD hypermobile patient is a fidget. That's the other thing they do.

They're always they're constantly changing position in the in the cinema. They're constantly crossing their legs. They're changing. They're moving. They're tapping their foot.

They fidget. We've actually found one of the reasons that some hypermobile people stay skinny is because they're actually burning so many extra calories by fidgeting. So they burn about a hundred calories now instead of 80. And so suddenly, they're just burning off. So these these this is a very, very heightened nervous system that's using a lot of energy.

We now know a lot about how the the brain distributes energy through the through the brain, and unfortunately, it's finite. So if you have an ADD brain, you have a Ferrari brain, you're also using a lot more fuel. And that's why they tend to crash. They tend to be night owls, so they they go to bed too late. They're doing the old doom scrolling at night while they're watching their their their iPad and so then they're getting poor sleep.

Then they get poor sleep, they get poor recovery, poor recovery, they get tired, they're intolerant, they can be batey and bad tempered with people, and I'm certainly guilty of that. And the worst thing is you can talk over people because you the wonderful superpower element of ADD is you see things in the world other people don't. We know that their process their sampling rate's much higher. So we notice detail. We are perfectionists.

We'll see the the fluff on on the fluff on the on the jacket. There will you see there's little imperfections, and it'll really irritate us. This is why you get a kind of OCD element to it too. Because we're really irritated by it. So it's it's almost pre autism, but it means that you, you have to regulate it.

And I'm a big advocate that it's a superpower. But like Superman, it's great if you can lift a building. But if you pull your wife's head off, it does not working for you. So you've got to relate, you know, you've got to regulate the superpower. And I would put it out of it.

It's well known that eighty five percent of the world's most successful people have ADD, and we've turned it into a problem. And that, I think, is very sad, and I think you get a label with it. I think it's massively over diagnosed to a certain extent. But the ADD nurse that you get with hypermobile, I actually want to give it a different name. And I've convened with my psychiatry friends, and they kind of agree, because it's actually slightly different to normal ADD.

And we'll call it something silly like hypermobility related hypervigilance trait or one of those stupid initial names. But we need to separate it because it needs to be understood. And the great thing is you can do more for it. You can give them strategies and hacks, which we can cover later, but which they really, really can take control. And it's it's very sad how many people I have crying in my room with joy simply saying, somebody has told me what the hell has been wrong with me for most of my life.

You've just described every the whole story of my life up to now. Like you with the ankles, you know. Yeah. And you they make these predictions, like, oh my god. This guy's seeing through me.

It's not. It's just once you know what they're doing, you can make various predictions. I hadn't realized that the hypersensitivity that you're describing, noticing everything was linked to that. One of my children so I have it, and one of my children has it. The upside is for me, the upside is the work that I do.

I'm able to connect dots that sometimes other people are not able to because I see more. The downside is sometimes my feeling gets hurt or I get annoyed, or I'm in a restaurant and the noise is really bothering me, or the smell, or because all my senses are slightly All senses are hyper hypersensitive. Yeah. Everything is on full volume. And one of my children has inherited that he's definitely hypermobile.

I mean, you pull his skin like me, it pulls the finger, it goes back. My extension. Yeah. All of that. Just just for your listeners, actually, the the thing you can do to yourself if you want to find out if you are is a thing called a Beighton's, b e I g h t o n s score.

And it's just a it's a seven it's a nine point score. It's mainly hyper extending elbows Yes. Fingers, etcetera. But they can do it to themselves. That's the nice thing.

You can just Google it, look it up. If you have a score of higher than five, I think it probably needs to be seven, but if you have a score of higher than five, I don't know, but if you have a score of higher than five, out of nine, you're considered hypermobile. But probably on the low end. For me and the study I'm doing with Jess Echols at the moment, we're looking at is actually skin extensibility. So how much your skin extends probably increases the amount of irritability that you get, the sensitization.

Because you're and one of the reasons I tell women who have, more extensible skin to wear leggings, then they actually naturally notice they want to wear tight clothing. Because what it does, it gives them a second interface with the world because they're getting a reference point from the surface. And they say, I just feel calmer. You're right. I don't know what it is.

I just feel calmer. And that's because when they're getting the reinforcement of the skin proprioceptors. And so it is like a second skin. So your Lululemon leggings, your your leisure wear, etcetera, fabulous and use it, and also provides a certain amount of compression. So they're probably getting better Venus return.

So they're just calming down the system by just wearing something tighter. So interesting. So what I was saying is one of my children has that, and one day he was little and started complaining because he picked up on the fact that he was slightly different on that front. And I said to him, I said, listen, I spent my childhood feeling bad about the fact that I could pick up on so much, to the point that I hid it with humor. So I just was like the cheerful, funny girl, because I didn't wanna show quite how sensitive I was.

I said, and it took me to get into my adulthood to finally embrace it and realize that you can make it a superpower. Yeah. You can take those things, and in instead of thinking it's painful, you think, well, actually, I see more. I'm gonna utilize it. Yeah.

But from a physical standpoint, you taught me this. I got injured in a yoga class by going too far in a pose, and now thanks to the conversations we've had in your practice, when I'm in a yoga class and I'm doing a triangle pose of trikonasana, instead of collapsing and going all the way to the floor and showing off in the class because I can do it, I actually hold myself and build my core to not tap into the fact that my joints are so flexible and that I can go it's not necessarily a good thing. So the reason why I'm saying this is if you're going to more is not more. If you're going to yoga class or and and you're looking at people and thinking, oh my god. They're so good at yoga.

I can't do that. It's not necessarily a good thing. No. If you can do it, don't go all the way. Don't risk an injury like I have done to myself.

I think we'll see it also in fact, in my experience, I don't do yoga. Unfortunately, it upsets my my back too much, but, because I stretch too much. If you are already capable of going more than the physiological limit that you should have, it is really not good for you to keep. So I tend to say to patients, look, do your yoga, but don't do the hathas, don't do the stretchy yogas, do the power yogas, the hold it position holdings, the tonic yogas. Because that and nine times out of 10, the smug ones at the front are usually hypermobile.

That's why they can do it. That's correct. But they're busy actually hurting themselves. I see a lot of, hip injuries from yoga that where the people are forcing their hips into too too far a distance. And and very sad because in some cases, it leads ultimately to arthritis of the hip.

So that, you know, they really shouldn't it's not a good thing to be able to do more than everybody else necessarily. Yeah. And it's after my injury. I was that person. Mhmm.

It's after my injury that I started doing more strength slash, pilates and Okay. Postural. Postural. And now all the workouts I share on the platform, a lot of people say to me, oh, they really help my back pain. It's because we're just building structure around the spine Absolutely.

To avoid that. Well, I mean, again, I mean, I I I teach quite a lot. One of the things I actually say to people is people we we call it the spinal column. It actually isn't a column at all. It's not it doesn't hold you up.

It forms an attachment for the basis of of this web of muscles. So you talk about the core, for example, but you've also got a series of chains that of muscles that run-in different directions and stabilize you. The problem is most of what we're doing in modern society is we sit all day and we're in flexion. So we're sitting slumped forward. And the problem is for a lot of people working out, they do things like planks, which personally I think is the worst exercise ever designed by a man, and yet everybody's doing it.

Okay. Because what it encourages you to do is to strengthen all the muscles that flex you, when what you need is all the muscles that stand you up. We come out of flexion in utero as a baby. We then go up onto four onto four point gait, which is a crawl, and then we come back and stand up. So if you look at children, they've all got great crawl.

Right? We lose it because we sit. Our abdomens aren't used. But if you look at all these ladies coming to me with flat bottom syndrome, right, their glutes are all shut down. There's two main reasons that.

One is they're not using them and they've had then there's nothing in their life where they switch them on. Secondly, they usually aren't taking enough protein in their diet. And thirdly, they're probably postmenopausal, and in my experience it's mainly testosterone. That's a whole different subject. But I'm getting I'm doing a whole set of patients at the moment with a colleague who's a gynecologist, and we're actually giving these ladies testosterone to support them postmenopausally because it's just not fact doesn't seem to be factored in.

They're only looking at the estrogens. And these are radically different women. Six weeks later, their mood is better. They're on it. They want to approach the world.

They want to take it by storm, and they're feeling strong and embodied. And they say, I just feel solid. And I say, yeah. Solid of mind, solid of mind. So they they they you've got to look at that muscle mass, and you've got to look at where they are in their life.

And this is why I don't do really books on back pain specifically or books on specificities because a liver, a head, a mind doesn't walk through my door, a patient does. Yalda walks through my door and everything that makes Yalda up. Her family, her lifestyle, her ethnic background, your hypermobility, all the things that make you. I've got to analyze that in a sort of bespoke kind of a way. I can't possibly.

So when people say what do you do for x? So I think hacks are sometimes dangerous. It's because there is no general hack for everything. And what you give a hypermobile person, you absolutely don't give a very stiff body type and vice versa. So it is hard and it's why you can't and that's why I think the podcast media like this is so much more constructive because you have those little subtle conversations.

Well, you know, what would you do this well if you do this? You can't that would be a book that was longer than the bible if you if you wrote it. Yeah. The drop in testosterone is a real thing. People don't realize that women produce testosterone, and when you come to your mid forties or early forties or late thirties, you're perimenopausal and you suddenly you're you're you're less entrepreneurial.

You don't wanna do as much, generally. Mhmm. It is a drop of test in testosterone, but also many also the lack of libido. Well, it's it's a it's a hormone of get up and go as I call it. So it doesn't that's why it satisfies strengthens your muscles because it moves you forward.

It's your low promoting, hormone. And, yep, sex drive, etcetera. But it's also drive to go and find it. So the whole thing about it, so it it switches you off in life. It really does.

I see it in these poor ladies, and they're really battling. So I just, you know, I'm really struggling to find the the, the energy to anything to do for them. We've so obsessed about the female hormones. And it's not that testosterone is a male hormone, it's just a hormone of drive. We just have to have four times more of it, because we have to, that's why we have bigger muscles.

But for for women, and the interesting thing I noticed at first, because when I took MRI scans of ladies backs, what we found was they had this fascinating marbling in the muscle. And you can see it in quite fit women. So this wasn't laziness. This wasn't, you know, inactivity. And what we realized was it was the muscle fibrils powered by the brain and switched on that were just shut down because the testosterone wasn't there.

And the real travesty at the moment is if you go to your NHS doctor, they only give it to you for sex drive. They won't give it to you for muscle mass. So I have to unfortunately mainly refer patients to private doctors, and they'll give it to them instantly. They think they can see the sense in it, and they're gobsmacked by the result. So I say one hack is, if you want to get it from your NHS doctor, don't say it's for my muscles.

Just say I never ever want to have sex ever again, and they'll give it to you instantly. I just wanna put a couple of disclaimers. The first is if you take testosterone replacement, there is a risk of hair loss. There is. Yeah.

There is. So I just wanna flag that out. But it depends on the type you're giving now. Yeah. And the second thing is a hack to actually increase your testosterone and libido immediately is to exercise.

%. And that's why I always joke. I'm like, that's why sportsmen are so horny. Exactly. Because they're exercising all day.

And they don't lose their muscles. And they're full of testosterone. So if you find that your libido is down, your sex drive, your drive in general, and you think your testosterone might be low, you don't have the drive to to exercise, but that's the first thing you should be doing to try and boost it in a natural manner. It's true. Yeah.

But in general terms, I think the the hair loss tends to come in patients who are either taking too much, and or they because again, women metabolize things very differently to men. We've seen that in a lot of drugs, especially when they're only tested on men. There's a famous one called Ambien where, which was meant to be for the neurotic housewife as it was designed. But actually, they'd only tested it on men, and a lot of the women who took it went bonkers, and which is a was completely appalling. But that's that's the problem.

So you've got to be then metabolize it. There are different types of testosterone now. You can get a simple gel, use it just, and you can just grade the things. Another one they also worry about is, I'm going to grow a beard'. They're not.

We're only replacing what you haven't got. We're not giving you oversupplementation, and that that you so there is a subtle balance to find. But that's why you should go to your GP. If they're not if you're not competent, feel that they're competent to do it, then try and go and see a gynecologist who will help you with with the balance of all three because you need them to be you have to balance testosterone with progesterone. Thank you, Nick, for this.

My next question, which we're gonna be covering in part two of the podcast is, what is the link between ADD, ADHD Mhmm. Pain and gut health? Can we come back on this and really cover how we feel more pain when our gut health is poor and diversity, and how people with ADD, ADHD might be feeling both things or have an effect on both things more. Thank you so much to all of you for listening to this podcast today. I hope you enjoyed it.

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