 You know, May 40 here So we are going out live across rumble. We're going out live across odyssey. We're going out live across YouTube And the whole world is here. I just it's got a very painful email Which was me to look at myself in a very painful way And the big Jesus, you know, am I really like this? I Sure, hope I'm not the person described in this email and Kind of reminded me of this lecture. I was just listening to ADHD And dopamine like the role of dopamine in attention deficit disorder addiction So wow this email is too painful to read right now in a little distance. All right, Andrew Huberman He is a professor at Stanford. All right out there in the scientific literature and in discussions about ADHD We will hear things like attention and focus and concentration and impulse control for sake of today's discussion Attention focus and concentration are essentially the same thing Okay, we could split hairs and the scientific literature does split hairs about these But if we want to understand the biology and we want to have a straightforward conversation about ADHD If I say attention or focus, I'm basically referring to the same thing unless I specify otherwise Okay, so people with ADHD have trouble holding their attention. What is attention? Well, attention is perception. It's how we are perceiving. Okay This is really painful because I do have a great deal of trouble holding my attention If the subject isn't about me If it's not something that I'm really interested in I get bored so easily and just kind of scanning for those few things I'm really interested such as me. Oh and then if If the subject isn't like compelling me, I just meant he's just describing me here guys, I think I think I've got I Think I've got another problem here. I think I've got another mental illness I think we have to add attention deficit disorder or hyperactivity ADHD whatever that is. I think That's me being the sensory world. So just a little bit of neurobiology 101 We are sensing things all the time there's information coming into our nervous system all the time For instance right now you are hearing sound waves you are seeing things you are sensing things against your skin But you are only paying attention to some of those and the ones that you're paying attention to are your perceptions So if you hear my voice, you are perceiving my voice You are not paying attention to your other senses at the moment Okay, you might even be outside in a breeze and until I said that you might not be perceiving that breeze But your body was sensing it all along So attention and focus are more or less the same thing But impulse control is something separate because impulse control requires pushing out or putting the blinders on to Sensory events in our environment. It means lack of perception impulse control is about limiting our perception People with ADHD have poor attention and they have high levels of impulsivity. They're easily distractible But the way that shows up is very surprising. You might think that people with ADHD. Yeah, this is me. I'm very distractible There's the subjects me gosh Or you know, there's a few things that I'm hyper interested in just simply can't attend anything They really can't focus even if they really want to but that's no that's not true Obviously, there are some things that I could really focus on not just me like certain ideas compelling personalities Simply not the case people with ADHD. Yes, they are distractible. Yes, they are impulsive Yes, they are easily annoyed by things happening in the room They sometimes have a high level of emotionality as well not always but often however people with ADHD can have a hyper focus An incredible ability to focus. Yeah, this is me. I very easily annoyed Have a hard time keeping my focus, but there are a few limited things that I can get hyper focused on Like I had bosses who said that you know, I tend to get focused on one thing lose the bigger picture On things that they really enjoy or and are intrigued by now This is a very important point because typically we think of somebody with ADHD as being really wild and hyperactive We're having no ability whatsoever to sit still and attend and while that phenotype as we call it that contour of Behavior, okay, I can't sit still I can't attend, right? I can do it guys. I'm 56 years age I'm sitting still right now. I am attending and Cognition can exist Many people if not all people with ADHD if you give them something they really love like the child loves video games Or if a child loves to draw or if an adult loves a particular type of movie or a person very much They will obtain laser focus without any effort So that tells us that people with ADHD have the capacity to attend But they can't engage that attention for things that they don't really really want to do and as we all know my so I've spoken to sex addiction therapists All right counselors whose main focus is helping people with sex addiction and every single one of them had ADHD According to her according to the other other addiction therapists I've spoken to so it seems like ADHD is it seems to be proportionally high among addicts of all kinds and I Don't think I've ever heard of an emotional addiction to which I'm not vulnerable. All right. I tend to be grandiose I tend to be self-centered. I tend to be pleasure seeking. I tend to be attention seeking I tend to be excitement seeking. I tend to engage a lot of maladaptive daydreaming. I Have I guess I'm have some co-dependent tendencies If there's an emotional addiction out there like I've struggled with gambling I Have watched too much TV. I've struggled with with pornography. I've struggled with romantic relationships to the extent I can't maintain a romantic relationship so far for longer than a year. I've struggled with that for about eight years. I carried Oh, no for about six years. I carried over $50,000 in credit card debt between 2012 and 2017 so I've never found it the process program dealing with emotional addiction that does not speak to me Much of life whether or not you're a child or an adult involves doing a lot of things that we don't want to do Much of our schooling involves doing things that we would prefer not to do and sort of forcing ourselves to do it to attend Even though we are not super interested in what we are attending to there are a couple of other things that be with ADHD display quite often One is challenges. So I've always had the hardest time attending to anything that I'm not hyper interested in I'm like either all in or I couldn't give a stuff Right. I'm all either like absolutely captivated by someone. I'm talking to I'm just completely cavalmita Just completely you know disregarding other people like I tend to have you know Small number of particularly intense friendships This guy is speaking about me here Which is with time perception time perception is a fascinating aspect of how our brain works And later we're going to talk about time perception and how you can actually get better at time perception It's very likely that right now you are doing things that get in the way of optimal time perception And I will tell you how to adjust your ability to measure time with your brain People they ADHD often run late. They often procrastinate But what's interesting and surprising is that if they are given a deadline They actually can perceive time very well and they often can focus very well If the consequences of not completing a task or not attending are severe enough a little bit Yeah, I can't really pull it together when I'm given a deadline or I see the very negative consequences heading my way If I don't pull it together, this is me like the way that people with ADHD can really focus if they like something Well, if they're scared enough about the consequences of not attending oftentimes not always but oftentimes they can attend If they're not really concerned about a deadline or a consequence Well, then they tend to lose track of time and they tend to underestimate how long things will take now Many people do that not just people with ADHD But people with ADHD have challenges understanding how to line up the activities of their day in order to meet particular deadlines Even if it's just a simple thing like finishing one set of tasks before lunch oftentimes They will remember that lunch starts at noon. So this is how I really benefited from time tracking. All right keeping keeping track of you know my time Keeping track of my money how much I was spending how much I was earning that kind of precision has really helped me Soon, but somehow they aren't able to fill the intervening time in a way That's productive and they can obsess about the upcoming deadline for instance We will talk about how to remedy this in addition Their spatial organization skills are often in sub par not always But often you will find that somebody with ADHD uses what's called the pile system in order to organize things They will take many belongings and this could be in the kitchen or in their bedroom or in their office or in any space And they will start piling things up according to a categorization system that makes sense to them and only them It doesn't really have any logical framework Many people use the pile system and if you use the pile system that doesn't mean that you have ADHD In fact, if you're unpacking a house or you've moved recently or you've received a lot of presents recently The pile system makes perfect sense to organize your space But people with ADHD tend to organize things according to the pile system all the time and that pile system doesn't work for them Okay, so that's the key distinction that they use a filing system It's not really files. They're piling things up in a way that makes sense to them But then it doesn't work for them in terms of what tasks they actually need to perform They can't find things or if anyone moves one thing that it's very disruptive to their overall plan because their overall plan Doesn't really work in the first place. So that's a common phenotype as we call it a phenotype By the way, it's just an expression of a particular set of underlying genetic or psychological Components, okay, so we see the phenotype so a phenotype be brown hair and green eyes like for me A phenotype could also be that somebody uses the piling system The other thing that people with ADHD have real trouble with is so-called working memory You might think that people with ADHD would have really poor memories But in fact, that's not the case people with ADHD often can have a terrific memory for past events They can remember upcoming events quite well their memory is clearly working However, one aspect of memory in particular that we call working memory is often disrupted Working memory is the ability to keep specific information online to recycle it in your brain over and over again So that you can use it in the immediate or short term a good example of yeah This is me like I'll be given one thing that I need to focus on one thing. I need to keep track of and I Will start daydreaming and lose track of it This would be you meet somebody they tell you their name They give you their phone number verbally and you have to walk back to your phone and enter it into your phone People without ADHD might have to put some effort into it. It might feel like a bit of a struggle But typically they would I remember at singles events I think I was asking a woman for a name again and a phone number I forgot that the first time she said we remember the names and the phone numbers that we want to remember Mr. Stab in the heart there We'll be able to recite that phone number in their mind over and over and then put it into their phone people with ADHD tend to lose the ability or lack the ability to Remember things that they just need to keep online for anywhere from 10 seconds to a minute or two Okay, so a string of numbers like six four three seven eight one where most people would be pretty easy six four three seven eight one six four three seven eight one You could probably remember that a minute from now without writing it down But if you add one more number to that six four three seven eight one three it gets tougher Okay, so there's a reason why phone numbers typically have seven digits in them. Of course, there's an area code So throughout my life. I've been berated accurately rightly profoundly so for my lack of attention to detail and It's professor at staff that he is just nailing it as I experienced it No excuse for the negative repercussions on other people right to me to have any recovery from this or other defective character traits after clean up my side and street and make amends to people I've heard but he's kind of describing how I experienced things there but remembering information that strings out longer than seven numbers or a Sentence or two that's challenging for most people people with ADHD have severe challenges even with much smaller batches of information over even much smaller batches of time Deficits in working memory are also something that we see in people who have front of temporal dementia So damage to the frontal lobes or age-related cognitive decline And so it will come as no surprise that later when we discuss Treatments supplements and other tools for ADHD that many of those treatment supplements and tools for ADHD are similar to the ones that work For age-related cognitive decline okay, so we've More or less establish the kind of menu of items that people with ADHD tend to have some have all of them Some have just a subset of them their severity can range from very intense to mild But in general it's challenges with attention and focus challenges with impulse control they get annoyed easily They've kind of an impulsivity that can't stay on task Time perception can be off They use the piling system or a system that doesn't work well for them in order to organize their things in physical space And they have a hard time with anything that's mundane that they're not really interested in but again I just want to highlight that people with ADHD are able to obtain heightened levels of focus even hyper focus Yeah, that's me. I have a hard time with the mundane, right? I have a hard day talking with the toss of ordinary life. I have a hard time cutting wood carrying water being a responsible adult Just you know accomplish it, you know basic life tasks. I Have I have a hard time with the mundane like everything has to be exciting for me to pay any attention If it's not exciting and riveting Yay Then it just I can't keep it in my mind The things that are exciting to them and that they really want to engage in so now you have the contour of what ADHD is And if you're somebody who doesn't have ADHD you should also be asking yourself Which aspects of ADHD are similar to things I've experienced before? Because what we know about the healthy brain is that there's also a range of abilities to focus Some people focus very well on any task you give them a task They can just laser in on that task other people they have to fight an internal battle They have to convince themselves that it's important or interesting. They have to have incentivize themselves internally other people Doesn't matter they could be bored to tears with the information, but they can do it just because they are quote-unquote very disciplined people Okay, so I've got a very painful email Just Just about an hour ago had to go off go for a jog go for a swim Do some push-ups go for a walk and Then you know come back and you know kind of kind of deal with it and confront it and base it It's like oh my god. It is really how I am It says like any red-blooded hetero sexual man Luke Ford will talk right use sexualized women, but he does not love nor respect them. Is that right? I mean, I know I've had I have had some problems in this area I'd like to think I'm making some progress as I'm growing older and wiser There's Luke Ford like women. I think not look I have had problems in this area Perhaps due to early childhood where I Was beaten a lot some of the women in my early childhood, right? And yeah, I Developed from these adverse early experiences There's something of a rage against women. So yeah, I've got a problem in this area 12-stepping in this area. Obviously, I can't sustain relationships Like to think I made some progress on this But yeah as a kid, I was regularly bounced off the walls by women. It wasn't men who beat me down It was women who bounced me off the walls smack me about Yeah, I was You know, I was brutalized as as a kid and just you know way too weak to fight back Didn't know what to do. I hung on I survived, but yeah, there's there's an element of me that develop from that Rational hatred of women case in point in Luke's fire. He writes so many times the youngest son of 7th Adventist Evangelist Dr. Desmond Ford. This is another immaculate conception known by my mother Gwen. She Died a horrible painful death the bone cancer over the course of about three and a half years She finally succumbed just before I turn four and Kind of say it's where I'm at right now In Queensland, Australia and whoop whoop out back Australia near the beginning of the barrier reef My grandfather my mother's father used to an 80% of this land this Habitable land Until he started I think subdividing settling lots of the 1960s Meeting Luke in person. It made me feel uncomfortable. He does not know my identity. So there was no previous impression He described me later as some kind of blonde The new unfamiliar feeling came over me. He does not like me But why I didn't do anything to him. He doesn't even know how much I helped him for nothing about judge dismissed and devalued Oh But it sounds like I've got some some amends to to be made because the person who's writing this to me has been a good friend to me I definitely called meeting her but she has been a good friend to me for two decades So I don't want to make people feel judged dismissed and devalued Hey Luke, you just earned a rabbinical degree without a rabbinical certificate speaker How you may ask by treating me just like the rabbis did I grew up all my life in orthodox home school youth group synagogue job society being my proper best Worrying about what people say. It's my reputation in check Am I you know sending Sherlock monos on the forum? That's the food gift that we give on forum my my southern table my homemade hollers meaning brands my clothing my outfits my shoes My kids Now in less than a minute a former goy who's new to the community with a horrible reputation Treats me just like every rabbi I've worked with in israel new york and los angeles No my three advanced degrees won't grant me entry to the boys club Or even if I was size zero plus plastic boobs Hard to do with poor kids and shumbas are waiting me around the corner each week. Do I really treat women like this? I hope not but I am smart. I love smart people Stop handling Hondling that means bargaining and if you're in a street market might never give you points Maybe you get further when you play it humble worthless dumb it down smile point out the nearest male happens to be there. That's safer But enough about lead let's get to the topic of the day and it's you you treat women In the triple x industry as whores, but not only them and anyway, why did you pick that muddy? Pond to splash it obviously. Yeah, it reflects my own Sickness why aren't you married with kids like your father any jewish? Orthodox jewish man. Yes, you talk the talk you've made lots of fancy theories ending the various isms You acquired the right lingo you hide well behind the bad boy image for years thinking you're safe Surprised today is you uh triple x is your triple x day. You are being Unmasked bare to the balls Luke. You really don't like women. How do I know? Siding the obscenity case files of jeff cabellus versus i ohio. I know it when I see it ouch Am I really like this? Am I making any improvement? That's that's painful to read from someone who's been a very good friend to me Tend to admire those people but as you'll see a little bit later It's not clear that that's the best way to run your attentional system There might be something to this business of having heightened levels of attention for the things that you are most interested or excited by So let's drill into this issue of why people with adhd actually can focus very intensely on so what I fear is right here Yeah, I can focus on anything. I'm intensely interested But is the one thing that I'm most intensely interested in in the whole entire universe? God forbid It's not me is it? Am I am I the one thing that I'm? Uh, most most interested in in the entire universe God forbid works and fails and how to treat it by looking at some of the current and previous treatments for adhd As well as some of the recreational drugs that people with adhd Tend to pursue and like now. I'm certainly not a proponent of people with adhd taking drugs recreationally That's not what this is about But if you look at their drug seeking behavior and you couple that drugs But luckily I have not indulged in drugs. I've not indulged in alcohol So I've tried to regulate myself through excessive junk food through excessive tv watching through excessive phone use through excessive attention seeking through excessive sports addiction Through excessive excitement chasing I mean for most of my life. I kind of go into almost every Interpersonal situation think how can I ring the most attention for me out of this situation? Seeking behavior to their desire to remedy their attention deficit You start getting some really interesting insight into how dopamine is regulating these circuits in normal circumstances And in people with adhd So what exactly is going on with the dopamine system in people with adhd? And what's going on with the dopamine system in people that have terrific levels of attention for any task? well In the year 2015 an important paper came out the first author is spencer And it came out in a journal called biological psychiatry and it formalized the so-called low dopamine hypothesis of adhd The idea that dopamine was somehow involved or not at the appropriate levels in people with adhd have been around for a pretty long time But a formal proposition of the low dopamine hypothesis led to some really important experiments and understanding of what goes wrong in adhd It turns out that if dopamine levels are too low in particular circuits in the brain That it leads to unnecessary firing of neurons in the brain that are unrelated to the task that one is trying to do And that is unrelated to the information that one is trying to focus on So if you think back before you've got this default mode network and a task related network Yeah, that that rings true to me if i'm feeling empty if i'm not feeling engaged With you know, whatever task is before me. I tend to daydream about something more pleasurable, which is frequently How awesome I am And then I really suck At the task in front of me and I let people down I'm careless and I'm hurt and I'm rude and I'm self-absorbed And I don't meet my adult responsibilities. God this sounds just like me Work and they need to be in this kind of concert of anti-correlation and in adhd. They're firing together Well, the problem seems to be that when dopamine is low Certain neurons are firing when they shouldn't be this is like a band, right? We'll go back to our band. That's a guitar, a bass and a person playing the drums And it's as if one of those or several of those instruments are playing notes when they shouldn't be playing Right, the pauses in music are just as important as the actual playing of notes So this is how I would describe it like when I'm feeling just unbearably empty inside And I'm just feeling bored and I'm just feeling oppressed by life and everything's just too mundane Then I have to you know act out so Hopefully that's old loop more But uh, yeah, if I'm not in Pete's spiritual condition, you know feeling connected to God feeling useful to other people feeling connected to community Then I get back to this kind of emptiness that I guess religious people would say that there's a God Size call in my soul. So I know being a kleptomaniac, but I know kleptomaniacs And when they feel anxious when they they're worried about their financial safety and taking care of their Other people that are close to them, right? Then you know, they become very susceptible to They're reaching out and taking things that aren't theirs and I become very susceptible to Pension seeking excitement seeking pleasure seeking thrill seeking Which are all symptoms that I need to you know, get back recalibrate pray meditate Get to a meeting talk to a sponsor You know general talk to a therapist When dopamine is too low Neurons fire more than they should in these networks that govern attention This is the so-called low dopamine hypothesis and if you start looking anecdotally at what people with ADHD have done for decades Not just recently since the low dopamine hypothesis has been proposed But what they were doing in the 1950s and in the 1940s and the 1960s what you find is that they tend to use recreational drugs Or they tend to indulge in non drug stimulants So things like drinking six cups of coffee or quadruple espressos Or when it was more prominent smoking a half a pack of cigarettes and drinking four cups of coffee a day Or if the person had access to it using cocaine as a recreational drug or amphetamine as a recreational drug All of those substances that I just described In particular cocaine and amphetamine but also coffee and cigarettes increase levels of multiple neurotransmitters But what I would do is just chase excitement chase the thrills and the spills and you know chase attention And just grab your attention That's what I try to do when I was in this very uncomfortable state like Now through through the 12 step process I've you know come to accept the idea that I was doing the best I could with the tools I had at the time to meet my needs Now I've got better tools and I don't have to behave in such a self-destructive and socially destructive and hurtful hurtful way But all have the quality of increasing levels of dopamine in the brain and in particular In the regions of the brain that regulate attention and these tasks related and default mode networks okay Now young children unfortunately don't have access to those kinds of stimulants most of the time and Those stimulants all have high potential for abuse in adults So we will talk about the potential for abuse in a few minutes But if you look at children even very young children with ADHD They show things like preference for sugary foods which also act as dopamine inducing stimulants Now of course once they get access to Soda pop and coffee and tea they start to indulge in those more than other people For a long time It was thought that children with ADHD consume too many sugary foods or drank too much soda Or adults with ADHD would take recreational drugs like methamphetamine or cocaine Or would drink coffee to excess or smoke cigarettes to excess Because they had poor levels of attention and because they couldn't make good decisions They were too impulsive and so forth and while that certainly could be the case Knowing what we now know about dopamine and the fact that having enough dopamine is required In order to coordinate these neural circuits that allow for focus and quality decision making An equally valid idea is that these children and these adults are actually trying to self-medicate by pursuing these compounds Right things like cocaine lead to huge increases in dopamine Well fun literature out there and many claims about so-called ginko bilboa Which has been shown to have minor effects in improving the symptoms of ADHD Not nearly as effective as Ritalin and Adderall Ginko bilboa is not appropriate for many people. I am one such person. I don't have ADHD, but When I've taken ginko even at very low doses, I get absolutely splitting headaches Some people do not experience those headaches, but it's known to have very potent vasoconstrictive and vasodilating properties That vary depending on when you took the compound So for those of you that are exploring ginko bilboa and you will see a lot of claims about ginko bilboa for attention In ADHD definitely take the vasodilation vasoconstriction headache issue into consideration So I'd like to talk about the drug modafinil and the closely related drug R modafinil That's AR modafinil because modafinil and R modafinil So I've been using modafinil almost daily for approximately Eight years now, I think Are gaining popularity out there both for treatment of ADHD and narcolepsy but also For communities of people that are trying to stay awake long periods of time So it's actively used in the military by first responders It's gaining popularity on college campuses and people are using it more and more as an alternative to Adderall and Ritalin And excessive amounts of coffee. It does increase focus and to a dramatic extent Modafinil typically was very expensive You know, I don't know if it's still this expensive But when one has a prescription for it, it could still cost as much as eight or nine hundred dollars even a thousand dollars a month Our modafinil is a far less expensive version That's chemically slightly different than modafinil regardless of price people are taking modafinil and R modafinil Want to emphasize that unlike Ritalin and Adderall modafinil and R modafinil are weak dopamine reuptake inhibitors And that's how they lead to increases in dopamine So whereas Ritalin and Adderall and phenamine and cocaine lead to big increases in dopamine Also through reuptake mechanisms and so forth modafinil is is a weaker dopamine reuptake Stimulator and so what that means is that it leaves more dopamine around to be active at the synapse the gaps between neurons However, it also activates other systems It acts on the orexin system Which is actually a peptide that we talked about in the episode on hunger because it regulates hunger and appetite And it regulates sleepiness and feelings of sleepiness. In fact, the excuse me orexin also called hypocretin system The orexin hypocretin system is what's disrupted in narcolepsy. That was the important discovery of my colleagues Emmanuel Mignon and Seji Nishino at Stanford some years ago They identified the biological basis of narcolepsy and it's a disruption in this orexin hypocretin system And modafinil is one of the primary treatments for narcolepsy It also has these other effects on the dopamine system and on the norepinephrine system Even though it doesn't lead to quite as intense levels of dopamine and arousal and focus It does have the property of raising levels of attention and focus and that's why people are using it So it's a somewhat milder form of aterol armodafinil for some people works as well as modafinil And as I mentioned before it's much lower cost for other people. It doesn't I have an experience Meaning I do have an experience that I'll share with you with armodafinil a few years ago I was suffering from jet lag really terribly and I was traveling overseas I went to a meeting to give a talk. I took half of the prescribed dose of armodafinil It was prescribed to me. I took that half dose and I gave my lecture and then I stayed around to answer questions and then Four hours later a friend of mine came up to me and said, you know, you've been talking for four and a half hours And uh, there are only a few people still here Luckily, there were still a few people be a lot weirder if the room was completely empty Because it wasn't being recorded So I have firsthand knowledge of the sorts of cognitive effects that it can create I personally would not want to be in that state for sake of studying or learning or for doing this podcast For instance, and I can honestly say that today all I've ingested is some coffee and some yerba mate tea and some water I'm not on any of the compounds that I've described during the course of today's episode You might ask why I took half the recommended dose of armodafinil And the reason is that I'm somebody who's fairly hypersensitive to medication of any kind What you find if you look in the literature is that about five percent of people are hyper hypersensitive to medication They require far lower doses of any medication than other people in order to experience the same effects. I'm somebody that Yeah, I think that's uh, pretty pretty accurate for me. Generally lower doses of medication tend to have More dramatic effects on me than normal. I also found that Taking medaffinil it keeps you so intellectually engaged that you tend to eat less. So I dropped about 10 pounds once I started taking medaffinil What are the other comments it also I find it gives you confidence and it kind of mutes some of the more negative emotions And it gives you kind of a low level of euphoria Now it's true. It's expensive. So I had a friend he first got a prescription for it And when he went to buy it at the pharmacist, he saw it was like $18 a pill So he got four of them and then god forbid he went online ended up buying the product from india And so he had like four of the fad dinkum, you know over the counter You know the pharmacy in in america, you know the real stuff So he was able to compare the effects of the real stuff with what he bought from india And it was essentially indistinguishable that instead of paying $18 a pill he paid $1.50 a pill God forbid to god forbid to illegally buy them from india I mean god forbid that people should break the law and buy you know pharmaceutical products overseas and 5% of the Price and rob now are hard working pharmaceutical companies like well no one quite cry for big pharma like think about how big pharma is being You know ripped off suffering, you know enormous revenue shortfalls Because americans are being parsimonious and buying a lot of their prescriptive medications illegally overseas And then god forbid sometimes you might buy Some pharmaceuticals overseas and then customs seizes them But if that happens then god forbid your pharmaceutical supplier overseas will always Well, if they're a reputable one will always replace it now the daffodil is like the lowest level of restriction So it's not regarded. It's particularly harmful or having you know addictive properties or you know very negative side effects and It's not like you need to taper off it. It has no street value But you can now god forbid how would one find a reputable pharmacy overseas god forbid that anyone should do such a thing God forbid that they do research online to try to find out, you know, which are the reputable reliable ones god forbid they should rely on hundreds of You know other testimonials from supposedly satisfied customers who are breaking american law by doing this and ripping off our big pharma companies buying their Their medication like 5% of the price I mean it's god forbid that people should break american law so that they can afford to To purchase the medication that they need Wouldn't it be better that people suffer wouldn't it be better if people go hungry or go homeless so that at least they can keep Keep rewarding big pharma for all the the fantastic things that they Done for us. I mean god Why won't they leave big pharma alone? Why do so many americans want to buy pharmaceuticals illegally overseas? It's just 5% Of the price that they'd have to pay in america Why would they stop ripping off big pharma? Why won't they leave big pharma alone or the criticism? Or the shady illegal dealing where individuals have the hutzpah to do research online and find god forbid Reconnable pharmacies god forbid in india that provide god forbid the very product that they advertise God forbid and provide it in a timely and highly inexpensive fashion god forbid that these overseas Pharmaceutical shops that they provide the very safe thing you could buy in america for 25 times the price And if god forbid customs seizes your illegal shipment then god forbid this indian pharmaceutical company Just sends you a replacement No worries god forbid that americans should do this to our blessed pharmaceutical companies who have suffered so much for us Who have invested in all this great technology and then how do we repay them? We we rip them up. We just like put a dagger in their heart by god forbid purchasing pharmaceuticals Overseas god forbid that that my friend should pay a dollar 50 for his Madaffin ill when he has the opportunity of paying 18 dollars a pill for the exact same Madaffin ill god forbid that americans should be so careless I mean god forbid that people use sites like library genesis where god forbid they can download You know almost any book that that's being published like god forbid that people don't keep subsidizing our left wing publishing Empires like god forbid think about all the great left wing publishing houses They're controlled by angry You know anti white male feminists on the left like god forbid that we should stop subsidizing these major publishing houses that hate us That want to subjugate and destroy and humiliate us god forbid that we should stop subsidizing them And god forbid you know we go to a website like god forbid like library genesis Or god forbid you know some other sharing site or god forbid we use site hub. There's so many scholars and Amateur scholars and just curious minds god forbid this makes me so so sad They go to a place like site hub sci-hu b So some you know russian site. All right, so You know russian bad really really bad And they can go there and they can just download and read for free all sorts of academic papers But normally you'd have to pay 25 55 $155 for and people With curious minds just going there, you know Downloading for free academic papers and like how do you think the journal of gerontology feels about that? How do you think you know our left wing academic publishers feel about that? Like if people god forbid Keep using sharing sites instead of sending money to you know left-wing media organizations God forbid if people stop Sending money to left-wing academic institutions like god forbid if we stop Subsidizing our elites who hate us god forbid that would be so terrible Just makes me so sad to think there's so many americans Are using sharing sites to get tv shows and movies because they don't want to subsidize That the left-wing entertainment companies that hate them and load them and despise them and portray them in all sorts of nefarious ways People are using library genesis to get the books they want without subsidizing our left-wing publishers People are using sharing slides like the pirate bay and so many others god forbid We should be sending money to record companies who brought us so many amazing rap artists like record companies pushing degeneracy and you know anti-traditional values and Sexual degradation like god forbid we should stop subsidizing The record companies the movie companies the tv companies the media enterprises the publishers who hate us and load us and denigrate us And promote a left-wing agenda god forbid that we should stop subsidizing And I think someone may have misinterpreted my earlier comment about you know asian massage in tenon sands My point was to to say how sad this is like los angeles is populated with hundreds Four houses and hundreds of marijuana shops Like there are hundreds of like massage parlors, you know, essentially four houses that are next to synagogues That are you know out there on main street where kids are walking by And you know men are going in and using these women are often in the country illegally So we we have you know hundreds of these illegal brothas, you know, populating up and down Los angeles bedley hills our main thoroughfares nexus synagogues now even tenon sands has one and Not for bid that we should stop subsidizing All these you know nefarious enterprises who hate us and want to Crap on You know everything that we hold sacred God forbid god forbid Okay dopamine nation dr. Anna lemke All right Great to have you here. Thanks Anna. Thank you for having me. I'm excited to be here I have a lot of questions for you I I and many listeners of this podcast are obsessed with dopamine and what is dopamine? How does it work? We all hear that dopamine is this molecule associated with pleasure I think the the term dopamine hits like I'm getting a dopamine hit from this from Instagram or from likes or from praise or from whatever is now commonly heard What is dopamine and what are maybe some things about dopamine that most people don't know and probably that I don't know either So dopamine is a neurotransmitter and neurotransmitters are those molecules that bridge the gap between two neurons So they essentially allow one neuron the pre-synaptic neuron to communicate with the person Here. Um dopamine is intimately Okay, I need feeling. All right. I need the science. Give me empathy. I'm suffering associated with the experience of reward But also with movement, which I think is really interesting because movement and reward are linked, right? If you think about you know, um early humans You had to move in order to go seek out the water or the the meat or whatever it was And even in the most primitive organisms dopamine is released when food is sensed in the environment For example, see elegans a very primitive worm So, um dopamine is this really um powerful important molecule in the brain that helps us Experience pleasure. It's not the only neurotransmitter involved in pleasure But it's a really really important one And if you want to think about something that most people don't know about dopamine Which I think is really interesting is that we we are always releasing dopamine at a kind of tonic baseline rate And it's really the deviation from that baseline rather than like hits of dopamine in a vacuum that make a difference So when we experience pleasure our dopamine release goes above baseline And likewise dopamine can go below that tonic baseline and then we experience a kind of pain Interesting So is it fair to say that one's baseline levels of dopamine how frequently we are releasing dopamine in the absence of some I don't know drug or food or experience just sitting being Is that associated with how happy somebody is a kind of baseline of happiness or level of depression? There is evidence that shows that people who are depressed may indeed have lower tonic Levels of dopamine. So that's a really reasonable thought and there's some evidence to suggest that that may be true The other thing that we know and this is you know, really kind of what what the book is about Is that if we expose ourselves chronically to substances or behaviors that Repeatedly release large amounts of dopamine in our brain's reward pathway that we can change our tonic baseline and actually lower it over time As our brain tries to compensate for all of that dopamine, which is that's funny One of the recommendations is to take a dopamine fast once a week. Don't listen to music. Don't go online Don't watch TV Right, don't don't engage in any of these easy dopamine hits that if you want to read a book Right, don't read it on a kindle. I pick up a high cover book essentially These professors were prescribing keep shovels, you know, keep the Sabbath in the traditional Jewish fashion Detach from the use of technology and take a dopamine fast once a week. You'll be much happier They're prescribing shovels for everyone More really than we were designed to to Experience interesting and is it is it the case that our baseline levels of dopamine are set by our genetics by our heredity? Well, I think, you know, if you think about sort of, you know, the early stages of development and infancy Certainly that is true You're kind of, you know, born with probably whatever is your baseline level But obviously your experiences can have a huge impact on where your your dopamine level ultimately settles out So if somebody's disposition is one of um constant excitement and anticipation or easily excited These are I think about the kind of people you say you want to check out this new place for tacos and like, yeah, that'd be great And other people are Yeah, that's kind of my disposition. I'm always excited. I'm always enthused about something And a lot of people like me. They're always enthused about something and it's just wearing on normies Like normal people they just they just feel so worn down I mean people I went to high school with it's like, uh, no one knew what to do with 40 and his brain Like it's just constantly going on this jag and that jag Um, a little more cynical harder to budge like my bulldog Costello Very very stable low levels of dopamine with big inflections in his case. Um Is that do you think that's a set in terms of um, our parents and obviously nature and nurture interact? But is that is dopamine at the core of our temperament? I don't really think we know the answer to that But I will say that people are definitely born with different temperaments And those temperaments do affect their ability to experience joy And you know, we've known that for a long time and we described that in many different ways One of the ways that we describe that in the modern era is to use psychiatric nomenclature Like this person has a dysthymic temperament or you know, this person has chronic major depressive disorder In terms of looking specifically at who's vulnerable to addiction That's an interesting sort of mixed bag because when you look at the research on risk factors for addiction So what kind of temperament of a person makes them more vulnerable to addiction? You see Okay, for me biggest risk factor for me falling into addiction is disconnection right or the other way I'm least vulnerable to Addiction when I mean like semi unofficially adopted You know, I'm part of something when I'm around healthy people Not like when I'm around my brother when I'm in tenum sands. It's like such a healthy community Uh, when I feel connected to other people when I feel at home in my synagogue when I feel connected to my rabbi When I have like useful role to play for an employer useful role to play for the community some you know volunteer position Where I feel connected to my friends then my need for bizarre attention seeking behavior is considerably reduced my My need for more more levels of pleasure and excitement and thrill seeking You know living on the edge that all kind of gets calmed down So just being in tenum sands as I'm sure you can you can see I just came back from swimming and doing push-ups running on the beach And so a cool calm collected All right, so in certain environments with certain people That when I feel connected to others that just kind of calms my need for bizarre acting out and thrill seeking and Just going to the edge Some interesting findings first you see that people who are more impulsive are more vulnerable to addiction So what is impulsivity? That means having difficulty I'm putting space between the thought or desire to do something and actually doing it and people who have difficulty Putting a space there who are who have a thought to do something and just do it impulsively. Yeah, that's me I came I decided to come to Australia in 20 minutes right it took me 20 minutes For a couple things to fall into place and decide to come to Australia for three months Very impulsive like when I want to do something when I want to eat when I want to read a book like I've got to have it now I'm I'm this impulsive creature. She is describing Are people who are more vulnerable to addiction? Interesting. Could I in terms of impulsivity? Is this something that relates literally to the startle reflex? Like I for instance as a lab director I'm familiar with walking around my lab and um when I decide deciding I'm going to talk to my people Of course when they knock on my door, it's always like wait. Why am I being bothered? So, yeah, I've traditionally had a really big startle reflex. So physiologically the startle reflex Shows itself by the head jumps forward and the shoulders right right up and the head tilts back Oh compressing the the neck compressing the spine the shoulders go out You're just kind of defending yourself And I would kind of walk around in about 10 or 20 percent of startle reflex eventually a lot of people do Some people walk around in like 50 percent of startle reflex or 30 percent. It's just You know wrecking their musculature wrecking their alignment wrecking their posture And you know people like this they're not going to be very pleasant to be around All right How pleasant you're going to be going to have a lot to do with how much at ease you feel in your body And if your body is all distorted by unnecessary tension and compression patterns If you're in this you know weird forward head posture and the shoulders riding up and the head tipping back compressing the neck They're putting unnecessary strain on on your back All right, you're not going to be a very pleasant person to be with so Through learning the alexander technique learning to let go of unnecessary compression in my face and in my back and in my neck learning To have a gentle desire from the head to release forward and up leading my whole torso into length and width I've been able to somewhat modulate and moderate my my startle response So i'm a lot calmer I think i'm i think i'm easier to be around these days. I mean a lot of people who've hosted me for shamans meals have said that Yeah, since the alexander technique have been a lot easier Right now, even though i love to talk to them, but I walk around my lab from time to time and some people I know as l say um Do you have a moment and they'll slowly turn around and say yeah or no in some cases And other people will jump the moment. I say their name. They actually have a And the chat says even the mighty alexander technique is no match for the smartphone or head posture I'm looking at my very low level australian op-op phone smartphone right now And uh, i'm not i'm not losing my alignment I'm not losing my upward sense of direction. My head is still releasing forward and up So one thing to do with the smartphone is to keep it kind of level with your eyes So you're not collapsing down So we tend to collapse down and into whatever we're paying attention to Yeah, our computer we tend to collapse down and in on our computer and the tv someone we're talking to so Inhibit habitual responses think up think the head releasing forward and up thinking about the width across my chest across my back across my shoulders Okay, so bring the bring the smartphone up eye level So i'm not going to attempt be as tempted to collapse down into it And you can you can nod your head up and down from your ears, right? There's a joint here in your head. So I can look down from here. I can look up from here instead of coming down or tipping my head back so I can turn my head from my ear Up and down without collapsing and unnecessarily compressing A kind of a heightened startle reflex is that related to impulsivity or is what you're referring to an attempt to With whole behavior that's very deliberate under very deliberate conditions Yeah, so I don't think that that startle reflex is is necessarily related to impulsivity that that can be related to anxiety So people who are high anxiety people will tend to have more of a startle reflex Impulsivity is a little bit different. And by the way, impulsivity is not always bad, right? Impulsivity is is that thing where There's not a lot of self editing or worrying about future consequences, you know, so Yeah, chiropractic generally speaking for my opinion are worthless at best and dangerous at most And just being hundreds of people who've had strokes when the chiropractors crack their neck And it's caused a stroke and the chiropractors used to work on my mother and they just caused your agony Just causes so much tremendous unnecessary pain They really did a number on my mother and and the benefits of chiropractic usually disappear within a few hours So it's essentially one big dangerous scam that is milking people and our medical system But billions and billions and billions of dollars like it's especially Initially prescribed that people after a car accident And you know at best, you know, it does nothing at best You know, you have the idea to do something and you do it and of course we can imagine many scenarios where that's absolutely wonderful Um, you know, there can be sort of uh, let's say intimate Interactions between people where you wouldn't really want to be super inhibited about it, right? You would want to be disinhibited and impulsive Um, there I can also like imagine like sort of um, fight or flight scenarios like battle scenarios, right? Where where it would really be good to be impulsive and just go right, you know Yes, that's right. That's right. But you know, and I think this is brings up a really Anything that I've come to believe that after 25 years. Yeah, so we all have these habitual reactions such as fight flight freeze and The tendencies towards you know, we want love we want sex. We want relationships We want financial safety physical safety. We want status. We get into trouble and these basic instincts Get out of whack. So that's when I've got into trouble one one basic instinct such as financial safety have turned into a miser right or the basic instinct of looking for love and Catch my reputation. I damage other people with the love in the wrong places So when I've gotten into trouble, it's when these basic instincts just simply escape the proper price Years of practicing psychiatry is that what we now conceptualize in our current ecosystem as mental illness Are actually traits that in another ecosystem might be very advantageous. They're just not advantageous right now Yeah, that's huge. So our fear of public speaking, right? We have a disproportionate fear of public speaking because for millions of millions of years We live in small fives our entire life and so if you're going to be around 50 60 people your entire life Getting out to speak publicly. There's just so many dangers to that That the payoff just isn't there. So this is evidentially a mismatch also our tendency to gobbled out, you know food, sugar, salty food Whenever you've got it used to be for millions of years if we've got access to such such food Yeah, you eat it down immediately. That was the most evolutionarily adapted thing to do and and now normal human sadness where you get the opportunity to Consider introspect about what you've been doing and realize that some things are not working that we've said Of course, and this is hard to other people. You can start to think about new ways of acting and speaking And then you can play out the scenarios for these new ways of acting and speaking. So all this time Very well likely to look depressed to people But this is normal human sadness and it's adapted frequently to go through these periods of normal human sadness to Reconsider your ways. So think about new ways of doing things and this gets medicalized. So also it's a normal human reactions And now medicalized so doctors can can prescribe medication All industry can make money Because of the world that we live in and and I think, you know impulsivity is potentially one of those, right? because we live in this world that's sort of like you have to Constantly be thinking sort of rationally about the consequences of x y or z and it's such a sensory rich environment, right? That we're being bombarded with all these opportunities these sensory opportunities And we have to constantly check ourselves. And so so so impulsivity is something that right now Can be a difficult trait, but isn't in and of itself a bad thing. I see yeah, and it's I'm beginning to realize It's a fine line between spontaneity and impulsivity. Yeah What is pleasure and how does it work at the biological level and if it feels right at the psychological level? I think we and if you don't mind painting a picture of sort of the the range of Things that you have observed in your clinic or in life that people can become addicted to But just to start off really simply what is this thing that we call pleasure? Okay to be continued. It's about time for a family dinner