Miss Diagnosis: Anxiety, ADHD, & Women

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It’s Q&A Day at 10almonds!

Have a question or a request? We love to hear from you!

In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

So, no question/request too big or small

❝Why is ADHD so often misdiagnosed as anxiety in women?❞

A great question! A short and slightly flippant answer could be “it’s the medical misogyny”:

Women and Minorities Bear the Brunt of Medical Misdiagnosis

…and if you’d like to learn more in-depth about this, we recommend this excellent book:

Unwell Women: Misdiagnosis and Myth in a Man-Made World – by Dr. Elinor Cleghornyou can read our review here

However, in this case there is more going on too!

Part of this is because ADHD is, like many psychiatric issues, a collection of symptoms that may or may not all always be present. Since clinical definitions are decided by clinicians, rather than some special natural law of the universe, sometimes this results in “several small conditions in a trenchcoat”, and if one symptom is or isn’t present, it can make things look quite different:

What’s The Difference Between ADD and ADHD?

There are two things at hand here: as in the above example, there’s the presence or absence of hyperactivity, but also, that “attention deficit”?

It’s often not really a deficit of attention, so much as the attention is going somewhere else—an example of naming psychiatric disorders for how they affect other people, rather than the person in question.

Sidenote: personality disorders really get the worst of this!

“You have a deep insecurity about never being good enough, and you constantly mess up in your attempt to overcompensate? You may have Evil Bastard Disorder!”

“You have a crippling fear of abandonment and that you are fundamentally unloveable, so you do all you can to try to keep people close? You must have Manipulative Bitch Disorder!”

etc

See also: Why Everyone You Don’t Like Is A Narcissist

In the case of ADHD and anxiety and women, a lot of this comes down to how the redirection of focus is perceived:

❝For some time, it has been held that women with ADHD are more likely to internalize symptoms and become anxious and depressed and to suffer emotional dysregulation❞

~ Dr. Patricia Quinn

Source: Attention-deficit/hyperactivity disorder and its comorbidities in women and girls: An evolving picture

This internalization of symptoms, vs the externalization more generally perceived in boys and men, is more likely to be seen as anxiety.

Double standards also abound for social reasons, e.g:

  • He is someone who thinks ten steps ahead and covers all bases
  • She is anxious and indecisive and unable to settle on one outcome

Here’s a very good overview of how this double-standard makes its way into diagnostic processes, along with other built-in biases:

Miss. Diagnosis: A Systematic Review of ADHD in Adult Women

Want to learn more?

We’ve reviewed quite a few books about ADHD, but if we had to pick one to spotlight, we’d recommend this one:

The Silent Struggle: Taking Charge of ADHD in Adults – by L. William Ross-Child, MLC

Enjoy! And while we have your attention… Would you like this section to be bigger? If so, send us more questions!

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  • Healthy Relationship, Healthy Life

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Only One Kind Of Relationship Promotes Longevity This Much!

    One of the well-established keys of a long healthy life is being in a fulfilling relationship. That’s not to say that one can’t be single and happy and fulfilled—one totally can. But statistically, those who live longest, do so in happy, fulfilling, committed relationships.

    Note: happy, fulfilling, committed relationships. Less than that won’t do. Your insurance company might care about your marital status for its own sake, but your actual health doesn’t—it’s about the emotional safety and security that a good, healthy, happy, fulfilling relationship offers.

    How to keep the “love coals” warm

    When “new relationship energy” subsides and we’ve made our way hand-in-hand through the “honeymoon period”, what next? For many, a life of routine. And that’s not intrinsically bad—routine itself can be comforting! But for love to work, according to relational psychologists, it also needs something a little more.

    What things? Let’s break it down…

    Bids for connection—and responsiveness to same

    There’s an oft-quoted story about a person who knew their marriage was over when their spouse wouldn’t come look at their tomatoes. That may seem overblown, but…

    When we care about someone, we want to share our life with them. Not just in the sense of cohabitation and taxes, but in the sense of:

    • Little moments of joy
    • Things we learned
    • Things we saw
    • Things we did

    …and there’s someone we’re first to go to share these things with. And when we do, that’s a “bid for connection”. It’s important that we:

    • Make bids for connection frequently
    • Respond appropriately to our partner’s bids for connection

    Of course, we cannot always give everything our full attention. But whenever we can, we should show as much genuine interest as we can.

    Keep asking the important questions

    Not just “what shall we have for dinner?”, but:

    • “What’s a life dream that you have at the moment?”
    • “What are the most important things in life?”
    • “What would you regret not doing, if you never got the chance?”

    …and so forth. Even after many years with a partner, the answers can sometimes surprise us. Not because we don’t know our partners, but because the answers can change with time, and sometimes we can even surprise ourselves, if it’s a question we haven’t considered for a while.

    It’s good to learn and grow like this together—and to keep doing so!

    Express gratitude/appreciation

    For the little things as well as the big:

    • Thank you for staying by my side during life’s storms
    • Thank you for bringing me a coffee
    • Thank you for taking on these responsibilities with me
    • I really appreciate your DIY skills
    • I really appreciate your understanding nature

    On which note…

    Compliment, often and sincerely

    Most importantly, compliment things intrinsic to their character, not just peripheral attributes like appearance, and also not just what they do for you.

    • You’re such a patient person; I really admire that
    • I really hit the jackpot to get someone I can trust so completely as you
    • You are the kindest and sweetest soul I have ever encountered in life
    • I love that you have such a blend of strength and compassion
    • Your unwavering dedication to your personal values makes me so proud

    …whatever goes for your partner and how you see them and what you love about them!

    Express your needs, and ask about theirs

    We’re none of us mind-readers, and it’s easy to languish in “if they really cared, I wouldn’t have to ask”, or conversely, “if they wanted something, they would surely say so”.

    Communicate. Effectively. Life is too short to waste in miscommunication and unsaid things!

    We covered much more detailed how-tos of this in a previous issue, but good double-whammy of top tier communication is:

    • “I need…” / “Please will you…”
    • “What do you need?” / “How can I help?”

    Touch. Often.

    It takes about 20 seconds of sustained contact for oxytocin to take effect, so remember that when you hug your partner, hold hands when walking, or cuddle up the sofa.

    Have regular date nights

    It doesn’t have to be fancy. A date night can be cooking together, it can be watching a movie together at home. It can be having a scheduled time to each bring a “big question” or five, from what we talked about above!

    Most importantly: it’s a planned shared experience where the intent is to enjoy each other’s romantic company, and have a focus on each other. Having a regularly recurring date night, be it the last day of each month, or every second Saturday, or every Friday night, whatever your schedules allow, makes such a big difference to feel you are indeed “dating” and in the full flushes of love—not merely cohabiting pleasantly.

    Want ideas?

    Check out these:

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  • Hemp Seeds vs Flax Seeds – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing hemp seeds to flax seeds, we picked the flax.

    Why?

    Both are great, but quite differently so! In other words, they both have their advantages, but on balance, we prefer the flax’s advantages.

    Part of this come from the way in which they are sold/consumedhemp seeds must be hulled first, which means two things as a result:

    • Flax seeds have much more fiber (about 8x more)
    • Hemp seeds have more protein (about 2x more), proportionally, at least ← this is partly because they lost a bunch of weight by losing their fiber to the hulling, so the “per 100g” values of everything else go up, even though the amount per seed didn’t change

    Since people’s diets are more commonly deficient in fiber than protein, and also since 8x is better than 2x, we consider this a win for flax.

    Of course, many people enjoy hemp or flax specifically for the healthy fatty acids, so how do they stack up in that regard?

    • Flax seeds have more omega-3s
    • Hemp seeds have more omega-6s

    This, for us, is a win for flax too, as the omega-3s are generally what we need more likely to be deficient in. Hemp enthusiasts, however, may argue that the internal balance of omega-3s to omega-6s is closer to an ideal ratio in hemp—but nutrition doesn’t exist in a vacuum, so we have to consider things “as part of a balanced diet” (because if one were trying to just live on hemp seeds, one would die), and most people’s diets are skewed far too far in favor or omega-6 compared to omega-3. So for most people, the higher levels of omega-3s are the more useful.

    Want to learn more?

    Take care!

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  • Our ‘food environments’ affect what we eat. Here’s how you can change yours to support healthier eating

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    In January, many people are setting new year’s resolutions around healthy eating. Achieving these is often challenging – it can be difficult to change our eating habits. But healthy diets can enhance physical and mental health, so improving what we eat is a worthwhile goal.

    One reason it’s difficult to change our eating habits relates to our “food environments”. This term describes:

    The collective physical, economic, policy and sociocultural surroundings, opportunities and conditions that influence people’s food and beverage choices and nutritional status.

    Our current food environments are designed in ways that often make it easier to choose unhealthy foods than healthy ones. But it’s possible to change certain aspects of our personal food environments, making eating healthier a little easier.

    Unhealthy food environments

    It’s not difficult to find fast-food restaurants in Australian cities. Meanwhile, there are junk foods at supermarket checkouts, service stations and sporting venues. Takeaway and packaged foods and drinks routinely come in large portion sizes and are often considered tastier than healthy options.

    Our food environments also provide us with various prompts to eat unhealthy foods via the media and advertising, alongside health and nutrition claims and appealing marketing images on food packaging.

    At the supermarket, unhealthy foods are often promoted through prominent displays and price discounts.

    We’re also exposed to various situations in our everyday lives that can make healthy eating challenging. For example, social occasions or work functions might see large amounts of unhealthy food on offer.

    Not everyone is affected in the same way

    People differ in the degree to which their food consumption is influenced by their food environments.

    This can be due to biological factors (for example, genetics and hormones), psychological characteristics (such as decision making processes or personality traits) and prior experiences with food (for example, learned associations between foods and particular situations or emotions).

    People who are more susceptible will likely eat more and eat more unhealthy foods than those who are more immune to the effects of food environments and situations.

    Those who are more susceptible may pay greater attention to food cues such as advertisements and cooking smells, and feel a stronger desire to eat when exposed to these cues. Meanwhile, they may pay less attention to internal cues signalling hunger and fullness. These differences are due to a combination of biological and psychological characteristics.

    These people might also be more likely to experience physiological reactions to food cues including changes in heart rate and increased salivation.

    Two young women sitting on a couch eating chips.
    It’s common to eat junk food in front of the TV.
    PR Image Factory/Shutterstock

    Other situational cues can also prompt eating for some people, depending on what they’ve learned about eating. Some of us tend to eat when we’re tired or in a bad mood, having learned over time eating provides comfort in these situations.

    Other people will tend to eat in situations such as in the car during the commute home from work (possibly passing multiple fast-food outlets along the way), or at certain times of day such as after dinner, or when others around them are eating, having learned associations between these situations and eating.

    Being in front of a TV or other screen can also prompt people to eat, eat unhealthy foods, or eat more than intended.

    Making changes

    While it’s not possible to change wider food environments or individual characteristics that affect susceptibility to food cues, you can try to tune into how and when you’re affected by food cues. Then you can restructure some aspects of your personal food environments, which can help if you’re working towards healthier eating goals.

    Although both meals and snacks are important for overall diet quality, snacks are often unplanned, which means food environments and situations may have a greater impact on what we snack on.

    Foods consumed as snacks are often sugary drinks, confectionery, chips and cakes. However, snacks can also be healthy (for example, fruits, nuts and seeds).

    Try removing unhealthy foods, particularly packaged snacks, from the house, or not buying them in the first place. This means temptations are removed, which can be especially helpful for those who may be more susceptible to their food environment.

    Planning social events around non-food activities can help reduce social influences on eating. For example, why not catch up with friends for a walk instead of lunch at a fast-food restaurant.

    Creating certain rules and habits can reduce cues for eating. For example, not eating at your desk, in the car, or in front of the TV will, over time, lessen the effects of these situations as cues for eating.

    You could also try keeping a food diary to identify what moods and emotions trigger eating. Once you’ve identified these triggers, develop a plan to help break these habits. Strategies may include doing another activity you enjoy such as going for a short walk or listening to music – anything that can help manage the mood or emotion where you would have typically reached for the fridge.

    Write (and stick to) a grocery list and avoid shopping for food when hungry. Plan and prepare meals and snacks ahead of time so eating decisions are made in advance of situations where you might feel especially hungry or tired or be influenced by your food environment.The Conversation

    Georgie Russell, Senior Lecturer, Institute for Physical Activity and Nutrition (IPAN), Deakin University and Rebecca Leech, NHMRC Emerging Leadership Fellow, School of Exercise and Nutrition Sciences, Deakin University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • The Power of When – by Dr. Michael Breus

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    There’s a lot more to one’s circadian rhythm than just when one wakes and sleeps. This book goes into that quite deeply!

    For example, those items in the subtitle? You could do them all at the same time, but it probably wouldn’t be optimal (although honestly, that does sound like quite a good life!). Rather, there are distinct times of day that we’re going to be better at certain things, and there are distinct times of day when certain things are going to be better for us.

    Of course, some items are not so simple as a one-size fits all, so Dr. Breus outlines for us how to figure out our own chronotype (within four main schemas), and how to make that work for us as well as possible.

    They style is easy-reading pop-science, with frequent summaries, bullet-points, quizzes, and so forth, making it easy to understand, learn, and apply.

    Bottom line: if you feel like your sleep could use a do-over, then this book can help you get it into order—and the rest of your daily activities too!

    Click here to check out The Power of When, and optimize your health!

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  • The Optimal Morning Routine, Per Neuroscience

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Dr. Andrew Huberman, neuroscientist and professor of neurobiology, has insights:

    The foundations of a good day

    Here are some key things to consider:

    • The role of light: get sunlight exposure within an hour of waking to anchor your body’s cortisol pulse, set your circadian rhythm, and boost mood-regulating dopamine. Light exposure on the skin also boost hormone levels like testosterone and estrogen, contributing to energy, motivation, and overall wellbeing.
    • The role of caffeine: delay caffeine intake for 60–90 minutes after waking to allow adenosine to clear naturally, preventing afternoon energy crashes. Otherwise, caffeine will block the adenosine for 4–8 hours, causing the wave of adenosine-induced sleepiness to resurge later.
    • The role of exercise: morning exercise helps clear adenosine, raise core body temperature, and improve wakefulness
    • The role of cold: cold showers or ice baths trigger adrenaline and dopamine surges, enhancing mood and drive for hours.

    For more on each of these, enjoy:

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    Want to learn more?

    You might also like to read:

    Morning Routines That Just Flow

    Take care!

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  • How Beneficial Is MCT Oil, Really?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Often derived from coconuts (though it doesn’t have to be), medium-chain triglycerides (MCTs) are trendy… But does the science back the hype?

    First, the principle

    MCTs are commonly enjoyed because unlike short- or long-chain fatty acids, they can be quickly broken down and either immediately converted quickly and easily into energy, or turned into ketones in the case of a surplus (in the case of true excess, however, it’ll simply be stored as fat).

    Most of that involves the liver, so for anyone who wants a refresher on liver health:

    How To Unfatty A Fatty Liver ← notwithstanding the title, this is also important knowledge even if your liver is healthy now—if you’d like it to stay healthy, anyway!

    You can also read about the ins and outs of glycogen metabolism and the body’s energy-based metabolic processes in general (including the body’s energy processes that go on in the liver), here:

    From Apples to Bees, and High-Fructose Cs: Which Sugars Are Healthier, And Which Are Just The Same?

    If the liver turns the MCTs into ketones, those ketones will then be used for energy if there is insufficient glucose available (as the body will always use glucose from the blood first, if available, before moving to alternative energy sources such as ketones and/or fat reserves.)

    Thus, many people look to ketones as a solution for having enough energy to function while on a very low-carb diet such as the ketogenic diet:

    Ketogenic Diet: Burning Fat Or Burning Out?

    …which as you’ll recall, does work for short-term weight loss, but brings long-term health risks, so should not be undertaken for long periods of time.

    So, does MCT Oil help?

    With regard to weight loss, the research is weak and mixed:

    • Weak, because often the methodology was shoddy, often there are many factors not controlled-for, and often the sample sizes were small (and also, RCTs by their very nature tend to be quite short-term (often 6, 8, or 12 weeks), whereas heavy reliance on ketones from MCTs may fall into the same long-term problems as the ketogenic diet in general).
    • Mixed, because the results varied widely (probably because of the aforementioned problems).

    Rather than pick at individual studies, let’s look at this review and meta-analysis of 13 studies, with a combined sample size of 749 people (so you can imagine how small the individual RCTs were):

    ❝Compared with LCTs, MCTs decreased body weight (-0.51 kg [95% CI-0.80 to -0.23 kg]; P<0.001; I(2)=35%); waist circumference (-1.46 cm [95% CI -2.04 to -0.87 cm]; P<0.001; I(2)=0%), hip circumference (-0.79 cm [95% CI -1.27 to -0.30 cm]; P=0.002; I(2)=0%), total body fat (standard mean difference -0.39 [95% CI -0.57 to -0.22]; P<0.001; I(2)=0%), total subcutaneous fat (standard mean difference -0.46 [95% CI -0.64 to -0.27]; P<0.001; I(2)=20%), and visceral fat (standard mean difference -0.55 [95% CI -0.75 to -0.34]; P<0.001; I(2)=0%).

    No differences were seen in blood lipid levels.

    Many trials lacked sufficient information for a complete quality assessment, and commercial bias was detected.❞

    So, if we’re going to take those numbers at face value, that means a net weight loss, over the course of the trial period, was…

    *drumroll*

    0.51kg (that’s about 1 lb).

    To put that into perspective, if you did nothing else but pee 1 cup of urine before getting weighed, you’d register as having lost 0.25kg (or about ½ lb) by virtue of the bathroom trip alone.

    Here’s the paper:

    Effects of medium-chain triglycerides on weight loss and body composition: a meta-analysis of randomized controlled trials

    What about cholesterol and heart health?

    With regard to cholesterol, MCT oil is touted as improving blood lipids, which means lowering LDL and increasing HDL (within a safe range, anyway).

    You’ll remember that the above review concluded “No differences were seen in blood lipid levels”.

    It may again be a case of individual studies cancelling each other out. For example…

    This study found that it improved lipids in 40 young women as part of a calorie-controlled interventional diet:

    Effects of dietary coconut oil on the biochemical and anthropometric profiles of women presenting abdominal obesity

    This study found that it worsened lipids in 17 young men, worse even than taking an equivalent amount of sunflower oil:

    Effects of medium-chain fatty acids and oleic acid on blood lipids, lipoproteins, glucose, insulin, and lipid transfer protein activities

    In short, it’s a gamble.

    It may be good for insulin sensitivity, though

    This one seems to be specific to people with type 2 diabetes. The paper heading says it all, but we include the link in case you want to know the details (the short version is, it improved insulin sensitivity in diabetic subjects only (not others), and didn’t affect anything else that was measured:

    Dietary substitution of medium-chain triglycerides improves insulin-mediated glucose metabolism in NIDDM subjects

    The sample size was small (20 people total, of whom 10 had diabetes), and the next study was with 40 people, this time moderately overweight and all with type 2 diabetes:

    Effects of dietary medium-chain triglyceride on weight loss and insulin sensitivity in a group of moderately overweight free-living type 2 diabetic Chinese subjects

    Want to try some?

    We don’t sell it, but here for your convenience is an example product on Amazon 😎

    Enjoy!

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