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 Cleghorn ← you 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
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❞
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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Exercise Less, Move More
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Exercise Less, Move More
Today we’re talking about Dr. Rangan Chatterjee. He’s a medical doctor with decades of experience, and he wants us all to proactively stay in good health, rather than waiting for things to go wrong.
Great! What’s his deal?
Dr. Chatterjee advises that we take care of the following four pillars of good health:
- Relaxation
- Food
- Movement
- Sleep
And, they’re not in this order at random. Usually advice starts with diet and exercise, doesn’t it?
But for Dr. Chatterjee, it’s useless to try to tackle diet first if one is stressed-to-death by other things. As for food next, he knows that a good diet will fuel the next steps nicely. Speaking of next steps, a day full of movement is the ideal setup to a good night’s sleep—ready for a relaxing next day.
Relaxation
Here, Dr. Chatterjee advises that we go with what works for us. It could be meditation or yoga… Or it could be having a nice cup of tea while looking out of the window.
What’s most important, he says, is that we should take at least 15 minutes per day as “me time”, not as a reward for when we’ve done our work/chores/etc, but as something integrated into our routine, preferably early in the day.
Food
There are no grand surprises here: Dr. Chatterjee advocates for a majority plant-based diet, whole foods, and importantly, avoiding sugar.
He’s also an advocate of intermittent fasting, but only so far as is comfortable and practicable. Intermittent fasting can give great benefits, but it’s no good if that comes at a cost of making us stressed and suffering!
Movement
This one’s important. Well, they all are, but this one’s particularly characteristic to Dr. Chatterjee’s approach. He wants us to exercise less, and move more.
The reason for this is that strenuous exercise will tend to speed up our metabolism to the point that we will be prompted to eat high calorie quick-energy foods to compensate, and when we do, our body will rush to store that as fat, understanding (incorrectly) that we are in a time of great stress, because why else would we be exerting ourselves that much?
Instead, he advocates for building as much natural movement into our daily routine as possible. Walking more, taking the stairs, doing the gardening/housework.
That said, he does also advise some strength-training on a daily basis—bodyweight exercises like squats and lunges are top of his list.
Sleep
Here, aside from the usual “sleep hygiene” advices (dark cool room, fresh bedding, etc), he also advises we do as he does, and take an hour before bedtime as a purely wind-down time. In gentle lighting, perhaps reading (not on a bright screen!), for example.
Ready to start the next day, relaxed and ready to go.
If you’d like to know more about Dr. Chatterjee’s approach…
You can check out his:
If you don’t know where to start, we recommend the blog! It has a lot of guests there too, including Wim Hof, Gabor Maté, Mindy Pelz, and come to think of it, a lot of other people we’ve also featured ideas from previously!
Enjoy!
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A Tale Of Two Cinnamons
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Cinnamon’s Health Benefits (But Watch Out!)
Cinnamon is enjoyed for its sweet and punchy flavor. It also has important health properties!
Let’s take a look at the science…
A Tale Of Two Cinnamons
In your local supermarket, there is likely “cinnamon” and if you’re lucky, also “sweet cinnamon”. The difference between these is critical to understand before we continue:
“Cinnamon” = Cinnamomum cassia or Cinnamomum aromaticum. This is cheapest and most readily available. It has a relatively high cinnamaldehyde content, and a high coumarin content.
“Sweet cinnamon” Cinnamomum verum or Cinnamomum zeylanicum. It has a lower cinnamaldehyde content, and/but a much lower (almost undetectable) coumarin content.
You may be wondering: what’s with the “or” in both of those cases? Each simply has two botanical names in use. It’s inconvenient and confusing, but that’s how it is.
Great! What’s cinnamaldehyde and what’s coumarin?
Cinnamaldehyde is what gives cinnamon its “spice” aspect; it’s strong and fragrant. It also gives cinnamon most of its health benefits.
As a quick aside: it’s also used as the flavoring element in cinnamon flavored vapes, and in that form, it can cause health problems. So do eat it, but we recommend not to vape it.
Coumarin is toxic in large quantities.
The recommended safe amount is 0.1mg/kg, so you could easily go over this with a couple of teaspoons of cassia cinnamon:
Toxicology and risk assessment of coumarin: focus on human data
…while in Sweet/True/Ceylon cinnamon, those levels are almost undetectable:
Medicinal properties of ‘true’ cinnamon (Cinnamomum zeylanicum): a systematic review
If you have a cinnamon sensitivity, it is likely, but not necessarily, tied to the coumarin content rather than the cinnamaldehyde content.
Summary of this section before moving on:
“Cinnamon”, or cassia cinnamon, has about 50% stronger health benefits than “Sweet Cinnamon”, also called Ceylon cinnamon.
“Cinnamon”, or cassia cinnamon, has about 250% stronger health risks than “Sweet Cinnamon”, also called Ceylon cinnamon.
The mathematics here is quite simple; sweet cinnamon is the preferred way to go.
The Health Benefits
We spent a lot of time/space today looking at the differences. We think this was not only worth it, but necessary. However, that leaves us with less time/space for discussing the actual benefits. We’ll summarize, with links to supporting science:
“Those three things that almost always go together”:
Heart and blood benefits:
- Reduces triglyceride levels
- Reduces high blood pressure
- Reduces insulin insensitivity
- Reduces fasting blood sugar levels
Neuroprotective benefits:
The science does need more testing in these latter two, though.
Where to get it?
You may be able to find sweet cinnamon in your local supermarket, or if you prefer capsule form, here’s an example product on Amazon
Enjoy!
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How (And Why) To Train Your Pre-Frontal Cortex
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Dr. Chapman’s Keys For Mental Focus
This is Dr. Sandra Chapman; she’s a cognitive neuroscientist, on a mission to, in her words, further our understanding of:
- what makes the brain stronger, faster and last longer
- what enhances human cognitive capacity, and
- what enhances the underlying brain systems across the lifespan.
To this end, she’s also the founder and Chief Director of the Center For Brain Health, where she has worked on her mission for the past 25 years (clocking up hundreds of peer-reviewed publications to her name), as well as being a professor of Behavioral and Brain Sciences at UT Dallas.
What does she want us to know?
Get your brain into gear
When it comes to your brainpower, it is “use it or lose it”, but it is also perfectly possible to use it and lose it.
Why?
Very often, what we are using our brains for is high-strain, low-yield stuff, such as multitasking, overthinking, or overthinking while multitasking. And to make it worse, we often do it without sufficient rest.
This is the equivalent of owning a Ferrari but trying to drive it in second and third gear at once by switching between the two as rapidly as possible. And doing that for 18 hours each day.
Suffice it to say, you’ll be going nowhere quickly.
An alternative “use” of brainpower is low-strain, low-yield stuff, such as having to pay close attention to a boring conversation. It’s enough to stop your mind from doing anything else, but not enough to actually stimulate you.
This is the equivalent of owning a Ferrari but keeping it idling. The wear and tear is minimal this time, but you’re not actually going anywhere either.
Better, of course, are the other two quadrants:
- low-strain, high-yield: consistently using our brain in relatively non-taxing ways that encourage its development
- high-strain, high-yield: here the Ferrari metaphor definitely fails, because unlike cars, our bodies (including our brains) are machines that benefit from judicious regular progressive overloading (but just by a bit, and with adequate recovery time between overloads).
See also: 12 Weeks To Measurably Boost Your Brain
How to do the “low-strain, low-yield” part
When it comes to “what’s the most important part of the brain to help in the face of cognitive decline?” the usual answer is either to focus on memory (hippocampi) or language (various parts, but for example Wernicke’s area and Broca’s area), since people most fear losing memory, and language is very important both socially and practically.
Those are indeed critical, and we at 10almonds stand by them, but Dr. Chapman (herself having originally trained as speech and language pathologist!) makes a strong case for adding a third brain part to the list.
Specifically, she advocates for strengthening the pre-frontal cortex, which is responsible for inhibition, task-switching, working memory, and cognitive flexibility. If that seems like a lot, do remember it’s a whole cortex and not one of the assorted important-but-small brain bits we mentioned above.
How? She has developed training programs for this, based on what she calls Strategic Memory Advanced Reasoning Tactics (SMART), to support support attention, planning, judgment and emotional management.
You can read more about those programs here:
Center For Brain Health | Our Programs
Participation in those is mostly not free, however, if you join their…
Center For Brain Health | BrainHealth Project
…then they will periodically invite you to join pilot programs, research programs, and the like, which will either be free or they-pay-you affairs—because this is how science is done, and you can read about yourself (anonymized, of course) later in peer-reviewed papers of the kind we often cite here.
If you’re not interested in any of that though, we will say that according to Dr. Chapman, the keys are:
Inhibition: be conscious of this function of your brain, and develop it. This is the function of your brain that stops you from making mistakes—or put differently: stops you from saying/doing something stupid.
Switching: do this consciously; per “I am now doing this task, now I am switching to this other task”, rather than doing the gear-grinding thing we discussed earlier
Working memory: this is effectively your brain’s RAM. Unlike the RAM of a computer (can be enhanced by adding another chip or replacing with a bigger chip), our brain’s RAM can be increased by frequent use, and especially by judicious use of progressive overloading (with rests between!) which we’ll discuss in the high-strain, high-yield section.
Flexibility: this is about creative problem-solving, openness to new ideas, and curiosity
See also: Curiosity Kills The Neurodegeneration
How to do the “high-strain, high-yield” part
Delighting this chess-playing writer, Dr. Chapman recommends chess. Although, similar games such as go (a Chinese game that looks simpler than chess but actually requires more calculation) work equally well too.
Why?
Games like chess and go cause structural changes that are particularly helpful, in terms of engaging in such foundational tasks as learning, abstract reasoning, problem-solving and self-control:
Chess Practice as a Protective Factor in Dementia
Basically, it checks (so to speak) a lot of boxes, especially for the pre-frontal cortex. Some notes:
- Focusing on the game is required for brain improvement; simply pushing wood casually will not do it. Ideally, calculating several moves ahead will allow for strong working memory use (because to calculate several moves ahead, one will have to hold increasingly many possible positions in the mind while doing so).
- The speed of play must be sufficiently slow as to allow not only for thinking, but also for what in chess is called “blunder-checking”, in other words, having decided on one’s move, pausing to consider whether it is a mistake, and actively trying to find evidence that it is. This is the crucial “inhibition habit”, and when one does it reflexively, one will make fewer mistakes. Tying this to dementia, see for example how one of the common symptoms of dementia is falling for scams that one wouldn’t have previously. How did cognitive decline make someone naïve? It didn’t, per se; it just took away their ability to, having decided what to do, pause to consider whether it was a mistake, and actively trying to find evidence that it is.
- That “conscious switching” that we talked about, rather than multitasking? In chess, there is a difference between strategy and tactics. Don’t worry about what that difference is for now (learn it if you want to take up chess), but know that strong players will only strategize while it is their opponent’s turn, and only calculate (tactics) while it is their own turn. It’s very tempting to flit constantly between one and the other, but chess requires players to have the mental discipline be able to focus on one task or the other and stick with that task until it’s the appointed time to switch.
If you feel like taking up chess, this site (and related app, if you want it) is free (it’s been funded by voluntary donations for a long time now) and good and even comes with free tuition and training tools: LiChess.org
Here’s another site that this writer (hi, it’s me) personally uses—it has great features too, but many are paywalled (I’m mostly there just because I’ve been there nearly since its inception, so I’m baked into the community now): Chess.com
Want to know more?
You might like this book by Dr. Chapman, which we haven’t reviewed yet but it did inform large parts of today’s article:
Make Your Brain Smarter: Increase Your Brain’s Creativity, Energy, and Focus – by Dr. Sandra Chapman
Enjoy!
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The Herbal Supplement That Rivals Prozac
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Flower Power: St. John’s Wort’s Drug-Level Effectiveness
St. John’s wort is a small yellow flower, extract of which can be bought inexpensively off-the-shelf in pretty much any pharmacy in most places.
It’s sold and used as a herbal mood-brightener.
Does it work?
Yes! It’s actually very effective. This is really uncontroversial, so we’ll keep it brief.
The main findings of studies are that St. John’s wort not only gives significant benefits over placebo, but also works about as well as prescription anti-depressants:
A systematic review of St. John’s wort for major depressive disorder
They also found that fewer people stop taking it, compared to how many stop taking antidepressants. It’s not known how much of this is because of its inexpensive, freely-accessible nature, and how much might be because it gave them fewer adverse side effects:
Clinical use of Hypericum perforatum (St John’s wort) in depression: A meta-analysis
How does it work?
First and foremost, it’s an SSRI—a selective serotonin reuptake inhibitor. Basically, it doesn’t add serotonin, but it makes whatever serotonin you have, last longer. Same as most prescription antidepressants. It also affects adenosine and GABA pathways, which in lay terms, means it promotes feelings of relaxation, in a similar way to many prescription antianxiety medications.
Mechanism of action of St John’s wort in depression: what is known?
Any problems we should know about?
Yes, definitely. To quote directly from the National Center for Complementary and Integrative Health:
St. John’s wort can weaken the effects of many medicines, including crucially important medicines such as:
- Antidepressants
- Birth control pills
- Cyclosporine, which prevents the body from rejecting transplanted organs
- Some heart medications, including digoxin and ivabradine
- Some HIV drugs, including indinavir and nevirapine
- Some cancer medications, including irinotecan and imatinib
- Warfarin, an anticoagulant (blood thinner)
- Certain statins, including simvastatin
I’ve read all that, and want to try it!
As ever, we don’t sell it (or anything else), but here’s an example product on Amazon.
Please be safe and do check with your doctor and/or pharmacist, though!
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From immunotherapy to mRNA vaccines – the latest science on melanoma treatment explained
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More than 16,000 Australians will be diagnosed with melanoma each year. Most of these will be caught early, and can be cured by surgery.
However, for patients with advanced or metastatic melanoma, which has spread from the skin to other organs, the outlook was bleak until the advent of targeted therapies (that attack specific cancer traits) and immune therapies (that leverage the immune system). Over the past decade, these treatments have seen a significant climb in the number of advanced melanoma patients surviving for at least five years after diagnosis, from less than 10% in 2011 to around 50% in 2021.
While this is great news, there are still many melanoma patients who cannot be treated effectively with current therapies. Researchers have developed two exciting new therapies that are being evaluated in clinical trials for advanced melanoma patients. Both involve the use of immunotherapy at different times and in different ways.
The first results from these trials are now being shared publicly, offering insight into the future of melanoma treatment.
Svitlana Hulko/Shutterstock Immunotherapy before surgery
Immunotherapy works by boosting the power of a patient’s immune system to help kill cancer cells. One type of immunotherapy uses something called “immune checkpoint inhibitors”.
Immune cells carry “immune checkpoint” proteins, which control their activity. Cancer cells can interact with these checkpoints to turn off immune cells and hide from the immune system. Immune checkpoint inhibitors block this interaction and help keep the immune system activated to fight the cancer.
Results from an ongoing phase 3 trial using immune checkpoint inhibitors were recently published in the New England Journal of Medicine.
This trial used two types of immune checkpoint inhibitors: nivolumab, which blocks an immune checkpoint called PD-1, and ipilimumab, which blocks CTLA-4.
More than 16,000 Australians are diagnosed with melanoma each year. Delovely Pics/Shutterstock Some 423 patients (including many from Australia) were enrolled in the trial, and participants were randomly assigned to one of two groups.
The first group had surgery to remove their melanoma, and were then given immunotherapy (nivolumab) to help kill any remaining cancer cells. Giving a systemic (whole body) therapy such as immunotherapy after surgery is a standard way of treating melanoma. The second group received immunotherapy first (nivolumab plus ipilimumab) and then underwent surgery. This is a new approach to treating these cancers.
Based on previous observations, the researchers had predicted that giving patients immunotherapy while the whole tumour was still present would activate the tumour-fighting abilities of the patient’s immune system much better than giving it once the tumour had been removed.
Sure enough, 12 months after starting therapy, 83.7% of patients who received immunotherapy before surgery remained cancer-free, compared to 57.2% in the control group who received immunotherapy after surgery.
Based on these results, Australian of the year Georgina Long – who co-led the trial with Christian Blank from The Netherlands Cancer Institute – has suggested this method of immunotherapy before surgery should be considered a new standard of treatment for higher risk stage 3 melanoma. She also said a similar strategy should be evaluated for other cancers.
The promising results of this phase 3 trial suggest we might see this combination treatment being used in Australian hospitals within the next few years.
mRNA vaccines
Another emerging form of melanoma therapy is the post-surgery combination of a different checkpoint inhibitor (pembrolizumab, which blocks PD-1), with a messenger RNA vaccine (mRNA-4157).
While checkpoint inhibitors like pembrolizumab have been around for more than a decade, mRNA vaccines like mRNA-4157 are a newer phenomenon. You might be familiar with mRNA vaccines though, as the biotechnology companies Pfizer-BioNTech and Moderna released COVID vaccines based on mRNA technology.
mRNA-4157 works basically the same way – the mRNA is injected into the patient and produces antigens, which are small proteins that train the body’s immune system to attack a disease (in this case, cancer, and for COVID, the virus).
However, mRNA-4157 is unique – literally. It’s a type of personalised medicine, where the mRNA is created specifically to match a patient’s cancer. First, the patient’s tumour is genetically sequenced to figure out what antigens will best help the immune system to recognise their cancer. Then a patient-specific version of mRNA-4157 is created that produces those antigens.
The latest results of a three-year, phase 2 clinical trial which combined pembrolizumab and mRNA-4157 were announced this past week. Overall, 2.5 years after starting the trial, 74.8% of patients treated with immunotherapy combined with mRNA-4157 post-surgery remained cancer-free, compared to 55.6% of those treated with immunotherapy alone. These were patients who were suffering from high-risk, late-stage forms of melanoma, who generally have poor outcomes.
It’s worth noting these results have not yet been published in peer-reviewed journals. They’re available as company announcements, and were also presented at some cancer conferences in the United States.
Based on the results of this trial, the combination of pembrolizumab and the vaccine progressed to a phase 3 trial in 2023, with the first patients being enrolled in Australia. But the final results of this trial are not expected until 2029.
It is hoped this mRNA-based anti-cancer vaccine will blaze a trail for vaccines targeting other types of cancer, not just melanoma, particularly in combination with checkpoint inhibitors to help stimulate the immune system.
Despite these ongoing advances in melanoma treatment, the best way to fight cancer is still prevention which, in the case of melanoma, means protecting yourself from UV exposure wherever possible.
Sarah Diepstraten, Senior Research Officer, Blood Cells and Blood Cancer Division, WEHI (Walter and Eliza Hall Institute of Medical Research) and John (Eddie) La Marca, Senior Research Officer, Blood Cells and Blood Cancer, WEHI (Walter and Eliza Hall Institute of Medical Research)
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Simple, 10-Minute Hip Opening Routine
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Hips Feeling Stiff?
If so, Flow with Adee’s video (below) has just the solution with a quick 10-minute hip-opening routine. Designed for intermediates but open to all, we love Adee’s work and recommend that you reach out to her to tell her what you’d like to see next.
Other Methods
If you’re a book lover, we’ve reviewed a fantastic book on reducing hip pain. Alternatively, learn stretching from a ballerina with Jasmine McDonald’s ballet stretching routine.
Otherwise, enjoy today’s video:
How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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