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
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❞
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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Aging Backwards – by Miranda Esmonde-White
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In this book, there’s an upside and a downside to the author’s professional background:
- Upside: Miranda Esmonde-White is a ballet-dancer-turned-physical-trainer, and it shows
- Downside: Miranda Esmonde-White is not a scientist, and it shows
She cites a lot of science, but she either does not understand it or else intentionally misrepresents it. We will assume the former. But as one example, she claims:
“for every minute you exercise, you lengthen your life by 7 minutes”
…which cheat code to immortality is absolutely not backed-up by the paper she cites for it. The paper, like most papers, was much more measured in its proclamations; “there was an association” and “with these conditions”, etc.
Nevertheless, while she misunderstands lots of science along the way, her actual advice is good and sound. Her workout programs really will help people to become younger by various (important, life-changing!) metrics of biological age, mostly pertaining to mobility.
And yes, this is a workout-based approach; we won’t read much about diet and other lifestyle factors here.
Bottom line: it has its flaws, but nevertheless delivers on its premise of helping the reader to become biologically younger through exercises, mostly mobility drills.
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How Aging Changes At 44 And Again At 60 (And What To Do About It)
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As it turns out, aging is not linear. Or rather: chronological aging may be, but biological aging isn’t, and there are parts of our life where it kicks into a different gear. This study looked at 108 people (65 of whom women) between the ages of 25 and 75, as part of a longitudinal cohort study, tracked for around 2–8 years (imprecise as not all follow-up durations were the same). They took frequent blood and urine samples, and tested them for thousands of different molecules and analyzing changes in gene expression, proteomic, blood biomarkers, and more. All things that are indicators of various kinds of health/disease, and which might seem more simple but it isn’t: aging.
Here’s what they found:
Landmark waypoints
At 44, significant changes occur in the metabolism, including notably the metabolism of carbs, caffeine, and alcohol. A large portion of this may be hormone related, as that’s a time of change not just for those undergoing the menopause, but also the andropause (not entirely analogous to the menopause, but it does usually entail a significant reduction in sex hormone production; in this case, testosterone).
However, the study authors also hypothesize that lifestyle factors may be relevant, as one’s 40s are often a stressful time, and an increase in alcohol consumption often occurs around the same time as one’s ability to metabolize it drops, resulting in further dysfunctional alcohol metabolism.
At 60, carb metabolism slows again, with big changes in glucose metabolism specifically, as well as an increased risk of cardiovascular disease, and a decline in kidney function. In case that wasn’t enough: also an increase free radical pathology, meaning a greatly increased risk of cancer. Immune function drops too.
What to do about this: the recommendation is of course to be proactive, and look after various aspects of your health before it becomes readily apparent that you need to. For example, good advice for anyone approaching 44 might be to quit alcohol, go easy on caffeine, and eat a diet that is conducive to good glucose metabolism. Similarly, good advice for anyone approaching 60 might be to do the same, and also pay close attention to keeping your kidneys healthy. Getting regular tests done is also key, including optional extras that your doctor might not suggest but you should ask for, such as blood urea nitrogen levels (biomarkers of kidney function). The more we look after each part of our body, the more they can look after us in turn, and the fewer/smaller problems we’ll have down the line.
If you, dear reader, are approaching the age 44 or 60… Be neither despondent nor complacent. We must avoid falling into the dual traps of “Well, that’s it, bad health is around the corner, nothing I can do about it; that’s nature”, vs “I’ll be fine, statistics are for other people, and don’t apply to me”.
Those are averages, and we do not have to be average. Every population has statistical outliers. But it would be hubris to think none of this will apply to us and we can just carry on regardless. So, for those of us who are approaching one of those two ages… It’s time to saddle up, knuckle down, and do our best!
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Also, if you’d like to read the actual paper by Dr. Xiaotao Shen et al., here it is:
Nonlinear dynamics of multi-omics profiles during human aging ← honestly, it’s a lot clearer and more informative than the video, and also obviously discusses things in a lot more detail than we have room to here
Take care!
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Three Daily Servings of Beans?
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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
❝Not crazy about the Dr.s food advice. Beans 3X a day?❞
For reference, this is in response to our recent article on the topic of 12 things to aim to get a certain amount of each day:
So, there are a couple of things to look at here:
Firstly, don’t worry, it’s a guideline and an aim. If you don’t hit it on a given day, there is always tomorrow. It’s just good to know what one is aiming for, because without knowing that, achieving it will be a lot less likely!
Secondly, the beans/legumes/pulses category says three servings, but the example serving sizes are quite small, e.g. ½ cup cooked beans, or ¼ cup hummus. And also as you notice, dips/pastes/sauces made from beans count too. So given the portion sizes, you could easily get two servings in by breakfast (and two servings of whole grains, too) if you enjoy frijoles refritos, for example. Many of the recipes we share on this site have “stealth” beans/legumes/pulses in this fashion
Take care!
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How to Boost Your Metabolism When Over 50
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Dr. Dawn Andalon, a physiotherapist, explains the role of certain kinds of exercise in metabolism; here’s what to keep in mind:
Work with your body
Many people make the mistake of thinking that it is a somehow a battle of wills, and they must simply will their body to pick up the pace. That’s not how it works though, and while that can occasionally get short-term results, at best it’ll quickly result in exhaustion. So, instead:
- Strength training: engage in weight training 2–3 times per week; build muscle and combat bone loss too. Proper guidance from trainers familiar with older adults is recommended. Pilates (Dr. Andalon is a Pilates instructor) can also complement strength training by enhancing core stability and preventing injuries. The “building muscle” thing is important for metabolism, because muscle increases the body’s metabolic base rate.
- Protein intake: Dr. Andalon advises to consume 25–30 grams of lean protein per meal to support muscle growth and repair (again, important for the same reason as mentioned above re exercise). Dr. Andalon’s recommendation is more protein per meal than is usually advised, as it is generally held that the body cannot use more than about 20g at once.
- Sleep quality: prioritize good quality sleep, by practising good sleep hygiene, and also addressing any potential hormonal imbalances affecting sleep. If you do not get good quality sleep, your metabolism will get sluggish in an effort to encourage you to sleep more.
- Exercise to manage stress: regular walking (such as the popular 10,000 steps daily) helps manage stress and improve metabolism. Zone two cardio (low-intensity movement) also supports joint health, blood flow, and recovery—but the main issue about stress here is that if your body experiences unmanaged stress, it will try to save you from whatever is stressing you by reducing your metabolic base rate so that you can out-survive the bad thing. Which is helpful if the stressful thing is that the fruit trees got stripped by giraffes and hunting did not yield a kill, but not so helpful if the stressful thing is the holiday season.
- Hydration: your body cannot function properly without adequate hydration; water is needed (directly or indirectly) for all bodily processes, and your metabolism will also “dry up” without it.
- Antidiabetic & anti-inflammatory diet: minimize sugar intake and reduce processed foods, especially those with inflammatory refined oils (esp. canola & sunflower) and the like. This has very directly to do with your body’s energy metabolism, and as they say in computing, “garbage in; garbage out”.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Burn! How To Boost Your Metabolism
Take care!
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Why You Probably Need More Sleep
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Sleep: yes, you really do still need it!
We asked you how much sleep you usually get, and got the above-pictured, below-described set of responses:
- A little of a third of all respondents selected the option “< 7 hours”
- However, because respondents also selected options such as < 6 hours, < 5 hours, and < 4 hours, so if we include those in the tally, the actual total percentage of respondents who reported getting under 7 hours, is actually more like 62%, or just under two thirds of all respondents.
- Nine respondents, which was about 5% of the total, reported usually getting under 4 hours sleep
- A little over quarter of respondents reported usually getting between 7 and 8 hours sleep
- Fifteen respondents, which was a little under 10% of the total, reported usually getting between 8 and 9 hours of sleep
- Three respondents, which was a little under 2% of the total, reported getting over 9 hours of sleep
- In terms of the classic “you should get 7–9 hours sleep”, approximately a third of respondents reported getting this amount.
You need to get 7–9 hours sleep: True or False?
True! Unless you have a (rare!) mutated ADRB1 gene, which reduces that.
The way to know whether you have this, without genomic testing to know for sure, is: do you regularly get under 6.5 hours sleep, and yet continue to go through life bright-eyed and bushy-tailed? If so, you probably have that gene. If you experience daytime fatigue, brain fog, and restlessness, you probably don’t.
About that mutated ADRB1 gene:
NIH | Gene identified in people who need little sleep
Quality of sleep matters as much as duration, and a lot of studies use the “RU-Sated” framework, which assesses six key dimensions of sleep that have been consistently associated with better health outcomes. These are:
- regularity / usual hours
- satisfaction with sleep
- alertness during waking hours
- timing of sleep
- efficiency of sleep
- duration of sleep
But, that doesn’t mean that you can skimp on the last one if the others are in order. In fact, getting a good 7 hours sleep can reduce your risk of getting a cold by three or four times (compared with six or fewer hours):
Behaviorally Assessed Sleep and Susceptibility to the Common Cold
^This study was about the common cold, but you may be aware there are more serious respiratory viruses freely available, and you don’t want those, either.
Napping is good for the health: True or False?
True or False, depending on how you’re doing it!
If you’re trying to do it to sleep less in total (per polyphasic sleep scheduling), then no, this will not work in any sustainable fashion and will be ruinous to the health. We did a Mythbusting Friday special on specifically this, a while back:
Could Just Two Hours Sleep Per Day Be Enough?
PS: you might remember Betteridge’s Law of Headlines
If you’re doing it as a energy-boosting supplement to a reasonable night’s sleep, napping can indeed be beneficial to the health, and can give benefits such as:
- Increased alertness
- Helps with learning
- Improved memory
- Boost to immunity
- Enhance athletic performance
However! There is still a right and a wrong way to go about it, and we wrote about this previously, for a Saturday Life Hacks edition of 10almonds:
How To Nap Like A Pro (No More “Sleep Hangovers”!)
As we get older, we need less sleep: True or False
False, with one small caveat.
The small caveat: children and adolescents need 9–12 hours sleep because, uncredited as it goes, they are doing some seriously impressive bodybuilding, and that is exhausting to the body. So, an adult (with a normal lifestyle, who is not a bodybuilder) will tend to need less sleep than a child/adolescent.
But, the statement “As we get older, we need less sleep” is generally taken to mean “People in the 65+ age bracket need less sleep than younger adults”, and this popular myth is based on anecdotal observational evidence: older people tend to sleep less (as our survey above shows! For any who aren’t aware, our readership is heavily weighted towards the 60+ demographic), and still continue functioning, after all.
Just because we survive something with a degree of resilience doesn’t mean it’s good for us.
In fact, there can be serious health risks from not getting enough sleep in later years, for example:
Sleep deficiency promotes Alzheimer’s disease development and progression
Want to get better sleep?
What gets measured, gets done. Sleep tracking apps can be a really good tool for getting one’s sleep on a healthier track. We compared and contrasted some popular ones:
The Head-To-Head Of Google and Apple’s Top Apps For Getting Your Head Down
Take good care of yourself!
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I’ve recovered from a cold but I still have a hoarse voice. What should I do?
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Cold, flu, COVID and RSV have been circulating across Australia this winter. Many of us have caught and recovered from one of these common upper respiratory tract infections.
But for some people their impact is ongoing. Even if your throat isn’t sore anymore, your voice may still be hoarse or croaky.
So what happens to the voice when we get a virus? And what happens after?
Here’s what you should know if your voice is still hoarse for days – or even weeks – after your other symptoms have resolved.
Why does my voice get croaky during a cold?
A healthy voice is normally clear and strong. It’s powered by the lungs, which push air past the vocal cords to make them vibrate. These vibrations are amplified in the throat and mouth, creating the voice we hear.
The vocal cords are two elastic muscles situated in your throat, around the level of your laryngeal prominence, or Adam’s apple. (Although everyone has one, it tends to be more pronounced in males.) The vocal cords are small and delicate – around the size of your fingernail. Any small change in their structure will affect how the voice sounds.
When the vocal cords become inflamed – known as laryngitis – your voice will sound different. Laryngitis is a common part of upper respiratory tract infections, but can also be caused through misuse.
Viruses such as the common cold can inflame the vocal cords. Pepermpron/Shutterstock Catching a virus triggers the body’s defence mechanisms. White blood cells are recruited to kill the virus and heal the tissues in the vocal cords. They become inflamed, but also stiffer. It’s harder for them to vibrate, so the voice comes out hoarse and croaky.
In some instances, you may find it hard to speak in a loud voice or have a reduced pitch range, meaning you can’t go as high or loud as normal. You may even “lose” your voice altogether.
Coughing can also make things worse. It is the body’s way of trying to clear the airways of irritation, including your own mucus dripping onto your throat (post-nasal drip). But coughing slams the vocal cords together with force.
Chronic coughing can lead to persistent inflammation and even thicken the vocal cords. This thickening is the body trying to protect itself, similar to developing a callus when a pair of new shoes rubs.
Thickening on your vocal cords can lead to physical changes in the vocal cords – such as developing a growth or “nodule” – and further deterioration of your voice quality.
Coughing and exertion can cause inflamed vocal cords to thicken and develop nodules. Pepermpron/Shutterstock How can you care for your voice during infection?
People who use their voices a lot professionally – such as teachers, call centre workers and singers – are often desperate to resume their vocal activities. They are more at risk of forcing their voice before it’s ready.
The good news is most viral infections resolve themselves. Your voice is usually restored within five to ten days of recovering from a cold.
Occasionally, your pharmacist or doctor may prescribe cough suppressants to limit additional damage to the vocal cords (among other reasons) or mucolytics, which break down mucus. But the most effective treatments for viral upper respiratory tract infections are hydration and rest.
Drink plenty of water, avoid alcohol and exposure to cigarette smoke. Inhaling steam by making yourself a cup of hot water will also help clear blocked noses and hydrate your vocal cords.
Rest your voice by talking as little as possible. If you do need to talk, don’t whisper – this strains the muscles.
Instead, consider using “confidential voice”. This is a soft voice – not a whisper – that gently vibrates your vocal cords but puts less strain on your voice than normal speech. Think of the voice you use when communicating with someone close by.
During the first five to ten days of your infection, it is important not to push through. Exerting the voice by talking a lot or loudly will only exacerbate the situation. Once you’ve recovered from your cold, you can speak as you would normally.
What should you do if your voice is still hoarse after recovery?
If your voice hasn’t returned to normal after two to three weeks, you should seek medical attention from your doctor, who may refer you to an ear nose and throat specialist.
If you’ve developed a nodule, the specialist would likely refer you to a speech pathologist who will show you how to take care of your voice. Many nodules can be treated with voice therapy and don’t require surgery.
You may have also developed a habit of straining your vocal cords, if you forced yourself to speak or sing while they were inflamed. This can be a reason why some people continue to have a hoarse voice even when they’ve recovered from the cold.
In those cases, a speech pathologist may play a valuable role. They may teach you to exercises that make voicing more efficient. For example, lip trills (blowing raspberries) are a fun and easy way you can learn to relax the voice. This can help break the habit of straining your voice you may have developed during infection.
Yeptain Leung, Postdoctoral Research and Lecturer of Speech Pathology, School of Health Sciences, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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