The Nutritional Mental Health Podcast: How to Learn Hunger + Fullness Cues With ADHD/Autism

Stephanie: Sure, yeah. So, my name is Stephanie. I am a registered dietitian who initially specialized in intuitive eating, and over the last few years, of serving a lot of clients and based on my own lived experience, kind of have niched it down to intuitive eating for neurodivergence. So I tackle specifically things like breaking cycles of under- and overeating, binge eating, disordered eating, and kind of just help people develop more consistent eating patterns in the context of their neurodivergence.

And help people facilitate building a little bit more of a health-promoting eating pattern, but in a neurodivergent way — because I’m sure a lot of neurodivergent people can relate that the majority of nutrition information out there feels very inaccessible. So that’s kind of the work that I do with my clients — breaking under- and overeating cycles and just kind of slowly building up to a more health-promoting eating pattern. So yeah, that’s a little bit about me. Why don’t you give a spiel, just in case some of my followers are watching too?

Annika: Oh yeah, so my name is Annika. I am an ADHD nutrition research expert — so basically it just means I’ve read lots of research on ADHD. My master’s degree was in health psychology, and so I’m more of the “what do we statistically do to help our ADHD with food” — that’s more of my expertise. Which I feel like is such a dynamic duo between the two of us, because though I know how to read research, it’s not my favorite part of this work, and I’m definitely more in the behavior-change realm at this point. So it’s nice to have a resource and colleague that I can refer people to, or ask questions — I literally have asked questions to you before. So yeah, I feel like we’re such a good duo between the science, the statistics, and the behavioral side of eating as well.

Stephanie: Oh yeah, it really is great, love meshing the two. But yes, so all y’all who have questions — we’re going to be chatting a little bit more about behavior change, things to help our ADHD in general — but there is a question box if you look at the bottom right, and you all can add all the questions you want. We have a few questions that some of y’all had put in our stories, and we’ll cover some of that too, so your questions can go there. Otherwise, always, you can throw them up in the little comment section too, and we will probably see it, but might not get to it.

Annika: Yeah, so — common experiences with ADHD and food. What is it for you? ‘Cause for me it was more unintentional restriction, because it’s hard for me to eat anything.

Stephanie: Totally, totally, absolutely. Yeah, I would say that that is one of the most common eating patterns that I see — it’s the inconsistent or sporadic eating, right, where it’s like we’re going too long without eating, we are not registering our body’s cues, so we’re missing some of those typical cues from our body to eat.

We get hyperfixated, hyperfocused on things, and task switching can present barriers that make it hard, even when we do notice that we’re hungry, to actually stop what we’re doing and go do that. Also, some other barriers for consistent eating that I’ve seen with neurodivergence in general just have to do with executive functioning and demand avoidance, and just some of the hidden labor of feeding yourself on a consistent basis — I think a lot of people underestimate how much labor it takes, especially if it’s something you’re not used to doing. So yes, undereating is a very common eating pattern that I see — where we’re going long periods of time not eating until later in the day, or having some days where you eat almost nothing, and then the next day it’s the opposite. But what I also see as a result of that kind of unintentional restriction is an overeating pattern that forms, usually in the evenings, where you’ve gone all day without eating, you’ve ignored or not registered your cues, and now you’re finally in a state where you can think about food, and kind of the floodgates open, and then it’s kind of an overeating event, or even binge eating. And then you pair that with some of the other neurodivergent needs, like unmasking, stimulation, dopamine-seeking, and burnout — all of those often exacerbate those binge eating behaviors as well.

So those are the two eating patterns I see, and I most commonly see them in a cycle, where it’s like some period of time where we’re underdoing it and some period of time where we’re overdoing it. I’m sure a lot of people watching relate to that — that was my personal cycle as well, which is why — if people aren’t familiar, who are watching — intuitive eating is this concept of tuning into your body, it helps with binge eating, it’s non-dieting, it’s just figuring out how to eat in tune with your body. Well, I was a binge eater, and I was like, “oh, intuitive eating is the solution, this is going to work, everyone says this helps your binge eating.” And I started trying it, and it worked, kind of, and it did help, but I was like, no one’s talking about how hard this is.

No one’s talking about how I really don’t want to be thinking about food. No one’s talking about how much of a struggle it is to even get myself to cook, period. No one’s talking about how even after I do all of this intuitive eating stuff, I feel like I’m bingeing just because I need oral stim. There was so much that I felt was undiscussed in the intuitive eating space, and that’s when I was like, “oh, my neurodivergence needs to be addressed in this conversation.” So yeah, that’s a little bit about the most common eating patterns that I see. Would you add anything to that?

Annika: Yeah, I mean, I guess the first thing I was thinking about was — I hope that we create basically like an “intuitive eating for neurodivergence” kind of thing, right? So that dietitians can get trained in it, essentially, because intuitive eating for ADHD is really, really important — like any mental health condition, ideally we’re intuitively eating, because we are so much more susceptible to eating disorders. That is where intuitive eating is really, really important.

Stephanie: Yes, and specifically, binge eating — well, undereating and then binge eating — are more common in ADHDers than they are in the general population, and it’s absolutely under-discussed. I am currently in a coursework group with — I can’t remember her last name, but it’s RDs for neurodiversity.

Annika: Yeah, I think I’ve seen that on my page.

Stephanie: Yes, yes. She does a lot about the autism spectrum, ARFID, which I don’t specialize in, but there’s a lot of discussions that have been happening about intuitive eating and where it misses the mark for neurodivergence. And you’re right, there needs to be a resource.

Annika: Yeah, hopefully it becomes — somehow, maybe you do it, or I don’t know — but anyway. So the whole binging thing — that’s not my experience, but I know a lot of people with ADHD have that, which is really hard. So when somebody asks me “how do I work through this,” I’m like, I’m so sorry, I’ve never experienced it — I have a hard time just eating even if I’m hungry.

Stephanie: Yeah, which is my hard thing too — a lot of the people that binge eat also have that struggle. A lot of the binge eaters probably relate to those same struggles that you have when it comes to the unintentional restriction, and they don’t realize it. And tackling that unintentional restriction will likely bring a lot of positive benefits when it comes to the frequency and severity of their overeating. So I still think your lived experience is probably really relevant to them, because if you have a hard time eating consistently, you’re going to relate to the binge eaters who have those same struggles, at least for part of the day.

Annika: Yeah, for sure. I think for myself, what I’ve noticed — just from talking to other people — is that we tend to have three different areas: one is the unintentional restriction to bingeing, the other one is just overeating in general, because you’re constantly overeating, and then the third is constantly undereating, where you’re just unintentionally restricting your food because you aren’t hungry, or it’s too much effort. And what I’ve also been noticing a little bit is it seems that people who are more autistic and ADHD tend to fall more into that unintentional-restriction aspect.

Stephanie: Yeah, because there are added layers in terms of the barriers to consistent eating, right, when you think about sensory sensitivities and the ways that your processing influences the way that you perceive and interact with food. Definitely — I would say AuDHD tends to lean more into the restrictive, unintentional-restriction category, and that’s why ARFID is so common and not talked about nearly enough.

Annika: Yeah, for sure. I’m so grateful I don’t actually have ARFID — I have a lot of tendencies toward it, but I’m so grateful it’s not full-blown ARFID. That’s really hard to experience.

Annika: Yeah, yeah. So for the bingeing aspect, or the undereating and then overeating later on — I feel like one of the hardest struggles there is to understand when you’re actually full. And maybe that’s just a conversation in itself — understanding when are we actually full, as well as understanding when are we hungry.

Stephanie: Yeah — and I’ll tell you, 90% of the insight that I have, as I’m answering these questions, is from my clients’ lived experiences. There’s not a lot of evidence out there — outside of, this is what I try to find, and there’s nothing. You’d know — I wouldn’t be asking you if there was research, because I would know. So what was your question again — how do we actually cultivate those?

Annika: Absolutely — someone asked that. Someone said, “interpreting bodily signs when your brain-body connection is weak?”

Stephanie: So what I’ve noticed is hunger cues typically need to get tackled first, in some way. But obviously, with interoceptive differences — neurodivergent people in general may never have really thriving hunger cues. However, hunger cues need a consistent eating pattern in order to thrive, so I always start there. I always start there — I’ll preface and say, you know, neurodivergent folks tend to have interoceptive differences, we’re not necessarily going to know what the max level of presentness of hunger cues will be for you specifically, but I do know that if you’re eating inconsistently, that’s not an accurate measure of what your hunger and fullness cues actually are.

So a consistent eating pattern first helps to nurture more abundant and readable hunger cues. And then, once we’re there, eating more consistently, then we can kind of gauge — are you noticing your hunger, what does hunger mean to you — because a lot of times, and this goes for a lot of bodily cues with neurodivergence, it’s like nobody explains what it’s supposed to feel like — you’re just supposed to know intuitively, right? Like hunger — you’re supposed to feel it and you’re supposed to know. But that’s really not the case for a lot of us who experience those interoceptive differences. So I’ve noticed that identifying what your typical signs of needing food are — which for a lot of people is brain fog, irritability, increased anxiety, lack of focus — sometimes we can actually find other signals to lean on from your body.

And then, outside of that, you might just need some level of structure — where we aren’t depending primarily on your body’s cues, we’re depending also on some level of an eating schedule or something, if that feels aligned. But I have very rarely actually encountered that — most of the time, when me and my clients focus specifically on consistent eating, they get to a point where they do sense their hunger, at least a little bit, and enough to facilitate more consistent eating. And then we can talk about fullness cues, because as long as you’re undereating, your body’s not really processing fullness cues as accurately — so when you’re going into every meal dysregulated, you’re way less likely to notice those fullness cues.

Annika: That is so good. Yeah, oh my gosh.

Stephanie: So I don’t even tackle fullness cues, or listening to and honoring your fullness, until my clients are eating more consistently. I also love to compartmentalize stuff, so I try to make sure clients are only focusing on one thing at a time so they’re not overwhelmed. So it’s like, put your blinders on — we’re doing hunger, we’re doing consistent eating, we’re seeing what’s going on there, we’re figuring out an eating routine that works for you — and then when you sit down to eat, you’re actually regulated and not feeling crazy, and feeling so out of body and dysregulated that you can’t register your fullness. And then another thing to consider with fullness cues is that they are kind of slow to set in — so for a lot of binge eaters/overeaters, when they’re going into their meals dysregulated, they’re also going into them quickly, and they’re crushing their meal really fast, and their fullness cues are like ten minutes behind them — so by the time they finish eating, ten minutes later they’re like, “whoa, I’m uncomfortable,” and they didn’t realize that they blew past that level of fullness.

But it’s because they needed to take their time and slow things down. So a lot of the work we’re doing with fullness cues is actually just creating time and space in their meals, and utilizing whatever brain-related tools help them slow down — whether that’s optimizing some level of stimulation with TV, or phone, or stims. I have a client — yesterday, who was like, “I realize I just like to stand when I eat,” and I’m like, period, and it helps her slow down. So we just kind of explore tools for slowing down, and then we can start to notice fullness cues a little bit more. But we still might be blowing past fullness cues if there are other contributors to overeating on board, like emotional eating, needs for stimming — there’s a lot of boxes we have to check to get to a place where we’re honoring our fullness. It’s almost like a flowchart that we get to learn, as we get to learn our specific body.

Annika: Exactly — I should — that’s a great visual that maybe I should work on making, because I feel like it is literally a flowchart.

Stephanie: You should, you 100% should.

Annika: Okay, maybe I will. Freebie alert. Also, a quick reminder if y’all have questions — I see a few people put it in the question box, yes, it’s hard to go back and look at all your questions, so make sure you put it in the question box, which is down to the right on the bottom. Anyway, I just had some thoughts as you were talking, but the starting cues, or the hunger cues — you said something and my working memory is horrible, and I will just rewatch this when I put it on my page after. But — it was — no, no — was it, the hunger cues rely on consistent eating patterns?

Stephanie: Oh yeah, yeah.

Annika: And then you talked about time and stuff — that is exactly what I have to do, I have my eating windows, and I tell myself I have to eat during these times no matter what, I have to eat something even if I don’t want to, even if it feels like I don’t need any, even if I’m in the middle of a task. But the eating window helps with the task switching, because it’s not like “I have to eat at this exact time.”

Stephanie: Yeah, exactly. I have a lot of clients who use eating windows, and then they also use apps like Finch — I’m sure you’ve heard of Finch before.

Annika: Oh yeah, yeah.

Stephanie: Eat Well is another one. But yeah, an eating window, I think that’s a great recommendation, because it’s less concrete — it gives you more leeway for the task switching, and gives you a little bit more leeway in case you’re feeling really averse to food at the beginning of that window — at least you have a little bit more time to get comfortable with the idea.

Stephanie: Yeah, that’s also why everyone’s tolerance for eating when you don’t want to varies quite a bit, and why I’m constantly having to ask my clients — how does that feel, to eat when you’re not hungry, what are your thoughts about that — because the last thing you want to do, and this should always be something we’re keeping a pulse on, is creating aversive experiences with food, because the more aversive experiences with food, the harder it’s going to be to eat consistently. I also see a lot of — and this comes from internalized ableism in diet culture, and in the wellness space in general — “oh, I need to be eating these specific types of foods in these specific ways in order for them to be healthy, I don’t like these foods, but it’s what I should be eating, so I’m going to force myself to eat it” — and then that forcefulness just causes them to have a worse and worse relationship with food, and then they don’t want to eat anything.

Annika: Yep. Yeah. Yes — the whole — I mean, that’s like another conversation, how diet culture makes eating harder for us.

Stephanie: Oh yeah. And then we get analysis paralysis. And then also, we have a really hard time existing in the gray area of anything, right — a lot of us are all-or-nothing, black-and-white thinkers, at least a lot of us are — and diet culture has made us believe that your food choice is either good or bad, and there’s no nuance or gray area in that. So I have a lot of clients who have analysis paralysis around their eating — they’re also inconsistently eating because they’re trying to eat healthy, but they can’t figure out — they can’t make the decision, there are too many options, and they don’t know how to make the right decision. So then they just get paralysis about it, and then they’re like, “I’m just not going to eat,” and they feel like not making a food decision is better than making the wrong one. But I would argue the only wrong thing is to not eat when you know you need to — outside of that, fed is literally best, from a health perspective. So I see that analysis paralysis often, because diet culture is so black-and-white with things.

Annika: And then, adding in our tendencies toward black-and-white thinking in general — 

Steph: and if you’re already struggling to eat consistently, and you’re approaching this eating event hungry and dysregulated, and likely your executive functioning is on the floor because you’re under-fueled and dysregulated, making food decisions feels so hard.

Annika: Oh gosh, yes. Yeah, yeah — that’s like — where I find having a list of foods, especially breakfast foods, for me — because breakfast is so hard, it’s the hardest — but because our cognitive ability is honestly — we just have so many things going on in our brain, and so we need to reduce as much of that as possible, so that we can actually make decisions. Decisions are so hard. So having a list of things to eat takes away that thing you have to think about.

Annika: Right, you don’t have to make it up.

Steph: Right, right.

Stephanie: And that’s also why that compartmentalization I talked about earlier — where my clients tend to do really well when we pick, when I give them permission to abandon all food-related goals and focus on putting something in their body within three hours of waking. That’s like the only thing — I’m like, literally nothing else matters, just focus on that. And then we come up with a list of options for that moment, and then they get consistent with that, and then we build from there.

Annika: And that’s exactly what we need to do — I feel like that’s another area that a lot of us just have a hard time with, we feel like we can do everything all at once.

Stephanie: All at once — you can’t. You can’t, you can’t. And I mean, sure, there’s people that can, but if you’ve tried that over and over, and it’s never worked— Maybe it’s time to consider micro-steps. Micro baby steps, perhaps. Tiny steps.

Annika: Yeah, I feel like my husband, every single time I try to do a huge goal or something, he’s like, “Annika — are you sure that’s how you want to go about it?” And you’re like, “yep, I can do it, I can do everything, I can completely change my life, this is not a huge goal” — and then — yeah, no, it’s a big goal. Yeah, that is. Yes, I mean, we’re just not the best at estimating ourselves. Oh no, I think that’s kind of what it comes down to.

Stephanie: Yeah, accurately assessing our bandwidth.

Annika: Yeah, for sure. I mean, that was literally me today — I have a few projects I need to get done, and they’re kind of on a short time span, and one of them is like, this seven-email sequence, and I’m like, okay, I wrote in my to-do list “email sequence” — like that’s not seven different emails, I wrote one task as that. And then I looked at it and I was like, I’m so overwhelmed, and then I deleted it and wrote one email, and I was like, “oh, I feel so much better” — like why do I do that to myself, even now. But at least there’s a level of awareness where I can go back to the drawing board now and go, I don’t have the bandwidth for that, what was I thinking.

Stephanie: Yeah — but there’s — when you are — this is one of the biggest struggles with a lot of my clients too, is how much internalized ableism they are living with, and how unaware of it they are — because it’s one thing to have that internalized ableism and then go, “oh, that’s ableism, let me pivot.” It’s another thing to not even realize that the dialogue you’re entertaining, and all this guilt and shame that you have about not being able to do things in a certain way, is informed by an oppressive system, and is doing you absolutely no good. So that’s one of the biggest things I’m working through with my clients on a day-to-day basis — just helping them reconsider their expectations.

Annika: Yeah, yeah — I mean, that’s — where I really appreciate conversations like this, because y’all know that we are some of the experts in this, and yet we still struggle so much.: Yeah, like you can know all the things — all the things — and still have — because it is a disability.

Stephanie: No, truly, it is. And a lot of times, people or clients will ask me, “oh, how have you gotten to a point where it’s just so managed?” And I’m like, one — slow down, so slow down. And second of all, I just have a lot of privilege — that’s also what it is for me. I own my own business, I have flexibility in my hours, I have flexibility in the amount of work that I take on at a given time. I had access to therapy for long enough to help me understand my cycles of hyperactivity and burnout, so that I could prevent them. I also moved to a desolate area where I’m not overstimulated and can go touch the grass when I need to. I have a lot of privilege that allows me to manage — but that’s just not the case for everybody. And if you need more tools and more accommodations, then that’s what you need. The struggle with the internalized ableism is clients do not want to own their needs — there’s a lot of guilt and shame for having them, in general.

Annika: Yeah, yeah, wow — that was a good soapbox right there. Oh, I mean — so much of my ability is honestly the fact that I’m living with another person who cares about me.

Stephanie: Oh my God, no, I should have said that — my boyfriend is so helpful, he does like all the dishes, he does all the laundry — there’s things that he makes my life a lot easier. So — agreed, yeah, yeah.

Annika: Yeah, seriously — I think it’s also that queueing, which is where living with another person is helpful if you have ADHD and you struggle with eating. Yeah, because even when I have — I have to eat between these times — if I don’t have another person around me, it’s like an external motivation part, you know.

Stephanie: Oh, absolutely, the queueing is huge. Oh my God, the queueing is huge — the amount of time that we’ve been like, “okay, we’re gonna go do this,” and I’m like, “really?” He’s like, “yeah,” I’m like, “okay” — and then I do it, I’m like, this isn’t that bad, I’m glad you told me to get up and do it with you.

Annika: Thank you — like, exactly. Yeah — or he actually helps me understand my hunger cues, actually, which is really — I mean, he’s just wonderful, I love him so much. But I’ll tell him, like, “oh my gosh, I feel so brain-foggy right now,” and he’s like, “Annika, when did you eat?” And — well, you’re right. Or I’ll be really irritable, and he’ll be like, “when did you eat?” That’s men’s number one response. Or, “you need some water, you should drink some water, you should eat, drink some water” — which, when you’re dating or married to someone with ADHD, that’s probably not a bad suggestion — do you just need some water?

Steph: You’re like, “wait, maybe actually — maybe, maybe I do.” Yep — 

Annika: oh, he also helps me navigate a lot of the pathological demand avoidance aspects of eating. Ever so often — I’m super curious if anyone else has experienced this — sometimes when I’m eating, I’ll feel like I literally can’t eat anything else, if I put it in my mouth I just can’t, no matter what, even if it’s something I love. Some days it just happens where I just can’t, and then I’ll say, like, “oh my gosh, this is so stupid, I hate that I’m like this” — and then he’ll be like, “yeah, it is stupid,” and then I’ll be like, “you know, no, it’s not,” and then I can eat it. You’re like, “wait a minute, that’s rude” — and he’s like, “that’s my point.”

Annika: Yeah. I feel like another weird thing that I struggle with is sometimes it gets boring — just, like, even bringing up the thing, or chewing gets boring.

Stephanie: Absolutely — yeah, you do have — you def do have ARFID-y vibes, like you have some symptoms that are similar to it, at least — so I could see how consistent eating could be a really big challenge for you. Do you have a lot of safe food options that are — not chewy things you don’t have to chew?

Annika: I definitely resort to liquid nutrition.

Stephanie: Say what’s your liquid nutrition game — you got liquid nutrition on deck?

Annika: Oh yeah, I make myself a lot of smoothies, love a smoothie. And well, that was a question that somebody had in a story — what are some good recipes to use — and liquid nutrition is honestly so great. What I do is soy milk, Greek yogurt, cocoa powder, peanut butter, and maple syrup — blend that all together, put a straw in it, love — and I will just drink that, and it’s like 600 calories, which is great, because I need calories.

Stephanie: Yeah, yeah — I have a post on my feed, you have to scroll a little bit down, but it’s about liquid nutrition and smoothies, and I have my smoothie recipe template — if anyone’s watching this and you want it, just DM me and I’ll send it to you. I have a template that’s basically all the different food groups, and how to turn a smoothie into a meal, and get some level of complete nutrition from them. So these are such valuable tools for my clients — those, and meal-replacement supplements, oral supplements, and things — which again, internalized ableism starts to come up, where they’re like, “well, I shouldn’t need that long-term.” And it’s like, what — we don’t “should” on ourselves here, we just give ourselves what we need, and if something like an Ensure is going to give your body the nutrition it needs to function, then that’s what you need. Or we can fight tooth and nail against these needs, and stretch out this struggle for months to years, denying our needs. And here’s the thing, specifically with consistent eating — the most important thing is to break the cycle of undereating in whatever way you can, because the more you undereat, the worse your symptom presentation — the worse the food aversions, the worse the food anxiety, the worse the executive functioning, the worse the decision fatigue. So whatever you need to do to get nutrition into your body, in some way, shape, or form — and releasing expectations of what that looks like — the more likely you’re going to be able to build more consistent eating patterns, and eventually maybe start cooking a meal, or having less liquid nutrition, if that’s a goal of yours, which it doesn’t need to be, but it can be. But a lot of times we look too far ahead at what we want our eating patterns to look like, instead of looking at what we need in order to break these cycles.

Annika: Yeah, yeah, definitely. Someone had a question about — are smoothies okay, because they break down the fiber?

Stephanie: Oh yeah — I’m 90%, they correct me — as long as you’re not juicing, you still have the fiber, it’s just — your body, when you blend it up, it’s like your mouth when you blend it up too, because your mouth is actually the part that does the majority of the breaking down of the starches, specifically. So yeah, the fiber is totally adequate in a smoothie. I will tell you, though, because the majority of your starch-digestive enzymes — the amylase — actually are in your mouth, not in your stomach — if you’re doing smoothies and you notice any type of digestional distress from them, switching from a straw to a spoon can help mix the saliva a little bit more and get more of those digestive enzymes in your smoothie, so you’re not experiencing bloat or indigestion. So that is really all I would say, but absolutely, the fiber is still adequate, and all the health benefits that come from adequate fiber intake are still there when you have a smoothie.

Annika: Awesome, yeah, perfect. Yes — and then I feel like the last weird thing — I don’t know if you’ve ever encountered this, but sometimes when I eat food and I get to that point, I will start to get an irrational amount of energy inside of my body, where I just want to hit my plate or something like that.

Stephanie: I was just going to say — do you feel like it was heat, or anger? Because I hear heat sometimes, I hear anger — I think a lot of times, maybe it’s unresolved anger.

Annika: I know that that is an emotion I do not experience.

Stephanie: Yeah, I mean, it’s probably frustration — it’s probably all of the things — I wouldn’t be surprised if it’s this suppressed rage, because — again — the PDA that’s surfacing for you with eating — there’s got to be some rage in there, with just the frustration that this is something you have to do.

Annika: I hear a lot of “I have to eat.”

Stephanie: Yes — I have a lot of clients come to me and be like, “could I just — I literally wish I could just be tube-fed.” I do wish that. And I completely understand that need, that desire — because when you get to a certain point where you and food are just — there’s beef there. No pun intended. Yeah, so — you’re definitely not the only one that probably has that desire. How do you usually handle that, in that moment?

Annika: I would usually tell my husband I want to hit my plate, and then he tells me, “okay, hit the plate,” and then I’m like, “okay, I’m not going to” — now it’s a meme, he knows.

Stephanie: Yeah, funny. Well, maybe you need to do a little somatic release.

Annika: I might, honestly — I feel like I should journal after this now, figure out what the heck is going on

Stephanie:  — this is a— this is a subcategory, or— Not subcategory, but a topic that I’ve been getting increasingly curious about, over the last year or so, in talking to a lot of my clients, is this — somatics, and how intertwined I think they are with neurodivergence and our need to release energy. So I’ve been recommending that a little bit more for clients, and referring them to a couple of providers that I know who do different types of somatics. Yes — I even heard that smashing fruit with a fork is not as good as eating the entire fruit. Oh, sorry, I got distracted, I thought that was about what I was saying. Anyways — yeah, like that literal physical, pent-up energy sometimes needs to just be let out — maybe you need a little pillow scream, or a pillow punch — to — maybe I do.

Stephanie: @The Untamed Herbalist — I follow her, her name’s — I forget — she talks about this a lot. She talks about hidden rage — she’s more like a PTSD/C-PTSD trauma provider, but she talks about needing to punch a pillow, or scream into a pillow. She also twerks for somatics a lot, so she dances and things — and I’m like, she’s on to something, she’s definitely onto something. So yeah — do a little journaling and see what you kind of need in those moments — I think being curious, right, like, something’s happening, something’s surfacing.

Annika: Yeah, yeah, something is.

Stephanie:  Yeah, don’t ignore it. Wow, this is — frustrated a therapy session for me on live. Great — you’re like, “I have another question,” so sometimes I do this.

Annika: All right, speaking of questions, though — let’s get into those. Make sure that y’all put questions into the question box, because I will start going through them.

Stephanie: Yes, let’s do.

Annika: And — right now, so let’s start with this one here — wait, if I tap it, do you see it? No —

Stephanie: You’ll have to read it.

Annika: Oh, dang it — it says if I tap a question, people can see it. Oh, that’s so annoying. Okay, anyway — the question was: “I like the idea of eating windows, how big of a window makes sense?”

Stephanie: Great question. I think it depends on how many windows you have, right — like, do you do three, four — what do you do?

Annika: I personally do three, because more than that is harder for me. Ideally we’re not just eating three meals with ADHD — ideally we’re eating throughout the day. 

Steph: But yeah, totally, most of my clients end up needing — and if you’re an overeater, add a snack to this, at least one snack, to my recommendation — but the majority need at least three meals, usually with one to two snacks as well. But I do have some clients who prefer to do four meals — they split up their midday meals, because that makes sense, or they do kind of like a smaller, appetizer-like breakfast, and then something a few hours later, because that makes sense. So I would say it depends on your wake window, because you do want to spread this out across your wake window, and then three to four windows of time — a few hours — what are your windows like?

Annika: Three — yeah, my windows are two hours. So my window is about — because I usually wake up around 7, it’s like 7:30 to 9:30 is my window, and then 11 to 1, and then 5 to 7.

Stephanie: Okay, yeah — so I would say two- to three-hour windows are pretty appropriate, and again, you’d want to be basing that off of your wake windows. A lot of times people ask me, “what time should I be eating lunch,” and I’m like, “I don’t know, what time do you wake up, what time do you go to sleep” — this has nothing to do with the time of day, and everything to do with how long you’ve been awake without eating. So yeah, I would say two- to three-hour windows, three to four windows, from when you wake up to when you go to bed.

Annika: Yeah, okay. Um, the next one was — ADHD and diabetes, do you know anything about ADHD and diabetes?

Stephanie: The intersection between them, or — I know a lot about diabetes, I worked in a diabetes clinic.

Annika: I guess — so the question was “ADHD and diabetes?” — it’s such a struggle, I forget to eat for like 12 hours and then forget to bolus.

Stephanie: Yeah, oh yeah, okay, I could see that. Yeah, I mean it’s funny, ’cause my recommendations are going to be very similar.

Annika: Oh, I can see the question now — “such a struggle, I forget to eat for 12 hours, then forget to bolus.”

Stephanie: Yeah — similar to what we talked about earlier, about figuring out how to just eat consistently, in whatever way that makes sense — because, they’re saying they’ve got to get — I don’t know if they have a reminder app or anything, but they might have to habit-stack, or figure out a way to be more consistent with the bolus. But for inconsistent eating — if you’re forgetting to eat for 12 hours, then definitely I would put the blinders up there and focus on increasing the frequency of eating, because that’s going to help with stabilizing your blood sugars. That’s a thing — I have a couple of clients with pre-diabetes or diabetes, and they get very overwhelmed, because they’re bingeing/eating and now they’re also supposed to be thinking about blood sugar and all this stuff — and I’m constantly telling them that inconsistent eating patterns are to the detriment of your diabetes just as much as making the “wrong” food choices. So don’t worry about the specifics, and focus on a consistent eating pattern first — especially if you have type 1 diabetes or insulin-dependent diabetes, where you need to be dosing — I would definitely focus on how to create a more consistent eating structure by slowly building up to it, and then worry about more specific nutrition/blood-sugar-balance stuff after that.

Annika: That’s really good advice, in general. But yeah, a lot of people with ADHD do have a higher incidence of diabetes — we don’t know what it’s about exactly. Yeah, there’s a few main theories — one is ADHD just tends to lead to behaviors that could induce diabetes.

Stephanie: Yeah, there’s some genetics that are similar with ADHD and diabetes as well. It’s, like everything, probably both genetic and behavioral — and then when you think about chronic illness rates in general, and ADHD presentation, and the chicken-or-egg conversation about that — I know diabetes is part of that conversation in terms of trauma too, so I’m sure there’s a trauma conversation in here as well. Yeah — someone said, “is the incidence higher because sugar gives dopamine?” I would argue no, because diabetes isn’t just about sugar consumption, it’s a little bit more complicated than that. So I wouldn’t say — I mean, sugar intake amongst ADHDers, yes, that’s definitely something, but I don’t think that’s what’s causing the rates of diabetes to be —

Annika: Yeah, no, I wouldn’t say so either. In fact, what we actually see is that even though people with ADHD tend to eat more sugar than the general population, it’s not increasing their ADHD symptoms — so really what that kind of means is that people with ADHD just might need more sugar.: Yeah, or they might need to eat more regularly.

Right — which is why we say eat at least three meals a day, ideally maybe four to five. 

Stephanie: This is why it’s so funny, because I feel sometimes like I’m just saying the same things over and over, and I hope people understand I’m not just saying this to say it — but this is why focusing on a consistent eating pattern is the number one thing to start with, because it’s so hard to even interpret what else is going on with sugar cravings or whatever, when your body is just underfed.

Annika: Yeah, yeah — I’d also argue another aspect would be, people with ADHD just tend not to eat as many fiber foods.

Stephanie: Oh, totally, totally — and then, because a lot of nutrition information is so inaccessible, a lot of us don’t find it feasible to be able to implement nutrition principles and eat more fiber. Every time I have a client where we’re inching our way toward talking about nutrition, there’s always this initial fear of, “well, I already know I don’t like a lot of healthy foods, I have the palate of a kid, and I know I’m not going to be able to eat all these things — I’m not going to be able to eat the fruits and vegetables” — and there’s so much fear around it, because they’ve only really ever been exposed to one way of healthy eating. So I would definitely agree with you that fiber intake is probably a lot lower.

Annika: Yeah — a similar question here is: “I went off sugar for at least two weeks and my emotions were all over the place, can you explain?” Do you have thoughts?

Stephanie: I do, but I don’t know how to word them. Do you have something initially you want to say?

Annika: I mean, I guess it kind of goes back to what we were talking about a little bit — sugar is our body’s main source of energy, right — Yeah, that is what it is. In general, we don’t want to overeat added sugar.

Stephanie: Yeah, and I’d be curious, when they went off sugar, are they just referring to added sugars?

Annika: Yeah, that would be a question — it’s really hard, because personally, I would just reduce sugar intake if you’re working on that — cutting out sugar completely is a shock to your system.

Stephanie: Yeah,

Annika:  it’s a complete shock — it can likely result in emotional dysregulation, because your body is used to something, it’s used to having a consistent amount of a certain type of energy. And then you take that energy away, and now your body is trying to reconfigure itself, to figure out “why am I not working the way I was working” — right, like, why is the person feeding me not giving me what it usually does.

Stephanie: Absolutely — and then, also, I’d argue that cutting things out completely — and someone said it feels like an addiction detox — the thing about sugar is, it’s not — there’s nothing being “detoxed,” and there’s no “after a certain amount of time you start to feel better.” The likelihood of cutting something out completely inducing a distorted relationship with that food, where you just start to overeat it afterward, is pretty high — the majority of people who try to cut out sugar, especially for a temporary amount of time, thinking it’ll be more like a detox, end up usually just craving it a lot more at the end, and once they give themselves permission to have it again, they feel very out of control around it. So, especially with ADHDers, and the higher prevalence of binge eating and overeating behaviors, I really wouldn’t recommend taking restrictive approaches to decreasing things like sugar.

Annika: Yeah, I feel like that encapsulated pretty much everything. Yeah, yeah, yeah — I know someone asked about sugars, like what are good sugars, bad sugars — obviously sugar doesn’t have morality, food doesn’t have morality. Yeah, it’s less about “bad sugars,” and more about how much sugar — and it’s not just about how much added sugar too —

Stephanie: Right, the context you’re having it in also matters — is your diet void of fiber, are you pairing things with protein — there’s a lot of other things to consider too, outside of, sure, added sugar is the thing we’d want to be looking at, and if we’re going to decrease anything it’d be decreasing the amount of added sugars — but there’s still a place for added sugars in your diet, especially if you’re pairing them with things like proteins and fiber, and overall having a balanced diet.

Annika: Yeah, and that’s what we see in the literature too — it’s less about how much, honestly, unless you’re going way over the recommended limits —Yeah, and more about how much you’re having at one time — 

Stephanie: which is why focusing on consistent eating patterns is so helpful, because that’s the issue with most of my clients — they’re like, “I’m eating so much sugar,” and I’m like, well, you’re eating so much sugar all at one time. That’s actually — I don’t know if you saw my post about the Oreos and the protein ice cream, did you?

Annika: I did, and it looks so good.

Stephanie: I posted, like — “adding three Oreos to your protein ice cream is unhealthy” — and I said, I used to eat an entire container of Oreos in one sitting, so I think I’ll live. And that, I feel like, also encapsulates this conversation about sugar — it’s like, well, yeah, but it’s not like adding a little bit of added sugar to something is where the harm lies — the harm lies in the fact that we’re sitting down and feel so out of control around these foods, that we don’t know when to stop, don’t know what context to eat them in, and to make ourselves feel comfortable and good. So yeah, that just made me think of my post.

Annika: Well, if anyone just has a desire to decrease their sugar intake — honestly, that’s the first thing you’ve got to know: the most important thing is not having a lot of sugar at one time.

Steph: Yeah, like our brain —

Annika: Yeah, just spread it out throughout your day before you try to decrease it in general.

Annika: Yep — and then maybe, as you’ve been doing that, then maybe you can try to decrease a little bit of your sugar intake. But if any of y’all want to know the reason why it impacts ADHD — when we binge, whether that’s sugar or just overeating in general, over time that impacts our D2 receptor in our brain. The D2 receptor is the dopamine receptor — we have a lot of dopamine receptors, but it’s one of them. Yeah, and basically it just makes us less sensitive to dopamine over time — so this is where, again, eating consistently is super duper important, because then it can help reverse a little bit of that.

Stephanie: I so love when I’ve found something to be so consistently true amongst my clients’ lived experiences, and then I see a post of yours and you’re like, “here’s a research article” — and I’m like, “see, I knew it,” I knew it was there, I just didn’t go looking for it myself. Shout-out to Annika for finding the science behind this.

Stephanie: I’d want to see that — that sounds so cool. Maybe soon I’ll be doing one that I can sell, maybe.

Annika: Yeah, that’d be so cool. But yeah — that is everything, thanks so much for joining, all y’all.

Annika: Thanks so much for listening to this episode. I hope you were able to get something out of it that helps you understand how to cultivate more of that bodily intuition — with hunger cues, fullness cues, and a lot of those other experiences that we have with food and ADHD. The best thing you can do to support me is subscribing and liking this video if you’re on YouTube, or if you’re listening on the podcast, please be sure to follow and give it a rating, because that really helps push out this information so more people can see it. Thanks again for listening, and I’ll see you next time.