INTRO: YOU ARE NOT LOSING YOUR MIND
Megan: Hey, I’m Megan Pfiffner, and welcome to Mornings with Megan. Grab your coffee and let’s have a convo.
Amy Jones is a certified functional nutrition practitioner, certified ADHD life coach, and certified Ontario teacher, currently completing her MSc in applied neuroscience at King’s College London. After 20 years teaching, Amy hit burnout in perimenopause while raising two young kids, and it was that season that she finally got the diagnosis that had eluded her for so much of her life: ADHD at 45, after years of being diagnosed with everything else first, and after her son was diagnosed before her. Her work looks at how nutrition, executive function, hormones, and ADHD show up together in midlife women. She builds food systems that still work on the days when planning, focus, and energy have run out, not just on our best days. Welcome to the show, Amy.
Amy: Megan, I am so excited to be here. Thank you.
Megan: I’m so excited for you to come. We have so many women in our audience who are living in this space and you’ve figured it out, and I think a lot of them think they’re losing their minds. So I’m so glad you’re here today to hopefully tell them that they’re not losing their minds.
Amy: They are not losing their minds. It’s so true. Yes.
Megan: That is the most important part.
AMY’S STORY: A DIAGNOSIS AT 45
Well, I would love to get a little history about you and sort of your origin story, because getting diagnosed at 45 kind of feels like you spent a lot of time spinning your wheels trying to figure this out. So what was actually happening in your body that eventually led to you getting the correct diagnosis?
Amy: Yeah. And I think that’s where it was so difficult. You touched on it earlier in terms of what I was already doing. I was a teacher for twenty years, and I was sort of compensating the whole time, just trying to be hyper-organized and one of those students who was excellent and could just do all the things. But I didn’t know at that time that I was compensating for so many things, and I just took that with me throughout my life. What did show up was anxiety and depression and all kinds of other mental health diagnoses, all kinds of different medications. I literally think I’ve been through every single one possible, every type of therapy, all of the things. Not saying that none of those things helped, but I think what I didn’t know then, and what helped me understand more clearly once I hit perimenopause, was that there was also something else that was being missed in terms of ADHD.
The reason I figured that out is because my youngest son was diagnosed with that. His first grade teacher, who was amazing, pegged it right away, probably within the first week of getting to know him. At that point in my life I didn’t know anything about ADHD. I’d sort of learned about it, but not really. And especially as a teacher, you’re not really given the education to understand what it looks like and how it presents in that level of depth, in my case anyway. So once that happened and I started doing the research, I was like, wow, this is more heritable than cancer in a family, which is true. It’s kind of mind-blowing when you think about it that way. And I was like, hmm, who could it be? It’s me. So that’s where it’s definitely, definitely not my…
Megan: Surprise.
Amy: …tax professional husband, right? Definitely not.
Megan: Yeah.
Amy: He’s a wonderful guy, and he’s super funny, great sense of humor, athletic, wonderful. Lots of stuff going on with him that is great, but he’s not boring, that’s what I’m trying to say. But I definitely was like, this is me. And then that’s where things started to shift for me.
I’d always been really interested in nutrition and health and wellness in general. And I’ve always moved my body. I’ve always had to. I’ve been active my whole life. I was a dancer, I was into sports. I live at the gym in the morning because that’s what my brain needs in order to work. And so I think a lot of that kind of hid and helped me manage some of the traits that might normally come up, I guess.
And also, you know, that diagnostic criteria was made for boys. So that wasn’t going to work for me. And it’s really only in the, gosh, 2006 or so that we’ve started to understand that ADHD doesn’t just happen when you’re a child. It actually happens and it stays with you through adulthood, because it was believed for a very long time that once your prefrontal cortex is fully grown, you grow out of it. That’s not the case. So it was only recently recognized. And now I think our voices, especially us with perimenopause, are giving that more visibility and allowing us to take a good look like I did and figure out, wow, maybe my brain works this way instead of the way I always thought, and that’s why everything was so flipping hard.
And I’ve been holding on for dear life for I don’t even know how long. And then as we hit perimenopause, all of those things become much louder because of our hormone fluctuations. So I don’t know if I answered your question, but that’s kind of where I’m coming from here.
WHAT THE DIAGNOSIS CHANGED: SEEING THE MASKING
Megan: You did. How did this diagnosis change, and you touched on it a little bit, but reframing and thinking about years of teaching, parenting, and everything beforehand? Because it sounds like you had some frameworks that were sort of what you knew instinctually you needed, but then after getting this diagnosis and those things making sense, how did that kind of change the way you saw everything that you’ve been doing for years?
Amy: Yeah, it really shone a light on my masking, or compensating, and what those behaviors were. Like the perfectionism, for sure, and the people-pleasing. There are so many pieces of this, just so that I could show others that I could actually do it, even though it didn’t feel good. It didn’t feel like I was actually doing anything of value. And it took me so much more literal physical effort, mental effort, and emotional effort just to get my homework in on time. And I didn’t know that no one else was feeling that way. So now it has given me that lens, and it also gives me that lens with both of my children, and I think that’s so invaluable to understand it more clearly.
Even when we start medication with ADHD, often we start and we just sort of see how we react. We look at how it makes us feel. I tried a couple of them, I’ve landed on one, and I’m just like, this is what it can feel like. This is what other people walk through the world like? Wait a second. So I think that was really helpful too.
Megan: It feels so unfair, and as you mentioned before, I think that when children are in this space, girls mask it better than boys because of the way we’re socialized, and just the way that our brains develop and what we’re focusing on with our families and our roles in society, for the better or for the worse, the things that we are taught to do. A lot of that people-pleasing and tending and befriending turns into a way to cover it up, because we’re trying so hard, as you said, to please everyone and prove that we can do whatever it is that we need to do. That can just cover up so much of the behind-the-scenes quiet work that we’re already expected to do as women. But then if you have this ADHD piece on top of it, that just gets exhausting.
Amy: Yes. And then we add in perimenopause, and it’s so similar to me, especially with the awareness we’re building now, and the more understanding, the more studies, starting now, more often, for women, that weren’t there years and years ago. But it’s kind of similar to that. We’re walking around in perimenopause, whether or not you have ADHD, feeling like, my gosh, there is something really off here, and why doesn’t anybody help me? It’s not just, here’s an SSRI. There’s something more. It’s really understanding the underlying structure, the underlying mechanisms around what ADHD is and how it operates in the brain. And it’s not a deficit in any way. It’s just a different way of moving through the world.
And so redesigning that has been life-altering, and that’s why I do it now for everybody else. That’s how we roll, because I don’t want anybody to have to go through this. This is not fun. And I think that’s where we align so similarly, too. But I think the ADHD piece that is really starting to show a little bit more, especially for us in perimenopause, is a really important link between the two, for sure.
WHY PERIMENOPAUSE UNMASKS ADHD
Megan: So why is it that perimenopause is when so many women actually get diagnosed for the first time? What is unmasking all of these symptoms?
Amy: Yes. It’s our lovely friend estrogen. I love her. She’s so great.
Megan: She is so wonderful. Well, when she leaves…
Amy: When she’s like, I don’t feel like it today, but maybe tomorrow. I don’t know. We’ll let you know. It’s definitely estrogen, progesterone, testosterone, and all of them have an effect, and it’s really more about the fluctuation and the inconsistency. That is what we see outwardly and what we’re struggling with, right? So estrogen, we have estrogen receptors on our neurons, our brain cells. And estrogen is protective, and it helps to regulate so many things, our metabolism, but also dopamine. It helps to regulate how much dopamine gets released. It slows how fast it gets cleared away between the synapse. And for most of our adult lives, if we think about it that way, estrogen has been sort of topping up some of this. So in a way it was easier to mask or easier to just push through our whole lives. I think that’s a big part of this.
So as soon as that system starts to be a little bit inconsistent or not as much, that’s when we’re going to start to notice either brain fog, irritability, frustration with whatever it might be. Maybe, if we think about our executive functions, so planning or organizing, working memory, and walking into the room and not knowing why you’re there, that can really start to shift. A lot of those things definitely are part of perimenopausal symptoms, but they become really intense, and those are ADHD traits. So those can definitely rear their ugly head around perimenopause.
I think this combination between women not being recognized for specifically how ADHD may present in them, women and girls, and then also perimenopause colliding, I think we’re in an interesting place. And I think that we’re the people who need to make it very clear what the difference is between perimenopause and just ADHD in that sense. And then future generations won’t have to do that, and we will have a little bit clearer understanding about how to differentiate between the two and really understand what’s going on inside of our brains and our bodies, for sure.
PERIMENOPAUSE OR ADHD? UNTANGLING THE TWO
Megan: So is that question still pretty hard to untangle right now, the difference between a woman who’s in perimenopause and a woman who’s in perimenopause and has ADHD?
Amy: Yeah, I think so. A lot of the women that I work with come to me and they’re seeing what feels like 87 different specialists, and not a single one of them has put the pieces together or spoken to each other or communicated. With ADHD, that’s really difficult to manage, right? Even just to take in what a doctor might be saying to you in any given moment. So often I end up acting as a person who pieces everything together. It’s like a big puzzle, and we try to put it together. I often even support them with, not so much scripts, but a bunch of bullet points you can have in your hand and read to this specialist or that one, just to try to get some answers based on everything else that might be going on. I think that is a big barrier as well.
I think also, looking at it, definitely in my case, mental health history and the extreme of it. With ADHD, it’s about the level of impairment that some of those traits might create and how they show up in your life. A good practitioner, a good doctor, somebody who has an understanding of neurodivergence, can see that and will recognize that, and not necessarily put you on an SSRI if they don’t think you need it, but will then refer out, or, if they can, depending on their expertise, look at medication or look at other resources to support you in that way. So it’s difficult, and there aren’t a ton of practitioners out there who have this level of expertise to do the weeding. What is it? Is it perimenopause? Is it ADHD? Is it both? And that’s tough. But that’s what we’re doing, right? That’s what we’re learning.
Megan: And it seems like with ADHD there’s a lot of things that tend to travel together, like anxiety, a later circadian rhythm, trouble sleeping, which can lead to depression. A lot of these things compound, and it seems like a lot of those are dismissed as just other mental health issues, versus what you’re saying, putting this together as a holistic picture. Because I work with women in a very similar way to you, where they come in and they’re just like, I’m seeing 87 people, I don’t know what’s happening, I’m not sure, is it perimenopause, I don’t know. And so giving them that script or those points, like, these are the questions you need to ask. This is the type of person that you need to see. This is how you address this with your insurance. Those things matter, because when your executive function is not topped off, and you add perimenopause and ADHD on top of that, how is that person showing up and functioning in the world and streamlining all of this information so that they can get the help and advocate for themselves? It’s like they need a standalone advocate.
Amy: Yeah, it’s so true. And I feel like that’s a whole other business idea.
Megan: Yeah.
Amy: But seriously, because I feel like that’s the majority of the time that I’m working with a woman, is managing all of this. They might be seeing a naturopathic doctor or their GP, and depending on what HRT is happening, if it is or not, and all of the things, and other interactions with other medications and how this is all working, and, are you even drinking water? Is that happening? And how do we figure that out? I really do think it’s this holistic lens that you definitely have and that so many of us are in need of at this time, for sure.
Megan: Yes, I think there are a lot of women that need someone to be in their corner and say, let’s look at all of you and not just this little sectioned-off piece of you, because it’s all connected.
ADHD MEDICATION, APPETITE, AND SLEEP
So let’s jump a little bit into some of the ways that women are showing up with this and how it’s addressed. One of the things that you mentioned earlier is ADHD medication. I know with that there are some symptomology things, especially when it comes to nutrition. So how does ADHD medication change appetite, blood sugar regulation, sleep?
Amy: Yeah, that’s a big one, and I still struggle with it, even though I help lots of people with it every day too. It’s not an easy thing, because that medication can definitely suppress our appetite as a side effect. For some people that lasts the entire time they’re on that medication. For some people it actually subsides and things are a little bit easier. But I think the first thing that I definitely see, and I know you’ve talked about this many times, is that in perimenopause, we are not eating enough. There’s so much there that is underlined from history and how we grew up and how we were socialized, and trying every diet on the planet, thinking that it was going to be the thing that finally worked, and then it didn’t. And then sometimes we just end up backing into, well, calories in, calories out. And it’s not like that, right? I’m not going to say it’s not entirely like that, definitely, but it’s so much more complex and there are so many other layers, especially for us, with these hormone fluctuations regularly.
So I’m always starting by looking at those patterns, especially when medication is there, because that medication flips us into the side of our nervous system that doesn’t allow us to really tune into our interoceptive awareness. So, those hunger cues, and I have to pee, and I’m thirsty. Those are already something that can be challenging to recognize with ADHD, because we’re thinking about a lot and doing lots of different things at once, often, so we don’t notice those things anyway, but that really can be amplified with medication.
So often what we will do is start to look at where we can put nutrition, where we can put fuel. That’s what I usually say: throughout your day, so that by the end of the day, when your executive function is totally drained, or hopefully not completely drained, that’s our goal, to try to shift some of that a little bit, so that you don’t end up at that dinner time moment and not want to cook or eat or do anything. So often it’s, you need to take your fuel medicine. You need to take your food medicine. It can be two almonds. I don’t care. Let’s just make sure that we’re getting something in our body to signal to our nervous system that we are not in constant fight or flight, or freeze mode, and that we actually are safe to literally do the processes we need to do in our body, like metabolism, and make energy and get it up to our brain. Otherwise, that’s where we can often struggle, especially if we’re not eating regularly enough.
And I think that’s probably the first thing I see: but I don’t do this, or I’m doing fasting, or I’m doing that, or, nope. Let’s just look at how we make these into mini meals throughout the day that are easy. That’s the thing that we focus on.
BLOOD SUGAR AND FOOD-SPECIFIC SYMPTOMS
Megan: Do you see any food-specific symptoms that show up with ADHD and perimenopause together?
Amy: I would say the food-specific one is definitely blood glucose. That is the number one thing. So balancing our blood glucose levels, keeping them as steady as possible, and all that means is, it’s going to rise when we eat. That’s normal. We want that. But that crash afterward, we’re so much more sensitive to that with the fluctuation in estrogen, because estrogen helps to manage when our liver and our muscles are being activated in order to release some of that glucose for energy. So it’s already difficult, and if we then are restricting, we’re creating this opportunity, this hamster wheel, where our blood glucose levels are constantly shooting up and then crashing, and then that’s when we’re going to be craving refined carbohydrates, and that could be throughout the day. And if we didn’t sleep well the night before, my gosh, that’s what’s going to happen the next day, and then we just perpetuate that same cycle.
So really thinking about where, how often, how steady is my eating pattern throughout the day? Where can I put nutrition, even if I’m not hungry, and this often is the case with medication? We need to get something in us before we take that medication. I don’t care what it is, to be honest with you, as long as it’s balanced. And yes, protein is a big thing, but it doesn’t have to be a three-course meal. It just has to be a handful of something or a couple scoops of Greek yogurt. That’s it. It doesn’t have to be a big deal.
And then even if we don’t want it, we keep that pattern going and attach it to other things throughout the day, so that those opportunities are made really easy for us and we just keep it going. And then our body is like, yeah, okay, I’m getting the fuel I actually need. It’s not an emergency. I don’t need to spike my blood glucose levels in order to make sure my brain is working, because that’s what’s happening. Your brain is yelling at you, and then that crash happens again and that cycle keeps going. So it’s really about managing our blood glucose levels, I think, from a physiological standpoint. And then moving on to, how do I do that, Amy? That’s what I get also with neurodivergence. You can tell me to drink water all day, but tell me how I’m supposed to do it, you know?
UP NEXT IN PART TWO
Megan: Understanding why this is happening doesn’t automatically tell you what to do about it. That’s exactly where we’re going next. In part two, Amy walks through her actual frameworks: the low, medium, high lift system for figuring out what you actually have capacity for on any given day, and a four-question method for redesigning any part of your routine that keeps falling apart. That’s next week on Mornings with Megan. I’ll see you then.
Can you do me a favor? If this episode gave you something to think about, share it with one woman in your life who needs a different story about perimenopause. Our bodies didn’t come with the user manual, and this perimenopause thing can feel confusing and lonely. But you are not alone. You are not crazy, and you are definitely not broken. And maybe someone in your life needs that reminder today. Let’s spread the word and be kind to each other and ourselves. Now the legal bit. I’m a nutritionist, but I’m not your nutritionist. This podcast is for information and education only. No client relationship is formed. Always seek medical advice when necessary. I’ll see you next Wednesday morning.
