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Kaelyn Johnson

What I'm so excited about is it's really expanding the research around the impact of when we help somebody's system that is really struggling with metabolic function. Look at everything that can improve.

Katie Weber

Hello and welcome to the Women and ADHD Podcast. I'm your host Katie Weber.

I was diagnosed with ADHD at the

age of 45 and it completely turned

my world upside down. I've been looking back at so much of my life, school, jobs, my relationships, all of it with this new lens and it has been nothing short of overwhelming. I quickly discovered I was not the only woman to have this experience and

now I interview other women who, like

me, discovered in adulthood they have ADHD and are finally feeling like they understand who they are and how to best lean into their strengths both professionally and personally.

Hello, hello and welcome back to Women and adhd. Today's episode is a little different from the norm here at Women in ADHD because it is the very first in a brand new semi regular series that we are calling Unmasking Our Health where we explore topics that reflect the holistic side of adhd. So not just what's happening in our brains, but what it's like to live in a neurodivergent body. For so many of us, neurodivergence isn't just a brain difference, it often comes with a whole host of co occurring physical symptoms. Many of us living with neurodivergent nervous systems also experience chronic pain, fatigue, autoimmune issues, migraines, gut problems, hypermobility, fibromyalgia, pots, mcas. The list goes on. Not to Mention the sleep issues, depression, anxiety and other mystery symptoms that never seem to fit neatly into one diagnosis. So in this series, the Unmasking Our Health Series, we will explore these layers of co occurring health conditions as we try to make sense of our neurodivergent bodies and how best to heal. I'm very excited to welcome as my co host Kaylin Johnson. She is one of my absolute favorite humans and a brilliant neurodivergent health practitioner to boot. Kaylin is a doctor of pharmacy, a licensed pharmacist based in Nebraska, as well as an ADHD and autistic advocate. She spent years working in academia before leaving to build her own practice focused entirely on neurodivergent clients who are, in her words, unexplainably unwell. These are adults with that swirl of overlapping issues. So adhd, chronic illness, pain, fatigue, gut stuff, autoimmune symptoms, hormonal chaos, you name it. Clients who have been bounced from specialist to specialist, told things like it's just

anxiety or you just need a good

night's sleep and who have never felt truly seen or understood by the medical system. I was one of those women. I am one of those women and working with Kaolin has absolutely saved my sanity and my health. Kaelyn's approach is the complete opposite of that siloed medicine that so many of us have experienced. She looks at everything, the brain, the body, hormones, inflammation, metabolic health, nervous system function, chronic pain, immune issues, and how all of it shows up in our day to day lives as neurodivergent women. So in this new series, Kaelyn and I are going to be digging into what is happening below the neck, things like hypermobility and Ehlers Danlos syndrome, chronic pain, autoimmune conditions, long Covid pots, MCAs, hormones, metabolism and more, and how all of that intersects with ADHD and executive functioning, especially for those of us who have lived undiagnosed until well into adulthood. So we are kicking things off today

with a topic that is absolutely everywhere

right now and one that I have a lot of complicated feelings about and one that Kaelyn has been watching very closely from a clinical perspective and that is the skyrocketing use of GLP1 medications, specifically the use of them for symptoms related to adhd. Now I want to be very clear. This episode is not a commercial for weight loss medications. We are not here to tell you whether or not you should be on one of these medications. What we are here to do is to take a closer, more informed look at what GLP1s are revealing about the connection between metabolic health and adhd and what they seem to be revealing about the bodies and brains of neurodivergent women more broadly.

We also get into estrogen, the vagus

nerve, food noise, binge eating, interoception, drug interactions, and my personal favorite geek moment of this episode, how GLP1s are related to Gila monsters. So you'll have to listen to the episode to find that one out.

Okay. Like I said, this is part one

of what is going to be an ongoing series.

Podcast Host/Announcer

So if you have an idea for

Katie Weber

a topic for us to discuss related to holistic neurodivergent health, reach out@womenandadhd.com contact and let us know. All right. I could not be more grateful to Kaelyn for partnering with me on this.

So enjoy. Okay. I am so excited. Hi, Kaelyn.

Podcast Host/Announcer

Hello.

Katie Weber

Can you believe I interviewed you four years ago, episode 97? I went and looked it up because I was like, I should mention Kaelyn's original episode. It was. Yeah, it was August of 2022.

Kaelyn Johnson

Oh, my God.

Katie Weber

I know, right? I mean, a lot has changed, right? You're a mom. That's a big one.

Kaelyn Johnson

I was the same. I have a child.

Katie Weber

But yeah, I was going down memory road of just like, oh, you know, like when we first were messaging back and forth in the women in ADHD community, which no longer exists, sadly. But like, you know, I'm just so grateful for getting to meet you and interviewing you and interviewing your wife Marnie too. And just like, you're such a huge part of my life and I'm just. I just got really verklumped and I'm so excited to do this series with you. So a little bit of background before I hand it over to you. So basically, Kaelyn is, you know, your. I don't even know what to call you, so I'm gonna let you talk about who you are because I have

Kaelyn Johnson

a little bit of everything.

Katie Weber

I know.

Right. But, like, officially you are a doctor of pharmacy.

Kaelyn Johnson

Yeah.

Katie Weber

Originally I would like talk to you about medications and kind of ADHD medications. But then I started working with Kaelyn, really about my own kind of physical stuff and my own body and, you know, the, the. This neurodivergent head to toe that I was realizing a lot of it had to do with neurodivergence, but also like interviewing client, you know, interviewing podcast guests over the years. I mean, it's been five years now of interviewing women and seeing these patterns of like, wow, that's another guest with like an immune disorder, right? Immune system disorder. Like another guest with pcos, another guest with fibromyalgia and autoimmune disorders. Hashimoto's like, it just felt like there was a lot of these co occurring physical things and then also, you know, learning more about hypermobility and hypermobile EDS and seeing a lot more about connective tissues and neurodiversions. And these, these Venn diagrams of the brain and the body were so fascinating to me and coming up everywhere. And really you were just like the person that I always came to. Because you seem to understand it all so well. You've, you've explained it to me in so many different ways. And I wish I could say I understand it. I still don't really, which is why I was like, I feel like when we were talking about doing this series, it was like one of the benefits to me is like, if I could get Kaelin down and record all of this, maybe I will at least have this for reference later.

Kaelyn Johnson

Just put it on loop. Yeah.

Katie Weber

But what we decided to do and what we wanted to do together was to create this series as an addendum to the adult diagnosis experience of like, it's not just a diagnosis of a brain.

Right.

Like, there is a lot happening below the neck that we are also just researching and understanding about, like, who we are holistically. And so for those listeners who haven't yet experienced you or heard about you on a podcast or heard your episode, like, why don't you just give us a little bit of background about who you are and what your interests are.

Kaelyn Johnson

Yeah, for sure. So, like Katie said, thank you so much for that wonderful introduction too. And we love being a part of your family and we love just being a part of your life. So, yeah, so, so glad to be here. And yeah, so my background, again, like traditionally is I'm a pharmacist, doctor of pharmacy, so a licensed pharmacist here in the state of Nebraska. And when I got out of pharmacy school, I immediately did a residency that focused a lot in ambulatory care pharmacy, which is all like outpatient based chronic disease state management. And I really, really quickly became very frustrated and disenchanted with our health care system, recognizing how siloed our approach was, that I kept seeing all these patients come in, sometimes with mental symptoms or neurocognitive symptoms or physiological symptoms. And each time it just felt like wall after wall after wall, because every, like providers and how our assistants are set up is to just at that condition or that organ or that symptom, but not to really look at this full big picture. And so I knew pretty quickly that that's what I not only wanted to do, but with how my brain works, it was like, that's the only way I can do it. Because as an ADHD autistic individual, which I was to say I didn't know at the time, I think I did know, but I wasn't officially diagnosed then. But I was like, yeah, if I see a hole in a system, I have to plug it. Like I have to. So I went and worked in academia for eight years, thought that that's where that was going to be, the place I was going to really be able to study this, make a difference. And I did to a degree and then found that that maybe wasn't really exactly the case. As well as having my own symptoms kind of go down the drain in a very dramatic fashion in my body, my health, ADHD symptoms, completely off the rails, burnout. All these physical symptoms that maybe had been there but now were just huge to where I couldn't stand for prolonged periods of time. I had brain fog. And no doctor I went to seemed to know what was going on other than just kept being like, oh, it's anxiety, like, oh, it's, you know, just,

Katie Weber

you just need a good night's sleep. I've been told that so many times.

Kaelyn Johnson

Yep, yep. If only, right? If that, only that would fix all the things. And I'll tell you now, as a mom of a 19 month old who does not like sleep, it's not the only problem. So it's rough. But yeah. So then I left and I started this practice and I really went then and kind of got everything else. I felt like I needed to be. Obviously I feel like I try to be like, like a Yoda or like a Gandalf or a Dumbledore. I need a better female, a Professor McGonagall. I don't know of helping neurodivergent women who were. The word I use is quote, unexplainably unwell, where they have this kind of conglomerate of symptoms that aren't fully explained by any one diagnoses and really starting to see then maybe in their symptoms that ADHD doesn't exist in a silo. Right. It's impacted by everything else that's happening in the body. And so for their quality of life and their understanding of the brain and be able to work with their brain and to feel good in their life, it's not just understanding their ADHD and their ADHD brain. It's understanding their entire body. So my kind of goal and focus has always been around quality of life. And what would the world look like if there were a bunch of healthy and, well, neurodivergent women in it? I think it would look pretty awesome.

Katie Weber

Yeah, right. I'm just reminding now of, like, when we first had our consultation and you said your. Your line, let's make you make sense. And it was like my whole body just exhaled where I was, like, oh. Like, it's all I've been wanting my whole life, right? Of just that feeling of, like, trying to connect the dots, going to so many different siloed specialists, always feeling like I was re explaining myself and never really understood. And the service you provide of, like, looking at all of these different, seemingly unconnected, like, it's just so valuable. So we'll talk all about, like, go have a consultation with Kaylin. You will never regret it. She is just incredible. But so we have a lot of topics we want to discover or talk about in terms of the, you know, we talked about hypermobile eds, connective tissues, histamines, mast cell activation syndrome. Like, I've gone down my own journey about hypermobility. I've also, like, my daughter has gone down her own journey of understanding pots and kind of that tachycardic system. So we're not going to go too deep for today into some of that stuff. But I think, like, you know, what I would like to do is, is have these episodes, go deeper into, like, what is that connection? And, like, you know, I always talk about ADHD as the gateway diagnosis of sort of understanding your body so much more. But the first topic we decided we wanted to address because it is so popular and so trendy right now and seemingly, like, it just feels like the wild West. As you said earlier before we hit record, like, there is a part of me that is like, oh, my God, is this the miracle drug? Should we have this in our water? Should everybody be on this? And then at the same time being like, whoa, like this. The train is on the tracks, there's no breaks, and everybody seems to be talking about it and embracing it. And that's GLP1s and semaglutides and tirzepatides and retatutrides and all of those. So, like, I don't think we can go too deep into the, you know, the use of them and the rise of them. That's probably better for another podcast. But what I want to talk about is what I'M seeing. And what a lot of us are seeing is the use of GLP1s for treating ADHD. So what is going on there? Like, what. As a pharmacist, what are you seeing? What are you. What have you noticed in terms of, like, why GLP1s?

Kaelyn Johnson

Yeah, first of all, yeehaw, Right? It's the Wild West. I was like, lasso, like, here we go.

Katie Weber

Have we seen anything like this? Like, I almost kind of feel like nothing. There's no precedent to this. Like, maybe SSRIs in the 80s felt like they flooded the market, but this is just something like, I don't feel like we've seen anything like this. Where it's like, we're going to test GLP1s for every random disease and dysfunction and just being like, yep, it works. Like, what is going on?

Kaelyn Johnson

Right. Okay. So, like, we are gonna so get into it. And it is so exciting because, like, that is, like, the first thing, honestly. Like, when I heard kind of about the GLP ones and people going on these and, like, kind of some of these benefits that expanded beyond kind of those traditional ones that we think about them regarding, like, weight loss and food noise and we'll kind of get into that, honestly. First off, it was. My first reaction was a bit of curiosity with a healthy dose of skepticism, right? Because it was kind of like, what? Like, what is this? And, like, also, as a pharmacist, man, people come to you all the time being like, I heard about this, I heard about this, I heard about this. And you get a little kind of jaded when somebody's like, hey, I heard about this. And you're like, yeah, yeah.

Katie Weber

Well, especially around diet culture too, right? Which is like, are we selling another weight loss drug? Is this all about weight? Or is there something deeper to explore here?

Kaelyn Johnson

So, yeah, but then again, here's the deal. As a pharmacist, I've definitely learned that when thousands of patients, like, you know, come to you or you hear, are independently reporting that same unexpected effect, it's probably worth paying attention to, right? Like, this wasn't just, like, one off, right. It was happening in my own patients. I was hearing it from my colleagues and, like, other providers I would chat with. And then you start hearing news articles about it. I know the New York Times just had a new an article about this too. So it was kind of everywhere. And, you know, people weren't just saying things like. Like, again, like, I lost weight. Like, they were saying things like, my brain is quieter. I don't feel that Same, like, compulsive drive to look at a patient who was just talking about. They were a big, like, nail picker.

Katie Weber

Yeah. Skin picking.

Kaelyn Johnson

Yeah, yeah. And that, that's pretty much gone away since they've been on the GLP1. I have a lot of patients talk about, like, it's so much easier to, like, pause before reacting. That, like, kind of emotional, that quickness has kind of quieted down. Or even I've heard things like, my ADHD meds seem to work better. And then when you tie in, again, some of that chronic illness part of this as well, whether that's burnouts, long Covid, long Lyme. I'm hearing things too. Like, I can stand for longer periods of time. I had two patients recently within four weeks of starting GLP1s, their autonomic stability withstanding, their pot symptoms dramatically improved within four weeks. So of starting a GLP one was crazy, minimal pain. So, like, we're hearing all of these things, like, right, these aren't weight loss outcomes. These are neurocognitive and physical outcomes. So what really fascinated me was that these reports were mirroring, though, what researchers were starting to study that we were starting to hear that they were really looking more into. So they're starting to explore things like addiction. Right. Compulsive behaviors, reward pathways, inflammation responses, and autoimmune conditions, and then metabolic psychiatry as well. So I don't think GLP1s are treating ADHD directly. But what I do think is they're revealing, though, how much metabolism, inflammation, and reward sign signaling influence ADHD symptoms. And I'll say specifically around that. And I don't know if it's probably not a term that a lot of people are familiar with, but the idea of metabolic psychiatry, Right. So psychiatry traditionally has focused on neurotransmitters. So dopamine, serotonin, norepinephrine. Right. We talk about adhd, we're always talking about neurotransmitters. But metabolic psychiatry is really asking a broader question. So what if some psychiatric symptoms are not only neurotransmitter problems, but also energy problems? Right. So in other words, can insulin resistance contribute to depression? Can inflammation worsen ADHD symptoms? Can mitochondrial dysfunction contribute to brain fog, unstable blood sugar affect emotional regulation? And can improving metabolic health overall include, like, improve any sort of neurocognitive or psychiatric symptoms? And the answer, increasingly, for at least some people, seems to be yes. And so this is super relevant for ADHD patients is that traditional ADHD model really focuses on dopamine and Norepinephrine. But metabolic psychiatry doesn't reject that model, it just really like expands upon it. So an ADHD woman could have insulin resistance, chronic inflammation, poor sleep, elevated cortisol, autonomic dysfunction, and all of those factors can worsen executive functioning. So the question then becomes how much really of what we call ADHD severity is actually being amplified by metabolic disease dysfunction. And so that's where metabolic psychiatry really becomes Interesting. And GLP1s have so much excitement around them because they really intersect at multiple metabolic pathways that guide things like insulin sensitivity, inflammation, reward, circuitry, energy regulation, addiction pathways. So yeah, if a patient is saying my brain is quieter, researcher asking is this a neurotransmitter effect, a metabolic effect, an anti inflammatory effect, or all three. And the answer is likely a combination. And for those late diagnosed women with adhd, I think this framework is really, really gonna resonate because they've probably spent years being told that their symptoms were purely psychological, when in reality we've got hormones, inflammation, insulin resistance, sleep disruption, chronic stress, nervous system, dysregulation, all affecting the same brain they're trying to use to function every day.

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Katie Weber

talking, I was just thinking about treatment resistant depression too, because I think that's another topic that comes up a lot for those of us who were diagnosed with depression long before a neurodivergent diagnosis, which is that notion of like, stop telling me I'm just depressed.

Right?

Cause it's, you know, one of the things that I've talked about with you a lot is this, like, is this even ADHD that we're talking about right now? Like, what even is adhd? And for me, it's, for me, I've like tried to understand it as executive dysfunct in the way that it is experienced kind of internally for so many women. Like what we are struggling with when we talk about struggling. And the traits that are diagnosable for ADHD tend to be around executive dysfunction deficits. And so that can come from, you know, there's the genetic element, but there's also like a lot of it is related to inflammation, right? And so inflammation. So what we know is that inflammation can be caused either by environmental factors, but it can also be caused by stress and trauma. Right? And so it's like, then we get to this idea of like the, the chronic or the, the complex PTSD of just being a woman, of being a nerd, an undiagnosed neurodivergent person. Right? Like there's all of these ways in which it comes back to inflammation for me, around the executive functioning. And so like, when I think about why GLP1s are working for executive functioning, like that's the first place my mind goes is like, well, it's just bringing, it's, it's reducing that low level inflammation that all of us have been girding in our bodies for our whole lives.

Kaelyn Johnson

Yes, I mean, you're exactly right there. Like that part, again, it's taking away such a big stressor on our body because that inflammation is so, so encouraged by that dysfunction in our metabolic pathway. So if inflammation is creating this like, kind of like cognitive drag, reducing inflammation is going to make the brain operate more efficiently. So again, like, if we're seeing such a decrease in inflammation with the GLP1s, you know, less fatigue, better clarity, improved emotional regulation, those are all things we'd expect if neuroinflammation were gonna be reduced. Again, that's not like ADHD disappears, but it's. The brain has way more Bandwidth than for there not to be so much stress on that specifically.

Katie Weber

You know, I don't know the numbers around this. Mostly this is just sort of like anecdotal readings and the women I've been working with as clients. But like I know that a lot of women who are perimenopausal and menopausal, so like women kind of over the age of 50 are going on GLP1s, I think faster than any other population. Right?

Kaelyn Johnson

Yeah.

Katie Weber

And so is there, what is the connection there between like we talk about estrogen and estrogen levels and their relationship to dopamine. How do hormones and estrogen relate to this whole metabolic psychiatry? Is that what you.

Kaelyn Johnson

Yeah, metabolic psychiatry.

Katie Weber

I feel like every single thing I have to be like, explain like I'm five. Explain like I'm fine. But yeah, what's the hormones side of this?

Kaelyn Johnson

Yeah, totally here like the point Dexter to say too. When Katie and I were talking about starting this, I was like, are you, are you asking me apart? Because every two seconds I'm like, well, there was a study.

Katie Weber

Like I love it. But this is what I mean about like I come away from these conversations with my mind blown. And also I'm like, I don't really understand a lot of what you said, but it sounded really cool. So.

Kaelyn Johnson

Yeah, well. And again I'll say that part of it is like there's so much in the stuff that, that we talk about too that we don't have a perfect in depth understanding of. And I think that's what is hard because talk about the Wild west, like we are just at the beginning, the grassroots of really even understanding what inflammation is like how the metabolic pathway connects to everything. And this is something I'm going to dive into to this answer here that what I'm going to talk about this combination with estrogen, metabolic system and inflammation. But even understanding how like the body communicates with the brain and how all these receptors interact and again that it's not siloed. So when we think about women, over 50 women in perimenopause and menopause, really, you know, seeking, seeing a lot of benefit with these. And this kind of puzzle piece here is. So when we think about estrogen, it impacts dopamine, it impacts insulin sensitivity, it impacts inflammation, it impacts energy metabolism. Dude, that's like everything right there that GLP1s help with, right? So as estrogen declines, many women notice worsening adhd, that increased weight gain, poorer sleep quality, greater insulin resistance and increased inflammation. All those systems are interacting so GLP1 isn't replacing estrogen, but it may improve a lot of those downstream metabolic consequences that emerge when estrogen declines. Which is why a lot of women will describe feeling like, okay, like I actually am feeling like myself again when I start this GLP one. So again, when we're thinking about all of this crossover and again, like the body and like hormones and why all of this really matters. The brain is such an energy hungry organ in the body. Executive functioning is expensive. Attention is expensive, impulse control is expensive. We need all systems and hormones operating on go to pay the price, right? To pay the piper. But when the body is inflamed, the brain has fewer resources available for those higher order tasks. So brain energy. The brain uses 20% of the body's energy, even though it only represents about 2% of the body weight. And so executive function, things like attention, planning, emotional regulation and impulse control are all energy intensive. And if the brain cannot efficiently access or utilize fuel, cognitive performance is going to suffer. And one of the most interesting things too is when we're often thinking about kind of like the brain and the body, I think people often, and I think especially ADHDers, we think the, the brain's controlling everything, right? But so much of what controls our autonomic nervous system, right? So the vagus nerve, which is has GLP1 receptors on it. So again, GLP1 isn't just found in the gut, it's also found in the brain. It's found in the brain stem, the vagal nerve. 80% of vagal fibers carry information from the body to the brain, so not the other way around. So many people think of the brain as directing the body, but in reality the body is constantly reporting its status back to the brain. So that vagus nerve, it really has this information highway, I guess, connecting the gut, the liver, the pancreas, the heart and the immune system. So when GLP1s activate that vagus nerve after eating, those gut cells release GLP1 and that GLP1 then activates receptors on the vagal sensory neurons and that travels then to the brain stem. And the brain receives messages like, we've eaten, calories are coming, slowed down, we don't need to look for more. And then the brain adjusts appetite, satiety, glucose regulation and reward behavior, which means that GLP1 can affect the brain without ever physically even entering larger portions of the brain itself, which is pretty dang cool. And so for adhd, this is really intriguing because that means again, the vagus nerve doesn't just transmit hunger Signals. It also influences emotional regulation, stress responses, attention and arousal, impulsivity, emotional reactivity, overwhelm, all of these things. So instead of the brain receiving like this constant stream also of like, maybe we're hungry, maybe we need dopamine, maybe we're stressed, the GLP1s are kind of like turning down the static of the signal. They're really improving the signal quality. And when again, talk about back to like women in midlife, when you take away the estrogen, the static becomes even more intense. Right? So like having that downstream consequence of an impaired metabolic pathway work much more efficiently is going to be huge for them having an improved quality of life and improved executive functioning.

Katie Weber

Now you mentioned earlier about like some of your clients, patients, you, you noticing that the GLP1s are actually helping the ADHD meds. And so Mike, I have a bigger question around, like, what is it safe to continue taking? Like, is there any, are there any negative interactions if somebody decides to take a GLP1S either in terms of like estrogen, like hormone HRT or SSRIs or ADHD meds, like, or do you just continue as, as with your cocktail of medication?

Kaelyn Johnson

Yeah, that's a really great, great question. Of course, always make sure you talk to your pharmacist, talk to your doctor about your meds specifically, including your supplements as well, just to check and be sure. But the really great thing about the GLP1s is they compared to a lot of just meds in general, not a ton of drug interactions. We do have to be careful about a couple of different things or adjusting doses sometimes because that's really the biggest thing is a lot of the drug interactions around GLP1s aren't direct. It's a physiologic interaction. So if we think about like stimulants specifically, take that for example. So GLP1s the, the big side effect that probably everybody hears about. And again, part of the reason why it works is it slows gastric emptying, which, that's going to alter the absorption timing of oral medications. So anything you take orally could potentially be impacted. So for ADHD patients, I'm usually saying things like, hey, pay attention to any changes in how effective your stimulant is or stacking of appetite support suppression, because we know sometimes stimulants also suppress that as well. Dehydration, constipation, things like that. So with that slow gastric emptying, it can take longer for the medication than to take effect. Right? It has takes longer to kind of reach your system to be able to start breaking down. So as well the medication is going to stay in your system longer because of delayed gastric emptying. So you may need to take it earlier for it to work. So if you're used to taking it and it's you're like I didn't work at 9am, I could take it at 8 and that's no problem. But all of a sudden now you're not noticing it take effect till 9, 30, 10. Okay. We may have to up that time because of the delayed gastric emptying or you may need to lower the dose. That's probably the thing I found the most then is needing to decrease that dose. And part of that is that effectiveness piece that delayed gastric emptying. But also if they're part of the problem of the executive functioning was metabolic dysfunction, all of a sudden we may not need as high of a dose either and we may start seeing more of adverse effects from the men without the benefit. So if the medication isn't working as well, we may also need to look at other things again like dehydration, nutrition issues to make sure also that the GLP1 hasn't caused a different physiologic issue that could then worsen executive functioning. And so less worry really on drug drug interactions with this med, but more about the physiologic changes it causes that can then impact the medication.

Katie Weber

Yeah. Which people with ADHD are really good at observing the difference the effects of medication. I can attest I'm super attentive to how, how I'm feeling from day to day.

Kaelyn Johnson

Well that actually brings highlights a really, really I think important part about GLP1s in ADHD is so one thing that's missing often from that broader conversation around GLP1 con conversation is interoception. So if we already have a hard time with that and then you give us a medication where the purpose is partly to like especially like to suppress hunger signals like that can become problematic. Plus you're also here's the irony, right. You're given this GLP1 med that requires a ton of executive functioning often to even get. So all of a sudden patients are having to manage prior authorizations, refill timing, med shortages, injections, dose titrations, maybe insurance appeals or like inconsistency and where you're getting it. Or I have some patients who have to go into the office every time they get their injection, depending on what their office, how their system runs. So a lot of ADHDers, even though you know, some of it sounds like, oh, my gosh, look, this is so awesome. It improves all these metabolic things. It's really hard, though, to try to do a medication occasion and be on board with this when the healthcare system really asks and perform dozens of executive functioning tasks while simultaneously trying to even get them at oh my God, preach.

Katie Weber

Yeah. But it does feel like the tracks are being laid for a much easier sort of distribution and less costly distribution. Like, it does feel like we are going in a direction of like, mass widespread usage. And so, you know, what does that mean for us? And like, should we be excited or should we be really worried? You know, And I don't want this episode to come off as like a commercial for GLP1s, but it is fascinating. And I, you know, there is a part of me that's like, is there anything, any red flags right now other than, like, the digestive stuff that some people are talking and the, and the price too, and the cost? Right. I think the biggest red flag for me, as somebody who has been very open about my own history with yo yo dieting and diet culture and has, like, really embraced body neutrality, I feel like there was like, we were really going to a really good place of, of accepting all bodies and sizes and redefining how we look at health. And now we've really done this backslide with GLP1s in terms of diet culture. And so, I mean, there is a part of me that feels wary. I think there's a lot of disordered eating in neurodivergent communities, especially binge eating. And so it's like, what are your thoughts? Because you were talking about food noise earlier and just the compulsive static. And I like how you talked about, like, turning the noise down on that static, but also, you know, to the flip side of that, like, are we turning it down too much so that we are putting ourselves in real danger in terms of, like, we're already forgetting to eat on ADHD meds. Are we setting ourselves up for some real disordered eating? I don't feel like I'm seeing a lot of that. And I don't know if that's just the loudness of diet culture just being like, it's fine, it's fine, weight loss is great. But, like, are you seeing people, like, having any real, like, side effects, effects in terms of, like, nutrition and, you know, I know they talk about, like, muscle mass and that kind of stuff.

Kaelyn Johnson

Yeah, that's a really, really good question. So, you know, exactly. There are some things, again, that we definitely need to be wary of. Again, the biggest thing I would say the biggest kind of like eek side effect that I do see is the issue with the delayed gastric emptying causing issues where we kind of get like everything basically backed up and then if that sees that way, that's really not a good thing. Surgery things can then happen, etcetera, etcetera. I have not had any patients have that. Talking just to my own provider, just kind of in conversation, just kind of picking her brain about it. My own pcp, she's had a number of patients have to have that happen. But again I will say for a lot of patients that is dose dependent. So so high doses being more likely to again cause that. Which I should also say that like when we're also exploring these medications outside of weight loss, again they're not, none of them are FDA approved for this. But if you have a conversation with your doctor and that is something that is considered, they are also looking at doing what we'll call microdoses, so much smaller doses too where you may be able to receive the metabolic benefits without having the more intense delayed gastric emptying and maybe not as much weight loss focus. You may not see as many of those benefits from that which I think kind of helps parlay those kind of, you know, scarier issues like you talk about. Like them kind of maybe either being abused or contributing to diet culture issues. I haven't really seen a ton of that. And actually like you said, I have a number of patients with binge eating disorders and I have seen these be helpful very much again in reducing some of that food noise. But I have had still patients though it doesn't solve the full problem, I guess I'll say and I think maybe that's a reality too. To like again state with these also is like so many like you talked about earlier with adhd. It's an onion of contributions that impact executive functioning and ADHD severity. These meds are helping with one aspect of that, but it's not going to take away all of that. So we're still sometimes left with things to identify and course correct. So yeah, those are kind of the big worries. But right now I'm not seeing it be at least this big I guess scary thing and that those impacts yet. So hopefully we'll see.

Katie Weber

Well and the other thing that just came to me too was this notion of I think there's like an existential or philosophical notion around medications that you should take for the rest of your life and medications that you shouldn't Take for the rest of your life. Right. And this kind of falls into this, like, well, we're not really solving the issue. Like I see a lot of influencers, like medical influencers who will talk about this, like in this very shaming way of like, you're not really changing your lifestyle, like always coming back to this idea that if you just like got off the couch and went for a run, your life would be solved. And so they're still working within that framework and not really looking at what is happening on a metabolic level as like disease.

Kaelyn Johnson

Yes.

Katie Weber

And so there is this shaming of like, well, this, you know, what are you going to do? You're just going to be on this for the rest of your life. But like, we don't have that shame around other medications that are just like, yeah, you're on this for the rest of your life.

Kaelyn Johnson

Exactly.

Katie Weber

Right. And so, but I do think, you know, any kind of medication, especially what it's costing right now, for a lot of people, it's, it's daunting to think about, like, do I have to be on this for the rest of my life? And I think that's a wider conversation about the pressure to wean off of medications as soon as possible. That's happening at, right now on a, on a national scale too.

Kaelyn Johnson

Yes.

Katie Weber

But I wanted to also get back to this idea of food noise too, because I feel like, or even just the compulsive static. I'm fascinated. Like, what do you think causes the compulsive static? Is that also just like inflammation and ADHD genetics and like, what do you think? Like, it feels like a little bit of a chicken egg thing there in terms of like calming it down versus what's creating it in the first place.

Kaelyn Johnson

Exactly. I think there's a lot of chicken, the egg component, and I think there's a lot of different possibilities that can kind of contribute to that. But generally, again, like food noise, really, when it comes down to it, it really is reward seeking behavior. So that when we talk about the ADHD brain, it's constantly scanning for simulation novelty, dopamine and relief. I think it's one we don't talk about enough too, that the ADHD brain is also constantly looking for that relief. And food happens to be one of the fastest and most reliable sources of dopamine. So GLP1s appear to dampen that activity in those reward circuits involving dopamine signaling. So the result isn't less pleasure, it's less urgency. So patients will often describe it as like, I can still want something. I just don't feel as driven by it. That's a very different neurological experience because it's not having, like, we are seeing those adjustments in those dopamine pathways. So we're not needing that same simulation novelty dopamine relief. It's just the one that's filling it, which is again, why we're seeing this being studied in addictive behaviors. Because that's really why things are addicting. Right. Even when it comes to alcohol. Alcohol is addicting, not because, like people who struggle with addiction, it's not the alcohol, it's what the alcohol is doing. Right? And then the brain learns, oh, that helps that quickly. I want that. And that's what starts creating those pathways. So the same here with this, like, it's going to quiet that piece that really is just looking for something to fill those receptors, that pathway, that dopamine, to fill that piece. And if we don't have that anymore, then we don't necessarily need that for that reason.

Katie Weber

So then by that logic, wouldn't GLP1s replace most ADHD beds? I mean, should they be working together or does it feel like a viable replacement?

Kaelyn Johnson

So that's a really good question. So I really think that more than likely they're going to be things that really work in tandem. So I think that what we'll likely see is the GLP1s are going to be especially relevant again for people who have metabolic issues. Right. Metabolic dysfunction that's driving that issue with dopamine. Right. And dopamine regulation, but that dopamine can be impacted also beyond things that are just related to metabolic dysfunction. I mean, even when we take the hormone piece of that too, like, the GLP one is helping a lot of that downstream effect, but the estrogen is still a big part of that. So, like, our GLP1 is completely replacing meds for people who are in, like, perimenopause. Menopause. No, not necessarily. But they may be working in tandem as well with the estrogen. And the other thing too, with these is every medication, we're trying to get the dose high enough to where the med is effective, but not so high that we're seeing a lot of adverse effects. And sometimes too, for people, we see this even, like with simulants, we may not be able to get the dose high enough to get all the benefit that we want in those areas. And so sometimes having meds in other areas as well can then be helpful to kind of even that out. So we don't really have evidence yet to support that GLP one's alone are gonna be it, but for a certain group of people, I think it's gonna be a really important tool. So those again who struggle with insulin resistance, binge eating, chronic inflammation, reward dysregulation or other metabolic based issues, they're really a modifier of the ADHD experience than a primary ADHD treatment.

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Katie Weber

Where do you think this is gonna be going? I mean, now we're having pills, we're having like monthly injections instead of weekly. Like it just feels like, I don't know do you have any theories about what this is, what's going to happen next, or where this is leading? Do you think we're all going to be on GLP1s? I feel like so much of this feels very much like the end of the biohacking version of the end of. Oh, crap, what's the movie with Evie and Wall E. The dystopian version of Wall E. But instead we're all gonna be like, biohacking. Yes.

Kaelyn Johnson

One time, Marnie and I say we did a Disney run and we dressed as the by and large people on the ship for the run. So yes, I'm. Yes, right there with you. It was great. But yeah, like, yeah, so here's the deal. There's the. I don't know, maybe I'm a bit of a positive poly at heart, where I do tend to kind of look at where do I think this is going in a lot of good ways. And where I think this is going in ways that gets me really, really excited is this expansion of the idea again of metabolic psychiatry, and again, no longer. I think it's really expanding our research and people's eyes and providers, other providers, beyond me looking at things and saying, hey, guys, this isn't just one thing influencing this condition. That's not true for any condition. And so what I'm so excited about is it's really expanding the research around the impact when we help somebody's system that is really struggling with metabolic function, look at everything that can improve. I mean, again, like, I'm hearing, you know, Marnie, my wife, has multiple sclerosis. And in that community, there's talk of people with autoimmune conditions getting off their biologics that come with awful side effects because they're able to manage the MGLP1s. And again, this isn't, this isn't every patient, but some people are finding that. So then looking at, okay, was their autoimmune condition really influenced by the stress of a dysfunction metabolic, A dysfunctional metabolic system? Like, that's the stuff I'm so excited about is really this expansion of us understanding the body and the brain and how all of this connects in this really, really full picture. So that's my big, like, woohoo. Like, part of that, because I've been waiting for that. And if it took the GLP1s to start driving the research for that and the understanding, Understanding of that, that's really, really cool.

Katie Weber

Yeah. Have you. That just reminded me of psoriasis, because that's another one that I sort of Feel like is one of the, like fibromyalgia, which is just like this huge, first of all, this huge medication industry with massively scary side effects and a lot of people who have it and don't know why. Is there anything about GLP1 since psoriasis? I guess I could Google it, but. Oh, yes, yes. So similar. It falls under that same umbrella. So it's like, is there anything that is doesn't seem to be affecting? I saw I it just earlier today and it looks like the trials for Alzheimer's were kind of not as. As impressive as they were hoping it would be in terms of dementia.

Kaelyn Johnson

Yes. So I think that what you're seeing though is how many conditions, which are a lot of them, and I almost want to say most that are influenced by a dysfunctional metabolic system. And how I want to say, easy it is for a metabolic system to start to have issues, to start to have struggles, because it is influenced by so many different things. So it can be a piece behind the added stress that can lead us down to any sort of condition now. Yes. Like there are things then where there are conditions where that maybe isn't as much of the primary impact, or you may see it for a smaller subgroup of patients where it's maybe that primary driver where you don't for another subset of patients. And again, I'll say that's even what I'm seeing right now with again, most of my patients hypermobile, Ehlers, Danlos syndrome, Long Covid, and then kind of a conglomerate of bunch of different autoimmune conditions. And I'm probably seeing, gosh, I'd say maybe about 60% of my patients on GLP1s have really, really positive side effects. And at least some of their symptoms, maybe not all of them, but at least some of them. And then I'm having probably, yeah, I would say about 30% that of patients who are on GLP1s where those impacts are pretty minimal. And then we have to start looking at, okay, like, what else is going on. Right. So like I have one patient who, you know, was like, maybe there was a little bit of improvement in some resiliency of her symptoms, again, prolonged standing, things like that, but overall not a huge impact. Well, we got her lab work back and her iron and ferritin were completely abysmal. So, yeah, like your executive functioning is going to be rotten and you're going to be super tired and fatigued and hungry and all of these things. No matter what we do for the metabolic system, we got to fix this other thing. So it's just one huge area of the body that has so much impact. So I get like, that's. That's where I'm the most excited. So do I think it will be in the water? No. Do I think everyone will be on it? No, But I think it will be a med that should be in conversation around a lot of conditions of, you know, patients going ahead and, like, asking their doctor, having conversations, like, with their doctor about things kind of like, you know, what is my metabolic health? Like, could insulin resistance be contributing to my symptoms? Do I have metabolic risk factors? Are there inflammatory issues affecting my health? How are my hormones influencing my ADHD about inflammation? How are sleep and stress affecting my executive functioning? And then, you know, would a GLP1 be appropriate given my overall health picture? And again, this big thing is like, adhd and any of these conditions, they don't exist in isolation. The brain is connected to the immune system, the endocrine system, the gut, and the metabolic system. So that future of ADHD care and also care of all these other conditions we're talking about isn't really choosing between psychiatry and metabolism. It's really recognizing that they're deeply intertwined.

Katie Weber

Yeah, yeah. And it sounds like also this Eureka moment with this medication, and like you said, it's pointing to the connection between the metabolic system and how it's affecting the brain. And it's almost like it's pointing to how we can then see all of this from a holistic viewpoint and then see it from a preventative viewpoint. Right. Which is like, you know, because. Because my interest has always been in the, like, why are we diagnosing people for systemic issues? Like, why aren't we focusing? Like, if we're diagnosing individuals and we're treating individuals, it's giving us a reason to not look at the systemic issues that are. That are creating the inflammation and the. And the disease in the first place. Right.

Kaelyn Johnson

Preach.

Katie Weber

Right. Like, it feels like seeing the way in which all of this one, this one approach and this one medication is affecting people on such a massive scale. Like, it feels like it would open up more conversations for, like, systemic prevention, you know, and looking at, like, oh, there might be, you know, this connection between the rise of autoimmune disorders and young women and stress and, like, looking at ways that we can kind of, I guess, get to the nitty gritty of what is actually going on with people with these seemingly disparate diagnoses.

Kaelyn Johnson

It's holding up a big mirror. Right. And I think with it should come an apology to a lot of neurodivergent women with complex chronic illness, because they're likely the ones who've been told things like, it's all in your head, dismissed, given, pick your name out of the hat, psychiatric kind of like, diagnosis that was ill fitting. It's kind of like the. Especially the neurodivergent women who are having success with these medications. They're likely the ones that current society has kind of labeled like the modern hysterical woman. Right. You know, you follow back hundreds and hundreds and thousands of years of history, and there's always been that, which I always find this weird connection we found and digging back through. One of my family members loves to look back down our lineage. And one of my ancestors was one of the last witches tried in Salem. And she actually, her husband broke her out of jail. She was sentenced to death, but they were able to escape to New York, and hence why I'm here. But I can't help but think, why was she targeted? She was probably neurodivergent. She was probably hypermobile. Ehlers Danlos syndrome. Right. She was different in all of these different ways. And she made a great target as this, quote, like, modern hysterical woman. And that's what this is now. And again, I think this med holds up a big mirror to people who struggle with those symptoms. And then, like you said, all of the things that we have just set up in our capitalistic society that puts a lot of stress on the individual. This is one of the things, though, where I think a lot of people get on maybe the negative, darker side. That would be really great if we started looking at that mirror, but I think instead it'll kind of be like, oh, cool, we don't have to change any of those systems because we've got this med that'll just kind of do it for us. Yep.

Katie Weber

Yeah, that part too.

Yeah.

Oh, my goodness, this is so exciting. I mean, I'm just. There's so many topics I'm excited to tackle with you. Thank you so much for agreeing to do this and sharing your wisdom and understanding. And while I blink, blink back at you, just being like, I kind of understand as I get, you know, I just find it all so fascinating, like I said. And so next time, we're going to talk about hypermobile Ehlers Danlos syndrome, which is another really sort of big topic. A lot of people, you know, a lot of research around it right now, and I think that is such a fascinating field and overlap. So I'm really excited to talk more about that with you. What other topics should we talk about? I mean, also, if you're listening and you want us to talk about, you know, some topics around chronic pain, inflammation, you know, anything. We're really just looking at the connection between a neurodivergent brain and everything else that's happening in our bodies that's making us hysterical and hormonal and hypermobile.

Kaelyn Johnson

Yeah, whatever. Is your version of modern hysterical woman. Right.

Katie Weber

That's what we should call this series. 100% hysterical, hypermobile and hormonal and. But yeah, I think also, like, mcas, too, is another one. I really would love to dig into a little more.

Kaelyn Johnson

Yeah, MCAs, I think pots, like you said. I think pain. I think even also, just talking about having conversations with your doctor, also about all of this, too, and kind of like, how do you even navigate all of this or even navigating? And I know this is something that pops up for a lot of my patients, too, of, like, feeling like, is it safe for me to have these conversations, like, like, with my doctor? Or do I feel safe, too? Or, like, even to tell them about, like, my adhd? Like, is that going to, like. I think really what I'm getting at is, like, bias in the healthcare system, which is 1000% there. Like a lot of you, what we're talking about is parlayed into it being a necessity to have a provider who is able and willing to be a thought partner and who believes your subjective experience, which should be present no matter the office you walk into. But we both know that's not, unfortunately, the reality. So there's also a whole array of topics that could go down that row. Autoimmune conditions. I think it'd be interesting. Oh, long Covid. I think that would be interesting. So give them to us. Oh, and I have to, because maybe I'll have, like, a little nerd fact at the end of every episode if you wait till you get your little sprinkle of nerd magic. Okay, so I think this is the coolest thing. So when I was in pharmacy school, true nerdom, just push my little glasses up. GLP1s were my favorite drug because I thought it was so cool how they discovered it. So they were able to make this drug from studying the saliva of the Gila monster. So it was back in the 1990s. Researchers were able to really study the saliva hormones, and they found this one called Exendin 4, and that basically mimics GLP1s that are found in humans. But the Gila monster uses this Peptide to be able to regulate its metabolism and sustain energy because it only eats like three times a year, which is crazy. Okay, right. So the Exendant 4, they found though that like it didn't break down in the bloodstream like GLP1 in humans it tends to break down in the bloodstream within minutes. So they were able to look this extended for this really highly resistant to enzymatic breakdown peptide that really allowed it to have blood sugar control and appetite suppression. And from that they were able to make the GLP1 receptor agonist for zexenatide or Byetta, which isn't really as popular anymore. But that laid the groundwork then for them, creating semaglutide and tirzepatide. So what you're taking then was discovered from the Gila monster, which I just think is so cool. So there's your little med fact.

Katie Weber

And I do not believe any Gila monsters have been diagnosed with adhd. So I think their executive functioning is on fleek. But like that was not that long ago. Right. Like I feel like we are just this one massive human experiment right now.

Kaelyn Johnson

100 we are. These were just coming out. Honestly when make me feel very nice and old. But like when I was graduating from pharmacy school which was like 2012, that was Byetta and Exeter. Tide was like just coming on the scene as like whoa, cool. We've got this, you know, weight loss med for patients with type 1, type 2 diabetes. And that was kind of the hot thing, but it came with a lot more side effects. And then from there they kind of kept, you know, working on it, finding these new versions. So yeah, you're right, we, we don't know. And I think that is the big thing when we think about kind of the, the ethical guardrails of all of this is really again, that, that I'll leave. That we'll leave you here with and in talking with your doctor too is that. Exactly. We don't know. And so just really understanding the possible risks of that, the possible benefits of the medication just along with that. And again, I guess the thing I'm seeing though is for these patients who are really struggling in these ways, there's a lot of desperation and so a lot of willingness to be like, hey, let's give this a go. So.

Katie Weber

And to bypass medical consultation, which I also really worries me that there's so much like kind of this gray market ordering of stuff online. And yes, it's all happening so fast and there hasn't been a lot of studies and not a Lot of these things are FDA approved. It just like, it's like madness. But I feel like a lot of, A lot of, at least PCPs are on board with this. Like, I, I'm not getting a. I'm not hearing from a lot of people who are getting, like, gaslit by their PCPs about this. And, and you also think about, like, our government right now has been very vocal about ADHD meds and SSRIs, but they've been curiously quiet about GLP1s, so, like, nobody. I don't feel like if this is something you want to try, I don't think there's going to be a lot of backlash. I mean, other than the expense, I

Kaelyn Johnson

haven't had any patients yet, really have much pushback at all. So like you said, I think a lot of providers, for whatever reason, this has been the thing. Back to my positive poly moment, that is opening their eyes to the impact of improving metabolic health in a lot of different areas. And that a lot of us, again, because of our systems, because of a lot of things, struggle with metabolic health. So I think a lot of providers are pretty on board to be in conversation about this. So open the dialogue and. Yeah. See if this may be something that will be helpful for you.

Katie Weber

Yeah. Tread carefully.

Kaelyn Johnson

Right? Yeah. Yeah.

Katie Weber

I don't know.

I don't know. Like, I. That's what I mean. I'm like, I don't want this to seem like this crazy commercial for GLP1, but I also feel like it is this miracle drug. Like, I. I'm really at that sort of intersection of curiosity, amazement, and also like you were saying earlier, like, there's some cynicism and concern, but also not really knowing what to make of it.

Kaelyn Johnson

Well, when I think of anything, a commercial for that I will say is like, I guess my push always for patience is exactly what I said earlier is that what I get excited about in the push for is to open the dialogue with your providers about what is the status of my metabolic health, what are my metabolic risk factors? Do you think that this could be impacting any of the things I'm struggling with? That's exciting to start having those conversations because what you're opening up the dialogue about is you are unsiloing whatever you're experiencing. And that's exciting and that. That I encourage you to do.

Katie Weber

Oh, well, thank you. You're awesome. This has been great. I cannot wait to have more conversations.

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Kaelyn Johnson

Heck, yeah. I'll be back.

Katie Weber

There you have it.

Podcast Host/Announcer

Thank you for listening. And I really Hope you enjoyed this episode of the Women and ADHD Podcast. If you'd like to find out more

Katie Weber

about me and my coaching programs, head over to womeninadhd.com if you're a woman

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Katie Weber

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Katie Weber

media to help reach more women who

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Katie Weber

I'll see you next time when I

Podcast Host/Announcer

interview another amazing woman who discovered she's

Katie Weber

not lazy or crazy or broken.

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But she has ADHD and she's now on the path to understanding her neurodivergent mind and finally using this gift to her advantage.

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Take care till then.

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