Season 8, Episode 5: The Intersection of ADHD, Neurodiversity, and Functional Medicine with Dr. Dan Sullivan

Evelyne Lambrecht: I’m very excited to have this conversation today because we’re talking about something that’s really important and something that’s overlooked. As many people with ADHD, they have the right plan and the right supplements and the right intentions, but they can’t get started. So I definitely want to talk about that. And I also want to talk about your background and how you got into medicine and what you’re doing now. So before we kick things off, what is lighting you up this week?

Dr. Dan Sullivan: I’m just letting me up this week. I think the weather in here in San Diego is, finally as it should be, sunny, beautiful, mid 70s. So I love getting out there in the sun, taking runs, getting on my bike. So I’m lit up just by that. And then the long weekend coming up here.

Evelyne Lambrecht: Absolutely same. I feel like such a shift in the last two weeks. It’s like, oh, I’m alive again. It was just seasonal depression. And we just we really are so lucky here.

Dr. Dan Sullivan is a licensed naturopathic doctor in California and New Mexico who helps patients optimize their mental, physical and emotional health through a functional root cause approach. He earned his doctorate from Boston University, California, and holds a bachelor’s degree in business management from the University of Maine, where he also played Division One ice hockey. He has completed functional medicine training from the Institute for Functional Medicine, and is currently in the process of becoming a certified practitioner.

And Dan, I would love to start by just hearing your story. How did you get into medicine and naturopathic medicine specifically?

Dr. Dan Sullivan: So I’ll try to make that long story into a short one here. Growing up, I was an athlete, avid golfer, played baseball growing up. But hockey was my main sport. And so over the years, as any athlete, is interested in, I was, kind of naturally drawn towards health optimization. What kind of diet could I be eating? What are the exercise hacks that I could be doing to optimize my performance on the ice? And so, fast-forward, my dream was to play in the NHL as a hockey player and fortunate enough to have, succeeded, going up the ranks in hockey, playing juniors and then having the opportunity to play for the University of Maine at the Division One level.

And so it was kind of right around that time in college where I was very fortunate to have met a mentor in the functional medicine realm. So he happened to be a chiropractor as well as an acupuncturist. And I don’t even know how I stumbled upon him. I think it was just for acupuncture, looking for an edge in hockey. And then, we got to know each other very well. And he helped me to radically change my diet. I was thinking, wow, I’m a division one athlete. I’ve got this all figured out. And he’s like, wow, you need to totally revamp your diet. At the time, I was taking stimulant medication, which I’m sure we’ll get into, further along in this interview, but, he was saying, how that had all these side effects, these consequences that I wasn’t really thinking about at the time.

And so over the next couple of years, as I was finishing out my college career, I had the opportunity to either continue playing professional hockey or, I was really just developing a very deep passion into something in functional medicine. And so ultimately, I decided to steer away from a career in professional hockey. And then he took me under his wing. Basically, I started to work for him. I was answering the phones, doing front desk, and inventorying supplement, just making basically minimum wage. But I loved it. And just I loved being around that type of medicine.

And so I got my health coaching certification from IIN during that point in time. And then I, to kind of answer your question, how did I get into naturopathic medicine? He would take me to all these conferences. And so I was learning and, I don’t even know if that was he was supposed to do that, but he did anyway, I just ended up at these seminars, and so, I just met other naturopathic doctors at these conferences and just loved the root cause approach. And really optimizing health from the inside out.

And so, long story short, I started going back to school. I was a business management major. And so I started taking classes on nights and weekends while I was still working for about two years to take the premed prerequisites and then got into naturopathic medical school here in San Diego.

Evelyne Lambrecht: That’s so cool. And it really speaks to the importance of having mentorship. I mean, you were so lucky, right? Kind of gave you that edge already going into school?

Dr. Dan Sullivan: 100%. Yeah. Yeah, he was great. I mean, I lived with him for a year and a half. He just lived and breathed this type of medicine, and so I just learned so much from him. So, great experience.

Evelyne Lambrecht: And I’d love to hear a little bit more about your personal journey with ADHD. And then, also, did you always know you were going to specialize in that because of your own experience?

Dr. Dan Sullivan: No, I don’t. I think it was definitely a keen interest of mine and I knew a lot about it. And then on social media, which I think we’ll talk about later, that was just the particular topic that seemed to do very well, that a lot of people were resonating with. And so for that reason, I just kind of stuck with it. And kept learning and kept developing and, for whatever reason, kept seeing patients with that.

Evelyne Lambrecht: And tell us a little bit more about your personal experience with it. You were on medication before, but then when you met this chiropractor, did you start taking the medication and start, like, doing supplements and things change? Tell us a little bit more about that.

Dr. Dan Sullivan: Yeah. So I was diagnosed a little bit later. So my late teens and basically the process was a 15 minute office visit. No labs. No thorough intake process. Here’s your script for Ritalin at the time. And that was kind of just it, that was the only option. And so just talking to friends of mine, who are also taking stimulant medications for their ADHD, they said that. Wow, this stuff really helps. And so that was my path.

And, so, yeah, ultimately, I was it really helped me. It was a game changer. I could barely get through a page of reading material. I would just lose focus, extreme brain fog, mood fluctuations and after seeing Dr. J, we just developed, I mean, we did a full, comprehensive blood work, full workup. He put me on some foundational supplements, some adaptogens, vitamins, I mean, the basics vitamin D, magnesium, things like that. And eventually I was able to incorporate a lot of different lifestyle strategies, a lot of different hacks. A lot of, I was reading a lot of books on personal development and psychology and all those, those topics that I think also helped. But it took several years for sure. And, to wean off of the medication and then to go completely naturally.

Evelyne Lambrecht: And I think the biggest thing that I want to really dive into with you is I think we all know great strategies, right? In our functional medicine world that can help with cognition and focus, etc., but the biggest thing with ADHD, the biggest barrier is the executive dysfunction, right. And so patients have the best of intentions. You can give them the best plan, but then it’s so difficult to actually either start it or to continue with it. So I’d love to hear how you address this piece specifically with your patients.

Dr. Dan Sullivan: So there’s a lot to that, and there are a lot of different avenues that we can go down. I think one of the biggest things that patients will come in complaining about is that there’s just so much out there. There’s an overwhelming amount of information. I’ll hear, oh, I tried rhodiola. It didn’t work for me. I tried l-thiamine or I tried exercise and it just wasn’t enough. I think putting the entire roadmap into context for somebody, doing the comprehensive lab evaluation, that really helps to have a lot more buy in and a lot more direction for the person so they know, oh, I know exactly where I’m going.

And I know that these are the most important steps to do in order to make that happen. Granted, you do have to really distill it depending on somebody’s executive function, right? If they’re very overwhelmed already, you really can’t give them too much. And I think that’s some of the art of just practicing medicine is to try your best to distill down and figure out what are those highest leverage supplements? What are those highest leverage activities or lifestyle changes that this person uniquely needs to start to implement in order for them to get some quick wins to develop that momentum? So whatever executive function they have access to, they’re doing those things that I think could be needle moving activities.

But there’s a lot to it. I think regular accountability either from somebody else in their network or myself, having regular visits, keeping them accountable, is very key to this process as well. And I think the frequent lab values, so having objective data to start with and then periodically checking in to have progress checks with them and say, oh, wow, look at all your numbers. Everything is improving or we still need to work on this or that. But I think all that stuff, and the distilling of it and having a clear roadmap and getting them out of overwhelm and into, okay, here are the three things that are highest priority. Let’s just focus on those to get the ball rolling.

Evelyne Lambrecht: Yeah. Thank you for sharing that. And I know it’s individual, but I’ll want to get into you know what some of those things are that you’re working on with patients. And I do think it can be so challenging, speaking from personal experience as well with just kind of the perfectionistic tendencies and then like the shame that also comes from not doing those things, even if you have the accountability, because then you feel even worse, right, when you’re accountable to someone and not doing it.

Before we go into some of these things, I want to talk about some of the physiological drivers behind ADHD and then talk about solutions. So aside from just the dopamine aspect, what are some of the biggest things that you see in your practice? What are you assessing. And also we are talking more about adults today. So you also see children in your practice, right?

Dr. Dan Sullivan: Correct. Okay. So I think in terms of drivers, obviously yes, there is that genetic component, that dopaminergic component to ADHD. But I think there’s a lot of things that really compound that and exacerbate that, namely a lot of different nutrient deficiencies like your vitamin D, magnesium or RBC magnesium, zinc and copper. The ratio of the two typically lower amounts of zinc is very typical. Different thyroid imbalances as well, which can be exacerbated by the deficiency in zinc, difficulties converting thyroid hormone. A lot of different gut issues and food sensitivities. So whether that’s intestinal permeability, whether that’s gluten, issues with dairy there, I mean, there are so many things, genetic, variations and people supplementing with the wrong forms of B vitamins, for instance.

And then I think the biggest thing too is a lot of the lifestyle as well as the psychological stressors, and I’d love to get into this more so, but like the self-esteem, the shame, all those types of things as well, I think those are really compounding the variables to be taken into consideration when taking a comprehensive look at a patient for sure.

Evelyne Lambrecht: And we can talk about that a little more right now. So are those issues that you are talking to your patients about. Do you send them to a therapist? Tell us more about that.

Dr. Dan Sullivan: Yeah. So it depends on the patient. Sometimes I will refer out. But I will have that conversation and recommend. There are a lot of books that were very helpful for me. Like for instance, one of the most inspirational, transformative books for me was Psycho Cybernetics by Maxwell Maltz, who was a plastic surgeon back, I believe in the 1960s, but talked a lot about self-image. And so I think that’s a big piece. And I’ve dealt with that myself personally, which is feeling different. My brain works differently than other people. I think about things differently. It takes different, strategies, different accountability, different systems, different task management strategies to really help me feel successful and to get things done and be productive.

So, yeah, I forget where I was where I was going with that, but I think there’s a lot there just in terms of, yes, the building up the self-esteem and the self-image and then giving resources, books, different resources, videos of building them up. But then also, I think just that therapeutic relationship of meeting with me and then checking back in and just giving them not too much that they can chew at one point in time.

So, having a couple things for them to do. So it’s manageable. And then when they start to do that, and they feel those quick, they feel better, and they come back at the next appointment wanting more and just feeling more buy in and feeling more, more confident in their in themselves for having been able to do that and then feeling better as well from a mental standpoint, from a physical standpoint, that really then just helps to kind of build a positive cycle.

Evelyne Lambrecht: So this made me think of the question, you said you’re checking in a lot with your patients. What does that actually look like? You’re doing the initial visit, but then do they have to come see you for a certain number of sessions after? Tell us a little bit about how you do that at your practice.

Dr. Dan Sullivan: So the best results I have seen are with patients that have buy-in for a certain amount of visits. And that’s in the form of like a package basically, a six-month package with an initial and then monthly check ins, monthly visits, typically about an hour long.

So those are kind of the best results because I think psychologically when you are, when you buy into something, you invest in something, you want to get your money’s worth. And so I think that’s really where you’re kind of throwing your hat over the fence and then you’re kind of, forced to take action and follow up. Other patients more than happy to see patients visit by visit. But typically, yeah, there’s definitely more handholding. There’s more accountability that takes place in those first, I would say three to six months for most people.

Evelyne Lambrecht: That’s great. And, I’m curious about the labs or assessments that you run. You mentioned GI testing. You mentioned food sensitivities. What are some of your top things that you’re always looking at when somebody comes to you with ADHD?

Dr. Dan Sullivan: So I always like to assess the entire person. And I found the two tests that I run the most often are comprehensive blood work, as well as a GI map or a stool test, comprehensive stool analysis, basically. So I’m trying to cast as wide of a net as possible with the objective data. And then I see my patients for an initial visit for upwards of 80 to 90 minutes. So I’m getting as much subjective information as possible from them about their diet, lifestyle, medications, supplements, all that kind of stuff. And then pairing that up with the data.

So I’ll run a lot of blood work. So, a full thyroid panel, a full hormone panel, in men very important as well. I think it’s, a lot of practitioners are recognizing that men that are younger and younger are having lower and lower levels of testosterone, and testosterone has a massive influence on the frontal lobe on the entire dopaminergic pathway. For women as well, that also applies. But estrogen, progesterone, the ratio there, a lot of women come in stress levels are out of control. Progesterone is in the tank.

And then just in terms of other labs that I run, like I mentioned, the zinc and copper ratio and omega check, full thyroid panel, obviously your B6, your CMP, CBC, vitamin D, and iron is a huge one. So serum iron and iron panel with ferritin. And I see that a lot, especially in women obviously, menstruating women, they’re ferritin, a lot of these women that come in like we’ve seen, I don’t know how many women with ferritin in the single digits, which is just wild how they’re even functioning, let alone thriving.

And so trying to think of any other, DHEA testing cortisol and cortisol, lipid panels, just for general health, versus the ADHD specifically, but, and then inflammatory markers, reflective of their B12 and folate status, like homocysteine, HSCRP. And so a lot of these people are also inflamed, which definitely takes a toll on all neurotransmitters.

And then I think from the standpoint of the comprehensive stool analysis, there’s almost always something going on or multiple things going on from that front. And so a lot of times, I mean, probably 80% of the time minimum, I’m seeing leaky gut as well as could be low blastates, a lot of different levels of dysbiosis, H. Pylori infections are cropping up very often. And so it all kind of contributes.

So a lot of what I do is just more general health. How do we build a stronger foundation first, before we start to layer in the more sexy, the nicotinamide ribose sides and the different things that we think about, the methylene blue or things of that nature where I’m definitely open to doing that. But for almost 100% of the patients, there is a significant amount of foundational work that needs to be accomplished before we do that.

Evelyne Lambrecht: Yeah, I feel like in every single episode it’s reiterated to just go back to the foundations, go back to the basics, and save the biohacking for later unless you have those foundations down. I’m glad you mentioned the Omega check because I’m a huge fan of measuring that. I think it’s underutilized in functional and integrative medicine, definitely in conventional medicine.

So I’m curious, what’s the reference range that you’re looking for or how do you use that in your practice?

Dr. Dan Sullivan: So I typically look for over 8% in the omega check. And so I use it a lot of times for just a great initial data point to make the patient or especially the parent, like a lot of times I’ll see kids with their Omega-3 status is just in the tank. Just to make them a lot more aware and cognizant of, oh, wow, this objective data point is telling us how poor your Omega-3 status is, and we know how important that is for overall cognition, for ADHD, for depression, for all kinds of mental health conditions.

And so it’s more powerful when you have that data point to go off of versus just saying here’s some fish oil, it’s really helpful for your brain, and it’s going to be good for your symptoms. I think it really helps out with the buy in. And that’s why I do that comprehensive lab evaluation at visit one or shortly thereafter to just say, hey we need to do a lay of the land and see what’s going on. And typically the Omega check will come back with a lot of work to be done.

Evelyne Lambrecht: Yeah. I was also curious, where do you like to see ferritin levels. I know we can kind of depend on like male versus female and ages, but generally?

Dr. Dan Sullivan: Generally 70 to 100. And so for most women, I would say if they’re menstruating, I rarely see a woman in that optimal reference range. Well, sometimes it’s in the 50s, 60s, but usually it’s somewhere could be even be as low as the teens up to kind of the mid 20s, 30s, a very common deficiency or, I guess not necessarily deficiency but suboptimal status of.

Evelyne Lambrecht: Yeah. And I don’t know if like because you’re always in naturopathic medicine doing so many things at once. Right. Like you’re fixing the omegas and the iron status and magnesium and vitamin D. But I’m curious, based on your experience, have you ever seen it where just getting ferritin to an optimal level, actually improved symptoms of ADHD?

Dr. Dan Sullivan: Oh, 100%. 100%.

Evelyne Lambrecht: That’s great.

Dr. Dan Sullivan: Yeah. And I think it’s just such a gray area as well because ferritin is so important in so many other reactions other than just manufacturing dopamine, involved in thyroid hormone metabolism, involved in just overall carrying of the red of oxygen throughout the bloodstream. And so they’re feeling more energized. So they feel better. They’re just thinking clearer. So, I don’t know what percentage is an ADHD related benefit versus them feeling better. And then they’re just able to function more optimally on an overall level. So tough to say. But that’s a huge one, that if that’s not optimized, they’re really not going to get better.

Evelyne Lambrecht: Yeah. Thank you for sharing that. And then in regard to the stool testing that you’re doing, you mentioned H. Pylori. You mentioned some dysbiosis. I’m curious, are there other patterns you’ve seen that are specific to your ADHD patients versus other patients who are coming to you with other issues?

Dr. Dan Sullivan: That’s a good question. Sometimes I’ll see a deficit in beneficial bacteria, but I wouldn’t say I’ve seen clear patterns in the majority of my ADHD patients, they’ve got this going on. I think it is very just dependent. I haven’t seen those patterns in doing this.

Evelyne Lambrecht: It would be a full study if there are any.

Dr. Dan Sullivan: That would be a cool study. I think there’s more and more coming out about that. And the different organisms that have an effect on the dopamine pathway. But I think we’re just so early on.

Evelyne Lambrecht: Absolutely. And then in regard to food sensitivity, curious, what are the most common ones that you see?

Dr. Dan Sullivan: So that I have seen trends and I would say by and far gluten is probably number one with a close follow-up being dairy. Sometimes I’ll see egg, sometimes I’ll see random like garlic or random vegetables come up or very rarely, animal protein like beef or chicken. It’s almost always going to be that gluten and dairy.

Evelyne Lambrecht: Yeah. Sounds pretty typical for a lot of issues that we see. All right. I want to talk about some treatments that you use in your practice. So we talked about some foundational nutrients a bit already. But I’m curious like how do you personalize it, and how do you layer this in? Lay out what that looks like in working with a patient.

Dr. Dan Sullivan: Yeah. So typically that first 3 to 6 months is really focusing on the other stuff that the person has going on basically that’s accumulated, taking care of an H. Pylori infection or, healing a leaky gut or balancing their different hormones, optimizing their iron status, things of that nature. So once that’s been accomplished, and I think that’s kind of an ongoing process to some degree.

But I would say that that’s the time where we can really layer in the next level of intervention, that we can talk about things like the macuna or the phospho-titoserines or the nicotinamide riboside products or animal products. We also do a fair amount of I.V. therapy in here. I would say that’s also very helpful for that initial phase of treatment. That first 3 to 6 months of, especially when there’s a lot of dysfunction in the gut, there’s a lot of absorption issues. They’re not able to absorb very much or very efficiently when they’re taking supplements, order orally. So we will integrate a lot more I.V. therapy in that first period of time. I will say that NAD has been phenomenally effective for that whole dopamine pathway. It’s used a lot in addiction, which is basically that was a very, very similar dopaminergic pathway where the NAD seems to be very helpful at resetting that and helping the mitochondria to just have more energy to give that person some more executive function to carry out the plan that they’re given.

So I think those things are really, really helpful in those beginning phases to kind of dig them out of the hole that they’re in. But I think the L-tyrosine is very helpful. Lithium oratate can be very helpful. I’ve seen that one to be effective, especially in kids and adults, but especially when there’s a lot of explosive anger, when there’s a lot of hyperactivity, when there’s just a restlessness.

I just had a patient I saw for the second visit who I gave a low dose lithium oratate, and, yeah, the mom was kind of dumbfounded when we had the conversation. She’s like, oh, yeah. Wow. I guess, because when I was asking her about how have the anger outbursts been? She’s like, oh, I guess, I guess we haven’t had any of those in the past while.

So I think it’s and then also just really layering in some of the other lifestyle strategies like body doubling is a powerful technique. The Pomodoro technique, there are different techniques as well that I kind of just feel out the patient, where do they need support? Is it more supplements. Is it more strategies to help with their productivity? A lot of times they have a lot of issues with task management. And so, dealing with overwhelm, they have all these lists going, and they have a lot of disorganization, which then leads to overwhelm, which then leads to more cortisol, which then leads to decreased executive function. And so, trying to kind of unwind that, to give them oftentimes a simplified way of doing things and tracking things, keeping track of their tasks. That can be very helpful as well. So it kind of depends on what’s going on, what does that person need? And then we start to layer in those kind of more tailored recommendations.

Evelyne Lambrecht: Woo, do I identify with that last part you shared. Remind me of the body doubling because I sometimes forget. Is it that there’s somebody in the room with you, like being talking to someone at the same time. Remind me.

Dr. Dan Sullivan: Just having somebody there, literally. So, I work with a lot of entrepreneurs and so they’re working from home especially during Covid. And some people will just literally put on a YouTube video of, you type in body doubling as just another person there that I think just subconsciously keeps you a little bit more accountable, doing whatever. It’s kind of like going to the library when you’re in college, it’s just the environment or like even going to a library now or a coffee shop where there’s just other people there, that aren’t necessarily going to shame you if you don’t get your stuff done, but it just makes you a little bit more likely to do your work if you’re going there for that reason. Yeah, just a little bit more likely.

And I think that’s another big thing I will mention too. How do we help the person when they’re struggling with executive function? How do we help them to develop an external prefrontal cortex with developing better systems, with the task management system, for example, with strategies or with habit formation. I think one of the biggest habits, that I implement with a lot of patients that I think is a game changer, is basically the bookends of the day. So what are they doing in the first 60 minutes after waking up, and then what are they doing in the 60 minutes before they go to bed? So a lot of people are crushing their dopamine by immediately waking up, going on social media, consuming a lot of content that’s highly stimulating. And then they sit down to actually do some work, and it’s like, you’ve dumped out a lot of dopamine already from doing that. So you kind of have to conserve that, do some meditation, do some journaling, go for a walk. Low stimulation, but high levels of just building the body up essentially, getting outside, getting sunlight.

And so I think that’s also really important, as well as how you develop these systems and these practices, because the ADHD brain also thrives on structure. And so that’s really, really effective for people is just kind of keeping them in a nice rhythm of life. And that can really just help facilitate change.

Evelyne Lambrecht: Yeah. And something that’s obviously important but also hard to continue doing. Funny you mentioned the library because in college I used to go to the library and then I would go wander and look at random books. We should’ve known then. And there’s a lot of points where I’m like, wow, how did I not realize this?

I want to go back to what we were just talking about with the bookends of the day, but more the circadian rhythm aspect of it. Right. And then I want to go back to the supplements. So talk a little bit more about the circadian disruption and how that impacts ADHD. And I’ve also found and this is true for me too. Like I love to stay up late you know. So yes, I do keep lights on, I go to bed later. And I have read that this is very common with ADHD and we kind of like don’t want to put ourselves to bed. Like it’s very hard for me. I want to go to sleep. I’m tired, but I want to keep doing things at the same time.

Dr. Dan Sullivan: So yeah, that’s definitely multifaceted. Some of that comes from there’s a lack of stimulation or in terms of the external world on us. So we feel like we can finally get some work done. We can do you what we might have failed to do during the day? So I think that’s part of it. I think some of it is. Yeah. Like if we’re taking stimulant medications, that can also really exacerbate our sleep wake cycle and going to bed later. Because typically what I and I see this every day is there will be patients will be taking their medication in the morning, they’ll be skipping breakfast. They’ll be having coffee, they’ll be having their Vyvanse or Adderall. And then they’re literally just starting that the first meal of the day could be at noon. And so then the meal timing also gets delayed. And so they’ll at the ending up eating dinner at 9:00 at night or later sometimes. And so that will also then push back your desire to go to bed. And the hormones involved with that, right.

If you’re in a fed state, you’re not going to be producing very much melatonin. And then I think the light exposure is another big piece of that. And then with obviously blue lights, being on our devices, I think some of it, in terms of the boundaries, I see that a lot in people with ADHD is the lack of boundaries. And I think that kind of ties back into the first point of not really getting what they needed to get done, done during the day, and then finally feeling like, oh, wow, I have the space or the energy or the bandwidth, the calmness to then do some great work.

So, I think there’s a lot there. I love blue blocking glasses. That’s really helpful. I think just the structure of the day. Having routine like for instance for myself personally I have a smoothie almost every day, high protein, organic frozen blueberries, etc. in that smoothie around 8:00 every morning. And that just kind of really sets the tone and just starts the day. And then it’s just so much easier, when certain things are in place and they’re done regularly, meal timing is regular. That’s another very common thing with ADHD is the hyper focus leading to the skipped meals. And then we’re kind of stuck with feeling deprived of nutrients like nutrition by the end of the day. So then it’s it ends up being a larger dinner, which can just postpone things as well. So, yeah, a lot there.

Evelyne Lambrecht: Yeah. So do you tell your patients, because I think telling them, you need to do like this for an hour in the morning, this for an hour in the evening. It’s like too much, right? But so when somebody is seeing you for the first time and you’re working on that circadian part, do you just tell them, five minutes of sunlight every morning or whatever, what’s the main thing that you’re suggesting to them?

Dr. Dan Sullivan: Yeah, I think that’s definitely key. The light exposure. Our brains are highly susceptible to light. So that is a big lever to pull. I think trying to get some kind of regularity to their sleep, even if it’s, let’s say they’re going to sleep at midnight or 1 a.m., at least try to get that to a point where they’re going to sleep every night at that time and then slowly but surely dialing it back, 11:45 11:30 and then and just kind of slowly. So it’s these kinds of imperceptible changes that accrue over time.

Evelyne Lambrecht: Right. Okay. And then I want to go back to what you said about NAD IVs, because I, I find this really fascinating. We haven’t really talked about them on the show. I think if I’m not mistaken, for addiction, people actually go, is it like ten days in a row and do like intensive treatment for hours a day? I’m curious, how do you treat it differently for ADHD? I’m assuming that somebody is not coming in like that for an extensive program right?

Dr. Dan Sullivan: Not typically. And those are a more expensive procedure. So it is cost prohibitive. So, we would generally do something like that on a weekly basis for, let’s say, the first month or so. Then we typically titrate it back down to once a once every other week, and then more of a maintenance type of a routine, like a once a month type thing. And then we’ll also play around with either the oral NAD precursors, or we’ll also recommend the subcutaneous injection of NAD a couple times a week, 3 or 4 times a week of 50, 75 mg of NAD injected subq.

Evelyne Lambrecht: And then when you’re using things like nicotinamide riboside, or NR, do you keep patients on that for a long time or is it like a shorter intervention. And then you’re kind of like good for a while or do you really need to keep taking it?

Dr. Dan Sullivan: Yeah, that’s a good question. I think. I don’t like to keep patients on something long term, just in general. I think it’s a great helper for getting them to an optimal state, or just helping them to dig themselves out of the hole that their mitochondria might be in. And then once they’re there, I’m of the opinion that we start to titrate down, and I don’t like when patients are on so many different supplements for long periods of time.

They usually are for the first 3 to 6 months when we’re doing deep protocol, we’re de-peeling at that point. But I think ultimately the goal is to use a minimum effective dose philosophy. And so I think the same thing applies with the ends. The NRs is use when needed type of thing.

Evelyne Lambrecht: Great. I want to go back to some of the other supplements you mentioned and talk about dosing a little bit and any other tips that you have, like mucuna, phosphoserine, I don’t think you mentioned saffron, but I think you and I talked about it separately.

Dr. Dan Sullivan: Yeah. So tyrosine can be very helpful. Dosing wise typically around 500 mg. That could be really helpful paired with the mucuna, couple hundred milligrams of mucuna as well. B vitamins, there’s different combinations. I know Designs for Health has some combinations there, that are very helpful. So one intervention I’ll do a lot of times and especially a little bit later on in the treatment process is when they’re on stimulants, a lot of times they’ll have that afternoon horrible crash.

And I think that can be helped out by optimizing their underlying physiology. But I think there is an inevitable crash that occurs when you’re off of a very potent stimulant medication. So, the addition of a tyrosine, a mucuna, things of that nature can be titrated in that kind of midafternoon phase to sort of step them down from the stimulant.

So not going from 100 to 0, but they’re getting a little bit of dopamine support on the way down. The saffron I probably should use more of I haven’t really use too much of that. I know there’s a lot of good research on it. One thing I do use a lot of, and is probably one of my favorite supplements, is the phosphatidyl serine. And so that I found very effective for, not only the stress management piece, I use that a lot in just general patient population for difficulty sleeping, difficulty winding down, kind of blunting a cortisol spike that they might be getting before bed. That one very effective can be helpful for the dopamine pathway.

Evelyne Lambrecht: So with the phosphatidyl serine I’ve usually also recommended it before bed. But are you giving phosphatidyl serine during the day?

Dr. Dan Sullivan: I will. And some people yes.

Evelyne Lambrecht: Okay. Yep okay.

Dr. Dan Sullivan: Yep. So typically about 100mg of that could be multiple times a day. And it could also be before bed for sleep if they’re having issues with sleep.

Evelyne Lambrecht: Okay. And then what about any adaptogens. Have you found those to be helpful?

Dr. Dan Sullivan: I like rhodiola a lot. I think that’s a really nice one for, especially the more inattentive ADHD. So the people that are struggling with, like myself included, I have inattentive ADHD. So, kind of the desire for more of a stimulant effect without necessarily going to a medication. So also obviously very helpful for athletic performance, for mental stamina, for just combating fatigue. I find that one to be particularly beneficial. And then I would say, your other ones, your gingko, the ashwagandha I find very helpful, especially, using that in combination with the phosphatidyl serine and especially before bed if we’re trying to blunt cortisol. So those have been particularly beneficial.

I mean, there are other ones as well, but couple monetary effect is, panics ginseng. It kind of depends too, what else is going on. And I try to hit a couple birds with one stone with any of these interventions, like, especially if they have some issues with testosterone and a man, for instance, I’ll maybe use a rhodiola/macca combination to try to get some benefit to the HPA or the, yeah, hypothalamic pituitary testicular axis and trying to kind of reject or kickstart that process to get some more testosterone going.

Evelyne Lambrecht: Great tips. Thank you. I can’t believe we’re already almost out of time. I want to talk about medications a bit. You did mention it before in terms of using the tyrosine. When somebody titrated. But for ADHD stimulant medications aren’t the only ones. Can you give us just a little overview? I know in just a few minutes on the types of medication ones and then how you are working with them in practice, like any clinical pearls you have.

Dr. Dan Sullivan: So I would say there’s both your stimulant medications and then your non-stimulant medications for ADHD. To put it broadly, 90% of the patients that I see coming in are on a stimulant medication. So that could be of the amphetamine family, like your Adderall, your Vyvanse or the methylphenidate family, like your Ritalin. They’ll sometimes be patients with polypharmacy. They’ll be taking SSRIs, they’ll be taking SMRIs, and, they’ll be taking other non-stimulant medications for ADHD. But it’s almost always going to be a stimulant. And so you know most often I’ll see difficulty with getting enough calories in the day. And then particularly a lot of difficulty with that first meal of the day. They just simply especially in kids too, they just they’ll just refuse to eat like until lunch, they’ll have a couple of bites of toast or something. And then go to school.

I think one tip I would have would be to just try to do whatever you can to get some kind of protein. And I typically do that with some kind of just a protein powder in the morning, just getting some level, for adults, at least at 30 grams of protein mark. And so that way it’s just a literal two-minute ordeal where you’re mixing up a shaker bottle because a lot of people with ADHD are also rushing in the morning and don’t have the time to make anything.

And so I think that can be particularly helpful, is just getting some kind of liquid protein in there. That will give them some of the building blocks to replete some of the neurotransmitters that are going to be affected by those stimulant medications.

Evelyne Lambrecht: Right. Thank you. Great tips. I want to shift a little bit just because we have a little more time to talk about business, stuff, and I didn’t mention it yet. So you work at Oasis Health and Medicine in Encinitas, and, you work with Dr. Pedi Mirdamadi, who was also on the podcast before. And both of you have grown really large Instagram followings. And I’m curious if you can share a little bit more about that journey of showing up and what has driven your growth. And then I’m also curious, because you have ADHD, but it looks to be very well managed because you really get a lot done. So if you want to share a little that.

Dr. Dan Sullivan: So I think in terms of the social media, Doctor Pedi has been instrumental. He really took me under his wing and showed me a lot of the ins and outs. And also just I think I’ve been very fortunate in my life, for whatever reason, to having, incredible mentorship. Like, I remember I played the saxophone growing up, and I had an incredible teacher who just, I don’t even know how to describe it, but, just had a way of believing in the students, showing them what was possible and just having a clear path of here’s what you need to do. And then this is the kind of results that you’re going to get. And it was a repeatable process. And so that’s something that I learned from Doctor Pedi is that the results were possible. I think that’s like belief is a big, huge, thing. And I think for patients as well, having been through the ADHD myself, been on the medication route, went off of the medications. I’m doing it naturally. And so just realizing that, oh, it is a possibility.

And so I think, with the social media, like anything, it’s the constant showing up every day. I think it took a long time to really accrue some significant growth. I think it was over, from two years ago, I think I started around 1,500 followers and then was posting almost daily for a year and then got up to about the 10,000 follower mark. And then the next year it was a more dramatic, growth curve, upwards of 150,000 over the following year. But, yeah, I think it was just getting over the discomfort of being on camera and then just showing up all authentically, just really doing my best to provide genuine value.

And then I think along the way, just having someone in my court like Doctor Pedi, I think the feedback, here’s what you could do better. And then actually doing that, actually being teachable. And then, just, facing the feedback and not internalizing that as, I’m not good at this or, I’m not, any of those kind of limiting beliefs that come up or I’m not getting the results. I think it was just. Yeah, belief in the process that it was possible showing up consistently and just doing my best to, to provide value.

Evelyne Lambrecht: I love that, and I love that both of you share just really educational content. You’re not doing trendy dances. You don’t have to do that, right? You can just share educational content. And I think that’s what so many people want to see on the platform, whether it’s talking about lab testing or certain nutrients. So, yeah, thank you for sharing that.

Dr. Dan Sullivan: Yeah. And I think, looking at the numbers, I think it’s a matter of what do I what am I passionate about? What do I enjoy talking about? But also, equally important is what do people want to learn about what do they want to learn and how do they want to digest this information. And I think a lot of people become jaded because they’re saying, the average person is just flipping through social media. Their attention spans are very short. And so for that reason, I can’t be successful or what have you those types of limiting beliefs. But on the flip side, you can also have the belief of, yes, people’s attention spans are shorter. They’re on social media, but it’s an opportunity for me to distill this knowledge into more bite size pieces that people can relate to. There’s a lot to that.

Tracking the numbers, seeing what works, and then for whatever reason, for me, it was every video that really took off happened to be about ADHD. So I just kind of ran with that because that’s what the people were kind of, in essence, telling me, we want to hear more about ADHD. And so, that’s kind of the path that I took.

Evelyne Lambrecht: Yeah. That’s great. And I love what you said about distilling it more and more. Right? Because that makes you a more effective communicator, whether it’s online or with your own patients. So getting to that essence.

Dr. Dan Sullivan: Yeah. Which is incredibly difficult sometimes. Yes. There’s still all this stuff down into a 60-second reel.

Evelyne Lambrecht: Yeah. Great. Well, I’d love to ask you some questions that we ask every guest. The first one is what are your three favorite supplements right now for yourself?

Dr. Dan Sullivan: For myself I would say I’m really liking the phosphatidyl serine for myself. Very helpful for sleep, for just the stresses of business, patient care.

I would say a magnesium glycinate is very effective for me. I’ve been taking that for years.

Evelyne Lambrecht: How much do you take?

Dr. Dan Sullivan: I take, what do I take? I think it’s 400mg, give or take.

Evelyne Lambrecht: Nice.

Dr. Dan Sullivan: Somewhere around that ballpark. And then I would say vitamin D, vitamin D3 with K2.

Evelyne Lambrecht: Great. And what are your favorite health practices? I know you mentioned some of them throughout the podcast, but what are your anchors in every day?

Dr. Dan Sullivan: I would say a meditative process. I meditate almost every day. That really helps me to ground, I would say, a happy and fulfilling relationship with my significant other who’s also an amazing, naturopathic doctor you’ll have to have on.

Evelyne Lambrecht: She’s lovely.

Dr. Dan Sullivan: She’s great. I think that really just brings me a lot of joy. Grounds me. And exercise is another big one. That really just helps me to feel my best, to feel energized. And I mean, there’s so many, but I think one that I’ll mention that’s always kind of been really instrumental in my life is reading books and just always exposing myself to new ways of thinking, new ideas. I just think it’s the greatest thing in the world that we’re able to take somebody’s life work, for instance. And they can distill that into a 200 or 300 page book or even a six- or an eight-hour audiobook, and we can digest that and just learn so much. And so, yeah, I’m a lifelong learner. So I think that really just keeps me motivated and keeps me inspired every day.

Evelyne Lambrecht: I love that. And final question for you, what’s something you’ve changed your mind about in your career?

Dr. Dan Sullivan: I think I used to place too much importance on the physical, the physiological, what medications, the supplement protocol, which I think is very important, don’t get me wrong, but I’ve just come to the conclusion that a person’s, how are they feeling emotionally? Are they living a life that they enjoy? Do they have healthy relationships around them?

I feel like some of these intangibles are just so critically important as a base for those nutraceuticals to really take hold and do what we want them to do.

Evelyne Lambrecht: Absolutely. I think about that when we talk about the blue zones, we’re like, oh, which diet is it. Is it related to wine or like the smoking or exercise? But it’s like, well, they’re social and they have connection. And is it really about the actual food they’re eating or like who they’re eating it with and the environment and so it’s interesting. I was reading something yesterday about, how in Greece, they always had siesta time in the afternoon and everything would close. And how now they’ve gotten rid of that and people just aren’t as healthy because it’s sort of natural to have that. But I mean, who can do that in the modern world? Can you imagine?

Dr. Dan Sullivan: We do our best. Yeah, yeah. Take many, many breaks.

Evelyne Lambrecht: Yeah. We might be better off if that was the case. Well thank you so much Dan. Where can practitioners learn more about you, what’s your Instagram?

Dr. Dan Sullivan: So Instagram is dr.dansullivan and then on the clinic website oasishealthandmedicine.com are probably the two places to find me.

Evelyne Lambrecht: Perfect. Well thank you so much. I really, really enjoyed this conversation with you. And it’s very clear that you walk the talk. So I really appreciate that and really appreciate you coming here.

Dr. Dan Sullivan: Thanks so much for having me. This was fun.

Evelyne Lambrecht: Absolutely. And thank you for tuning into Conversations for Health today. Check out the show notes for resources from today’s episode. Please share this podcast with your colleagues. Follow, rate, leave a review wherever you listen or watch. And thank you for designing a well world with us.

Voiceover: This is Conversations For Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts, exploring evidence based, cutting edge research and practical tips.