Transcript 

 

 

 Michelle Shapiro [00:02:39]:

There is so much misunderstood from a medical perspective, from a holistic, integrative, functional medical perspective about the condition ADHD. There is also, more importantly, so much misunderstanding about the beautiful brains of those with ADHD. On this episode, I'm sitting down with my incredible colleague and friend, Dr Laura Gouge, who's a naturopathic physician, to talk about ADHD and not only ADHD as it exists in isolation, but as it exists within the context of the body and as it exists in the context of other conditions. There's actually a cluster of symptoms and conditions that what I would say is travel together. And Dr Laura Gouge brilliantly explains this one genetic theory called the RCCX theory in this episode to let us know how those conditions relate to each other. In this episode, you're going to hear me using terms like mast cells, mast cell activation syndrome, and I'm going to be using the word histamine.

 

Michelle Shapiro [00:04:09]:

I wanted to take a minute just to talk about those terms and talk about what you can expect when we bring those into this episode. Mast cells are a highly intelligent type of immune cell that exists within our connective tissue. I'd like to think of them as kind of the guards on the watchtower of our body. They are monitoring for changes and then sending messengers to the rest of our body to enact changes based on them. One of the chemical messengers that these mast cells send out is something called histamines. We usually think of histamines in the context of seasonal allergies, right? Those antihistamine drugs. Histamines have many more functions outside of that. And what Dr Laura brings in so beautifully is this connection between these highly intelligent cells, these mast cells and histamines, and ADHD and hypermobility.

 

Michelle Shapiro [00:05:00]:

These are topics that we've heard about in the podcast before, but we've never uncovered them in this context. And with understanding how they might actually be connected, it's not so common that we think of hypermobility or feeling like you're double jointed and that relating to ADHD like symptoms. I think the most important message of this episode specifically is that people with diagnoses of ADHD, or those without, who suspect they have it, have not only different brains and different ways that their bodies function, but there are so many benefits and there's so much beauty and so much we can learn from the wisdom of these symptoms. There's so much we can learn from the people who have been diagnosed or suspect they have these symptoms. One specific theory we also talk about during this episode is how ADHD brains may actually lead to periods of low cortisol, when in fact, a lot of the information we see online relates to how people with ADHD experience chronic high cortisol. This is a fascinating piece of the puzzle I can't wait to explore with you here. And a little bit more about our guest, Dr Laura Gouge. She is a licensed naturopathic doctor and nutritionist with a focus on integrative mental health, ADHD and chronic illness.

 

Michelle Shapiro [00:06:24]:

Dr Gouge graduated from the National University of Natural Medicine in 2015, where she then completed two years of residency. After residency, Dr Gouge worked as the medical director of a community based mental health clinic for over three years. She serves on the board of the psychiatric association of Naturopathic Physicians. Her passion is helping people with ADHD mystery illnesses and bridging the gap between conventional and holistic care. I loved recording this episode with Doctor Laura Gouge. I know you're going to love it, and I really want the message that we take away from this to be how we can work with our bodies and with our genes as opposed to against them.

 

What is your background and journey?

Dr. Laura Gouge [00:07:12]:

By trade. I'm a naturopathic physician, but before I ever went to school or anything like that, I am probably the classic person who visits a functional medicine provider because I am very healthy on paper. But I have struggled with so many chronic, often severe symptoms going back to childhood. So before I put all the pieces together, I never really saw a connection between. There was PM's, I got these weird. I didn't have allergies as a kid. I had these weird allergic reactions that would happen, insomnia, I would get anxiety, I had painful periods, IB's symptoms, chronic fatigue. And so I ended up pursuing becoming a naturopathic doctor to be able to hopefully help people like me.

 

Dr. Laura Gouge [00:08:05]:

And I was still on my own healing journey and I really wanted to be able to go deeper and ask that question of, well, why are these symptoms happening? And I was also the person who visited the doctor. They're like, everything looks great. I just still had my symptoms. I wasn't really getting help. And so as I continued on that journey, I ended up being diagnosed with ADHD myself at age 31. And I started learning more and more about things that could be impacting that and also how histamine was affecting me my whole life, and I think I had these genetic predispositions that caused hives and allergic reactions. And these probably was underlying so many of my gut symptoms, because I remember thinking, oh, I just. Sometimes I can't eat strawberries because sometimes they make my stomach hurt.

 

Dr. Laura Gouge [00:08:59]:

And, like, looking back, it's like they're all histamine rich foods. Like, oh, why do I feel like crap when I have kombucha? Oh, okay, it's high histamine. I later learned, like, I start to put the pieces together, and I think histamine and ADHD are really having a moment right now in the social medicine sphere.

 

How do you define ADHD?

Michelle Shapiro [00:09:17]:

They really are. And also tell us, when you hear ADHD, what comes to mind for you?

 

Dr. Laura Gouge [00:09:22]:

When I hear ADHD, I don't think of just one thing. I mean, I think I am still influenced by the cultural bias that originally told me that ADHD looks like a little boy who is acting out in school, being disruptive, loud, impulsive, can't focus. And now I have evolved that so much as I've dedicated so much time into learning about this condition, that I see it as this complex, beautiful combination of personality traits, specific sensitivities, challenges, and areas of executive function. So often with so many of the people I work with, we have this saying of, hard things are easy and simple things are so hard because so often with ADHD, we are these incredible high performers who are really bright, who can put information together so quickly, yet who just want to have a breakdown when it comes to tidying the house or going to the post office or holding your laundry or these, like, really basic, boring parts of being a human being. And so, yeah, I think of so many different things. I think we're really having kind of, like, a renaissance and recognizing how women are impacted in being neurodivergent and how different we may show our symptoms. Like, I would say, like, for myself, I'm that classic woman who wasn't diagnosed until I was an adult because I was a good student and I was really quiet, and nobody recognized the quiet, daydreaming girl in the classroom who got good grades as maybe having a lot of trouble focusing. And I didn't know what was normal for other people, so I didn't think there was a problem.

 

Dr. Laura Gouge [00:11:20]:

I think, like a lot of women, I had, honestly, I never told anyone this. I just decided that I had a learning disorder. Like, I knew I couldn't focus when the teacher was talking, but I could ace the test, because to me, the test was like the game. And so I just decided I had this auditory learning disorder, never told anyone, and just kind of did my own thing. I found my workarounds in school, and I think so many women do this, where we find workarounds in the places that feel hard or challenging, and we find other ways to succeed.

 

Michelle Shapiro [00:12:00]:

So it's almost like some compensations while noticing, and some compensations without noticing, too. I will tell you that very profoundly. My sister often says that she believes neurodivergence is like the next evolution of human, that it's what we will all be. Because your brain capacity is, in many cases, brain capacity can be a lot higher. And it's really fascinating. And where we have this impression of it being something like you said, that was this negative kind of connotation historically, I think now we're starting to understand it's a little bit more of a superpower than we might have realized, too.

 

Dr. Laura Gouge [00:12:33]:

The more we can lean in, and I think work with how our neurodivergent brains process information, like, to do things like that is where I see people who are neurodivergent. Being. Having an easier time with things is often the hardest part, is when we're expected to fit into molds that maybe aren't quite right for us. And that's where I think our modern, conventional educational system has so much room for improvement, is because everyone does not have the same learning style.

 

There are some people who have been diagnosed with ADHD who have kind of an internal world, and then other people who are experiencing their symptoms on an external plane or seeing things outside of themselves. Can you talk a little bit about that?

Michelle Shapiro [00:13:01]:

100%. And you said something really interesting before, too, which was a question that my sister Jen had asked me. She said, you have to ask doctor Laura this question. There are some people who have been diagnosed with ADHD who have kind of an internal world, and then other people who are experiencing their symptoms on an external plane or seeing things outside of themselves. Can you talk a little bit about that?

 

Dr. Laura Gouge [00:13:23]:

So, traditionally speaking, ADHD is put into three categories. We have hyperactive, impulsive type, inattentive type, and combined type. I think those definitions are mildly useful, but there's a lot left that's not necessarily explained, because with people who are inattentive, we can still experience hyperactivity. It just may be more in the form of raising thoughts, it may be more in the form of something invisible. And I think that, like every other disorder, we can experience symptoms of ADHD differently over the course of a lifetime, where people as children may experience more hyperactivity because children naturally are more hyperactive, and there's more room for that. And then, as an adult, like you still can learn new things and train your body and your brain to do different things. We have neuroplasticity so we can find new ways of doing things. So I don't know exactly what your.

 

Dr. Laura Gouge [00:14:24]:

I don't know exactly how to speak to what your sister was talking about as far as, like, internal and external worlds, but I find that some people are very much daydreamers. Like, it's almost like they're not quite there. It's like they're very much living internally. They have a really rich, often really sensitive internal experience. I tend to relate to most people, but especially those with that internal experience is probably fitting the category of being a highly sensitive person.

 

Michelle Shapiro [00:14:56]:

Absolutely.

 

Dr. Laura Gouge [00:14:57]:

And people who are more on that classic hyperactive spectrum are often more external. They're looking for external stimulation. It's why that kind of classic picture of a class clown who's disruptive, yelling when the teacher's talking, it's like they're getting something out of that. There's probably dopamine and adrenaline and good feelings ultimately, that might come from that. It also could be that they're feeling anger. We don't know why, but it's like they're relating to the world more for an external response.

 

What about people who are also diagnosed with ADHD who are more sensory seeking or sensory avoidant?

Michelle Shapiro [00:15:28]:

So there are certain people who are also diagnosed with ADHD who are more sensory seeking or sensory avoidant. Can we speak into that a little bit too?

 

Dr. Laura Gouge [00:15:36]:

A really big part of ADHD is this idea of having an interest based nervous system, which can also tie into an idea of often being adrenaline seeking. And that does not like, while it might mean adrenaline in the form of bungee jumping, it does not always mean that it could be as simple as loving to perform or telling jokes or being really social or reaching out. And so I think for. I think most people with ADHD actually experience both sides of this coin. But there's a sensory seeking part where it's like, I'm looking for stress hormones, probably possibly addicted to stress hormones. I'm really running on and relying on adrenaline to feel good. And then there's also part of ADHD where you are so over stimulated, you are so past your point of nest, probably being done, that it's almost like a shutdown. Some people will call it an ADHD paralysis or ADHD burnout, but it's this feeling of.

 

Dr. Laura Gouge [00:16:48]:

It's where you might see people have a little bit of a meltdown, but it's like, I just can't do more. I can't go on. I'm done. And some people with ADHD will go through periods of being really burned out and really in kind of like a low state where everything feels like too much and now I'm speaking just the ADHD experience because I do think that there can be very specific sensory sensitivities that just can go along with being neurodivergent, you know, sensory processing disorder that I think most people with ADHD have some sensitivities, but they may not be full on sensory processing disorder. So I'm just speaking in terms of, like, the ADHD itself. But that's what I observe.

 

Could the sensory input be from any of our senses?

Michelle Shapiro [00:17:27]:

That makes total sense to me, too. And when you're saying sensory inputs just for people who are totally new to the topic, do you mean any sensory input and that could be from any of our senses?

 

Dr. Laura Gouge [00:17:37]:

Yeah, it really could be anything. I think for a lot of people it comes up as a sensitivity with socializing, just being around people, needing to do things like get stuff done, loud noises, bright lights, all sorts of things like that.

 

Michelle Shapiro [00:17:56]:

And certainly smells, by the way, they can be so disruptive, honestly, sounds and smells can be so disruptive. It's so true. I know in my clients who have mass cell activation syndrome, I often say it's a little bit like having an allergy to stress. And that's like kind of, any kind of stress that could come up. And I was like, so, you know, one of my clients who went on an airplane recently was asking me about it and was saying, like, why was that the worst experience ever? And I'm like, it's kind of, it's a mass sells worst nightmare in some ways. And in the same way, because the sensory load is so high that your brain is kind of assessing for those threats in so many different ways, and it's also your brain going, why am I in the air when I'm supposed to be on the ground? I don't understand. You know, there's that component of it as well, too. So, all right, I've been waiting to ask you about the RCCX genetic theory.

 

What's going to happen if your child gets diagnosed with ADHD? What options are offered and what's the pathway?

Michelle Shapiro [00:18:45]:

So I am going to wait ten more seconds and I'm going to ask you one more question first. When we think about the conventional allopathic model of ADHD generally, can we just go through in a couple sentences what that looks like? And then we'll look at the functional model, and then we'll look at what model you're laboring under, which is a combination of all. But tell me a little bit about what's that allopathic? What's going to happen if your child gets diagnosed with ADHD? What options are offered and what's the pathway?

 

Dr. Laura Gouge [00:19:10]:

Usually in the conventional world, a child or adult is either going to be diagnosed in a very short visit with their primary care provider or a psychiatrist, and sometimes they're going to be referred for more specialized testing. So some sort of psychological or neuropsychological assessment. It's a clinical diagnosis. There's no blood test or imaging to confirm it. So it's made by the discretion of the person who's interviewing you. There are some standardized assessments that can be given where it can really say you're very likely, you're not likely, but it's still a clinical diagnosis. Then the treatment is medication. It could be a stimulant.

 

Dr. Laura Gouge [00:19:47]:

There are a couple of other medications that are used, but most commonly it's stimulants, the famous Adderall and Ritalin. And now there's so many derivatives of those basic medications, then sometimes that's combined with behavioral therapy. So it's therapy, psychotherapy, CBT, sometimes something called skill building. But, you know, there's often a behavioral component to kind of learn new ways of doing things. And some people, quite a few people with ADHD experience internalized shame and low self esteem from their experience in the areas of life where they struggle. And so the behavioral component can be very helpful. But medication tends to be what is given as a treatment.

 

Would you consider medication for ADHD a root cause treatment or symptom management?

Michelle Shapiro [00:20:28]:

Would you consider these, and this might be a hard question, would you consider these treatments a root cause treatment or symptom management?

 

Dr. Laura Gouge [00:20:36]:

It's complete symptom management. So even if you go full conventional with full symptom, like going for symptom resolution, you'll usually have improvement in your symptoms while medication is in your body, which ranges from two to 12 hours at most, and that's it. So you're not going to have necessarily benefit except from the behavioral parts. As you kind of learn new ways of doing things, you probably have an easier time in certain areas of life, but it's really symptom management.

 

Michelle Shapiro [00:21:04]:

Do other symptoms get managed, like if you had a histamine symptom, if you had others? Or is it really just focused on what we would consider like more? The neurological supportive symptoms.

 

Dr. Laura Gouge [00:21:15]:

The stimulants are going to primarily focus on like the executive function piece, the ability to focus. They're going to give you energy and make it easier to and do the things you need to do in life. You know, interestingly, I do see that some people have improvement in other symptoms, like some of the kind of histamine. People that I've worked with. Some people do feel bad, but it's really, I think it really depends on what's going on underlying someone's physiology, where some people are going to get lots of improvement, some people are going to get lots of side effects. Like, I think it really varies person to person and exactly what improvement looks like and how their body responds.

 

Please explain the RCCX genomic theory

 

Michelle Shapiro [00:21:57]:

And it goes without saying that, you know, both of us are not insinuating by any means that these medications are not functionally useful by saying that they're not necessarily a root cause treatment. Of course they're functionally useful for many people. It's not even a question. Of course. So now tell me. All right, doctor Laura, it's your time in the spotlight. Tell us about the RCCX genomic theory. We want to hear the genetic theory.

 

Michelle Shapiro [00:22:17]:

Tell us about it.

 

Dr. Laura Gouge [00:22:19]:

So I discovered this theory. I was working as the medical director of a mental health clinic, and I was working with a large population of people who were experiencing treatment resistant mental health conditions. And so really complex cases where people had gone the full route of conventional treatment and were just not feeling better. And I started to notice this pattern almost to a predictable nature, of when I would do an intake and I would get someone's medications. There was almost always asthma medication, allergy medication, pain medication. And I started to just ask this, like, question of why does it seem like all of these people are hypermobile? Why are so many of these people in their twenties and thirties in chronic pain? Why does it seem like every single child with ADHD has asthma and eczema? And there were just these trends I was noticing. And I, you know, at that time, I had not learned about this. I could not put the pieces together.

 

Dr. Laura Gouge [00:23:22]:

But it was this question of, like, what? Why? Like, what is happening that so many of these people have pots, they have histamine issues. I don't even think I knew about mast cell activation disorder at this point, because this was six years ago. And so there was this question. So fast forward a couple of years, I learn about this theory called the RCCX theory. I've never actually said her name, so I hope I say this right, but it was put together by a really bright psychiatrist. Her name is doctor Sharon McLaughery. I may be saying it wrong. And she started to piece together this genetic theory that is called RCCX.

 

Dr. Laura Gouge [00:24:07]:

And it's a theory of four genes that tend to travel together. And there's the idea that these genes are very susceptible to changing. And there are certain traits that tend to go with RCCX cluster. And this is still a theory, this has not been proven. So I just want to be really transparent. I love this, but it's the first thing I've ever heard heard of that connected the dots for me and for so many of the people that I know and that I work with. So the core genes have to do with hypermobility, our response to stress, which can be predisposing to most of our mental health conditions, and then also impacting the immune system. So you can see a really high likelihood of autoimmunity with this population of people.

 

Dr. Laura Gouge [00:25:05]:

There's a big histamine component in seeing mass cell activation syndrome, seeing pots and dysautonomia, and a whole cluster of inflammatory disorders. Neurodivergence fits into this. All of the Ehlers Danlos, but especially the hypermobile part of Ehlers mast cell, and then so many of our immune system issues. So one trait of RCCX is people who actually don't necessarily get sick very often, but they may be very prone to things like long COVID, long Epstein bar, more susceptible to mold illness. Cause it's like the immune system should just mount a response, handle it, and then you move on. But for a lot of the people who may fit this genetic phenotype, we're not mounting that initial immune response and then going into this kind of long inflammatory form. And so there are certain personality traits that tend to go with this. So it's often people, it's more common in women.

 

Dr. Laura Gouge [00:26:10]:

And a big hypothesis of this is how it potentially impacts our hormones. So women may be more predisposed to it because we have the more estrogen, progesterone. That's a whole other conversation, by the way. Exactly. So, being very bright, very sensitive to stress, potentially easily traumatized. There's often a feeling with RCCX that over time, it's almost like traumas are compounding and stressors are compounding. So most people start out pretty healthy. And then when you look back, I know I can say this for myself, when I look back over my life, almost every single health change followed a life change, even if it was good, but it followed some form of stress, like going to college, very positive life experience, naturally stressful.

 

Dr. Laura Gouge [00:27:01]:

My body didn't just bounce back from that stress like the average person would. So people who are with the RCCX phenotype seems like other trends are being good critical thinkers. So people are usually much more open minded and able to kind of like, see the big picture, like, kind of think beyond just what's told us on the news. Very empathic, probably that highly sensitive person, very creative, often very like social, bright, lovely people, but also where there are mystery symptoms absolutely.

 

Michelle Shapiro [00:27:37]:

And it feels like this amazing population of people. It's almost like the experiences of life. They're like sponges for the experiences of life. And then not releasing the water after, it's just in you, and you're kind of holding on to it, and then it's going to show up in different ways. Basically, I do think of mast cell issues, or when and if people aren't familiar with mast cell specifically, I'm really talking about this allergy type thing that people don't understand. It's just this allergy thing, and that's how people would classify it. But I really think of mast cell type issues as being exactly, like you said, said, delayed. So it's not like someone would get COVID and they would have the worst COVID experience.

 

Michelle Shapiro [00:28:16]:

Actually, they'd have a fine COVID experience, and then seven days after, they have a whole different weird kind of symptoms. Because it's really not usually the event that's the issue. It's the reaction to the event that ends up being really symptomatic for people. And something I also wanted to mention before you get into the cortisol piece of this, which I'm obsessed with, is also that I've had. You know what my aha moment for all this was is when they did a long COVID study. I think it was about 80 people, and they gave them. They didn't know how to help them. There was nothing.

 

Michelle Shapiro [00:28:48]:

They were throwing everything at the wall, and they ended up giving them pepcid. And pepcid reduced the symptoms. I think it was over 80%, like. And I think it was something so substantial. So I've had clients who've had. Who are, like, very typical mast cell clients who have taken ambien to sleep. They have severe insomnia, and they just switched to, like, a pepcid under their doctor's guidance, and never switching medications without doctor's guidance. And then they're sleeping, like, through the night.

 

Michelle Shapiro [00:29:14]:

So it's really fascinating also, because histamines are so stimulating that it would only be natural in this conversation that histamine y, I really call it the zinginess of histamines. They're buzzy, they're under your skin, they're itchy. Kind of sensation really would relate back to, if we're talking about an ADHD experience, there has to be a histamine component to it. It's so symptomatically similar to me.

 

Dr. Laura Gouge [00:29:40]:

Absolutely. The histamine component of ADHD is being studied. I've read some really interesting papers kind of looking at what that connection could be. And there's all of these hypotheses because it doesn't seem like it's everybody. There's a good percentage of people with ADHD where I think it's at least 50%, where there's a histamine component. And I'm taking this from research I've read about the connection between atopic diseases like asthma and allergies and eczema, and the correlation to developing adhd at some point in life. And there's different theories as to why this is. Is it that histamine's inflammatory? Is it that the histamines are somehow changing neurotransmitter receptors? Like, we don't know exactly what that component is.

 

Dr. Laura Gouge [00:30:29]:

And people always ask this. I just want to say it's not always as simple as just taking antihistamine. For some people, that is helpful. And, you know, if you have other symptoms, you can talk to your doctor about whether or not an antihistamine is appropriate, but it's not always as simple as that.

 

Michelle Shapiro [00:30:44]:

No. 

 

Michelle Shapiro [00:33:09]:

And sometimes people are extremely negatively reactive to taking antihistamines too, which I mean, as a naturopath yourself, we also understand the force of any drug can have a backlash. Maybe supplements have a little bit less force and maybe foods have a little bit less force than that. But in a body that's defending, you can't just throw things inside of it and expect there's not going to be reactions from it. So absolutely agree with you on that too. But when it works, it's so amazing when antihistamine can remove something like you're saying insomnia or PMDD symptoms like you just posted about. I mean, it's really so deeply incredible.

 

Dr. Laura Gouge [00:33:51]:

Also, let me just share with you one thing, because we share a love for pepcid. There was an interesting study that was done that pepcid specifically, so famotidine, it seems to actually calm inflammatory reactions. And so this isn't going to be in everybody, but there was a study that was done specific to COVID that it seemed to potentially be helpful because it was actually calming that inflammatory cytokine storm. And this is like an off target reaction because the other h two blockers did not have that same benefit. There's something about pepCid, which is why there's almost this movement of people online who get PMDD who are finding that famotidine is helpful. And it's not everybody, but for the people that it works, it's like a miracle.

 

Michelle Shapiro [00:34:34]:

There's like the, I can't explain it. There's like the person, and it's usually people who are very treatment resistant otherwise, honestly, because if you have a histamine issue and you're treating it with anything else, you're not going to get there. Sometimes it's just really hard. And again, there's other approaches. There's nettle leaf tea, there's ginger supplement. Like, you don't have to choose medications, but since these are notoriously challenging to diagnose, and I'm assuming you would say not only histamine issues, but ADHD is not diagnosable by blood in any capacity either. It's by, like you said, by symptomology. It's really hard to get any sort of blood markers for that.

 

Michelle Shapiro [00:35:12]:

Is there anything you can look for in blood for ADHD? Not really.

 

Dr. Laura Gouge [00:35:15]:

Right. There's no reliable blood marker in ADHD, unfortunately.

 

Can you explain cortisol as a component of the RCCX theory?

Michelle Shapiro [00:35:20]:

And now this is my question for you too. So in the RCCX theory, okay, let's talk about cortisol as a component of it.

 

Dr. Laura Gouge [00:35:27]:

So in the personality type that has a brain wired for danger, there's going to be increased, just like arousal. So a lot of people are probably listening and relating to this, but it's like your stress response is stronger than the average person's. And so you really feel those stress hormones. A lot of people actually really like that feeling. So for a lot of people with RCCX, they actually tend to run on stress hormones until they can't anymore. Like, I would say that was my sort of, you know, I never would have said I was low energy. Like when I was in my twenties, it was like, I'm exercising six days a week and I'm going to grad school and I'm doing all this and I'm, you know, I'm going to be social every night and I'm doing so much without ever checking in with how I was actually doing. And so there's actually this tendency to push through.

 

Dr. Laura Gouge [00:36:16]:

And that's part of the theory of why people with RCCX may end up chronically ill is that we're not as sensitive to our own internal signal that.

 

Michelle Shapiro [00:36:24]:

Says, stop, slow down.

 

Dr. Laura Gouge [00:36:29]:

And so part of the theory is that this, like, heightened stress response ultimately leads us to a state of burnout and having really low basal cortisol. And so low cortisol can look like depression, it can look like just being exhausted, it can look like low motivation, it can actually look a lot like ADHD, where it's like, I don't have the energy to do this. I really just feel like doing the dishes will be too much right now. It's this just feeling of like, I don't have it. And to have it, I have to get some adrenaline. Like, I really have to kind of amp myself up. So it ties into ADHD and the idea of, I'm going to wait until the last possible minute to get this project done because with the adrenaline of knowing my deadline is hours away, I'll be able to focus. So it kind of ties into the RCCX theory there.

 

Dr. Laura Gouge [00:37:26]:

But so we have low cortisol. There's just this fatigue and low energy and low motivation, probably feeling depressed and then even more sensitivity to stress.

 

Michelle Shapiro [00:37:41]:

It's just when you wrote low cortisol on that one slide, my heart, like, sunk because I was like, that just makes so much sense because I think what people can't usually understand, it was kind of hard for me to understand, to be honest with you, is about these medications, which are clearly stimulants, right? Like, they clearly are up. Why would someone who feels like they have hyperactivity want something that's stimulating to the brain, right. And it's really because according to this theory, people are laboring under a baseline, it almost seems like, of low cortisol. And then when they need to recruit energy, like you're saying, they're recruiting it from stress hormones. So you're running on stress hormones when you're running and you're running hot on those stress hormones, and then the come down is quite low, which would leave people in kind of that depressive state. How do these, or just really low energy state, it doesn't necessarily need to be depressive. How do these medications, like the stimulant medications, help with those symptoms? Is it because people are not having the low cortisol feeling because they're getting boosted up essentially during the day?

 

How do stimulant medications help with the low energy/cortisol symptoms?

Dr. Laura Gouge [00:38:46]:

The stimulants are going to increase dopamine and a little bit of norepinephrine. So like adrenaline and a little bit of serotonin. So everybody responds to a stimulant. It's not just people with ADHD. They tend to make people feel good. They increase feelings of energy. And so it's like you can focus, you can get stuff done. And so they work for everybody.

 

Dr. Laura Gouge [00:39:06]:

Sure. And so, yeah, it doesn't really matter what's causing the ADHD symptoms. The stimulants are going to correct it.

 

Michelle Shapiro [00:39:16]:

Absolutely. I would assume that from a naturopathic perspective, your goal would be to not have people kind of burn out as much as possible and not be living on those stress hormones and crashing down when someone's already been diagnosed with ADHD. I want to kind of talk about that path. And then if you don't mind, if we talk about something just kind of more sensitive around all this, I think there's a lot of controversy in the world of neurodivergence because a lot of parents, proud parents of neurodivergent children, will say, I don't want to change my child. These interventions are going to change my child's personality, and I love them exactly like they are. Do you think early intervention is, first of all, kind of ruling out the moral quandary of it, or you can even speak into it? Is there things that can be done if you already have this RCCX picture when you're younger? Does it get harder as you're older? Take us through the lifespan a little bit with that.

 

Are there things that can be done if you already have the RCCX profile when you're younger? Does it get harder as you're older? 

Dr. Laura Gouge [00:40:13]:

I'm just speculating, but I suspect that if we can know that maybe your child is more sensitive. Like, if I had a child that I identified as probably RCCX, which I probably would have, because, like, I mean, it seems like RCCX people are attracted to each other. So, like, my husband is probably RCCX, just healthier than me because he's gone. And so if we had a child who was like that, I would want to do everything that I could to support my child's stress response. And it wouldn't mean that we want to avoid stress because we all want to be resilient, right? We all want to be able to experience stress. Like, this is not about avoiding life, but I think it would be really about how much can I build into my child's life, even if it's just mindfulness and ask learning to support them in their own energy. Like, do you want to do this today? What do you have energy for? What would feel good today? Like, and not encouraging this, like, push through kind of culture where, like, yeah, there's. There's probably a time.

 

Dr. Laura Gouge [00:41:25]:

Exactly. Exactly. Not encouraging that, like, really building in time in nature, gentle exercise, child friendly ways to modulate stress. So maybe doing, like, kids yoga or kids breath work or little kind of simple things like that so that they can learn how to, like, regulate better.

 

What is your response to the naturopath who is attempting to eradicate ADHD in ways of gut cleanses and, for small children, in ways of candida cleanses?

 

Michelle Shapiro [00:41:43]:

Absolutely. Which also is going to give downstream effects on your stress hormones. Just any nervous system regulation tools. And then what would you say to. There's actually a particular naturopath who is pretty obsessed with eradicating ADHD in ways of gut cleanses and ways of, for small children in ways of candida cleanses and those kinds of things. What's your response to that kind of approach?

 

Dr. Laura Gouge [00:42:10]:

My focus is not on eradicating ADHD.

 

Michelle Shapiro [00:42:13]:

I would think it's not.

 

Dr. Laura Gouge [00:42:14]:

And it's not. Cause I actually feel like that reinforces this idea of, like, there's something broken in you, there's something fixed. And, you know, I do think that especially in children, like the so called early intervention can be really helpful. Like, if it were my child, I would want to get them behavioral support, and then I would gauge whether or not it seemed like I would not be quick to medicate. I would try everything else as far as mineral support and supplements and dietary changes and all of those things. I would make sure they were sleeping because there's a huge connection between ADHD and sleep. So I would do all, like, medication would be my last resort, but I would want to be intervening as quickly as possible. And as far as, like, eradicating ADHD, I, you know, I'd be really curious on what that would even mean, because in my experience, there's certain personality traits that go with ADHD and that I can even say for myself, I have eradicated so many of the problems that came for me with ADHD diagnosis.

 

Dr. Laura Gouge [00:43:25]:

There's so much that used to be hard. That's now pretty easy. There's so many. And yes, I had gut dysbiosis. So by treating that, it resolved brain fog, it resolved so many of the issues I was having, but that was because I had that. But I wouldn't be chasing it in a kid who had no symptoms at all, but maybe had a little bit of candida. I wouldn't be, like, going hard after that.

 

Michelle Shapiro [00:43:51]:

Absolutely not. And of course, you know, it's every single parent's decision what works for them and their kids. I think that's. It's a fear that parents experience when their child maybe if they're exhibiting also skin conditions at the same time and they're seeing like, a trend, it's every parent's right to intervene and do everything they need for their kids, but I think the language around it and also really talking about, yes, you're working on some level of a root cause of nervous system regulation, but not working on fundamentally eradicating a deficiency of some kind. And there's plenty of research that links behaviors to gut dysbiosis changes. I mean, we definitely know there's a tremendous amount of research there. Is there anything you do around the gut microbiome in your practice as well? Or is it really focused on, like, stress nervous system approach?

 

Is there anything you do around the gut microbiome in your practice as well? Or is it focused stress nervous system approach?

 

Dr. Laura Gouge [00:44:40]:

I look at the whole body, so I always look at the whole body, so I think the gut can be a factor. I think in functional medicine, we may have gone a little too far down. Like, the gut is everything, because I don't think it's always everything. It's a factor. And especially for working with people with ADHD, often we do see, like, even the conventional world recognize there can be significant improvement with elimination diet. So if there is something your body is sensitive to and it may come back to histamine, like, when you look at, like, why is red dye so famous and worsening hyperactivity, it seems that it increases histamine, and then it can make some kids symptoms worse for other people. No issue with the red dye. So it's like, I never want to instill fear into my patients where, especially when you're working with children, where it can be a really big deal to remove foods from their diet.

 

Dr. Laura Gouge [00:45:32]:

And a lot of times these are kids where we want to make sure they're eating enough. So it really depends on the family and the level of sensitivity of the child and kind of like, where the family is. But I think as much as there is openness, I think if we can just check out the gut, what is going on? Is there dysbiosis? Because, like, if there is dysbiosis, candida parasites, things like that, like treating it will often improve everything. Like, I don't know if it'll improve adhd symptoms, but I know they'll probably feel better.

 

Michelle Shapiro [00:46:04]:

Except good luck treating parasites when you have a histamine issue. But I love, you know, I have had more clients come to me post parasite protocol gut cleanse, because it's the way I try to explain it to clients, is that you can't wage a war that your body's not prepared for. So if you want to go in with a kill protocol, you're going to have a histamine response probably to it after, and a mast cell response, more importantly, because your body's going to say, oh, my gosh, what is this? And I don't have the nutrients to clean this up. Which is why I do have a kind of big problem with long term elimination diets. Specifically because the nutrients your liver needs are often included in the foods that you're excluding. But if you are in a flare for five days because you eat a strawberry, you might have to make a move in the short term. I mean, let's be realistic for people's lives, right? But in the long term, we take those nutrients out and we really deprive our liver of the exact things we need to detoxify in the first place. So I do want to talk about the liver, too, because I have, like, this in TCM or ayurveda.

 

How is the liver important to ADHD? 

 

Michelle Shapiro [00:47:05]:

I think of these conditions as being very airy and windy and very liver focused. Do you, have you had experience also with, like, liver focus? And is that something that you, as a naturopathic doctor who obviously bridges the best of the east and the best of the west, have you experience that or looked into that or work with that, too? I mean, you look at the whole body, but I just want to talk about the liver, basically.

 

Dr. Laura Gouge [00:47:26]:

I think the liver is very important in ADHD. And this is just really that naturopathic perspective where I can't necessarily back it up with like, this is where, like, naturopathic and conventional are not going to align. But I do find it, because if we're thinking about, okay, we have to metabolize all of these, these hormones, the liver has so much work to do. And with something like mast cell activation or just when we're dealing with a body that is reacting to a lot of stuff, there's probably something going on with the liver where there may be difficulty breaking down some of the toxins. We know that heavy metals can be connected to ADHD. Again, not going to be every person, but when they're there, it can be a complete 180 to do some gentle, you know, I use just corrective minerals, I'm not doing chelation or anything like that, but a lot of times just bringing balance, like, do we have enough selenium, do we have enough calcium, do we have enough magnesium, do we have copper and zinc in the right balance? A lot of times as those come into balance, the body can then, like, let go of those metals that maybe it was having trouble eliminating. So I like really gentle liver support. So things like certain herbs, castor oil packs, really making sure just that we have the minerals that we need.

 

Dr. Laura Gouge [00:48:48]:

Because, like, we don't have what we need, the liver is not going to be as efficient using foods as much as possible. And yeah, I try to be gentle there versus like, the hardcore liver flush, things like that.

 

Michelle Shapiro [00:49:03]:

Oh, no. Oh, no, not for our people. No, no, no, no. I'm so, you know, it's really fascinating, too, because I would assume in your population, which, you know, I work with people who have mass activation syndrome, pots hypermobility, that triad neurodivergence sometimes comes along. But I know that's really, like, the group of people, that's the condition that you lead with in ways of, like, it's interesting because it can be any of the four and it ends up being a lot of the same RCC xers. I think with people who have adhd too, there's definitely this. I'm assuming sensitivity like we said to a lot of things in life, but certainly to supplements. And there's this really frustrating thing about our mast celli clients, our histamine clients, which I myself am this exact person.

 

Michelle Shapiro [00:49:46]:

Doctor Laura said she's this exact person, but let's say I'm deficient in vitamin b twelve. I can't just take a bunch of b twelve because then my body's going to be like, whoa, whoa, whoa, that's really threatening to me and I don't know what that is and I don't know what to do with it. So I'm sure you see this a lot where you maybe aren't doing such harsh interventions because it's harder to integrate and more reactive when you're putting those supplements in as well.

 

Dr. Laura Gouge [00:50:09]:

Absolutely. I have everybody keep empty, like gel caps in their drawer. Like, I have some right here. And so when you're starting a new supplement, either, I'll say just dump half of it out, like, whatever, just start with like half a pill, or we just open up a capsule and pour a little bit in, or you cut your tablet in half. Like, we start really low doses. I'm always really thoughtful of how we kind of stagger intervention so we're not changing five things at once, and then there's a reaction and then we have no idea what happened, and then the person feels just unsafe with their protocol. So really slow and steady, really gentle. I often feel like, intuitively too, like a person often kind of knows what works for them and what doesn't.

 

Dr. Laura Gouge [00:50:50]:

And so we'll really work as a team in figuring out how we're going to add things in. And that's also where I think starting with the stress reduction can make a huge difference. And I mean, sometimes, like, often the initial conversation I'll have with someone is, how can you do less? Like, because a lot of these people, like, I was this person where I just over scheduled myself. I never asked myself the question, do I have time? Do I have the capacity? Does this work with my schedule? So I would just be kind of burning myself out doing so much. So sometimes it's as simple as like, buffer time, leaving room to get bored, planning nothing on a weekend, so you just kind of see what happens, increasing time in nature. And I mean, I am a huge fan of meditating a person who's willing to. I think it can really, really change how we're able to respond to stress and how we're able to relate to our own internal presence. Because a lot of times, especially with the mast cell which I'm not full mast cell, but I'm a histamine person.

 

Dr. Laura Gouge [00:51:55]:

And when I can feel those reactions starting, a lot of times there's been a huge stress or anxiety where it's like, oh, no, I don't want to feel sick if I'm at an event or I can feel it building. Being able to just drop that drop back into my body, breathe and regulate can just like night and day. My symptoms, it's.

 

Michelle Shapiro [00:52:20]:

I mean, you know, it's funny, but what we're talking about is every single one of the conditions is a dysfunction of the nervous system. These are all dysfunction or a different way the nervous system functions. We don't need to call it even dysfunction, but this is an alteration how it functions. So if you do something like meditate, the benefits of that can hit you on a histamine level, on a blood flow level, on an ADHD level, there's really, like, boundless benefits. And that is, in my opinion, with all these conditions, the only root cause approach. There's of course, other treatment options and pathways to go. Of course, I use supplementation. Food changes.

 

Michelle Shapiro [00:52:57]:

Hilarious that we didn't even talk about food, but all these different things that are so, so important. But at the root, these are dysfunctions or changes in the nervous system. So there's no way around that. It's just, you will have to do that work to get better. And how I'll see clients again who are, have pots and they're doing their compression socks and their salt. And I'm like, if you don't do the thing, though, you know, the actual change in what makes your blood flow go to a different place or what chemical messenger like histamine you're releasing doesn't change either. So that is the kind of, that's the gold in all this.

 

Dr. Laura Gouge [00:53:32]:

I think, you know, I love supplements. Like, I use them. I think they can be incredible in helping people with reversing chronic health issues. And in this kind of RCCX population, I find that people are so quick to say, well, what supplement can I take for that? And it's almost that same. I'm going to push through because I am not going to change my life, I'm not going to change my lifestyle, I'm not going to slow down because it feels good to keep going on those stress hormones. There's kind of like it's. It's the devil, you know? And so I always come back to the thing that people really don't want to hear is like, yeah, you can, you cannot out supplement this. You know, if you have mast cells, you have ADHD.

 

Dr. Laura Gouge [00:54:17]:

It's not as simple as just take this one thing. If it, if there were one supplement, the creator of that supplement would be very rich.

 

Michelle Shapiro [00:54:26]:

Well, it's pepcid. I'm kidding. It's not pepcid. I'm blinking. It's not pepcid.

 

Dr. Laura Gouge [00:54:30]:

Yeah, exactly. But if there were.

 

Michelle Shapiro [00:54:34]:

Yeah, exactly. I told doctor Laura that, like, my clients joke that pepcid is their other boyfriend because there's sometimes, it's really the only thing that helps in these really, you know, intense situations, which is so weird. Again, this acid reducing drug, the functional medicine world is so against acid reducing drugs. And I laugh with my friends who also have mast cell, and I'm like, did we ever think we'd be back around the corner in western medicine's hands? And you know, this, you know, because really, really awesome practitioners, we're open to everything. Anything that will help someone, I think is, you know, and I know you're like that too, of course. And so I had one question I didn't want to forget about too. So in this low cortisol RCCX picture, a lot of people, a lot of my clients who are diagnosed with ADHD, they also like that bottoming out feeling. If they aren't on medication, they, like, need coffee.

 

Michelle Shapiro [00:55:24]:

So it's really interesting because one of my friends asked me the other day, should I, can I drink coffee? Is it a histamine thing? And I'm like, well, everything's a seesaw, right? Because if the caffeine is necessary for you to function, then you have to kind of drink the coffee or something equivalent. But maybe a tea has tannins and the tannins might be histamine. So tell me a little bit about why does coffee really seem to help people and how do you deal with those conversations that are so nuanced where it's like, yes, but you know, which I'm sure a lot of conversations you have very nuanced.

 

Why does coffee really seem to help people with ADHD?

Dr. Laura Gouge [00:55:58]:

A little bit of caffeine, I think, can help when someone's in that low, just low state of low cortisol. I mean, there may be a low dopamine component too, if someone's like, been on medication for a long time. The stimulus. Yeah. And I do find that when I was kind of early in practice, I tried to get everybody off of caffeine, just in this mindset of, we've got to calm their anxiety, we've got to help them sleep. And I quickly found that it did help certain things, but some people never fully seem to bounce back from cutting out the caffeine. And so I think it's a balance, like you said. And I really just try to work with people because Adhders often have a lot of trouble moderation with caffeine, especially caffeine use disorder, which is real, is much more likely in the ADHD population.

 

Dr. Laura Gouge [00:56:47]:

And so I really try to work with people to say, like, you know, I like matcha a little bit more because you get that l theanine, and it's just not quite as addictive. Like, because coffee, you get a. I mean, look, I love coffee. I want to say, like, I love it, but it's like a dance of how it fits into my life. But either a little bit of coffee, ideally with some food in your system, just so that it's a little slower.

 

Michelle Shapiro [00:57:13]:

Release, then the cortisol straight up or something like that.

 

Dr. Laura Gouge [00:57:17]:

Yeah, exactly. But I mean, it can help with that feeling of, like, low energy, low motivation. And so ideally, I love it if people can get to a place where they don't need caffeine or it's really minimal, but we got to meet people where they are in a lot of ways.

 

Michelle Shapiro [00:57:30]:

We do. Yeah, we were the same people.

 

Dr. Laura Gouge [00:57:34]:

Elimination. Exactly.

 

Can you tell us more about interest based stimulation?

 

Michelle Shapiro [00:57:36]:

We were like, let's do elimination diets and cut out caffeine. And then it's like, but that's not real life. There are actual people, and there's a lot of studies that show some moderate benefits to having caffeine as well, and especially in this population, I can imagine. It's like the benefits are very high. You also mentioned interest based stimulation, which I think is so interesting. And I often think of people being exhausted either from being tired physically or being uninterested in things and not engaging in things because they don't care about it or they're not interested. Tell us a little bit more about that, too.

 

 Dr. Laura Gouge [00:58:11]:

Well, it's often said that ADHD, there's an interest based nervous system. I mean, in many ways, I think neurotypical, like, most of us have an interest based nervous system. But with ADHD, it's almost a feeling of, I can't if I'm not interested in it. It's this feeling of, you know, there's subjects in school you may not like, but with ADHD, you can feel like, I cannot do that because it's so boring. It almost feels like it hurts.

 

Michelle Shapiro [00:58:39]:

So do you get regulated from doing things that are of interest? Does it regulate your nervous system to do that?

 

Dr. Laura Gouge [00:58:47]:

So you are regulated by doing things you like, and then you also get feel good hormones. Dopamine is naturally released. And so there's just. I mean, I think there's also just serotonin and there's joy in doing things that you're really interested in. Cause it's one of those paradoxes of ADHD where people will say, my child cannot focus except they can sit and do the thing they love, hyper focus for hours. Right. And so I actually think it's important to both lean into that of, like, what does that look like? And there's also a lot of behavioral tools and strategies that I'll use with people to. To reduce that ick factor that comes with the things.

 

Dr. Laura Gouge [00:59:31]:

Like, I would say I still have an interest based nervous system. I still get this ick feeling around things that I find really boring and I don't enjoy. I'm able to do them due to using different, like, tools and techniques and just kind of, like, ways I can make it interesting to me, ways I can make it a game, and also just mindful awareness. Like, I remember unpacking a suitcase used to be super hard for me. And there was this moment where I just remember saying to myself, you know, it's going to be hard today, and it's going to be hard in ten days. If I leave it there, it's never going to not be hard, so I might as well just do it. And, you know, I want to be mindful that, like, I know in the ADHD community, this, like, just do it is not helpful. So I'm not.

 

Dr. Laura Gouge [01:00:14]:

It's rather the mindful awareness that I kind of learned. I'm going to get that ick whether I do it now or whether I do it in ten days. So instead of tripping over it and making a big deal, let's just, like, make it easier on myself. So I think awareness and just kind of like going through life and aging, I learned new ways to relate to a lot of the things that had previously just felt impossible.

 

Michelle Shapiro [01:00:39]:

Absolutely. And do you, is there actual studies that show there's differences in those with ADHD diagnoses and if they. The dopamine levels or anything? Is there anything like different parts of the brain light up? Anything interesting like that?

 

Dr. Laura Gouge [01:00:53]:

I don't know of any studies that have truly confirmed dopamine. I actually think conventional psychiatry has really worked backwards and that they happened to discover that stimulants were effective. It happened completely by accident. It started in the thirties where a doctor was trying to treat children with headaches and just made a note in his research study that they were better behaved and that kind of set off this slow.

 

Michelle Shapiro [01:01:22]:

Is it a vasoconstriction thing, by the way? Because migraine medications are vasoconstrictors now. I'm thinking on a whole different now. I'm like, what was that about? That's interesting.

 

Dr. Laura Gouge [01:01:30]:

I honestly don't know what exactly the mechanism of his study was. They discovered that stimulants worked on accident and children were actually being prescribed them through the seventies before we actually had a diagnosis of ADHD come out in the DSM in the eighties. And so we kind of worked backwards where we know that. We do know these medications seem to stimulate dopamine and some norepinephrine, but it's never been truly confirmed. Like, it's hypothesized that people with ADHD have lower dopamine sometimes. It's also said that we might have fluctuating dopamine levels.

 

Michelle Shapiro [01:02:07]:

Because that's what I'm curious about, is.

 

Dr. Laura Gouge [01:02:08]:

That, you know, when you are able to hyper focus on something, you're probably. You feel good.

 

Michelle Shapiro [01:02:15]:

You're in it when it's happening. Yeah. That's probably a result of really nice. Yeah. I have the feeling that possibly the fluxes are high, isn't it? So I don't have the study for this, but maybe again, the fluxes are higher, so that when people feel really good, they feel really, really good, and they really want to do that. And when they're not feeling that way, they really, really don't feel good doing something that would seem to like hair with the picture you've drawn. Thank you so much. Is there anything that you feel we missed in the kind of conversation around ADHD?

 

Is there anything that you feel we missed in the conversation around ADHD?

Dr. Laura Gouge [01:02:45]:

The only thing I would ADD is that I think when we were talking about this kind of like chronic stress piece that can tie into it, one of the things that I think can then happen is that we can end up depleted in a lot of our minerals, our minerals, and especially if someone is neurodivergent and maybe has specific food tastes. Like with ADHD, people will hyperfocus and eat the same foods over and over again, and then it might change. But I think specific dietary patterns combined with chronic stress can then lead to imbalances. And even in the conventional world, they recognize that there can be. Minerals can sometimes help. They're usually really small studies, but that they don't draw big conclusions from, which I would suspect, is because the minerals are going to be different for different people. So it's not going to translate really well into like a randomized placebo controlled trial, but looking at things like calcium, magnesium, iron, and how that plays into copper and zinc, and then I just think about our vitamins. That can make a really big difference.

 

Dr. Laura Gouge [01:03:47]:

And this is going to be more individualized. But I think that's kind of like just the last piece when we talk about stress, because reducing stress is so important. But then also if the body is in a more depleted state, replenishing is kind of like the next step.

 

Michelle Shapiro [01:04:04]:

100%. I would, if I had to guess about the picture of someone who has ADHD, I would really think minerals of concern would be sodium, magnesium, and the copper zinc ratio, I think is something that you would definitely be looking at in an HDMA, or even if you can get something from the blood, you know, it's not as accurate, obviously, but.

 

Dr. Laura Gouge [01:04:24]:

I'm sure that I'd want to see.

 

Michelle Shapiro [01:04:26]:

Both just to kind of get a.

 

Dr. Laura Gouge [01:04:27]:

Sense of what's going on.

 

Michelle Shapiro [01:04:29]:

Absolutely. So important. And then hilariously, we didn't talk about food, but we might just have to have you back on for an entire food episode. You did touch upon it. And in episode season one, episode two of this podcast, we did an entire episode on stress and minerals with Amanda Montalvo, my BFF, and who's the Mineral Queen? And we really talked about what minerals we deplete during times of stress. If we are under the assumption that this is a group of people who potentially are running on stress hormones, they might be depleting these minerals quicker than other people. Even so, this is definitely something that's really, really important. And because you might not be able to get the diversity of food due to sensory issues, it's also important to make sure you're covered on those key vitamins.

 

Michelle Shapiro [01:05:13]:

I would always be looking at B vitamins, but you would really want to work with a practitioner on this specifically because like Doctor Laura and I said, it's not only so personalized, it's likely this population will be more reactive. And then we could have done methylation and we could have done all that too. But we went through a lot and I took enough of your amazing time. I will have to have you back. Doctor Laura, where can people find you?

 

Where can people find you?

 

Dr. Laura Gouge [01:05:34]:

So you can find me on all platforms? Doctor Laura Gouge. I am currently taking one on one clients, so you can find that through my Instagram bio or my website. All of them are Doctor Laura Guj. I'm probably the most active on Instagram, so connect there.

 

Michelle Shapiro [01:05:49]:

I am so grateful you came on today. I was really buzzing all week about this episode and I'm so excited and we covered so much and I know people will get so much value from you and just your interest based nervous system. You're so brilliant and so thoughtful with everything you say, and you're obviously an HSP yourself, so thank you so much for being here. And please, I'll put all the links below if you want to work with Doctor Laura Gouge, and I really would recommend that you seem like the exact type of practitioner I'd want to work with.

 

Dr. Laura Gouge [01:06:17]:

So thank you so much, so much. And thank you so much for having me. Of course.