24. ADHD, Stimulants, and Real Results with Dr. Mark Su

Once a month I open up one hour to five people only. Real questions, real answers, real direction. 

Grab your spot at go.rootseekhealth.com/askdrmark.

You've probably been told the story about stimulant medication goes one way. You take it, you focus better, maybe you sleep less, maybe you lose your appetite. That's the whole conversation. But what if the real story is bigger than that, and most people never get to hear it because nobody in the exam room takes the time to tell it?

In this episode, Dr. Mark Su breaks down what 22 years of treating ADD has actually taught him, including the secondary benefits of getting ADD under control that almost never come up in a standard prescribing visit. From sleep to relationships to anxiety relief, this one might reframe everything you thought you knew.

What You'll Learn in This Episode:

• Why Dr. Su believes environmental toxicity is one of the primary drivers behind the rise in ADD and brain dysfunction across all age groups.
• Why stimulant medication is absolutely on the table as a root-cause medicine tool, and what it means to use it thoughtfully rather than reflexively.
• How getting ADD under control can dramatically reduce secondary anxiety, the kind that builds up around everything you forgot to do, didn't finish, or couldn't organize.
• Why some patients report sleeping better on stimulants, not worse, and the brain-based reason Dr. Su believes explains it.
• How treatment can improve presence, listening, and emotional availability in relationships in ways that patients and their partners often notice before the patient does.

Key Insights:

There is a version of this conversation that never happens in a five-minute prescribing visit. Dr. Su has watched patients go from struggling academically, relationally, and emotionally to experiencing what many of them describe as feeling normal for the first time. Not just more productive. Actually comfortable in their own skin. That distinction matters, and it is one he has never heard discussed in a standard clinical handoff.

The secondary cognitive capacity piece is worth sitting with. Dr. Su uses Maslow's hierarchy as a lens here. When your brain is stuck in the noise of what you forgot, what you didn't finish, and what you're dreading tomorrow, there is simply no bandwidth left for the deeper questions, your goals, your relationships, your sense of self. Getting ADD under control does not just clear the task list. It creates the mental space to actually live.

Dr. Su is clear that he is not dogma-driven in either direction. Stimulants are a tool, not a mandate, and not a cure. But he has seen enough life-changing outcomes, in students, adults, long-term patients, and even family members, to say plainly that dismissing them without a real conversation does patients a disservice.

-------------------------------------------------------------------------------------------------------------

Dr. Su and the RootSeek team work with patients across the country who are navigating exactly this: unexplained symptoms, labs that don't add up, and a conventional system that keeps telling them everything looks fine.

Ready to finally get answers? 

Once a month I open up one hour to five people only. Real questions, real answers, real direction. Grab your spot at go.rootseekhealth.com/askdrmark.

Have questions about your labs?

Download your free lab results guide at rootseekhealth.com/labs

Subscribe and Leave a Review: If this episode made you think differently about your brain health or someone you love, share it with them and leave us a review. It helps more people find their way here.

Disclaimer: This podcast is for educational purposes only.  Information discussed is not intended for diagnosis, curing, or prevention of any disease and is not intended to replace advice given by a licensed healthcare practitioner. This podcast and its guests may have direct or indirect financial interests associated with products mentioned.

Transcript

Welcome And Show Mission

Dr. Mark Su 0:09

I'm Dr. Mark Stu and welcome to the Functional Medicine Reality Podcast. Join me and our community weekly as we bring you unfiltered health from inflation to longevity, real stories, real people, real solutions. Experience real life health changes from both patients and practitioners, and learn how to turn cutting-edge information into real results in your own life so you can feel better, live longer, live healthier, and be confident and clear in your healthcare choices. Let's get real and get results. Hey

Defining ADD Without The Label

Dr. Mark Su 0:42

friends, I want to talk today. I want to tackle the topic of ADD slash ADHD and stimulant medication. The goods and the bads, the uglies, the pros and cons. Let's just start right now by saying I'm gonna refer to that ADD and ADHD topic together as just ADD right now. It's I don't care which one we use, ADD or ADHD. Personally, I don't even care if we label it specifically as attention or focus attention deficit or not. We could just call it executive function challenges. We could call it attention and focus troubles. I don't if you're a person who doesn't like to lay put a label on things or you don't like to use are repulsed by being defined or diagnosed as ADD or ADHD, ADHD, I totally get that. I respect that. I validate you. You don't need to accept the label, all right? But we'll just use that for communication terms as the umbrella term for the symptomatic and functional life experience challenges that you might be you might wrestle with, or someone you know of wrestles with or has been outright diagnosed with, okay? So we'll use the term ADD. Here's my thing about ADD. I do, I first of all, I do believe that I am strongly convicted that one of the major reasons, if not the major reason, we deal with it more now than we did years before, as many patients ask me, it's so overdiagnosed, right? It's over-treated. Why do we think it's overdiagnosed? Is it just quote unquote overdiagnosed? Is it because we're so much more aware of it and we're so much more on the lookout for it? And oftentimes patients are coming to us asking about it and almost self-diagnosing, is a lot of it because it's not something we have, a blood test or an image test for. There's no way to diagnose it otherwise, other than just subjective interview and what we call history and physical, just the discussion, the clinical, it's a clinical diagnosis. And so therefore, because it's so subjective, it's really easy to diagnose it because you can't that, you can't, you can't, it's easier to meet criteria when it's subjective, as opposed to it doesn't show up in blood testing or imaging, so you don't have it. Okay. All those, all the above are true on some level. But my personal conviction is indeed that we live in a more toxic world. There's a lot more environmental toxicity, and all those pieces play a role in on a population level to all of us being more predisposed to having dysfunction with our brain function, even including in utero. And for those of you who already know this, maybe not surprised to you, but this is seen in research that my my wife's work at Harvard, in her, as again, she's I'll brag on her that she is a arguably a top five. I'm just because it's too extreme to say top, but I'll say top five research in the world of metabolomics, especially in nowadays in the world of age uh anti-aging and longevity, age-related diseases, but including a lot of these environmental toxins. And uh they are seeing data in their research also, all right, about very the aspect, the effects of various toxins, even in utero on kids, babies, and then followed as toddlers out X number of months to years with their neurodevelopment. All right. At the time of this recording, certainly the whole RFK move RFK and is very much in the news. And uh, I'll just say I have a this is not political one way or the other, but I don't know if I've met any, I don't know if I have any colleagues who disagree, colleagues or patients for that matter, who, regardless of their political principles, their political party alignments, if they have any, which a lot of most people do, regardless of anything else, on the topic of healthier foods and reducing or eradicating, if we can, eliminating toxicity from our food sources, I don't know if anyone disagrees with that. All right. Just on an intuitive level, just as a basic intuitive humanistic level, I don't know that there's arguments against that. How far that goes in the policies and and how much it's directly attributed to this and that, that's where a lot of the arguments take place. But the bottom line is I will, I'll go to bat that there's plenty of arguments that a lot of the environmental toxicities we deal with and are identifiable these days do play a role in brain development and brain health. All right. Whether you want to talk about spectrum disorders as in in childhood, or you want to talk about dementia and memory loss, brain fog issues with late later life or post-COVID, et cetera, et cetera, I think it's all one, it's very arguable in my mind that very plausible, certainly, and quite arguable that it we're all in the same, it's all in the same bucket. Okay. Toxicity of the brain in the brain, right? Microplastics under the news these days, et cetera, et cetera. All right. A little digression there, but coming back

When Stimulants Make Sense

Dr. Mark Su 5:24

to ADD, all right. Uh regardless of cause, putting the putting root cause pieces behind us for a second, compartmentalizing that to the side for a second. Let's just talk directly about treating ADD, whether it's mild, moderate, outright dysfunctional, et cetera. So here's the thing. I'm as uh as you or will get to know, become aware of for me, I'm an all-comers with tools. I am not dogma really, I'm not dogma based in my decision making. I'm not all pharma or all non-pharma. I want the best tools for the person in front of me and what makes the most sense for them and for them to be, for that person, you to be educated about the pros and cons of what the options are. All right. And then we're gonna make a decision together. So when it comes to AD and stimulants, they're absolutely on the table for me. All right. That doesn't mean that they're just all without side effect, without risk, that they're they're just God's gift to the earth or whatnot, okay? But they're absolutely on the table. Here's examples of why. I've had just I've just had too many people where it it's totally impacted their, it totally changed their quality of lives. Okay. I've had individuals where it totally changed their academic performance in high school. And so in reflection, they're severe, severely ADD. There's a there's one individual I assertively asked to write a letter for their college application because prior to senior year, they were struggling. I don't know if they ever had Fs, but they were on the D scale commonly, okay, or at least to my memory, there was definitely D's involved. And they started, they started out all in the summer after junior year. And in senior year, if I recall, they had a freaking A in honors physics. Now, what compelled them to take honors physics as a senior after they're getting like seasoned D's, I have no idea, but I I it just blew me away because I don't, I wouldn't, I wasn't, I wouldn't have been able to take I hated physics. I don't, I wouldn't have, I would have never even thought about taking honors physics, much less been able to get an A. And this person went on to become a highly successful on paper, and I would say in life, academically a performer in college, and then they had a job offering that was an accelerated leadership level with a humongous big-time company in the US, right? They were given major opportunities and they've done really well for themselves. I've had multiple people have other life-changing store uh experiences, including in the year 2024, I believe it was, a couple few people who came to me after knowing them for years. I've known them for well over 10 years apiece, one maybe close to maybe coming up close to 20 years as patients. And they both, the these two individuals in particular, said to me, I really think I have ADD. And it just kind of struck me as, huh? I've never observed that suspicion. Okay. But when they explained out their symptoms and what they read on online with the checklist and whatever else fed their coming to this moment of suspicion, I validated that. I was like, wow, I did not realize this is what goes on up here in your daily life and your thinking in your brain, et cetera. Again, there's no test for blood testing, imaging or whatever. And I said, hey, look, subjectively, with all the the uh criteria, et cetera, by official medical diagnosis, give me criteria, all right. And uh they went on treatment and it was life-changing. It brought me to tears. I think both with both individuals, I literally was tearful, tears of joy, with how much benefit they had in their lives. And it wasn't just, oh, I got more work done, all right. And it wasn't just, oh, my room and house is cleaner. It was relationships, all right. It was it was the ability to sleep, all right. I have m I've had multiple people who've told me, okay, a side effect of these stimulants it potentially is insomnia, but holy crap, I sleep like a baby now. It used to take me up to a couple people, up to three hours. Okay, this is a recurring story. It's not tens of people, but I've had enough people with this experience where it would take maybe hours, sometimes up to three hours to fall asleep. But holy crap, I take the Adderall or Ridlin or whatever, and now I I fall asleep within less than 30 minutes, sometimes within minutes, and I stay asleep. I'm not waking up recurrently in the middle of the night. Why is that? I don't know. I could totally explain that, but I really believe it's because the thoughts of all the stuff I didn't do today that I should have done are now flooding in my head or or they're bouncing around. My to-do list is has been knocked down. My and then the secondary anxiety around all that stuff has been quieted. Okay. And a couple people have said to me, being treated, that wow, like I've never felt so normal. I've never felt so comfortable in my own skin. When I hear things like that, who am I to say, this isn't good for you? Let's not do that. Let's this isn't let's let's take that off the table. So yeah, I there those are more dramatic or more one end of the scale, one end of the spectrum kind of positive experiences. There's they're certainly not, those are not cross-the-board common experiences, but the uh it is pretty common, it is very common that students, whether high school, college, et cetera. I've had three students just this last school year, 24 and 25, have meaningful change in their uh academic performance. They were not getting D's and C's and F's, okay? They're not like that, but they're they were getting, let's say, B's, but they're working awfully hard and they're frustrated within themselves about how much effort it takes them. And they're saying to me, like, I know it's taking me longer than it should. All right. And their parents are saying, yeah, it's we know that they're not living to their potential. And as a parent, that's ext that's beyond frustrating. That's that's a heartfelt level of I want more for my kid. And it's not just to be, I want more for them to be more competitive and to be top of the class and to be to be living their best life in in out in society and with their being able to be a higher earner in finances or whatever the case may be. It's just you just want your kid to not be struggling in in some way that they can tell that they are. In this case, there were these three students, their B's have become A's, and there's more potentials for the opportunities, I should say, for collegiate scholarships, for athletics became a more definitive reality because they'd already were told, yeah, a couple of individuals, it was a question mark as to whether they would be able to be offered because they're because of their academic performance. And then the other couple of people in college, it's just being able to optimize their function and be happier with their lives and have more time because they're not spending so much time and effort studying when they just are wrestling with themselves, grasping, wrestling with, having to feel like they're rereading, reading, reading, relearning, not being able to process, assimilate, and retain the information. All right. We even have our own family member who we have if a family member between my wife and I, a family member who has struggled a bit with this condition and asked me for some help on it. And uh, after being diagnosed years prior, but not treating because of some seeming intolerance of the treatment, years later decided by better self-recognition that yeah, there's some struggle

Sleep, Anxiety, And Hidden Gains

Dr. Mark Su 12:50

here. And upon starting treatment and tolerating it fine, who knows why that is, I won't get into that right now. Yeah, their life is uh their quality of life is m meaningfully improved. And when my wife and I were talking about this in somewhere in the near recent future, a recent past, she was talking about it in the from the framework of perhaps just life maturity. Have you noticed that it seems like their life maturity is their maturity is increased, improved, et cetera, et cetera. And I said, I'm not taking away from that and I'm not disagreeing per se, but you got to remember that they've been on Adoll for the last year. And the take-home message there is I've seen enough people over the many years now where the secondary benefits of getting ADD under a control, okay, and that can be pharma, non-pharma, I don't care, but it happens certainly with the stimulants for sure. The secondary benefits can include lesser anxiety, as I said. If you're a person who you want to do a good job with your workplace, with your personal life, you want to be held, you want to be reliable to your friends and family, you want to be responsible within your own family or the loved ones in your the loved ones in your life. That matters for you. And a lot of people develop a secondary anxiety around what did I not get done? There's something I'm supposed to do, and I don't remember what it is, or oh crap, I'm just trying to go to bed now. Oh crap, I totally forgot that I was supposed to do that for the for my boss or for my sister or whatever for tomorrow. Oh my God, I totally didn't do that, blew that, I'm not gonna be able to get done, all that stuff. Secondary anxiety. And then there's also what I'd consider more categorically, this secondary cognitive capacity, okay, functionality. It's almost like if you Maslow's hierarchy of needs, it's called, right? If I'm at if I'm at risk of not having a shelter, food, if I have food scarcity, shelter scarcity, I'm not my brain and my internal, my my priorities, I'm not worried about like my self-fulfillment. Okay. That's that Maslow's hierarchy of needs. In the same way, if I can't organize my thoughts and I can't stay attuned to in the moment, I am not consciously or subconsciously able or interested in being able to think more deeply about who am I as a person and where is my place in this world? What do I want to envision for my life down the road? How big of an important goal is X, Y, or Z that I'm faced with in my chapter of life right now. Those are just not as important to me as in the moment. I cannot freaking figure out how to accomplish that sequence of, hey, I was asked by my mom to do the laundry, get my get my laundry done, put away that kind of thing and fill out that form for my class or next semester or whatever. Okay. If I can't get those three things done, I'm not thinking so much about sequencing my timeline for writing essays for my college application that's due four, six months from now, right? Much less who do I want to be? How do I want to, what would I like to see improved about myself as a person to be a better person with my friends, my family, and how do I contribute to society when I'm post-college and where do I want to go with my professional life or whatever that looks like. It it those are things that are not, I never hear discussed, even by when patients see, certainly when they see psychiatrists, and I'm I don't mean to sound like a judge, but recurrently patients are telling me whether it's a any kind of prescriber, I don't care if it's a psychiatrist or nurse practitioner, psychopharmacologist, et cetera. It's there, we're currently the story is I go in there, they listen to me, they ask a couple few questions, they write prescription, I'm out the door. And that's that's the system, all right. I'm not judging the practitioners, it's the system. More and more visits, more and more revenue, or to help pay the bills. You got to do more visits to pay the bills, et cetera. And people think that prescribers all whatever medicine, there's a lot of there's so much extra money around, and that's for another time, all right. The finances around healthcare are kind of shocking for people, all right. I'm not complaining about I'm not being a woe is me or whatever, but they're not the way people read about in in media,

Relationships, Presence, And Life Direction

Dr. Mark Su 16:50

all right. I I understand where those practitioners are coming from, but nonetheless, it is the experience that people have. And many of you, you've had that experience, right? I'm in and out in five minutes, I don't, I'm not heard, I'm a number, etc. And so all that in context, the prescriptions really they don't, they the benefits of getting ADD under control. I've never once in 22 years heard a patient relay to me that they had that kind of conversation with a prescriber or even a diagnostic tester for neuropsychology, et cetera, about those secondary benefits. But it all does come together as one sort of one one lump experience. Those for me have immense quality of life value, immense quality of life value. It's not just about the grades and the work performance and et cetera. It's the relationship quality, right? Having stronger relationships, being heard. How many times it is a dime a dozen, all right, of stories where patients tell me, when I ask them as adults, what do you notice differently? And I'm always asking them to journal what their loved ones tell them, if anything. Okay. So a lot of times I'm saying, don't tell your spouse that you're on this. But after like three weeks, two or three weeks, put down your calendar now, okay, as a functional reminder. Don't just rely on yourself to remember. Put it in your iPhone, your phone calendar or whatever. Three weeks from now, ask your spouse if they've noticed anything differently, talk to them and then et cetera, et cetera. And if there's nothing comes out of it, then tell them that you've been on some focused medication treatments and see what they say. The number of people who tell me, She said I'm a better listener. She said I'm actually listening to her now. All right. That's the fun part. It's commonly the guys, all right, who say that about the women, but it goes both ways, all right? They feel like I'm I'm I'm more present or they feel like I have more, I'm I'm more engaged in whatever kind of wording, I'm more engaged with them, with the family, et cetera, et cetera. That's quality of life, all right. That's really important stuff. When your loved ones feel that you're in it, in the game, in life, with them, in the moment, experiencing these things,

The Five Minute Visit Problem

Dr. Mark Su 18:55

like we're only gonna live life once. It's nice to feel like you've your partner is there to go through these life experiences together and that they're not alone or feeling semi-alone. All right, so there you have it. That's a snapshot on a download on my take on stimulant specifically with the topic of uh ADD slash ADHD. That is the reality of functional and slash conventional medicine as I see it in my world as it is.