Dr. Alison DeMiero Functional Health Educator

03/07/2026

ADHD is one of the most misunderstood conditions I see in my practice.

Many of my patients spent years thinking they were just lazy, undisciplined, or not trying hard enough — before they finally got answers.

But here's what I wish more people knew: ADHD isn't just about attention. It involves the brain's dopamine and norepinephrine pathways, and it often shows up alongside gut issues, nutrient depletions, blood sugar instability, and chronic inflammation.

Medication can be an important tool — and I prescribe it when appropriate. But when we also investigate what's happening underneath the symptoms? That's when people often start to feel like themselves again.

If you know someone who's been struggling with focus, motivation, or attention — please share this. It might be the thing they needed to see today.

This is educational content and not medical advice. Always consult your healthcare provider.

Seattle Therapeutic Services | Virtual Psychiatric Care in Washington State

(206) 672-2122 | seattletherapeuticservices.com

02/23/2026

You wake up at 3 AM. Every. Single. Night. Wide awake. Mind racing. Can’t fall back asleep no matter what you try.

You’ve tried melatonin. Sleep hygiene. Putting the phone away. Magnesium gummies. Nothing works. Your doctor offers trazodone or Ambien and says “let’s see if that helps.”

But nobody is asking WHY you’re waking up at 3 AM in the first place.

That 3 AM wake-up often has a very specific pattern behind it — a cortisol spike. Cortisol is your body’s main stress hormone. It’s supposed to be at its lowest in the middle of the night and rise gradually to wake you in the morning.

But when your stress response system is dysregulated, research suggests cortisol can surge hours too early. It may suppress melatonin, activate your nervous system, and snap you wide awake.

No amount of sleep hygiene addresses a hormone that may be firing at the wrong time.

So what may be contributing to the cortisol misfiring?

Chronic stress that has worn down your HPA axis over months or years. Blood sugar dropping too low overnight — research shows that insufficient protein or fat at your last meal may contribute to overnight blood sugar instability, which can trigger a cortisol response.

Gut inflammation that may activate an immune response affecting your stress hormones. Hormonal shifts — especially in perimenopause, when progesterone drops and cortisol may lose its counterbalance.

This is why a sleep medication might help temporarily but often doesn’t resolve the underlying pattern. You may be treating the wake-up without addressing what’s contributing to it.

In my practice, when a patient tells me about the 3 AM wake-up, I start with questions. What does your evening meal look like?

How long have you been under chronic stress? Where are you in your hormonal cycle? And I assess cortisol patterns, fasting insulin, inflammatory markers, and hormones — to look for what may be driving the problem.

When we investigate and address what may be underneath, many patients find their sleep begins to improve on its own.

If this sounds familiar, talk to your provider about looking beyond sleep hygiene.

And if you’re looking for a provider who takes this approach, I see patients virtually across Washington state.

Regence, Premera, Kaiser, Aetna, Lifewise, UMP, RGA accepted.

This content is for educational purposes only and is not medical advice. Always consult with your healthcare provider before making changes to your treatment plan.

02/21/2026

Your ADHD medication worked great at first. Maybe for weeks, maybe for months. But now it's not working like it used to. You need a higher dose. The side effects are getting worse. And your doctor's only answer is to try a different medication.

But here's what almost nobody checks before prescribing — or before increasing your dose:

Your zinc levels. Research shows that zinc plays a critical role in dopamine production. Without adequate zinc, your brain may not be able to produce dopamine as efficiently — which can affect how well stimulant medications work. The medication may not be failing you. Your brain may be missing what it needs to respond to the medication properly.

The same is true for iron — specifically ferritin, which is your stored iron. A ferritin of 15 is technically "in range" at most labs. But studies show that ADHD symptoms are often more pronounced when ferritin falls below 30-50. Restlessness, poor focus, brain fog, irritability — all associated with low ferritin in the research.

Then there's magnesium, B6, and omega-3 fatty acids. These aren't trendy supplements. They're essential building blocks that research shows play a role in how your brain regulates attention, mood, and energy.

I'm not anti-medication. I prescribe stimulants regularly in my practice. But I also assess nutrient levels — because when we address what may be missing at the foundation, many patients find their medication works more effectively, sometimes at lower doses with fewer side effects.

If your medication isn't working the way it used to, ask your provider about checking your nutrient levels. It could make a meaningful difference.

I see patients virtually across Washington state and accept Regence, Premera, Kaiser, Aetna, Lifewise, UMP, and RGA.

This content is for educational purposes only and is not medical advice. Always consult with your healthcare provider before making changes to your treatment plan.

02/15/2026

Your ADHD medication worked great at first. Maybe for weeks, maybe for months. But now it's fading. You need a higher dose.

The side effects are getting worse. And your doctor's only answer is to try a different medication.

But here's what almost nobody checks before prescribing — or before increasing your dose:

Your zinc levels. Zinc is a critical cofactor for dopamine production.

Without enough zinc, your brain physically cannot produce the dopamine that your stimulant medication is designed to regulate.

The medication isn't failing you. Your brain is missing what it needs to make the medication work.

The same is true for iron. Not just your basic iron level — your ferritin, which is your stored iron. A ferritin of 15 is technically "in range" at most labs.

But research shows that ADHD symptoms worsen significantly when ferritin is below 30-50. Restlessness, poor focus, brain fog, irritability — all connected.

Then there's magnesium, B6, omega-3 fatty acids. These aren't trendy supplements. They're essential building blocks your brain needs to regulate attention, mood, and energy.

I'm not anti-medication. I prescribe stimulants regularly in my practice. But I always check nutrient levels first — because when we address what's missing at the foundation, the medication works better, often at lower doses, with fewer side effects.

If your medication stopped working, don't just increase the dose. Ask your provider to check your nutrients. It could change everything.

I see patients virtually across Washington state and I accept Regence, Premera, Kaiser, Aetna, Lifewise, UMP, and RGA.

02/15/2026

Have you gotten the influenza this year? If so, how did you fare?

01/12/2026

Let's talk about anxiety in perimenopause.

Many women report increased anxiety, worry, or a general sense of unease that wasn't there before.

Research shows this has a biological basis:

Studies suggest that progesterone affects GABA (your brain's calming neurotransmitter). When progesterone declines in perimenopause, GABA signaling may be reduced.

Lower GABA activity could contribute to:
- Increased anxiety
- Racing thoughts
- Difficulty relaxing
- Worry that feels "out of proportion"

This isn't "all in your head." It's neurochemistry.

Understanding the mechanism can help you explore evidence-based approaches with your healthcare provider.

Have you experienced increased anxiety in perimenopause? 👇

⚠️ Educational content only. Not medical advice. Always consult your healthcare provider.

01/09/2026

🌸 Exciting News! I just launched a FREE educational community for women navigating perimenopause.

If you're experiencing:
- Brain fog that's affecting your daily life
- Sleep issues (especially 3 AM wake-ups)
- Unexplained weight gain
- Chronic fatigue
- Mood swings or anxiety

You need to understand what's actually happening in your body.

The 10 Metabolic Shifts

Research shows there are 10 specific metabolic changes that occur after 40 during perimenopause. These shifts affect your:
🧠 Brain function (memory, focus, clarity)
😴 Sleep quality and architecture
⚡ Energy levels
⚖️ Metabolism and weight
😊 Mood and emotional regulation

When you understand these root causes, you can have much more informed conversations with your healthcare provider about approaches that might help.

Join my new educational community:
👉 skool.com/perimenopause

Inside you'll find:
✅ Research-based educational content
✅ The science behind each metabolic shift
✅ Evidence-based information
✅ A supportive community of women going through the same thing
✅ No ads, no spam—just education

Led by Dr. Alison DeMiero (DNP, PMHNP-BC, Functional Medicine Fellowship)

⚠️ Important Disclaimer:
This community provides educational content only. This is not medical advice. I am not acting as your healthcare provider. Always consult your qualified healthcare provider before making any health-related decisions.

Join us! 💙

Research-based solutions for brain fog, insomnia, weight gain & fatigue. Led by Dr. Alison DeMiero (DNP, PMHNP-BC, Functional Medicine).

01/06/2026

Can we talk about brain fog for a second?

Because I'm seeing the same story over and over from high-achieving women in their 40s-50s:

"I used to be so sharp. Now I can't remember what I walked into a room for."

"I forget my client's name mid-meeting."

"I read the same paragraph five times and retain nothing."

And when they go to their doctor, they're told: "You're just stressed. Try meditation."

But here's what's actually happening:

If you have ADHD (diagnosed or not) and you're in perimenopause, you're experiencing a dopamine crisis.

Estrogen regulates dopamine receptor density in your brain. When estrogen drops during perimenopause, your dopamine receptors drop with it.

Your ADHD brain already has lower baseline dopamine. Now it's even lower.

This isn't "normal aging." This isn't "just stress."

This is a neurometabolic shift that affects your cognitive function, your memory, your ability to focus, and your executive function.

And here's the thing: once you understand the MECHANISM, you can address it.

Over the next 30 days, I'm sharing the science behind ADHD + perimenopause brain fog and the specific interventions that actually work.

If this resonates, drop a 🧠 in the comments so I know you're here.

And if you know someone who needs to hear this, please share.

You're not losing your mind. Your brain chemistry changed. And it's fixable.

- Dr. Alison DeMiero, DNP, PMHNP-BC
Board-Certified Psychiatric Mental Health Nurse Practitioner
Specializing in Functional and Integrative Psychiatry

⚠️ **IMPORTANT DISCLAIMER:**
I am not a medical doctor. I'm a Board-Certified PMHNP with a doctorate in nursing practice and additional training in functional psychiatry, sharing educational information only. Nothing in this post constitutes medical advice, diagnosis, or treatment. I'm not acting as your healthcare provider. Always consult your own physician before making any health-related changes.

01/05/2026

How many of you eat "so good" all day and then completely lose control at night?

🙋‍♀️ Me. For YEARS.

Until I understood what was actually happening neurochemically.

Here's the thing about ADHD brains: we use about 25% more glucose than neurotypical brains. We're burning through dopamine all day just to function.

Add perimenopause (which drops estrogen and takes dopamine receptors with it), and by 8 PM, we're running on fumes.

Our brains are smart. They know food = instant dopamine.

So that "lack of willpower" you're beating yourself up about? It's actually your brain doing exactly what it's designed to do: survive.

The solution isn't more discipline. It's addressing the dopamine depletion and blood sugar dysregulation that's driving the behavior.

I'll be sharing the complete protocol in my free upcoming Skool community.

01/05/2026

Can we talk about night eating for a second?

Because I'm hearing the same story over and over from women with ADHD in perimenopause:

"I eat so well all day. Protein breakfast, balanced lunch, healthy snacks. I meal prep. I plan. I'm GOOD at this.

And then 8 PM hits and it's like a switch flips. I'm standing in front of the fridge eating cold leftovers. Then chips. Then ice cream. Then I feel terrible and promise myself tomorrow will be different.

But tomorrow is the same."

Here's what I want you to know: This isn't a willpower problem.

Research shows that ADHD brains use 25% more glucose than neurotypical brains. By evening, your dopamine is depleted. And when estrogen drops during perimenopause, it takes your dopamine receptors with it.

Your brain is doing exactly what it's supposed to do: seeking the fastest dopamine source available. Which is food.

You're not broken. Your brain is just running on a different operating system.

If this resonates, I'm so excited to be opening up a new (free) community in Skool that will not only be a place for support but where I will also share science-backed solutions!

I'm still getting the community ready, but I'd love to hear from you if you want to be one of the first members to join! Feel free to comment below or send me a private message.

01/04/2026

January shouldn’t be a punishment for surviving the holidays.

If you’re feeling inflamed, anxious, and exhausted right now, "more willpower" isn't the solution. For most midlife women, the "holiday puffiness" and burnout are signs of a maxed-out nervous system, not a lack of discipline.

When your cortisol is high and your detox pathways are sluggish, your body stays stuck in survival mode. At that point, restriction doesn't work—regulation does.

The Goal: A total system reset, not another restrictive diet.