Part II: ADHD and Dopamine/Norepinephrine modulation - Ritalin and Wellbutrin Ritalin  and Wellbutrin —two medications that affect brain chemicals like dopamine  and norepinephrine , but in very different ways. 🧠 How They Work Ritalin Wellbutrin Type Stimulant Antidepressant (NDRI) Dopamine Boost Strong Moderate Norepinephrine Boost Moderate Moderate Onset Fast (30–60 min) Slow (1–2 weeks) Serotonin None Minimal What They're Used For Ritalin  is FDA-approved for ADHD  and works quickly to improve attention and reduce impulsivity. Wellbutrin  is approved for depression  and smoking cessation , and used off-label for ADHD , especially with coexisting low mood. Pros and Cons Ritalin Pros: ✅ Fast, potent focus aid✅ Proven ADHD treatment Ritalin Cons: ❌ May cause insomnia, anxiety, appetite loss❌ Controlled substance Wellbutrin Pros: ✅ Non-stimulant, less abuse risk✅ Helps with energy, mood, and smoking cessation Wellbutrin Cons: ❌ Slower onset❌ Can worsen anxiety or raise seizure risk Which Should You Choose? Need quick, strong ADHD relief ? → Ritalin Battling focus + depression/fatigue ? → Wellbutrin Concerned about stimulants or addiction risk ? → Wellbutrin Bottom Line Ritalin  is best for classic ADHD symptoms. Wellbutrin  is great when low motivation, mood, or energy are also in the mix. Reasearch: Can Wellbutrin (bupropion) treat ADHD as well as Ritalin (methylphenidate)? Results A total of 146 subjects in four RCTs comparing bupropion with methylphenidate in the treatment of ADHD were included. The pooled mean changed scores of the Iowa–Conner’s Abbreviated Parent and Teacher Questionnaires and the ADHD Rating Scale‐IV for parents and teachers of children and adolescents with ADHD in the bupropion‐ and methylphenidate‐treated groups were not significantly different. Additionally, the pooled mean changed score in adult ADHD between the two groups, measured by the ADHD Rating Scale‐IV and the Adult ADHD Rating Scale, was also not significantly different. The pooled rates of response, overall discontinuation, and discontinuation due to adverse events between the two groups were not significantly different. Maneeton N, Maneeton B, Intaprasert S, Woottiluk P. A systematic review of randomized controlled trials of bupropion versus methylphenidate in the treatment of attention-deficit/hyperactivity disorder. Neuropsychiatric disease and treatment. 2014 Aug 1:1439-49.

PART 1 - RITALIN & DOPAMINE/NOREPINEPHRINE How Ritalin Boosts Dopamine to Help Manage ADHD: Understanding Root Causes May Allow Functional Medicine to Explore Alternative Ritalin by focusing on Dopamine Norepinephrine: Ritalin (methylphenidate) is one of the most widely prescribed medications for attention deficit hyperactivity disorder (ADHD). While it’s often associated with improving focus and reducing hyperactivity, the key to how it works lies in its effect on a powerful brain chemical: dopamine . Dopamine plays a central role in attention, motivation, impulse control, and reward processing. Research shows that individuals with ADHD often have dysregulated dopamine activity, especially in brain regions responsible for executive functioning. Ritalin helps correct that imbalance. How Ritalin Works: Dopamine in Action Blocks Dopamine Reuptake - Ritalin attaches to dopamine (and norepinephrine) transporters in the brain, blocking their reabsorption into neurons. This causes dopamine to remain longer in the synaptic cleft—the space between brain cells—enhancing its activity. The prefrontal cortex and striatum, both crucial for focus and self-regulation, are particularly affected. Increases Dopamine Release - Ritalin also promotes the release of dopamine from neurons, further increasing its availability. This dual action provides a stronger and more sustained dopamine signal, helping the brain filter distractions and stay on task. Improves Brain Function in ADHD By increasing dopamine and norepinephrine, Ritalin strengthens the connections between neurons involved in planning, attention, and impulse control. In people with ADHD, this leads to better focus, reduced impulsivity, and improved emotional regulation. What to Expect: Timing and Effects Onset : For immediate-release formulations, effects typically begin within 30 to 60 minutes. Duration : The benefits usually last 3 to 6 hours for short-acting Ritalin and up to 12 hours for extended-release versions (like Concerta). Metabolism : Ritalin is broken down in the liver and excreted through the urine. Potential Side Effects While many find Ritalin effective, it's not without risks. Common side effects include: Insomnia Reduced appetite Increased heart rate or blood pressure Anxiety or restlessness Because of its stimulant properties and potential for misuse, Ritalin is classified as a Schedule II controlled substance  in the U.S. Ritalin Is a Tool—Not a Cure Ritalin doesn’t cure ADHD—it helps manage the symptoms by supporting the brain’s natural chemistry. Its effectiveness can vary between individuals and is often optimized when paired with behavioral therapy, coaching, or lifestyle interventions. Part II will explore further dopamine/norepinephrine hypothesis Part III will explore serotonin and endorphine Part IV Functional Medicine and ADHD In summary, understanding the root causes of how Ritalin (methylphenidate) works may allow functional medicine to explore alternative by focusing on Dopamine/Norepinephrine modulation. Part II will explore ADHD and dopamine/norepinephrine modulation by comparing Ritalin (methylphenidate) to Wellbutrin (bupropion)

A novel combination of drugs—an immune checkpoint inhibitor and the anti-parasitic medication ivermectin —has shown powerful results in preclinical research against triple-negative breast cancer, according to a City of Hope study published in npj Breast Cancer . Triple-negative breast cancer is notoriously hard to treat because it lacks three key proteins (estrogen, progesterone, and HER2 receptors) that are typically targeted by existing therapies. But researchers, led by Dr. Peter P. Lee, discovered that combining anti-PD1 monoclonal antibodies with ivermectin dramatically improved outcomes. Here’s how it works: Ivermectin turns "cold tumors" (lacking immune cells) into "hot tumors" by triggering immunogenic cell death , which attracts cancer-fighting T cells. Once tumors are "hot," checkpoint inhibitors (anti-PD1) can effectively activate the immune system to destroy the cancer. Individually, these drugs had little effect—but together, they had a powerful, synergistic  impact. In animal models, 40–60% of treated subjects completely eradicated their tumors and  resisted reintroduction of the cancer. “This is the first time we can show that by adding an inexpensive, existing drug, we can make breast cancer treatable with immune checkpoint therapy,” said Dr. Lee. “It’s the combination that’s the magic.” Why this matters: Anti-PD1 therapies can cost ~$15,000 per dose. Ivermectin? About $30 per dose. Both drugs are already FDA-approved and have established safety profiles. The research also found the combo worked in a wide range of scenarios: before and after tumor surgery, and even against metastatic cancer. Next step: Testing optimal dosing in preparation for a first-in-human clinical trial.

How Can Integrative and Functional Medicine Help Solve Complex Conditions? Integrative and functional medicine are uniquely suited to addressing complex medical conditions. Integrative medicine considers the full spectrum of a person's well-being—mind, body, emotions, and spirit—acknowledging how each aspect contributes to overall health. Functional medicine complements this by expanding the investigative scope, allowing for a deeper understanding of the root causes of illness. Take a seemingly straightforward thyroid condition, for example. What appears simple may actually be quite complex. Functional medicine enables a comprehensive evaluation by utilizing advanced diagnostic tools and extensive lab testing. This includes not only TSH, but also free T3, free T4, reverse T3, anti-thyroglobulin antibodies, and thyroid peroxidase antibodies—just to name a few. There are numerous other tests available to provide a more complete picture. The strength of this approach lies in its ability to both zoom out—viewing the body as a whole system through an integrative lens—and zoom in—using functional tools to explore specific biochemical imbalances at a microscopic level. This dual perspective allows practitioners to uncover underlying causes that might otherwise go undetected, offering truly personalized and effective care.

For those exploring integrative oncology options: Most major centers—such as MD Anderson, Memorial Sloan Kettering (MSK), and City of Hope—offer services under the Society for Integrative Oncology (SIO) framework. In my opinion, SIO can be somewhat dated and conservative in its approach. For our integrative oncology patients, I often recommend a metabolic approach to cancer —specifically therapeutic ketosis—combined with low-dose naltrexone (LDN) . I encourage you to look into the work of Berkson  on this topic (search: "Berkson + LDN + Cancer"). This combination has yielded the most consistent clinical benefits in my practice, particularly for symptom management and quality of life during active treatment or in advanced disease stages. The original Berkson protocol also incorporates IV alpha-lipoic acid. Another helpful resource is Jane McLelland’s book , which outlines the Care Oncology Clinic protocol  using generic medications. While I have not adopted that specific protocol at this time, I do see its value. In fact, a recent patient of mine chose the Care Oncology route and declined the ketogenic approach; unfortunately, they later developed brain metastases. While anecdotal (n=1), it highlighted for me the potential neuroprotective advantages of ketosis. Instead of pharmaceutical protocols, my practice focuses on matching medicinal mushrooms to cancer types , alongside an acupuncture protocol  developed by a late Korean master. This protocol addresses energy balance, physical discomfort, and emotional well-being. Herbal support is customized based on each patient’s symptoms. Most importantly, I always recommend patients read Bernie Siegel, MD’s work , especially Love, Medicine and Miracles , and begin cultivating a mindset of becoming an “exceptional cancer patient.” Mental health and resilience are vital—working with a therapist or counselor can be transformative. During my time at the University of Kansas Integrative Medicine program , I participated in research on high-dose intravenous vitamin C. While it was found to be safe and supportive of quality of life, it did not improve survival outcomes. Currently, I lead the Integrative Oncology program at the Memorial Institute of Health & Healing in Carthage, IL , where we accept most insurance plans, including Medicare and Illinois Medicaid. Learn more here: Memorial Institute of Health & Healing . I also have a telemedicine private practice  serving Texas, Florida, and Georgia for those who cannot travel to Illinois. For those located elsewhere: California : I highly recommend Dr. Myrto Ashe  for a functional medicine approach and Dr. Donald Abrams (UCSF)  for a more conservative integrative oncology perspective. New York City : MSK is a strong starting point. Advanced cancer patients : I urge you to consider a second opinion at MD Anderson (Houston, TX) . They tend to take the most aggressive approach, and I’ve seen them help patients outlive prognoses after other institutions had given up. Finally, I encourage all patients to explore clinical trials  and empower themselves with knowledge. As Bernie Siegel emphasized, the empowered patient often becomes the exceptional one. Yoon Hang Kim MD MPH www.directintegrativecare.com www.yoonhangkim.com

I recently saw a patient with neuropathy of the feet unable to walk barefoot without pain. Patient came seeking relief from the pain. After using anti-inflammatory protocol, patient feels pain has improved more than 60%. Patient is now able to walk barefoot without pain. Patient also was able to lower medication Lyrica from 75 mg BID to 50 mg BID. Functional medicine offers a personalized and holistic approach to neuropathy by focusing on identifying and addressing the root causes of the condition rather than just treating the symptoms. Neuropathy, which refers to nerve damage that can lead to pain, numbness, tingling, or weakness, may result from a variety of underlying issues such as diabetes, autoimmune diseases, infections, toxin exposure, or nutritional deficiencies. Here’s how functional medicine may approach the treatment of neuropathy: Root Cause Analysis The first step is to identify the underlying cause(s) of the neuropathy, which may include: Diabetes Inflammation Toxin Exposure Nutritional deficiencies Personalized Diet and Nutrition Anti-inflammatory diet Specific nutrient supplementation: Based on testing, supplements like alpha-lipoic acid, B vitamins, acetyl-L-carnitine, curcumin, and omega-3 fatty acids may be recommended to support nerve repair and function. Gut health optimization: Since the gut plays a key role in inflammation and nutrient absorption, gut health is often a focus. This may involve addressing dysbiosis, leaky gut, or food sensitivities Integrative Therapies Acupuncture: Can help reduce pain and improve nerve function. By focusing on the individual’s unique biology and addressing all possible underlying causes, functional medicine aims to not only alleviate neuropathy symptoms but also restore optimal nerve function and overall health.

I recently saw a type 2 diabetes patient who has been treated with conventional medical approach. In conventional medicine, management of diabetes often relies on medications like Metformin.  While initial treatments can be successful, most people require higher dose and eventually other medication(s).    Patient wanted a functional medicine approach or root cause treatment approach to reverse diabetes.  Because root cause of type 2 diabetes often involves elevated blood sugars as a natural consequence of underlying metabolic dysfunction, patient was given a specific diet aimed at reversing the metabolic dysfunction.   In one month, patient lost about 10 pounds of weight –also a contributor to metabolic dysfunction – and resulted in reduced Hemoglobin A1c level by 10 to 8.  More significantly, patient’s fasting blood sugar has dropped to 90’s which is normal level.   Because Hemoglobin A1 level reflects long-term blood sugar levels, further improvements in Hemoglobin A1c is very likely.   I feel grateful to see these improvements through services performed through Memorial Institute of Health & Healing at Memorial Hospital, Carthage, IL.  I am looking forward to continuing to support the patient and observing the improvements – which hopefully could include reversing his type II diabetes.

What is Celiac Disease? Celiac disease is an autoimmune disorder triggered by the ingestion of gluten , a protein found in wheat, barley, and rye. The pathogenesis of celiac disease involves both genetic and environmental factors. Individuals with specific genetic markers, such as HLA-DQ2 and HLA-DQ8, are predisposed to developing the disease. When these individuals consume gluten, their immune system mounts an abnormal response. Gluten fragments, particularly gliadin , are modified by the enzyme tissue transglutaminase (tTG) in the small intestine. This modified gliadin is then presented by antigen-presenting cells to CD4+ T cells, triggering an inflammatory immune response. The resulting inflammation damages the intestinal villi, leading to malabsorption, nutrient deficiencies, and gastrointestinal symptoms. In addition to the immune response, other factors such as changes in the gut microbiome and increased intestinal permeability (often referred to as "leaky gut") contribute to the pathogenesis of celiac disease. In some cases, environmental triggers like infections may also influence the onset of the disease. Over time, the chronic inflammation caused by repeated gluten exposure can lead to more severe complications, including an increased risk for certain cancers and other autoimmune disorders. The only effective treatment for celiac disease is a strict, lifelong gluten-free diet, which helps prevent further immune activation and allows the intestinal lining to heal. What is Gluten Sensitivity? Gluten sensitivity, also known as non-celiac gluten sensitivity (NCGS), is a condition in which individuals experience symptoms related to gluten consumption, despite not having celiac disease or a wheat allergy. People with NCGS may experience gastrointestinal symptoms such as bloating, diarrhea, and abdominal pain, as well as extra-intestinal symptoms like headaches, fatigue, joint pain, and brain fog. Unlike celiac disease, gluten sensitivity does not involve an autoimmune response or damage to the intestinal lining. The exact mechanism of NCGS is not well understood. Diagnosis is typically made after ruling out celiac disease and wheat allergy, and symptoms usually improve on a gluten-free diet, although some may tolerate small amounts of gluten. How to test for this? Functional medicine offers many tools that can help to explore GI function, intestinal permeability, as well as IgE, IgG, IgG4, and complement reaction.

I recently saw a patient who came to me with hives. A functional medicine approach to treating hives (also known as urticaria) aims to address the root cause of the condition rather than merely managing symptoms. Functional medicine considers a variety of factors including diet, lifestyle, environment, and underlying health conditions that could be contributing to the hives. 1. Identifying Triggers and Root Causes Functional medicine looks for what might be driving the hives, such as: Food Sensitivities: I usually perform a food allergy test to include IgE (food allergy) and IgG, IgG4, and complement. Allergies: Because environmental allergens (dust, pollen, mold, pet dander) may trigger hives, I usually recommend patients to consider respiratory allergy tests. Gut Health Imbalance: Because conditions like leaky gut or dysbiosis (imbalance of gut bacteria) can result in food particle (molecules) to cross over, it can trigger hives. Chronic Infections: Underlying infections (such as candida, H. pylori, or viral infections) can sometimes provoke an immune response resulting in hives. Toxin Exposure: Chemicals, heavy metals, or other environmental toxins might play a role in immune dysregulation. Stress and Hormonal Imbalances: Stress or conditions like adrenal fatigue, thyroid issues, or hormonal fluctuations can trigger hives. 2. Testing and Diagnostics For this patient, below tests were chosen to start with: Comprehensive Stool Testing to check gut health Food Allergen test 3. Dietary Interventions Elimination Diet: Removing common allergens and inflammatory foods like gluten, dairy, soy, and sugar, then gradually reintroducing them to identify any triggers. Anti-inflammatory Diet - low carbohydrate diet promoting ketosis consistent with Duke Keto Diet developed by Eric Westman MD at Duke University Results: complete resolution of hives on keto diet and elimination diet based on food allergy list

I recently saw a patient with hives whose condition is in remission. In this person, two factors played crucial role for success: Elimination diet and ketosis. At first we used multiple approaches including anti-inflammatory diet in the form of ketosis (fat burning state), low dose naltrexone to normalize immune function (addressing autoimmunity), eliminating foods that were responsible for allergic/food sensitivity reactions, and anti-inflammatory supplements. When condition improved with ketosis and elimination diet, additional measures were discontinued - such as LDN and supplements. Success continued. Additional experiments of adding allergic foods were done resulting in hives. Functional medicine approaches the treatment of hives (also known as urticaria) by identifying and addressing the root causes rather than just managing symptoms. Here’s how functional medicine may help treat hives: Identifying Underlying Triggers: Functional medicine practitioners look for potential triggers contributing to hives, such as: Food sensitivities/allergies: Common culprits include dairy, gluten, corn, soy, nuts, and shellfish, but often requires testing Environmental triggers: Pollens, dust mites, mold, or chemical exposure can add to the immune inflammation burden. Stress and emotional health: Chronic stress or acute stress can trigger or worsen hives. Infections and gut imbalances: Hidden bacterial, viral, or parasitic infections, as well as conditions like small intestinal bacterial overgrowth (SIBO), leaky gut, or dysbiosis can make it easier to trigger hives. Functional Medicine Testing: Food sensitivity testing: Identify specific foods that might be causing or exacerbating hives. Gut health assessment: Evaluate for imbalances in the microbiome, leaky gut, or infections. Hormone and stress level testing: Measuring cortisol and other stress-related markers. 3. Personalized Nutrition and Dietary Changes: There are many types of diets including anti-inflammatory diet What I have seen most effective is the state of ketosis (fat burning state) 4. Gut Health Restoration: If gut issues are identified, treatments might involve: pre-biotics, probiotics, fiber etc. probiotic foods, prebiotics foods, and fiber 5. Detoxification and Reducing Environmental Exposures: Reducing exposure to toxins, pollutants, and heavy metals also may help in reducing hives. 6. Addressing Autoimmunity: If autoimmune issues are suspected (e.g., chronic urticaria), functional medicine focuses on calming the immune system.

What is Longevity Medicine? Longevity medicine focuses on extending the human lifespan and promoting healthy aging. It combines advancements from fields like biotechnology, genomics, and personalized medicine with traditional healthcare practices to prevent age-related diseases and enhance the quality of life as people age. Below are some approaches that are now available. 1. Preventive Care and Risk Assessment: Advanced functional medicine test for genetic, metabolic, and other screening tests for chronic diseases (e.g., heart disease, diabetes, cancer). 2. Precision Medicine or Individualized Medicine: Using genetic, metabolic, and other biological information to create tailored interventions, such as customized nutrition, exercise plans, and pharmaceutical treatments. 3. Biological Age Measurement Tools like epigenetic clocks and other biomarkers assess biological age, which may differ from chronological age, guiding interventions to slow down or reverse aspects of aging. 4. Regenerative Medicine: Employing therapies like stem cells, tissue engineering, and cellular reprogramming to repair or replace damaged tissues and organs. 5. Lifestyle and Wellness Optimization: Integrating evidence-based practices in diet, exercise, stress management, and sleep to optimize longevity. 6. Pharmacological Interventions: Investigating and applying compounds (like metformin, rapamycin, and senolytics) that have shown potential in delaying aging and age-related conditions. Longevity medicine aims to not only increase lifespan but also improve "healthspan"—the period of life spent in good health. It is an interdisciplinary field combining insights from gerontology, molecular biology, and functional, integrative, lifestyle & anti-aging medicine to help individuals live longer, healthier lives.

I recently saw a patient that has multiple complex issues including: RA or Rheumatoid Arthritis Autoimmune thyroid disorder Food allergy - eating peanuts can cause rash all over the body After being treated with LDN, patient noticed that pain from RA disappeared. When patient stopped taking LDN, the pain returned. In this case, patient has not yet achieved remission. However, there are significant improvement in quality of life not having the debilitating pain RA and there is the promise of trial of reducing her current RA medication which can be attempted as a next step after starting additional anti-inflammatory supplements and anti-inflammatory diet. Without LDN, likelihood is that this person's condition will continue to worsen and would need additional medications. I feel extremely grateful to be a privileged observer.