@DrMariano 6701 wrote:

One of the biggest problems in medicine is that when one has a complex illness, often only one underlying cause of the illness is addressed – and often with only a medication treatment.

One example is diabetes type 2. Diabetes is a complex illness often involving:
1. insulin resistance – resulting in blood sugar control problems and excessive insulin signaling (until the pancreas beta-cells are destroyed).
2. suboptimal thyroid signaling
3. excessive pro-inflammatory signaling with an activated immune system
4. an overactive sympathetic nervous system – which increases insulin resistance
5. nutritional deficiencies – such as vitamin D deficiency, along with other animal fat associated nutrients.
6. hypogonadism
7. obesity – and its attendant ramifications
8. dyslipidemia and cardiovascular problems including hypertension
9. mental impairment/illness/nervous system dysfunction – with an increased risk for dementia, mood disorders

Addressing blood sugar control alone will not be adequate to limit the damage that results from diabetes (that result in complications from diabetes including blindness, heart disease, kidney failure, stroke, and eventually an early death). Each identifiable underlying factor needs to be addressed. These underlying factors are the pathophysiology of the illness.

Until the pathophysiology of an illness is well-described, treatment is trial and error and mostly error.

When it comes to mental illness, such as ADHD, the biggest problem is that too often, the pathophysiology is never identified by the treating practitioner prior to treatment.

DSM-IV is only a description of the illness. It does not identify the pathophysiology underlying the illness. It is insufficient to determine the treatment an individual patient needs.

When it comes to ADHD, the most common underlying problems I find are:
1. nutritional deficiencies
2. suboptimal thyroid signaling
3. excessive pro-inflammatory signaling – such as from autoimmune problems, inappropriate production of antibodies against foods, an overactive immune system.
4. suboptimal nervous system dopamine signaling
5. excessive norepinephrine signaling – which over time may result in hypothalamic-pituitary-adrenal axis dysregulation and mood problems common in ADHD

Each of the underlying pathophysiologies can impair attention, memory, and information processing as found in ADHD. Each can influence the other pathophysiologies.

Each of the underlying pathophysiologies can be considered a separate illness in its own right. But like diabetes, the sum of them is the illness of ADHD. ADHD or mental illness can be considered the umbrella diagnosis overlying multi-system problems.

Stimulants are the single most effective treatment for ADHD. Clearly. But they do not work all the time, particularly if there is HPA Axis dysregulation and/or excessive pro-inflammatory signaling. The increase in norepinephrine signaling from a stimulant may worsen these underlying factors, thus negating the benefit of the stimulant.

Addressing the underlying factors generally reduces the need or dose for stimulants, particularly if the effects summate to an optimal dopamine signaling state and nervous system metabolism. For example, if you can make dopamine yourself, why would you need a stimulant to raise levels? You may not need it when production is corrected.

If the other underlying factors are not addressed in treatment, then stimulant treatment does pose a risk. For example, once HPA-Axis dysregulation occurs, then one may not be able to control the inflammation or norepinephrine signaling that increases with stimulant treatment.

The article has a lot of inaccuracy. For example, it classifies Lithium oratate as a non-pharmaceutical treatment. It is a medicinal and thus pharmaceutical treatment. Lithium is not an essential nutrient in the body. Pharmaceutical lithium is not poorly absorbed into the brain. It is used in high doses because it is a medicinal treatment for bipolar disorder where there are therapeutic blood levels that need to be achieved. Amino acid treatments which are not addressing a nutritional deficiency, to me, are medicinal treatments. The use of a cholinesterase inhibitor is not useful in ADHD. It reduces dopamine production (which is why depression, mental impairment and suicidal behavior may occur particularly if there is no demonstrated acetylcholine signaling problem as in Alzheimer’s disease). Piracetam is a treatment I would never use in children. It doesn’t work well either. Nor is its mechanism of action clear – thus making the treatment roll of the dice. Most of the treatments described rely on statistics to demonstrate efficacy rather than identifying a pathology to target. Thus, from my point of view, they are all used medicinally/pharmacologically. The value of the article is that it does encourage practitioners to look for underlying factors though he calls each underlying factor a separate illness rather than a part of ADHD.

Thank Dr Mariano.
Two more theory about diabetes type 2 is the “leaky gut”, HCSF and POP. Many pollutants cause insulin resistance

@Jean 6723 wrote:

Also a nice study about gut microbia and diabetes