A New YOU to Start the Year!        Fundamentals of personal and hormonal optimization      Louis B. Cady, MD – CEO & Foun...
“There are two objects of medical education: to healthe sick and to advance the science.”- Dr. Charles H. Mayo, MD        ...
Purpose of this talk:• Real-world, clinical application of age  management concepts• Avoiding “knee-jerk” reaction for “ju...
Differences in life expectancy (2006-      08) – as a function of age
“F as in Fat – How Obesity Threatens America’s         Future 2012” – Robert Wood Johnson foundation  Current and future I...
S                 N             O        TI    CA                         BODYD    IN         M
The CWI NeuroVitality® Breakthrough – May 2010    These are the only THREE ways that human    behavior and performance can...
CURRENT PRACTICE OF MEDICINE:What a patient had to say about her “specialists”: •“They just monitor  my degeneration.”
American Journal of Health Promotion;                 November/December, 2002                                    66%      ...
How to get the MOST out of this presentation:
My bias: whatever works for thepatient; whatever it takes.
Topics:•   Thyroid•   Cortisol•   DHEA•   Estradiol/Progesterone•   Testosterone•   Lab techniques: saliva or blood?•   We...
SOURCE LabCorp testing manual – THYROID section
AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS      MEDICAL GUIDELINES FOR CLINICAL PRACTICE       FOR THE EVALUATION A...
• “Thyrotropin (Thyroid-Stimulating Hormone or  TSH). Measuring TSH is the most sensitive  indicator of hypothyroidism.” (...
FEEDBACK                                      INHIBITIONSelenium                 CORTISOLrequired! “the foot soldier” “the...
% Mineral depletion from the soilduring the past 100 years, by continent           North America             85%          ...
SELENIUM DEFICIENCY in FASEB:                             • “Adaptive dysfunction of                               selenop...
(permission granted to use photos & data)
(permission granted to use photos & data)
•   Early 20’s college student•   Weight gain, fatigue, brain fog•   Saw “numerous” MD’s asking for help•   Told “nothing ...
(permission granted to use photos & data)
Useful Target Symptoms in             Major Depression  ♦   Depressed mood 100%  ♦   Reduced energy: 97%3  ♦   Fatigue or ...
Modern Medicine’s Paradigm:Two Standard Deviations – “if you are not     sick, then you must be well.”                    ...
Definition of “normal labs”:            “When your lab            values are as            crappy as            everyone e...
“Conventional practice”           “Age management”No fuel additives should be      There are fuel additives weused. They a...
Average (normal) or optimal?• Would you like an normal wife (husband) or  an optimal one?• Would you like a “normal” marri...
Yet TSH is the only thing that gets       checked by your doctor????Serum concentrations of Free T3, Free T4, morning cort...
Treatment resistant depression is a common challenge.Best augmenting strategies available:-Lithium-Thyroid hormone-Anti-an...
LEVEL III RESULTS:  Per HDRS – 17, remission in:         15.9% on Li         24.7% on T3  Per QIDS-SR16, remission in:    ...
63 patients with “subclinical hypothyroidism”HAM-D and MADRS scales with serum TSH Free T4, free T3TPO AB and Tg-AB levels...
Aim: Evaluate relationship of subclinical hypothyroidism andcognition in the elderly.- 337 outpatients; {177 = men; 160 = ...
The Glamorous Grandmother• 4/8/11 – 80 yo returned to practice. No real  complaints. History of depression. On des-  methy...
G.G. - interventions 5/2/11 & Follow-up• Interventions:  – DHEA – 25 mg SR q a.m.  – Progesterone 50 mg then 100 mg HS,   ...
G.G. – labs before and after               4/11/11   interventions 7/11/11    changesTSH            3.84      Raise T4 fro...
24 post-menopausal women with intact uterus. Neuropsychtesting. No hormone therapy used in the past. Recruited bynewspaper...
Medroxyprogesterone in women and rats• MPA – used in hormone therapy and as  DepoProvera, is implicated in  detrimental co...
Conclusions regarding thyroid• It’s not just about eyebrows (or reflexes)• Low or subclinical hypothyroidism  associated w...
The state of adrenal exhaustion can             be determined• 53 year old male  executive• Partner in four  businesses.• ...
Relevant hormone markers by salivary &              conventional testing• DHEA              120.12 pg/ml (L)   {137 – 336}...
DHEA – the critical hormone most  conventional doctors never check• Produced in the adrenal cortex  – Humans and primates ...
349 citations on “DHEA with energy” – as of                 of 10/3/2012
DHEA – other interesting points• No nuclear receptor for DHEA or DHEA-S ever found;  mechanisms of action are not fully un...
DHEA has been correlated with lower susceptibility to anxietyand mood disturbance.Behavioral task – series of anagram puzz...
91 students ½ male, ½ female – taking OrganicChemistry in the USA.Displacement activities (DA’s) screened for by videoreco...
Treatment for the Stressed Executive• Empirically started at ¼ grain Armour with  increase to ½ grain at first appt (based...
Five month follow-up• “I think all the stuff is working. My energy  level is good. If there’s anything lingering –  it’s j...
July 2011   Nov 2011         Dec 29, 2012Interventions                    100 mg DHEA SR   100 mg DHEA SR                 ...
Saliva or blood?• Saliva:                                      • Blood testing:   – 4 cortisols give rhythm, plus:        ...
One destigmatizing notion:            Estrogen as MAOI• Estrogen & Testosterone (!) decrease  monoamine oxidase (MAO)  – L...
What if we could just look at neurotransmitters as well as homones like they would on Star Trek ?                         ...
Low estrogen, DHEA, cortisol, and low NT’s – putting it all together       52 yo woman, s/p TAH with fatigue and depressio...
Estrogen: Good For Your Brain• Estradiol influences performances of learning and  memory tasks as well as increase working...
Traditional vs.          Bio-identical “HRT”:• Synthetic means that the molecule is not natural to the human body.• Bio-id...
Women’s Health Initiative Study• Flawed study - it was designed as a  “Premarin & Provera” study, not a  bioidentical estr...
Women’s Health Initiative                 Study• The results presented did not justify  their overall broad conclusion:   ...
Women’s Health Initiative StudyTHE PARTICIPANTS:• 2/3 of the women in the study were older  than sixty• Of these women, mo...
Women’s Health Initiative Study    Facts You Should Know• In the first 1-3 years there was a higher  incidence of M.I.’s.•...
Women’s Health Initiative Study     Facts You Should Know• When the W.H.I. Study was  organized, the subjects were not  pr...
Hx of Baseline Health Characteristics   (total # of participants 16,608)Disease               HRT      PlaceboHypertension...
Traditional vs.             Bio-identical “HRT”:• Premarin raises C-reactive protein  significantly.• CRP is an inflammati...
Testosterone: The “sexist” bias against women  (e.g., “your loss of sex drive is just natural for                     your...
Estrogen-related mood disorders –  reproductive life cycle factors.    Douma SL et al. Adv. Nursing Sci. 2005. 28 (4):364-...
The Case of the Crying Cleaner                                    • 1/11/12 - Symptoms:                                   ...
Testosterone (Men)      • Decline in male sex steroids not as        abrupt as menopause, but equally        debilitating ...
Observational study of randomly selected men –Boston3 cohorts of men: 1987-1989; 1995-1997; 2002-2004.1374, 906, and 48...
Fast food (low Zn) is bad for you.• Fast food = high energy density = low essential  micronutrient density, ESPECIALLY ZIN...
T vs Cognitive Function     Rosario ER. Age-related testosterone depletion and thedevelopment of Alzhiemer disease. JAMA. ...
T vs. Cognitive Function• 400 independently living men, 40-80yo  – 100 in each age decade  – MMSE 21-30, average 28  – TT:...
T vs. Mood in men• Study: 278 men, >45yo, followed 2 years• Compared to eugonadal patients,  hypogonadal men w/TT <200ng/d...
Testosterone appears to be good for               guys.• Serum T, DHT and E(2) displayed no  decrease associated with age ...
T vs. Heart Disease• Men with CAD have significantly LOWER  levels of androgens than normal controls.  –    English, KM et...
Relevance of testosterone (and DHEA              + Thyroid)                                                    (photo shot...
Testosterone appears to be seriously        good for guys’ brains• “Results from cell culture and animal studies provide  ...
Testosterone and “Prostate Cancer risk”• Prostate CA found 2.15 & 2.26 times more  likely in lowest compared to highest te...
Benefits (and minimal risk) of testosterone –              J Sex Med Sep 2012Risks of Low T:         Risks of TX:•Reduced ...
The Case of the Mismanaged         Executive - summary• 42 year old male ADHD CEO. Background in psychology.  Now EXTREMEL...
Current stats on obesity         National Center for Health Statistics
How do you lose it?
The Doc Cady “Candy Bar a Day”     Weight Loss Program• 1 lb. of fat = 3,500 kcal (“calories”)• 3,500 / 7 = 500 calories p...
One problem…• It doesn’t work!• TBL: It’s the  INSULIN  RESPONSE• RX: EAT LESS  CARBS AND  SUGAR!!!
Glycemic index• A measure of how fast a  carbohydrate triggers a rise in  circulating blood sugar.• The higher the number,...
The Old FDA Food pyramid – R.I.P 2005
W. Wheat      Rice     Big Mac,       Ice cream;Toast, OJ,   cakes,   Fries, Shake   Coke & chips coffee      coffee      ...
Benefits of low-glycemic eating                              H - 90
The horrifying facts about the foods you eat!         (food)                      (glycemic index)         Glucose        ...
“It’s really not thatSo what the heck am I      complicated!”supposed to do with thisstuff?
Behaviors/status       Interventionsstress          Job/life stress        Meditation, spiritual practice, T’ai chi,      ...
Upcoming lectures!Dr. Louis B. Cady, MD – Founder, CEO – Cady Wellness Institute& Dr. W. Whitney Gabhart, Naturopathic Doc...
How obvious does it have to be?LET’S START CHECKING THOSE LEVELS!                    Ron Hunt lost an eye but suffered    ...
“Sit down before fact asa little child,be prepared to give upevery preconceivednotion,follow humbly wherever… nature leads...
Contact information:                                      Louis B. Cady, M.D.                                         www....
New YOU in 2013
New YOU in 2013
New YOU in 2013
New YOU in 2013
New YOU in 2013
New YOU in 2013
New YOU in 2013
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In this first lecture of 2013 at Cady Wellness Institute, Dr. Cady presented the facts and strategies in front of a live audience for rebroadcast on WNIN - our local public television station. These are the EXACT SLIDES used in the presentation. We would like to thank all of those in the live audience who attended. For questions or comments, please feel free to contact us at front desk@cadywellness.com or call the Institute at ()812) 429 - 0772.

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  • Depressed mood is the most commonly cited symptom in major depressive disorder. Studies have shown that fatigue and reduced energy are nearly as common as depressed mood. As many as 94%-97% of patients may experience reduced energy and fatigue, while 73% may complain of tiredness. Impaired concentration is also common and occurs in as many as 84% of patients. Hypersomnia, or excessive sleepiness as opposed to physical weariness, is less common and occurs in 10%-16% of patients.
  • One goal is to rectangularize the health span curve. I.e. to improve vitality from middle age onward.
  • These symptoms correlate to decrease in bioavailable testosterone
  • RIA (in-house after diethylether extraction) Total testosterone - T (RIA) 208-1141ng/dL, average 536+/-153ng/dL Bioavailable testosterone - BT (calculated) 78-470ng/dL, average 236+/-63ng/dL
  • Hypogonadal if TT &lt; 200ng/dL or FT &lt; 0.9ng/dL
  • Hypogonadal if TT &lt; 200ng/dL or FT &lt; 0.9ng/dL
  • New YOU in 2013

    1. 1. A New YOU to Start the Year! Fundamentals of personal and hormonal optimization Louis B. Cady, MD – CEO & Founder – Cady Wellness InstituteAdjunct Asst. Prof of Psychiatry – IU School of Medicine Department of Psychiatry Child, Adolescent, Adult, Functional Neuropsychiatry – Evansville, Indiana Presented at Cady Wellness Institute January 15, 2013
    2. 2. “There are two objects of medical education: to healthe sick and to advance the science.”- Dr. Charles H. Mayo, MD “The glory of medicine is that it is always moving forward, that there is always more to learn.” H -2 - Dr. William J. Mayo
    3. 3. Purpose of this talk:• Real-world, clinical application of age management concepts• Avoiding “knee-jerk” reaction for “just being depressed.”• Understanding relevance of thyroid, cortisol and several other hormones in mood and brain dysfunction• Review of cost-effective ways of screening for hormonal and neurotransmitter abnormalities
    4. 4. Differences in life expectancy (2006- 08) – as a function of age
    5. 5. “F as in Fat – How Obesity Threatens America’s Future 2012” – Robert Wood Johnson foundation Current and future IN obesity rates:2011 – 25 %2030 –49.5%(if BMI reduced5%)2030 – 56% http://healthyamericans.org/report/100/
    6. 6. S N O TI CA BODYD IN M
    7. 7. The CWI NeuroVitality® Breakthrough – May 2010 These are the only THREE ways that human behavior and performance can be influenced.
    8. 8. CURRENT PRACTICE OF MEDICINE:What a patient had to say about her “specialists”: •“They just monitor my degeneration.”
    9. 9. American Journal of Health Promotion; November/December, 2002 66% 19% of those 18.8% “Incompletely healthy” surveyed completely were unhealthy, completely defined as healthy with having low high levels of levels of health both physical with high Two-thirds of the adults and mental levels of reported some health and a illness. degree of mental low level of or physical illness that kept them illness. from being completely healthy. “Incompletely healthy.”DEAD HEALTH continuum O
    10. 10. How to get the MOST out of this presentation:
    11. 11. My bias: whatever works for thepatient; whatever it takes.
    12. 12. Topics:• Thyroid• Cortisol• DHEA• Estradiol/Progesterone• Testosterone• Lab techniques: saliva or blood?• Weight loss – last (can’t lose it without hormones optimized)
    13. 13. SOURCE LabCorp testing manual – THYROID section
    14. 14. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE EVALUATION AND TREATMENT OF HYPERTHYROIDISM AND HYPOTHYROIDISM AACE Thyroid Task Force Chairman H. Jack Baskin, MD, MACE Committee Members Rhoda H. Cobin, MD, FACE Daniel S. Duick, MD, FACE Hossein Gharib, MD, FACE Richard B. Guttler, MD, FACE Michael M. Kaplan, MD, FACE Robert L. Segal, MD, FACE Reviewers Jeffrey R. Garber, MD, FACE Carlos R. Hamilton, Jr., MD, FACE Yehuda Handelsman, MD, FACP, FACE Richard Hellman, MD, FACP, FACE John S. Kukora, MD, FACS, FACE Philip Levy, MD, FACE Pasquale J. Palumbo, MD, MACE Steven M. Petak, MD, JD, FACE Herbert I. Rettinger, MD, MBA, FACE Helena W. Rodbard, MD, FACE F. John Service, MD, PhD, FACE, FACP, FRCPC Talla P. Shankar, MD, FACE Sheldon S. Stoffer, MD, FACE John B. Tourtelot, MD, FACE, CDR, USN 2006 AMENDED VERSION This amended version reflects a clarification to specify pertechnetate as the compound attached to 99mTc. ENDOCRINE PRACTICE V ol 8 No. 6 November/December 2002 457
    15. 15. • “Thyrotropin (Thyroid-Stimulating Hormone or TSH). Measuring TSH is the most sensitive indicator of hypothyroidism.” (hunh?!) – accessed 9/5/2011• “…blood tests for measuring levels of TSH and free thyroxine (T4) are the only definitive way to diagnose hypothyroidism” – 10/6/2012 http://www.umm.edu/patiented/articles/how_serious_hypothyroi
    16. 16. FEEDBACK INHIBITIONSelenium CORTISOLrequired! “the foot soldier” “the evil twin”
    17. 17. % Mineral depletion from the soilduring the past 100 years, by continent North America 85% South America 76% Asia 76% Africa 74% Europe 72% Australia 55% Source: UN Earth Summit Report 1992
    18. 18. SELENIUM DEFICIENCY in FASEB: • “Adaptive dysfunction of selenoproteins from the perspective of the ‘triage’ theory: why modest selenium deficiency may increase risk of diseases of aging.”Foundation of American McCann, J, Ames BM. FASEB J.Societies for Experimental 2011 Jun;25(6):1793-814.Biology
    19. 19. (permission granted to use photos & data)
    20. 20. (permission granted to use photos & data)
    21. 21. • Early 20’s college student• Weight gain, fatigue, brain fog• Saw “numerous” MD’s asking for help• Told “nothing is wrong with your thyroid; your labs are fine.” (permission granted to use photos & data)
    22. 22. (permission granted to use photos & data)
    23. 23. Useful Target Symptoms in Major Depression ♦ Depressed mood 100% ♦ Reduced energy: 97%3 ♦ Fatigue or loss of energy: 94%2 ♦ Impaired concentration: 84%3 ♦ Tiredness: 73%1 ♦ Hypersomnia: 10%–16%4 (Insomnia)1. Tylee et al. Int Clin Psychopharmacol 1999;14:139-151. 2. Maurice-Tison et al. Br J GenPract 1998;48:1245-1246. 3. Baker et al. Comp Psychiatry 1971;12:354-65. 4. Horwath etal. J Affect Disord 1992;26:117-25. 5. Reynolds and Kupfer. Sleep 1987;10:199-215.
    24. 24. Modern Medicine’s Paradigm:Two Standard Deviations – “if you are not sick, then you must be well.” “NORMAL” OPTIMAL? OPTIMAL
    25. 25. Definition of “normal labs”: “When your lab values are as crappy as everyone else’s.” - Neal Rouzier, MD (World Link Medical Seminar II – Spring 2011)
    26. 26. “Conventional practice” “Age management”No fuel additives should be There are fuel additives weused. They are unnatural. Gas can use to keep our carsis all that is required. burning cleaner and preserve engines.The quality of the gas is We should use optimalirrelevant. Anything that the quality of gas. Cheap gasmotor will burn is adequate. causes “pinging” which is hard on the engine.Preventive maintenance? This We should take our car in foris silly! Wait until something preventive maintenancebreaks, then have the car before anything breaks.towed in so the mechanic can (THAT way, maybe it will lastreally tell what is wrong. a long time!!!)
    27. 27. Average (normal) or optimal?• Would you like an normal wife (husband) or an optimal one?• Would you like a “normal” marriage or an exciting and optimal one?• Would you like a “normal” sex life or would you like to feel like optimal (!!) stimulating one?• Would you like “normal” labs or OPTIMAL ones?
    28. 28. Yet TSH is the only thing that gets checked by your doctor????Serum concentrations of Free T3, Free T4, morning cortisol,afternoon cortisol and change in cortisol concentrations.Adjustments for: age, sex, body mass index, hypertension, previousMI, heart failure, diabetes, NY Heart Assn. functional class,depressive symptoms and anxiety symptoms.Lower Free T3 = more physical fatigueLower Free T4 = more exertional fatigueLower morning cortisol and change in cortisol concentration = moremental fatigue.
    29. 29. Treatment resistant depression is a common challenge.Best augmenting strategies available:-Lithium-Thyroid hormone-Anti-anxiety medications-Atypical antipsychotics.
    30. 30. LEVEL III RESULTS: Per HDRS – 17, remission in: 15.9% on Li 24.7% on T3 Per QIDS-SR16, remission in: 13.2% on Li 24.7% for T3 ** Fava & Covino: Augmentation/Combination Therapy in STAR*D Trial,Medscape Psychiatry
    31. 31. 63 patients with “subclinical hypothyroidism”HAM-D and MADRS scales with serum TSH Free T4, free T3TPO AB and Tg-AB levels Prevalence of depressive symptoms in this population was 63.5% “This study suggests the importance of a psychiatric evaluation in patients affected by subclinical hypothyroidism.” Hunh?
    32. 32. Aim: Evaluate relationship of subclinical hypothyroidism andcognition in the elderly.- 337 outpatients; {177 = men; 160 = women}MMSE scores were SIGNIFICANTLY lower insubclinical hypothyroid patients compared toeuthyroid (p<0.03)“Patients with subclinical hypothyroidism had aprobability about 2 times greater (RR = 2.028, p<0.05) ofdeveloping cognitive impairment.”
    33. 33. The Glamorous Grandmother• 4/8/11 – 80 yo returned to practice. No real complaints. History of depression. On des- methylvenlafaxine. – Daughter “handling her finances”• 5/2/11 – “doing terrible.” – TSH 3.84, Free T3 2.8 – on 50 MICROgrams T4 – Fasting BS 120; HgBA1C 6.5% – Fasting insulin 36 (!!!) {3 – 25} – Progesterone – 0.2 {0.2 – 1.4 follicular} – Total testosterone 11 – DHEA-S = 25 MICROgrams/dL (!!) • Age adjusted {10 – 90} . Optimal = {c. 350-500} • Rouzier = {300 –females, 600 males}
    34. 34. G.G. - interventions 5/2/11 & Follow-up• Interventions: – DHEA – 25 mg SR q a.m. – Progesterone 50 mg then 100 mg HS, transdermal. – Testosterone – 2 mg for one week, then 4 mg transdermal – Referred to better MD for intervention with AODM.• 6/13/2011 – improvement in fatigue. Labs rechecked.• 7/11/2011 – “feeling wonderful”
    35. 35. G.G. – labs before and after 4/11/11 interventions 7/11/11 changesTSH 3.84 Raise T4 from 0.01 (L) none 50 – 75 ugFT4 1.16 “ 1.24 “FT3 2.8 “ 3.3 “Progesterone <0.2 100mg topical 0.9 None HSTestosterone 11 4mg topical 15 4 mg LABIALDHEA-S 25 25 mg SR n/a continue
    36. 36. 24 post-menopausal women with intact uterus. Neuropsychtesting. No hormone therapy used in the past. Recruited bynewspaper ads.Randomized to CEE + PL, CEE + MPA, CEE +MP (Micronized progesterone)Mood improved in all groups.CEE + MP performed significantly better on a test ofworking memory than the other two groups.
    37. 37. Medroxyprogesterone in women and rats• MPA – used in hormone therapy and as DepoProvera, is implicated in detrimental cognitive effects in women.• In ovariectomized rodents – MPA impairs cognition and alters the GABA- ergic system.• Findings suggest that MPA treatment leads to LONG-LASTING cognitive impairments in the rodent, even in the absence of ongoing circulating MPA Braden BS, et al. Cognitive-impairing effects of medroxyprogesterone acetate in the rat: independent and interactive effects across time. Psychopharmacology (Berl). 2011 Nov;218(2):405-18. Epub 2011 May 12.
    38. 38. Conclusions regarding thyroid• It’s not just about eyebrows (or reflexes)• Low or subclinical hypothyroidism associated with: – Depression – More exertional and mental fatigue – Higher risk of suicide • Poorer cognition • 2 x likelier to have cognitive impairment.
    39. 39. The state of adrenal exhaustion can be determined• 53 year old male executive• Partner in four businesses.• “The last year or so, I’m more tired… don’t have the energy… I’m having more trouble getting out of bed in the morning.”
    40. 40. Relevant hormone markers by salivary & conventional testing• DHEA 120.12 pg/ml (L) {137 – 336}• Testosterone 59.06 pg/ml {30.1 – 142.5, males, not on tx}• TSH 1.20 uIU/ml {0.40 – 4.50• Free T4 1.7 mg/ml {0.8 – 1.8}• Free T3 303 pg/ml {230 – 420}• Reverse T3 44 (H!) ng/dL {11 – 32}
    41. 41. DHEA – the critical hormone most conventional doctors never check• Produced in the adrenal cortex – Humans and primates are unique in secreting large amounts – “the most abundant steroid hormone in the human body.” (Maninger et al. Front. Neuroendocrinol. 2009 Jan; 30(1):65-91.)• Immune system booster; Insulin regulator• Energy increase – remarkable• Boosts growth hormone – 20% in men; 30% in women in one study • [Yen, Morales Khorram – one year double-blind placebo controlled crossover experiment – with 100mg DHEA]• Antidepressant effects
    42. 42. 349 citations on “DHEA with energy” – as of of 10/3/2012
    43. 43. DHEA – other interesting points• No nuclear receptor for DHEA or DHEA-S ever found; mechanisms of action are not fully understood• Some actions may be through conversion into more potent sex steroids (and activation of androgen or estrogen receptors in tissue).• Stimulate neural growth (from animal studies) – DHEA – increases axon length – DHEA-S – stimulated dendrite growth.• DHEA-S promoted survival of adult human cortical brain tissue in vitro. – DHEA increased neurogenesis in addition to neuronal survivalManninger, N et al. Neurobiological & neuropsychiatric effects of DHEA and DHEA
    44. 44. DHEA has been correlated with lower susceptibility to anxietyand mood disturbance.Behavioral task – series of anagram puzzlesfrom possible to IMPOSSIBLE.Other indices: ACT scores, # of college classes droppedor failed, current GPAHigher DHEA: cortisol ratio associated with“lowest probability of failing the task.”
    45. 45. 91 students ½ male, ½ female – taking OrganicChemistry in the USA.Displacement activities (DA’s) screened for by videorecording during tests.A logistical model built on GPA, DA’s, andsalivary hormone levels of cortisol andDHEA correctly predicted 90% of thestudents who passed the class.
    46. 46. Treatment for the Stressed Executive• Empirically started at ¼ grain Armour with increase to ½ grain at first appt (based on previous thyroid tests) – This was continued at next appt per labs.• Start on DHEA 25 mg extended release tablets, then increase to 2– 3 tablets as needed and as tolerated. (Ultimately increased to 100 mg SR per day)• High potency mulivitamin with high dose B, C, minerals.
    47. 47. Five month follow-up• “I think all the stuff is working. My energy level is good. If there’s anything lingering – it’s just stress from work stuff. I actually feel pretty good.”• “0 – 10 energy scale” probe: – 24 – 25 yoa – maximum energy “10” – July 2011 (before labs and interventions) – “4” – October 2011 – “5 – 6” – January 2012 – “8”
    48. 48. July 2011 Nov 2011 Dec 29, 2012Interventions 100 mg DHEA SR 100 mg DHEA SR ½ grain Armour ½ grain Armour 1 pump T to each inner thighTSH 1.2 0.86 0.93Free T4 1.7 1.5 1.3Free T3 303 373 361Rev T3 44 (H) 57 (H) 39 (H)DHEA-S 128 472 (“H”) 306 (“H”)IGF-1 81 106 120Total testosterone 820 913 969Free Testosterone 87.7 131.5 100.8
    49. 49. Saliva or blood?• Saliva: • Blood testing: – 4 cortisols give rhythm, plus: – More published literature • Average x 4 of: targeting specific blood levels of – DHEA, testosterone, estradiol, sex hormones and DHEA (S) and progesterone – More predictable dosing of – Much easier to obtain hormones with assiduous blood – Early a.m. cortisol arguably monitoring. more accurate. – 4 lab values in a day averaged • Downsides: arguably more accurate – woefully skewed a.m. cortisol – Cheaper if cash pay – Less likely to get 4 cortisols – Perfectly acceptable as a screening tool. – No averaging of four specimens of other hormones. Downside: Apparent “disconnect” between post-treatment levels and salivary measurements
    50. 50. One destigmatizing notion: Estrogen as MAOI• Estrogen & Testosterone (!) decrease monoamine oxidase (MAO) – Luin, VN. Effect of gonadal steroids on activities of MAO and choline acetylase in rat brain. Brain Res. 1975;86:273-306• Platelet MAO levels inversely correlated to estradiol levels – Klaiber EL et al. Psychoneuroendo- crinology. 1997 Oct;22(7):549-58.• Estrogen decreases MAO-A & MAO-B – Holschneider DP et al. Life Sci. 1998;63(3):155-60
    51. 51. What if we could just look at neurotransmitters as well as homones like they would on Star Trek ? Cell rate 
    52. 52. Low estrogen, DHEA, cortisol, and low NT’s – putting it all together 52 yo woman, s/p TAH with fatigue and depressionHormone Value normsCortisols All barely various above pathologicalDHEA 47.66 {106-300}Estradiol (E2) <1.00 {1.0 – 3.2 = post menopausal}Testosterone 8.44 {6.1 – 49 – female}
    53. 53. Estrogen: Good For Your Brain• Estradiol influences performances of learning and memory tasks as well as increase working memory – Sub-point – women are living three decades longer; hence they are spending more time hypoestrogenic – Pompilli A et al. Estrogens and memory in physiological and neuropathological conditions. Psychoneuroendocrinology. 2012 Sept; 37 (9):1379-96• Estradiol = protective against schizophrenia. – Kulkarni J, et al. Hormones and Schizophrenia. Curr Opin Psychiatry. 2012 Mar;25(2):89-95
    54. 54. Traditional vs. Bio-identical “HRT”:• Synthetic means that the molecule is not natural to the human body.• Bio-identical hormone is one whose molecule is identical to that made by a human organ. SV2003- 57
    55. 55. Women’s Health Initiative Study• Flawed study - it was designed as a “Premarin & Provera” study, not a bioidentical estrogen study.• Premarin is a non-bio-identical substance• Provera is a non-bio-identical substance• Premarin is an equine derived array of 30+ female horse hormones. SV2003- 58
    56. 56. Women’s Health Initiative Study• The results presented did not justify their overall broad conclusion: – “Premarin & Provera yielded these findings; therefore, Hormone Replacement Therapy is not appropriate for women.”SV2003- 59
    57. 57. Women’s Health Initiative StudyTHE PARTICIPANTS:• 2/3 of the women in the study were older than sixty• Of these women, most were first-time users of HRT.• Had already experienced cessation of endogenous hormone production (for a DECADE!!!), therefore, at risk for: – Heart attacks, strokes, clots, cancer SV2003- 60
    58. 58. Women’s Health Initiative Study Facts You Should Know• In the first 1-3 years there was a higher incidence of M.I.’s.• Patients who stayed on that program beyond the 8th year started to actually outperform women on placebo.• WHY???? SV2003- 61
    59. 59. Women’s Health Initiative Study Facts You Should Know• When the W.H.I. Study was organized, the subjects were not prescreened for heart disease.• Without prescreening, a group of women was included with pre- existing heart disease.•SV2003- 62
    60. 60. Hx of Baseline Health Characteristics (total # of participants 16,608)Disease HRT PlaceboHypertension 37% 3039 2949High Cholesterol 11% 944 962Myocardial Infarction 2% 139 157Angina 288 234Stroke 61 77Embolism 79 62Family Breast Cancer 1286 1175Diabetes 374 360Fracture 1031 1029
    61. 61. Traditional vs. Bio-identical “HRT”:• Premarin raises C-reactive protein significantly.• CRP is an inflammation marker.• Inflammation is either the root cause (e.g., rupturing plaque), or a strongly contributing cause, of both Cancer & Heart Disease.SV2003- 64
    62. 62. Testosterone: The “sexist” bias against women (e.g., “your loss of sex drive is just natural for your age.”)• Fall in the circulating testosterone and the adrenal preandrogens most closely parallel increasing age.• Accelerated decrease occurs in the years preceding menopause (like estrogen).• Their loss affects: libido, vasomotor symptoms (hot flashes), mood, well-being, bone structure, and muscle mass. – Burd, Bachmann. Androgen replacement in menopause. Curr Womens Health Rep. 2001 Dec; 1(3):202-5.
    63. 63. Estrogen-related mood disorders – reproductive life cycle factors. Douma SL et al. Adv. Nursing Sci. 2005. 28 (4):364-375• “Clinical recovery from depression postpartum, perimenopause, and postmenopause through restoration of stable/optimal levels of estrogen has been noted.”
    64. 64. The Case of the Crying Cleaner • 1/11/12 - Symptoms: – Crying/depressed = on Citalopram – Hot flashes – Night sweats • RX: – Estradiol – 2 mg @HS – Prometrium – 100 mg @HS – (continue citalopram) • 1/15/12 – RESOLVED • In 4 days!Photo & data used with permission
    65. 65. Testosterone (Men) • Decline in male sex steroids not as abrupt as menopause, but equally debilitating –Between 40 – 70, average male loses: • Nearly 2" of height • 15% of bone density • 10 – 20 pounds of muscle • At 70 yoa, 15% completely impotent
    66. 66. Observational study of randomly selected men –Boston3 cohorts of men: 1987-1989; 1995-1997; 2002-2004.1374, 906, and 489 men, respectively.“Age independent decline in T that does not appear tobe attributable to observed changes in explanatoryfactors, including lifestyle characteristics such assmoking and obesity.”“Recent years have seen a SUBSTANTIAL, and asyet UNRECOGNIZED age-independent population- November 2009level decrease in T in American men.” “Alpha Male” issueTravison, Araujo, et al. Jrnl of Clin. Endocrinol & Metabol 92:1; 196-202.
    67. 67. Fast food (low Zn) is bad for you.• Fast food = high energy density = low essential micronutrient density, ESPECIALLY ZINC• Antioxidant processes are dependent on Zinc• Fast food = severe decrease in antioxidant vitamins and zinc, correlating with inflammation in testicular tissue – with underdevelopment of testicular tissue and decreased testosterone levels
    68. 68. T vs Cognitive Function Rosario ER. Age-related testosterone depletion and thedevelopment of Alzhiemer disease. JAMA. 292(2004):1431-2
    69. 69. T vs. Cognitive Function• 400 independently living men, 40-80yo – 100 in each age decade – MMSE 21-30, average 28 – TT: 208-1141ng/dL; Bio-avail T 78-470ng/dL• HIGHER T = better cognitive performance in OLDEST AGE category• Men with lowest 1/5 T = worse than men with highest 1/5 T• Highest Bio-available T more significant than TT, age, intelligence level, mood, smoking, and alcohol. Muller M, et al. Neurology. 2005 Mar;64(5): 866-71
    70. 70. T vs. Mood in men• Study: 278 men, >45yo, followed 2 years• Compared to eugonadal patients, hypogonadal men w/TT <200ng/dL had – 4-fold increase risk of depression – Significantly shorter time to depression diagnosis• Depression risk inversely related to TT w/statistical significance <280ng/dL Shores MM, Arch Gen Psychiatry. 61(2004):162-7
    71. 71. Testosterone appears to be good for guys.• Serum T, DHT and E(2) displayed no decrease associated with age among men over 40 years of age who self-report very good or excellent health – Sartorius G, et al. Serum testosterone, dihydrotestosterone and estradiol concentrations in older men self-reporting very good health: the healthy man study. Clin Endocrinol (Oxf). 2012 Nov; 77(5):755-63
    72. 72. T vs. Heart Disease• Men with CAD have significantly LOWER levels of androgens than normal controls. – English, KM et al. Men with coronary artery disease have lower levels of androgens than men with normal coronary angiograms. Eur Heart J. 2000 June; 21(11):890-4.• “There is early evidence from non-randomized studies that physiological testosterone replacement is extremely safe and may reduce cardiovascular mortality.” – Hackett G. Testosterone and the heart. Int J Clin Pract. 2012 July;66(7):648-55.
    73. 73. Relevance of testosterone (and DHEA + Thyroid) (photo shot 15 months after tx)RX: dairy free diet (+IgG test); D3 5000 IU/d; Armour thyroid,Testosterone cypionate 100 mg IM q wk, MVI, Zinc, DHEA 50 mgSR, CoQ10 400mg (permission granted to use photos & data)
    74. 74. Testosterone appears to be seriously good for guys’ brains• “Results from cell culture and animal studies provide convincing evidence that testosterone could have protective effects on brain function.”• “Testosterone levels are lower in Alzheimer’s cases compared to controls, and some studies have suggested that low free testosterone (FT) may precede AD onset.”• “Positive associations have been found between testosterone levels and global cognition, memory, executive functions and spatial performance in observational studies.” Holland J, et al. Testosterone levels and cognition in elderly men: a review. Maturitas. 2011 Aug; 69(4):322-37.
    75. 75. Testosterone and “Prostate Cancer risk”• Prostate CA found 2.15 & 2.26 times more likely in lowest compared to highest tertile of total and free testosterone• “. . . there are several papers showing a relationship between LOW testosterone and prostate cancer. Specifically, low testosterone has been associated with high-grade tumors, advanced stage of presentation, and worse prognosis.” Morgentaler A. Eur Urol. 50(2006):935-9 Morgentaler A. Urology. 68(2006):1263-7
    76. 76. Benefits (and minimal risk) of testosterone – J Sex Med Sep 2012Risks of Low T: Risks of TX:•Reduced longevity •“There is no compelling evidence•Fatal Cardiovascular events Testosterone therapy causes that•Obesity prostate cancer or its progression in men.”•Sarcopenia•Mobility limits Conclusions: men with sexual•Osteoporosis dysfunction, visceral obesity, and•Frailty metabolic diseases should be•Cognitive impairment screened for testosterone deficiency and treated. Young men•Depression with TD should also be treated.•Sleep Apnea Syndrome Buvat J et al. Testosterone deficiency in men: Systematic Review. J Sex Med. 2012 Sep 12
    77. 77. The Case of the Mismanaged Executive - summary• 42 year old male ADHD CEO. Background in psychology. Now EXTREMELY stressed.• “So tired I feel like I’m dying.” “Depressed.”• Lab findings – low testosterone, despite multiple pumps daily of low potency FDA-approved “BigPharma” transdermal testosterone gel managed by endocrinologist• Low thyroid. Low DHEA.• RX: Testosterone cypionate IM – 60 mg twice weekly. DHEA – 50 mg SR. Armour thyroid – ½ grain.• Clinical status: total resolution of symptoms in 3- 4 weeks. No antidepressant used.
    78. 78. Current stats on obesity National Center for Health Statistics
    79. 79. How do you lose it?
    80. 80. The Doc Cady “Candy Bar a Day” Weight Loss Program• 1 lb. of fat = 3,500 kcal (“calories”)• 3,500 / 7 = 500 calories per day – You need to not eat’em, or burn’em • Starving yourself slows your metabolism down, and you lose muscle mass – Therefore: reduce 250 calories; burn 250 calories• 250 calories = no candy bar, or “NO” to 1 & ½ Cokes• 250 calories = ½ - ¾ hour on treadmill• NET = 500 calories per day, or 1 lb. lost per week
    81. 81. One problem…• It doesn’t work!• TBL: It’s the INSULIN RESPONSE• RX: EAT LESS CARBS AND SUGAR!!!
    82. 82. Glycemic index• A measure of how fast a carbohydrate triggers a rise in circulating blood sugar.• The higher the number, the greater the blood sugar response.
    83. 83. The Old FDA Food pyramid – R.I.P 2005
    84. 84. W. Wheat Rice Big Mac, Ice cream;Toast, OJ, cakes, Fries, Shake Coke & chips coffee coffee H - 89
    85. 85. Benefits of low-glycemic eating H - 90
    86. 86. The horrifying facts about the foods you eat! (food) (glycemic index) Glucose 100 Table sugar (sucrose) 64 Tofutti 115 French bread 95 Instant rice 90 Baked potato 85 Rice cakes!!/ (jelly beans) 77!! / (80) Cheerios 74 Spaghetti, white 41 Spaghetti, protein 27 H - 91 enriched
    87. 87. “It’s really not thatSo what the heck am I complicated!”supposed to do with thisstuff?
    88. 88. Behaviors/status Interventionsstress Job/life stress Meditation, spiritual practice, T’ai chi, Qigong, make needed life changesAbnormal Presumptively low or Get levels – saliva or blood (pre-treatment)hormones unknown Check Neurotransmitters (urine ELISA) Thyroid DHEAInterventions Optimize/support cortisol Testosterone, Estradiol & Progesterone Growth hormone? Amino acid precursor loading for NT’s? Prescriptive agents – e.g., anti- depressants, neurostimulants, etc.
    89. 89. Upcoming lectures!Dr. Louis B. Cady, MD – Founder, CEO – Cady Wellness Institute& Dr. W. Whitney Gabhart, Naturopathic Doctor
    90. 90. How obvious does it have to be?LET’S START CHECKING THOSE LEVELS! Ron Hunt lost an eye but suffered no brain damage after a freak accident with a large drill bit. (ABCNEWS.com)
    91. 91. “Sit down before fact asa little child,be prepared to give upevery preconceivednotion,follow humbly wherever… nature leads, or you shall learnnothing.”- Thomas H. Huxley
    92. 92. Contact information: Louis B. Cady, M.D. www.cadywellness.comOnce more….  www.facebook.com/cadywellnessWhere to “get the slides” - www.indianaTMS-cadywellness.comwww.slideshare.net/lcadymd Office: 812-429-0772 E-mail: lcady@cadywellness.com 4727 Rosebud Lane – Suite F Interstate Office Park Newburgh, IN 47630 (USA) @LouisCadyMD @TMS4depression

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