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In this, the second part of the "Queen of Denial" lecture for Deaconess Women's Hospital, Dr. Cady takes up where Dr. Gabhart left off, reviewing - briefly and succinctly - the following topics: the needless "psychiatric victimization" of women, discrimination against women in terms of optimal levels of hormones (including testosterone), and the dangers of low DHEA, low cortisol, and low thyroid. The emphasis is that there are BIOLOGICAL things that are frequently wrong, and simply looking at the supposedly "psychiatric" or "depressed" symptoms is frequently barking up the wrong tree.

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  1. 1. THE QUEEN OF DENIAL – PART IIWith Dr. Louis B. Cady, MD – Founder, CEO – Cady WellnessInstitute & Dr. W. Whitney Gabhart, Naturopathic Doctor
  2. 2. Disaster awaits.“If some real disaster impends in the city, it is not becauseparking spaces are hard to find, because architecture isbad, because department store sales are declining, or even If there is a genuinebecause taxes are rising.crisis, it has to do with the essential welfareof individuals or with the good health of thesociety, not merely with comfort, convenience,amenity, and business advantage, important as theseare.”from The Unheavenly City, Edward C. Banfield, 1968, 1970
  3. 3. CURRENT PRACTICE OF MEDICINE:What a patient had to say about her “specialists”: •“They just monitor my degeneration.”
  4. 4. Cady Wellness Institute – July 2005 The Reasons:• A lot of “psychiatric cases” WEREN’T “psychiatric.”• Nobody was integrated.• Nobody was looking at ALL of the peer-reviewed literature.
  5. 5. S N O TI CA BODYD IN M
  6. 6. PMS – typical views
  7. 7. Left Front of brain DORSOLA TERAL PFC LEFT Prefrontal Right side Left side cortex Front of brainSlide courtesy of Dr. Daniel Amen, MD and Amen Clincis.
  8. 8. Things that your [normal] doctor could tell you if he/she looked:• Anemia – menstrual or GI blood loss• Hypothyroidism*• Obstructive sleep apnea, or other sleep disorders• The REAL REASON you are gaining weight*TSH>2.5, or perhaps even >2.Free T3 and Free T4 in optimum (high normal?) rangesReverse T3 well within normal limits
  9. 9. Consequences of untreated hypothyroidism • Central nervous system: – Fatigue! – Drowsiness – Poor memory and concentration • Decreased metabolism: – Body weight increases – Heat production goes down – Basal metabolic rate goes down • Gut: decreased activity; constipation • Cardiovascular – decreased cardiac output; blood pressure falls
  10. 10. % 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
  11. 11. 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
  12. 12. (permission granted to use photos & data)
  13. 13. (permission granted to use photos & data)
  14. 14. • 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)
  15. 15. Solutions for hypothyroidism: • Get informed! • DEMAND at least a Free T3 and Free T4 with your TSH. • If you are still symptomatic with “normal” labs, you may require a “hotter” setting. • Pursue supplementation to the optimal level.
  16. 16. Things that your [normal] doctor is not looking for: • Adrenal exhaustion • Less than optimal values of hormones
  17. 17. The worst case scenario – Addison’s Disease
  18. 18. Hypoadrenia: The Adrenal Problem Your [conventionally trained] M.D./D.O. won’t know about • Non-Addison’s hypoadrenia • Subclinical hypoadrenia • Neurasthenia • Adrenal neurasthenia • Adrenal apathy • Adrenal fatigue
  19. 19. Adrenal Burnout
  20. 20. DHEA – the critical hormone your doctor never checks• Produced in the adrenal cortex – Humans and primates are unique in secreting large amounts• 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]
  21. 21. Signs & Symptoms of Adrenal Fatigue• Difficulty getting up in a.m.• Ongoing lethargy during the day.• Continued fatigue not relieved by sleep.• Craving for salt or salty foods.• Increased effort to do daily tasks• LESS PRODUCTIVE• Decreased sex drive• Decreased ability to handle stress.• Light-headed when standing up quickly• Increased recovery time for illness• Generally less happy about life.
  22. 22. 349 citations on “DHEA with energy” – as of of 10/3/2012
  23. 23. Don’t be MISS – diagnosed with 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. 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” medical practice or an incredible, exciting, and (optimal!!) stimulating one?• Would you like “normal” labs or OPTIMAL ones?
  26. 26. How would you take care of a classic? “Chronic diseases affect at least 125 million Americans & cost more than $500 billion last year.” Centers for DiseaseControl – Dec 2003
  27. 27. “Age management” “Conventional practice”There are fuel additives No fuel additives shouldwe can use to keep our be used. They arecars burning cleaner and unnatural. Gas is all thatpreserve engines. is required.We should use optimal The quality of the gas isquality of gas. Cheap gas irrelevant. Anything thatcauses “pinging” which is the motor will burn ishard on the engine. adequate.We should take our car in Preventive maintenance? Thisfor preventive is silly! Wait until something breaks, then have the carmaintenance before towed in so the mechanic cananything breaks. really tell what is wrong.
  28. 28. 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
  29. 29. One destigmatizing notion: Estrogen as MAOI• Estrogen & Testosterone (!) decrease 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
  30. 30. 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
  31. 31. 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.
  32. 32. What if we could just look at neurotransmitters like they would on Star Trek ? Cell rate 
  33. 33. 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}LOW ESTROGEN CAUSES LOW NEUROTRANSMITTERS
  34. 34. North Americans, unfortunately, obtainabout one-third of their total caloriesfrom nutrient-poor junk food. Even well-educated, presumably well-nourished,adults taking nutritional supplementsfrequently do not consume nutritionallyadequate diets and, despite theirsupplements, fall short in theirconsumption of important minerals, likemagnesium, iron, zinc, and calcium. Hallfrishch, J., Muller, D. 1993. Experimental Gerontology, v28 : 473-83.
  35. 35. These experiments reveal that carotenoids are a good indicatorof antioxidant status. They show that people with high oxidativestress, like smokers, and subjects with high sunlight exposure, ingeneral, have reduced skin carotenoid levels, independent of theirdietary carotenoid consumption. We find the Raman technique tobe precise, specific, sensitive, and well suitable for clinical aswell as field studies.
  36. 36. Your bettings odds• 1/8 women will develop breast cancer • 40,000 deaths per year, nationally – 150 Delta 777-200 aircraft crashing per year- or 1 every 2.4 days• Cervical cancer – 3,900 die of it each year – 11% of women do not have regular exams• 10% men will develop prostate cancer• Colon cancer – #2 cause of cancer deaths – 75% of patients are greater than 50 years of age with NO KNOWN RISK FACTORS – One colonoscopy decreases risk of death 90%
  37. 37. Actuarial programs abound:
  38. 38. Breast cancer as exemplar of better decision making through new research• 1 – 2 drinks per day increases risk of breast cancer 10%• 3 drinks per day = 30% increased risk. – (= equivalent of one pack of cigarettes per day) – Dr. Arthur Klatsky - Kaiser Permanente Medical Care, Oakland, Calif., European Cancer Organization in Barcelona, 9/27/2007• NIGHT WORK increases risk – new finding – Disruption in melatonin rhythm? – Increased cortisol (stress hormone)? • Cf: American Cancer Society, 9/13/2007• 10% reduction possible by 2024 with (a) exercise, (b) reduction in long term (“fake”) HRT, (c ) decrease alcohol • Max Perkin, National Cancer Research Conference, Sept 2007
  39. 39. Weight and insulin• What are the stats?• How does this eating and insulin thing work?• Is the problem “all in your glands”?• What have the Feds said and why are their recommendations so stupid?• What’s a rational way to eat (with references)
  40. 40. Current stats on obesity National Center for Health Statistics
  41. 41. “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%
  42. 42. 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
  43. 43. One problem…• It doesn’t work!• TBL: It’s the INSULIN RESPONSE• RX: EAT LESS CARBS AND SUGAR!!!
  44. 44. 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.
  45. 45. The Old FDA Food pyramid – R.I.P 2005
  46. 46. Lobbying dolalrs (in BILLIONS) 1998-2012
  47. 47. Top five crops receiving US farm subsidies • Wheat • Corn • Soybeans • Rice • Cotton Source: - What are U.S Farm Subsidies? - accessed 04 15 2013
  48. 48. W. Wheat Rice Big Mac, Ice cream;Toast, OJ, cakes, Fries, Shake Coke & chips coffee coffee H - 56
  49. 49. Doc Cady “Candy Bar a Day” program FLAWS:• Not all calories from food do the same thing to your body: – Removing 250 cal of sweet potatoes is not the same as removing 250 calories from candy bar.• Doesn’t account for thyroid or thyroid resistance.• This program only focuses on WEIGHT LOSS, and not OPTIMUM HEALTH H - 57
  50. 50. The horrifying facts about the foods you eat (and think are safe) (FOOD) (glycemic index) •Tofutti 115 •Glucose 100 •French bread 95 •Instant rice 90 •Baked potato 85 •Rice cakes (jelly beans) 77/80 •Cheerios 74 •Table sugar (sucrose) 64 •Spaghetti, white 41•Spaghetti, protein enriched 27
  51. 51. • FINAL CONCEPTS: – ”Denial " is not acceptable. – Your “glands” – may, in fact, be at fault! – IT MAY NOT BE “PSYCHIATRIC”!!! – There are things that should be checked that most physicians do not. – Education is the key! – The sooner you start taking care of your body the more lasting the positive effects will be.
  52. 52. Personal collection Louis B. Cady, M.D.