SEXY! Part 3 of 3, plus…21st Century Medicine

Louis B. Cady, MD – CEO & Founder – Cady Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute Wellness Institute Adjunct Professor – University of

Southern IndianaAdjunct Professor – Indiana University School of

MedicineWith Whitney W. Gabhart, ND - With Whitney W. Gabhart, ND - Cady Wellness

InstituteNewburgh Public Library July 11, 2012Newburgh Public Library July 11, 2012

What we do NOT want to see happen:

CURRENT PRACTICE OF MEDICINE: What a patient had to say about her “specialists”:

“They just monitor my degeneration.”

Cady Wellness Institute – July 2005The Reasons:

• Conventional medical practice had failed me twice.• A lot of “psychiatric cases” WEREN’T “psychiatric.”• Nobody was integrated.• Nobody was looking at ALL of the peer-reviewed

literature.

Orientation to this talk• Review the fundamental differences

between “wnl” and OPTIMAL

• Quick review of hormones having to do with with “slim and sane” sections of this series– Thyroid– DHEA– estradiol/progesterone– IGF-1 (“food soldier” of growth hormone)– Integration of testosterone

• Exposure to current “state of the art”

American Journal of Health Promotion; November/December, 2002

19% of those surveyed

were completely healthy with high levels of both physical

and mental health and a low level of

illness.

18.8% completely unhealthy, defined as having low

levels of health with high levels of illness.

Two-thirds of the adults reported some

degree of mental or physical illness that kept them from being completely healthy.

“Incompletely healthy.”

HEALTH continuum

DE

AD

OP

TIM

AL

66%“Incompletely healthy”

Critical area of concern for men & women. Things that will make them:

• Tired &/or depressed

• Unable to cope

• “Mean”

• Stressed

• Demented

• Deficient in libido or in the bedroom

How would you take care of a classic?

There are fuel additives we can use to keep our cars burning cleaner and preserve engines.

No fuel additives should be used. They are unnatural. Gas is all that is required.

We should use optimal quality of gas. Cheap gas causes “pinging” which is hard on the engine.

The quality of the gas is irrelevant. Anything that the motor will burn is adequate.

We should take our car in for preventive maintenance before anything breaks.

Preventive maintenance? This is silly! Wait until something breaks, then have the car towed in so the mechanic can really tell what is wrong.

“Age management” “Conventional practice”

And if you’re just a tired ol weenie (or weenette), you will definitely note be feeling SEXY.

Death

Optimal Health

TraditionalMedicine

Functional & Informed Lab Testing

No

Dis

ease

= H

ealth

Vitamins, HRT, Nutrition, Exercise

INTEGRATED Medicine

Diagnose andTreat Disease

New DrugsNew Drugs New Surgical New Surgical TechniquesTechniques

Forestall and PREVENT Disease –

Optimize Mood & Function

Toward an INTEGRATED approach:

Interesting lab values – Cady – 3/11/03:

Lab Value Cenegenics Normal

a.m.glucose 87 mg/dl 65 – 85 65 – 109

Fasting insulin 3 u U/ml <5 <20

HgB A1C 4.9 % <5.1% < 6.0 %

Cholesterol 241 mg/dl <200 <200

Triglycerides 42 mg/dl <120 <150

Cor. Risk ratio 3.3 <4.0 Av = 5 – 6

Homocysteine 7.9 <8.0 5.4-11.4

DHEA-S 148 350 – 500 59 – 452

Modern Medicine’s Paradigm: Two Standard Deviations – “if you are not

sick, then you must be well.”

“NORMAL”

OPTIMAL

Miami - 2002 - 17

What are We Trying to Accomplish?

The Laboratory midrange of the 30 y/o is the same

as the upper quartile of the 70 y/o.

4

• 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.”

Selenium, the Thyroid, and You

• “T3” is the ACTIVE form of thyroid

• Conversion of T4 to T3 is selenium dependent

• LP Nano has 200% of RDA of selenium

Se+

“Thyrotropin (Thyroid-Stimulating Hormone or TSH). Measuring TSH is the most sensitive indicator of hypothyroidism.” (hunh?!)

http://www.umm.edu/patiented/articles/how_serious_hypothyroidism_000038_6.htmAccessed: 9/5/2011

“the foot soldier” “the evil twin”

CORTISOLSe

Rev T3

Case report:

• 55 year old male entrepreneur

• Runs company with 200 employees – multi hundred million dollar budget

• Stressed with economy

• Very tired in the a.m.

• “Crashes” at night.

• Still golfing, exercising.

• Looks marvelous.

334 citations on “DHEA with energy” – as of 07 29 2011

Why isn’t adrenal fatigue diagnosed?

• Not a medical emergency.• Patient is blamed”

– “just neurotic”

– “avoidant”

• “Functional medicine” testing not typically done (& rarely is DHEA-S checked)

• Modern medicine focuses on NORMAL, rather than OPTIMAL. function.

• “Bell Curve” paradigm

“Women’s issues”

SEXY!!

One destigmatizing notion:Estrogen as MAOI

• Estrogen & Testosterone (!) decrease MAO– Luin, VN. 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

Psychoactive Progesterone* Increases energy and libido Has a calming effect, acting like a

benzodiazepine to the brain (HS dosing) Enhances mood Balances blood sugar (appetite) Regulates fluid balance, sodium mineral balance Necessary for fertility Helps relieve menopausal symptoms Decreases risk of endometrial cancer and may help protect

against breast cancer, fibrocystic breasts, and osteoporosis

* Adapted from Whitney Gabhart, N.D.

Testosterone: The “sexist” bias against women

• 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.

Brief Description of Hormone Function (Men AND Women)

Testosterone–Enhances sex drive–Builds muscle & decreases

fat–Elevates mood–Prevents osteoporosis – Improves memory –Lowers cholesterol –Protects against heart

disease

We use Bio-identical “HRT” at CWI:

• 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- 34

50’ish year old female, post-menopausal, on no hormones

• On aggressive supplement regimen with daily MVI and others

• Not ill

• Top rated medical care with previous labs done

• Nothing identified as seriously abnormal

• “Just interested in having my hormones checked.”

Treatment for this “normal” patient

1. Armour thyroid – ¼ grain for 1 week, then ½ grain. (Aiming for T3 in “high 3’s.”

2. DHEA – 25 mg SR micronized, compounded – in a.m.

3. Progesterone – 50 mg SR compounded – at night.

4. Testosterone – 3mg topical per day x 1 wk, then 6 mg. “Decrease dosing as needed for side effects.”

5. Vitamin D – 5,000 IU twice daily x 3 weeks, then decrease to one dose per day.

6. Fish oil – 4.6 grams (c. 1660 mg EPA and 1,250 mg DHA by compound weight, plus misc. Omega 3)

What’s life like now?• “it’s like the colors of the rainbow have gotten more into the

pink.”

• “My computer will survive – I use to ‘lose it’ over my computer. I would swear obscenities.”

• “I’ve gotten into a zen like mode. Handling everything that life can throw at me.”

• “It’s almost as if I’ve taken a pill or drug that jus makes me handle everything that life is throwing at me. I can roll with it.”

• “I’m not irritable any more. Time pressure has just one away.”

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 2 WEEKS!!!.

Photo & data used with permission

November 2009 “Alpha Male” issue

Observational study of randomly selected men – Boston3 cohorts of men: 1987-1989; 1995-1997; 2002 -2004.1374, 906, and 489 men, respectively. “Age independent decline in T that does not appear to be attributable to observed changes in explanatory factors, including lifestyle characteristics such as smoking and obesity.”“Recent years have seen a SUBSTANTIAL, and as yet UNRECOGNIZED age-independent population-level decrease in T in American men.” Travison, Araujo, et al. Jrnl of Clin. Endocrinol & Metabol 92:1; 196-202.

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

Special needs - Zinc

• Low Zinc- associated with low testosterone– Per USDA, 60% of US men between 20 – 49

years of age do not get enough.– N.B.: Do not supplement with > 50 mg daily (can

interfere with Cu+ metabolism)• Tsai, E.C., Boyko, E.J., Leonetti, D.L., & Fujimoto,

W.Y. (2000). Low serum testosterone level as a predictor of increased visceral fat in Japanese-American men. International Journal of Obesity and Related Metabolic Disorders, 24, 485-491

Testosterone functions (Men AND Women) • Enhances sex drive

• Builds muscle & decreases fat

• Elevates mood• Prevents osteoporosis

• Improves memory • Lowers cholesterol

• Protects against heart disease

Physiology of testosterone

• T regulates – Nitric oxide (NO)– Phosphodiesterase type 5 (PDE-5)– Both critical for initiation & maintenance of

erectile function

• T maintains– Penile structural integrity– Functional integrity

Wang C, J Clin Endocrinol Metab. 89(2004):2085-98

“Hence, among older men reporting excellent asymptomatic health, age has no effect on serum T or E2 with a minor increase in DHT while obesity decreases serum androgens…”

“…both estrogencs and androgens can play a protective role against AD related neurodegeneration.”“Hypogonadal in later life” = “problems with memory”

• 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

Testosterone (Men)

Andropause: Characteristics of Change

• Insidious & unpredictable onset

• Slow progression

• Subtle & variable manifestations

• Cannot be linked directly to a decrease in the hormone testosterone

• Very different from menopause in women!

• (Hubby reference: www.isitlowt.com)

Charlton R. JMHG. 1(2004): 55-9 Kaufman JM. Endocrine Reviews. 26(2005):833-76

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. Neurology. 64(2005):866-71

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

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 of Androgel per day 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.

Treatment options – not just “the needle”

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

Treatment options – the needle

Testosterone cypionate – 200mg/cc – dosing determined by size – administered IM – one to two X per week– (bigger needle; on-label per FDA, works in everyone, shrinks testicles).

HCG – human chorionic gonadotropin -1250 – 2500 x/wk (tiny needle; “off-label”, doesn’t work in much older men)

Evansville Courier & Press: May 29, 2006

What is Raman Spectroscopy?Monochromatic photons interact with molecules that have vibrational energy (e.g., carotenoids), and gets scattered at a higher wavelength. Sir C. V. Raman, Nobel Prize in Physics, 1930

Carotenoid molecules shift blue laser light color to green:

473 nm to 510 nm

Where to read more…

“Pending strong evidence …from randomized trials, it appears prudent for all adults to take vitamin supplements.” Fletcher & Fairfield, JAMA 2002

“The Complete Idiot’s Guide to the “Cady White Paper”

• Pp 1-3 Patent claim synthesis: assessing the overall antioxidant status in human tissue via Raman spectroscopy via measuring carotenoids– Carotenoids are antioxidants

• Identified in 1992

• Potent antioxidants

• Lycopenes and carotenoids appear to diminish risk of prostate CA.

• P 4 Further discussion of prostate CA

Lipid peroxidation, antioxidant status & survival in institutionalized elderly

• Plasma MDA predicted mortality independently of all other variables.

• B-carotene and alpha tocopherol were independently association with survival. Huerta JM et al. Free Radical Research

2006, vol 40, no 6. pp 571-578.

• Study population:– N=1,389; age range {59-71 yoa}– 9 year study

• Relative risks:– all cause mortality at 2.94X in men in lowest

quintile (95% CI, P=0.03)– cancer 1.72X in men (95% CI, P=0.01

• “Total plasma carotenoids levels were independently associated with mortality risk in men.”

Epidemiology of Vascular Aging (EVA)

Antioxidants and brain tumors?

• “free radicals are another etiological factor of brain tumor and are removed by cellular antioxidants in the human body.”

• Inverse correlation between:– antioxidant levels and oxidative DNA damage– Grades of malignancy

• Decrease in antioxidants are associated with severity of malignancy

A quick look back in history

The Interpretation of Dreams – 1885 - 1890

Ugo Cerletti 1935Prozac - 1987

The Therapeutic Trifecta of Psychiatry:ShrinkingShocking

or Drugging

[Supposedly] the only three things you could do to a patient’s

brain…]

Faraday’s Law of Induction

TMS Magnetic

field

Induced neuronal current

From electricity to magnetism

• Bartholow, R (1874)– Stimulation of human brain

(exposed cortex) of patient with cranial defect.

• d’Arsonval – “Phosphenes and vertigo” induced inside powerful magnetic coil

• Silvanus P. Thomson, Ph.D. – new type of magnetic stimulation (1910)

Thompson, SP. “A Physiological Effect of an Alternating Magnetic Field.” Proceedings of the Royal Society of London B82:396-399, 1910

Neuron

NeuroStar Directly Depolarizes Cortical Neurons

Pulsed magnetic fields from NeuroStar: •induce a local electric current in the cortex which depolarizes neurons •eliciting action potentials•causing the release of chemical neurotransmitters

Neurons are “electrochemical

cells” and respond to either electrical or

chemical stimulation

Does it work?• Original registration trial

– 307 major depressed patients• 67% women

• 93% recurrent depressives

• 43% had been hospitalized already

– 42 sites– Treatment per label

• Results: ½ patients responded; 1/3 of patients remitted.

• 80% patients completed the treatment.

Who Was Studied?• Primary diagnosis: DSM-IV Major Depressive Disorder

– Unipolar type, non-psychotic– Moderate to severe symptoms at baseline– Approximately one-third of patients had a co-morbid anxiety

disorder (OCD excluded)

• Antidepressant Treatment History:– Average number of antidepressant medication trials in current

episode = 4 (range: 1 to 23 attempts)• Majority of treatment attempts were unable to achieve adequate

dose and duration of treatment due to intolerance

– In the indicated patient population, all patients failed to achieve satisfactory benefit from one antidepressant medication at an adequate dose and duration in current episode

Demitrack and Thase (2009) Psychopharm Bulletin

82

H - 85

www.drlife.com

“But my patients don’t know about this and aren’t asking for it….”

“It’s not the consumers’ job to know what they want.” - Steve Jobs

Perhaps the ability not only to acquire the confidence of the patient, but to deserve it, to see what the patient desires and needs, comes through the sixth sense we call intuition, which in turn comes from wide experience and deep sympathy for and devotion to the patient, giving to the possessor remarkable ability to achieve results.

...William J. Mayo, 1935