This is the first of three lectures that Dr. Cady will present in Sao Paulo, Brazil, for Laboratorio Great Plains. In it, he reviews key concepts of integrative medicine, functional testing, and a rational style of thinking through a patient's problems down to the fundamental level. IgG food allergies, depression, low testosterone, and nutrient deficiencies are all covered

1. Introduction to Integrative
Medicine for Mental Health
Louis B. Cady, MD
Founder, CEO Cady Wellness Institute

2. “There are two objects of medical education: to
heal the 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.”
- Dr. William J. Mayo

3. “There are more things in Heaven
and Earth than are dreamt of in
your earthly philosophy, Horatio.”
“Hamlet” – by William Shakespeare

4. A case of depression? Symptoms at
presentation:
• 43 year old aerobically fit male – competitive cyclist/
pharmaceutical rep. Drinks protein shakes (whey).
• Mind and emotions:
– Depression
– Difficulty with memory, attention,
– Short attention span
– Weakness, fatigue, loss of energy
• Miscellaneous:
– Fatigue
– Apathy/lethargy
– Sleep apnea (previously reviewed)
– Difficulty getting out of bed in the a.m.
– Recurrent apthous ulcers

5. TREATMENT

6. Classic “atypical presentation”
• History continued:
– Exhausted/fatigued with multiple vague symptoms for 3
years. Taking naps in car in afternoon while working.
– Intermittently nauseated for last two years. MD ignored
him.
• Known attention deficit disorder. Started on
lis-dexamfetamine by family physician
• Past history: at 41 yoa – diagnosed with Rocky
Mountain Spotted Fever. Treated with Doxycycline
– Ulcer dx by GI doc, with + h. pylori.
• Rx: macrodantin + metronidazole.
– “Pins & needles sensation under skin began – May
2009 (Antihistamine tried – didn’t work. )

7. Diagnostic Interventions and Trial Tx
• Sleep study – non revealing
• IgE food allergy possibility per dermatologist. Anti-
histamine used. Sxs would stop then come back.
• Soreness – consulted pain management doctor.
No help.
• Transdermal testosterone tried (low normal T) –
no help.
• Cholecystectomy – Sept 2009
• Severe constipation Dec 2009 – went days
without bowel movement
• Colonoscopy – benign. Possible “small bowel
bacterial overgrowth.” ABX used.
• Dx’ed with possible Lyme’s – more ABX.

8. Other past dx/tx procedures:
- CT brain – normal
- CT abdomen – normal
- HIDA (gallbladder) scan – abnormal
- (Gallbladder subsequently removed)
- MRI – lower lumbar – essentially normal but
with slightly bulging disc
- MRI – thoracic and cervical – good
- Colonoscopy & sigmoidoscopy – benign.
- Muscle biopsy – “nerve damage”
- Stress EKG and Stress Echocardiogram –
normal.

9. More symptoms at presentation
• dry/brittle skin; puffy wrinkled skin
• dark circles under eyes
• persistent rash with pins and needles sensations on skin
• “heaviness” in legs; shortness of breath
• exhaustion with minor exertion
• certain foods cause ill feelings
• difficulty losing weight
• Needs to drink coffee to get going in a.m.
• Tired 1 – 3 hours after eating
• Feels faint or weak.
• Rates self as overweight

10. Lab review – May 2011
– Testosterone 460 {300 – 890}
– % Free Testosterone 1.4%(L) {1.6 – 2.9%}
– CBC shows ANEMIA
• RBC 3.87 (L) {4.5 – 6.0}
HGB 12.8 (L) {14 – 17}
• HEMATOCRIT 37% (L) {42 – 51%}
– TFT’s
• TSH 1.13
• FTI 4.50 (L)
• T4 thyroxine 4.9 (L) {6.1 – 12.2}
• T3% uptake 36.4% {32 – 48.4$}
– A.m. cortisol 10.4 {5 – 23}
– Iron 103 {76 – 198}
– 25-OH Vitamin D low (outside lab)

11. Working hypotheses, treatment
• Anemia – etiology unclear
• Hypoadrenia
• Rule out post-viral fatigue syndrome
• Subclinical hypothyroidism
• Possible symptoms of low testosterone
• Possible IgG food sensitivities (dairy?)
• Probable candida (by history)
• Low Vitamin D
• History of depression and ADHD – on treatment
• History of Lyme Disease – allegedly treated

12. Initial treatment planning
• Consider transition to compounded porcine
thyroid
• Consider testosterone
• Dairy free diet. (based on history)
• Start Xymogen IgG 2000 DF
• NutraProbiotics – one daily
• Get more labs, including IgG

13. Interventions and follow-up
• 6/14/2011 – Start NO DAIRY DIET.
Baseline medications (incl. Lexapro, T4),
continued. Probiotics. Minimize exposure to
brewer’s yeast.
• 6/30/11 – better energy. “allergic shiners”
gone. (Labs reviewed)
– Rx: started DHEA – 50 mg SR; 5HTP – up to
100 mg daily for documented low serotonin.
Slight increase in thyroid Rx. Start Nystatin.

14. Most relevant labs (ordered before
appointment):

16. Other interventions and current status
• Testosterone cypionate – 100mg cc IM q wk.
• Armour thyroid – (needed it for a while), then didn’t
• Supplements – in addition to high potency multivitamin
twice daily (including Zinc)…
– Adrenal supplementation – 2 twice daily
– DHEA 50 mg SR daily
– B-12 – liquid
– Vitamin C – 2500 mg per day in 4 – 5 divided doses
– Vitamin D – 5,000 IU daily
– IGF2000 DF (Xymogen) – one scoop periodically.
– Calcium and 5HTP
– Coenzyme Q10 400 mg per day
• Continue 70 mg lis-dexamfetamine and 20 mg
escitalopram

17. Zinc & Testosterone
• Low Zinc- associated with low testosterone
– 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.
• Per U.S. Department of Agriculture, 60% of
US men between 20 – 49 years of age do
not get enough.
• Fast food = low zinc = testicular tissue
inflammation = decreased testosterone
– El-Sewedy MM et al. J Pharm Pharmacol. 2008 Sept;60 (9):1237-
42.

18. Inadequate micronutrient intake in men and
women in southern Brazil
1,222 adults 22 – 63 years old in Florianópolis1,222 adults 22 – 63 years old in Florianópolis
Inadequate micronutrient intake estimatedInadequate micronutrient intake estimated
Inadequate intake of Vitamins A, C, D, and E (52-100%)Inadequate intake of Vitamins A, C, D, and E (52-100%)
Calcium (87.3%) and iron intake(13.7%) inadequate in womenCalcium (87.3%) and iron intake(13.7%) inadequate in women
25.1% Zinc deficiency in men25.1% Zinc deficiency in men

19. T vs Cognitive Function
Rosario ER. JAMA. 292(2004):1431-2

20. 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 testosterone in lowest quintile – did worse
than men in highest quintile
• Highest Bio-available Testosterone more
significant than TOTAL Testosterone, age,
intelligence level, mood, smoking, and alcohol.
Muller M. Neurology. 64(2005):866-71

21. 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

22. Low Vitamin D linked to depression
[Muhlestein JB et al. Am Heart J, 2010; 159(6):1037-43.
(citation from Dr. Shaw)
• 7,358 patients >/= 50 yoa with CV diagnosis
and NO HX of depression
• “Vitamin D levels were significantly
associated with an increased risk of
depression, compared with optimal vitamin
D levels.”
• Optimal level: > 50 ng/ml
– Normal 31 – 50 ng/ml
– Low: 16 – 30 ng/ml; “very low = < 15 ng/ml

23. 8/1/2011 follow-up: strict dairy free diet
• “Some days I don’t feel as hot in terms of
energy level. But it has improved. I’m
thinking more clearly.”
• Lost 8 lbs (by desire)
• Rode bike in extreme heat on Sunday for 1
hour.
• “I’m able to get out and do things that I feel
like doing –working around the house,
hanging around my family, and going
fishing.”

24. 9/13/2011
• Went out and rode three hours on his bike
for first time in years.
– “But I came home and crashed.”
• Working full time as pharmaceutical
representative. No longer napping.
• Lyme disease diagnosed based on new
labs. Treatment started.

25. 9/13/2012 – one year later
• Vigorous. Working around the house.
• No limit to activities (or distance for his
rides)
• Career going well
• Biking going well
• Enjoying life.

28. The treatment – quick review
(some had been tapered one year later)
• Testosterone cypionate – 100mg cc IM q wk.
• Porcine thyroid – (needed it for a while), then didn’t
• Supplements – in addition to high potency multivitamin
twice daily (including Zinc)…
– Adrenal supplementation – 2 twice daily
– DHEA 50 mg SR daily
– B-12 – liquid
– Vitamin C – 2500 mg per day in 4 – 5 divided doses
– Vitamin D – 5,000 IU daily
– IGF2000 DF (Xymogen) – one scoop periodically.
– Calcium and 5HTP
– Coenzyme Q10 400 mg per day
• Continue 70 mg lis-dexamfetamine and 20 mg
escitalopram

29. BODY
M
IN
D
A
C
TIO
N
S

30. The Story of Alan
• 2/24/2010 – “ADHD hampers his ability to focus and
comprehend information. He becomes overwhelmed.
Lacks confidence in reading. Teacher believes he is
capable.”
• Past history: “a busy child. “Couldn’t keep him in a chair.”
• ADHD dx in kindergarten. Multiple Rx since, incl. Abilify
• At presentation:
– 20 mg amphetamine salts XR in a.m., 3 mg guanfacine ER in a.m.,
5 mg aripiprazole at 4 pm.
– “Heart is racing” for two months.
– Hx of stimulant rebound and having to push the dose
– Stools like tar since starting on Abilify.
• Rating scales:
– DSM-IV 9/8 before meds; DSM-IV 9/4 ON meds

31. Treatment summary and new developments
• Medications adjusted. Stimulant lowered
and L-tyrosine started with it (increased to 1
gram twice daily ).
– Changed to Concerta + Ritalin (a.m.), Intuniv,
Risperdal, and Depakote (250 mg 3x/day)
• 11/9/10 and 12/6/10 – “meltdowns” at
school. States “I am going to KILL you,”
when he is upset. Kicking the table at
school and not looking at the teacher.
• OAT test and IgG Food Allergy panel
ordered.

32. December 7, 2 010

33. Organic acid testing – 12/23/2010
Pertains to energy production, Kreb cycle, B vitamins, CoQ10, Mg

34. Interventions
• 1/5/2011:
– School insisting he is “autistic” (meltdowns)
– At appointment told to remove wheat,
peanuts, and milk from diet
– Started on CoQ10, high potency balanced B-
complex, alpha lipoic acid, Vit C & Vit E
• 2/8/2011 – Alan - “for the first time I think
the medicine is getting right.” (no changes
made to Rx). Barlean’s Lemon Zest oil
added.

36. Winding up of case
• 4/1/2010 – five weeks of “awesome behavior” at school
with “no blow-ups whatsoever.”
– “The school authorities are amazed.”
– Won STUDENT OF THE WEEK (!!)
• 5/31/2011 – concluded school year; no blow-ups.
• 8/30/11 – some blowups, but not the “explosive kind like he
had last year.”
• 12/21/11- scored “distinguished” in math and “proficient” in
reading. (continues supplements and diet)
• 2/17/2012 – “Tired.” RX: lower Concerta from 54 to 36
mg
• Having more meltdowns at school. New labs ordered.

37. IgG results – 3/29/2012

38. - Started on Nystatin,
compounded, liquid – up
to 50,000 IU three times
daily. Also Probiotic.
- ELIMINATE MILK &
WHEAT

39. Progress!
Repeat IgG testing 06/28/2012
Original IgG 3/9/2012

40. Organic acid test – 6 26 2012
• Arabinose c/w candida
• All B-vitamin markers improved
• Coenzyme Q10 high normal
• HVA, VMA, 5HIAA – all increased.
• Vit C low but c/w water solubility and a.m. spec.

41. Alan – conclusion 7/31/2012
• Concluded school year well.
• “Was more interactive and playing on the
playground.”
• Went up on state testing 17 points in
reading. At grade level in math.
• Playing outside more, riding his bicycle.
• Vitamin C increased to 500 mg twice daily
• Start on Curcumin/turmeric for inflammation
• STABLE. See back 9/30/2012.

42. Do we really need all those
supplements and vitamins???
Iodine, selenium, and iron

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

45. Ames & Micronutrient Triage - deconstructed
1. Inadequate dietary intakes of vitamins/minerals
are widespread. [United States & Brazil are not
exceptions!]
– Excessive consumption of energy-rich, micronutrient-
poor, refined food
1. Deficiencies in many micronutrients cause DNA
damage in cultured or living human cells.
2. Proposal: DNA damage and late onset disease
are consequences of a triage allocation based on
micronutrient scarcity.
– Natural selection favors short-term survival at expense
of long-term health.
Ames B. Proc Natl Acad Sci U S A. 2006 Nov 21;103(47):17589-94. Epub 2006 Nov 13.

46. Ames & Micronutrient Triage - deconstructed
4. If proposal is correct, “micronutrient deficiencies
that trigger the triage response would accelerate
cancer, aging, and neural decay but would leave
critical metabolic functions, such as ATP
production, intact.”
5. “A multivitamin-mineral supplement is one low-
cost way to ensure intake of the Recommended
Dietary Allowance of micronutrients throughout
life.”
Ames B. Proc Natl Acad Sci U S A. 2006 Nov 21;103(47):17589-94. Epub 2006 Nov 13.

47. North America 85%
South America 76%
Asia 76%
Africa 74%
Europe 72%
Australia 55%
% Mineral depletion from the soil during the
past 100 years, by continent
Source: UN Earth Summit Report 1992

48. • “Iron deficiency impairs thyroid hormone
synthesis by reducing activity of heme-
dependent thyroid peroxidase.”
– Zimmermann MB, Kohle J.
Thyroid. 2002 Oct;12 (10):867-78
– Subclinical
hypothyroidism assoc.
with Fe deficiency.
– Nekrasova TSA, 2013 Kloin Med
(Mosk).2013; 91 (9):29-33.
– Fe deficiency associated with
Thyroid microsomal antibody levels.
– Wang YP et al. J Formos Med Assoc.
2014 Mar;113(3):155-60.
– Fe salts + T4 worked best.
– Ravanbod M et al. Am J Med. 2013
May;126(5):420-4.
Consider IRON deficiency
136 citations search on “iron deficiency hypothyroidism” as of 8/27/2017

49. Must have selenium to make
Liothyronine (T3)
Se+

THYROID
HORMONE
Must have Iodine & Iron to make
thyroid hormone

50. Must have iodine to make T4!
Source: Office of Dietary Supplements, NIH accessed 8/11/2013
http://ods.od.nih.gov/factsheets/Iodine-QuickFacts/
Louis B. Cady, MD

51. CONCLUSIONS: Only few studies have been performed
and enrolled populations from south/southeast region of
Brazil. The actual Identification and background
information: [Iodine Deficiency Disorder] prevalence
analysis is complex because it was detected bias due
influence of individual studies and very high
heterogeneity. IDD might still be high in some areas but
this remained unknown even after this meta-analysis
evaluation. The generation of a national program for
analysis of iodine status in all regions is urgently
required.
CONCLUSIONS: Only few studies have been performed
and enrolled populations from south/southeast region of
Brazil. The actual Identification and background
information: [Iodine Deficiency Disorder] prevalence
analysis is complex because it was detected bias due
influence of individual studies and very high
heterogeneity. IDD might still be high in some areas but
this remained unknown even after this meta-analysis
evaluation. The generation of a national program for
analysis of iodine status in all regions is urgently
required.

53. Sources/locations of iodine
deficiency:
• Chlorinated or fluorinated drinking water
• Not using iodized salt
• Consumption of NaCL in processed foods
• Consumption of soy & “goitrogens” -
cabbage, broccoli, cauliflower and Brussels
sprouts
• Being pregnant
• People living with iodine deficient soils &
eating local foods
Louis B. Cady, MD

54. 24 citations as of September 4, 2017
• “Low selenium status is associated with increased risk
of thyroid disease. Increased selenium intake may
reduce the risk in areas of low selenium intake.”
– Wu Q et al. Low population selenium status is associated with increased
prevalence of thyroid disease. J Clin Endocrinol Metab. 2015 Nov;100
(11):4037-47.
• “We demonstrated …the beneficial effects obtained
by selenomethionine treatment on patients affected
by subclinical hypothyroidism.”
– Nordio M. Combined treatment with myo-inositol and selenium ensures
euthryoidism in subclinical hypothyroidism patients with autoimmune thyroiditis.
J Thyroid Res. 2013;2013:424163

55. From Chet Holmes - Grow Your Business 10X web presentation

56. 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