This document summarizes key points about balancing thyroid, adrenal, and sex hormones for optimal health and mental wellness. It discusses how these hormone systems can become imbalanced, leading to fatigue, depression, and other symptoms. The document contrasts an "optimal" level of hormone functioning with merely being in the "normal" range. It also critiques conventional medical approaches and advocates an integrated approach considering all aspects of these hormone systems.

1. Thyroid, Adrenals & Sex Hormones: A Balancing Act Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute Adjunct Professor – University of Southern Indiana Adjunct Professor – Indiana University School of Medicine Integrative Medicine for Mental Health Conference Sedona, Arizona September 17-18, 2011

2. Framework for this presentation: “ Slumber not in the tents of your fathers. The world is advancing. Advance with it.” - Giuseppe Mazzine

4. 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 DEAD OPTIMAL 66% “ Incompletely healthy”

6. BODY MIND ACTIONS

8. How would you take care of a classic?

9. “ Age management” “Conventional practice” 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.

13. Stahl, SM. Symptoms & Criuits, Part 1 Major Depressive Disorder. “Brainstorms.” J Clin Psych 64:11, Nov 2003:1282-1283. “ Each symptom may be mediated by separate and distinct neuronal [AND PHYSIOLOGICAL – (Cady)] circuits.”

14. Toward an INTEGRATED approach: Death Optimal Health Traditional Medicine Functional & Informed Lab Testing No Disease = Health Vitamins , HRT, Nutrition, Exercise INTEGRATED Medicine Diagnose and Treat Disease New Drugs New Surgical Techniques Forestall and PREVENT Disease – Optimize Mood & Function

17. 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

18. Modern Medicine ’s Paradigm: Two Standard Deviations – “if you are not sick, then you must be well.” “ NORMAL” OPTIMAL

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20. Releasing Factors Adrenal Gland Ovaries Testicles Thyroid Liver Testosterone Estrogen Cortisol DHEA Progesterone T3 & T4 GH LH & FSH TSH Prolactin ACTH IGF-1 Pituitary Brain Hypothalamus DHEA

22. “ the foot soldier” “ the evil twin ”

23. “ 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.htm Accessed: 9/5/2011

24. “ the foot soldier” “ the evil twin ” CORTISOL Se

26. Transthyretin (a systemic amyloid precursor) may be protective for Alzheimer’s (Why?) Li X et al. J Neurosci 2011 Aug 31;31(55):12483-90

27. Per HRSD – 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 LEVEL III RESULTS:

31. Fatigue from Adrenal Dysfunction - The Worst Case Scensario: Addison ’s Disease

34. The state of adrenal exhaustion can be determined Early-stage Chronic Stress Response Mid-stage Chronic Stress Response End-stage (exhausted) Chronic Stress Response

36. 334 citations on “DHEA with energy” – as of 07 29 2011

38. Modern Medicine ’s Paradigm: 2 Standard Deviations – a model “ NORMAL” OPTIMAL

39. 432 citations on DHEA with depression as of 9/5/2011 “ Neuroeconomic paramaters predicted to be related to suicidal behavior. ” DHEA is related to these, acting in amygdala. Low levels of DHEA/DHEA-S assoc. with depression, as per Western studies. “DHEA was significantly assoc. w/ [Chinese] Geriatric Depression Scale (GDS).”

41. Source: Maninger, N et al : Front Neuroendocrinol. 2009 Jan;30(1):65-91. Epub 2008 Dec 3.

42. “ Women’s issues”

54. Hx of Baseline Health Characteristics (total # of participants 16,608) 37% 11% 2%

70. “ 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…”

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

74. T vs Cognitive Function Rosario ER. JAMA . 292(2004):1431-2 “ Testosterone depletion likely precedes and thus may contribute t o rather than result from the development of AD, since low brain testosterone is observed in men with early indications of AD neuropathology”

77. Treatment options – not just “the needle”

79. HOW OBVIOUS DOES IT HAVE TO BE? The Challenge of Empathic Listening & CREATIVE THINKING Ron Hunt lost an eye but suffered no brain damage after a freak accident with a large drill bit. (ABCNEWS.com)

80. Do you really want to try 100,000 miles without changing the oil?

81. Definition of ‘normal’ – “where your hormone levels are as lousy as everyone else’s.” Neal Rouzier, MD “ NORMAL” OPTIMAL

82. American Journal of Health Promotion; November/December, 2002 HEALTH continuum DEAD OPTIMAL 66% “ Incompletely healthy ” * *“treatment resistant”?

83. “ For me, the practice of medicine has opened the door to the greatest adventure in life. Medicine is like a hallway lined with doors, each door opening into a different room, and each room opening into another hallway, again lined with doors. Medicine is always wonderful and never will be finished. ” - Charles H. Mayo, M.D.

84. Extra slides for further background follow in notes  Contact info: Louis B. Cady, M.D. www.cadywellness.com Office: 812-429-0772

85. Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. - World Health Organization

87. The R-Factor Question* If we were meeting here three years from today – and you were to look back over those three years all the way back to today – what has to have happened during that period …for you to feel happy about your progress and what you have accomplished and the changes made? *Adapted from The Dan Sullivan Question © Dan Sullivan May 2010

89. Indole-3-Carbinol – good with or without HRT (for women AND men) Estradiol 16 alpha-OH Estrone (Ca) 4-OH Estrone (B) 2-OH Estrone (B) I3C “ I-3 C raises the 2:16-OH Estrogen ratio” N.B.: available from LabCorp