This is the lecture presented by Dr. Cady at SWIRCA - (Southwestern Indiana Regional Council on Aging) on May 7, 2013.

1. Louis B. Cady, MD – CEO & Founder – Cady Wellness InstituteLouis B. Cady, MD – CEO & Founder – Cady Wellness Institute
Adjunct Clinical Lecturer – Indiana University School of Medicine
Department of Psychiatry
Child, Adolescent, Adult & Forensic Psychiatry – Evansville, Indiana
In teleconference: April 11, 2013
Brighten Your Brain & Optimize Your Mind &
Body for Peak Performance
This presentation and webinar is © Louis B. Cady M.D. and
may not be reproduced or used without permission.

2. “Love and work are the
cornerstones of our
humanness.”
- Sigmund Freud

3. www.slideshare.net/lcadymd

4. What are we going to talk about:
Staying healthy and optimized
(CWI = “integrating mind & body for peak
performance”)
• Staying alive –
• Optimizing ability to think and perform while
staying alive.
– AND THAT MEANS:
• Having adequate energy
• Staying energetic and physically /sexually vigorous
• (Can’t do love and work if you’re tired or
dead.)

5. Why listen to the psychiatrist?
• Because my patients care about the same
things as you do.
• Because neuropsychiatric wellness,
vascular, and nutritional health correlate with
most domains of “medical” wellness.
• Guarding against
– Loss of life
– Loss of mental faculties
• Somae & psyche = the fundamental balance.

6. BODY
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7. Aging in America: The New Paradigm
“Don’t put an Age Limit on your Dreams” – Dara Torres
•The Oldest Swim Medalist in Olympic History
•41 Year Old Dara Torres

9. Aging in America - 80 – The 3rd
Half of Life!
www.bobdelmonteque.com

10. Bob Delmonteque – lived to 85
• At 85 years of age.
– Running marathons
– Cycling 120 miles
– Bench pressing over 250
pounds.
• Personal trainer to first 2
sets of Apollo astroanauts
• Personal trainer to John
Wayne, Errol Flynn, Clark
Gable, & Marilyn Monroe

11. What can you do at 100?
• Rita Levi Montalcini, MD
• Nobel Prize – Medicine 1986
• Birthday – April 18, 1909
• “At 100, I have a mind that is
superior – thanks to
experience – than when I
was 20.”
• “Above all, don’t fear difficult moments. The
best comes from them.”

15. Common neuropsychiatric
(& MEDICAL) problems
• Cognitive decline and senility (sneaks up on you)
• Lack of mental (& physical) vitality
• Sleep problems - from 1/3rd
to 1/8th
of the
population
• Stress
• Attentional Difficulties
• If it’s bad, it’s linked to oxidative stress
– PSYCH: Depression, anxiety, autism, ADHD, bipolar disorder and
schizophrenia)
– MEDICAL: Alzheimer’s, Parkinson’s, pain & arthritis

16. 1/3rd
of all US elderly die WITH dementia

17. The Cognitive Continuun
Decline vs. Dementia
• One study 403 randomly subjected subjects 67 – 78 yoa
–38.4% - age-associated memory
impairment.
– 24.4% women, 30.1% men fulfilled ageing associated cognitive decline.
• Hanninen T et al. Prevlaence of ageing-associated cognitive decline in an
elderly population. Age Ageing. 1996 May;25(3):201-5
• British study – 15,051. Prevalence of cognitive
impairments was 18.3% (95% CI). (MMSE 23/24)
– Rait G et al. Prevalence of cognitive impairment: results from the MRC trial
of assessment and management of older people in the community. Age
and Ageing 2005;34:242-248.

18. More studies
• 1/3rd
of individuals in 131 eligible subjects in
Australia, age 70 – 79, community-dwelling met
criteria for “Cognitive Impairment No Dementia”
(CIND).
– Low, L-F, Brodaty H, et al. The prevalence of ‘cognitive impairment no
dementia’ in community-dwelling elderly: a pilot study. Australian and New
Zealand Jrnl Psychiatry 204;38:725-731.
• “Oxidative damage occurs in the brain of subjects
with mild cognitive impairment, suggesting that
oxidative damage may be of the earliest events in
the onset and progression of Alzheimer disease.”
– Keller JN et al. Neurology. 2005 Apr 12;64(7):1152-6

19. 1997 study - changes in memory between 35-80yoa
Burke DM, Mackay DG. Memory, language, and ageing. Philos Trans R
Soc Lond B Biol Sci. 1997 Dec 29;352(1363):1845-56.

20. But…
It’s actually worse than
that!!!!

21. Salthouse TA. When does age-related cognitive decline begin? Neurobiol Aging
2009 April 30 (4):507-14.

22. The majority – senile senescence
mild cognitive
• If you don’t die of heart disease or cancer, you
will suffer from senile senescence (to varying
degrees).
• But you can intervene in the process – you can
change the natural history.
• LIEESTYLE INTERVENTION (diet + exercise =
stress management) + SELECTIVE
SUPPLEMENTATION is a proactive, preventive
program that you can follow.

23. BODY
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24. “… physical exercise may trigger processes
facilitating neuroplasticity and, thereby,
enhance an individual's capacity to
respond to new demands.”

25. “in inactive older adults with cognitive
complaints, 12 weeks of physical plus
mental activity was associated with
significant improvement in global cognitive
function…”

26. CHILDREN: increase in working memory
YOUNG ADULTS: UPDATING of
working memory; also task-switching
OLDER ADULTS: improved task-
switching & selective attention, inhibition
of automatic responses, increase in working
memory

27. BODY
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28. 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

29. One problem…
• It doesn’t work!
• It’s the INSULIN
RESPONSE.
• RX: EAT LESS
CARBS AND
SUGAR!!!

30. 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.

31. The Old FDA Food pyramid – R.I.P 2005

32. The horrifying facts about the foods
you eat (and think are safe)
(FOOD)
•Tofutti
•Glucose
•French bread
•Instant rice
•Baked potato
•Rice cakes (jelly beans)
•Cheerios
•Table sugar (sucrose)
•Spaghetti, white
•Spaghetti, protein enriched
(glycemic index)
115
100
95
90
85
77/80
74
64
41
27

33. H - 33
Doc Cady “Candy Bar a Day”
program FLAWS:
• Not all calories from food do the same
thing to your body.
• Doesn’t account for thyroid or thyroid
resistance.
• Only focuses on WEIGHT LOSS, and not
OPTIMUM HEALTH
• Virtually impossible to “diet your way to
weight loss.”
– Needs diet AND exercise

34. BODY
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35. …low levels of the antioxidant vitamins (Vitamins A, E, and C)
may increase risk for several chronic diseases. Most people do
not consume an optimal amount of all vitamins by diet alone.
Pending strong evidence of effectiveness from randomized trials,
it appears prudent for all adults to take vitamin
supplements.

36. Antioxidant (& other)
targets and
measurements
(c) 2013 Louis B. Cady, M.D. - all
rights reserved

37. RAMAN SPECTROSCOPY
+
=

38. (c) 2013 Louis B. Cady, M.D. - all
rights reserved
Raman
shift

39. Antioxidants and carotenoids
1) Carotenoids ID’ed 1992. Five important in human diet:
alpha and beta carotene, lycopene, lutein zexanthin –
found in blood and important in human health.
– Khachik F et al. Separation and quantification of carotenoids in human plasma.
Methods Enzymol. 1992;213:205-19.
1) Carotenoids are POTENT ANTIOXIDANTS. Carotenoid
molecules can sustain 20 free radical hits before being
consumed. If they are in skin, then they are in every
other cell of the body.
– Tsuchiya, M et al. Antioxidant activity of alpha-tocopherol, beta carotene, and
ubiquinol in membranes:cis-parniaric acid-incorporated liposomes. Method
Enzymol. 1994; 234:371-83.
– Tsuchiya M et al. Antioxidant radical-scavenging activity of carotenoids and
retinoids compared to alpha-tocopherol. Methods Enzymol. 1992; 213:460-72.

40. Blue photons into hand… green photos out of hand
Counted by detector, computation by computer…
= skin carotenoid score
F D C B A

41. The options
$25
No pain! 
Results in 90 seconds
$246
PAIN! 
Wait 3 weeks.
Go back to your
doctor.
$303
Wallet pain! 
Wait 3 weeks.
Go back to your
doctor.
Oxidative stress analysis - www.gdx.net

42. What to do??
(c) 2013 Louis B. Cady, M.D. - all
rights reserved

43. WILL an apple a day keep the doctor
away?
• Liu S, et al. Intake of vegetables rich in carotenoids and risk of coronary heart disease in
men: The Physician’s Health Study. Int. J Epidemiol. 2001 Feb;30(1):130-5.
• Findings adjusted for age, randomized treatment,
BMI, smoking, alcohol intake, physical activity, DM
history, HTN history, high cholesterol, use of
(conventional) MVI’s..
• 2.5 servings/day of vegetables had a
“RR (relative risk) of 0.77” for CAD vs.
men in lowest category
– (<1 serving per day)

44. • “It is concluded that
administration of antioxidants
could reduce the incidence of
brain tumors and probably other
types of cancer.”
• - Shewelta SA , Sheikh, BY Curr Drug Metab. 2011
Jul;12(6):587-93. (Dept.of Biosciences & Technology,
Alexandria University, Egypt.)

45. 15,318 US adults in 3rd
National Health and Nutrition
Examination Follow-up study. (Different lifestyles and health risk
factors were accounted for in the study)
“serum alpha-carotene concentrations
were inversely associated with risk of
death from all causes, CVD, cancer,
and all other causes[sic].”

47. Epidemiology of Vascular Ageing (EVA study)
Total plasma carotenoids are inversely related to mortality (Br J Nutr, Jan
2009, Akbaraly TN, et al
• Study N=1389
– Age range = 59 – 71 years; 9 years duration; 6 follow-ups
• Findings:
– For men - 2.94X higher relative risk
of mortality of being in lowest
quintile compared to highest quintile.
– “The present study suggests that total plasma
carotenoid levels could be a health indicator in
elderly populations.”

48. Lipid peroxidation, antioxidant status
& survival in institutionalized elderly
• Plasma MDA
predicted mortality
– (independently of all variables)
• B-carotene and alpha
tocopherol were
independently
associated with
survival.
Huerta JM et al. Free Radical Research
2006, vol 40, no 6. pp 571-578.

49. As of 4/11/2013

50. As of 4/7/2013

51. Multiple lines lines of evidence indicate that
oxidative stress not only strongly participates in
an early stage of Alzheimer's disease prior to
cytopathology, but plays an important role in
inducing and activating multiple cell signaling
pathways that contribute to the lesion formations
of toxic substances and then promotes the
development of Alzheimer's disease.

52. As of 4/11/2013

53. Adult ADHD and antioxidant status
• Selek S et al. Evaluation of total oxidative status in adult
attention deficit hyperactivity disorder and its diagnostic
implications. J. Psychiatry Research. 2012 Apr;46(4):451-5
• CONCLUSION: “In ADULT ADHD,
oxidative balance in impaired.
High antioxidant levels may be
compensatory against the oxidant
increase.”

54. what about other
things besides carotenoids
and “Antioxidants”??
B12, Magnesium, Selenium, Zinc, fish
oil…

55. “Inadequate intakes may result in chronic
metabolic disruption, including mitochondrial
decay.”
“[They] cause DNA damage, such as chromosome
breaks, in cultured human cells or in vivo.”
“triage theory

56. The Physicians’ Health Study II
• Take a multivitamin!
CONCLUSIONS: “Daily multivitamin
supplementation modestly but
significantly reduced the risk of total
cancer.”

57. Over 50% of the women in the Iowa study
lived longer than the average life
expectancy
38,000 White Women in Iowa
Early results showed women who used
C, D, E, and Calcium had significantly
lower rates of death

58. • Irritability
• Apathy
• Anxiety
• Personality changes
• Depression
• Memory loss
• Dementia
• Subtle subclinical
cognitive impairment
• Hallucinations
• Violent behavior
Symptoms of B12 Deficiency
• Diminished sense of
touch and pain
• Clumsiness
• Weakness
• Pernicious anemia
• Chronic fatigue
• Tremors
• GI problems
• Peripheral neuropathy
Mental Physical

59. Your brain and B12
• If you are in the bottom 1/3rd
for B-12
levels….
• SIX TIMES increase risk of
brain volume loss (Odds ratio =
6.17, 95% CI)
– Vogiatzoglou A et al. Vitamin B12 status and
rate of brain volume loss in community-dwellers.
Neurology. 2008 Sep 9;71(11):826-32.
– (107 volunteers aged 61-87 years of age)

60. Non-branded nutrient discussion
Nutirient Premier (%RDA) Solid %
RDA
B12 1000% 250%
Magnesium 76% 100%
Zinc 100% 100%
Selenium 200% 200%
Vitamin C 417% 333%
Vitamin B3 (Niacin) 88% 87.5%
Vitamin E 333% 250%
Carotenoid mixture Yes – nano-ized Yes
Essential Fatty acids 4 grams (600 mg
EPA/400 mg DHA)
- none-

61. Do YOU Need Fish Oil?
5X reduction

62. Back to B12
= induced
B12
deficiency

63. Magnesium mementos
• One of the first minerals to disappear with:
– Processed food
– Stress
• Decreased by EtOH, caffeine, sodas, meds
• Considered “anti-stress” mineral
– Decreases cortisol (rel to sleep disruption)
– Relaxes muscles, prevents cramps (sleep
disruption)
– Decreases anxiety; improves sleep

64. Symptoms of Magnesium Deficiency
PSYCHIATRIC ISSUES:
•Difficulty with memory
and concentration
•Depression, apathy
•Emotional lability
•Irritability, nervousness,
anxiety
•Insomnia
Autism
ADHD
 Migraine headaches
 PMS
 Dysmenorrhea
 Fibromyalgia
 Fatigue
 CONSTIPATION
Health Conditions Associated
with Magnesium Deficiency

65. Vitamins E & C Supplements Limit Oxidative
Brain Cell Damage, Cognitive Dysfunction
• Head, E, Christie L. (UC Irvine). Cognitive performance, dementia and
DNA/RNA oxidative damage in the oldest old.” Poster 256 Oxidative
Stress and Synaptic Transmission, San Diego, 2007.
• “The two antioxidant vitamins were
associated with decreased oxidative
damage to brain cells in the frontal
cortex. The researchers found that better
cognitive performances in elderly subjects is
associated with lower levels of oxidative
DNA & RNA damage in the brain…”

66. Vitamin B3 Restores Memory Loss
Associated with Alzheimer’s Disease
• Green K et al. (UC Irvine) “Oral Nicotinamide Treatment
Induces Ubiquitin-dependent degradation of phospho-tau
and restores cognitive function in a mouse model of
Alzheimer disease.” Poster 157, Nov 4 at Alzheimer’s
Disease and Other Dementias: Therapies II; San Diego
2007
• B3 given to rice BRED to develop plaques and tangles.
• Mice that received this had lower levels of phosphorylated
tau.
• “These findings suggest that Vitamin B3… might be a safe
and effective therapy for people with Alzheimer’s disease.”

67. Putting it all together with vitamins

68. The Effects of high dose B vitamins
on stress at work
• 3 month, double blind, placebo control, randomized study
– Measured: Personality, work demands, mood, anxiety, and strain
• The vitamin B complex treated
group reported significantly lower
personal strain and a reduction in
confusion and depressed/dejected
mood after 12 weeks.
Strough C et al. The effect of 90 day administration of a high dose vitamin B-
coplex on work stress. Hum Psychopharmacol. 2011 Sept 8. doi
10.1002/hup.1229 (Swinburne University of Techbnology – Hawhorn, Victoria,
Australia.)

69. Double-blind, placebo controlled trial
on MVI’s

70. RESULTS:
[Serris et al. Nutrition Journal 2012, 11:110]
• Increased energy levels
(p=0.22)
•(most evident on women)
• Enhanced mood (p=.027)
• No significant negative effects

71. BRAIN SHRINKAGE…
Smith AD, Smith SM, de Jager CA, Whitbread P, et al. (2010) Homocysteine-Lowering by B Vitamins Slows the
Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment: A Randomized Controlled Trial. PLoS ONE
5(9): e12244. doi:10.1371/journal.pone.0012244
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0012244
CONCLUSIONS: “The
accelerated rate of brain
atrophy in elderly with MCI can
be slowed by treatment with
homocysteine-lowering B-
vitamins.”

72. OK. It slows shrinkage. But are they sharper?
[deJager CA et al. Int J Geriatr Psychiatry. 2012 June;27(6):592-600]
“B-vitamins appear to slow cognitive and clinical
decline in people with MCI.”

75. Reference: R2
in Physician’s Desk Reference, 2013
Cordyceps sinensis
Cs-4 Mushroom Mycelia Panax Ginseng
Pharmanex Asian Ginseng Rb1 (Panax
ginseng) Root Extract—a proprietary
ginseng extract with a balance of
biological activity not found in other
ginseng extracts;
Pomegranate
a unique, patented extract from
Punica granatum.
Proprietary and patent pending blend
3 unique extracts

76. ”Mitochondrial Dysfunction in the Elderly: Possible Role in Insulin
Resistance” Science 16 May 2003:Vol. 300. no. 5622, pp. 1140 – 1142
MITOCHONDRIAL ACTIVITY DECLINES WITH AGE
18~39
8
6
4
2
61~84
- 40%

77. TARGET & RESET YOUTH GENE CLUSTERS
77
Old Gene
Expression
Young Gene
Expression
TARGET
Old Gene
Expression
RESET
1
Transcriptional Biomarkers of Mitochondrial Aging and Modulation by Cordyceps
Sinensis Cs-4. Gordon Research Conference, Biology of Aging, Determinants of
Health-Span: From Cells to Humans, August 22-27, 2010. Les Diablerets Conference
Center, Les Diablerets, Switzerland.
Column 3 shows how this product
RESET 92% OF THE
MITOCHONDRIAL GENES
to their youthful state.
92%

78. “Targeting Age-related gene expression
improves mental and physical vitality”
Ferguson SB SM et al. Paper presented at 1st
World Congress on Targeting
Mitochondria, Strategies, Innovations & Clinical Applications. Berlin, German.
November 18-19, 2010.
• Human cognitive change trial most exciting.
• Four groups, 10 per group, ages 28 – 50 years of age
– Positive control group - took 200 mg Phosphatidylserine DHA, 300 mg Bacopa, and
30 mg of Vinpocetine.
– Vitality blend took 2,270 mg/day of CS4+ PG+ PGE
– Placebo – monocrystalline cellulose, caramel color
– No supplementation.
• 6 Parameters measured and averaged to = the COMPOSITE
COGNITION INDEX* (CCI): * from http://www.mybraintrainer.com
– Three choice reaction time
– Short term memory
– Executive function
– Information processing
– Pattern recognition
– Working memory.

79. Week 12 = +20%
P=0.021
Vitality vs. Placebo

80. A personal close:
How do YOU want to age?
Me – Jan 2013

81. Wrapping Up: The “Survival Curve” –
Where Are You?

82. “There are things
known and there are
things unknown, and
in between are the
doors.”
- Jim Morrison

83. Contact information:
Louis B. Cady, M.D.
www.cadywellness.com
www.tms-relief.com
Office: 812-429-0772
Download from
iTunes or Android App store now!
Thanks for
coming!

85. Tech Rules…. Please turn
your phones ON (just
silenced).
• Shoot photos!
• Tweet! ( @LouisCadyMD )
• “Like us” www.facebook.com/cadywellness

86. BioGinkgo 27/7 (50:1)
(EGb761 = standard. Composition is 26/6)
• Comprised of 27% ginkgo flavonone glycosides and 7%
terpene lactones
– Typical is 22 – 27% flavonone glycosides
– 5 – 7% terpene lactones
• Two mechanisms of actions:
– Gingko flavone glycosides – mainly anti-oxidant properties (free-
radical scavenging comparable to Vitamin E and Vitamin C)
– Anti-platelet effects
• Ginkgolide B – a potent and long-lasting platet activating factor antagonist
• Terpen lactones, ginkgolides, and bilobalide also = platelet activating factor
antagnosits.
• Drug interactions: do not use with anticoagulant, ASA daily, MAO
inhibitor, allergic to ginkgo
•

87. • aadsfasfd
EGb761 is used in most trials. Dosages: 80 –
720mg/day
Mechanisms of action: increasing cerebral
blood flow, antioxidant and anti-
inflammatory effects, with
antiplatelet effects attributed to flavone
and terpene lactones.
(“Possible interactions with MAOI’s,
alprazolam, haloperidol, warfarin, and nifedipine
have been reported.”)

88. Gingko – color commentary
• 2,991 citations in PubMed as of 3 30 2013
• Cognitive enhancement:
– 34 outpatients with moderate cognitive impairments tx’ed with
standard extract of Ginkgo Biloba (EGb761) – 240 mg twice daily .
Significant improvement in attention, memory, orientation, and
visual-spatial/executive functions as well as anxiety and
depression.”
• Boiko AN et al. Zh Nevrol Psikhiatr Im S S Korsakova. 2013 – “Possibilities of
medical correction of moderate cognitive impairment.”
• In addition to cognitive effects:
– Might be useful in patient with early diabetic nephropathy . Zhang L
et al. Evid Based Complement Alternat Med. 2013
– Anti-inflammatory on osteoarthritis of knee. Chen YJ et al. J
Orthop Res. 2013 Mar 11.

89. How much insomnia?
Buysse DJ. Insomnia. JAMA. 2013 Feb20;309(7):706-16
• Prevalence is 10 – 20%
–Approximately 50% of these have chronic
course
• Major risk factor for impaired function,
developmental of other medical nad
mental disorders, and increased health
care costs.

90. • Mitochondrial diseases are due to impairment of
chemical reactions.
• A reasonable theory is oxidative stress.
• Few studies have actually been done on this.
• Glutathione deficiency is known in mitochondrial
disease.
• Biosynthesis of glutathione depends on cysteine
availability.
• “Our findings reinforce the notions that in
mitochondrial disease, oxidative stress is
important and can be reduced by
administration of a cysteine donor.”