This is the third of three lectures that Dr. Cady did in Sao Paulo, Brazil, for Laboratorio Great Plains. Dr. Cady dispenses with the "Dopamine hypothesis of schizophrenia" quickly, and notes that the most powerful drug for schizophrenia, clozapine, is actually only a weak blocker at that receptor. Using the concepts of Dale Bredesen, MD, Dr. Cady advances the idea that there is no "one magic bullet" approach to the treatment of schizophrenia, but that, rather, multiple possibile causes of schizophrenia exist, multiple nutritional laboratory values exist, multiple other physiological perturbations exist (including gluten sensitivyt), and that the thoughtful practitioner's approach should be to attempt to identify, integrate, and address all possible causes and exacerbating influences on the causes, and treatments of schizophrenia. Obviously, this is not a comprehensive treatment on the subject - which would take days - but does scratch the surface at other ways to look at schizophrenia and approach its treatment.

1. The Integrative Medicine Approach to
the Treatment of Schizophrenia
Louis B. Cady, MD

2. “Streaking”, or…..
Better Buckle Up!!!
• Definition: Streaking is the act of taking off
one's clothes and running naked through a
public place. [ref:
http://en.wikipedia.org/wiki/Streaking - accessed 09
02 2013]
• “In 1973, what the press called a ‘streaking
epidemic’ hit Stephen F. Austin State University in
Nacogdoches, TX, with streakers being seen in
residence halls, at football games and at various
other on-campus locations and events, including
Spring graduation.(Harvard-Yale game, 2006)

3. Attention class!!
www.slideshare.net/lcadymd
Cady Wellness Institute app – Apple
“app” store (currently pending re-
approval) or Google Android store
Resources for you to master this material:
Louis B. Cady, MD

4. Schizophrenia – multiple domains and
defects
• Positive symptoms
– (delusions, auditory & visual hallucinations)
• Morris R et al. Schizophrenia Bulletin (2012). 39, 575-582
• Negative symptoms
– Anhedonia, apathy, amotivation, and inappropriate (blunted) affect.
• Rabinowitz J et al. (2012) Schizophrenia Research 137, 147-150.
• Neurocognitive dysfunction, including attention deficits
– Fioravanti M et al. Neuropsychol. Rev. 15, 73-95.
• Learning & memory problems
– Goldman-Rakie PS. (1994). J Neuropsychiatry Clin. Neurosci. 6,348-357.
• Decreases in executive functioning, processing speed, and IQ
– Hutton SB et al. (1998) Psychol Med. 28, 463-473.
– Rodriguez-Sanches JM et al. (2007) Br. J Psychiatry Suppl. 51, s107-s110.
• More recently noted: defects in social cognition and function.
– Nuechterlein K H, et al. (2004) Schizophrenia Res. 72,29-39.
– Fett AK et al. (2011) Neurosci. Biobehavioral Research Rev. 35, 573-588.

5. Schizophrenia
• Historically:
– “Dementia praecox” - Heinrich Schule in 1886.
– Emil Krapelin (1893) refined classification between
dementia praecox and a mood disorder.
– Eugene Bleuler(1908) – coined term schizophrenia
– a “splitting of the mind.”
• Currently - diagnosed per
American Psychiatric Association’s Diagnostic and
Statistical Manual of Mental Disorders, or the World Health
Organization’s International Statistical Classification of
Diseases and Related Health Problems (ICD-10).
– DSM 5 removed all previous subtypes (paranoid type, disorganized,
catatonic, undifferentiated, and residual types)

6. Schizophrenia
heterogeneities:
• Etiopathogenesis
• Course
• Effective agents
• Treatment response

7. “Dopamine hypothesis of
schizophrenia”
From Stahl’s Essential Psychopharmacology, 4rth edition, 2013.

8. How much D2 blockade is enough?
From Stahl’s Essential Psychopharmacology, 4rth edition, 2013.

9. Clozapine – a problem with the D2 blockade
theory
From Stahl’s Essential Psychopharmacology, 4rth edition, 2013.

11. Multiple pathways for Alzheimer’s
Disease…

12. Schizophrenia Etiopathogeneses:
some theories
• Immuno-inflammatory response
– From dysfunctions of brain-gut axis
– Intestinal pathological processes.
• Alterations in intestinal microbiome
• Permeable intestine (leaky gut syndrome)
• Hypersensitivity to food antigens – especially
gluten and casein of cow’s milk.

13. Case presentation
• Alan – presents on Feb 16, 2007,
diagnosed with depression vs. psychosis.
– Previous treatment at Pfeiffer Treatment Center
• He appeared notably fatigued and grossly
over-sedated.
• Morose and depressed. Lucid. Intelligent.

14. Past history• “Ever since I can remember, I’ve always had
the same feelings about things – how people
treat each other and stuff like that.” “My
feelings just kept getting worse and worse the
more I was picked on. That was the only
thing that was wrong, people just calling you
names and stuff.”
• Alan became suicidal in middle school – 8th
grade year. “I just thought everyone was
making fun of me, so why should I go on.”

15. • Treated with fluoxetine in the past for depression
• Stopped being able to do homework as a sophomore
in high school
• “I was just really resentful of my parents a lot during
the past few months [at that time] – I just started
yelling at them in front of the therapist guy.”
• Ultimately stabilized by previous MD on aripiprazole
(20 mg), olanzapine (20 mg) and sertraline (50mg).
• Per Mom – “It was hard for him to be out and be
around a lot of people.”
Past history

16. March 2007• Evaluated for obstructive sleep apnea & now on
CPAP (continuous positive airway pressure
device).
• Improved energy.
• Conventional labs ordered
• Sertraline changed to duloxetine, which helped.
• Sertraline and olanzapine both decreased by 5
mg. Modafanil stable at 100 mg
• Very specific about self-identified “Paranoid
thoughts.” “I didn’t used to have them.”

17. Clinical course through July
2007• Continued in treatment with me every 1 – 3
month appointments. Still isolated.
• Seemed to improve on;
– Duloxetine 60 mg twice daily
– Olanzapine 30 mg @ 9 pm
– Aripiprazole 20 mg in the a.m.
– Topirimate – 100 mg at bedtime (originally for
weight loss, but improved mood).
– L-methylfolate 7.5 mg per day, empirically started
– 5HTP 100 mg tid

18. 2007 - 2009
• More explosive outbursts. Lamotrigine
(200 mg) added topirimate continued
• “I know that I’m acting ridiculous – like a
schizophrenic, but I feel good, and I’m
talking more to everybody, and I’m trying
to get my point across, and I don’t feel as
evil as I used to.”

19. June 30, 2009• He comments that he
feels his “mouth is
going faster than his
thoughts.”
• Mom reports that
“traveling out here (to
appointment) wears on
him.” “He does better
when he’s quiet and in
the house.”
• RX:
– Olanzapine 30 mg 9 pm
– Aripiprazole 20 mg a.m.
– Topirimate 100 mg HS
– Lamotrigine 200 mg in
a.m.
– Duloxetine – 120 mg /
day
– Modafanil – 100 mg daily
– 5HTP 100 mg in the a.m.
INTEGRATIVE MEDICINE
TESTING finally ordered!

20. Integrative (“functional”)
medical testing done
TESTING• Micronutrient analysis (functional
intracellular analysis) – deficiencies in:
– Vitamins A & D, zinc, Oleic acid, antioxidant
capacity
• IgG food allergy testing 7/22/2009
– 12 total sensitivities
• 2+ to eggs, cow’s milk, wheat, brewer’s yeast
• 1+ to cheese, mung bean, oat, pork, pumpkin,
sesame, tuna & baker’s yeast.

21. 8/12/2009 Follow-up
• Very irritable and sarcastic at
appointment.
• Continue baseline Rx as is.
• NEW: start diet – dairy free, gluten free
• NEW: start vitamins:
– 4000 IU Vitamin D daily
– Flavored cod liver oil
– “ACES” – A, C, E, and Selenium

22. Last four months January 21,
2010• On IgG diet. “He has been doing well on it.”
• At Christmas, however, he “went off of it.” Had cookies
everywhere – couldn’t keep him out of the wheat.
Following that gluten feast he exploded on New Year’s
eve.
• Prior to that, his last explosive episode was in May – and
has been good pretty well up until New Year’s eve.
When the two brothers got in the car it set Alex off. “It
was bad.”
• After the outburst, Alan specifically wanted to go back on
the diet program. “He seems really good [now].”
• More functional medicine testing ordered.

23. November 18, 2012

25. January 2010 to present
• November 2012 – high IgG allergies to dairy and
wheat. Diet again emphasized.
• August 2014 – elevated Arabinose on OAT test –
treated with Nystatin
• Probiotics added to deal with acid reflux
• Macro and Micronutrient deficiencies identified in
hair testing and organic acid testing.
• Generally stable. Subtle improvement. No more
meltdowns. No more concerns about going out in
public.

26. August 31, 2014
Fungal markers went up; Nystatin
started.

27. April 15, 2013
Low dose Lithium orotate started

28. Repeat testing 13 months later – May 21, 2014

29. Schizophrenia & candida
As of October 4, 2017

30. Candida – what is it?
• “C. albicans is a diploid, polymorphic
yeast residing in mucosal surfaces of
the human respiratory,
gastrointestinal (GI) and genitourinary
tracts.”
– Severance EG . NPJ Schizophr. 2016; 2: 16018.

32. Antimicrob. Agents Chemother. October 2009 vol. 53
Caspofungin

33. The only four papers in the
literature
• 1. Clozapine found to inhibit yeast budding to
hyphal transition. This and other antifungals
might have therapeutic activity in the future.
– Midkif J et al. Small molecule inhibitors of the Candida albicans
budded-to-hyphal transition act through multiple signaling pathways.
PLoS One. 2011;6(9):e25395.
• 2. Cyclic dipeptides from food and intestinal yeast cyclic
dipeptides may play a role in causing psychiatric
disorders such as schizophrenia. From cancer research,
cyclic dipeptides such as cyclo (proline-phenylalanine)
have been found to activate the pathways of apoptosis
and to cause programmed cell death.
– Semon BA. Dietary cyclic dipeptides, apoptosis and psychiatric
disorders: a hypothesis. Med Hypotheses. 2014 Jun;82(6):740-3.

34. 3. Odds ratio of schizophrenia with
candida albicans seropositivity
• Case control differences investigated regarding candida
albicans.
• 947 individuals studied
– 261 with schizophrenia (139 of which had 1st
episode schizophrenia
– 270 with bipolar disorder
– 277 non-psychiatric controls
• C. albicans seropositivity conferred increased odds for a
schizophrenia diagnosis (OR 2.04-9.53, P 0.0001).⩽
• Severance EG et al. Candida albicans exposures, sex specificity and cognitive deficits
in schizophrenia and bipolar disorder. NPJ Schizophr. 2016; 2: 16018.
• Published online 2016 May 4.
– Full article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898895/

35. 4. Probiotic normalization of Candida
albicans in schizophrenia: A randomized,
placebo-controlled, longitudinal pilot study.
• Longitudinal, double-blind, placebo-controlled pilot
investigation of 56 outpatients with schizophrenia.
Studied impact of probiotic treatments on yeast
antibody levels, and between levels of antibodies
and abdominal discomfort/ psychiatric symptoms.
• “Results from this pilot study hint at an association
of C. albicans seropositivity with worse positive
psychiatric symptoms, which was confirmed in a
larger cohort of 384 males with schizophrenia.”
Severance EG et al. Brain Behav Immun. 2017 May;62:41-45.

38. • HPHPA found in higher concentration in urine samples of
children with autism compared to controls.
• Highest value ever measured was 300X the median normal
adult value, in a patient with acute schizophrenia during an
acute psychotic episode.
• HPHPA source – appears to be from multiple species of the
Clostridium genus.
• Appears to be a metabolic of 3-hydroxyphenylalanine – a
tyrosine analog which depletes brain catecholamines and
causes symptoms of autism in experimental animals.

39. Normal colon vs.
pseudomembranous colitis

40. June 23, 2015
• “The past few days I’m
doing pretty good. It’s
been a miraculous few
days. This week has
been pretty good. We
have been going out a
little bit more. We’re
going to Biaggi’s after
this. That’s going to be
a first in a long long
time.”
• RX:
– Olanzapine 30 mg 9 pm
– Aripiprazole 20 mg a.m.
– Topirimate 100 mg HS
– Lamotrigine 100 mg in
a.m.
– Duloxetine – 60mg / day
– Liothyronine 5
MICROgrams 2x/day
• PLUS SUPPLEMENTS

41. 2015 supplementation – in
collaboration with CWI biomedical
specialist
• N-acetyl cysteine complex (glutathione
precursor) – 3 two times/day
• D3 (2,000 IU) – one per day
• ACES – one tablet per day (Vitamin A –
10,000 IU in 2 soft gels, Vitamin C 1000 mg
in two capsules, Vitamin E 400 IU in two
capsules , Calcium 119 mg in two capsules
• Selenium 100ug in two capsules).
• Vitamin C (500 mg. twice daily)
• Zinc (25 mg. 2x/day) – 50 mg per day
• Lithium Orotate (10 mg./day)
• CoQ10 (200 mg.)
• Fish Oil - Previous had (EPA 1100 mg.;
DHA 720 mg.; Other Omega 3: 230 mg.)
• Niacinamide – 500 mg three times daily
recommended by Marci.
• B5 (Pantothenic Acid) – 250 mg. 1x/day
MWF
• Manganese 15 mg./day
• Chromium polynicotinate 200 mcg./day
• Magnesium glycinate 200 mg 2x/day
• P-5-P 50 mg. 2x/day
• Grapefruit Seed Extract – as
recommended on the label (for yeast) –
liquid form
• Olive Leaf Extract – 1 per day (for yeast
and bacterial overgrowth) – liquid form
(with the grapefruit seed extract)
• Enzymedica Digest + Probiotics – take 1
capsule at the beginning of each meal
– Probiotic: Ther Biotic Complete from Klaire
Labs – 1 capsule per day
• Copper (1 mg./day) – added in a
multivitamin (“Headache Free”)
• Potassium was added 99mEq twice daily

42. Schizophrenia and Gluten

43. As of September 24, 2017

44. Patient “Alan”

45. Another recent schizophrenic patient for comparison

46. Differential antibody responses to gliadin-
derived indigestible peptides in patients
with schizophrenia
• IgG and IgA antibodies against indigestible
gliadin-derived peptide antigens by ELISA
• 169 patients with schizophrenia; 236 controls.
• RESULTS:
– Patients with schizophrenia had increased levels of
plasma IgG against the gamma-gliadin-derived
fragment (AAQ6C) compared to control subjects.
– No difference against NATIVE gliadins between
patient and control groups.
McLean RT et al. Translational Psychiatry. 2017
May 9;7(5):e1121.

47. Immunoglobulin G genotypes and risk
of schizophrenia
• Assessment of highly polymorphic immunoglobulin GM
(gamma marker) genes in schizophrenia.
• N=798: 398 patients with schizophrenia, 400 controls
• GM Alleles were determined by the TaqMan® genotyping
assay.
• GM 3/3;23-/23- genotype were over three times as likely
to develop schizophrenia as those without the genotype
[Odds Ratio 3.4]
• Notably GM alleles have been implicated in gluten
sensitivity
Pandey JP et al. Human Genetics. 2016
Oct;135(10):1175-9.

48. “Bread and Other Edible Agents of
Mental Disease”
• Cereal grains – the world’s most abundant food source – can
affect human behavior.
• “Bread makes the gut more permeable and can thus
encourage the migration of food particles to sites where they
are not expected, prompting the immune system to attack
both these particles and brain-relevant substances that
resemble them.”
• Causes release of opioid-like compounds
• “A grain-free diet, although difficult to maintain… could
improve the mental health of many and be a complete cure
for others.”
Bressan P, Kramer P. Frontiers of Human
Neuroscience. 2016 Mar 29;10:130

49. Schizophrenia & Vitamin D

50. *
*
As of September 24, 2017

51. Some current research
• “Patients with schizophrenia have low plasma Vitamin D level.”
(Does not appear to be associated with severity or type of
antipsychotics used.)
– Akindlade KS et al. Frontiers of Psychiatry June 2017
• “Average Vitamin D values were deficient for first episode of
psychosis patients, especially those 22 with a final diagnosis
of schizophrenia.”
– Salavert J et al. Association between Vitamin D Status and
Schizophrenia: A First Psychotic Episode Study.
• Vitamin D Deficiency highlighted as potential environmental
risk factor in multiple sclerosis, schizophrenia, and autism.
– (Causation versus consumption duality reviewed.)
– Kocovska E et al. Frontiers of Psychiatry 2017 Mar 27;8:47.
– Link to full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5366333/

52. More Vitamin D Research
• Evaluation of 80 patients with chronic stable schizophrenia with residual
symptoms and Vitamin D deficiency were recruited randomly and received
600,000 (!!) IU Vitamin D injection along with their antipsychotic regimen.
– A negative but not significant correlation was found between serum Vitamin D level changes
and PANSS []Positive and Negative Syndrome Scale] negative subscale score.
• Vitamin D deficiency in a psychiatric population:
– 118 patients with bipolar disorder
– 202 patients with schizophrenia or schizoaffective disorders.
– Vitamin D levels were deficient in 30.3%
– Vitamin D deficiency was 4.7 times more common among outpatients with bipolar disorder,
schizophrenia, or schizoaffective disorder than among the Dutch general population.
– “We believe that outpatients with bipolar disorder, schizophrenia, or schizoaffective disorder
should be considered at risk of having low levels of Vitamin D.”
– Boerman R et al. J Clin Psychopharmacol. 2016 Dec; 36 (6):588-592.
• “In up to 16,125 individuals with measured serum 25 (OH)D, there was no
clear evidence that genetic risk for schizophrenia causally lowers serum
25(OH) D).”
– Taylor AE et al. Investigating causality in the association between 25(OH)D and schizophrenia.
Sci Rep. 2016 May 24;6:26496.

53. Patients vs. professional
staff• Naturalistic study – the Netherlands
• Study:
– Vitamin D levels measured in therapy-resistant schizophrenia in
April, after the winter, and in patients and staff members in June
after an exceptionally sunny spring.
– Patients had HIGH rates of Vitamin D deficiency (79-90%) and
lower levels of vitamin D than staff members (p<0.001).
• Conclusions: “The vitamin D deficiency of therapy-resistant
schizophrenia patients is pronounced and cannot be explained by
differences in skin pigmentation, or by an inactive, indoor lifestyle on
the ward.”
– (“Even theoretically sufficient exposure of the patients to daylight did not
ameliorate the low vitamin D levels”)

54. Anti-inflammatory strategies

55. Vitamin D & Omega 3 fatty acids –
relevance for SCHIZOPHRENIA
“VITAMIN D & marine omega 3 fatty acid intake may help prevent and
modulate the severity of brain dysfunction.”
“VITAMIN D & marine omega 3 fatty acid intake may help prevent and
modulate the severity of brain dysfunction.”
JUNE 2015

56. As of October 8, 2017

57. Inflammation and the Mind

58. Gut bugs and brain
• “Intestinal microbes in
the gastrointestinal tract
regulate peripheral
immune responses,
CNS function and
behavior.”
• Probiotics such as
Bifidobacterium and
Lactobacillus have
potent anti-
inflammatory properties
that reduce behaviors
associated with anxiety
and depression.
Fung TC, et al. Nat Neurosci. 2017;20(2):145-155.

59. Inflammation and schizophrenia
• Short chain fatty acids (SCFAs) linked to a
shortened lifespan with schizophrenia. Use of
Mediterranean diet, omega 3 fatty acids, and
probiotics may improve immune and
cardiovascular outcomes.
– SCFA derived from gut fermentation of fiber.
• Evolving literature that short chain fatty acid can
cross the blood brain barrier and target key
inflammatory pathways.
– Joseph J et al. Modified Mediterranean Diet for Enrichment of Short
Chain Fatty Acids… Frontiers of Neurosceicne. 2017 Mar 27;11:155.

60. B-vitamins and inflammation
References:
Mikkelsen K, et al. Maturitas. 2017;’96:58-71.
Brown HE et al. Vitamin Supplementation in the Treatment of Schizophrenia. CNS Drugs. 2014 Jul;28(7):611-
622.
B vitamin Immune response Deficiency outcome
B1 – Thiamin Antioxidative effect
Suppressed oxidative stress activation of NF-
kB
Neuroinflammation
Stimulation of CD40 & CD40L which triggers death
of neurons
Memory defects, cognitive decline emotional
disturbances
B2 – Riboflavin Activates MAIT [mucosal-associated invariant
T cells]
Interferes with macrophages adherent
Enhance apoptotic d4ath
B3 – Niacin Positive benefits on lipids
Dampens inflammation
Inhibits NF-kB activity
Historically used by Abraham Hoffer to treat
schizophrenia
B6 – (P5P) –
pyridoxal-5-
phosphate
Down regulates NF-kB activity levles in LPS
stimulated mouse macrophages
Adverse effects on methylation reactions
Altered lymphocyte differentiation and maturation
Triggers many diseases related to chronic
inflammation; possible consequences in depression
B9 Folic acid Regulation of immune response
Inhibits homocysteine induced NF-kB
activation in cultured human monocytes
IMPAIRED IMMUNE RESPONSE
Decreased response of T lymphocytes
Alterations of thymus function
.
B12 - Cobalamin
Immune system regulation
Immunomodulator of cellular immunity
Involved in cell division
Reduced cytotoxic T cells (CD 8+)
Reduced natural killer cells
Ghigh CD4/CD8 ratio
High levels of TNF-alpha; IL-6 decreased

61. Decreased Brain levels of Vitamin
B12 in Aging, Autism and
Schizophrenia
• Cobalamin exists in multiple forms, including
methylcobalamin & adenosylcobalamin
• Cobalamin levels measured in postmortem human frontal
cortex of:
– 43 controls – from 19 weeks of fetal development through 80 years
of age.
– 12 autistic subjects
– 9 schizophrenic subjects.
• In autistic and schizophrenic subjects: methyl-
and adenosylcobalamin levels were 3 times
lower than age-matched controls.
Zhang Y et al. PLoS One. 2016 Jan 22;
11(1):e01467978.

63. Stahl SM. L-methylfolate: a vitamin for your monoamines. J
Clin Psychiatry. 20089 Sep;69(9):1352-3
Strategy: test for “MTHFR genotype.”
References:
www.genomind.com www.genesight.comn

64. Folinic acid treatment for schizophrenia
associated with folate receptor
autoantibodies
• Autoantibodies against folate receptor alpha at the
choroid plexus that block methyltetrahydrofolate
(MTHF) transfer into the brain found in catatonic
schizophrenia. .
– Acoustic hallucinations disappeared following folinic acid
treatment.
• Study examines patients with schizophrenia
unresponsive to conventional treatment.
– had normal levels of homocysteine, folate, and B12.
– But had positive FR Autoantibodies of the blocking type.
• Conclusion: assessment of FR auto-antibodies in serum
is recommended for schizophrenia patients.
Ramaekers VT et al. Mol. Genet Metabolism. 2014
Dec; 113(4):307-14.

65. Modified Mediterranean Diet for Enrichment of Short Chain
Fatty Acids: Potential Adjunctive Therapeutic to Target
Immune and Metabolic Dysfunction in Schizophrenia?
Joseph J et al. Front Neurosci. 2017;11:155
• Multiple immune pathways that accompany
systemic inflammation are dysregulated in
schizophrenia.
• “The presence of inflammatory markers
indicates that a tissue injury mechanism is
active.”
• Dysregulated reward circuitry leads to unhealthy
dietary intake.
– [hyperdopaminergic mesolimbic pathway combined
with poor cognitive control]
Link to full text article:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5366345/

66. Modified Mediterranean Diet for Enrichment of Short Chain
Fatty Acids: Potential Adjunctive Therapeutic to Target
Immune and Metabolic Dysfunction in Schizophrenia?
Joseph J et al. Front Neurosci. 2017;11:155
INTERVENTION STRATEGIES
• Gluten free diets.
– Celiac disease and non-celiac gluten sensitivity is higher in schizophrenia
than the general population.
• Psychotic symptoms can be triggered by gluten in those with a gluten intolerance [Lionetti et
al, 2015]
• Omega 3 fatty acid supplementation (especially docosohexanoic acid)
• Ketogenic diets
• Colonic generation of short chain fatty acids and transport (via
probiotics, if necessary.)
• Mediterranean style diets
– Have already been shown to reduce overall heart disease risk.
– Adherence reduces c-reactive protein and TNF-alpha.
Link to full text article:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5366345/

67. • Case reports of two patients
with schizoaffective disorder
• Both had failed clozapine
– 1 patient failed 12 Rx.
– 1 patient failed 17 Rx.
• Ketogenic diet tried by
female patient for weight
loss.
– All delusions resolved (and
she lost 10 lbs)
• Also tried by 322 lb male,
who lost 104 lbs during a
year.
– Coincidentally, his PANSS
scores dropped from 98 to only
49.

68. Alan – the rest of the story
October 25, 2014
http://cadywellness.com/a-shattered-mind-and-
music-within/
Tip: www.youtube.com - type in Bethany Yeiser

69. Alan & Clozapine
• Maximum benefit on meds and
supplements reached. Still symptomatic.
• Clozapine was suggested in 2016.
• Started Clozapine March 3, 2017
• Seen on March 30th
. Vastly better.
Chuckled, “I’ve been paranoid for ten
years.

70. What it’s like from the inside-
March 30, 2017
• Alan: “I am not as dizzy – still feel like I’m in a dreamlike
state – but not as bad.” “There is a whole world of
difference since taking this stuff. We’ve been going out
more.” “
• Clozaril® (Clozapine) has eliminated basically every
paranoid thought I’ve had – I know they’re there. I
noticed it the first day.” He notes that he has been “too
sedated for them to hit me. It’s like the paranoid
thoughts can’t catch up.”
• Mother comments when he goes places, he is not
troubled by voices.

71. March 30, 2017
• Clozapine – 100 mg
a.m. + 175 mg pm
• Olanzapine +
Aripiprazole stopped
• Nystatin1.5 million IU 2
– 3X/day
• Topirimate
• Lamotrigine
• Duloxetine reduced
• Liothyronine 5 ug
2x/day
• D3 (2,000 iu) – one per day
• ACES – one tablet twice daily (Vitamin A – 10,000 IU in 2 soft gels,
Vitamin C 1000 mg in two capsules, Vitamin E 400 IU in two
capsules , Calcium 119 mg in two capsules
• Zinc 30 mg – one time per day (elevated from anti-dandruff
shampoo)
• Lithium Orotate (10 mg/day)
• CoQ10 (200 mg.)
• Fish Oil - Metagenics high potency EPA/DHA fish oil
• Niacinamide – 500 mg three times daily recommended by Marci.
• B5 (Pantothenic Acid) – 250 mg. twice daily
• Manganese 15 mg twice daily
• Chromium polynicotinate 200 mcg twice daily
• Neuromag - two capsules before bedtime.
– Marci has expressed interest in more magnesium using Epsom salts
baths.
• P-5-P 50 mg. 2x/day
• Grapefruit Seed Extract – as recommended on the label (for yeast) –
liquid form
• Olive Leaf Extract – 1 per day (for yeast and bacterial overgrowth) –
liquid form (with the grapefruit seed extract)
• Enzymedica Digest + Probiotics – take 1 capsule at the beginning of
each meal
– Probiotic: Ther Biotic Complete from Klaire Labs – 1 capsule per day
• Copper (1 mg./day) – added in a multivitamin (“Headache Free”)
twice daily
• Potassium was added 198 mEq twice daily (increased in
September.)
• Ferrochel added – one tablet per day.
• Rubidium – 100 MICROgrams per day

72. April 14,
2017
• Clozapine – 100 mg a.m.
+ 125 mg pm
• Nystatin 1.5 million IU 2 –
3X/day
• OFF OF:
– Olanzapine
– Aripiprazole
– Topirimate
– Lamotrigine
– Duloxetine
– Liothyronine 5 ug /day
– Rosuvastatin
• DIET: Still casein
free/gluten free

73. Concluding thoughts
• Just because someone has a classic “biological
psychiatry” diagnosis doesn’t mean that there
can’t/won’t be functional (or medical) impairments.
[e.g., obstructive sleep apnea, hypothyroidism,
vitamin deficiency, gluten sensitivity, intestinal
candidiasis etc. ]
• You may not be able to get rid of the main diagnosis,
but you can improve the patient’s quality of life.
• You MAY be able to get rid of a phenotypic diagnosis
if there is an underlying physiological problem that
can be addressed.
• Integrative medicine is of paramount importance in
identifying root causes and helping the patient.

74. Louis B. Cady, MD
Cady Wellness Institute
4727 Rosebud Lane – Suite F
Newburgh, IN 47630 USA
Office (812) 429-0772
info@cadywellness.com
Available on Apple “app store” and
Google Android store.
www.slideshare.net/lcadymd
Louis B. Cady, MD

75. Appendix – one slide

76. “The movers and shapers in immune
privilege of the CNS.”