Day 1: Rewriting the Story of Cardiovascular Disease at 2026 Boca Symposium for Metabolic Health

The 2026 Boca Symposium for Metabolic Health devoted the first full day entirely to cardiovascular health — and what unfolded was nothing short of paradigm-shifting. Instead of repeating outdated cholesterol-driven narratives, this day explored how heart disease actually develops, how we can detect it earlier, how hormones shape vascular health, and how metabolic terrain determines risk far more than any single lab marker.

Three exceptional physicians led the day.

Together, they painted a radically more accurate, humane, and effective picture of cardiovascular medicine — one grounded in imaging, physiology, metabolic health, and prevention, rather than in fear-based numbers and reactive procedures.

Arthur Agatston, MD

Integrating Coronary Imaging into Clinical Decision Making

For decades, they’ve taught us to fear cholesterol — to chase numbers rather than understand physiology. But as Dr. Arthur Agatston so powerfully demonstrated, cholesterol alone tells us very little about who will actually suffer a heart attack.

Instead, what truly matters is what is happening inside the artery wall itself. And for the first time in history, we now have the imaging technology to see it. Using advanced coronary CT angiography combined with artificial intelligence, Dr. Agatston showed how we can directly visualize plaque formation, track its progression, and even determine its biological age. This allows us to differentiate dangerous, newly forming soft plaque — the kind that ruptures and causes heart attacks — from older, stable calcified plaque that often reflects healing rather than danger. In other words, we are no longer guessing. We can now see cardiovascular disease unfolding in real time.

Perhaps most importantly, Dr. Agatston demonstrated how early metabolic and lifestyle intervention can dramatically alter the course of coronary disease. When we can correct insulin resistance, inflammation, and nutrient signaling early, plaque progression slows — and in many cases, halts entirely. This shifts cardiology away from crisis-driven intervention and toward true prevention, where imaging becomes a
feedback tool guiding personalized metabolic therapy. It is a breathtaking glimpse into a future where heart attacks become rare events, not inevitable ones.

David Nabert, MD

Hormones, Metabolism & Heart Rhythm Disorders

Dr. David Nabert offered a deeply human, physiologic, and refreshingly honest
exploration of heart rhythm disorders — revealing that arrhythmias are rarely just electrical glitches. They’re metabolic stories written into cardiac tissue over decades. Atrial fibrillation, in particular, emerges not from bad luck, but from the cumulative effects of insulin resistance, inflammation, autonomic imbalance, mitochondrial stress, and metabolic overload.

As he explained, when the heart is chronically bathed in excess glucose, insulin, and inflammatory signaling, its delicate conduction system begins to change. Fat infiltrates cardiac tissue. Fibrosis develops. Autonomic signaling becomes distorted. Over time, this reshapes electrical pathways, laying the groundwork for rhythm disturbances that may not appear until decades later. What we call “heart rhythm disease” is often the late expression of long-standing metabolic injury.

Yet woven throughout Dr. Nabert’s talk was a message of hope. When we can restore metabolic health — through nutrition, circadian rhythm optimization, sunlight exposure, movement, nervous system regulation, and inflammation reduction — the heart often regains remarkable stability. His work reframes arrhythmias not merely as procedural problems requiring ablation or medications, but as biological feedback systems inviting deeper healing. It was a powerful reminder that the heart listens closely to the metabolic terrain in which it lives.

Lily Johnston, MD

Hormone Therapy & Cardiovascular Health

Dr. Lily Johnston delivered one of the most important cardiovascular lectures of the conference — a masterclass in how hormones shape vascular biology, metabolic health, and long-term survival. Estrogen, she explained, is not a luxury molecule reserved for fertility or youth. It is a foundational metabolic signal, deeply woven into the physiology of blood vessels, cardiac muscle, immune function, insulin sensitivity, and mitochondrial health.

Menopause, therefore, is not simply a reproductive transition. It represents a profound metabolic turning point. As estrogen levels fall, insulin resistance accelerates, visceral fat accumulates, inflammation rises, and vascular resilience erodes. Cardiovascular risk climbs — not gradually, but sharply. When viewed through this biological lens, the dramatic increase in heart disease following menopause becomes tragically predictable.

Yet Dr. Johnston also dismantled decades of fear surrounding hormone therapy, clarifying that modern menopausal hormone replacement, when started early and delivered in physiologic forms, not only improves quality of life — it may extend it. Properly timed estrogen replacement improves endothelial function, reduces inflammation, supports glucose regulation, stabilizes plaque biology, and lowers
cardiovascular risk. In doing so, it restores a metabolic terrain in which the heart can once again thrive. Her message was both deeply scientific and profoundly hopeful: aging does not have to mean metabolic collapse — if we understand the biology well enough to intervene wisely.

Q&A

What emerged most clearly was a shared rejection of cardiovascular medicine built on isolated numbers and reflexive prescriptions. Again and again, the speakers returned to the same truth: cholesterol does not “attack” arteries on its own. Vascular disease begins with injury — metabolic injury, inflammatory injury, hormonal injury — and unfolds over decades before a single lab value ever crosses a threshold. When hyperglycemia, insulin resistance, smoking, processed carbohydrates, and disrupted circadian biology are removed, the disease process often slows dramatically. Sometimes, it stops.

The discussion around ketogenic and low-carbohydrate diets made this explicit. Far from being reckless, these approaches consistently improve the biomarkers that actually matter: inflammation, insulin resistance, triglycerides, HDL, and LDL particle size. What matters is not how high LDL-C rises on paper, but whether new, unstable plaque is forming inside the artery wall. With modern coronary imaging, we no longer have to speculate. We can see whether lifestyle alone is enough — and adjust only if it isn’t. This represents a profound shift away from fear-based medicine and toward shared, data-guided decision-making.

Perhaps most striking was the humility expressed around hormones, arrhythmias, and prevention. Menopause and andropause were framed not as inevitable decline, but as metabolic turning points — moments where biology becomes more vulnerable, but also more responsive to thoughtful intervention. Arrhythmias were no longer treated as mysterious electrical failures, but as metabolic and structural adaptations to years of physiologic stress. Even here, the message was not absolutism, but nuance: early intervention can help, late disease may require procedures, and no single therapy fits everyone.

Throughout the Q&A, a unifying principle emerged: we must stop pretending we know everything — and start using the tools we now have to listen more closely to the body. Imaging, physiology, symptoms, lifestyle, and timing all matter. When medicine becomes curious instead of dogmatic, prevention becomes possible — and cardiovascular health becomes something we can actively preserve, not simply hope for.

Eric Westman, MD

Hypertension, Heart Failure & the Metabolic Model

Dr. Eric Westman delivered a quietly radical message: hypertension and heart failure are not mysteries — they are the metabolic consequences of how we live. When insulin levels remain chronically elevated, sodium is retained, blood volume expands, vascular tone tightens, and the heart is forced to work harder against rising pressure. Treating blood pressure without addressing insulin resistance is like tightening a valve while ignoring the pump behind it. How many physicians don’t know this?

What makes his work so compelling is its clinical consistency. Time and again, his patients —thousands of them — placed on low-carbohydrate or ketogenic diets experienced rapid reductions in blood pressure — often while coming off medications entirely. This is not magic. It is physiology. Lower insulin means less sodium retention, less volume overload, and reduced cardiac strain. The diet itself acts as a metabolic diuretic, easing preload and allowing the heart to function more efficiently.

Perhaps most striking were his heart failure observations. Improvements in cardiac function occurred even in patients who did not lose significant weight — suggesting that ketones themselves may serve as a preferred myocardial fuel. In a field that often fears nutritional ketosis, Dr. Westman reminded us of something the heart has always known: it thrives on fat. When we relieve metabolic pressure, cardiac resilience can return — sometimes dramatically.

Philip Ovadia, MD

Plaque to the Future: Measuring Disease, Not Fear

Dr. Phillip Ovadia’s talk cut through decades of confusion with a simple, uncomfortable truth: if we’re worried about a disease, we should measure the disease. Cholesterol panels, inflammatory markers, and insulin metrics all serve as clues — but none of them are the disease itself. Plaque is. And for the first time, we now have reliable tools to see it early, track it over time, and intervene with precision.

He reframed coronary calcium scanning as a public health necessity, not a fringe tool. Just as we screen for breast and colon cancer before symptoms appear, we should be identifying coronary disease before a first heart attack. The “power of zero” — a CAC score of 0 — offers reassurance. But even more powerful is zero progression — the ability to confirm that plaque is no longer advancing under metabolic therapy.

Most importantly, Dr. Ovadia dismantled the false comfort of cholesterol reduction alone. Lowering LDL-C does not guarantee plaque stability — and in some cases, it actually worsens particle quality. What truly halts disease is correcting insulin resistance, reducing inflammation, and restoring metabolic balance. Imaging allows us to see whether those efforts are working — and to adjust when they’re not. This is how we ground cardiovascular care in reality, not fear.

Robert Cywes, MD

Risk Calculators, Broken Models & the Case for Early Detection

Dr. Robert Cywes delivered a blistering critique of modern cardiovascular risk
assessment — and it was impossible to ignore. Today’s cardiology relies heavily on probability algorithms that estimate who might get sick, rather than identifying who already is. Meanwhile, heart disease has become largely silent. Symptoms no longer
warn us. Women, in particular, are disproportionately missed — with most discovering disease only when a heart attack strikes.

Risk calculators, he explained, are not disease detectors. They are statistical abstractions built on outdated assumptions — assumptions rooted in a nicotine-dominated era that no longer exists. Metabolic dysfunction, ultra-processed foods, chronic hyperglycemia, and inflammation have replaced smoking as primary drivers, yet the models have not kept pace. Worse, composite endpoints blur biology with procedures, penalizing early detection while inflating the perceived success of medication-first approaches.

Coronary calcium scanning changes everything. It transforms theoretical risk into visible disease. It tells us who truly has plaque — and who does not — regardless of cholesterol levels or calculated risk. Most importantly, it allows clinicians to align treatment intensity with actual disease burden. Prevention, Dr. Cywes argued, is not about preventing death from heart disease. It is about preventing the disease itself.
And that requires seeing it early — before it sees us.

Day 1 at 2026 Boca Symposium for Metabolic Health underscored a stunning truth: cardiovascular disease is not primarily a cholesterol problem. It’s a metabolic, inflammatory, hormonal, and environmental problem. This conference painted a radically different vision for heart health — one rooted in early detection, personalized therapy, and biological understanding rather than fear-driven algorithms.

Q&A

If the afternoon lectures dismantled outdated cardiovascular dogma, this Q&A dismantled the way we think about certainty itself.

Again and again, the panel returned to a simple but radical principle: no number is an island. A rising calcium score, an elevated LP(a), a “high” LDL — none of these mean anything in isolation. What matters is the story they are telling together. Is inflammation falling? Is insulin resistance improving? And is weight stabilizing? Is the patient metabolically healthier than they were six or twelve months ago? In that context, even a rising CAC score may reflect plaque stabilization rather than progression. Medicine, they reminded us, is not arithmetic. It is narrative physiology.

The discussion around medications crystallized this theme. Drugs like SGLT2 inhibitors were not condemned — but they were clearly reframed as tools with limits, particularly dangerous when layered onto ketogenic diets without mechanistic understanding. Treating blood sugar after it spills into the bloodstream does nothing to undo the damage already triggered at ingestion. True disease modification happens upstream — at the level of hormones, substrate selection, inflammation, and nutrient signaling. When those are corrected, medications often become unnecessary rather than indispensable.

Perhaps the most human moment came in the discussion of carbohydrate addiction. The panel acknowledged what many clinicians quietly know: most patients cannot change overnight. And yet, with education, coaching, patience, and respect for the stages of change, most can change eventually. Progress, not perfection, was the ethos. Plant the seed. Explain the “why.” Walk beside them. And when pharmacology fails — as it often does — patients remember who once showed them a different path. It was a reminder that metabolic medicine is not just biochemistry. It is relationship.

Lori Calabrese, MD

My poster presentation

By the time I presented my poster at 2026 Boca Symposium for Metabolic Health – which was developed in collaboration with Maria Gabriella Da Silva Braga, a Touchpoints180 Research Intern and exceptional sophomore already demonstrating the curiosity, discipline, and clinical thinking of a future physician – the intellectual groundwork of the conference had already been laid. And it could not have been a more natural fit. Throughout the day, speaker after speaker emphasized that we must understand cardiovascular disease through physiology, imaging, metabolic context, and longitudinal patterns rather than isolated lab values. The poster lived squarely within that framework, translating these principles into a concrete clinical narrative. It didn’t challenge the themes of the conference; it reflected them back in a way that was tangible and clinically relevant.

People speaking up…

What made the experience especially meaningful, however, was what happened around the poster. Colleagues and attendees came forward — often quietly, sometimes hesitantly — sharing their own stories of living with very high lipid numbers while experiencing profound metabolic and mental health improvements. Many had been carrying private questions for years….. Am I a lean mass hyper-responder? ….Could I have familial hypercholesterolemia? ….Do I need to abandon a way of eating that has changed my life for the better? The poster created a space where those questions could be voiced without fear or shame.

Those conversations were thoughtful, nuanced, and deeply collegial. They reflected
exactly what 2026 Boca Symposium for Metabolic Health represented at its best: a
willingness to sit with uncertainty, to look beyond population-level assumptions, and to
individualize care using the best tools we have. In that sense, the poster didn’t just fit
the theme of the conference — it embodied it.

It affirmed that when we move away from dogma and toward context, physiology, and compassionate inquiry, we create room not only for better science, but for honesty, relief, and forward movement.

Across every lecture and Q&A, the message was consistent: cardiovascular disease is a metabolic, inflammatory, and longitudinal process, best understood through physiology, imaging, and context rather than isolated numbers. My poster sat squarely within that framework, translating these principles into a concrete clinical narrative that resonated immediately with attendees. It didn’t feel like a departure from the day’s themes — it felt like a natural extension of them.

Embracing a Transforming Field

What was especially gratifying was the quality of the conversations it sparked. Colleagues lingered. Questions were thoughtful, nuanced, and curious rather than skeptical. Many commented on how the poster brought together ideas that had been discussed throughout the day — metabolic health, plaque biology, risk contextualization, and prevention — and grounded them in real-world clinical decision-making. The reception was not just positive; it was engaged. In a conference devoted to rethinking cardiovascular care from first principles, the poster felt right at home — and the response affirmed that this way of seeing, measuring, and treating disease is not fringe, but firmly part of where the field is heading.

Day 1: Cardiovascular Health Reimagined

By the end of the first full day, a new cardiovascular paradigm had unmistakably emerged.

Heart disease is not a cholesterol disorder. It’s not a risk score. And it’s not a lab value to be managed in isolation.

It is a metabolic disease — driven by insulin resistance, inflammation, hormonal disruption, autonomic imbalance, nutrient deficiency, and decades of cumulative exposure. And for the first time, we now have the tools to see it early, understand it mechanistically, and intervene before catastrophe strikes.

Across six lectures and two deeply clarifying Q&A sessions, the message was consistent: measure the disease, not the fear. Coronary imaging — especially CAC and AI-enhanced CTA — allows us to visualize plaque directly, distinguish danger from healing, and track whether interventions are working. Lifestyle and metabolic therapy are not “adjuncts” to cardiovascular care; they are often the primary treatment. Medications become supportive when needed — not reflexive defaults.

Just as importantly, Day 1 reframed prevention as a long-term relationship rather than a one-time prescription. Patients are not numbers to be normalized. They are systems in motion, capable of healing when given the right signals, the right education, and enough time. When cardiology moves upstream — toward metabolism, behavior, and biology — heart disease stops being inevitable.

Day One did not simply update cardiovascular science. It returned medicine to first principles.

Day 2: What Drives the Risk?

Tro Kalayjian, DO

Enhancing Health Outcomes

Dr. Tro Kalayjian opened the morning by gently but firmly reframing what “good medicine” actually looks like in the modern metabolic era. His message was not about rejecting guidelines — it was about understanding their limits. When physiology improves, when insulin resistance resolves, when inflammation quiets, risk does not
behave the way our algorithms predict. And pretending otherwise does a disservice to both clinicians and patients.

What resonated deeply was his insistence on trajectory over snapshot. A patient who has reversed diabetes, normalized blood pressure, and restored metabolic flexibility is not suddenly fragile because a single biomarker sits outside a population-derived range. Health outcomes, he argued, improve when clinicians honor momentum, context, and individual response rather than reflexively correcting numbers divorced from physiology.

The Q&A underscored this theme. Questions weren’t about whether metabolic health “counts” — they were about how to practice responsibly when it clearly does. Dr. Kalayjian modeled a calm, grounded approach: stay curious, follow outcomes, individualize care, and resist the false security of one-size-fits-all medicine.

Dave Feldman

The Signal vs. the Noise

Dave Feldman’s presentation was one of the most anticipated of the morning — and one of the most disciplined. Rather than arguing theory, he let imaging speak. In a cohort of lean, metabolically healthy individuals with very high LDL cholesterol, longitudinal CT angiography revealed something that standard risk models would never
predict: remarkably low plaque progression — and in some cases, regression.

Equally important was what didn’t correlate with plaque change. LDL cholesterol. ApoB. Lp(a). Even years on a ketogenic diet showed no meaningful relationship with plaque progression. Feldman carefully walked the audience through effect sizes, correlation coefficients, and the difference between statistical significance and clinical relevance — a masterclass in scientific humility and rigor.

The Q&A brought the room into a shared moment of recalibration. If metabolic health dramatically weakens traditional risk signals, then the “noise” we’ve been trained to fear may not deserve the authority we’ve given it. Imaging, not inference, becomes the anchor. And the signal — quiet, longitudinal, and physiologic — finally gets its due.

David Diamond, PhD

LDL Cholesterol and Health

Dr. David Diamond delivered a sweeping, evidence-dense challenge to the idea that LDL cholesterol is inherently dangerous. Drawing from decades of epidemiology, genetic studies of familial hypercholesterolemia, immune biology, and particle physics, he made one point unmistakably clear: LDL does not operate in isolation — and context changes everything.

He showed that individuals with lifelong, genetically elevated LDL often live long, healthy lives. That coronary calcium, insulin resistance, and clotting tendencies outperform LDL as predictors of events. That LDL plays a vital role in immune defense. And that the real culprit is not LDL quantity, but LDL quality — particularly the small, dense particles produced in metabolically unhealthy states.

During Q&A, the implications crystallized. When metabolism is repaired, triglycerides fall, HDL rises, and LDL particles shift toward a benign, buoyant form. In that context, fear-based LDL suppression becomes not just simplistic, but potentially misguided. The talk didn’t argue for recklessness — it argued for precision. And it left the audience with a sobering realization: we may have been measuring the wrong thing for far too long.

Day 2: From Numbers to Meaning

If Day 1 dismantled outdated cardiovascular dogma, the morning of Day 2 addressed the deeper question left in its wake: once metabolism improves, what signals actually matter?

Across three very different voices—Tro Kalayjian, Dave Feldman, and David Diamond—a shared truth emerged. Risk is not static. Biology is not linear. And health cannot be responsibly assessed through isolated biomarkers divorced from physiologic context and time.

What unified the morning was not a single conclusion, but a disciplined way of thinking. Trajectory mattered more than snapshots. Imaging mattered more than inference. Effect size mattered more than statistical theater. When insulin resistance resolves, inflammation quiets, and metabolic flexibility returns, traditional risk markers behave differently—and sometimes lose their predictive power altogether. That does not mean risk disappears. It means our models must evolve.

Importantly, each speaker paired rigor with humility. There were no sweeping claims, no absolutism—only a repeated call to measure what is real, follow outcomes longitudinally, and resist the false comfort of algorithms that were never designed for metabolically restored humans. Day 2’s opening did not offer certainty. It offered something better: clarity about what we still need to learn, and how to learn it responsibly.

Eugene Chung, MD

Sports Cardiology & Metabolic Context

Dr. Eugene Chung delivered an important corrective to one of medicine’s most persistent myths: that athleticism equals immunity. The afternoon began with a clear reminder that fitness and metabolic health are not interchangeable, and that
cardiovascular risk does not politely step aside just because someone trains hard or competes at a high level.

What made this session especially compelling was its nuance. Dr. Chung didn’t diminish the value of movement — he contextualized it. Endurance training induces real, adaptive changes in the heart, but those changes exist alongside sleep deprivation, stimulant exposure, under-fueling, inflammation, and insulin resistance more often than we like to admit. In athletes, particularly, risk can hide behind performance. VO₂ max can look pristine while coronary plaque quietly accumulates. The message was not fear-based, but precise: exercise is powerful, but incomplete. Cardiovascular assessment must account for metabolic health, recovery, fueling, and long-term physiology — not just mileage, medals, or muscle tone. It was a reminder that the heart responds to the whole system, not just the training plan.

Mark Cucuzzella, MD

Operationally Simple Metabolic Care in Veterans

Dr. Mark Cucuzzella’s session was quietly powerful — not because it was flashy, but because it was honest. He spoke from the trenches of veteran care, where complexity is high, resources are limited, and compliance is often mislabeled when the real issue is treatment burden.

What emerged clearly was this: veterans are not failing our systems — our systems are failing them. Programs that require frequent visits, rigid scheduling, calorie tracking, and constant willpower collapse under the weight of real life. In contrast, simple, metabolically aligned interventions — particularly low-carbohydrate, food-first approaches — consistently reduced hunger, improved glycemic control, decreased medication reliance, and actually kept people engaged.

Perhaps the most resonant idea was his framing of metabolic care as minimally disruptive medicine. When interventions align with physiology instead of fighting it, adherence improves not because patients try harder — but because the process finally works with them. His work was a reminder that scalability doesn’t come from more layers of care, but from clarity, simplicity, and respect for lived experience.

Siobhan Huggins

Therapeutic Carbohydrate Reduction for Lipedema

Siobhan Huggins offered one of the most quietly validating talks of the conference — particularly for women whose bodies have long been misunderstood. Lipedema is not a failure of discipline. It is not “refractory obesity.” It is a distinct, painful, inflammatory disorder — and it demands care that is both metabolically informed and emotionally intelligent.

What stood out was her refusal to oversimplify. Therapeutic carbohydrate reduction was presented not as a universal prescription, but as a tool that must be tailored — to symptom severity, metabolic state, emotional readiness, and lived history. For some, modest carbohydrate reduction is sufficient. For others, deeper ketosis can dramatically reduce pain and swelling within weeks. The goal is not aesthetic normalization, but functional relief and dignity.

Equally important was her insistence on a holistic lens. Diet does not exist in isolation. Psychological safety, social support, prior diet trauma, comorbid conditions, and sustainability all matter. Her work bridges communities that too often talk past one another — metabolic health, lymphatic medicine, and patient advocacy — and reminds us that effective care begins with listening.

Day 2: From Risk to Responsibility

If Day 1 reframed cardiovascular disease as a metabolic process that can be seen, measured, and modified, Day 2 asked a more demanding question: once we see the disease, how do we practice responsibly in a world where physiology is changing faster than our models?

The morning sessions dismantled the illusion of static risk. Metabolic health is not a checkbox; it is a trajectory. As insulin resistance resolves and inflammation quiets, the meaning of traditional risk markers shifts. LDL cholesterol, ApoB, and Lp(a) do not disappear in importance—but they become context-dependent signals rather than absolute verdicts. Imaging, longitudinal data, and effect size replaced dogma and population averages. What emerged was not certainty, but precision with humility: follow outcomes, follow physiology, and resist the false comfort of algorithmic medicine.

By the afternoon, that philosophy was grounded in real-world populations. Athletes were revealed as biologically complex, not biologically exempt. Veterans were shown to thrive when care became simpler, not more bureaucratic. Women with lipedema were finally framed as metabolically responsive rather than refractory, with carbohydrate reduction presented as a therapeutic tool delivered through a holistic, patient-centered lens. Across these sessions, the through-line was unmistakable: biology responds when we stop fighting it and start aligning with it.

Day 2 did not offer a new checklist. It offered a new posture: Measure disease directly. Track people over time. Reduce treatment burden. Honor individual context. Stay scientifically rigorous—and human.

In a conference dedicated to metabolic health, Day 2 felt like a turning point. Not just in what we know, but in how we are being asked to practice. The message was clear: the future of cardiometabolic care will belong not to the loudest theories, but to the clinicians and researchers willing to follow physiology wherever it leads.

Day 3: Application, Resilience, and What Comes Next at 2026 Boca Symposium for Metabolic Health

Day 3 beckoned us further upstream — into mechanisms and unresolved questions that will define the next chapter of metabolic and cardiovascular medicine. If the first two days taught us how to see and care more wisely, the final day asked: what must we be willing to rethink in order to practice medicine that reflects biology as it is?

Annette Bosworth, MD

Stories That Make Ketogenic Therapy Real

When Annette Bosworth opened Day 3 with stories, the energy in the room
changed immediately. Not because the science disappeared — but because it got a pulse. These were not curated success stories designed to impress. They were clinical lives. Messy. Imperfect. Human. People who didn’t transition cleanly. Who relapsed. Who misunderstood the assignment. Those who improved cognitively before their family relationships caught up. Who felt better — and then got scared by that fact. And yet….

Again and again, the same pattern emerged: when the brain’s fuel changed, the person changed. Attention stabilized. Anxiety softened. Emotional reactivity quieted. Identity reassembled. Not all at once. Not forever. But enough to matter. What made this session land wasn’t inspiration — it was honesty. When asked about failure, Dr. Bosworth didn’t defend the intervention. She reframed the question. Failure wasn’t a verdict. It was information. It told you where support was missing, where expectations were unrealistic, where the environment hadn’t yet caught up to the biology.

What made this session powerful was its honesty. Ketogenic therapy was not presented as a cure-all, but as a tool that demands structure, support, and humility. Failure wasn’t framed as weakness — it was feedback. And success, when it came, was never accidental. It was earned through consistency, environment, and trust in the process. By the end, it was impossible to see ketogenic therapy as some new trend. It stood revealed as what it truly is: a legitimate neurometabolic strategy with real human consequences.

Melanie Tidman, DHSc

Parkinson’s Disease Through a Metabolic Lens

Melanie Tidman brought the room somewhere quieter — and deeper. This was not a talk about curing Parkinson’s disease. It was a talk about living inside it. About the erosion of trust patients feel when medication adjustments dominate the conversation while the body continues to fail them. About the grief of watching capability slip — and the dignity that comes from reclaiming even a fraction of agency.

She spoke about metabolism not as rebellion, but as realism. If neurons are starving, she asked, why are we surprised when function falters? Ketogenic therapy, in this framing, wasn’t an alternative. It was an adjunct of compassion — a way to support energy production when neurotransmitter manipulation alone is insufficient.

The Q&A was telling. No one asked for guarantees. They asked about sustainability. About quality of life. About how to talk to patients without overpromising. She answered carefully. She didn’t sell hope. But she did describe possibility. And in doing so, modeled something rare: how to speak honestly about neurodegeneration without stealing either realism or dignity.

Ben Bocchicchio

Exercise as Metabolic Signaling, Not Punishment

Ben Bocchicchio did not motivate the room. He liberated it. With decades of perspective, he dismantled the idea that exercise is a moral obligation or a punishment for eating. Instead, he returned it to its rightful place: a biological signal. One of the most potent ones we have. Muscle, he reminded us, is not cosmetic. It is endocrine. It speaks to mitochondria, insulin receptors, inflammatory pathways, and the aging brain. Exercise is not about burning calories — it’s about signalling, about instructing cells how to behave.

What made his presentation land was its generosity. This wasn’t exercise versus diet. It was exercise with diet, exercise amplifying diet. He reframed movement as a therapeutic tool — one that, when paired with metabolic nutrition, restores insulin sensitivity, reduces inflammation, and reclaims agency over aging. It was a reminder that strength, quite literally, is protective. People asked how to scale exercise for fragile patients. For those already overwhelmed. For those recovering from illness. Dr. Ben didn’t prescribe heroics. He prescribed respect. Start where the body is. Pair movement with metabolic nutrition. Let strength accumulate quietly.

Dom D’Agostino, PhD

Traumatic Brain Injury and the Metabolic Crisis of Aging

Dom D’Agostino’s session carried a different weight. This was not about optimization. It was about fragility. He spoke about traumatic brain injury in older adults with a clarity that bordered on uncomfortable. Falls. Polypharmacy. Anticoagulants. Undiagnosed hypoxia. A brain already struggling to metabolize glucose — suddenly injured — with no backup fuel available.

His framing was precise. Age, he argued, is not the problem. Frailty is. Metabolic dysfunction is. Medication burden is. When a brain already struggling to metabolize glucose sustains injury, the result is a prolonged energy crisis — one that standard imaging often fails to capture and standard care rarely addresses. Ketones, in this context, are not a wellness trend. They are emergency fuel.

The Q&A reflected this gravity. Questions were precise. Answers were sober. There were no promises. Only a clear articulation of risk — and a compelling argument for metabolic resilience as preventative medicine.

Closing Panel at 2026 Boca Symposium for Metabolic Health — A Community Thinking Out Loud

The closing panel did not attempt to tidy things up. Instead, it did something far more valuable: it demonstrated how grown-up medicine sounds.

LDL. NAD. Psychiatric medications. Supplements. Imaging. N-of-one data. Population trials. The questions were sharp. The answers were nuanced. No one pretended the field was settled. No one retreated into dogma.

What stood out was how the panelists handled uncertainty — not defensively, but fluently. They acknowledged limits. And distinguished data from belief. They respected disagreement without dramatizing it. And they returned, again and again, to the same anchor: the person in front of you matters more than the model you’re tempted to apply.

It was an ending that felt earned. And mature.

By the end… 2026 Boca Symposium for Metabolic Health closed with our shared commitment to physiology over ideology. To humility over certainty. And to caring for real people living real lives.

And that, quietly, is how meaningful fields evolve.

To your best life,