Friday

7:00-8:00 AM – Registration Opens 

8:00 – 8:15 Welcome and Introduction 

8:15 – 9:15 AM 

Physiological Basis of Exercise for Health Benefits: A Primer

Exercise is a subset of physical activity that is planned and structured with the objective to improve or maintain health, functional capacity, or performance. Regular aerobic exercise increases cardiorespiratory and musculoskeletal fitness by enhancing the capacity to transport and utilize oxygen and convert fuels such as sugars and fats into cellular energy. This session will consider the physiological basis of exercise responses and how training-induced changes in the cardiovascular, respiratory, and skeletal muscular systems are linked to improved health and reduced risk of cardiometabolic diseases.

Martin Gibala, PhD 

9:15 – 10:15 AM 

HIIT to Get Fit: Application of interval training in the prevention and treatment of cardiometabolic disease

High-intensity interval training (HIIIT) describes a style of exercise involving repeated bouts of hard work interspersed with recovery periods. The method is commonly viewed in the context of athletic performance and is an essential component of the training programs of high-level endurance athletes. The concept of interval training to improve health, including in a rehabilitative context or when practiced by individuals who are insufficiently active or deconditioned, has also been advanced for decades. This session will consider the practical application of diverse HIIT protocols including the potential for brief, vigorous intermittent exercise to improve health and reduce cardiometabolic disease risk.

Martin Gibala, PhD 

10:15 – 10:45 Break 

10:45 – 11:45 AM 

Supporting Exercise and the Maintenance of Behaviour Change: Guiding without Shaming

The most efficacious exercise prescription won’t work unless your patients do it. For the vast majority of North Americans, sticking with an exercise program is not easy. How can healthcare professionals facilitate exercise adherence in their patients? In this talk, practical strategies and psychological techniques will be shared that have been designed and tested specifically for healthcare professionals to use when attempting to motivate behaviour change in diet and exercise. Foundational concepts of therapeutic alliance and motivational interviewing will be detailed in a practical, tangible manner.

Mary Jung, PhD

11:45 – 1:00 PM Lunch  

NON-CME sponsored by Belmar “Your Single Source for Compounded Medications” Jonathan Banks, PharmD

1:00 – 2:00 PM 

Deprescribing Harmful Medications:  Putting “Do No Harm” into Practice 

The average BHRT patient arrives at your door on multiple medications such as SSRIs, OCPs, Statins, Bisphosphonates, Sulfonylureas, Diuretics, Benzodiazepines and Proton Pump Inhibitors (to name a few). Many of these medications were initiated to treat symptoms of hormone deficiencies and do not correct the underlying disease state. To make matters worse, many of them come with deleterious side effects that give your patients a new disease. The human body can never be “deficient” in a synthetic drug.   Once you optimize your patient,  take the next step to deprescribe unnecessary medications and eliminate the harmful side effects they may have from them. During this talk, we will address the most common chronic disease medications that your patients do not need anymore because of all of your hard work!  

Nicole Lovat, MD, PhD 

2:00 – 3:00 PM 

Updates on Melatonin & Pregnenolone: Unsung Heroes in BHRT 

Melatonin has beneficial impacts on multiple disease states including metabolic syndrome, cancer and the circadian rhythm. We will review updates on melatonin and how important it is as part of a comprehensive BHRT therapeutic plan.  

Pregnenolone is also an under-rated hormone involved in neuroinflammation and the synthesis of steroids in various issues including the brain and lymphocytes. Via its anti-inflammatory effects, it helps maintain immune homeostasis in response to various inflammatory conditions. Pregnenolone and its metabolites impact memory, learning and mood.  In various neuroinflammatory diseases, we see decreased levels of pregnenolone. We will review the pharmacology of Pregnenolone, it’s clinical applications and dosing in various patient groups.  

Nicole Lovat, MD, PhD 

3:00 – 3:30 PM Break 

3:30 – 4:30 PM 

Is Sleep Really Necessary?  

Turns out it is and in many more ways than you may have imagined.  Join me as I take a closer look at sleep; so beneficial but so misunderstood and mysterious.  It effects everything from mood, learning, hormones, dementia, metabolism, appetite and so much more.  It’s going to be a fascinating hour that I hope results in more sleep for everyone especially the younger generation.

Connie Casad, MD

4:30 – 5:30 PM 

MTHFR/NAD+: What you don’t know could kill you and your patient! 

MTHFR (methylenetetrahydrofolate reductase) mutations are the most common methylation defect you will encounter. Patients who suffer with this genetic condition cannot metabolize the common vitamin Folate unless they are the natural or methylated forms, meaning certain versions of Folate can lead to toxic build-up and elevated homocysteine levels (such as Folic acid, present in all fortified grains in our food supply). We will review the genetic defect, clinical implications and approach to the diagnosis/treatment.  

NAD+ (Nicotinamide adenine dinucleotide) is a super-power supplement for mitochondrial health. A coenzyme for redox reactions, it is central to energy metabolism. In non-redox reactions, it is an essential co-factor involving sirtuins, CD38 and poly(ADP-ribose) polymerases. By these mechanisms, NAD+ can influence many cellular functions, metabolic pathways, DNA repair, immune system operation as well as modulating cell lifespan. As we age, we gradual lose NAD+ levels in multiple organs. In a causal relationship, low NAD+ increases cognitive decline, cancer, metabolic syndrome, sarcopenia and frailty. We will review the impact of NAD+ on health and wellness as well as provide recommendations on methods of supplementation and dosing.  

Nicole Lovat, MD, PhD 

Adjourn 

Saturday

8:00 – 9:00 AM 

Website Do’s and Don’ts:  A Legal Perspective 

Your website is how you are presented to the world. Patients, other providers, malpractice insurance companies and even medical boards can inspect your website and find shortcomings. During this talk. Attorney Grant Baldwin will go over the essential Do’s and Don’ts of website material including terms to avoid, compliance issues and advertising faux pas. During this talk, Grant will highlight the good, the bag and the ugly of a BHRT Website.  

Grant Baldwin, JD 

9:00 – 10:00 AM 

How to Chart Your Way to Success:  Legal Pearls, Pitfalls and Medical Necessities 

Will your charting and consents hold up to scrutiny from a panel of “experts” at a Medical Board or in a court of law? During this talk, we will go over the pearls and pitfalls to medical documentation as well as the consent process. Dr Lovat and her husband, Attorney Grant Baldwin will go through examples of medical documentation, terms to include in your notes and forms as well as common mistakes to avoid when practicing BHRT.  

Nicole Lovat, MD, PhD and Grant Baldwin JD 

10:00 – 10:30 AM Break 

10:30 – 11:30 AM 

Consent and How It Fits Into an Overall Risk Mitigation Strategy

Excel Medical is the leading BHRT clinic in the U.S. We’ve helped tens of thousands of patients with our Excel Advantage protocol. Following the principles taught by Dr. Rozier and Worldlink Medical, our protocol empowers our medical providers with the knowledge to make a real difference with BHRT.

When practicing BHRT, your peers’ misconceptions can expose you to scrutiny and potential board reviews.

Craig Larsen, CEO, and Dr. Peter Fotinos, Medical Director of Excel Medical, will share their experiences with all 50 states and governmental investigations. They will also cover their proactive risk mitigation strategy and the details of their consents to help you and your practice.

11:30 – 12:30 PM  

Residual Risk: Additional Tools for High Risk Patients When Hormones Are Not Enough

For patients with severe metabolic disarray, cardiovascular disease, and/or stubborn symptoms, BHRT may not provide adequate relief or risk mitigation. This presentation will highlight additional areas for investigation and intervention, including nutrition, exercise, sleep, supplementation and medication.

Lily Johnston, MD, MPH

12:30 – 1:45 PM Lunch Networking Lunch

1:45 – 2:45 PM 

The Nutritional Strategy to Mend Metabolic Health 

Insulin resistance is the most common health disorder worldwide, and at its heart is the fat cell. This talk will review the evidence that puts the fat cell at the center of the origins of insulin resistance. Following this, science-based strategies will be presented to enable the listener to understand the ideal “fat cell shrinking” journey.  

Ben Bikman, PhD 

2:45 – 3:45 PM 

Glycemic enhancement of glycation and inflammation

Hyperglycemia contributes to or exacerbates nearly every global chronic health condition. A poorly understood phenomenon that occurs when sugar is excessive is glycation. This talk will summarize data that show how the accrual of glycation products elevates inflammation and worsens systemic health. The listener will understand the impact of glycation-mediated inflammation and the rationale for sugar replacement strategies.

Paul Reynolds, PhD

3:45 – 4:15 Break 

4:15 – 5:15 PM 

GLP-1 Consequences and Considerations for GLP-1 based drugs 

With the explosion in obesity and related co-morbidities worldwide, greater attention than ever is focused on developing drug interventions to reverse the trends. However, with a system as intricate and important as metabolism, it’s no surprise that such strategies to force fat loss can have unintended consequences. This talk will review the history of GLP-1-based therapies, highlight the mechanisms of action, and elaborate on some of the oft-overlooked consequences.  

Ben Bikman, PhD

Adjourn 

6:30 – 7:00 PM Reception (cash bar)

7:00 – 10:00 Dinner and Entertainment

All Attendees are invited, Guests require a ticket to enter

Please wear your badge to dinner

Location to be announced (outside weather permitting) casual attire

Sunday

8:00 – 9:00 AM 

A Contemporary View of Menopausal Hormone Therapy – Are we Still Stuck in 2002?

This talk will review the history of menopausal hormone therapy and discuss the evolution of our thinking regarding hormones for treatment of symptoms, preservation of function and prevention of disease.

Barbary Levy, MD

9:00 – 10:00 AM

Literature you Should Know in Order to be Your Patient’s Advocate

Is the USPSTF still correct in their recommendations against use of HRT/ERT? Is estrogen safe in women over age 65? What about estradiol? Does current literature suggest a difference? Current literature/support for the use of estrogen in breast cancer survivors. Can or should we be giving estrogen to breast cancer survivors? Based on current literature/science/knowledge, can we protect against breast cancer which is the most common cancer in women? How can we increase the risk/incidence of breast cancer? What are we thinking? How long should we use estrogen blockers/AIs? When to stop and what to do thereafter? The case for recommending progesterone to women that have had hysterectomies. Why such resistance against P4? Does anyone not see the elephant in the room?

Neal Rouzier, MD

10:00 – 10:30 AM Break

10:30 – 12:15 PM

Neal Rouzier, MD Continued

• New HRT medical literature that you must know, understand, grasp, and be conversant in that no one else knows. You will be the expert.
• Why do we continue to do what we do when the medical literature, science, and research prove that we should be doing the opposite? The more that you know, the more passionate you will become.
• When can hormones be used when they are classically contraindicated, as in heart disease and cancer? What you should know but don’t. You must become your patient’s advocate and have a thorough understanding of the literature before prescribing BHRT.
• The harm of estrogen deprivation in women.
• The harm of estrogen deprivation in men.
• The relative risk of breast caner in women: Should we be using estrogen as prophylaxis? ACOG just can’t pull the trigger.
• Why the USPTF is wrong and should keep their mouths shut.
• How YOU can and should treat active breast cancer. But only with a good WRITTEN (not typed) informed consent that is signed by the patient. In addition, include a handwritten and signed informed consent letter from the patient that acknowledges the patient understands and acknowledges the risks. The letter is then placed in the chart along with the medical literature supporting the safety and efficacy of the hormone treatment.
• You must document in every chart the reason for prescribing each hormone.
• Is estrogen safe to use in breast cancer survivors? What about in patients that experience a recurrence of breast cancer that is now a hormone resistant cancer that has failed the usual endocrine therapy for breast cancer?
• Who in their right mind would give estrogen to a patient with active breast cancer? Well, that’s what they did in the WHI, the DOPS, and FINNISH studies.
• Is estrogen safe to use in patients with active breast cancer? So, what’s the dose? It will scare you.
• What percent of women in the WHI treated their breast cancer with estrogen? In the Danish 10-year study, what percent of women treated their breast cancer with estrogen? What percent of patients that you treat have active breast cancer that you haven’t diagnosed yet?
• Does HRT (not ERT) cause breast cancer in women? The WHI proves not! Lies, damn lies, but what about statistics? (I didn’t believe it either).
• What hormones are apoptotic to breast cancers and should be utilized to prevent breast cancer as well as breast cancer recurrence in breast cancer survivors? Again, use statistics and the medical literature to guide your therapy.
• What long-term endocrine therapy/drug used to prevent breast cancer actually increases the risk of breast cancer recurrence long-term?
• What long-term endocrine therapy to prevent breast cancer recurrence actually increases breast cancer mortality in the long run? What long-term endocrine therapy decreases the risk of breast cancer recurrence and mortality in the long run? Use statistics to guide our therapy and not consensus of opinion.
• How to increase breast cancer recurrence, mortality, and CVD. Here, read this! “And then there’s statistics.”
• What to do when the breast tumors develop resistance to AIs and tamoxifen and there is a recurrence of breast cancer? So, now what?
• What major study proved that HRT increases dementia? What recent study proved that E2 increases risk of dementia? What recent study proved that E2 protects against Alzheimer’s disease? What is the difference in the study designs that must be understood before interpreting any study and before coming to conclusions? “And then there’s statistics.”
• Don’t be misled by studies whose conclusions are false (not true) and that are not reliable. How to determine reliability.
• Was the WHI really that bad? Not according to the most recent re-analysis. How could the original researchers be so wrong in their original interpretations and publications?
• Which endocrine/hormone therapy increases breast cancer mortality, and which one reduces breast cancer mortality. So, which one does everyone get?
• How can you reduce the risk and incidence of breast cancer in you and yours and your patients?
• Review of one of my top 5 favorite papers written by the top world experts proving that BHRT lowers the risk of CVD, breast cancer, and overall mortality from all causes. Don’t fear “biologic identical” hormones.
• Does estrogen cause dementia. Answer is yes, it can. Does E2 cause dementia? Answer is no, despite what Pourhadi’s study showed.
• What study proved that E2 was associated with dementia? Answer: It was Pourhadi’s study which was a Grade-D evidence retrospective review of an insurance database.
• Review of the most comprehensive paper on estrogen in men. Understand the harm of estrogen deprivation and the benefits of estrogen replacement in men. So, how much should you take?
• At what age and under what conditions should men consider taking estrogen?
• If one in seven men over 60 have an active prostate cancer growing that has not been diagnosed yet, what does the most recent literature show concerning the use of testosterone and prostate cancer risk and occurrence.
• What is the mechanism by which phosphodiesterase inhibitors decrease the risk and severity of prostate cancer? Then, why aren’t they used to prevent prostate cancer?
• What is the mechanism by which aromatase inhibitors increase the risk/incidence of prostate cancer?
• Based on long-term use, what medicine/drug has been shown to decrease the incidence of breast cancer?
• What drugs/medicines were recommended in JAMA to reduce breast cancer risk in both premenopausal and postmenopausal women?
• Based on long-term use, what medicine/drug has been shown to decrease the incidence of prostate cancer but that is not used for prevention? What drug was shown to increase the severity and Gleason score of prostate cancer?
• What hormone proved protection against prostate cancer in long-term studies?
• It takes years of experience, insight, a grasp of medical literature, and critical thinking to understand when to block estrogen in men and when to give estrogen to men.
• The last and final studies demonstrating that the RR for blood clots/DVTs with oral E2 (RR 0.6) is much less than that for transdermal E2 (RR 0.9). So, stop preferentially using TE2 over oral E2 to prevent blood clots.

Neal Rouzier

Adjourn