Manuel J. Diaz, MD

05/30/2025

Coffee is widely enjoyed but often misunderstood as a beverage. It is commonly believed that due to its caffeine content, coffee poses cardiovascular risks. This isn't entirely accurate.

Research suggests that regular, moderate consumption of caffeinated coffee—defined as about 4-6 cups daily—may actually be beneficial for health. Importantly, this refers to black coffee without added creams or sugars. While caffeine can temporarily cause blood vessel constriction and increase blood pressure in people who aren't accustomed to it, these effects seem to be reduced in habitual coffee drinkers.

On the positive side, coffee contains polyphenols, which have a vasodilatory effect, potentially lowering blood pressure. Overall, regular, moderate coffee intake is linked to neutral or even positive cardiovascular outcomes. Moreover, emerging studies suggest that such coffee consumption might reduce the relative risk of developing certain cancers, like liver and endometrial cancer, as well as diabetes. However, these health benefits are modest, and generally, individuals with good baseline health experience the lowest risks.

05/27/2025

Fascinating research on brain health has, not surprisingly, revealed that optimal cardiometabolic health is at the core of brain health. In fact, most of us don't realize that the most common form of dementia is actually vascular dementia.

Aggressive cardiovascular disease risk reduction should be at the core of brain health, cancer risk reduction, and longevity. Furthermore, the approach towards cardiovascular disease risk reduction should be holistic. We should not let ourselves be distracted by false debates over whether one approach (lifestyle versus pharmacotherapy) or one particular risk factor (LDL versus insulin resistance, etc.) is more important. They're ALL important and they should ALL be addressed. The optimal health and wellness of our patients demands this.

What new research reveals about lifestyle choices, longevity, and brain health, plus exactly what to do about it.

05/23/2025

So-called "seed oils," when used for cooking and/or on salads, often get a bad rap. The reality is that many seed oils are a better alternative, at least from a heart prevention standpoint, than oils that are high in saturated fats, such as butter, palm, or coconut oil.

The fact that most seed oils - sunflower, safflower, and corn, to name a few - contain a greater amount of omega-6 polyunsaturated fats, as opposed to omega-3 fats, is often conflated to make us believe that seed oils are "bad" for us. They're not necessarily bad, just not as beneficial from a dietary point of view than oils, say, that contain more omega-3s, i.e., flaxseed oil, another "seed oil." Flaxseed oil is loaded with omega-3 polyunsaturated fats.

Of course, perhaps the best source of culinary fat are your monounsaturated oils, olive oil, avocado oil, and rapeseed (canola) oil, another "seed oil." The problem with monounsaturated fats is that they're not found in too many of our food sources.

12/24/2024

Should non-diabetics consider wearing CGM devices? I’d say absolutely! CGM stands for continuous glucose or blood sugar monitoring. Most commercially available devices are worn on your upper arm or lower abdomen. They connect, usually via Bluetooth, to an app on your smartphone that continuously monitors your blood sugar levels. The app in turn is able to process that data and provide you with averages over time, time that your blood sugar is in a normal or ideal range, highs, lows, etc. Why is this a good idea for folks with supposedly normal blood sugar levels?

Recent evidence suggests that what we thought are normal blood sugar or A1c levels may mask some folks who are actually at risk. Two factors not typically captured on routine blood tests, that are revealed on CGMs, are glucose variability and post-prandial sugar levels. Post-prandial refers to sugar levels usually 1-2 hours after you eat. Folks whose blood sugars fluctuate quite a bit between meals and/or tend to spike after meals may be at higher risk of developing diabetes later on even if their current blood sugar or A1c levels are normal!

12/22/2024

The medical management of obesity continues to evolve.

Retatrutide in a recent phase 2 trial demonstrated an average weight loss of almost 25% in over 300 non-diabetic patients with a mean BMI of 37. Retatrutide, as opposed to drugs like Ozempic and Mounjaro actually targets 3 weight regulating gut hormones, as opposed to one and two, respectively.

Another drug, bimagrumab, is an antibody that targets and blocks a receptor on skeletal muscle leading to fat loss and lean muscle growth. This one’s particularly interesting because it’s one of the first agents developed that favorably impacts weight by altering body composition. In essence, it substantially decreases fat mass while increasing lean muscle mass! In one study subjects, over 48 weeks, lost 20% fat mass while gaining 3% muscle mass!

12/21/2024

Lipoprotein a is the new kid on the block when it comes to cholesterol. Everyone should have their lipoprotein a level checked at least once in their lifetime. It’s a type of bad cholesterol that is purely genetically determined, meaning lifestyle changes such as diet and exercise won’t work to lower high levels.

Some drugs are being developed that specifically target this form of bad cholesterol and other existing drugs that are now commonly used in cholesterol management, the PCSK9 inhibitors, can potentially lower lipoprotein a levels as well.

Lipoprotein a can now be checked as an individual lab or as part of an advanced lipid panel. It’s an established and fully recognized independent risk factor for the development of heart disease, just like high blood pressure and/ or a high LDL cholesterol level. Make sure you know your lipoprotein a level as how you’re other bad cholesterol - LDL - level is treated may be influenced by your lipoprotein a level.

09/27/2023

Fascinating research conducted by Dan Buettner…I highly recommend his Netflix series on “Blue Zones…”

Longevity hacks don't have to be expensive — boost your lifespan on the cheap with tips from worldwide Blue Zones where people live to 100.

09/13/2023

There's another vaccine that's been recently approved by the FDA - the RSV (respiratory syncytial virus) vaccine. This one's recommended for everyone 60 and up.

09/13/2023

A new COVID booster is available for everyone 6 months and up as per the CDC...it should cover the current circulating strains fairly well.

If you've recently had COVID, you can delay getting the booster for up to 3 months if you're over 65 and have comorbidities, or up to 6 months if you're relatively healthy.

If you've been recently vaccinated, you may want to wait up to 6 months to receive the new booster.

Immunity starts to develop within approximately 2 weeks of getting the shot and it should protect you from acquiring severe disease, i.e., being hospitalized or dying, for up to a year.

The CDC recommended that all Americans aged 6 months and older receive the new COVID booster that targets currently circulating variants.

05/06/2023

Clearly there’s been a lot of hype associated with this newly available class of “weight loss” or “weight management” drugs, the GLP1 receptor agonists.

A few clarifying points. All of these drugs were originally developed for the management of diabetes. We quickly realized that one of the main reasons why they were effective at controlling blood sugar levels is precisely because folks were losing weight on them.

That being said, up until the present time, only 2 of the branded GLP1 receptor agonist formulations have been granted an FDA approval for weight loss - Wegovy, which is one of the branded formulations of semaglutide, and Saxenda, which is one of the branded formulations of liraglutide.

All of the other popular branded products, including Ozempic (semaglutide) and Mounjaro (tirzepatide) are approved for type 2 diabetes but not specifically for weight loss. In other words, when Ozempic, for example, is prescribed strictly for weight loss in someone who’s NOT diabetic, it’s technically being prescribed “off label.” Of course, drugs are often prescribed by practitioners off label, but off label prescribing may complicate insurance coverage, and all of these branded products are quite expensive.

Another thing that’s gained popularity is the practice of compounding, where compounding pharmacies or pharmacists create and dispense their own generic versions of the active molecule, such as semaglutide. Of course, with this approach, one should be wary of quality control issues, as well as issues with dosing, product contamination, etc.

Overall, however, these drugs seem to be safe and, in most cases, effective. As such they’re truly revolutionary in their application for weight loss.

11/09/2022

Interesting how red yeast rice, which contains a chemically identical component to lovastatin (a weak statin), was unable to do the trick as well…

The list of supplements without effects on LDL in the placebo-controlled trial include commercial preparations of fish oil, cinnamon, garlic, turmeric, plant sterols, and red yeast rice.