Issue: 24

January is a time for fresh beginnings, breaking new ground, and realizing the Health of your dreams.  Let's make it happen together!


John A. Schmidt, Jr., MD



Prevention of Diabetes by the Mediterranean Diet

Regular readers of my newsletter will recall the landmark study published last February in the New England Journal of Medicine documenting that the  reduces death due to cardiovascular causes. Why is the Mediterranean diet, supplemented with extra virgin olive oil or mixed unsalted nuts, so effective?  


Part of the explanation was reported in the January 7 issue of the Annals of Internal Medicine. The supplemented Mediterranean diet significantly reduced the incidence of type 2 diabetes mellitus in patients 55 to 80 years old with cardiovascular risk factors.  Interestingly, there was no intervention to increase physical activity or reduce weight. The study therefore suggests that a change in diet can, by itself, prevent diabetes in some older adults. Conclusion? Exercise, weight loss, and the right foods work together to prevent diabetes, a key cardiovascular risk factor.

Correlation between Body Mass Index (BMI) and All-Cause Mortality in New Diabetics

As published in the January 16 issue of the New England Journal of Medicine, among new diabetics who never smoked there was a direct linear relationship between BMI and all-cause mortality.  The lowest risk was observed in new diabetics with a BMI between 22.5 and 24.9.  The authors conclude, "Maintenance of healthy body weight should remain the cornerstone of diabetes management, irrespective of smoking status." Calculate your BMI on our Healthy Links page.


Should Vitamins Be Included in Your New Year's Resolutions?

In an editorial published in the January 7 issue of the Annals of Internal Medicine entitled "Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements," the authors note that studies involving more than 450,000 participants showed no benefit of vitamins or supplements on all-cause mortality, cardiovascular disease, cognitive decline, memory, or cancer.  They suggest that your money would be better spent elsewhere. (For example, on a blood pressure cuff!  See below!)


I remind my patients that pregnant mothers must take folic acid to prevent neural tube defects in their newborns. Likewise, persons whose diet consists largely of alcoholic beverages should take thiamine to treat alcoholic brain disease!  With these exceptions, the value of vitamins and supplements for well-nourished patients eating a balanced diet remains unproven and, as discussed in the editorial, some vitamins taken in excess may be dangerous.


Get a Grip on Your Blood Pressure: New Guidelines Released!

High blood pressure, the "silent killer," is initially asymptomatic but ultimately leads to stroke, heart failure, and premature death. 


The long awaited recommendations from the Eighth Joint National Committee (JNC 8) were published online in the Journal of the American Medical Association (JAMA) on December 18.  Here is a concise summary:


1) In the general population aged 60 or older, medications should be used to reduce systolic blood pressure to less than 150 mm Hg (mm Hg = millimeters of mercury) and diastolic blood pressure to less than 90 mm Hg.


2) For individuals less than 60 years old, medications should be used to reduce systolic blood pressure to less than 140 mm Hg and diastolic blood pressure to less than 90 mm Hg.  This more aggressive goal was also recommended for all adults with diabetes and/or chronic kidney disease.


3) Among non-blacks, first-line treatment options include thiazide-type diuretics (e.g., hydrochlorothiazide), calcium channel blockers (amlodipine), angiotensin-converting enzyme inhibitors (lisinopril), and angiotensin receptor blockers (losartan). Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are interchangeable and should not be used together. Many familiar medicines often used in the treatment of high blood pressure such as metoprolol, atenolol, carvedilol, clonidine, hydralazine, spironolactone, furosemide and aliskirin are only recommended if the first line medicines are ineffective in combination or poorly tolerated.


4) Among blacks, initial treatment should include a thiazide diuretic and/or a calcium channel blocker. 


5) Among individuals with chronic kidney disease, an angiotensin converting enzyme inhibitor or angiotensin receptor blocker should be used, though not together.


6) All patients should limit daily sodium intake to less than 2000 mg, and preferably, 1500 mg a day, exercise, and adopt the Mediterranean diet.


Controversy Over the New Guidelines

As published online in the Annals of Internal Medicine on January 14, not all of the JNC 8 experts agreed with setting the threshold for systolic blood pressure treatment at 150 mm Hg for persons age 60 or older, arguing that two of the key trials upon which the recommendation was based achieved systolic blood pressures closer to 140 mm Hg.  Having reviewed the arguments pro and con, I am in agreement with the minority view and will work with all of my patients to consistently achieve a systolic blood pressure less than 140 mm Hg.  I further recommend that all of my patients invest in an automatic, battery powered, blood pressure cuff and follow the directions found on the American Heart Association web site describing the proper way to measure resting blood pressure or watch this video. Email me with any questions.

Arthroscopic Surgery for Meniscal Tears
Arthroscopic partial meniscectomy is one of the most common orthopedic procedures yet rigorous evidence of its efficacy is lacking.  Swedish investigators report in the December 26 issue of the New England Journal of Medicine that in 146 patients aged 35 to 65 years old with a degenerative medial meniscus tear, meniscectomy was no better than "sham surgery" (exactly the same operation but without removing the damaged meniscus).  There was no greater reduction of pain, improvement of function, or prevention of subsequent knee surgery.  Most patients improved over the course of six months even if they had the sham operation.  The authors conclude that the current practice of performing arthroscopic partial meniscectomy for medial meniscal tears is generally not warranted.

Turn Cell Phones Off While Driving

The best way for teenagers and young adults to stay healthy is to avoid unsafe practices.  This article is a case in point.


As published in the January 2 issue of the New England Journal of Medicine, investigators from Virginia Tech installed cameras in the vehicles of 42 newly licensed drivers aged 16 to 17 years of age.  There were 167 crashes or near crashes during a 27 month period.  The risk of a crash or near crash increased 8 times while dialing a cell phone, 7 times while reaching for a cell phone, 4 times if sending or receiving text messages, and 3 to 4 times while looking at a roadside object or eating.  Among experienced drivers, dialing a cell phone increased the risk of a crash or near crash 3.5 times. Talking on a cell phone was not associated with increased risk in this study. The results strongly endorse turning off mobile devices, keeping eyes on the road, keeping both hands on the wheel, and avoiding distractions including food while driving.  Though not addressed in this study, blue tooth and voice activated devices allow one to keep hands on the wheel and eyes on the road.  Healthy people die in automobile accidents.  Safety first!!


Goal Setting for 2014

Some of my healthiest patients have the good habit of setting SMART health goals at the beginning of the year. SMART stands for Specific, Measurable, Attainable, Realistic, and Timely. Let me give you an example. Instead of saying, "I am going to lose weight this year," say "I am going to reduce my BMI to 25."  Instead of saying, "I am going to see my doctor this year," say, "I am going to work with my doctor to reduce my elevated blood pressure to 140/90." The benefit of including the more specific targets is huge because you can chart your progress forward on a monthly basis and revise your strategy as needed to succeed.  Write down your 2014 goals and bring them to your next appointment!


Valerie and I look forward to working with you to make 2014 your healthiest, safest year ever!

In This Issue
Prevention of Diabetes by the Mediterranean Diet
BMI and New Diabetics
Should Vitamins Be Included
Blood Pressure - New Guidelines
Controversy Over New Guidelines
Arthroscopic Surgery for Meniscal Tears
Turn Your Cell Phone Off
Goal Setting
John A. Schmidt Jr., M.D.

 is one of the leading Internists in Monmouth County to offer  Medical Home Services 



"Take care of your body. It's the only place that you have to live"

- Jim Rohn

John A. Schmidt Jr., MD
Meaningful Medicine in Your Medical Home
709 Seventh Avenue
Belmar, NJ 07719
Phone:  732-282-8166  .  Fax:  732-280-0147 .  E-Mail:  [email protected] 
Disclaimer: The articles in Healthy Living are for general information only and are not medical advice.
Discuss all medical concerns and treatment options with your physician.