Issue: 32


Autumn Already?!

It's hard to believe how much cooler and shorter the days have become! The glistening morning dew is back and the mums are in full and glorious bloom. The Boards are no longer crowded and cyclists are welcome!


Rita and I are making friends at Fairway Mews and Barlow's has planted our window boxes with cabbage, pansies and ornamental peppers. Beautiful!


We would like to thank all of our patients who have inquired about our daughter's wedding. In a word, it was glorious! And with a first grandson just born to our oldest daughter and her wonderful husband, we are feeling very blessed indeed. Even though my Phillies and Val's Mets will not be in the Fall Classic, Thanksgiving has arrived early this year!


John A. Schmidt, MD 


Avoid the Hibernation Instinct!

Mammals prepare for winter by eating more, putting on fat, and reducing activity to conserve calories. Avoid these ancient instincts! Rather than waiting until New Years, join a gym now and adopt the Mediterranean diet! If you are prone to Seasonal Affective Disorder (SAD), call me for a safe and effective treatment.

The Great Fat Paradox

As published in the September 2 issue of the Annals of Internal Medicine, individuals who followed a low-carbohydrate diet for 12 months lost more weight, had lower fat mass, lower triglyceride levels and lower cardiovascular risk score than those who followed a low-fat diet. Yes, you read it right. A low fat diet led to more body fat than a low-carb diet. How can this be? Those assigned to the low fat diet were allowed up to 55 percent of their caloric intake from carbohydrates (breads, potatoes, pasta, etc.). Excess carbohydrate is efficiently converted by the body into, you guessed it, ___________ (Answer: Fat!!). Message: Avoid concentrated carbs to reduce body fat!


Read the label of your favorite unsalted nuts: high in fat, high in protein, low in carbohydrates, zero cholesterol. Perfect!

Carbon and You

Many of us are tired of hearing about carbon in the atmosphere, carbon in the ground, and carbon on our automobile's engine valves. But did you ever stop to think about the carbon you put into your body? Fats and sugars, like the gas we use to run our cars and heat our homes, are made of carbon. And where that carbon ends up is very important. When we exercise, we safely exhale carbon dioxide. When we eat too much and exercise too little, the ingested carbon deposits in our body and in our arteries as fat.  

How Fat Build Up Leads to Diabetes

As beautifully summarized by Dr. Gerald Shulman in the September 18 issue of the New England Journal of Medicine, type 2 diabetes currently affects more than a third of a billion people worldwide and is the leading cause of end-stage renal disease, non-traumatic amputations, and blindness in working adults. Diabetes, far more than any virus, is epidemic in China and India and mainly afflicts the rising middle class who, like us, are increasingly sedentary and overfed.


How It All Gets Started

The beginning of diabetes is called prediabetes and can be detected by a rise in hemoglobin A1c. Interestingly, most patients with prediabetes and type II diabetes make more, not less, insulin than normal individuals. The need to make more insulin is due to insulin resistance. This means that muscle and liver require higher blood levels of insulin to import glucose. A large amount of data now supports the notion that fat accumulation in liver and muscle is the culprit. The author cites well conducted studies showing that a weight reduction of 10 percent leads to marked reductions in liver fat and reversal of type II diabetes. As mentioned above, a low calorie, carbohydrate restricted diet is the best way to reduce body fat! Furthermore, a single 45 minute session of moderate intensity exercise on an elliptical markedly reduces insulin resistance in muscle thereby diverting glucose away from liver where it would otherwise be converted into fats responsible for heart attack, stroke, renal failure, and blindness.

What About Testosterone?

Testosterone has been shown to increase lean body mass. However, the FDA has now added a warning regarding deep venous thrombosis and has launched a review to assess cardiovascular risk. Thus, testosterone appears to be a poor hedge against fat accumulation based on current knowledge. If you wish to pursue this approach, we should begin by measuring your testosterone levels.


Screening for Asymptomatic Carotid Artery Stenosis (CAS)

Accumulation of cholesterol and fat in the blood vessels supplying the brain is a leading cause of stroke, death, and disability in the United States. So it may seem strange that, as reported in the September 2 issue of the Annals of Internal Medicine, the United States Preventive Services Task Force recommended against screening for carotid artery disease with ultrasound in asymptomatic adults. Why? First, the prevalence of CAS in the U.S. is low, about one percent. Atherosclerosis usually occurs in the smaller vessels inside the brain beyond detection by the ultrasonographer. Second, surgery and stenting are only slightly more effective than medical treatment (low dose aspirin, anti-hypertensives, statins, etc.) Third, any benefit from surgery or stenting is wiped out by complications which, perversely, can include stroke. Bottom Line: Interrogation of the carotid arteries with ultrasound at Community Health Fairs has the potential to do more harm than good.


As mentioned in the accompanying editorial, hypertension, atrial fibrillation, cigarette smoking, and hyperlipidemia are far more important risk factors for stroke than carotid artery stenosis. It therefore makes far more sense to treat these risk factors than to perform carotid artery ultrasound. Bottom Line: address risk factors to prevent stroke.  

Flu Vaccination, Young and Old Alike!

As reported in the August 14 issue of the New England Journal of Medicine, High Dose Influenza vaccine is more effective than Standard Dose in protecting seniors and has fewer side effects. Ask for the High Dose (HD) flu vaccine and do it now! Remember that the Centers for Disease Control recommend vaccination for everyone six months of age and older.


In another article published in the September 4 issue of the New England Journal of Medicine, the children of vaccinated pregnant mothers had a lower incidence of influenza. Pregnancy is therefore an indication, not a contraindication, for flu vaccination. Protect your children before they are born!   


Your Skin is Guarding You! Watch Out for Hair Dyes Containing PPD!

All living creatures, ourselves included, live in a hostile environment full of intruders! Our immune system stands on guard to defend us on three frontiers: the airway, the gut, and the skin. Sometimes the intruder is a product we paid to have applied to our scalp or skin.


Paraphenylenediamine (PPD), a component of many hair dyes, is a case in point.   PPD can induce a virulent response from the immune system in some individuals causing a serious scalp rash. Why? The dye binds tightly to scalp proteins and the immune system mistakes this as an intruder. The result is a violent eruption of the scalp and surrounding skin.


Ask your hair dresser if your hair color contains PPD and if you would be safer using a product that is PPD free!


Avoid Tanning Salons! 

Pilots have a higher incidence of malignant melanoma as a result of higher ultraviolet radiation exposure. This is an occupational hazard. Some subject themselves to the same risk by attending tanning salons in the winter months. Avoid exposing your skin to carcinogenic tanning rays! Tanning leads to crocodile skin and frequent visits to the dermatologist later in life.


Autumn is a wonderful time to reflect on the Circle of Life and enjoy gatherings of friends and family in warm, cozy, and colorful surroundings. Valerie and I wish you and yours a Happy and Vibrant Autumn!

In This Issue
Autumn Already
Avoid Hibernation Instinct
The Great Fat Paradox
Carbon & You
Fat Build Up Leads to Diabetes
How It All Gets Started
What About Testosterone
Screening for CAS
Flu Vaccination
Your Skin is Guarding You Avoid PPD in Hair Dye
Avoid Tanning Salons


John A. Schmidt Jr., M.D.

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



Of all the seasons, autumn offers the most to man and requires the least of him. ~Hal Borland

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 
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.