An Introduction to Metabolic Medicine

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Metabolism is the never ending biochemical process by which life carries out its functions. Doctors who deal with disease by means or attempting to restore normal metabolism are said to practice metabolic medicine. At first glance one would think this should be the only type of medicine practiced, but in fact main stream medicine uses man-made drugs to try to alter the natural process of metabolism and induce an artificial state in which undesirable symptoms are not allowed to be expressed. This is called allopathic medicine.

Metabolic medicine, in its most liberal definition, overlaps, includes, and is included by several other medical disciplines. Nutritional medicine, homeopathy, environmental medicine, enzyme potentiated desensitization, chiropractic, orthomolecular medicine, anti-aging, holistic, and preventive medicine all come to mind.

The job description of a doctor practicing metabolic medicine is to identify the areas of breakdown of the normal metabolic process and restore them to full functioning through supplying the missing nutrient or hormone, or by encouraging the release personal stress, realigning the body, readjusting the immune system, and working to prevent future recurrence of the problem. This process takes time and careful study.

Metabolism is the process your body uses to get or make energy from the food you eat. Food is made up of proteins, carbohydrates and fats. Chemicals in your digestive system break the food parts down into sugars and acids, your body's fuel. Your body can use this fuel right away, or it can store the energy in your body tissues, such as your liver, muscles and body fat.

A metabolic disorder occurs when abnormal chemical reactions in your body disrupt this process. When this happens, you might have too much of some substances or too little of other ones that you need to stay healthy.

You can develop a metabolic disorder when some organs, such as your liver or pancreas, become diseased or do not function normally. Diabetes is an example.

Metabolic: Pertaining to internal metabolism.

Metabolism: The term metabolism refers to all of the chemical reactions by which complex molecules taken into an organism are broken down to produce energy and by which energy is used to build up complex molecules. All metabolic reactions fall into one of two general categories: catabolic and anabolic reactions, or the processes of breaking down and building up, respectively. The best example of metabolism from daily life occurs in the process of taking in and digesting nutrients, but sometimes these processes become altered, either through a person's choice or through outside factors, and metabolic disorders follow. Such disorders range from anorexia and bulimia to obesity. These are all examples of an unhealthy, unnatural alteration to the ordinary course of metabolism; on the other hand, hibernation allows animals to slow down their metabolic rates dramatically as a means of conserving energy during times when food is scarce.

Metabolic Diseases: Inborn errors of metabolism comprise a large class of genetic diseases involving disorders of metabolism. The majority are due to defects of single genes that code for enzymes that facilitate conversion of various substances (substrates) into others (products). In most of the disorders, problems arise due to accumulation of substances which are toxic or interfere with normal function, or to the effects of reduced ability to synthesize essential compounds. Inborn errors of metabolism are now often referred to as congenital metabolic diseases or inherited metabolic diseases, and these terms are considered synonymous.

* m. acidemia — acidemia due to metabolic error.

* m. bone disease — includes a range of bone diseases associated with metabolic diseases, e.g. secondary hyperparathyroidism, rickets and osteoporosis.

* m. defect — generally an inherited defect that is present at birth, but which is not necessarily evident clinically for several months afterwards. The defect creates a metabolic error, which leads to the accumulation of end products which cause clinical signs, e.g. mannosidosis, porphyria or an exaggerated response from an end-organ, e.g. inherited goiter. See also inborn error of metabolism.

* m. diseases — diseases in which normal metabolic processes are disturbed and a resulting absence or shortfall of a normal metabolite causes disease, e.g. hypocalcemia in cows, or an accumulation of the end products of metabolism causes a clinical illness, e.g. acetonemia of dairy cows. Many diseases in this group really have their beginnings in a nutritional deficiency state. See also production diseases.

* m. encephalopathy — many disorders of metabolism can lead to neurologic abnormalities through alterations in electrolytes and acid–base balance, accumulation of endogenous toxins. See also encephalopathy.
* m. error — see metabolic defect (above).

* m. inhibition technique — a virus neutralization test in tissue culture in which phenol-red indicator is used to detect the acid metabolic products of actively metabolizing cells or the lack of metabolism when cells are infected and destroyed by the virus.

* m. laminitis — see laminitis.

* m. myopathies — muscular dystrophies caused by metabolic defects; include systemic glycogenoses, deposits of a PAS-positive glycoprotein, the lipid storage disease of cats caused by carnitine deficiency.

* m. pathways — groupings of enzymic processes leading to the synthesis or breakdown of carbohydrates, amino acids and lipids.

* m. polymyopathy — a muscle disease associated with a metabolic disorder, e.g. hyperadrenocorticism.

* m. polyneuropathy — a disease of the nerves associated with a metabolic disorder, e.g. uremia, diabetes mellitus or hypothyroidism.

* m. profile — results of a spectrum of tests of metabolic functions.

* m. profile test — see compton metabolic profile test.

* m. rate — the rate of energy metabolism in the body. The basal metabolic rate (BMR) is the rate of energy consumption by the body when it is completely at rest.

* m. syndrome — characterized by hypertension, insulin resistance, an abnormal plasma lipid profile, and obesity.

* m. toxins — include histamine, other toxic amines, ketone bodies, phenols and cresols from the large intestine, which are normal end-products of metabolism and indigestion but if their normal excretion and detoxication are impeded, cause intoxication. See also toxin.

* m. water — the water produced in the body by oxidative metabolism of food; it represents 5–10% of the body's water utilization.

Metabolic Pathways:

In biochemistry, a metabolic pathway is a series of chemical reactions occurring within a cell. In each pathway a principal chemical is modified by chemical reactions. These reactions are accelerated, more accurately catalyzed, by enzymes. Dietary minerals, vitamins & other cofactors are often needed by the enzyme to perform its task. Many pathways are elaborate. Various metabolic pathways within each cell form that cell's metabolic network. Pathways are needed by an organism to keep its homeostasis.

Metabolism is a step by step modification of the initial molecule to shape it into another product. The result can be used in one of three ways.

• Stored by the cell.

• Be used immediately, as a metabolic product.

• Initiate another metabolic pathway, called a flux generating step.

A molecule called a substrate enters a metabolic pathway depending on the needs of the cell & the availability of the substrate. An increase in concentration of anabolical and catabolical end products would slow the metabolic rate for that particular pathway.
Overview

Metabolic pathways often have these properties:

• They contain many steps, like a cascade. The first step is usually irreversible. The other steps need not be irreversible and in many cases, the pathway can go in opposite direction depending on the current need of the cell.

• Glycolysis features excellent examples of these features:

1. As glucose enters a cell it is immediately phosphorylated by ATP to glucose 6-phosphate in the irreversible first step. This is to prevent the glucose leaving the cell.

2. In times of excess lipid or protein energy sources glycolysis may run in reverse (gluconeogenesis) in order to produce glucose 6-phosphate for storage as glycogen or starch.

• They are regulated, usually by feedback inhibition, or by a cycle where one of the products in the cycle starts the reaction again, such as the Krebs Cycle (see below).

• Anabolic and catabolic pathways in eukaryotes are separated by either compartmentation or by the use of different enzymes and cofactors.

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List of Metabolic Disorders.pdf188.44 KB
Metabolic Medicine, Education, 2007.pdf133.55 KB
Metabolic Medicine Curriculum, 2003.pdf69.57 KB