Hannah Prime interviews Dr Robin Lachmann, specialist consultant from University College London Hospitals. Their discussion covers the training pathway, what the specialty involves, and what it takes to be a metabolic medicine trainee.
Introduction to metabolic medicine
Metabolic medicine is a subspecialty that can be defined as a group of overlapping areas of clinical practice with common dependence on detailed understanding of basic biochemistry and metabolism, which fall within the expertise of both the physician and biochemist. It focuses on diseases where perturbations in basic biochemistry have direct effects on human health. This brings together a diverse collection of diseases:
- common conditions such as diabetes and rare ones like the lysosomal storage disorders
- acquired nutritional deficiencies and inherited defects of energy metabolism
- polygenic disorders (hyperlipidameia) and monogenic ones (familial hyperchoesterolaemia)
- phenylketonuria, which is diagnosed on newborn screening and diseases of old age like osteoporosis.
For all of these conditions, an understanding of the underlying biochemical and metabolic changes informs diagnosis and clinical management.
As well as insulin and lipid-regulating drugs, familiar to all doctors, metabolic diseases are also treated with simple vitamins, complex biologicals and solid organ and haematopoeitic stem cell transplants. Lifelong dietary treatment is an essential part of the management of many conditions.
Training in metabolic medicine can be combined with either chemical pathology or general (internal) medicine. For physicians interested in hyperlipidaemia, nutrition or metabolic bone disease, metabolic medicine might provide an attractive alternative to training in cardiology, gastroenterology or rheumatology. For those interested in inherited metabolic disease, metabolic medicine training is the ideal entry point.
Dr Robin Lachmann
Training and working in metabolic medicine
For information on the training pathway, see the Joint Royal College of Physicians Training Board.
Metabolic medicine is not participating in the JRCPTB ST3 recruitment process, but is being coordinated by Health Education East Midlands. You can learn more about the recruitment and interview process by visiting the metabolic medicine ST3 recruitment page.
Metabolic medicine resources
- Consultant physicians working with patients – metabolic medicine chapter (p167)
- Clinical Medicine articles:
- Lee PJ, Lachmann RH. Acute presentations of inherited metabolic disease in adulthood.
- Stewart PM. Tissue-specific Cushing’s syndrome uncovers a new target in treating the metabolic syndrome – 11β-hydroxysteroid dehydrogenase type 1. Clin Med 2005;5:142–6.
- Parkes M. Personalised medicine and genetic prediction – are we there yet? Clin Med 2013;13:62–64.
- Rees DC. The acute porphyrias. Clin Med 2012;12:37–40.
- Rees DC. Metabolic medicine SAQs – Self-assessment questions: The acute porphyrias. Clin Med 2012;12:41.
- Future Hospital Journal articles:
- Simmons D, Yu D, Bunn C et al. Hospitalisation among patients with diabetes associated with a Diabetes Integrated Care Initiative: a mixed methods case study. Future Hospital Journal 2015;2:92–8.
- Ebooks available online to members [email email@example.com for a password] include:
- Oxford Handbook of Nutrition and Dietetics (Oxford University Press, 2012)
- Holt T, Kumar S. ABC of diabetes (Wiley-Blackwell, 2009)
- Books available by postal loan from the library include:
- Matfin G (ed). A clinician's guide: endocrine and metabolic medical emergencies (D.C : Endocrine Press, 2014)
- Clarke Joe TR. A clinical guide to inherited metabolic diseases (Cambridge : Cambridge University Press, 2006)
Historical highlights from the library, archive and museum collection
The library has had digitised our copy of New aspects of diabetes: pathology and treatment from 1912, a series of lectures delivered to the New York Post-Graduate Medical School in which Carl von Noorden detailed a case of a 48-year-old English man on a diabetic diet plan. In these lectures von Noorden continued to stress his medical opinion that diet was the best method of treating diabetes. He doubted the long term benefit of medication and he rubbished the drinking of mineral waters and other ‘secret remedies and patient medicines’.
The RCP holds in its archives papers and correspondence relating to metabolic rate studies performed on Princess Mary, the Princess Royal, 1935, performed Sir Edward Charles Dodds FRCP (1899-1973). Sir Edward became President of the RCP in 1962. He was an authority on food and diet and also devoted time and energy to the problems of rheumatism. He provided facilities and gave advice and encouragement to younger colleagues in such work as immunopathology, steroid chemistry, cytochemistry and the work which led to the discovery of Aldosterone.
Robert (‘Bob’) Cohen FRCP (1933-2014) was professor of medicine and director of the academic medical unit at Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London. His research was primarily focused on biochemical functions of the liver, foetal programming and acid base disorders. Bob and his research group over the years meticulously investigated in vitro and in vivo hepatocyte metabolic function and the responses to alterations in acid-base status. His group were the first to demonstrate the modifications by diabetes mellitus, metabolic acidosis and maternal malnutrition of functional zonation of hepatic lobules, information that continues to inform therapeutic developments.
Bob’s expertise was recognised nationally and internationally. He co-wrote the acclaimed definitive 1976 text on lactic acidosis Clinical and biochemical aspects of lactic acidosis and (until one year before his death), the section on acid-base disorders in The Oxford textbook of medicine. Both texts are available in the library.