Metabolism and Medicine

Brian J Fertig, M.D., F.A.C.E., is the Founder and President of the Diabetes & Osteoporosis Center in Piscataway, New Jersey (https://siomar2.wixsite.com/diabandosteocenter), established in1994. Dr. Fertig’s experience in diabetes, endocrinology and metabolism, including internship, residency, fellowship, and private practice, spans a period of 34 years. Dr. Fertig is also an Associate Professor at Robert Wood Johnson Medical School and the Chairman of the Department of Diabetes & Endocrinology at Hackensack Meridian Health—JFK University Medical Center. His passion for patient care and for finding the root problems of disease was his motivation and purpose for writing a two volume book series titled Metabolism and Medicine. On his exploratory journey, Dr. Fertig discovered modern conceptual tools to improve the problem-solving skill sets of great utility for him, his practitioner colleagues, and the next generation of healthcare providers. His genuine concern for the future of medical student education is one of the main factors that motivated him to write this book. Additionally, he is also concerned with the need for interdisciplinary expertise to augment the execution of patient care, but particularly in light of an expanding reliance on Nurse Practitioners and Physician Assistants. His philosophy is based on the concept that the greater the network of interdisciplinary scientific and clinical expertise, the greater the collective skill set and hence the benefit to the patient. The ever-increasing use of bioinformatics paves the way toward personalized-scale medicine. However, the way forward for medicine should also include skillful adaptation of methods developed in physics, which will allow quantification of therapeutic solutions with unprecedented precision. Since physics has a tendency to generalize empirical observations to formulate laws of nature while biology takes pains to tease out detailed specificities, the marriage of the two fields promises the most enlightened future direction for medicine as both an art and a science.

Contents

Prologue................................................................................................................................................... xv

Acknowledgments.....................................................................................................................................xvii

Author........................................................................................................................................................xxi

Personal Statements...................................................................................................................................xxiii

1. Introduction to Metabolism: A New Model for Medicine.................................................................. 1

2. The Stress Response: From Health to Disease................................................................................... 49

3. Nuclear Hormone Receptors: Mediators of Dynamic (Patho)physiological Responses................. 105

4. The Biology of Time: How Molecular Clocks Make Living Cells Tick...............................................131

5. Calorie Restriction, Intermittent Fasting, Ketogenic Fasting, and Time-Restricted Feeding ……...191

6. The Microbiota in Symbiotic Entanglement with Human Metabolism................................................ 225

7. The Role of Insulin Resistance in Metabolic Disease.............................................................................. 275

8. Mitochondrial Function and Dysfunction and Insulin Resistance......................................................... 323

9. Chronic Diseases of Aging as Metabolic Disorders.................................................................................. 355

Epilogue ............................................................................................................................................................413

Index..................................................................................................................................................................417