Ukudla nezidakamizwa: Ukufana nomehluko (2017)

Pharmacology Biochemistry kanye nokuziphatha

Volume 153, February 2017, Amakhasi 182–190

Peter J. Rogers^,

http://dx.doi.org/10.1016/j.pbb.2017.01.001

Amaphuzu avelele

Ukufana kokudla phakathi kokudla kwezidakamizwa nokudla kulindeleke ukuthi kube ngokufana.
Izidakamizwa zokuhlukunyezwa zinemiphumela emandla kakhulu kunokudla.
Ukudla nsuku zonke ngokweqile akubonakali kahle njengomlutha wokudla.
Ukweqiwa okwenziwa njalo kokudla komoya onamandla kuchaza kangcono ukukhuluphala.
Ukunikela ekudleni ngokweqile kumlutha wokudla kungazuzisa.

abstract

Lokhu kubuyekezwa kuhlola ukufaneleka 'kokulutha kokudla' njengencazelo yokudla ngokweqile (okungukuthi, ukudla ngokweqile kwalokho okudingekayo ukugcina isisindo somzimba esinempilo). Ichaza ukufana okuhlukahlukene okubonakalayo ekuthandeni ukudla nezidakamizwa. Isibonelo, izindlela ezinemibandela yezemvelo zingavusa isimilo sokudla nokufuna izidakamizwa, 'ukulangazelela' kungukuhlangenwe nakho okubikwe ukuthi kwandulela ukudla nokudla izidakamizwa, 'ukuzitika' kuhlotshaniswa nokudla nokusetshenziswa kwezidakamizwa, futhi ukubekezelelana okunemibandela nokungenamibandela kwenzeka ekudleni futhi ukungena kwezidakamizwa. Lokhu kungalindelwa, njengoba izidakamizwa eziluthayo zingena ezinqubweni ezifanayo nasezinhlelweni ezavela ukuze zishukumise futhi zilawule izindlela zokuziphatha eziguqukayo, kufaka phakathi ukudla. Ubufakazi, nokho, bukhombisa ukuthi izidakamizwa zokuhlukumeza zinemiphumela enamandla kakhulu kunokudla, ikakhulukazi maqondana nemiphumela yazo ye-neuroadaptive ebenza 'bafunwe.' Ngenkathi ukuzitika ngotshwala kubhekwe njengohlobo lokuziphatha okuluthayo, akuyona imbangela enkulu yokudla ngokweqile, ngoba ukudla ngokweqile kunesifo esiphansi kakhulu kunokukhuluphala. Esikhundleni salokho, kuhlongozwa ukuthi ukukhuluphala kubangelwe ukusetshenziswa ngokweqile kokudla okuminyene kwamandla. Ukudla okunjalo, ngokuhlobene, kuyakhanga futhi (ikhalori lekhalori) kuyasuthisa. Ukunciphisa ukutholakala kwabo kunganciphisa kancane ukudla ngokweqile futhi ngenxa yalokho kunciphise ukukhuluphala. Ngokusobala, abenzi bezinqubomgomo zokukholisa ukuthi lokhu kudla kuyalutha bangaxhasa isenzo esinjalo. Kodwa-ke, ukusola ukudla ngokweqile ekuluthweni kokudla kungaba yinzuzo, ngoba kusengozini yokunciphisa ukulutha okungathi sína, futhi ngoba ukunikezwa kokudla ngokweqile ekuluthweni kokudla kusho ukwehluleka ukulawula indlela umuntu adla ngayo. Ngakho-ke, ukubeka ukudla kwansuku zonke ngokweqile ekuluthweni kokudla kungahle kungachazi noma kusize kakhulu ekunciphiseni le nkinga.

Amagama angukhiye

Umlutha;
Isifiso;
Isimangalo;
Ukudla;
Izidakamizwa;
Umvuzo;
Ukukhuluphala;
Ukunxanela;
Ukuluma

1. Isingeniso

Ukusetshenziswa kwesayensi kwegama elithi umlutha ngokubhekisele ekudleni (ushokoledi) kulandelwe emuva ku-1890, kwalandelwa yisifiso esenzeka ngesihloko ngesihloko esivela kuma-1950s, kanye nokushicilelwa kwezincwadi endaweni yakamuva kakhulu (UMeule, 2015). Lolu cwaningo lwakamuva luqukethe izifundo zokuziphatha nezomzimba kubantu, kanye nokuthuthukiswa kwamamodeli ezilwane 'eziluthwa lokudla' ezithinta kokutholakele okubanzi kusuka kumamodeli ezilwane okulutha kwezidakamizwa. Ingxenye enkulu yokubaluleka kokulutha, empeleni, ilele ekulimaleni okwenziwe kubantu abanomlutha, emindenini yabo nakwabanye abathinteka ngokungaqondile, kanye nomthwalo obekelwe abahlinzeki bezempilo kanye neziphathimandla zikahulumeni nezikahulumeni. Izindleko ngazinye nezomnotho zokukhuluphala ngokweqile nokukhuluphala, ngezimo ezihambisana nazo ezinjengesifo sikashukela se-2, isifo senhliziyo kanye ne-osteoarthritis, nazo zikhulu kakhulu, ezidinga 'isenzo esiphuthumayo somhlaba jikelele' (Ng et al., 2014). Ukuxhumanisa lezi zinkinga kungenzeka ukuthi ukudla ngokweqile (okuchazwa njengokudla ngokweqile kwalokho okudingekayo ukuze ulondoloze isisindo somzimba onempilo) kungaqondakali, okungenani ngokwengxenye, njengokuluthwa kokudla. Inhloso yalokhu kubukeza ukuhlola ukuthi kunezinto ezingakanani ezijwayelekile phakathi kokusetshenziswa kokudla kanye nokusetshenziswa kwezidakamizwa eziluthayo ezinjengotshwala, ama-opioid, ama-stimulants kanye nogwayi, nokuthi ngabe lokhu kuqhathanisa kungasiza yini ekulweni nokudla ngokweqile.

I-2. Kuyini ukulutha?

Lo mbuzo ubaluleke kakhulu ekunqumeni ukuthi ukuziphatha okuhlukile noma cha, njengokudla ushokoledi noma ukubhema ugwayi, kuyafaneleka yini ukuba umlutha. Uma, ngokwesibonelo, izindlela eziqinile kakhulu zisetshenzisiwe kungenzeka ukuthi kuphethwe ukuthi ukulutha kokudla bekuqabile noma kwakungekho.

Ezimweni zokwelapha zokulutha zibekwe, ngokwesibonelo, i-Diagnostic and Statistical Manual of Mental Disrupt, 5th Edition (DSM-5) (I-American Psychiatric Association, i-2013) kanye ne-International Statistical Classization of Diseases kanye Nezinkinga Ezihlobene Nezempilo (I-World Health Organization, i-1992). Lezincwajana ezimbili zivumelana kakhulu ekuluhlu lwezinto ezisetshenziswayo ezichaza umlutha njengobukhona okungenani okungenani ezimbili noma ezintathu kulokhu okulandelayo: ubunzima ekulawuleni ukusetshenziswa kwezidakamizwa; isifiso esinamandla noma ukufisa into; ukubekezelela okunjalo okunyusa imithamo yento kuyadingeka ukufeza ukudakwa noma imiphumela oyifunayo; imiphumela emibi yokuhoxiswa okunamandla kwento; ukunganakwa kwezintshisekelo ezihlukile, kanye nemisebenzi yezenhlalo, yomndeni nomsebenzi; imizamo engaphumelelanga yokuyeka ukusetshenziswa; futhi nokuqhubeka nokusebenzisa naphezu kolwazi lokulimala ngokomzimba noma kwengqondo okubangelwa yile nto. Empeleni, zombili lezi zincwajana zigwema ukusebenzisa igama elithi umlutha, esikhundleni salokho zikhetha 'Izinkinga Zokusebenzisa Izidakamizwa' kanye 'nokuxhomekeka kokusetshenziswa kwezidakamizwa,' ngokulandelana. Abanye bavumela umlutha 'kwisimo esisezingeni eliphakeme noma se-psychopathological lapho ukuphathwa kokusetshenziswa kwezidakamizwa kulahlekile,' futhi bahlukanise lokhu kuncike lapho abathi 'kubhekisa esimweni sokudinga umuthi ukuze usebenze ngaphakathi kwemikhawulo ejwayelekile' nokuthi yikuphi 'okuvame ukuhlotshaniswa nokubekezelela nokuhoxa, nangomlutha '(I-Altman et al., 1996, p 287).

Ukuhambisana nokubukwa kochwepheshe, izincazelo zesichazamazwi zinikeza ubufakazi obuhle kakhulu bokuthi amagama asetshenziswa kanjani empilweni yansuku zonke. Incazelo enkulu yesichazamazwi somlutha ingafushaniswa ngokuthi 'ukuba ngokomzimba futhi / noma ngokuxhomekeka entweni ethile noma emsebenzini othile,' kuncike kulo mongo ochazwe ngokuthi 'ukungakwazi ukwenza okuthile ngaphandle kokuthile.' Okuhambisana nalezi zincazelo kungumqondo 'wokuphoqelela' kanye 'nokuqaphela', noma ngobumnene 'ukuthanda' noma 'ukuthanda' okuthile. Lokhu kokugcina kungasebenza kozithandayo noma, ngokwesibonelo, umuntu othi 'angumlutha wokubukela ama-opera,' edlulisela uthando lwawo ngezihloko ezithile zomdlalo we-TV, kepha mhlawumbe futhi egcizelela ukuthi banomuzwa wokuthi bachitha isikhathi sabo esiningi ku lo msebenzi. Ngokufanayo, umuntu othi ungumuntu 'we-chochoric' kungenzeka azimisele ngalokho abakubona njengokusebenzisa kwabo chocolate ngokweqile (URoger noSmit, 2000). Kodwa-ke, kungangabazeka okuncane ukuthi lezi zibonelo ziveza ubunzima obungathi sína obubangelwa 'umlutha' kunalezo ezibhekene nomuntu onenkinga enkulu yokugembula noma umuntu one-Alcohol Use Disorder njengoba kuchaziwe kwi-DSM-5.

Lokhu kukhomba kunesidingo sokucabanga ngengozi yokulutha ehambisana nokuchayeka ezintweni ezahlukahlukene kanye nemisebenzi, kunokuba kuhlukaniswe into njengento eyimilutha noma engeyona umlutha. Isibonelo, iningi labathengi botshwala ababa imilutha, kepha abanye bayakwenza. Yize ukuphuza ikhofi kubeka engcupheni ephansi yokulutha, ingxenye encane kakhulu yabathengi be-caffeine mhlawumbe bahlangabezana nezindlela ezinqala zokuxhomekeka kwezidakamizwa (umlutha) (I-Strain et al., 1994). Qaphela, noma kunjalo, okusekelwe U-Altman et al.'s (1996) Incazelo yokuncika (ngenhla), iningi elikhulu kakhulu labathengi be-caffeine emhlabeni lithembele ku-caffeine (Roger et al., 2013). Ngokuphathelene nokudla, isibonakaliso esiyisihluthulelo senani lomvuzo sibonakala njengobukhulu bamandla (amakhalori ngesisindo seyunithi, Isigaba 4.3), noma kunjalo kunecala elibhalwe phansi kahle lokulutha ikherothi (I-Kaplan, 1996). Ngakho-ke, ngokuya ngobuthakathaka kanye nezimo ngazinye, uhla olukhulu kakhulu lwezinto nezinto okufanele zenziwe kufanele zibhekwe njengezinamandla umlutha.

Ngaphezulu, umlutha uchazwa ikakhulukazi esisekelweni sokuziphatha ngokubhekisele ezintweni nezinto ezenziwayo, kanye nemibiko yokuqonda okuhambisanayo, imizwa kanye nokunye okuhlangenwe nakho. Lokhu kuthambekela kokuhlangenwe nakho kanye nokuhlangenwe nakho kuzomelwa ebuchosheni kepha, ngaphezu kwalokho, ukusetshenziswa kwezidakamizwa kuguqula i-chemistry yobuchopho ngezindlela ezisebenzisela phambili nokusebenzisa amandla okudlayoI-Robinson ne-Berridge, i-1993, I-Altman et al., 1996 futhi I-American Psychiatric Association, i-2013). Ikakhulu, ushintsho lwe-neural oludonswe izidakamizwa kwizakhiwo ze-cortical and basal ganglia, ezibandakanya i-dopaminergic, i-GABAergic ne-opioid peptidergic neurocircuitry, kucatshangwa ukuthi zibucayi ekuthuthukiseni umlutha wezidakamizwa (Everitt noRobbins, i-2005 futhi U-Koob no-Volkow, i-2016). Lezi zinguquko zibonisa ushintsho kusuka kwesinye isikhathi, ukusetshenziswa kwezidakamizwa ngokuzithandela kuya ekusebenziseni umkhuba, ukuphoqelelwa kanye nokulutha okungapheli futhi, kanye nokuxineka okuphezulu, kubeka ngaphansi kwalokho okuchazwa njengomjikelezo ophindaphindeke kathathu wokulutha, okungukuthi 'ukuluma / ukudakwa,' 'ukuhoxa / okubi kuthinta 'kanye' nokuqikelela / ukulangazelela (ukufisa) '(U-Koob no-Volkow, i-2016). Lokhu kubalulekile ngoba iningi lezincwadi ezikumlutha wokudla libheka ukuthi umlutha wokudla ufana nokuluthwa yizidakamizwa (isib. I-Avena et al., I-2008, UJohnson noKenny, 2010 futhi UGearhardt et al., 2011a) kunokuba umlutha wokuziphatha. Umbuzo olandelayo ke, ukuthi ukudla nezidakamizwa kunemiphumela engakanani ekuziphatheni nasebuchosheni?

I-3. Ukufana kanye nokwehluka kokudla kwezidakamizwa nezidakamizwa

Ithebula 1 lifingqa okunye ukufana okungenzeka kuzimpawu zezifiso zokudla nokudla kwezidakamizwa. Lezi zakhiwe njengezimpawu zokuziphatha, kepha lapho kusebenza khona, ubufakazi bokuthi izindlela ezisetshenziswayo ze-neurobiological nazo zifingqiwe. Ukufakwa ohlwini akusho ukuthi kusondele ukufana, futhi lapho kukhona khona, umehluko phakathi kokudla nezidakamizwa ezisezimpawu kuyaxoxwa ngazo.

Ithebula 1.

Okunye ukufana okungenzeka kuzinimpawu zokudla kokudla nezidakamizwa.

Ukudla	Izidakamizwa	Isigaba (s)
Ukulawulwa kwecue kwangaphandle kwesifiso sokudla, kufaka phakathi isifiso esithile sokudla	Amakheli ahlotshaniswa nokudla izidakamizwa akhulisa isifiso sokuthatha izidakamizwa futhi athole i-'isisentious incence '	3.1 futhi 3.8
Isifiso siza ngokudla	I-Priming	3.2
Ukuvezwa kokuvinjwa kokudla	Umphumela wokuphulwa kokungafanele	3.3
Ukulangazelela kokudla	Isifiso sezidakamizwa	3.4
Ukubekezelela imiphumela ephazamisayo ngokomzimba yokufakwa kokudla, 'ukubekezelela ukubekezelela,' njll.	Ukubekezelela izidakamizwa	3.5
Imiphumela emibi yokuhoxiswa kokudla okunamandla	Imiphumela emibi yokuhoxiswa kwezidakamizwa	3.6
Ukuzitika ngokudla	Ukuzitika ngezidakamizwa	3.7, 3.6, 4.1 futhi 4.2
Ukuthanda nokufuna ukudla	Ukuthanda nokufuna izidakamizwa	3.8, 3.9 futhi 4.3
Umvuzo wokuntuleka kokukhuluphala	Ukuntuleka komvuzo ngenxa yokuchayeka ezidakamizweni	3.9

Izinketho zethebula

I-3.1. Ukulawulwa kwecue kwangaphandle kokudla kwezidakamizwa nezidakamizwa

Kusungulwe kahle kakhulu ukuthi ukuchayeka kokubona kanye nephunga lokudla, kanye nokushukunyiswa okungaphandle kokungqubuzana okuhlotshaniswa nokudla ngaphambili, kukhulisa isifiso sokudla nokuziphatha kokuhlanya (Roger, 1999). Lezi zintambo ezifanayo futhi zibangela izehlakalo zomzimba, kufaka phakathi i-saves ekhuphukayo, ukugcinwa kwe-gastric acid kanye nokukhishwa kwe-insulin (Woods, 1991). Kungenzeka ukuthi lezi zimpendulo impendulo, okungenani engxenyeni ethile, zibangele ukwanda kwesifiso sokudla, yize iqhaza labo eliyinhloko libonakala lilungiselela umzimba ukuthola ukudla (Isigaba 3.5). Kodwa-ke, imiphumela, ngisho nokunambitha ukudla (I-Teff, i-2011), mincane kakhulu kunemiphumela yomzimba ehambelana nokulandelana. Ukuchayeka ezinkanjini ezihlobene nokudla futhi kusebenza njengesikhumbuzo sokudla kanye nenjabulo yokudla, futhi kubonakala sengathi isifiso sokudla sikhushulwa kakhulu ngokudla okulondoloziwe uqobo noma ukudla okufanayo, noma ukudla okuqondene naleyo simo (isib, e-UK kaningi okusanhlamvu noma ubhontshisi wesidlo sasekuseni, kanye no-popcorn ku-cinema) (Roger, 1999 futhi UFerriday neBrunstrom, 2011).

Ngokufanayo, kunencwadi ebanzi ekhombisa imiphumela yezimpawu ezihlobene nezidakamizwa ekuziphatheni nasephiliniology. Imiphumela ifaka phakathi ukufisa okwandayo kwezidakamizwa kubasebenzisi bezidakamizwa okuvezwa kukhuthazo oluhlobene nezidakamizwa, kanye nokubuyiselwa kokuphendula izidakamizwa ezilwaneni ngemuva kwesikhathi sokuphendula okungaphendulwanga (ukuqothulwa) futhi, okuhlobene kakhulu nokusetshenziswa kwezidakamizwa zabantu, ngemuva kokuhlala isikhathi eside ngaphandle kokuqothulwa (I-Altman et al., 1996 futhi I-Koob et al., 2014). Ngokuqondene nokudla, lezi zinqolobane ziyizikhumbuzo zokusetshenziswa kwezidakamizwa, futhi zingaveza izimpendulo ezinemithi efana nokusebenzisa izidakamizwa okuhlobene nezidakamizwa (I-Altman et al., 1996). Futhi, ngokusetshenziswa okuphindaphindiwe kwezidakamizwa, abasebenzisi bezidakamizwa bangathola ukuthakazelelwa kakhulu ezimeni zokukhuthaza zezinto ezihambisana nezidakamizwa (I-Robinson ne-Berridge, i-1993; Isigaba 3.8). Ukuchayeka, okuwukulawulwa noma ukuzilawula, kwenani elincane lomuthi ngokwawo kungaba nemiphumela enamandla ngokwedlula izinto ezihlobene nomuthi. Lokhu ngokuyinhloko ukukhipha, okuxoxwa ngakho ngokulandelayo (Isigaba 3.2). Endabeni yokuphuzwa komlomo kwesidakamizwa, utshwala, ngokwesibonelo, imilomo yokuqala noma imilomo embalwa ihlanganisa ukuvezwa kwezimpawu zokunambitheka (izintambo zangaphandle eziphikisanayo) nedosi yokuphakamisa umuthi.

Kungalindelwa ukuthi imiphumela yezinkomba zangaphandle izolungiswa isimo samanje sokusutha (ukugcwala maqondana nokudla nokudakwa maqondana nokusetshenziswa kwezidakamizwa). Kodwa-ke, ukubona ukuthi imikhondo yangaphandle ehlobene nokudla kungashukumisela ukusetshenziswa ngisho nasemagundwini ahleliwe nabantu (Weingarten, 1983 futhi UCellell et al., 1989) akumele kuthathwe njengobufakazi bokuthi izinkomba zangaphandle 'zokweqile' kwezimpawu zokulawula zangaphakathi (cf. UPetrovich et al., 2002). Lokhu kungenxa yokuthi ukunqamuka okuzenzakalelayo kokudla (okuwukuhlolwa kokwethiswa) kuvame ukwenzeka ngaphambi kokuba isisu sigcwaliswe, ukuze ekugcineni kokudla cishe kube khona 'indawo yokuningi' uma okunye ukudla kwethulwe (Ro Roger and Brunstrom, 2016). Izinqolobane zokudla ezihlobene nokudla zikhombisa ithuba lokudla, futhi amandla okugcina izakhamzimba ngokweqile kwezidingo ezisheshayo avumela amathuba anjalo ukuxhashazwa, futhi kuvumela nokuthi ukudla kuphuthelwe ngaphandle kwemiphumela emibi. Lokhu kuqhathaniswa namandla alinganiselwe okubekezelela ukweqiwa kwezidakamizwa nokuhoxiswa kwezidakamizwa.

I-3.2. Umphumela we-appetizer kanye nokugunda

Inkulumo ethi l'appétit vient en mangeant (isifiso siza nokudla) ibona isipiliyoni sokuthi umlomo wokuqala wokudla okuthandwayo esidlweni ukhulisa isisusa sokudla. Lokhu kuphenywe ngu Yeomans (1996), obize lo mkhuba ngokuthi 'umphumela we-appetizer.' Ukuhlolwa kwamagundane kukhombisa umphumela omuhle ofanayo wokuxhumana ngomlomo nokudla, umsebenzi wawo okungaba ukugcina ukuziphatha 'kukhiyiwe' ekudleni, ngaleyo ndlela kuvikele ukuphazamiseka kwawo ngaphambi kwesikhathi ngomunye umsebenzi (I-Wiepkema, 1971). Njengoba isidlo sithuthukisa impendulo enhle, engahle ibandakanye ukunambitheka kanye namasibonakaliso wokungena kwangaphambi kokungena (de Araujo et al., 2008), kancane kukhungathwa ngempendulo engemihle evela ekuqongeleleni kokudla emathumbu (Roger, 1999). Esinye isibonelo sokudla okuhlobene nokudla (isifiso sokudla 'sokudla') isifundo UCellell et al. (1989). Ngokwe-Behaviourally okungenani, umphumela we-appetizer, noma incane, kuyafana nalokho okubhekiselwa kukho ezincwadini zokuluthwa yizidakamizwa njengemiphumela yokwehla kwesikhashana, futhi iqiniso lokuthi lokhu kwenzeka futhi nokudla kuyaphawulwa kulolo ncwadi (isib. de Wit, 1996). Ngisho nomuntu osebenzisa izidakamizwa isikhathi eside okwamanje, ukuthatha isilinganiso esincane somuthi kukhulisa isifiso salo muthi. Kulesi simo ukunqunywa kuyakhathaza ngoba kungaphoqeleka ukuthi kuqale kabusha ukubuyiswa ngokuphelele ekusebenziseni izidakamizwa. Lokhu kusekela i-tenet yokuyeka ngokuphelele okunconyelwe ezinhlelweni eziningi zokusebenzisa kabi izidakamizwa.

I-3.3. Ukudla okuvinjelwe kanye nomphumela wokuphulwa kokuvinjwa

Okunye okubandakanyekile ekubuyeleni kabusha ukudla izidle kanye nokwephulwa kokuhlobene kokuvinjwa kanye nemiphumela ye-snowball (Baumeister et al., 1994). Lezi zimo zibhekisele kokungahlosiwe noma okukhulu kunokusetshenziswa okuhlosiwe, futhi zithathwa ngokomqondo ikakhulukazi ngokuya ngemibono nemizwelo ebandakanyeka ekwephuleni izinhloso zokuziyeka. Okwedlulele, izeqo ezincane zibhekwa njengezinhlekelele, lapho-ke zibeka phansi eminye imizamo yokuzibamba. Lokhu kuziphatha kubonakaliswa yinto elandelayo esikalini esisetshenziswa kakhulu ekudleni okukhishwa ku-disinhibition: 'Ngenkathi ngidla, uma ngidla ukudla okungavunyelwe, ngivame ukuchitha ukudla ngidle okunye ukudla okuphezulu kwekhalori' (IStunkard neMessick, 1985). Ngemuva kwalokhu yisitayela sokucabanga konke noma cha: 'Yini isihogo, ngishaye indlela engidla ngayo, ngingaqhubeka nokudla - ngingahle ngiqale njalo (ukudla kabusha) kusasa.' Kokubili maqondana nokudla nokusetshenziswa kwezidakamizwa isincomo ukuqondisa ukunikezwa kokwephulwa kwemigomo (ukubuyela emuva) kuzimo ezilawulwayo (isib., Kulindeleke ukuthi umuntu adle ikhekhe emcimbini wosuku lokuzalwa), kunalokho ngaphakathi, izinto ezinzile njengokuntuleka kwamandla, noma umlutha noma isifo (Baumeister et al., 1994). Futhi kunjalo ukuthi isimo esiphansi kanye nokuxineka kungabangela ukucwaswa bese kubuyela emuva, okungenzeka ngokwengxenye ngokunciphisa izinsiza kusebenza zokuqonda. Ukudla- okuhlobene nokudla okuhlobene nokuxineka yizinto ezivelele esikalini sokudla magciwane. Ukudla i-disinhibition kuyisibikezeli esinamandla sokukhuluphala nokukhuluphala (UBryant et al., 2008).

I-3.4. Ukunxanela

Ukulangazelela kokudla nezidakamizwa kuchazwa njengesifiso esinamandla noma ukunxusa ukudla ukudla okuthile noma isidakamizwa esithile (URoger noSmit, 2000 futhi I-West kanye ne-brown, i-2013), futhi njengokuthi i-ciding enjalo isho okuhlangenwe nakho okuhambisana nokudla nokusetshenziswa kwezidakamizwa. Ukulinganiswa kokufisa ngakho-ke kuncike emibikweni yokuzichaza kwawomlomo yesipiliyoni, nezimpendulo ezikalini zokulinganisa ezinamagama ngokufanele. Lokhu akuvimbeli ukusetshenziswa kokufisa njengendlela yokwakha ukuchaza ukusebenza kwezilwane (isib. Kungahle kusetshenziswe njengezinga lokuphendula ngomvuzo wezidakamizwa), noma empeleni kubantu, kepha ukubaluleka kwako maqondana nesisusa somuntu sokudla ukudla nezidakamizwa kulele ekutheni ukufisa kumelele imbangela yokuziphatha kokungathandi kanye nokusebenzisa, noma umphumela wemizamo yokugwema ukusetshenziswa. Impela, ukusetshenziswa kwezidakamizwa, ngokwesibonelo ukubhema ugwayi, nokudla kungenzeka ngaphandle kokuthi kwandulelwe ngokufisa (ITiffany, 1995, I-Altman et al., 1996 futhi URoger noSmit, 2000). Ngempela, ukudla akuhlotshaniswa nokulangazelela. Esikhundleni salokho, singasho ukuthi 'ngilambile' lapho ngilindele ukudla, noma ukuthi 'bengilambile' lapho sichaza ukuthi kungani sidle ukudla okuningi. Noma lokhu, noma kunjalo, kuyihaba, ngokuqondene nabantu abondliwe ngokwanele, ukulungela ukudla empeleni kulawulwa ukungabi khona kokugcwala (isisu esigcwele sivimbela isifiso sokudla) kunokushoda kwesikhathi esifushane ekunikezelweni kwamandla kuzitho zomzimba nezicubu zomzimba (Ro Roger and Brunstrom, 2016).

Ukufisa, noma kunjalo, kubikwa ngokudla okuthile, ngokwesibonelo e-UK nase-US kuvame kakhulu ukuthola ushokoledi nokunye ukudla okubukwa njengokudla. Isimo sokuthi ukudla okunjalo kufanele kudliwe ngenani elilinganiselwe ngoba, ngenkathi kumnandi, kutholakala nokuthi 'kuyakhathaza,' akunampilo, 'indulgent', njll. Ukudla okwenqunyelwe kubangela ukucatshangelwa kwemicabango ngokudla nokuxakeka ngethemba lokukudla. Le micabango nemizwa ehambisana nayo ibhalwa njengokufisa, noma 'ukuqina kakhulu' (kwesokunxele kufisa okuningi) uma umkhawulo wenzeka ngesikhathi sokudla ukuze unciphise ukudla ngaphambi kokuvimbela inkanuko ngokugcwala (URoger noSmit, 2000). Lokhu kuhlaziya kusikhumbuza UTiffany's (1995) isiphakamiso sokuthi ukusetshenziswa kwezidakamizwa kulawulwa kakhulu izinqubo ezizenzakalelayo futhi ngaphandle kokuba khona kwesipiliyoni sokufisa ngaphandle kokuthi ukusetshenziswa kwezidakamizwa kuvinjelwe noma kuvinjelwe. Ngakho-ke izimo zengqondo eziguqukayo ngokudla okuthile nokusetshenziswa kwezidakamizwa nemizamo ephumelelayo yokunciphisa ukunqotshwa noma ukuvimbela ngokuphelele idlala indima enkulu ekubangeleni isifiso sokudla nezidakamizwa.

I-3.5. Ukubekezelela

Ukubekezelelwa kwezidakamizwa wukuncipha komphumela wesidakamizwa osuka ekuchayweni okuphindaphindiwe kwento. Noma ukusebenza, 'kungukushintshela kwesokudla emsebenzini wokuphendula umthamo ukuze imithamo ephezulu (yesidakamizwa) iyadingeka ukukhiqiza umphumela ofanayo' (I-Altman et al., 1996). Ukubekezelela kungenzeka kwimivuzo emihle kanye nemiphumela engemihle yezidakamizwa zokuhlukunyezwa, futhi kuphumela ekuguqukeni okuhlukahlukene, kufaka phakathi i-metabolism yezidakamizwa nomsebenzi we-kwelitshe receptor, kanye nokuthuthukiswa kwezimpendulo ezilindelekile (ezifundile) eziphikisana nemiphumela ethile yesidakamizwa (I-Altman et al., 1996). Ukubekezelela kuyahlukahluka kuzo zonke izidakamizwa, futhi futhi kuyehluka ngemiphumela ehlukile yesidakamizwa, kuze kufike lapho ukuzwela (ukwanda kokuzwela) kungenzeka nemiphumela ethile (I-Altman et al., 1996). Njengesibonelo sansuku zonke, imiphumela ye-caffeine ikhombisa ukungafani kokubekezelelana. Ukubekezelela okuphelele noma cishe okuphelele kokuvuka kanye nemiphumela emincane yokukhathazeka ye-caffeine kwenzeka ngamazinga alinganiselwe wokuvezwa kokudla ku-caffeine (izinkomishi ze-2-3 zekhofi ngosuku). Ngokuqhathanisa kukhona ukubekezelela okuyingxenye kuphela kokukhuphuka kokuqhaqhazela kwesandla okubangelwa yi-caffeine, nokungabekezelelani okuncane noma okuncane komphumela we-motor Speed (noma ukukhuthazela) we-caffeine (Roger et al., 2013). Ngokuvamile, ukubekezelela imiphumela emibi nengaphendukezelayo (yezidakamizwa) yezidakamizwa, kufaka phakathi ugwayi, utshwala kanye ne-opiates, kubalulekile ekusungulweni nasekugcinweni kokusetshenziswa kwezidakamizwa nokuhlukumezeka (I-Altman et al., 1996). Ukubekezelela imiphumela ezuzisayo yezidakamizwa nakho kungakhulisa ukusetshenziswa kwayo (I-Altman et al., 1996 futhi I-West kanye ne-brown, i-2013), kepha imvamisa uma isimilo (ie, izidakamizwa noma ukudonsa kokudla) siba nomvuzo omncane, ngokuqhubeka kwesikhathi, ukuphendula kungalindelwa ukuthi kwehle (URoger noHardman, 2015). Lokhu kuxoxwa ngakho ngezansi ngokuqondene 'nokushoda komvuzo' (Isigaba 3.9).

Ekubuyekezweni kwakhe 'I-Paratingx Yokudlela: Indlela Esikudinga Ngayo Ukudla,' Ama-Woods (1991) yenza ukuxhumana okucacile phakathi kokubekezelelana kwezidakamizwa nokudla. Uveza ukuthi izimpendulo zesigaba se-cephalic esibizwa ngokuthi (sezinemibandela) sokushushuluzwa kwesisu, ukugcotshwa kwe-gastric acid kanye nokukhishwa kwe-insulin okulindeleke ukuthi ukudla kudle ngokulungiselela umzimba inselelo yokudla kokudla. Ngokwenza kanjalo, basiza ukugcina i-homeostasis yomzimba, ngokuhambisana nomsebenzi wokubekezelelwa kwezidakamizwa onemibandela. Ubunikazi bezimpendulo buyehluka phakathi kokudla nokusetshenziswa kwezidakamizwa naphakathi kwezidakamizwa, futhi okungenani ekudleni ubukhulu bomphumela obonakalayo mncane kunezimpendulo zomzimba ngokudla emlonyeni nangemva kokugwinya.

Enye into yokubekezelela ukudla ukukhuphuka komthamo wesisu okuhlobene nokudla kokudla kakhulu (UGeliebter noHashim, 2001). Lokhu kungahle kubangele ukubekezelelana kokuhluthuka, okungasiza ekusetshenzisweni kokudla okukhulu kunama-binges alandelanayo. Ngokufanayo, ukubekezelelana kwesatiety kungahle kuthuthuke, yize kuhamba kancane, kubantu abakhulisa usayizi wabo wokudla kanye / noma imvamisa yokudla ngokuqhubekayo ngokuhamba kwesikhathi, kepha abenza kanjalo ngaphandle kokuzitika. Ngokuphambene nalokho, ukukhawulela ukudla kungakhuphula ukuzwela kokuhlutha futhi kusize ekuqhubekiseleni phambili ukungena, ngokwesibonelo, abantu abane-anorexia nervosa (imingcele yohlobo). Okukhombisa lokhu, ukuyekela ukudla (kepha hhayi iphunga elingelona ukudla) 2 h ngemuva kokudla ibhulakufesi kutholakale ukuthi kwandisiwe kubantu abane-bulimia nervosa futhi kwehla kubantu abane-anorexia nervosa, uma kuqhathaniswa nezilawuli. Lapho amaphethini wokudla ayekade ejwayelekile ngemuva kwezinsuku ezingama-60 zokwelashwa okunamandla kweziguli, lokhu kwehluka kokuncipha kokudla okuncishisiwe kuncishiswe kakhulu (I-LeGoff et al., 1988). Okokugcina, ukubekezelela emiphumeleni yokuvinjwa kokudla kwamafutha omzimba akhuphukile (isib, 'leptin ukumelana') kungaba ngenye into enomthelela ekuzuzeni isisindo ngokweqile (Ro Roger and Brunstrom, 2016; Isigaba 3.9).

Ukuguqulwa kwezimpendulo zombili ezinesimo futhi ezingenamibandela zokusetshenziswa kokudla nezidakamizwa kusebenza ukuze kulondolozwe i-homeostasis yomzimba. Ngokuhlobene, noma kunjalo, ukubekezelela kufaka isandla ekhuphukeni kokusetshenziswa futhi, okungenani ngokwengxenye, ngokufanayo kugcizelela imiphumela emibi nokuphikisayo yokuhoxiswa kwezidakamizwa (I-Altman et al., 1996). Kokubili ukubekezelela nokuhoxa yizindlela ezifakiwe encazelweni yokulutha. Ukuhoxisa kuchazwe esigabeni esilandelayo.

I-3.6. Ukuhoxiswa

Isikhathi esandisiwe sokuyeka ngokuzithandela noma sokuphoqelelwa ekusetshenzisweni kwezidakamizwa kungaholela emiphumeleni emibi, kufaka phakathi i-dysphoria, ukukhathazeka, ukuqwasha, ukukhathala, isicanucanu, ubuhlungu bemisipha, imiphumela yokuzimela kanye nokuquleka (I-American Psychiatric Association, i-2013). Ubukhulu bemiphumela yokuhoxa kwehluka kakhulu esigabeni sezidakamizwa, ngokuziyeka kotshwala nama-opioid kube nemiphumela emibi kakhulu. Ukubalekela nokugwema imiphumela emibi yokuhoxisa kubonakala kudlala indima enkulu ekugcineni ukusetshenziswa kwezidakamizwa (I-Altman et al., 1996 futhi U-Koob no-Volkow, i-2016) futhi, ngokwesibonelo, i-nicotine replacement therapy ehlose ukunciphisa imiphumela yokuhoxa ehambisana nokubhema, ikhulisa kakhulu impumelelo yokuyeka ukubhema (UStead et al., 2012). Futhi, ngokusebenzisa isibonelo se-caffeine futhi, ubufakazi bukhomba ukusetshenziswa kwe-caffeine kugqugquzelwa kakhulu ukubuyiselwa emuva. Lokhu kumayelana nokugcinwa kokusebenza kokusebenza kokunye kanye nokusebenza kwengqondo (Roger et al., 2013), nokuthanda okungaqondile kokunambitheka kwemoto (itiye, ikofi, njll.) lapho kudliwa khona i-caffeine (Isigaba 3.8).

Ngokucatshangelwa ukuthi ukudla kuvame ukwenzeka lapho kungekho khona isidingo sokondliwa (okwabantu abaningi abasendaweni enothile yokudla isikhathi esiningi), akunakulinganiswa ukuthi kufanelekile ukuhoxiswa. Noma kunjalo, ukungabikho kokugcwala, ukudla kunomvuzo (URoger noHardman, 2015), ngakho-ke ukungavimbeli kokudla noma imikhawulo kusho ukuphuthelwa emvuzweni wokudla, okunokwenzeka okunzima kokubili ukumelana nokucindezele.

Isibonelo semiphumela yokuhoxiswa komvuzo wokudla ukutholwa kumagundane anikezwa ukufinyelela ngezikhathi ezithile kwezixazululo ze-25% noma i-10% sucrose solution (i-cola nezinye iziphuzo ezithambile ziqukethe mayelana ne-10% sucrose, neziphuzo ze-'amandla 'ziqukethe cishe i-10% ushukela) (UColantuoni et al., 2002 futhi I-Avena et al., I-2008). Kulezi zifundo, amagundane anikezwe ukufinyelela ku-glucose nokudla okujwayelekile kwama-laboratory (chow) ngosuku lwe-12 ha aqhathaniswa namanye amaqembu wamagundane anikezwe, ngokwesibonelo, ukufinyelela okuqhubekayo kwe-glucose ne-chow, noma ukufinyelela okuqhubekayo kokuthola i-chow noma ukufinyelela okuphakathi kuphela i-chow kuphela. Lapho zivezwa ukufinyelela okufika ngezikhathi ezithile amagundane aqale alahlekelwa isisindo, kepha ngemuva kwalokho akwazi ukukhuphula ukudla kwawo ukugwema ukulahleka kwesisindo okwengeziwe (UColantuoni et al., 2002). Kuthiwa amagundane okungena-glucose-plus-chow-intermittent-access ngokuhamba kwesikhathi afike akhombisa izimpawu zokulutha ushukela. Ngakho-ke bachazwa ngokuthi 'ukuzitika ngokweqile' ngoshukela, ikakhulukazi lapho utholakala ekuqaleni kwesikhathi sokufinyelela kwamahora ayi-12. Isibonelo, ukungena kwe-glucose ngaphezulu kwe-3 h yokuqala yokufinyelela kukhuphukile kusuka ku-8 ml ngosuku lokuqala lokufinyelela okufika ngezikhathi ezingama-30 ml ngosuku 8. Kodwa-ke, uma lokhu kungukuthuthuka kokuzitika, amagundane abuye abhonce ku-chow, ngoba bekukhona ukwanda okufanayo kokudla kwe-chow (kusuka ku-2.7 g ngosuku 1 kuya ku-10.5 g ngosuku 8) (UColantuoni et al., 2002). Kunoma ikuphi, kuwukweqisa ukubiza ukudla kokuqala kwe-sucrose okudliwayo ngemuva kokuncishwa nsuku zonke ngokuthi 'ukulunywa,' ngoba lokhu kufinyelela cishe ku-5% yamanani wokudla wamandla nsuku zonke (I-Avena et al., I-2008). Enye indlela yokuchaza lokhu kuziphatha ukuthi imelela ukuzivumelanisa nokufinyelela okunqunyelwe kokudla. Ngokuhlangenwe nakho okuphindaphindwayo kokufinyelela ngezikhathi ezithile amagundane ayakwazi ukubikezela ukutholakala futhi lokhu kusiza ukubekezelelwa okunesimo futhi okungekho emibandeleni ekudleni ezinkulu zikashukela kanye ne-chow (Isigaba 3.5).

Ngokudabukisayo, Avena et al. (2008) thola ukufana phakathi kwemiphumela yokuhoxiswa kwezidakamizwa nemiphumela yokuhoxiswa kokufinyelela kushukela (kanye ne-chow). Imodeli ingumphumela wokuhoxa kuma-opiates ancishiswe ukuphathwa kwe-opiate antagonist naloxone, okubangela ukucindezeleka njengoba kukhonjisiwe, ngokwesibonelo, ukucindezeleka kokuziphatha nokukhathazeka, kukalwa ngokulandelana ngokuhlolwa kokuphoqelelwa kokubhukuda nesikhathi esichithwa ezandleni ezivulekile i-plus-maze ephakeme. Ngemuva kwe-naloxone, amagundane angena phakathi kukashukela nokwe-chow (ukufinyelela kwezinsuku ezingama-21) akhombise 'ukuhoxa' okubi kakhulu kulezi zinyathelo kunamaqembu ahlukahlukene okulawula, yize ukuvivinywa okuphoqiwe kokuvivinywa iqembu eliphakathi nendawo-le-chow kuphela laliphakathi ama-intermittent-sugar-and-chow namaqembu ad aditum ad (I-Avena et al., I-2008). Olunye ucwaningo kulolu chungechunge luveze eminye i-neuroadaptations ukuphendula i-glucose etholakala kanye nokudla oku-chow okufana nemiphumela yokuchayekelwa izidakamizwa zokuhlukumeza. Lokhu kufaka phakathi ushintsho olukhombisa ukusebenza kwe-dopamine yobuchopho obuguquliwe, isibonelo kwandise i-D1 ne-D2 receptor ebopha kuyi-dorsal striatum, futhi kwandise i-D1 receptor ebopha enkabeni negobolondo le-nucleus accumbens (I-Avena et al., I-2008). Kutholakale nokuthi ukukhishwa kwe-dopamine ekuphenduleni ushukela ophuzwayo kwahlala kuphakanyisiwe ezinsukwini ezingama-21 zokondla okuphakathi noshukela-plus-chow, uma kuqhathaniswa nempendulo enciphile ye-dopamine ngokuhamba kwesikhathi eqenjini lezikhathi eziphakathi namanye amaqembu okulawula (I-Avena et al., I-2008) lokho kujwayelekile lapho isishukumisi se-appetitive siphulukana nento yaso entsha.

Abalobi baphetha ngokuthi 'Ubufakazi busekela umbono wokuthi ezimweni ezithile amagundane angancika kushukela' (okungukuthi, umlutha, njengoba kukhonjisiwe yisihloko sephepha labo) (I-Avena et al., 2008, p 20). Lokhu kucatshangelwa ngezinga lokungena kokufinyelela, kanye nokuhoxa, ekudleni okuzuzisayo (ushukela) ngaphansi kwezimo zokuphindaphindeka kokudla okuphindaphindekile, endaweni engenakuphazamisa, kubaluleke kakhulu. Ngaphezu kwalokho, lokhu kungabonisa ezinye zezici zokudla kokuzidla ngemuva kwenkathi (evamile) yokuvinjelwa kokudla okubekiwe (3.5 futhi 3.7). Okubalulekile nokho, ukuthi amagciwane okushukela afinyelela kanye noshukela wokudla awadli ngokweqile futhi angabi ngokweqile (I-Avena et al., I-2008). Ngokuphambene, abantu abasengozini yokudla ngokweqile banokufinyelela okuqhubekayo kokudla okuthandekayo. Kulomongo (ukufinyelela okungavinjelwe), ucwaningo ngezilwane lukhombisa umehluko omkhulu ekuphenduleni kwe-neural ushukela nezidakamizwa. Isibonelo, ukukhishwa kwe-dopamine egobolondweni le-nucleus kuqukethe ngokushesha ukuphendula ushukela nokudla okuthile okuthandekayo, kepha hhayi ezidakamizweni eziluthayo, kufaka phakathi i-morphine, utshwala ne-nicotine. Ngaphezu kwalokho, izinkomba zokuqagela kokudla okunempilo nezidakamizwa ngokufanayo zivusa ukukhishwa kwe-dopamine ku-cortex yangaphambi kwangaphambi kwamehlo, kepha izinkomba ezibikezela izidakamizwa kuphela ezinalomphumela kuma-nucleus accumbens (UDi Chiara, 2005). Olunye ucwaningo luthola umehluko emaphethini wokudubula kwamaseli ku-nucleus accumbens yamagunds aphendula ukudla kwe-cocaine kanye nokudla, okuphakanyisiwe kungavela ku-neuroadaptation elethwe ukuvezwa kwezidakamizwa okungapheli (I-Carelli, i-2002).

Ngenkathi ukufana kwezindlela zokufinyelela ezimeni zesimo somuntu kungabaza, kuyindlela yokuthi ukufinyelela okuqhubekayo kokudla okubandakanya ukudla okuphezulu, futhi kukhulu ngamafutha noshukela, kuholela ekukhuphukeni okukhulu kokudla kwamandla nesisindo somzimba . Lokhu kuxoxwa ngakho ngezansi Isigaba 3.9.

I-3.7. Ukuluma

Ukudla inyama edla inyama kuchazwa njengokuthi 'ukudla, esikhathini esinqunyiwe (isib., Nganoma yisiphi isikhathi sehora le-2), inani lokudla likhulu kunalokho abantu abaningi abazokudla ngesikhathi esifanayo ngaphansi kwezimo ezifanayo.' kuhlanganiswe 'nomuzwa wokungakwazi ukulawula ukudla ngesikhathi sesiqephu.' (I-American Psychiatric Association, i-2013). Ukudla ukudla okune-bacterium kuwuphawu lwabantu abane-bulimia amanosa kanye ne-binge ekudleni ukudla (BED), futhi kungenzeka futhi kwenzeke kubantu abane-anorexia nervosa. Ukuphuza ngokweqile, kubhekiselwa ekuphuzweni kotshwala ngokushesha kuze kufike ku-inebriation, mhlawumbe kuyisibonelo esifanayo sokusetshenziswa kwezidakamizwa, kepha umehluko umehluko emiphumeleni yotshwala ekwenzeni izinqumo nokunakwa (isib, 'alcohol myopia') (I-Gable et al., 2016). Ngokuvamile, noma yikuphi ukudakwa ngomuthi wokuhlukumeza kungalingana nokuyaluma (I-Koob et al., 2014).

Engxoxweni yamanje, noma kunjalo, ukubaluleka kokudla okulingene kulele kukho lapho kugcwaliseka khona izindlela ezibalulekile zokuziphatha okulutha ngaphezu kokusebenzisa ngokweqile, kuqala ngomqondo wokulahlekelwa ukulawula, kodwa futhi kufaka phakathi ukubhekana nezithiyo ezinamandla zokuzidla ukudla, ubumnandi noma impumuzo lapho. isikhathi sokudla kakhulu, ukubekezelelana (Isigaba 3.5), futhi nokuqhubeka kokudla kokudla yize kunolwazi ngemiphumela emibi ephikelelayo. Ngalesi sisekelo, ocwaningweni olulodwa i-92% yabesifazane abatholwe bane-BED bagcwaliswa i-DSM-IV yaguqulwa yezimo zokunciphiswa kwezinto (umlutha), yize ingaphansi kwengxenye lelo nani (i-42%) yahlangabezana nezindlela ezilukhuni zokulutha (UCassin no-von Ranson, 2007).

Yize kunjalo, umlutha wokudla njengoba uboniswe ngokudla kokudla okuningana ngeke kubonakale njengokudla okuningi okweqile okunomthelela ekukhuluphele kanye nokukhuluphala. Abantu abane-anorexia manthaosa, ngokwezincazelo, baphansi, kanti i-bulimia amanosa ne-BED kuhlotshaniswa nokukhuluphala ngokweqile nokukhuluphala, ukubhebhetheka kwabo (isib. Ngokulandelana i-1-1.5% ne-1.6% yabesifazane e-US (I-American Psychiatric Association, i-2013)) liphansi kakhulu ukwedlula ukwanda kokukhuluphala (isib., njengamanje cishe nge-37% kwabesifazane e-US) phakathi kwabantu abafanayo (cf. U-Epstein noShaham, 2010 futhi UZiauddeen et al., 2012).

I-3.8. Ukuthanda nokufuna njengezinhloso zokusebenzisa izidakamizwa

Ekuhlaziyeni kwabo okunamandla kwezidakamizwa, I-Robinson ne-Berridge (i-1993) hlukanisa phakathi kokuthanda izidakamizwa nokufuna, futhi I-Berridge (1996) inikeza ukuhlaziywa okufanayo kokudla kokukhuthaza (umvuzo wokudla). Ukuthanda izidakamizwa 'kuyimiphumela ejabulisayo yokuzithoba' yesidakamizwa futhi ihlukaniswa nemiphumela yokukhuthaza yokugqugquzela okuhlobene nezidakamizwa, noma ukufuna. Ukwenza kusebenze i-nucleus accumbens ehlobene nokujikeleza kwe-neural kususelwa ekunikezelweni 'kwesisusa sokukhuthazeka' ukuthola isikhuthazo esifanelekile ('ukubenza bafune'), nangokusebenzisa okuphindaphindiwe kwemithi ethile lolu hlelo luyakhuthazeka. Ngokuphambene, ukusetshenziswa okuphindaphindiwe kungadala ukuthi ukuthanda izidakamizwa kunciphiswe. Umphumela wokufuna okwandayo ukufuna nokuthatha izidakamizwa okuyimpoqo, yize kuncishisiwe injabulo emiphumeleni etholakele. Kuyacaca ukuthi ama-neuroadaptations afanayo adla ukudla ngokweqile, mhlawumbe ikakhulukazi ukuzitika ngotshwala. Ocwaningweni ngokuziphatha komuntu kokudla, noma kunjalo, ukukala kokuthanda nokufuna kuvame ukudideka. Ngenkathi kuqondile ukuqonda ukuhlola ukuthanda ukudla ngokucela ukuhlolwa komuntu ubumnandi bokuthi 'ukunambitheka' kokudla, lokho okubizwa ngokuthi yizinyathelo zokufuna mhlawumbe kuyizilinganiso zangempela 'zomvuzo wokudla' (okusho ukuthanda ukuthanda)URoger noHardman, 2015). Noma kunjalo, kubonakala sengathi ukuthanda nokufuna kuthinta kakhulu umvuzo wokudla ngokuzimele ngoba, isibonelo, umvuzo wokudla kepha hhayi ukuthanda ukudla kuyanda ngokungadli amahora amaningi. Ama-nucleus we-distinct accumbens opioid 'izindawo ezishisayo' akhonjwe njengokuthanda nokufuna (ukudla okudlayo ngaphandle kokuthanda okuthe xaxa) (I-Peciña neBerridge, 2005), nolunye ucwaningo lwakamuva lukhombise ngokugqamile ukuthi ukunambitheka kanye nezakhi zomsoco womvuzo wokudla kusatshalaliswa kanjani yimigudu ehlukile yesibindi ye-dopamine (UTellez et al., 2016).

Ukuthanda ukudla, noma kunjalo, kungavela kwehluke ngandlela thile ekuthandeni izidakamizwa. Ukuthanda ukudla kuyinjabulo (impendulo ethintekayo noma ye-hedonic) eyenziwe ngokuyinhloko ngokuxhumana ngomlomo ne-stimulus yokudla, kanti ukuthanda izidakamizwa kubonakala sengathi kubhekisa emiphumeleni eyenziwe ngemuva kokungenisa. Ngezidakamizwa ezithile, noma kunjalo, ikakhulukazi, i-caffeine, utshwala ne-nicotine, ukuphathwa kuhlanganisa zombili lezi zici zokuthanda. Ekuphuzeni ikhofi, ubhiya, iwayini nophuzo lwe-whisky, nakubhemayo kagwayi nogwayi, imiphumela ye-oro-sensory yizici ezibalulekile zenjabulo yokusetshenziswa, kuze kufike ezingeni lokuthi kube khona ukucwaswa okuphezulu phakathi kwemikhiqizo nezinhlobo. Imiphumela (ukuzwa), kufaka phakathi umunyu we-caffeine namanye amakhemikhali ekhofi, umphumela ovuthayo wotshwala emlonyeni kanye 'nokuklwebheka' kwe-nicotine emphinjeni, ekuqaleni kuyaphambana futhi akuthandi, kepha kubonakala sengathi kuthola ithoni enhle ye-hedonic njengoba umphumela wokusetshenziswa kwawo kubhangqwe nemiphumela elandelayo yokugwinya yezidakamizwa. Lokhu kukhonjisiwe nge-caffeine, etholwe iqinisa ukuthanda ukunambitheka okungahambelani (izithelo 'zeti' neziphuzo zezithelo) ezibhanqwe nokudla kwe-caffeine (Yeomans et al., 1998), noma lokhu kwenzeka kuphela kubathengi be-caffeine abancishwe ngokuphelele i-caffeine, okubonisa ukuqiniswa okungekuhle. Ngale ndlela, ukuthanda ukuqinisa izidakamizwa ngemiphumela ye-oro-sensory yesidakamizwa futhi nemoto yayo kungasebenza njengesisusa esengeziwe sokusetshenziselwa, njengoba kuzofakwa ubumnandi (obuthandwa yibo) ubumnandi, ngoshukela noma okunye okumnandi, ekhofi, itiye, njll. nakwimikhiqizo kagwayi neyotshwala. Okuhlobene nokufuna, kepha-ke, ukubaluleka kwalesi sizathu se-oro-sensory hedonic ukusetshenziswa kuyancipha kakhulu kumlutha (isb. Ku-Alcohol Use Disorder).

I-3.9. Ukuntula komvuzo

Ukushoda komvuzo (noma ukuntenga), noma umvuzo 'hyposensitivity,' kubhekisa emcabangweni wokuthi ukuncishiswa komholo wezidakamizwa nokudla kubangela ukweqiswa okuthe xaxa kwalezi zinto (I-Blum et al., 1996, U-Wang et al., I-2001, UJohnson noKenny, 2010 futhi I-Stice ne-Yokum, i-2016). (Lokhu akufani nokuzwela komvuzo kumqondo wokuqinisa ukuzwela kaGrey (I-Corr, 2008), yize zingahlangana ngaphezulu). Ukwehluka komuntu ngamunye ekuzwiselweni komvuzo kungenzeka kubikezele ingozi yokuba umlutha, kepha ngaphezu kwalokhu kuhlongozwa ukuthi ukuvezwa kwezidakamizwa eziluthayo nokudla okuthile kudala i-neuroadaptations, ikakhulukazi ukubekelwa phansi kwe-striatal dopamine D2 function, okwehlisa ukuzwela komvuzo. Lokhu kubangela ukwanda kokusetshenziswa futhi, esimweni sokuchayeka kokudla okunempilo okumnandi nokunamafutha amaningi, kuhoxa ukukhuluphala. Ukusekelwa kwalokhu UJohnson noKenny (2010) baphetha okulandelayo kusuka ezifundweni zabo zemiphumela ye-neurochemical kanye nokuziphatha yokunikeza amagundane 'ukufinyelela okufinyelelekile' (okungukuthi, ukufinyelela ku-18-23 h ngosuku amasonto ambalwa) kokudla okunje: 'Ukuthuthukiswa kokukhuluphala kwamagundane anwezekwayo kufinyeleleke eduze nokushoda okuthuthukayo emsebenzini wokuvuza komqondo'(p 636); futhi 'Ukushoda kwemivuzo kumagundwane asinda ngokweqile kungakhombisa ukwehla okuhambisanayo kokuzwela okuyisisekelo kokujikeleza komvuzo wobuchopho ukuphikisa ukweqiwa kwabo ngokweqile ngokudla okuthandekayo. I-Hypofunction yomvuzo onjalo odonswe ekudleni ingasiza ekuthuthukiseni ukukhuluphala ngokwandisa isisusa sokudla umvuzo omkhulu 'obesogenic' Ukudla ukuze ugweme noma udambise lesi simo somvuzo ongemuhle'(p 639).

Inkinga eyodwa yalesi nezinye iziphakamiso ezihlobene eziphathelene nokushoda komvuzo njengesizathu sokudla ngokweqile kanye nokukhuluphala umbono wokuthi ukuncipha komvuzo kuholela ekusetshenzisweni okwandayo. Ngokunengqondo ngokwengeziwe, ukusetshenziswa kungalindeleka kube kuncishisiwe uma kutholwa njengomvuzo omncane URoger noHardman, 2015), futhi nobufakazi ngokudla kokudla kumaphoyinti wokudla wokukhuluphala kokudla kuleyo ndlela. Amagundane ashintshelwa ekudleni okunamandla komoya ngokushesha andisa kakhulu amandla awo futhi ngenxa yalokho athole isisindo somzimba (ikakhulukazi amafutha). Kumaviki amaningi, noma kunjalo, ukubamba amandla ngokweqile kwehla futhi isilinganiso sokuthola isisindo sinciphile. Lokhu kukhombisa umphumela ongemuhle wokukhuluphala kokudla (isibonakaliso se-leptin kungenzeka ukuthi sibandakanyeka lapha) (Ro Roger and Brunstrom, 2016). Lokhu kusekelwa ngokwengeziwe ukuthi lapho kukhishwa ukudla okunamandla amandla futhi amagundane akhuluphele okudliwayo abuyiselwa ekudleni okujwayelekile kwe-chow, angaphansi kokudla uma kuqhathaniswa namagundane okulawula ayehlale enakekelwa ku-chow, kuze kube yilapho amagundane akhuluphele kakhulu phambilini isisindo siwela ukufana nesamagundane wokulawula (Roger, 1985). Lezi zinto eziguquguqukayo zingabukwa ngokuya ngokulingana phakathi kokuvuselelwa kwesifiso ngenani lomvuzo (kanye nokwehliswa komphumela we-satiety nge-calorie) yokudla kwaminyene komoya kanye nokuvinjwa kokudla okulingana nokuqukethwe kwamafutha omzimba (Ro Roger and Brunstrom, 2016). Kususelwa kule ncazelo, UJohnson noKenny (2010) iziphetho, zingabhalwa kabusha ngale ndlela: Ukuthuthukiswa kokukhuluphala kwamagundane anwetshiwe kufinyeleleke eduze nokuncishiswa komvuzo womqondo wobuchopho; futhi umvuzo ancishisiwe kumagundane asinda ngokweqile kungahle kubonise ukwehla kokuguquguqukayo kokuzwela okuyisisekelo kokujikeleza komvuzo wobuchopho ukuphikisana nokuvuswa kwabo ngokudla okuthandekayo. I-Hypofunction ekhuthaza ukukhuluphala okunjalo ingamelana nokukhula kokukhuluphala ngokwehlisa isisusa sokudla. Umphumela owengeziwe wokuncoma lokhu kuvuselelwa ngukuthi UJohnson noKenny (2010) ifunda ukushoda komvuzo, njengoba kulinganiswa ngokwanda komkhawulo wamanje wokuthola umvuzo wokukhuthaza ubuchopho (ama-electrodes afakwe ku-hypothalamus ye-lateral), aphikelele ezinsukwini eziningi ngaphandle kokuhoxiswa kokudla okunamandla kakhulu, ngokungafani nemiphumela etholakele kuzivivinyo ezifanayo zokuhoxiswa kwe-heroin , i-cocaine ne-nicotine (U-Epstein noShaham, 2010). Esikhundleni sokuba ngumphumela oqondile wokuqedwa kokudla okunamandla, ukuphikelela kokushoda komvuzo kumagundane wokudla-okhuluphele kuhambisana nokuncipha kancane kancane kwesisindo kulezi zilwane (Roger, 1985).

Ngokuvamile, ubufakazi bokuntuleka komvuzo njengencazelo yokudla ngokweqile kanye nokukhuluphala kuxubeke kakhulu. Lokhu kufaka ubufakazi obuvela kwizifundo ze-neuroimaging (UZiauddeen et al., 2012 futhi I-Stice ne-Yokum, i-2016), kanye nezifundo zokuziphatha. Isibonelo salokhu okulandelayo ngocwaningo olusebenzise indlela ye-tyrosine / phenylalanine depletion yokunciphisa kahle umsebenzi we-dopamine yobuchopho kubahlanganyeli babantu, okuphikisana nokushoda komvuzo okutholakele, uma kukhona, lokho kuncipha kunciphisa isifiso sokudla kanye nokudla (UHardman et al., 2012). Ngaphezu kwalokho, izifundo ezingaba yimicabango zokucabanga ziye zathola ukuthola ukuthi ukusabela okuphansi emvuzweni wokudla kubikezela inzuzo ephansi yesikhathi esizayo. Ngokusekelwe kulokhu, nobufakazi obuvela kwezinye izinhlobo eziningi zezifundo, I-Stice ne-Yokum (2016), uphetha ngokuthi 'idatha ekhona ihlinzeka kuphela ukwesekwa okuncane kakhulu ngomqondo wokuntuleka kwemvuzo,' kodwa nokuthi kukhona 'ukwesekwa okuqinile kombono wokukhuthaza ukukhuluphala' (p 447). Ngokufanayo, isiphakamiso sokuthi umehluko ngamunye ekucindezelweni kwemithi yezidakamizwa ngenxa yokushoda komvuzo kuhlobene nokuhlukahluka ekusebenzeni kwe-dopamine D2 receptor function (I-Blum et al., 1990 futhi I-Blum et al., 1996) liphikisiwe ngokulandelayo. Ngokwesekwa, kunobufakazi obukhombisa ukuthi, ngokwesibonelo, ukwehla kwe-dopamine D2 receptor bindication kukhulisa ubungozi bokuhlukumeza i-cocaine, nokuthi kungumphumela wokuchayeka ku-cocaine, nayo enomthelela ekunakekelweni kokusetshenziswa kwezidakamizwa (I-Nader ne-Czoty, i-2005). Ngakolunye uhlangothi, ukuhlangana kwe-dopamine D2 receptor gene Taq1A polymorphism and alcoholism, ekuqaleni kubikwe ngu Blum et al. (1990), akuqinisekisiwe (Munafò et al., 2007). Kuvela futhi kucace bha ukuthi akukho budlelwano obunenjongo phakathi kwale polymorphism nokukhuluphala komuntu (UHardman et al., 2014).

I-4. Ingxoxo

Ukuhlaziywa okungenhla kukhombisa ukuthi kunokweqiwa okuningana kwezinqubo zokuziphatha nezinqubo zobuchopho ezibandakanyeka ekudleni nalabo abahileleka ekusebenziseni izidakamizwa nokuhlukumezeka kwengqondo. Ukwahluka kuyabonakala futhi, ngokwesibonelo emvelweni nemininingwane yokubekezelela nemiphumela yokuhoxa, yize kunjalo kulezi zici kuzoba nomehluko kuzo zonke izigaba zemithi. Njengoba kuvame ukubonwa, ukudla nezidakamizwa kuyahluka ngoba ukudla kuyadingeka ukuze usinde futhi ukusetshenziswa kwezidakamizwa akuyona (isib, U-Epstein noShaham, 2010 futhi UZiauddeen et al., 2012), kepha ke ukudla okunempilo akudingeki ukuthi kufakwe ukudla okunamandla kakhulu (U-Epstein noShaham, 2010- - empeleni umuntu angaba nempilo enhle uma ukudla okunjalo kugwenywa kakhulu.

Vele, ukufana phakathi kwesisusa sokuthola nokudla ukudla kanye nezidakamizwa eziluthayo kungalindelwa, njengoba le mishanguzo ingena ezinqubweni nasezinhlelweni ezifanayo ezivele zokugqugquzela nokulawula izimilo eziguqukayo, kufaka phakathi ukudla (UZiauddeen et al., 2012 futhi Salamone no-Correa, i-2013). Umthelela onamandla uthi izinto ezithile 'ziduna' lezi zinqubo zokulawula eziholela ekuziphatheni okubi nasekulimazeni, ngoba zinemiphumela enamandla evuzayo nekulimaza. Beka ngokungacabangi, 'izindlela zobuchopho ezivele ukuze ziphendule imivuzo yemvelo nazo zenziwa izidakamizwa eziluthayo' (I-Avena et al., 2008, p 20). Kodwa-ke, iqiniso lokuthi izinkambo ezihlobene nokudla nokudla ziyasebenza ziyindlela akubona ubufakazi bokuluthwa kokudla. Engxenyeni enkulu lokho kuhlukaniswa kwehla kulokho okufanela ukuba umlutha kanye ne-potency ehlukile yezidakamizwa ezahlukahlukene nokudla okuhlukile ukudala imiphumela echaziwe.

I-4.1. Ngaphezu kwendaba yencazelo

Ithuluzi elisetshenziswe kabanzi ocwaningweni lokuluthwa kokudla yi-Yale Food Addiction Scale (YFAS; UGearhardt et al., 2009). Kuyisikali sokuzibika (okungukuthi, hhayi inhlolokhono yokuxilonga) enezinto ezingama-25 ezihlobene 'nezimpawu' ezahlukahlukene zokulutha, kufaka phakathi ubunzima bokulawula ukusetshenziswa kwezidakamizwa (isib. 'Ngithola ukuthi lapho ngiqala ukudla ukudla okuthile, ngigcina ngidla kakhulu kunalokho obekuhleliwe '), imiphumela emibi yokuhoxa (isb.' Ngiye ngaba nezimpawu zokuhoxa njengokuxakeka, ukukhathazeka, noma ezinye izimpawu zomzimba lapho ngisika noma ngiyeka ukudla ukudla okuthile '), ukubekezelelana (isib,' Over isikhathi, ngithole ukuthi ngidinga ukudla ngokwengeziwe ukuthola umuzwa engiwufunayo, njengokunciphisa imizwa engemihle noma ukwanda kenjabulo '), nesifiso esiphikelelayo sokuyeka, okusho imizamo engaphumelelanga yokuyeka (isb.' Ngizamile ukunciphisa noma ukuyeka ukudla izinhlobo ezithile zokudla '). Igama elithi 'ukudla okuthile' lichazwa kwabaphenduli ekuqaleni kohlu lwemibuzo ngale ndlela elandelayo: 'Abantu kwesinye isikhathi baba nobunzima bokulawula ukudla kwabo njengokufana,' kulandelwe uhlu lokudla okuhlukaniswe njengamaswidi, isitashi, ukudla okulula okunosawoti, okunamafutha ukudla neziphuzo ezinoshukela. Izindlela 'zokuncika kwempahla' (umlutha) isibalo sezimpawu ze-out 3 kokungaphezulu kwe-7, kanye nokuvunywa kwento eyodwa noma zombili 'ezibalulekile zomtholampilo' (isb., 'Ukuziphatha kwami maqondana nokudla nokudla kubanga ukucindezeleka okukhulu '). Kunikezwa nendlela yokubala amaphuzu aqhubekayo akhiqiza isibalo sezimpawu 'ngaphandle kokuxilongwa' (kokuncika kwento).

Okukhathazayo nge-YFAS ukuthi kubonakala sengathi kubandakanywa ngokweqile ekunikezeni ezinye zokuziphatha okuhlobene nokudla njengobufakazi bokulutha kokudla. Isibonelo, okunye kokudla okusohlwini (isib, isinkwa, i-pasta nelayisi) kungukudla okuyisisekelo emhlabeni wonke, kanti ngenkathi ukudla okunjalo kungahle kube nokudla kokudla okulingene, umbono wokuthi nsuku zonke kungaba nzima ukukunciphisa ukudla lokhu kudla ikude 'nesimo ngokwedlulele ngokwengqondo' abanye abacwaningi abasibheka njengophawu lokulutha (I-Altman et al., 1996; Isigaba 2). Ukuthola ukuthi izikolo ze-YFAS ziphakeme kubantu abane-BED (kubuyekezwa ngu Long et al., 2015) ayisebenzi i-YFAS njengesilinganiso somlutha wokudla, ngoba abantu abaningi abangahlupheki nge-BED bahlangabezana nezindlela ze-YFAS zokulutha kokudla. Futhi akutholakali okuhlanganisiwe kwe-neural kwezikolo ze-YFAS (UGearhardt et al., 2011b) qala i-YFAS njengesilinganiso somlutha wokudla. Izikolo ze-YFAS ezihlangene nokusebenza kobuchopho kudalulwe ngokutholwa kokulindelekile kokudla (ushokoledi woshokoledi). Lokhu kufaka phakathi ukwenziwa okukhulu kwe-cortex ye-anterior cortex, i-medial orbitof Pambal cortex, i-amygdala kanye ne-dorsolateral preortal cortex. Ngenkathi le miphumela ifana namaphethini wokusebenza kobuchopho atholakala ngokuchayeka ezindlini zezidakamizwa, lezi zimpendulo ngokwazo azizibonakaliso zokulutha. Kancane nje, bakhombisa, ngokwesibonelo, ukuheha okukhulu kanye nokungamelana nokudla ubisi lwe-chocolate kubantu abanezilonda eziphakeme ze-YFAS.

Muva nje, abakwaGearhardt nozakwabo bashicilele inguqulo ebuyekeziwe ye-YFAS. Bathuthukise i-YFAS 2.0 (UGearhardt et al., 2016) okuyingxenye ukuhambisana nezincazelo zokuphazamiseka okuhlobene nezidakamizwa nokulutha ku-DSM-5. Ukulutha kwezidakamizwa kunqunywa ukutholakala kokukhubazeka okuphawulekayo emitholampilo kanye nezikolo zokubalwa kwezimpawu (esiphezulu = 11) se-2 noma i-3, i-4 noma i-5, ne-≥ 6 emele ukulutha kokudla okuncane, okulinganiselayo futhi okunzima, ngokulandelana. Isibalo sezimpawu sitholwe ukuthi sihambisana kahle nenkomba yomzimba futhi, ngokwesibonelo, ngezikolo ezilinganisweni zokulinganisa ukuzitika kokudla ngokweqile nokudla okungavinjelwe. Ezimweni eziningi i-YFAS ne-YFAS 2.0 ziyefana, kepha ukusabalala kwezinye izimpawu kuncane ku-YFAS 2.0 (isib. 'Ukunciphisa' ukusetshenziswa kokudla okuthile), okubonakala kungenxa yokuphindwaphindwa kwezinto ezinikelayo.

Vele, ngaphandle kokuphikisa okuhlukahlukene okuvezwe ngenhla, kungashiwo ukuthi i-YFAS (ne-YFAS 2.0) yindlela esemthethweni yokusebenzisa umlutha wokudla. Kodwa-ke, okungenani ingxenye enkulu yokubaluleka kokulutha njengomqondo isendaweni yokuthi konke kungachaza indlela yokuziphatha ngokweqile futhi kuqondise ukungenelela kokulapha ngempumelelo nokugwema inkinga (cf. Long et al., 2015). Lokho kungahle, noma kungahle (I-Fairburn, i-2013), bambelela ngokweqiniso ngokuphatha i-BED njengomlutha wokudla, noma mhlawumbe 'njengomlutha wokudla,' njengoba kungekho ukudla okukodwa okubandakanyekayo (Hebebrand et al., 2014). Ngokuphikisana, kungenzeka kungabi lusizo ukubuka ukukhuluphala, uma kungatholakali isifo se-BED, njengomphumela wokuluthwa kokudla. Izizathu zalokhu zixoxwa ngokulandelayo.

I-4.2. Ingabe umlutha wokudla uyincazelo ewusizo noma engenasisekelo yokukhuluphala?

Njengoba kuchaziwe ngaphambili (Isigaba 3.7), ukuxhaphaka kokukhuluphala kukhulu kakhulu kunokwanda kokudla kokudla kakhulu, ngakho-ke ingozi enkulu eyenziwa ngokudla ngokweqile yimiphumela yokukhuluphala enhlalakahleni yomzimba neyengqondo. Kodwa umlutha wokudla awubonakali njengembangela enkulu yokudla ngokweqile okubangela ukukhuluphala. Isibonelo, okunye ukuhlola kutholile ukuthi kuphela i-7.7% yababambe iqhaza ngokweqile noma abanamafutha amaningi abahlanganyele, izinhloso eziphikisayo, izinqubo ze-YFAS zokulutha kokudla, uma kuqhathaniswa ne-1.6% yababambiqhaza abangaphansi kwesisindo nabanempilo. Kulesi sampula yabantu be-652 abahlala eCanada ukubhebhetheka kokukhuluphala nokukhuluphala kwakungu-62% (UPedram et al., 2013). Ngokusobala, ukusetshenziswa kwamandla ngokweqile kwezidingo zamandla kwenzeka kaningi ngokungabi bikho komlutha wokudla.

Lokhu akusho ukuthi ukuthi ukuqonda okuvela ocwaningweni wokulutha kungenzeka kungazisi izindlela zokwelapha ukukhuluphala, kodwa ngokufanayo kungenzeka ukuthi ukubanga ukukhuluphala ekuluzweni kokudla kungahle kube nomthelela emgomeni wokudla okuncane. Ngempela, encwadini yakhe ethi The Myth of Addiction, UDavies (1992) Uveza ukuthi umqondo wokuba umlutha ungaxakaniseka nokuthi usetshenziswa ekusetshenzisweni kwezidakamizwa okuphathelene nezengqondo. Isibonelo usikisela umjikelezo lapho ihaba ngokweqile yemiphumela emibi yokuhoxiswa kwezidakamizwa isebenza ukuchaza (izaba) ukuqhubeka kokusebenzisa izidakamizwa. Futhi, lokhu kukhulisa okulindelwe mayelana nobunzima bokuhoxa, njalonjalo. Ngokufanayo, inkinga yokukholelwa ukuthi imikhawulo yokudla izokwenza umuntu azizwe elambile kakhulu, 'aphelelwe amandla,' noma azizwe ekhungathekile noma ekhungathekile, ukuthi lokhu kungenza ukudla ukuthi wehlise isisindo kube nzima kunokuba kungaba njalo (Ro Roger and Brunstrom, 2016). Ukukholelwa ukuthi umfutho wokudla, isibonelo, u-ayisikhilimu noma ikhekhe, kungenxa yokulutha kokudla, kusho ukuthi umfutho awulawuleki, okwenza ukuthi kube lula ukuthi u-ayisikhilimu noma ikhekhe lingamelana nalo (futhi cf. Isigaba 3.3). Esinye isibonelo ukuthi inkolelo eyabiwe ekulangazeleleni ushokoledi nokunikezwa kwalokhu ku 'chocoholism' kungehlisa umdlandla nomthamo wokudla ushokoledi omncane (URoger noSmit, 2000). Umzekeliso wethonya elinamandla lokukholelwa kwisipiliyoni sokudla yisifundo lapho ababambiqhaza baholelwa khona ukuthi baqonde ukuthi ukudla okuwuketshezi kuzobhoboza esiswini. Le nkolelo iyodwa (ngaphandle komphumela we-gelling) ikhuphule ukuqonda okugcwele, yanciphisa ukudla okwalandelayo, futhi futhi kwathinta ukukhishwa kwamahomoni e-gastro-emathunjini kanye nezinga le-gastric lefeing rate (UCassady et al., 2012).

Lokhu kuphakamisa umbuzo mayelana nomphumela wokulebula ukudla okuthile njengokulutha. Ocwaningweni lwakamuva (UHardman et al., 2015ababambiqhaza bafunde izindima ezintathu belungiselela isivivinyo sakamuva senkumbulo yokuqukethwe kwabo. Isigaba sesithathu besimayelana nokulutha kokudla, kuthi ingxenye yabahlanganyeli ithole inguqulo ethi ukulutheka kokudla bekungokoqobo kanti uhhafu uthola inguqulo ethi inganekwane. Kulokho ababambiqhaza abakhonjwe kukholelwa ukuthi kwakuyisifundo esehlukile, babamba iqhaza 'esivivinyweni sokunambitha' lapho bahlola khona ukudla okune, base beshiywa bodwa imizuzu eyi-10 ukuba badle ukudla okuningi njengokufisa kwabo. Ukutholwa kwama-crisps namakhukhi (ukudla kohlobo obekushiwo ukuthi kungalutha) kwakungu-31% ngaphezulu (akubalulekanga) futhi kuguquka kakhulu eqenjini lokulutha-kungokoqobo kuneqembu lezinganekwane. Kwakungekho mehluko ekudleni kokunye ukudla okubili (amagilebhisi nezinti zokudla). Umphumela owengeziwe kwaba ukuthi ukukhohlisa kuthinte ukuzihlola ngokwakho kokulutha kokudla - ababambiqhaza abaningi eqenjini lokulutha-lingokoqobo baphendule ngoyebo embuzweni othi 'Ingabe uzibona ungumlutha wokudla?' ukwedlula ababambe iqhaza eqenjini lezinganekwane. Isiphetho esisodwa kulolu cwaningo ukuthi ukuvuma kwangaphandle komqondo wokuba umlutha wokudla kukhuthaza abantu ukuthi bazibheke njengabantu abayimilutha yokudla, okungahle kube nomphumela wokuthi kungenzeka babe nokudla kwabo ekuluthweni kokudla. Ukwehluka okukhulu kokudla kokudla okungenzeka kube 'ukudla okuluthayo' kukhomba emiphumeleni emibili eyehlukene yokukholelwa ekuluthweni kokudla, okungukuthi ukugwema ukudla ngenxa yokwesaba ukwehlulwa amandla uma kuqhathaniswa nokuvumela ukwehluleka ngokungenakugwenywa kolawulo. Ngakho-ke ukubona isimilo sokugcina mayelana nezidakamizwa kungasiza noma kungasizi ekugwemeni ukulimala. Ngokuphawulekayo, kungalindelwa ukuthi umphumela uzoncika esigabeni sokusetshenziswa kwezidakamizwa. Isibonelo, kumuntu omusha ocabanga ukubhema ugwayi, umqondo wokuthi ugwayi ulutha kakhulu ungabavimba ukuthi baqale ukubhema. Kodwa-ke, kumuntu obhema izinsuku ezingama-20 lolu lwazi kungenzeka luyekise imizamo yokuyeka.

I-4.3. Ingozi yokuluthwa

Njengoba kuchaziwe ngaphambili (Isigaba 2), amathuba okuba umlutha kwehluka kakhulu ezintweni ezihlukile. I-Heroin ingaba umlutha kakhulu, ushokoledi kancane. Ngokuphawulekile, ukuqhathanisa phakathi kwemiphumela ye-cocaine nemivuzo yokudla kuthola ukuthi ukudla okuvinjelwe amagundane kukhethe ukudla ngaphezulu kokufakwa kwe-cocaine kwe-70-80% kwezilingo (Tunstall kanye Kearns, 2014). Ukulethwa kukakhukhunathi kanye nokudla kudwetshwe ngocingo olwehlukile. Intambo eboshwe ngotshwala i-cocaine yatholakala ivuselela ukuphendula ngemuva kokuqothulwa ngamandla amakhulu kunaleyo ekhishwe ngopende odonsa ngopende. Lo mphumela ungahunyushwa njengokubonisa ukuthanda okukhulu ukudla kepha ukufunwa okukhulu kwe-cocaine (Tunstall kanye Kearns, 2014), ehambisanayo ne-cocaine ethula ubungozi obukhulu bokulutha kunokudla. Mayelana nokwehluka phakathi kokudla kuhlongoziwe ukuthi umlutha uhambisana kakhulu nokudla okwenziwe kakhulu (Schulte et al., 2015). Lokhu kudla okuvame ukuba nomthwalo we-glycemic ophakeme (okusho, anoshukela omningi kanye / noma amanye ama-carbohydrate acwengekile), noma aqukethe amafutha amaningi, noma womabili. Ngokucabangayo, ukuheha okuphezulu, noma 'i-hyper-palatability' yokudla okunjalo ngezinga elikhulu kulele ezimweni zabo zokunambitheka, ikakhulukazi ubumnandi babo, usawoti kanye / noma ukulondolozwa (ukunambitheka kwe-umami), konke okuthandwa ngabantu kakhulu, amandla abo aphezulu. Kuphakanyisiwe ukuthi ukudla okuminyene kwamandla kuthola inani eliphakeme lomvuzo ngenxa yezithako zazo eziphezulu (ngokuyinhloko i-carbohydrate namafutha) ku-satiety ratio (Ro Roger and Brunstrom, 2016). Lokhu kungenxa yokuthi ukungenisa izakhi zomzimba kungumgomo wokugcina wokudla, kepha imikhawulo yokugcwala iyaqhubeka nokudla. Ukutholakala okuphezulu kokudla okuminyene kwamandla kufanele ukuthi kugqugquzelwe umthamo wamandla ngokweqile ngenxa yezizathu ezimbili ezihlobene: ayakhanga futhi athambekisa ikhalori ngokuthambile. Kodwa-ke, lokhu kweqisa kwamandla kanye nomphumela obukhulu ngokweqile kanye nokukhuluphala kakhulu kwenzeka lapho kungekho mkhuba wokudla kulokhu kudla ngaphandle kokuthi, ukuthi, umlutha wokudla uchazwa ngokuqondile (Isigaba 4.2).

Ubungozi bokulutha buyehluka kubo bonke abantu (njengoba kubeka engcupheni yokukhuluphala), futhi umehluko ngamunye ekuphenduleni komvuzo kuxoxwe ngawo Isigaba 3.9. Ukuhlaziywa okuqhubekayo kokungezwani komuntu ngamunye ekubeni sengozini yokuba umlutha kungaphandle kwalokhu kubuyekezwa, ngaphandle kokuthi uqaphele ukuthi izinto eziningi ezibandakanyayo ziyabandakanyeka ekunqumeni ubungozi bomuntu bokuba umluthaI-Altman et al., 1996 futhi I-West kanye ne-brown, i-2013). Lokhu kuhlanganisa, isibonelo, ufuzo, ukukhula, ubuntu, imvelo, inhlalo yezomnotho kanye nezamasiko kanye nomthetho. Kuhlanganiswe lapha ukulingana kokuthola imivuzo engeyona yezidakamizwa (kanye nokudla). Ezinye zalezi zici zobungozi ziyashintshiseka kalula kunakwezinye.

Ngokuphathelene nokudla ngokweqile, izindawo ezenziwa emazweni asethuthukile zigcwele ukudla. Ubiquity bezintambo zokudla kanye nokufinyelela okungenamsebenzi kokudla, ikakhulukazi ekudleni okunamandla, kukhuthaza ukusetshenziswa okungaphezulu kwezidingo ezisheshayo (Ro Roger and Brunstrom, 2016). Umehluko ohlukile wokukhuthazeka namandla okumelana nomvuzo wokudla, uzocacisa ukuthi ubani okhuluphayo, kepha izinguquko ezindaweni zokudla zingasiza kakhulu labo abasengozini yokudla ngokweqile. E-UK, ngokwesibonelo, ukudla okunamandla okuncishisiwe kuthengiswa ngenkuthalo ('kusunduzelwe') kuma-Checkout, kufaka phakathi izitolo okungezona ukudla okuthengiswayo. Mhlawumbe ekugcineni lo mkhuba uzoyeka ngoba, njengokuphuza utshwala noma imikhiqizo kagwayi, ukwenza lokhu kuzothathwa njengokulimaza okungafanele empilweni yomphakathi.

I-5. Ukuphawula kokugcina neziphetho

Ukuhlaziywa kwamanje kukhombisa ukufana, kepha futhi nomehluko othile, emiphumeleni yokudla yokudla nezidakamizwa zokuhlukumeza. Ngokuvamile, izidakamizwa eziluthayo zinemiphumela enamandla kakhulu kunokudla, ikakhulukazi maqondana nemiphumela yazo ebuchosheni ebenza 'bafunwe.' Ngenkathi ukudla ukudla okunezihlakala kungacatshangwa njengendlela yokuziphatha okuluthayo, ukudla ukudla okungeyona eyakho imbangela yokudla ngokweqile, ngoba kunomthelela ophansi kakhulu kunokukhuluphala ngokweqile noma ukukhuluphala. Esikhundleni sokubonwa ngokuluthwa kokuluthwa kokudla, ukudla ngokweqile kuchazwa kangcono ukutholakala okubanzi, ukuheha kanye nomthamo ophansi we-satiating (ikhalori yokudla ikhalori) yokudla kwaminyene. Kuke kwaqalwa ukuthi ukusungula umlutha wokudla okunjalo kuzosiza ekuncengeni abenzi bemigomo nabanye ekuvimbeleni ukumaketha nokutholakala kokudla okunjalo, njengoba kuye kwenziwa ngempumelelo, ngokwesibonelo, ngokutshala ugwayi ngokuncipha okulandelana kokuxhaphaka kokubhema nokubhema. impilo ehlobene nokugula (UGearhardt et al., 2011a). Kodwa-ke, ukusakazwa kwencazelo yokuluthwa okungahle kudinge kunganciphisa kakhulu umthelela wayo. Ukungezelela umlutha wokudla ngale ndlela kubuye kube nengozi yokunciphisa umlutha omkhulu, noma kungenze ukudla okuthile (okungukuthi, 'ukudla okuluthayo') kubonakale kunzima ngokwengeziwe ukumelana. Kungaba nayo yonke le miphumela engahlosiwe.

Omunye umfanekiso wendlela amagama anikezwa ngayo wumbukiso wokuthi isisusa esifanayo esishubile (i-1: ingxube ye-1 ye-isovaleric ne-butyric acid) sithathwa njengesihle kakhulu uma sibhalwe njengoshizi weParmesan kunalokho okubhalwe njengokuhlanza (UHerz no-Cle Clef, 2001). Ngokufanayo, ukusebenzisa 'ukufisa,' ukuchaza unesifiso esinamandla sokudla ushokoledi, 'ukuluma' ukuchaza ukudla isidlo esikhulu (noma sikhulu kangako), nokuthi 'ungumlutha wokudla' ukuchaza ukuthambekela ekudleni ngokweqile, kuvusa okuhlukile imibono yalokhu okuhlangenwe nakho okujwayelekile. Okukhathazayo ukuthi ukuqonda ngokweqile ukudla ngokweqile njengomlutha wokudla akuchazi ukudla ngokweqile futhi akunikezeli amasu okunciphisa ngempumelelo ukudla ngokweqile.

'Kumele sifunde ukuphatha amagama ngokuphumelelayo; kodwa ngasikhathi sinye kufanele sigcine futhi, uma kunesidingo, sandisa amandla ethu okubheka umhlaba ngokuqondile hhayi ngokusebenzisa isigamu se-opaque semi concepts, esidukisa yonke iqiniso ngokunikezwa okujwayelekile kakhulu kwelebula elejwayelekile noma elichazayo ukukhishwa. '

Kusuka ku-Doors of Percept, ngu-Aldous Huxley.

Izingxabano ezingaba khona zenzalo nokuvuma

Umlobi uthole uxhaso lokucwaninga ngemiphumela yoshukela ekudla kanye nokugculiswa kwabakwaShukela Nutrition UK (isibonelelo Ref. 47190). Uhlinzeke ngezinsizakalo zokubonisana nabakwaCoca-Cola Great Britain futhi wathola nezimali zesikhulumi kwi-International Sweeteners Association. Imibono ephathelene nomvuzo wokudla, ukusuthisa ngemuva kokudla ngamandla namandla esele yathuthukiswa ngokwengxenye ngesikhathi kulungiswa isibonelelo esikhokhelwa yiBBSRC DRINC (BB / L02554X / 1). Ingxenye yocwaningo oluholele kulokhu kubuyekezwa yathola uxhaso kuHlelo lwe-European Union lweSikhombisa Uhlaka lokucwaninga, ukuthuthukiswa kwezobuchwepheshe kanye nokukhombisa ngaphansi kwesivumelwano sosibonelelo cha. 607310.

Okubhekwayo

I-Altman et al., 1996
UJ. Altman, BJ Everitt, S. Glautier, A. Markou, D. Nutt, R. Oretti, GD Phillips, TW Robbins
Izisekelo zemvelo, zenhlalo kanye nezomtholampilo zokulutha kwezidakamizwa: ukuhlaziya nokuphikisana
I-Psychopharmacology, 125 (1996), iphe. 285-345
I-CrossRef