title: Food addiction: detox and abstinence reinterpreted?
abstract: The senior patient and/or the geriatrician are confronted with a confusing literature describing how patients interested in combating metabolic syndrome, diabesity (diabetes plus obesity) or simple obesity might best proceed. The present paper gives a brief outline of the basic disease processes that underlie metabolic pro-inflammation, including how one might go about devising the most potent and practical detoxification from such metabolic compromise. The role that dietary restriction plays in pro-inflammatory detoxification (detox), including how a modified fast (selective food abstinence) is incorporated into this process, is developed. The unique aspects of geriatric bariatric medicine are elucidated, including the concepts of sarcopenia and the obesity paradox. Important caveats involving the senior seeking weight loss are offered. By the end of the paper, the reader will have a greater appreciation for the challenges and opportunities that lie ahead for geriatric patients who wish to overcome food addiction and reverse pro-inflammatory states of ill-heath. This includes the toxic metabolic processes that create obesity complicated by type 2 diabetes mellitus (T2DM) which collectively we call diabesity. In that regard, diabesity is often the central pathology that leads to the evolution of the metabolic syndrome. The paper also affords the reader a solid review of the neurometabolic processes that effectuate anorexigenic versus orexigenic inputs to obesity that drive food addiction. We argue that these processes lead to either weight gain or weight loss by a tripartite system involving metabolic, addictive and relational levels of organismal functioning. Recalibrating the way we negotiate these three levels of daily functioning often determines success or failure in terms of overcoming metabolic syndrome and food addiction.
authors.affiliation: University of Florida, Department of Psychiatry, Gainesville, FL 32610-0183, USA. shriner@ufl.edu
authors.forename: Richard L
authors.initials: RL
authors.lastname: Shriner
mesh_terms: D000368:Aged; D049088:Bariatrics / Q000379:methods*; D001921:Brain / Q000502:physiology; D031204:Caloric Restriction / Q000379:methods; D002450:Cell Communication / Q000502:physiology; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology / Q000517:prevention & control / Q000523:psychology; D004040:Dietary Carbohydrates / Q000009:adverse effects; D004041:Dietary Fats / Q000009:adverse effects; D004068:Digestive System Physiological Phenomena / Q000502:physiology; D050171:Dyslipidemias / Q000209:etiology / Q000503:physiopathology; D005215:Fasting / Q000502:physiology; D005227:Fatty Acids / Q000378:metabolism; D051858:Forkhead Transcription Factors / Q000502:physiology; D005632:Fructose / Q000494:pharmacology; D006801:Humans; D006963:Hyperphagia / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D007333:Insulin Resistance / Q000502:physiology; D007662:Ketosis / Q000209:etiology; D024821:Metabolic Syndrome / Q000503:physiopathology / Q000517:prevention & control; D008960:Models, Psychological; D009765:Obesity / Q000503:physiopathology / Q000517:prevention & control / Q000523:psychology; D010353:Patient Education as Topic; D013315:Stress, Psychological / Q000517:prevention & control
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D005227:Fatty Acids; D051858:Forkhead Transcription Factors; D005632:Fructose