Eating Disorders (e.g. Anorexia, Bulimia, Obesity)

Medical Cannabis and Eating Disorders

An eating disorder is any range of psychological disorders characterized by abnormal or disturbed eating habits and/or an unhealthy relationship with food.

Eating disorders are usually referred to as bulimia and anorexia nervosa but can also include obesity and binge-eating disorder (BED). Medical cannabis, and tetrahydrocannabinol (THC) in particular, is renowned for stimulating the appetite, which could help with necessary weight gain.

What are Eating Disorders?

Eating disorders include any condition where the patient has an unhealthy relationship with food and body image. Excessive dieting, exercise, and purging are signs of an eating disorder, as are excessive eating and binge eating.

Characteristics of eating disorders can resemble addiction. Anorexia nervosa, bulimia, and binge eating disorder (BED) are the most common eating disorders, but obesity is sometimes considered one as well.

Obesity costs the U.S. approximately $117 billion in direct health costs, making up 6% to 12% of national healthcare expenditure in the U.S. In the developing world, obesity is becoming a bigger and bigger problem, as people’s diets include an increasing amount of refined sugars and processed foods. Obesity affects an estimated 600 million adults and 100 million children worldwide.

Eating disorders such as anorexia and bulimia have an extremely high mortality rate, and treatment methods are complex. Therefore, treating eating disorders of all kinds is a matter of utmost importance, and effective treatment could also help prevent many other conditions. The lifetime prevalence for bulimia nervosa and anorexia nervosa are 1% and 0.6%, respectively. Many who have an eating disorder also have an anxiety disorder.

Brief Summary of Current Treatments

There are currently several treatment options for eating disorders, including therapy and counseling, like cognitive-behavioral therapy (CBT) and family-based therapy. Patients may also seek assistance from a registered dietitian and a dentist or oral surgeon for any eating disorder-related issues with oral health.

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) may be prescribed to manage depression and anxiety associated with an eating disorder. Atypical antipsychotics like olanzapine may also be prescribed, as the distorted perception of one’s body is often considered a form of psychosis.

Medications for obesity may include:

• Statins like atorvastatin (Lipitor), pravastatin (Lipostat) and simvastatin (Zocor) to reduce cholesterol.
• Blood-thinners like aspirin and clopidogrel.
• Anticoagulants like warfarin and apixaban.
• Blood pressure medications like beta-blockers and angiotensin-converting enzyme (ACE) inhibitors.

How Might Medical Cannabis Help?

One of the most well-known side effects of cannabis use is that it can give a person the “munchies” – an urge to eat. This makes cannabis and cannabinoids a perfect candidate for the treatment of eating disorders of many kinds. When it comes to obesity – which is often also considered an eating disorder – it is a shock that cannabis may help. However, cannabis users tend to have a lower body mass index (BMI) and lower rates of obesity compared to the general population.

Eating disorders of various types could be due to a dysfunctional endocannabinoid system (ECS). Leptin and ghrelin levels are lower in those with eating disorders, and cannabinoids may help induce the production of these two hunger-causing hormones. As for those with obesity, there is an increase in the concentration of cannabinoids made available in the body, and this increased availability of cannabinoids can stimulate hunger. Phytocannabinoids like tetrahydrocannabinol (THC), a partial agonist of CB1 receptors, stimulate appetite.

Cannabinoids such as low doses of tetrahydrocannabivarin (THCV), cannabigerol (CBG), and cannabidiol (CBD) may help curb this hunger and help regulate insulin levels, which could be more useful in those with obesity and diabetes.

Medical cannabis may also be an alternative to prescription medications like antidepressants and antipsychotics, some of which may exacerbate pre-existing eating disorders.

Cannabinoids

Depending on the type of eating disorder: For bulimia/anorexia, THC and CBG may be of particular use; for obesity, THCV and CBG. However, care must be taken with high doses of THC, lest it makes depressive episodes potentially worse.

Cannabinoid Ratios

• THC:CBD 1:3
• THC:CBD 1:2
• THC:CBD 1:1
• THC:CBD 2:1

Terpenes and Terpenoids

Terpenes like limonene, pinene, linalool, beta-caryophyllene, and myrcene may all aid relaxation and help improve mood.

Flavonoids

As people with eating disorders are often not eating enough or eating the wrong foods, a flavonoid-rich diet can help reduce the likelihood of several health problems like cardiovascular diseases (CVDs) and cognitive decline. Colorful, flavonoid– and nutrient-rich food can also be appetizing and help one want to eat.

Effective Ways of Taking Medical Cannabis for Eating Disorders

Routes of Administration

• Inhalation
• Sublingual
• Ingestion

Special Formulations

There is little information available on which specific cannabinoid ratios and dosages are best for eating disorders, although some reports of a THC:CBD 1:1 ratio are helpful.

Dosing Methods

• Vaporization
• Inhaler
• Tincture
• Edible

What are the Pros and Cons of Taking Medical Cannabis for Eating Disorders?

Potential Pros

• In those with diabetes and/or obesity, tetrahydrocannabivarin (THCV) may help curb hunger and ameliorate insulin sensitivity.
• CBD may help regulate insulin levels.
• In those with anorexia or bulimia, THC may increase hunger.
• Euphoria can help overcome the anxiety and depression associated with eating disorders.

Potential Cons

• Although the evidence so far is convincing, with a logical theoretical framework, more research is needed.
• Some may increase paranoia, anxiety, and depressive episodes, which can be an issue for eating disorders of all types.
• Ensuring that the patient uses the appropriate chemovar of cannabis is necessary to prevent loss of hunger in those with anorexia or bulimia. Those with obesity may prefer such a chemovar.

Useful Anecdotal Information

“Can Medical Marijuana Help Anorexia?” Social Chats, Jul. 15, 2020

“Using Cannabis for Eating Disorder Recovery.” Plantriotic, Oct. 17 2018

Scientific Data Overview and Studies

Anorexia

• Total Studies = 44
• Positive Studies = 38
• Inconclusive Studies = 6
• Negative Studies = 0
• 27 Meta-Analyses (22 positive, 5 inconclusive); 8 Animal Studies (all positive); 4 Double-Blind Human Trials (3 positive, 1 inconclusive); 4 Human Trials (all positive); 1 Lab Studies (positive)
• 9 studies include CBD (7 positive, 2 inconclusive); 19 studies include THC (16 positive, 3 inconclusive); 3 studies include CBG (all positive); 5 studies include a THC:CBD 1:1 ratio (all positive)
• No. of Leafwell Patients = 368 (anorexia)
• Possible Overall Efficacy: Moderate to High

Obesity

• Total Studies = 60
• Positive Studies = 49
• Inconclusive Studies = 10
• Negative Studies = 1
• 31 Meta-Analyses (25 positive, 6 inconclusive); 19 Animal Study (18 positive, 1 negative studies); 3 Double-Blind Human Trials (2 positive, 1 inconclusive); 2 Human Trials (1 positive, 1 inconclusive); 5 Lab Studies (3 positive, 2 inconclusive)
• 9 studies include CBD (all positive); 6 studies include THC (all positive); 2 studies include CBG (both positive); 1 study includes CBC (positive); 1 study includes CBDA (positive); 1 study includes THCA (positive); 1 study includes a THC:CBD 1:1 ratio (positive)
• Possible Overall Efficacy: Moderate

Quotes from Studies

“Anorexia nervosa (AN) is characterized by anhedonia whereby patients experience little pleasure or reward in many aspects of their lives. Reward pathways and the endocannabinoid system have been implicated in the mediation of food intake.” Source: Verty, Aaron N A et al. ‘The cannabinoid receptor agonist THC attenuates weight loss in a rodent model of activity-based anorexia.’ Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology vol. 36,7 (2011): 1349-58. doi:10.1038/npp.2011.19

“There are few studies and the level of evidence is low. The only properly designed, low bias and highly powered study found a weight increasing effect of dronabinol in AN, while the other, using Δ9-THC at a high dose, found no effect and where the dose may have counteracted the weight gaining effects due to adverse events. More research on cannabinoids in anorexia nervosa is warranted, especially its effects on psychopathology.”

Source: Rosager EV, Møller C, Sjögren M. “Treatment studies with cannabinoids in anorexia nervosa: a systematic review.” Eat Weight Disord. 2021 Mar;26(2):407-415. doi: 10.1007/s40519-020-00891-x. Epub 2020 Apr 2. PMID: 32240516.

Conclusion

There are various compounds in cannabis that could have therapeutic potential for multiple types of eating disorders. The appetite-stimulating properties of THC could be beneficial for disorders like anorexia nervosa. However, few studies show cannabis and cannabinoids’ efficacy for eating disorders.

Related Articles

Loss of Appetite and Medical Cannabis

Diabetes and Medical Cannabis

Does Weed Make You Lose Weight?

Please note: the information in this article does not constitute medical advice

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