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Cannabis and Eating Disorders

Cannabis and Eating Disorders

At any given time, between one to three out of every 100 women in the U.S. are suffering from anorexia. Studies estimate that among college women, as many as 10 percent may suffer from a clinically diagnosable eating disorder. While the illness disproportionately affects women (particularly at vulnerable ages like adolescence and college), an estimated 0.3 percent of men suffer from anorexia nervosa. Clinically referred to as anorexia nervosa, the disease has highest mortality rate (12.8%) of any psychiatric disease. 6% of those afflicted commit suicide (Bulik et al, 2007).

Characterized by an irrational fear of weight gain, low body weight, and body dysmorphia, it is distinct from anorexia associated with other conditions like AIDS/HIV. Sufferers frequently develop a powerful fear of food, severe body distortions, and an excessive need to control all aspects of their environment.

According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD) — one of the largest non-profit organizations dedicated to helping people overcome their fears and issues with eating and body image —

individuals suffering from anorexia nervosa will generally experience the following:

  • Severe food restriction and dramatic body weight loss: Not getting enough calories in, which leads to a significantly low body weight.

  • Food-related anxiety: An intense fear of gaining weight or becoming fat. Or if the fear is not shown, there is still persistent behavior that interferes with weight gain, even though weight is significantly low.

  • Denial: Difficulty recognizing the seriousness of one’s current weight, or incapable of seeing how thin or underweight they are.

  • Self-worth tied to body image: Dependent on their body weight and shape for their self-evaluation.

  • Reduced pleasure: Sufferers report experiencing less pleasure in daily activities, particularly eating (which they often fear).

What causes anorexia?

Anorexia nervosa was typically viewed as a disorder caused primarily by sociocultural factors. In recent years, perceptions have evolved, and genetics and neurobiological causes are thought to play a significant role in the disease. Moreover, studies have found anorexia often runs in families, with twin studies affirming the presence of potential additive genetic factors.

It seems unlikely that anorexia can be caused by a single factor, but rather a constellation of factors (including genetic, neurobiological, sociocultural, and neuropsychological) come together to trigger onset of the disease. Well before onset, sufferers commonly struggle with the following issues:

  • Low self-esteem: Often related to unresolved childhood trauma including abuse or neglect.

  • Perfectionism: Individuals with anorexia often never feel like they’re “good enough” or “think enough.” This type of thinking often leads to a distorted sense of self-value.  

  • Obsessive or compulsive personality traits: Sufferers commonly report an obsession with calorie counting or other obsessive behaviors.

  • Low levels of serotonin: A brain chemical often involved in depression and other anxiety disorders.

Cannabis Becoming a Popular Treatment for Anorexia

Sona Patel founder of Doc420, an L.A.-based physician who has recommended medical cannabis for anorexia says that in recent years, she’s seen an uptick in patients treating anorexia with cannabis. Patel notes that anxiety disorders often accompany anorexia, which cannabis may also be helpful treating.

State by state, as medical cannabis becomes legal, patients and physicians are taking a closer look at whether cannabis could help treat those suffering from an eating disorder. However, only five states explicitly list anorexia as a qualifying condition, but many include health issues associated with the eating disorder, such as nausea, anxiety, and uncontrolled weight loss.

Everyone knows cannabis can give you the ”munchies.” It's a signature characteristic of cannabis. And, the butt of many jokes. For recreational users, this effect can be pleasurable. For medicinal users — like chemotherapy patients who often lose their appetite — the effect can be indispensable. The appetite stimulative effects of cannabis have been well studied in cancer and HIV/AIDS patients. If it's effective for those types of patients, people are asking, “why not for anorexia?”

The treatment community, however, remains skeptical (and the research so far has been inconclusive). However, Tamara Pryor, director of clinical research at the Eating Disorder Center of Denver, offers a measured view: "They [anorexia sufferers] feel power in not giving in to the desire to eat, so stimulating their appetite can't necessarily overcome the neurobiological issues that are also intimately involved with their disorder," says Tamara Pryor. "That said, marijuana may be a helpful tool for some people — in conjunction with therapy.”

How Can Cannabis Treat Anorexia?

Dr. Patel explains treating anorexia with cannabis may be helpful, but its potential is complex. She notes research suggests anorexia can cause changes in the brain, particularly pathways tied to the endocannabinoid system (the body’s own “cannabinoid system”). She points to a 2014 Belgian study that implicates a dysfunctional endocannabinoid system in eating disorders, but that the changes to the body’s cannabinoid system occur as an effect of anorexia, rather than a cause.

“Specifically, their findings suggest that the body creates more receptors to compensate for a ‘chronically hypoactive’ endocannabinoid system in cases of anorexia. But these changes may only be temporary, since receptors rebounded to normal levels after the experiments stopped,” says Patel. “The endocannabinoid system acts as a regulator of appetite. Some scientists believe that the body may produce lower levels of cannabinoids in order to improve the ability to survive during prolonged starvation or anorexic states.” Consequently, anorexia sufferers could experience a decrease in their appetite because of alterations in the endocannabinoid system.

What does the research say about cannabis and anorexia?

The endocannabinoid system plays a powerful role in stimulating the brain’s reward process, enhancing sensory and pleasure mechanisms. And, in fact, appetite stimulation and reversing anorexia in cancer and HIV patients was one of the first symptoms cannabis was found to treat effectively (Beal et al, 1995; Jatoi et al, 2002). So it’s surprising that we have few studies that specifically examine anorexia nervosa. And, the few studies that exist have produced somewhat conflicting results.

The first randomized double-blind study in 1983 failed to demonstrate THC promotes more weight gain in anorexia nervosa patients than the control drug (diazepam) they compared it to. However, other researchers have pointed out that the results shouldn’t have been surprising, because later studies show that diazepam (which they used as the control drug) also stimulates food intake and body weight in both animals (Naruse et al, 1994; Patel and Ebenezer, 2008) and humans (Frisbie and Aguilera, 1995).

However, it’s been well established that those suffering from anorexia find many activities — particularly eating — less pleasurable and rewarding than the general population. And, well-established evidence indicates cannabinoid agonists can powerfully influence the brain’s reward pathways. So, it would make sense that cannabinoids like THC could enhance the pleasure and reward of eating, thereby potentially reversing weight loss in anorexia nervosa patients. Australian researchers decided to test this hypothesis.  

Administering THC in three doses to experimental rodent models (“lab rats”), they found moderate and high doses stimulated food intake, while the high dose significantly reduced body weight loss. Moreover, high dose THC in conjunction with a high-fat diet stimulated food intake and promoted weight gain. Their findings were published Mar. 2011 in the Journal of Neuropsychopharmacology.

A 2014 animal study explained the mechanistic action for why cannabis may make eating more pleasurable, and increase food intake. European neuroscientists led by Giovanni Marsicano of the University of Bordeaux recently published a study in Nature Neuroscience in which they found THC (the ingredient in the cannabis plant that makes you feel high) activates CB1 receptors in such a way that induces feeding cues by heightening odor sensitivity, thereby increasing our ability to smell and taste.   

Researchers from the Center for Eating Disorders at Odense University Hospital in Denmark also found encouraging results. The researchers followed 24 women afflicted with severe, persistent anorexia nervosa (that had lasted five years or more). Participants were given dronabinol — a synthetic version of THC (the primary psychoactive constituent in cannabis) — over a period of four weeks.

After four weeks. study participants gained on average 0.73kg (1.6lbs) more on dronabinol treatment than the placebo (a “control” drug with no therapeutic effect). The study authors noted: “Dronabinol therapy was well tolerated. During four weeks of exposure it induced a small but significant weight gain in the absence of severe adverse events.”

Even more impressive, the researchers followed up one year after the trial and found that the patients continued to improve their nutrition without developing an addiction or withdrawal symptoms. The authors of the randomized-control trial (RCT) published their findings in the International Journal of Eating Disorders Jan. 2014 issue.

What do anorexia patients say about cannabis?

While their may only be limited scientific data suggesting cannabis is effective, there is no shortage of people who credit cannabis for helping them overcome their eating disorder. Amanda (not her real name), a Los Angeles-based entrepreneur in her late 30s, told Wikileaf she credits cannabis for helping her overcome her long-term off-and-on battle with anorexia and bulimia. “For me, cannabis was an effective short-term solution that kicked a long-term problem,” says Amanda. “I’ve long struggled with body image issues, but after a puff or two from my vape, those issues would melt away.”

“It helps me feel less self conscious about my body.”

Amanda claims once she kicked her eating disorder, she no longer used cannabis to medicate (except occasionally). “While thankfully I no longer have to deal with eating disorders, I still have insecurities about my body sometimes which can affect intimacy,” recounts Amanda. “So I still occasionally use cannabis with my partner which helps immensely with intimacy. I helps me so that I don’t feel self-conscious and I’m able to feel much closer with my partner.”

“Cannabis makes eating more fun and pleasurable!”

According to Amanda, another issue she dealt with in her anorexia is that she dreaded eating. It seemed like a chore, not something pleasurable. But, with cannabis eating became a source of pleasure — rather than something to dread. No doubt, anyone who has had a case of the munchies will attest to the notion that eating can truly become an epicurean experience — even when eating food that may be pretty simple.

“Cannabis quiets the noise in my head and calms my nerves.”

Women’s magazine Cosmopolitan (popularly known as ‘Cosmo’) featured a story on cannabis as a potential treatment for anorexia. That Cosmo publishes stories on anorexia seems ironic to some, as many have criticized for perpetuating unrealistic body images, thereby contributing to the problem of eating disorders. Nonetheless, the story was well done. Jessica, a 31-year old from Denver told Cosmo she medicates with cannabis four to six times per week. She doesn’t need much — just a couple of puffs to calm her nerves, breath easier, and quiet the noise in her head. This allows her to better process her “disordered thoughts.” “I'm finally able to feel hungry instead of nauseous and uncomfortable," says Jessica.

“Cannabis reminds me to eat.”

YouTube personality, “The Duchess of Dank,” (who based on her avatar, clearly has a sense of humor), reports that for three years she suffered from anorexia (during which time it destroyed her stomach). Duchess claims she doesn't get signals from her mind telling her when to eat or when she's hungry. She can only get those signals through the “munchies,” which a puff or two of cannabis restores those signals. Unfortunately, Duchess doesn’t live in a jurisdiction where medicinal cannabis is legal, so she has to rely on the “black market.”  She insists she’d be willing to take a legal prescription drug — if there actually was one! (There are no approved drugs developed specifically to treat anorexia nervosa.)

“Cannabis helps me let my control issues go.”

A prominent feature in anorexia is perfectionism and the need to control every aspect of one’s environment. Seattle college student, Claire (not her real name), who was also featured in the Cosmo article says, "Anorexia is a control thing for me — excessive perfectionism — so it's a relief to have something [cannabis] that allows me to let go and be more flexible."

A common manifestation of this need for control is an obsession with counting calories. Claire claims cannabis helped rid herself from obsessive calorie counting. After trying cannabis, she got the munchies, and it affected her memory so that she couldn’t recall how many calories she consumed.

"I felt bad and guilty at first, but I noticed I felt good physically and it also felt good to rebel against my harmful thoughts," Claire says. "Since I'd already lost track, I figured it couldn't hurt to go two days without counting, and so I started smoking more regularly and I haven't counted calories since." Evidence is well established that cannabis produces a short-term effect on our ability to encode new memories. So, from a scientific perspective, Claire’s experience makes sense.

Could Cannabis Help Patients “Forget” Traumatic Memories?

Notably, through different pathways both CBD (the most prominent non-psychoactive constituent in cannabis) and THC can help people forget aversive (or traumatic) memories (Gazarini L et al, 2014; Campos AC et al, 2012). This is partly why many PTSD patients find cannabis to be helpful. People with anorexia similarly have experienced traumatic memories, so it would be interesting for researchers to conduct further studies on the effect of cannabis on memory may potentially help individuals with anorexia.

Final Thoughts

Keep in mind anorexia nervosa is a very serious condition. If you or someone close to you is suffering from this potentially life-threatening disease, it’s important to enlist whatever help required for recovery. 69% of sufferers who seek treatment are fully recovered within five years. Nonetheless, it’s important to take recovery serious and enlist professional help while developing a support network.

Online resources are available to find support including:

Anorexia also has a high rate of comorbidity, meaning sufferers are often afflicted with other conditions or ailments. A high percentage of patients deal with anxiety disorders, depression, and insomnia. Thus, it’s important to take a holistic approach to treatment and seek out options that will alleviate — not exacerbate — comorbid conditions.

A puff is enough

If considering cannabis as part of a treatment plan, keep in mind that while some early studies suggest cannabis may be effective to treat anorexia, the research is far from conclusive. But, if considering cannabis as a treatment option, patients should follow the adage “less is more.” Most people report positive effects from small doses. In fact, owing to the biphasic effect of THC, cannabis is generally most therapeutically effective in low doses. The biphasic properties of THC mean low doses generally produce desirable effects, while high doses can produce adverse effects potentially exacerbating one’s condition and accompanying symptoms.  

Anorexia nervosa is a very serious eating disorder, particularly if it is accompanied by co-occurring psychiatric and addictive disorders. Like bulimia nervosa and other eating disorders, anorexia is a medical disease that can result in irreversible health complications, including death. Likewise, note that while compared to most drugs, the risk of cannabis producing an adverse reaction with other substances is fairly low, there is a risk that cannabis could make other drugs — like commonly prescribed antidepressants — less effective.

References:

Andries, Alin, Jan Frystyk, Allan Flyvbjerg, and René Klinkby Støving. "Dronabinol in Severe, Enduring Anorexia Nervosa: A Randomized Controlled Trial." International Journal of Eating Disorders 47, no. 1 (2013): 18-23. doi:10.1002/eat.22173.

Baker, Jessica H., Sara E. Trace, Lauren E. Janson, and Cynthia M. Bulik. "Genetics of Anorexia Nervosa." ELS, 2013. doi:10.1002/9780470015902.a0024614.

Beal, Jeffrey E., Richard Olson, Linda Laubenstein, Javier O. Morales, Paul Bellman, Bienvenido Yangco, Lewis Lefkowitz, Terry F. Plasse, and Kirk V. Shepard. "Dronabinol as a Treatment for Anorexia Associated with Weight Loss in Patients with AIDS." Journal of Pain and Symptom Management 10, no. 2 (1995): 89-97. doi:10.1016/0885-3924(94)00117-4.

Campos, A. C., F. A. Moreira, F. V. Gomes, E. A. Del Bel, and F. S. Guimaraes. "Multiple Mechanisms Involved in the Large-spectrum Therapeutic Potential of Cannabidiol in Psychiatric Disorders." Philosophical Transactions of the Royal Society B: Biological Sciences 367, no. 1607 (2012): 3364-378. doi:10.1098/rstb.2011.0389.

Casteels, Cindy, Nathalie Gérard, Kris Van Kuyck, Lies Pottel, Bart Nuttin, Guy Bormans, and Koen Van Laere. "Small Animal PET Imaging of the Type 1 Cannabinoid Receptor in a Rodent Model for Anorexia Nervosa." European Journal of Nuclear Medicine and Molecular Imaging 41, no. 2 (2013): 308-21. doi:10.1007/s00259-013-2522-8.

Frisbie, James H., and Elsa J. Aguilera. "Diazepam and Body Weight in Myelopathy Patients." The Journal of Spinal Cord Medicine 18, no. 3 (1995): 200-02. doi:10.1080/10790268.1995.11719393

Gazarini, L., C. A. J. Stern, R. R. Piornedo, R. N. Takahashi, and L. J. Bertoglio. "PTSD-Like Memory Generated Through Enhanced Noradrenergic Activity Is Mitigated by a Dual Step Pharmacological Intervention Targeting Its Reconsolidation." International Journal of Neuropsychopharmacology 18, no. 1 (2014). doi:10.1093/ijnp/pyu026.

Gross, Howard, Michael H. Ebert, Vivian B. Faden, Solomon C. Goldberg, Walter H. Kaye, Eric D. Caine, Richard Hawks, and Norman Zinberg. "A Double-Blind Trial of Delta-9-Tetrahydrocannabinol in Primary Anorexia Nervosa." Journal of Clinical Psychopharmacology 3, no. 3 (1983). doi:10.1097/00004714-198306000-00004.

Jatoi, A. "Dronabinol Versus Megestrol Acetate Versus Combination Therapy for Cancer-Associated Anorexia: A North Central Cancer Treatment Group Study." Journal of Clinical Oncology 20, no. 2 (2002): 567-73. doi:10.1200/jco.20.2.567.

Mickle, Kelly. "Can Marijuana Really Help Treat Anorexia?" Cosmopolitan. 2016. Accessed 29 Sept. 2016.

Patel, Sunit M., and Ivor S. Ebenezer. "The Effects of Acute Multiple Intraperitoneal Injections of the GABAB Receptor Agonist Baclofen on Food Intake in Rats." European Journal of Pharmacology 601, no. 1-3 (2008): 106-10. doi:10.1016/j.ejphar.2008.10.059.

Soria-Gómez, Edgar, Luigi Bellocchio, Manuel Guzmán, et al. "The Endocannabinoid System Controls Food Intake via Olfactory Processes." Nature Neuroscience Nat Neurosci 17, no. 3 (2014): 407-15. doi:10.1038/nn.3647.

Verty, Aaron NA, Megan J. Evetts, Geraldine J. Crouch, Iain S. McGregor, Aneta Stefanidis, and Brian J. Oldfield. "The Cannabinoid Receptor Agonist THC Attenuates Weight Loss in a Rodent Model of Activity-Based Anorexia." Neuropsychopharmacology. Nature Publishing Group, 2011. Web. 29 Sept. 2016.

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