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                                                                                                         Anorexia and Cachexia

 

     Anorexia nervosa is an eating disorder based on the overwhelming fear of becoming fat or overweight. Cachexia is also known as the wasting syndrome, and can result in lack of appetite, emaciation, weakness and fatigue.  Both of these disorders involve lack of proper nutrition and the inability to intake, regulate, and control eating to maintain proper homeostatic balance and well-being. There are psychological, social, medical, and digestive issues to consider. This article will look at the effects of medical cannabis on anorexia and cachexia and the negative impact these disease’s can have.

 

     The result of anorexia is an aversion toward food which results in major weight loss, self-starvation, emaciation and undernourishment. In addition, other bodily systems are affected and it can cause hormonal imbalances, anemia, irregular heartbeat and the development of brittle bones, as well as mental imbalance. Patients can easily suffer from anxiety and depression, as well as other mental deficits and delusions.  Victims of anorexia also can have excessive dieting, extreme exercising, severe weight loss, and a distorted body image. In addition, food becomes an obsession, calorie counting is common, and these patients experience hair loss, suppression of menstrual cycle (90% afflicted are females), insomnia, and constipation or bulimia (vomiting to lose weight). About half of anorexics become bulimic and purge after eating to prevent weight gain.

 

     The onset of anorexia is generally in adolescence or young adulthood, and it affects about 1% of American women. A serious illness, this disease can require prompt and extensive medical intervention by a team of doctors and specialists. Approximately 15% of anorexics can die from this disease in severe cases. Anorexics can become angry or defensive if others try to intervene to treat this disease, and most deny or refuse to admit that they have a problem. Psychological factors play a key role in this disease, and anorexics have high levels of achievement, and are often compulsive and perfectionists. They have a negative body image and feel that they are fat- when in fact they are emaciated, skinny, and gaunt. The diagnosis of this disease is made upon observation of emaciation in your body due to fasting, and key psychological signs of food obsession and compulsiveness.

 

     Cachexia, or wasting syndrome, is characterized by weight loss as well, but body mass is lost mainly as a result of skeletal muscle loss with or without loss of fat tissue. More than just loss of appetite, cachexia is usually due to an underlying disease state such as AIDS or cancer. It can also be common in multiple sclerosis patients (MS), those with obstructive pulmonary disease (COPD), and tuberculosis. The key to treating cachexia and anorexia is to reverse the loss of muscle mass, increase food and caloric intake, and regain normal body mass and function. Patients with cancer can develop cachexia due to the cancer itself, or from the chemotherapy, radiation, or surgical treatments. Some may have the inability to eat properly, for example due to oral cancer involving pain and difficulty in eating or swallowing. Others have diminished or no appetite and simply become adverse toward food and nutrition, and the smell or taste of food can become repulsive. These cachexia patients slowly decline due to the underlying disease, and they continually lose weight and need motivation and discipline to force eating properly. Patients receiving chemotherapy for cancer can also experience chemotherapy induced nausea and vomiting (CINV), which can make eating difficult. In some cases of cachexia, it can become difficult to even ingest liquids and a feeding tube, or PEG (gastric feeding tube) may be necessary.

 

     It is recognized by cannabis practitioners and researchers that the endocannabinoid system regulates appetite, and it can control digestive functions as well as regulate appetite and food intake. Cannabinoids stimulate receptors in the hypothalamus and structures in the hindbrain to regulate appetite and stimulate eating. It is also postulated that phytocannabinoids modulate cytokine activity and inflammation in the immune system. It is possible that the inflammatory response linked to cytokine activity is responsible for cachexia, so further research is being done in this area. There is also an interaction between cannabis and the protein Leptin which is important in appetite control and stimulation.               

 

     Conventional medications used to treat these two diseases can often be effective for nausea and vomiting, but not effective in stimulating the appetite. In 1992, a cannabinoid medication called Marinol (Dronabinol) was approved by the FDA for stimulating the appetite in AIDS patients. This is made from synthetic THC only, and no other components. It was patented by the US Government even though it was a schedule 1 drug. Although it was partly effective, it lacked the other myriad of compounds in the cannabis plant, and users experienced an uncomfortable psychoactive effect and many discontinued use or switched to vaping or smoking the cannabis flowers. As a cancer survivor myself, I can attest to the benefit of whole plant cannabis compared to just the THC in Marinol in being effective to combat nausea, vomiting, and poor appetite.

 

     Inhaled or vaped cannabis with a balance of THC and CBD in a 1:1 ratio can be beneficial to stimulate the appetite in both patients with anorexia and cachexia, and reduce the adverse or unwelcome side effects of THC when used alone. Some studies also indicate that oral ingestion of cannabinoids is also very effective, with a slower onset and longer duration than smoked cannabis. THC is the predominant cannabinoid responsible for appetite stimulation, but a sufficient quantity of CBD is necessary to combat unwelcome side effects of THC in non- cannabis users. Important to note is that the cannabinoid THCV (tetrahydrocannabivarin) is also an appetite suppressant and of no benefit in these two disease’s where additional appetite stimulation is needed. In fact, it is contraindicated. Durban Poison, for example, is a strain that is high in THCV, and this is contra-indicated for use. Note however that THCV has a high vapor point (428 degrees F*) and will not liberate when vaping the flowers, but it is liberated when smoking the flowers. Varieties of cannabis that are high in beta-caryophyllene, a terpene often found in cannabis, are also recommended. Strains of cannabis high in CBDV (cannabidivarin) are also being studied and are promising to use to treat these conditions.  

 

     GW Pharmaceuticals, a company growing and researching cannabis in Great Britain, is also doing clinical studies and has applied for a patent to use CBG (cannabigerol) to treat cachexia. In summary, any high THC strain with the distinct peppery aroma of beta-caryophyllene and also CBG and CBDV is recommended. Panama Red, Super Skunk, and most Mexican landraces contain adequate beta-caryophllene, as well as many other strains. Strain fingerprints and analysis of cannabinoids and terpenes will allow for a better choice of cannabis used to treat these conditions. This information can be found on the internet simply by searching under the term “cannabis strain fingerprints”.  Five common cannabinoids and five common terpenes are diagrammed in each strain fingerprint, and thereby appropriate strains for these two disease’s can be targeted (i.e. high THC, high beta-caryophyllene, CBG and CBDV).

 

     Cannabis has been known anecdotally for years to increase appetite and give users the “munchies”. It is known to combat the metabolic syndrome, and also regulate weight gain by increasing carbohydrate metabolism and it can also limit the appetite in some people. But by and large it is an appetite stimulant hands down!!  Now science and research has led to multiple avenues of investigation on how this effect occurs and thru what mechanism it is mediated. Unfortunately, cannabis does not lend itself readily to randomized controlled clinical studies due to the inherent multiplicity of compounds in the plant, and variations in effect with each individual. Patients with this disease require a myriad of therapies involving several specialties, cognitive behavioral therapy, continued care and follow up, and also the addressing of underlying mental health issues. As far as a pharmaceutical approach, cannabis therapy should not be ruled out, as other drugs seem relatively ineffective or have adverse side effects. However, skilled guidance by a cannabis practitioner with knowledge of the disease and medical cannabis can be of benefit, and perhaps improve the odds of cure or remission.