February 1 to 7, 2018 is Eating Disorder Awareness Week. When it comes to disordered eating, the media has been a gift in bringing issues to light. Eating disorders like most mental health issues remained something that wasn’t discussed, researched or even talked about for many years. Unless a close friend, family member or co-worker had experienced it, the average Canadian would never be exposed to it. With the recent rise of mass media, the everyday person has likely heard of and seen the effects of disordered eating on the human body. Social media has had a similar impact by allowing first-hand experiences and opinions to be exchanged within our culture. With exposure comes understanding. With understanding, we see an increased amount of people who have begun to seek treatment. Eating disorders are no longer seen as shameful but as a medical issue with millions of sufferers worldwide.
Conversely, the media has contributed to the problem by distorting the body image of its consumers leading to lowered self-esteem and altered eating behaviours. Being slender has been equated with attractiveness for years with the help of television, magazines and the Internet but food has been consistently marketed to all demographics (unhealthy foods at that). This conflicting media is nothing new when it comes to a medication that could aid in recovery from certain eating disorders: cannabis.
Cannabis has been a casualty of the media in like manner. Misinformation has been spread that lead to the prohibition and stigmatization of marijuana. However, the relevant scientific and medical information has been able to be disseminated through the same channels. Myths need to be dispelled involving the nature and symptoms of cannabis, eating disorders, and the use of one to treat the other. Marijuana has been used as an appetite stimulant for decades. Decreased appetite and weight loss from of cancer treatment, chronic disease and HIV are all indications for cannabis use and improve the symptoms dramatically.
Tetrahydrocannabinol or THC is the main cannabinoid used for this effect. Our hypothalamus and its POMC neurons are the main portions of our brains involved in feeding behaviour. They are rich in CB1 receptors which respond to THC. The stimulation of the POMC neurons with THC causing an increase in hunger. Not to mention that cannabis use increases dopamine-making food being more pleasurable and rewarding to eat.
Knowing this mechanism, what kind of illnesses can cannabis help? Chiefly, anorexia nervosa.
Anorexia nervosa, like most eating disorders, tends to develop in early adolescence and are more than nine times more prevalent in females than males. Gender isn’t the only predisposition. People with anorexia tend to be more affluent, perform well at their school or job, have a family member with the same condition and may have psychiatric issues such as depressive features or drug dependency.
When anorexia nervosa is present eating is restricted, or activity is increased in the hope of reducing body fat. Falling under 85 per cent of one’s expected body weight with restricting is enough for a diagnosis. Besides the risk of malnutrition, electrolyte imbalances leave many at risk for irregular heartbeats and even heart attacks. Other resulting symptoms are an intolerance to cold, menstruation is absent, intense fatigue and even osteoporosis. As mentioned with the psychiatric issues, up to 30 per cent of those dealing with anorexia nervosa will attempt suicide. Ultimately 5 to 20 per cent of those suffering from anorexia will have fatal complications from their illness.
Eating disorders are not limited to excessive dieting and exercise. There are binge-purge types of anorexia and bulimia nervosa where copious amounts of food are consumed and then followed by extreme restriction. For these types of eating disorders, cannabis is not recommended because it may only increase binge behaviour and exacerbate the amount and severity of compensation (ie. purging).
Knowing the effects of THC there have been valid concerns over paternalistic and authoritarian forms of medicine. If a patient has mental issues which prevent them from eating, is it ethical to provide the patient with medication that will increase their hunger and possibly distress the patient further? Patients who are in recovery are healing from the underlying body image issues, the dysmorphia, and the anxiety involved with gaining weight. They may be able to use cannabis to increase appetite to aid in recovery. Achieving a healthy weight can be done with the help of hunger stimulants if the patient is consenting and complicit in their treatment.
Cannabis, while useful, is not a substitute for nutritional intervention, rehabilitation, inpatient medical treatment and therapy. When recovery has occurred and the mental issues are overcome it can be an extremely valuable asset for stimulating hunger, coping with depressive features and maintaining a healthy and happy body weight.
Dr. Ifeoluwa Abiola, B.Sc, MD.
Medical Director – 420 Clinic Ltd.
Millington GWN. The role The role of proopiomelanocortin (POMC) neurones in feeding behaviour., Nutrition & Metabolism 2007; 4:18.
Steiger H, Séguin JR. Eating disorders: anorexia nervosa and bulimia nervosa. Million T, Blaneyu PH, David R, ed., Oxford Textbook of Psychopathology. New York: Oxford University Press, 1999: 365-88.
Zhu AJ, Walsh BT. Pharmacologic treatment of eating disorders. Can J Psychiatry 2002; 47:3:227-34.
Woodside DB, Garfinkel PE, Lin E, Goering P, Kaplan AS, Goldbloom DS et al. Comparisons of men with full or partial eating disorders, men without eating disorders, and women with eating disorders in the community. Am J Psychiatry 2001; 158:570-574.
Kaplan AS. Psychological treatments for anorexia nervosa: a review of published studies and promising new directions. Can J Psychiatry 2002; 47:3:235-42.