Anorexia/Lack of Appetite

Anorexia/Lack of Appetite

conditions anorexia header

Anorexia means a lack or loss of appetite. It can be brought on by a variety of chronic conditions or result from taking certain medications. This can lead to malnutrition and other dietary deficiency problems. For example, cancer and AIDS patients experience weight loss and the wasting away of muscle or tissue due to an increase in their metabolism and a decrease in calories in their diet. Often anorexia is associated with nausea, an unpleasant side effect of chemotherapy and antiviral medicines.

Anorexia nervosa is a psychological disorder associated with a lack of self-esteem, which results in self-inflicted, extreme weight loss (at least 15% below normal weight). This difficult condition is most often seen in adolescent girls but can also happen to males and adults. 30% of patients have a family history of eating disorders. Some of those suffering anorexia don’t just restrict food but may also binge and purge.

Anorexia and Cannabis

NOTE FOR FIRST TIME READERS: Cannabinoids – such as THC, CBD – and terpenes are the main medically active components in cannabis (aka marijuana). For more information on these components and much more about the plant, see our section on the Science of Cannabis.

Cannabinoids appear to regulate eating behavior in several ways within the brain and the intestinal system. THC may play a critical role in what is known as leptin pathways, which stimulate appetite. Leptin is a hormone that signals the hypothalamus, which senses the nutritional state and modulates food intake. There is strong association between these leptin signaling pathways and the cannabinoid receptors located in the brain that bind with THC.

Appetite stimulation by cannabinoids have been studied for several decades, particularly in relation to the wasting away (known as cachexia) and malnutrition associated with cancer or HIV/AIDS. A synthetic THC, known as dronabinol, is FDA approved for the treatment of anorexia associated with weight loss in patients with HIV/AIDS. Early studies of dronabinol in this population showed promising increases in caloric intake or weight gain. Many patients with AIDS continue to use medical marijuana as an appetite stimulant.

Other studies with dronabinol are inconclusive. A randomized placebo-controlled clinical trial in 243 patients with cancer-related anorexia–cachexia syndrome found that the cannabis extract and dronabinol were not any better to a placebo (a non-active drug) in how it affected appetite or quality of life. On the other hand, a smaller study of dronabinol in cancer patients showed that recipients who took the medication said food tasted better and had a healthier appetite with an increase in calorie intake.

A pilot study of nine outpatients with anorexia nervosa treated with THC showed a significant improvement in depression and perfectionism scores, though without any significant weight gain. It is unclear whether the physiologic response to cannabinoids differs in patients with anorexia nervosa than in those without the condition. It is also not clear if the effect of cannabinoids is sufficient to overcome the strong psychological drive for weight loss that these patients have.

We know that THC itself is an appetite stimulant, but there is great variation in strain specificity for this condition. Sometimes a puff of an appropriate strain is most effective. It really depends on how the emotional component of anorexia is addressed. Most people seem to have a better appetite when they relax, in response to indica hybrids.

References

Strasser F, et al. on behalf of the Cannabis-In-Cachexia-Study-Group Comparison of orally administered cannabis extract and delta-9-tetrahydrocannabinol in treating patients with cancer-related anorexia–cachexia syndrome: a multicenter, phase iii, randomized, double-blind, placebo-controlled clinical trial from the Cannabis-In-Cachexia-Study-Group. J Clin Oncol. 2006, 24: 3394–400.

Brisbois TD, et al. Delta-9-tetrahydrocannabinol may palliate altered chemosensory perception in cancer patients: results of a randomized, double-blind, placebo-controlled pilot trial. Ann Oncol. 2011, 22: 2086–93.

Abrams DI. Integrating cannabis into clinical cancer. Oncol. 2016, 23(Suppl 2): S8–S14.

Kola B. et al. Cannabinoids and ghrelin have both central and peripheral metabolic and cardiac effects via AMP-activated protein kinase. J Biol Chem. 2005, 280(26): 25196-201.

Lutge EE, Gray A, Siegfried N. The medical use of cannabis for reducing morbidity and mortality in patients with HIV/aids. Cochrane Database Syst Rev. 2013, 4: CD005175.

Furler MD, Einarson TR, Millson M, Walmsley S, Bendayan R. Medicinal and recreational marijuana use by patients infected with HIV. AIDS Patient Care and STDs 2004, 18(4): 215-228.

Prentiss D, Power R, Balmas G, Tzuang G, Israelski DM. Patterns of marijuana use among patients with HIV/AIDS followed in a public health care setting. Journal of Acquired Immune Deficiency Syndrome-2004, 35(1): 38-45.

Aquino G. Medicinal Marijuana: A legitimate appetite stimulant? – Nutrition Bytes. 2005, 10(1). eScholarshiphttps://escholarship.org/uc/item/3wr5g87k.

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