Cannabis and Anorexia
Anorexia nervosa is a well-known but uncommon eating disorder that affects less than 2% of the worldwide population. However, for those who have anorexia, the complications can be serious, sometimes leading to osteoporosis as a result of bone thinning, digestive issues, heart problems, and even death.
The “munchies” are a phenomenon long associated with cannabis. Could the appetite-stimulating effects of cannabis benefit individuals with anorexia nervosa and other eating disorders? The answer may not be so simple, as eating disorders tend to have a strong underlying mental health component. If treating anorexia were as simple as encouraging appetite, then the disorder would likely not exist.
What cannabis may be able to help with, however, are the comorbid conditions associated with anorexia, such as anxiety and depression.
Current research demonstrates that cannabis could treat some of the conditions that often coexist with anorexia.
In 2013, a Danish study published in the International Journal of Eating Disorders found that dronabinol, a synthetic form of cannabis, may help anorexic patients gain weight. The medicine was reportedly well-tolerated and linked to weight gain in subjects who took 2.5 milligrams of dronabinol twice daily compared with those who took a placebo.
Anxiety is frequently experienced alongside anorexia, and it has also been cited among the top five reasons for using medical cannabis in North America. A 2018 study published in the Journal of Affective Disorders found that cannabis significantly lowered anxiety levels, stress, and depression in the short-term. Caution should be exercised over the long term, however, as this study also found that depression symptoms (but not anxiety) could get worse when cannabis is used for prolonged periods.
Interestingly, researchers revealed that women experienced a greater reduction in anxiety than men in the short-term. This is an important consideration, given that women are three times more likely to experience anorexia than men.
However, the relationship between anxiety and cannabis use is complex. A meta-analysis of 31 separate studies published in 2014 in BioMed Central Psychiatry found that there was a positive relationship between cannabis use and anxiety. That is, anxiety is more common in cannabis users than non-users. Whether cannabis is simply a common coping strategy for these individuals, or alternatively, contributing to mood disorder, remains unclear. Randomized controlled trials examining the effect of cannabis on anxiety are much needed.
While cannabis has demonstrated the ability to help people suffering from anorexia, it’s important to note that research has also found that when people with anxiety use cannabis to cope, it could potentially lead to misuse or dependence on cannabis. A 2019 study published in the journal Substance Use & Misuse found that social anxiety may be associated with using cannabis to decrease negative effects, which could increase the frequency of cannabis use and potentially cause a dependency risk.
Missy Hope, who requested her real name not be disclosed, had never heard the term “anorexia nervosa” when her eating disorder developed. At 15, insecure about her body and depressed after her parents’ recent divorce, Hope began to starve herself.
“At first, I didn’t realize I was starving myself,” Hope shared in a phone interview with Weedmaps . “I just thought I was being really disciplined by eating only fruits and vegetables every day. When I dropped down to 95 pounds, I didn’t realize that my appearance was scaring people.”
Now 32, the real estate agent has conquered her anorexia, through an inpatient treatment program that was supplemented by medical cannabis use. According to Hope, she discovered cannabis around the same time she entered the program.
Like many former anorexia patients, Hope still battles with the adverse effects of this disorder from time to time, but cannabis use provides her with much-needed relief to this day.
“Smoking a joint here and there has helped with my anxiety and depression, but I still battle with them,” she explained. “But I feel like I’ll always struggle to some extent with these issues and even with food.”
What the Experts Say
Hope’s continued efforts to deal with her depression and anxiety are common among individuals recovering from anorexia. Some medical experts believe that cannabis may be beneficial in helping to manage these ongoing psychological symptoms.
The authors of a 2017 study published in the Israeli Journal of Psychiatry Related Science concluded that THC “may be an effective component in treating the psychological symptoms of AN (anorexia nervosa).”
This assertion stems from the results of the physicians’ study of nine anorexic women who reported improvements in self-care and mood following treatment with 1 to 2 milligrams of THC daily administered over four weeks.
The Bottom Line
Cannabis may help ease anxiety, stimulate appetite, and uplift mood, all of which make medical cannabis a potential complementary treatment option for anorexia nervosa. However, anyone with anorexia should consult with a physician before beginning any course of treatment while addressing the psychological factors that contribute to the disorder.
Cannabis and Anorexia Anorexia nervosa is a well-known but uncommon eating disorder that affects less than 2% of the worldwide population. However, for those who have anorexia, the complications
For Patients with Eating Disorders, Cannabis May be the Right Medicine
It’s morning in New York City, and Jessica Mellow is preparing for a long day. She pours her first of many cups of coffee and steels herself for another day of work — and another day of anorexia treatment. Not only does the body-paint model have a long session booked, she also has an appointment with her psychiatrist, and dinner with a meal-support specialist. She takes some cannabidiol (CBD) oil to help calm her nerves. Her anxiety is ever-present.
“I’ve found that when I use a bit of pot or take some CBD oil, it helps with anxiety and pain, and helps me get to sleep, sans side effects,” Mellow said. “Treatment for anorexia is trickier than for a lot of mental illnesses, largely because it requires doing the exact opposite of what feels safe and instinctual. If the brain perceives food as a threat, but the only way to get better is to continuously eat, the anxiety increases drastically, and as treatment goes on, often gets worse instead of better.”
Anorexia isn’t a qualifying condition for a medical marijuana certification in New York, even though a review of studies has shown cannabinoids can decrease anxiety and promote weight gain in anorexic patients.
Mellow, for one, is eager for more anorexia treatment protocols. “I think it would be really helpful to have [legal] cannabis as an option,” she said.
Eating Disorders’ Origins
Despite what TV movies depict, eating disorders don’t just stem from a drive to be thin. Some people are born with a genetic predisposition to anorexia, bulimia, and binge-eating disorder. Further, the intrusive thoughts that often plague sufferers are similar to those of obsessive-compulsive disorder (OCD) .
According to the National Eating Disorders Association (NEDA), “ two-thirds of those with anorexia [show] signs of an anxiety disorder (including generalized anxiety, social phobia, and obsessive-compulsive disorder) before the onset of their eating disorder. ” These comorbid conditions are only part of the reason anorexia is notoriously hard to treat.
Restrictive eating disorders such as anorexia and avoidant/restrictive food intake disorder (ARFID) can lead to progressive starvation that affects the brain, and therefore the intellect, making treatment for these patients even more challenging. Critically ill anorexic patients may want to eat, and want to recover, but may feel trapped in ritualistic thoughts and behaviors.
Bulimia and binge-eating disorder present a different but similar set of challenges, and symptoms of these disorders often overlap with anorexia symptoms. Binges can last for hours and result in the consumption of tens of thousands of calories. People with bulimia or binge-eating disorder can be of a normal weight or very overweight. Body weight doesn’t change the severity of the disease, but due to the risk of starvation or heart failure, anorexia remains the deadliest of all psychiatric disorders, with an estimated mortality rate of 10%.
Eating Disorders and the Endocannabinoid System
The endocannabinoid system (ECS) is a network of receptors, enzymes, and endocannabinoid molecules that maintains homeostasis, or a range of healthy functions in the body. The CB1 receptors, found in the central nervous system, transmit a “calm down” signal to overactive neurons. Because these receptors are plentiful in brain regions that control food intake, clinical evidence suggests that there may be a link between a defective ECS and the development of an eating disorder.
The ECS is involved in the regulation of eating and energy balance, and CB1 receptors — one of the two kinds of cannabinoid receptors in our brains, the other being the CB2 receptors — are plentiful in the brain regions that regulate hunger and control eating behaviors. Because of the way they bind to CB1 receptors, ingested cannabinoids can help reduce patients’ anxiety and increase (or decrease, in the case of high-CBD strains) the amount of food they consume. What stoners have long known to be true turns out to be backed by science: Cannabis can chill you out and give you the munchies.
“Cannabis helps me in two ways. First, it helps with hunger cues,” Cassidy said. “When you’ve been restricting for a while, your body stops asking for food when it needs to. The munchies help with that. Second, [cannabis] helps with the anxiety. It kind of quiets the wave of negative self-talk that often comes with eating.”
Anorexia sufferer Cassidy, whose name has been changed agrees. “Cannabis helps me in two ways. First, it helps with hunger cues,” Cassidy said. “When you’ve been restricting for a while, your body stops asking for food when it needs to. The munchies help with that. Second, [cannabis] helps with the anxiety. It kind of quiets the wave of negative self-talk that often comes with eating.”
The OCD Connection
The American Psychiatric Association’s “Practice Guideline for the Treatment of Patients with Eating Disorders ” states that eating disorders are often comorbid with other psychiatric conditions, particularly OCD , anxiety disorders, and personality disorders. And a ccording to the International OCD Foundation, 64% of people with eating disorders also have an anxiety disorder, and 41% of those have OCD.
What all these statistics mean is that people with eating disorders — especially the restrictive type – often operate according to a strict set of rules that may not make sense to people without eating disorders. For example, a person with anorexia may deem foods “safe” and “unsafe” based on reasons other than calories or nutrient content, or develop rituals around how they cut food and where they place it on the plate. It’s not so different from having to turn the lights on and off a certain number of times before leaving the house, or having to wash one’s hands a certain number of times before going to bed, behaviors typically associated with OCD.
In a 2019 study published in Cannabis and Cannabinoid Research, researchers from the New York State Psychiatric Institute at the Columbia University Department of Psychiatry found preliminary evidence that suggests the body’s endocannabinoid system may play a role in OCD, and cited case reports from three patients for whom the cannabinoid drug dronabinol reduced compulsive behaviors. One patient, who displayed treatment-resistant OCD symptoms following a thalamic stroke, was able to participate in cognitive behavioral therapy (CBT) after using dronabinol. While more research is needed, this preliminary evidence suggests that cannabis-based treatments may allow patients struggling with compulsive behaviors to more effectively participate in talk therapy. In addition, a 2005 study showed that rates of the endocannabinoid anandamide are increased in patients with anorexia and binge-eating disorder, but not in patients with bulimia. The possibility of modulating the endocannabinoid system to treat certain eating disorders deserves more research.
Future of Eating Disorder Treatment
Scientific studies of patients with HIV and cancer show that cannabis increases appetite and can lead to significant, life-saving weight gain. However, established eating-disorders treatment programs have been slow to accept the medical efficacy of cannabis.
Fortunately, clinicians such as Dr. Ziv Cohen, a psychiatrist in New York City licensed to certify patients to the state medical-marijuana program, think it could be a helpful addition to eating disorder treatment protocols.
“I think that there is a lot of promise in cannabis-based products for restrictive eating disorders in the same way that cannabis products are very helpful for cancer patients who have problems with their nutrition,” Cohen said. “Anxiety is reduced and appetite is increased, and that combination can kind of push patients over the hump and get them to eat things that they wouldn’t normally eat, or that they’re phobic about.”
Cohen stressed that not all patients with eating disorders are good candidates for cannabis medicine; comorbidity is an important consideration. Inducing uncontrollable munchies in patients who purge has obvious consequences, but for patients with trauma histories who restrict or binge in response to post-traumatic stress disorder (PTSD) triggers, Cohen said cannabis could be helpful.
“We want to make sure we’re not conditioning the patient to only be able to eat when they’re using a cannabis product; just like with other medications, we would want [cannabis] to facilitate developing regular eating habits, not to become a ritual that is necessary [in order] to eat,” Cohen said. “Cannabis treatment could be very helpful, as long as it’s within the context of a good multidisciplinary team.”
Mellow agreed, and stressed the importance of her treatment team and the need for alternatives to psychiatric medications.
“Malnutrition can prevent psychiatric medications from being effective, so having [cannabis] to help with the anxiety could potentially make a treatment that often feels punitive much more tolerable and effective,” Mellow said.
“I don’t believe there’s any miracle cure,” Mellow said, “but if cannabis can reduce some of the biggest barriers to treatment — exhaustion, anxiety, physical discomfort — that leaves more room to focus directly on recovery, and I don’t see how that could be anything but positive.”
For Patients with Eating Disorders, Cannabis May be the Right Medicine It’s morning in New York City, and Jessica Mellow is preparing for a long day. She pours her first of many cups of coffee