Eating Disorders and Medical Cannabis

by Dr Nicola Davies In general, people enjoy eating – we have a biological need to eat to survive so our brain takes pleasure when we do so. However, media and social pressure has caused many to view themselves as overweight and up to 91 percent of women have attempted to control their weight through dieting. Of this number, 25 percent will potentially develop an eating disorder (ED). Eating disorders are more common in women, but up to 15 percent of ED sufferers are men. With so many people now suffering from eating disorders, there seems to be a growing disconnect between the innate pleasure of eating food and the body’s basic need for survival. People with eating disorders like anorexia nervosa and bulimia nervosa are usually treated with nutritional therapy and psychiatric treatment. If someone with these types of eating disorders is prescribed medication, it is generally an antidepressant to help with the psychological impact of their disorder. Statistics reveal that 50 percent of people with an ED meet the criteria for  clinical depression. People with anorexia tend to look on food with trepidation, while those with bulimia overcome this anxiety by eating large amounts of calories and then purging them away. Bingeing and purging keeps their hunger abated and gives them a sense of control over their bodies. Antidepressants can help with the anxiety associated with both of these disorders, although the side-effects of some antidepressants can be severe. However, most people who struggle with eating disorders aren’t on any type of medication. This isn’t necessarily due to indifference by the medical profession, but rather that the shame often associated with the condition makes them dangerously under-reported. The Endogenous Cannabinoid System In  2011,  a  study  reported  in  Biological  Psychology  found  that  the  body’s endocannabinoid system (ECS) influences a person’s mood and response to food. It was also found that those with anorexia and bulimia had impaired or particularly underactive endocannabinoid systems. The ECS is a system of cannabinoid receptors (namely CB1 and CB2) found on the surfaces of some of the cells in our bodies. The CB1 receptors are found mainly in brain cells, but also throughout the body, while the CB2 receptors are located in the cells of certain organs and deal primarily with the body’s immune system. The body naturally produces its own endogenous cannabinoids, Anandamide and 2-Arachidonyl-glycerol (2AG), to stimulate the CB1 and CB2 receptors. The goal of the ECS is to stabilize the body’s internal environment in response to the body’s external environment. One of these stabilizing  forces is appetite – when the body needs fuel, it gets hungry. We often get this impulse from the Anandamide and 2AG cannabinoids in breast milk during infancy. These cannabinoids stimulate our appetites. Some researchers believe that EDs are linked to a dysfunctional ECS, which can be rectified through medical cannabis. People with anorexia or bulimia have hypersensitive CB1 receptor functions that influence body awareness, whereas the receptors associated with pleasure in eating seem to be stunted. Medical cannabis produces phytocannabinoids that stimulate both the CB1 and CB2 receptors. THC (delta – 9 – tetrahydrocannabinol) and CBD (cannabidiol) are two phytocannabinoids that directly affect the endocannabinoid system and can help maintain balance when the body’s ability to self-stabilize becomes impaired. THC has been shown to amplify the CB1 receptors responsible for scent and taste, as well as increase dopamine levels and feelings of hunger. This makes eating pleasurable and helps relieve depression. In short, THC can actually activate those areas of the brain which trigger a euphoric reward response to food. This is good news for ED sufferers, who often have a dysfunctional ECS and/or clinical depression.

The CBD cannabinoid can affect both the CB1 and the CB2 receptors and reduce anxiety, as well as have a stabilizing effect on some of the drawbacks of THC. This would help ED sufferers reduce the anxiety experienced in response to eating and weight gain. Indeed, studies have shown that excessive cannabis consumption can cause feelings of panic, depression, and anxiety, which would exacerbate some eating disorders.

It was also found that those with anorexia and bulimia had impaired or particularly underactive endocannabinoid system

Pressures of Unrealistic Expectations

In general, most cultures promote unhealthy body types as ideal. Social media is a constant challenge to the self–esteem of the average person, with unrealistic views of everyday men and women. Just watch a fashion show to understand the unhealthy and unrealistic body types being promoted as a standard of beauty. Unfortunately, regardless of realistic expectations, modern media plays a powerful role in people’s definition of self-worth and “attractiveness,” and most likely will continue to do so in the foreseeable future. Unless perspectives change, popular media will continue to play a role in the rising number of people living with anorexia and bulimia.

People with anorexia eat very few calories and a large number may exercise too much, in a desperate effort to achieve unrealistic body image ideals. Even though someone with anorexia may look extremely thin, they will often feel fat or worry that eating will reflect a lack of control in their efforts to be thin. Those with bulimia constantly fight with their weight, often binge eating to feel satiated, before purging through vomiting, fasting, abusing laxatives or over-exercising. Both types of eating disorders tend to make sufferers feel powerless to control their weight – which is why they go to extremes to control their eating habits. Studies are showing there is an imbalance in brain chemistry, which is affecting the endocannabinoid system’s neurotransmitters, enhancing the CB1 receptors influencing how a person with these disorders views their body.

Expectations in Treatment

Most eating disorder treatment focuses on cognitive behavioural change and there is little in the way of physical treatments, bar hospitalization in extreme cases. Yet, research has shown medical cannabis can help the endocannabinoid system influence mood, body perception, and appetite. However, medical cannabis is not approved for use with regard to eating disorders in most states. This is due to the misconception that eating disorders are solely a mental health issue rather than a medical health issue.

Medical cannabis faces resistance in the treatment of diagnosed mental disorders. Pre-existing conditions like clinical depression have been shown to be amplified with certain strains of cannabis, particularly those strains that focus more on the THC cannabinoid than the more stabilizing CBD cannabinoid. There is also concern with regard to abuse of any recommended medical cannabis. People still consider it an illicit substance capable of being easily abused and with long-term side-effects. There are ongoing, completely conflicting arguments about how cannabis affects the brain at different levels of concentration, but most of these trials focus purely on the THC cannabinoid without regarding the others. The fact is, any substance can be abused when taken outside of a doctor’s recommended dosage and a lot of the stigma regarding medical cannabis comes from a long-term, sometimes accurate bias against recreational drug abuse.

As more countries embrace and acknowledge the therapeutic use of medical cannabis, its full medical potential will be able to be realized. In the U.S., 23 states currently allow the use of medical cannabis. As more follow suit it is likely that the stigma of using cannabis for medical purposes will erode. It is also likely that more studies will be funded with regard to the full potential of medical cannabis and how certain genetically developed strains can be used for many different illnesses, including treatment for eating disorders.

   

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