How Cannabis Can Prevent Wasting Syndrome
This article arrives on the heels of an announcement by the World Health Organization that obesity and obesity-related diseases are now a greater problem than world hunger and starvation. Imagine that.
However, and in contrast to the WHO report, we have a population of patients across the planet who are ‘starving’ due to their medical condition regardless of what they may eat. But it’s far worse than simply not being able to gain muscle mass or body fat. In fact, many of these patients will witness their bodies wasting away on a daily basis in a futile attempt to control their disorder. It’s a perilous process which ultimately for some ends in death.
These people suffer from ‘wasting syndrome’ and sarcopenia which is a type of muscle loss. These all fall under the banner of ‘cachexia’, which is a general term for wasting from any disease. Generally, most of these patients will have a chronic condition that makes maintaining a normal body weight impossible. Often times these disorders are terminal.
This article also serves as a reminder that indeed there are medical indications for marijuana contrary to the latest disappointing, yet predictable, announcement by the United States Drug Enforcement Agency (DEA) to maintain weed’s schedule one status.
From the American Society of Clinical Oncology (2006):
Anorexia and weight loss contribute to cancer-related fatigue, functional loss, impaired survival, and intolerance of treatment. Efforts to palliate these conditions include studies of the endocannabinoid system, which modulates appetite through cannabinoid receptor–related processes. Hyperphagic [increased appetite] effects of cannabinoids and hypophagic [decreased appetite] actions of selective cannabinoid receptor antagonists have been reported.
Cannabinoids reputedly stimulate appetite, both historically and in recent studies of human volunteers and AIDS patients. Studies of patients with multiple sclerosis or pain have evaluated oral mixtures of THC and CBD or whole-plant cannabis extract (CE), replacing smoked marijuana. Data from four dose-finding and phase II studies of 161 patients with cancer-related anorexia-cachexia syndrome (CACS) suggest cannabinoids’ potential at fixed doses of 2.5 mg of THC twice to three times daily; (JCO July 20, 2006 vol. 24 no. 21 3394-3400 ).
The causes of cachexia are serious illnesses. These include:
Chronic obstructive pulmonary disease
Congestive heart failure
Tuberculosis (remember the old term for TB? It used to be called consumption)
Familial amyloid polyneuropathy
PHARMACEUTICALS KNOWN FOR CAUSING WEIGHT GAIN
Of note, there are several drugs which can cause a boost in hunger, including tricyclic antidepressants (TCAs), tetracyclic antidepressants, natural or synthetic cannabinoids, first-generation antihistamines, most antipsychotics and many steroid hormones.
However, most patients prescribed these pharmaceuticals are not looking to gain body fat which at times can be impressively large. They often experience significant side effects from these as well.
The most notorious would be the corticosteroids such as prednisone and the newer atypical antipsychotics. The effects of prednisone are impressive. Anyone who ever owned an ‘itchy’ pet has probably witnessed first-hand how obese your pet can get in a matter of weeks!
Yet, it would be imprudent to prescribe these medications solely for weight gain as they are very powerful drugs with defined indications. There are a handful of anabolic steroids such as testosterone which can also be used in this setting for maintaining muscle mass. Furthermore, growth hormone can stimulate appetite and mass gain, so it can be used for this purpose. Another drug called megestrol acetate, is a synthetic derivative of the naturally occurring steroid hormone, progesterone. It too is frequently used to increase appetite by an unknown mechanism.
But for the vast majority of patients suffering from cachexia these drugs do little to alter the downward spiral of diminishing body weight.
AIDS AND AIDS WASTING SYNDROME
That doesn’t leave us much to prescribe to patients suffering from AIDS for example. Let’s examine AIDS Wasting Syndrome (AWS) since the use of marijuana in this class of patients is indicated and should be encouraged since AWS appears to be a prognostic factor in death from AIDS.
Indeed, we do have clinical evidence of THC’s efficacy from a surprisingly large group of studies. Contrary to what you have been told by the DEA (and its British equivalent), we have decent evidence that shows THC to be particularly good at improving appetite and increasing weight gain.
Said differently, cannabis does have a firm medical indication here, and it is proven to do just that by medical science.
Keep in mind that many, but not all, of these studies used dronabinol (Marinol) a synthetic version of THC. Well over a dozen studies were performed in the nineties, another half-dozen from the 1980s, and another half-dozen or more were done in the early 2000s. And nearly every one of them showed that marijuana (THC) can increase appetite and weight gain in cachectic patients.
THE STRUCTURE OF THC AND DRONABINOL
As you can see the chemical structure of dronabinol (figure 1) is the same as THC (figure 2) which begs the question, how is it that dronabinol could have been patented?
Let’s start with HIV positive patients and the smoking of cannabis for treating their symptoms. From the UK we have the results of a survey from 2005:
Science: Cannabis in HIV
523 HIV positive subjects were asked about cannabis use with an anonymous questionnaire in the UK. 143 (27 per cent) reported using cannabis for treating symptoms. Patients reported improved appetite (97%), muscle pain (94%), nausea (93%), anxiety (93%), nerve pain (90%), depression (86%), and paresthesia (85%). (Source: Woolridge E, et al. J Pain Symptom Manage 2005;29(4):358-67).
As you can plainly see, this survey demonstrated that the smoking of pot vastly improved several important parameters such as increased appetite, and a decrease in nausea.
In 2007 Dejesus et al, performed a retrospective study on 117 patients to determine whether dronabinol affects appetite and weight status in patients living with HIV/AIDS. Their conclusion: when taken [THC] for 3 months to 1 year, dronabinol significantly improves appetite and reverses weight loss in patients living with HIV/AIDS.
Also in 2007 another team led by Wilson, et al found that 40% of the study’s 84 patients gained over ten pounds (0.71 stone). Interestingly, they found that 64% of the subjects who failed to gain weight died during the study.
They concluded: Dronabinol therapy was well tolerated. Overall, there was a trend toward weight gain in LTC [long term care] residents treated with 12 weeks of dronabinol. Failure to respond to dronabinol may indicate increased risk of death.
Dr Haney and his team published an article also in 2007 which demonstrated that:
THC and cannabis caused an increase in caloric intake and weight.
Going back to 1995 Beal et al published a trial ‘Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS’. In it they found that nearly a quarter of the 139 participants gained at least 2 kg (.32 stone) at doses of 2.5 mg THC (dronabinol) two times per day (BID). Their conclusion: Dronabinol was found to be safe and effective for anorexia associated with weight loss in patients with AIDS.
Nelson et al published similar findings in the Journal of Palliative Care 1994;10(1):14-18. Entitled: ‘A phase II study of delta-9-tetrahydrocannabinol for appetite stimulation in cancer-associated anorexia.’ Here the dosing schedule was increased to 2.5 mg of THC three times a day (TID).
They selected nineteen patients with various malignancies and all had cancer-associated anorexia and a life expectancy greater than four weeks.
Ten patients out of 18 completed the 28-day study. Seventy-two percent reported an improved appetite. Conclusion: THC is an effective appetite stimulant in patients with advanced cancer. It is well tolerated at low doses.
Keep in mind that most of these trials also looked at nausea and the effects that THC may have. They all report similar findings in that THC acts as a good modulator of nausea.
This makes sense since it’s pretty difficult for a nauseous patient to want to eat anything. So the combined effects of appetite stimulation and amelioration of nausea go hand-in-hand as if pot were tailor made for this syndrome.
In 1993 Struwe et al published the ‘Effect of dronabinol on nutritional status in HIV infection.
This study was a Double-blind, randomized, placebo-controlled, crossover trial with two five-week treatment periods separated by a two-week washout period. This type of study is considered the gold standard in medical research. Patients received dronabinol 5 mg twice daily before meals, while the other arm received a placebo.
Although the study enrolled only 12 HIV positive patients and only five actually completed the study, the results showed that during dronabinol treatment, subjects experienced increased percent body fat; decreased symptom distress; and trends toward weight gain (0.5 kg/0.08 stone), increased prealbumen (a marker for starvation) and improved appetite score.
This trial lasted for 84 days. Their conclusions: In a selected group of HIV-infected patients with weight loss, short-term treatment with dronabinol may result in improvement in nutritional status and symptom distress.
Incidentally, many patients report that the psychic effects of dronabinol differ considerably from natural THC in cannabis. The vast majority of patients that dropped out of the studies mentioned above were due to intolerance of the ‘euphoria’ caused by dronabinol. If cannabis were used instead, would we see less dropouts?
In conclusion, we have clear evidence from scores of studies showing THC to be an excellent drug for treating cachexia in general, and the myriad symptoms of AIDS Wasting Syndrome.
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