Anorexia nervosa, more commonly known as anorexia, was first discovered in 1873 by William Gull. It is a psychiatric condition resulting in an eating disorder characterized by low body weight and an irrational fear of gaining weight. Anorexia, which typically strikes teenage women and afflicts about two million people worldwide (eating disorders overall afflict 24 million), involves body-image issues in cultures that too often market clothing fashions using emaciated supermodels, giving young women unrealistic — and unhealthy — perceptions of their own bodies.
While only about 0.3 percent of men suffer the condition, 1-3 percent of women are believed to have anorexia. The condition most often afflicts white adolescent females from middle and upper socioeconomic classes. In addition to severe weight loss and malnutrition, anorexia can result in anemia, digestive problems, loss of bone density, and heart-rhythm disturbances — as well as imbalances in hormone and electrolyte levels.
Some anorexics resort to food purging (forced vomiting) following a meal to give the impression that they are eating regular meals and to hide their condition from those around them. If done on a daily basis, this may cause severe sensitivity in the esophagus and even lead to stomach and throat damage. The vicious cycle of hyper-critical self-image assessment, which leads to avoiding food or purging, results in a lack of proper nourishment. This, in turn, can produce a variety of conditions, including lack of energy and fatigue, weakness, and difficulty dealing with things like the common cold or allergies.
In 2013, anorexia killed about 600 people. Roughly five percent of those who suffer long-term anorexia will die of the condition over a ten year period. It frequently results in depression, with suicide being one of the leading causes of death among those who suffer anorexia. Beyond psychological factors, it can also be caused by stomach disorders, reactions to medications, and the use of hard narcotics like heroin and cocaine.
Cannabis can be an effective treatment for anorexia for a number of reasons. First and foremost, it is a powerful appetite stimulant. One of the ages-long memes associated with marijuana is the onset of severe hunger (“the munchies”), with scenes involving stereotypical pot-smoking college students scarfing down bags of Doritos and Oreos. In fact, the three greatest efficacies of cannabis as medicine are appetite stimulation, pain reduction, and its role as an anti-inflammatory (making it good for everything from Crohn’s disease to arthritis to strokes).
Using cannabis to stimulate the appetite of severe anorexia sufferers, some of whom refuse food, is also a more humane and less traumatic treatment than a feeding tube. Anorexia patients suffering from debilitatingly low self-esteem gain no psychological benefit from enduring the discomfort and embarrassment of a feeding tube. Cannabis also decreases the anxiety suffered by patients due to their psychological condition and may help them to open up to counselors, medical professionals, or parents about their self-image perceptions and reasons for refusing food or purging.
Dr. Donald Abrams, a professor of clinical medicine at the University of California and medical cannabis advocate, wrote in 2011 in response to a study that showed a synthetic form of THC was effective in stimulating appetite in cancer patients:
“I don’t think there’s anything startling about the fact that cannabis or cannabinoids increases the appetite. That’s been well known for years.”
A review of the studies indicating that cannabis and, specifically, the cannabinoid THC are effective treatments for loss of appetite in cancer and HIV/AIDS patients is appropriate when considering the effectiveness of cannabis for anorexia. A 2002 study revealed that cannabis treatment helped a group of Alzheimer’s patients who had previously refused food to gain weight. However, the same study revealed that patients with anorexia nervosa gained little similar effect from the same cannabinoids.
“In patients diagnosed with primary anorexia nervosa, there was no measurable cannabinoid effect, presumably because the underlying pathological mechanism is not loss of appetite.”
This study illustrates that anorexia is a psychiatric condition that manifests itself physically, for which the appetite stimulation provided by cannabis may not be a complete solution or target the root cause.
A study conducted by the Michigan Department of Health in 1982 involving cancer patients undergoing chemotherapy and seeking to alleviate nausea and vomiting involved 165 participants who were randomly placed into one of two control groups: Those using cannabis and those taking a pharmaceutical drug called Torecan. If the initial treatment was declared a failure, patients could elect to switch to the alternate therapy.
This unique study revealed that 90 percent of the patients who received cannabis desired to continue using it; only eight of 83 patients randomized to marijuana chose to discontinue and try Torecan. However, of the Torecan group, 22 of the 23 patients elected to discontinue its use and switch to cannabis. The study concluded that 71 percent of the patients who received marijuana reported no vomiting and only moderate nausea following chemotherapy treatment.
The study, when publishing “serious side effects” related to the use of cannabis, found the most common to be increased appetite, with 32 percent of patients reporting enhanced hunger.
In 1999, the Institute of Medicine in Washington, D.C. (a nonprofit organization founded in 1970 as part of the National Academy of Sciences) released a detailed report regarding medical cannabis. The report, an examination of 15 previous studies, concluded that “accumulated data indicate a potential therapeutic value for [cannabis] drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation.”
It has been found that the body’s endocannabinoid system plays a major role in mediating hunger and stimulating appetite. A 2011 study published in the journal Biological Psychiatry found a link between anorexia nervosa and bulimia based on a brain malfunction that leads to a loss of endocannabinoids. Because the endocannabinoid system is known to regulate bodily functions such as hunger, this endocannabinoid deficiency results in a distortion of appetite.
The study concluded that the functionality of CB1 receptors in the brain and nervous system, which bind with THC, was reduced in the brains of women with anorexia. The study reported:
“The role of endocannabinoids in appetite control is clearly important. These new data point to important connections between this system and eating disorders.”
A 2013 study published in the European Journal of Nuclear Medicine and Molecular Imaging confirmed the 2011 study published in Biological Psychiatry by finding that “widespread transient disturbance” in the endocannabinoid system plays a major role in eating disorders like anorexia. It found that such “disturbance” occurs primarily in the CB1 receptors of the brain and nervous system.
“Several lines of evidence strongly implicate a dysfunctional endocannabinoid system (ECS) in eating disorders.”
A study published in the journal Innovations in Clinical Neuroscience in 2014 revealed that rodents that were put into an anorexic state of being, after returning to regular diets and exercise levels, fully recovered only if they had been administered cannabinoids during the test. Subjects deprived of cannabinoids during anorexia remained in an anorexic state, even after food conditions returned to normal. The report concluded:
“The control group, which was given cannabinoids in its feed, [recovered].”
Gaining a Better Perspective
From a psychological perspective, cannabis therapy may assist anorexia patients in gaining a more realistic understanding of their body type and decrease the stress, anxiety, and depression that commonly accompany a patient’s false perception that they are overweight — when, in fact, they are actually underweight and malnourished.
Because an irrationally skewed body-image is the root psychiatric cause that leads to many different eating disorders, including anorexia, the soothing, mellow psychoactive effects of cannabis and THC may help patients gain insight into their condition and a more realistic perspective. If self-perceptions that are more based in reality lead to less depression and anxiety and, thus, the consumption of more calories, cannabis and THC may offer much more than mere appetite stimulation.