Empower Me Blog
Budding New Considerations about the Use of Cannabis in Eating Disorder Treatment
Eating Disorders and Co-Occurring Substance Dependency
Eating disorders are complex psychopathologies, which present clinical challenges for many reasons. A major one is that eating disorders often co-occur with a Substance Use Disorder (SUD). This includes cannabis abuse, which can begin before, concurrently with, or after the onset of an eating disorder. Given this, EDCare uses an integrative model in treating the SUD, along with other eating disorders symptoms such as anxiety, OCD, and depression.
Another challenge is that individuals with anorexia are empowered by resisting the temptation of eating. Therefore, the appetite-stimulating properties of cannabis can’t necessarily overcome the neurobiological issues that are also intimately involved with their eating disorder.
That being said, medical cannabis might be a helpful tool for some people in conjunction with therapies such as Cognitive Behavioral Therapy (CBT). There are three primary strains of cannabis: sativa, indica, and hybrids.
- Sativa is the activating strain of cannabis that tends to energize the user and produced the “high”. It can be used to relieve the symptoms of depression, fatigue, and mood disorders.
- Indica is a more sedating strain that produces relaxation and full-body effects and is preferred by the majority of our eating disorder patients.
- Hybrids are varying functions of these two strains that are thought to balance the positive effects of both.
Cannabis and Eating Disorder Treatment
One EDCare patient reported that medical cannabis helped slow down her mind, allowing her to observe her irrational thoughts surrounding food. Food began to taste better making her mealtimes an enjoyable experience.
Substance abuse of course, is a big concern. In Denver, between 7 and 9% of our eating disorder patients who use cannabis show signs of substance dependency. With 364 legal dispensaries in Denver and 1,021 in Colorado, we can clearly expect that up 50% of our eating disorder patients are using. Moreover, testing an individual’s level of intoxication has proven to be a challenge due to the length of time THC takes to clear the body.
How do we deal with this dilemma? We begin with a very extensive physical and psychological diagnostic assessment for the history of the eating disorder and substances use/abuse. We need to determine whether the patient can participate in our program, and whether they are using edibles, tinctures, or smoking. Are they using Indica or Sativa? Can we wean them off the higher levels of THC with a mix of CBD and a much lower percentage of THC? And finally, what withdrawal effects such as irritability, insomnia and changes in appetite need to be treated while still focusing upon their compromised emotional and medical state due to their eating disorder?
There are many unanswered questions concerning medical cannabis usage in eating disorders. We have learned to practice “beginner’s mind” with an attitude of openness, curiosity, and lack of preconceptions or judgment when learning the adaptive function of both the eating disorder and the cannabis use.
Can CBD Help Control Overeating?
Obesity is a medically recognized global phenomenon that is, like anxiety and depression, not confined to gender, age or socioeconomic backgrounds. According to the World Health Organization in 1995 there were an estimated 200 million obese adults worldwide and another 18 million under five children classified as overweight. In 2000 an estimated number of 115 million adults in developing countries suffer from obesity related health problems.
How is it that issues with overeating have become so widespread? The answers are complex, but an interaction of genes and lifestyle play a major part. There are as many different triggers for overeating as there are individuals, but at the core of the problem is the idea of eating your feelings. Food cravings are the body’s way of seeking a dopamine release, which is a firing of the reward system. Impulsive eating replaces unwanted feelings, so eating becomes associated with minimizing unpleasant feelings.
In my researching of CBD oil as an appetite suppressant, I spoke to Sarah, (not her real name) a 71 year old woman from Southern California with a history of emotional eating. Sarah is retired but used to run a newsroom and she says she has battled with compulsive eating all her life. Over the years she has tried an array of treatments to alter the course of her relationship to food, ‘I tried 12 steps, pills, herbs, everything works a little bit.’ Sarah was looking to find a supplementary treatment alongside exercise and healthy eating, something that could be holistically effective.
In the 60’s and 70’s Sarah explained, ‘I smoked with my friends to get high but I quit smoking about 3 years ago.’ This was when she discovered Dr Allan Frankel, an internal physician from Santa Monica who set up the Greenbridge Medical Group in 2007. Dr Frankel, an internal physician trained at UCLA for 27 years, recognized that his toolbox for treating chronic conditions was becoming limited. He no longer wanted to prescribe xanax, benzodiazepine and other addictive tranquilizing medicine to manage anxiety and pain as there are too many negative side effects. Medical marijuana, as Frankel has discovered through his clinical work, integrates very well with internal medicine and patients are looking for non-addictive treatments, alternative to the pharmaceutical options.
With the help of Dr Alan Frankel, Sarah found that by working through different combined dosages, she has found for her combining 2.5 milligrams of THC and 2.5 milligrams of CBD along with the carrier oil MCT (coconut oil) is what appears to stop the emotional component of her compulsive eating. Combining THC with CBD appears to have a bidirectional effect, meaning it can support the benefits of each component and reduce the side effects. MCT oil has been known to act as an appetite suppressant but Sarah noticed that if taken on its own, it can cause digestive upset.
Within a year of following this dosage, and not changing her diet, Sarah lost between 20 and 25 pounds in weight. She argues the weight loss is due to the fact that she is now not reaching for food every minute. The emotional component of eating has been suppressed, helping Sarah effectively lose weight. Sarah reported few side effects, aside from occasionally experiencing a dry mouth but the main benefit is that she stops thinking about food, ‘it has helped take the edge off so that I don’t think about food constantly.’
I asked Sarah what she thought of the explosion in the CBD market, when it is still largely unregulated. Sarah recommends going to a marajuana doctor because they understand the nuances of focused dosing, accurate to the milligram, which means that the doctor, the patient and the dispensary all know exactly what is in the medicine. This is because the plants are tagged, there is proper extraction and they are fully laboratory tested for dosage. There is an assurance that you know the quality and consistency but also you are optimizing the effects through medical dosing. Sarah buys the CBD oil with THC from StateWide Collective. She uses a sublingual spray but there are many different methods of taking it, such as cannabis capsules or edibles.
Unlike THC, the high inducing, addictive component of cannabis, CBD has been shown to regulate the body’s stress response and support the body to reduce compulsive behaviors, such as overeating. CBD is ‘like a full body massage at a molecular level’ (New York Times) perhaps this may be the reason that CBD oil is being marketed as a cure for all.
‘We know cannabis affects appetite but, ‘by studying exposure to cannabis plant matter, the most widely consumed form, we’re finding genetic and physiological events in the body that allow cannabis to turn eating behavior on or off.” explained Jon Davis, Ph.D., researcher in the Department of Integrative Physiology and Neurosciences at Washington State.
Most people associate cannabis with a stimulated appetite, as people who smoke cannabis tend to feel more hungry than usual. THC activates the CB1 receptors in the body, causing many effects, including stimulating the appetite. However, as the authors of one 2018 study paper note, CB1 receptor antagonists may help reduce appetite and control obesity. This is because CB1 receptor agonists block off or “deactivate” the receptor.
The reality is little longitudinal research has been done on humans because Marijuana is still a federally classified C grade drug. The CBD industry is in a legally grey area, because the FHA has not regulated it for dietary purposes and yet it is widely available to consume, so consumers need to be aware of this. “It’s very disconcerting for me” says Yasmin Hurd, a professor at the Icahn School of Medicine at Mount Sinai, “that CBD is so easily accessible without adequate studies.”“CBD is not a cure-all.”
Anecdotally at least for now, it is being presented as a cure for all, so caution is needed and good judgement. The good news is you cannot overdose on CBD oil and it is non addictive, and with the nation in the grip of opioids, CBD may be a more holistic solution.
Hetty Clark is an Integrative Arts Psychotherapist, Singer songwriter and Writer. She is from the UK but lives in Los Angeles.