CBD for Anorexia Nervosa
What is Anorexia Nervosa
Anorexia nervosa is a widespread eating disorder with patients ranging in age, gender, sexual orientation, races, ethnicities and socio-economic backgrounds. In fact, the disease is so widespread that historians and psychologists have found evidence of people displaying symptoms of anorexia for hundreds or thousands of years.
Typically anorexic behaviors develop most frequently during adolescence, an increasing number of children and older adults are also being diagnosed with the disease. Patients in which anorexia nervosa is diagnosed, severely restrict the number of calories, and the types of food they eat. Some people with the disorder may also exercise excessively and compulsively, engage in binge eating, and / or bulimic behaviors that entail the purging of the consumed food after a binge.
The disease is often characterized by extreme weight loss or a lack of appropriate weight gain in growing children and adults, difficulties in maintaining a body weight appropriate for height, age, stature and gender as well as a distorted body image. However, it is important to understand that one cannot tell if a person is struggling with anorexia by looking at them as a person does not need to be emaciated or underweight to be struggling. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity.
In anorexia nervosa, the cycle of self-starvation results in the body being denied the essential nutrients it needs to function normally. In order to conserve energy, the body systematically shuts down biological processes, finally shutting down essential biological functions that can have serious medical consequences. It is therefore incredibly important to understand the many ways that eating disorders affect the body.
Psychological consequences and medical complications of anorexia include:
- Depression, anxiety and other mood disorders
- Personality disorders
- Obsessive-compulsive disorders
- Alcohol and substance misuse
- Self-injury, suicidal thoughts or suicide attempts
- Cardiovascular problems, such as mitral valve prolapse, abnormal heart rhythms or heart failure
- Bone loss (osteoporosis), increasing the risk of fractures
- Loss of muscle
- In males, decreased testosterone
- Gastrointestinal problems, such as constipation, bloating or nausea
- Electrolyte abnormalities, such as low blood potassium, sodium and chloride
- Kidney problems
Symptoms of Anorexia Nervosa
Researchers are not sure exactly sure about what causes anorexia but think that it may present itself because of a person’s biology and psychology in combination with life events. This combination includes having specific genes, a person’s biology (including changes of serotonin levels and other neurotransmitters), body image and self-esteem, social experiences, family health history, and sometimes other mental health illnesses.
Emotional and behavioral symptoms include:
- A preoccupation with weight, food, calories, fat grams and dieting
- Refusing to eat certain foods, for examples “no sugar”, “no fat” or “no carbohydrates”
- Making frequent comments about feeling “fat” or overweight despite weight loss and / or being at a low body weight
- Has intense fear of weight gain or being “fat,” even though underweight
- Has disturbed experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight
- Denies feeling hungry
- Develops food rituals like eating foods in certain orders, excessive chewing or rearranging food on a plate
- Cooks meals for others but not eating themselves
- Consistently avoiding mealtimes
- Avoiding activities like birthday parties or dinner events that involve food / eating
- Withdrawing socially and becoming more isolated, withdrawn, and secretive
- Expresses limited social spontaneity
- Shows concern for eating in public
- Expresses a need to “earn” or “burn off” calories taken in
- Feels ineffective
- Shows inflexible thinking and / or strongly needs to control everything
- Has overly restrained initiative and emotional expression
Physical symptoms include:
- Dramatic weight loss
- Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
- Muscle weakness
- Poor wound healing and / or impaired immune function
- Feeling cold all the time and dresses in layers to hide weight loss or stay warm
- Cold, mottled hands and feet or swelling of feet
- Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
- Maintains an excessive, rigid exercise regimen, despite weather, fatigue, illness, or injury
- Loss of menstrual period in post-pubescent females or menstrual irregularities including amenorrhea, irregular periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
- Difficulties concentrating
- Dizziness and / or fainting spells
- Sleep problems
- Cuts and calluses across the top of finger joints (a result of inducing vomiting)
- Dental problems, such as enamel erosion, cavities, and tooth sensitivity (from vomiting)
- Dry skin and dry, brittle nails and hair
- Swelling around area of salivary glands
- Fine hair on body (lanugo) and / or thinning of hair on head
Anorexia Nervosa Medications & Treatments
Treating anorexia nervosa is challenging at best, primarily because most people with the disorder deny they have a problem, or are so terrified of gaining weight that they oppose all efforts to help.
Treatment is aimed at restoring the patient to a healthy weight, treating emotional issues such as low self-esteem, correcting distorted thinking patterns, and developing long-term behavioral changes. This usually means that patients require a comprehensive treatment plant that includes a combination of pharmaceutical and psychological treatment methods.
Anorexia - Pharmaceutical Interventions
In severe cases, emergency care for anorexia may be needed where dehydration, malnutrition, kidney failure, or an irregular heartbeat may pose imminent risk to life. In such cases, medications will be prescribed to address each particular medical complication.
Long-term medications to help treat anorexia nervosa often include antidepressants such as selective serotonin reuptake inhibitors (SSRIs). These may be used to help control anxiety and depression associated with an eating disorder. In addition, some antidepressants may also help with sleep and aid in stimulating the appetite.
Anorexia - Non-Pharmaceutical Interventions
The majority of the focus in any anorexia nervosa treatment plan is on psychotherapy and nutritional therapy.
Psychotherapy, also called “talk therapy” is a type of individual counseling that focuses on changing the thinking (cognitive therapy) and behavior (behavioral therapy) of a person with an eating disorder. Treatment includes practical techniques that help develop healthy attitudes toward food and weight, as well as approaches for changing the way the person responds to difficult situations. This therapy may also focus on the importance of talking about feelings and the effect they have on the person.
Nutritional counseling is a strategy that is designed to teach a healthy approach to food and weight, help restore normal eating patterns, and teach the importance of nutrition and a balanced diet.
CBD for Anorexia Nervosa
Research and Scientific Evidence on using CBD for anorexia
The clinical evidence for Cannabidiol (CBD) as a viable treatment option for Anorexia Nervosa is limited, with most studies focusing on medical cannabis and THC for treating the disease.
However, cannabinoids such as CBD does have potential benefits for anorexia nervosa patients in that it can help improve mood and reduce anxiety and depression, both of which are associated with anorexia while also having the ability to interact with several biological systems involved with hunger.
Antidepressant-Like and Anxiolytic-Like Effects of Cannabidiol: A Chemical Compound of Cannabis sativa
Where CBD may be particularly useful for use in anorexia nervosa is improving the mood disorders associated with anorexia, including reducing anxiety. In a 2014 study published in CNS and Neurological Disorders - Drug Targets, investigators reviewed studies of animal models using CBD as an anxiolytic-like and antidepressant-like compound.
They analyzed data from studies involving animal models that involved a variety of experiments on anxiety and depression disorders, including research protocols such as the forced swimming test (FST), elevated plus maze (EPM) and Vogel conflict test (VCT). The results suggest that CBD exhibited an anti-anxiety and anti- depressant effects in animal models, and that it can be concluded that CBD shows promise for becoming a new drug for the treatment of psychiatric disorders.
Cannabidiol: A Potential New Alternative for the Treatment of Anxiety, Depression, and Psychotic Disorders
In a more recent 2020 review published in Biomolecules, unlike the review above, the researchers focussed on the anxiolytic, antidepressant, and antipsychotic effects of CBD found in both animal and human studies.
In rodents, The data confirmed previous review papers in so far as the results suggesting that CBD does show positive anxiolytic, antidepressant, and antipsychotic properties, and that the effects depend on the dose, the strain, the administration time course (acute vs. chronic), and the route of administration.
Similarly, preliminary clinical trials also support the efficacy of CBD as an anxiolytic, antipsychotic, and antidepressant in human populations as well, primarily via certain key targets, including cannabinoid receptors, 5-HT1A receptor and neurogenesis factors. However, more importantly, CBD has a much more positive risk-benefit profile compared to pharmaceutical anti-anxiety and antidepressant medications.
Hypothalamic POMC neurons promote cannabinoid-induced feeding
However, cannabinoids such as CBD may also have a more direct benefit for anorexia nervosa sufferers. In a 2015 paper published the prestigious Nature, researchers investigated the role of cannabinoids and thypthalamic pro-opiomelanocortin (POMC) neurons in promoting satiety.
It has been found that the cannabinoid receptor 1 (CB1) is critical for central regulation of food intake and feeding behavior is under control of hypothalamic circuits, specifically PMOC neurons and gene codes. Using mice, the researchers looked at whether CB1-controlled feeding is paralleled by decreased activity of POMC neurons.
They found that the chemical promotion of CB1 activity increased feeding while, paradoxically, CB1 activation also promoted neuronal activity of POMC cells. They also found that the Pomc gene encodes both the anorexigenic peptide, α-melanocyte-stimulating hormone (α-MSH), as well as the peptide, β-endorphin and that CB1 activation selectively increased β-endorphin but not α-MSH release in the hypothalamus. Similarly, the systemic or hypothalamic administration of the opioid receptor antagonist, naloxone, blocked acute CB1-induced feeding.
The researchers concluded that all these various processes involved mitochondrial adaptations, which, when blocked, terminate CB1-induced cellular responses and feeding. And that, when taken together, the results reveal an unsuspected role of POMC neurons in promotion of feeding by cannabinoids.
Anecdotal Evidence on using CBD for Anorexia
There are several success stories of people using cannabis to help manage their anorexia nervosa. However, when it comes to CBD, there are fewer success stories. Regardless, as outlined above, for most people suffering from an eating disorder such as anorexia, the primary reported benefit is that it helps them manage their anxiety, but also the pain associated with many of the physical consequences that accompany the disease.
CBD as a Complementary Treatment for Anorexia
While the research is suggesting that CBD can help reduce psychological factors that can help reduce some underlying causes and / symptoms around anorexia nervosa, CBD may also help attenuate other symptoms people with anorexia have to deal with.
For instance, as mentioned, many patients have anorexia induced conditions like constipation, bloating or nausea, bone loss, alcoholism and substance misuse, and difficulties with sleep. CBD can help relieve many of these, including gastrointestinal issues. Similarly, CBD has also been shown to help with both the addictive and relapse behaviors related to alcoholism and substance abuse, while also promoting bone growth and density and density as well as promote REM sleep that reduce many sleep difficulties.
To date, research on CBD for anorexia nervosa is limited. However, CBD does have several properties that can directly help manage many issues that are either underlying factors, or exacerbate anorexia nervosa. For instance, CBD’s anxiolytic and antidepressant properties can help treat mood disorders and reduce stress levels that encourage healthy eating as well as help improve anxiety and depression. If you are considering using CBD for anorexia nervosa, always speak to your treating physician first, as they can also monitor dosage, symptom severity and other clinical parameters, to ensure that your CBD treatment is both safe and effective.