Medicinal Cannabis and Wasting Syndrome: What Can It Do?
Cachexia is a condition, also known as ‘wasting syndrome’, characterised by loss of body mass associated with an underlying medical condition such as HIV, tuberculosis, autoimmune conditions, cancer and cancer treatments – to mention a few.
Patients suffering from cachexia, from any underlying condition, experience increased energy metabolism and severe lack of appetite. In this, they struggle to obtain necessary caloric intake with a flow-on effect being a lack of essential nutrients, leading to symptoms of fatigue, depression and decreased quality of life.
As cachexia progresses the loss in body fat, as well as skeletal and smooth muscle, can be devastating to the health of the patient. Increases in inflammatory responses, changes to protein synthesis and energy metabolism can fuel symptoms, further negatively impacting the underlying condition.
CACS: Cancer-related anorexia-cachexia syndrome
Cancer-related anorexia-cachexia syndrome (CACS) or cancer cachexia-anorexia (CCA) can be related to the side effects of the cancer treatment or as a result of the cancer itself, modifying metabolic and hormonal processes that impact hunger and appetite.
While there is evidence emerging for the use of medical cannabis for anorexia nervosa, the anorexia referred to here is relevant to the presentation of extreme lack of appetite, not the psychological illness. Cachexia refers to the changes in metabolic processes that contribute to a decrease in body mass.
In CACS these two conditions, cachexia and anorexia, collide creating a maelstrom of increased metabolic rate due to high inflammatory chemicals in circulation and extreme lack of appetite, resulting in patients “wasting” away. Additionally, malnutrition can impact the efficacy of drug treatments, making patients more susceptible to the toxicity of chemotherapy.
Treating cachexia with medical cannabis
The effects of cannabis on hunger may well be one of its most well-known consequences. Thus research into its effects on appetite has been widespread yet so far ambiguous.
Certain research has shown that when compared, cannabis formulations, THC-only preparations and placebo, have little variation in efficacy. Other research has shown that medical cannabis has been no more effective than its conventional counterparts.
To the contrary of the aforementioned studies, when assessing smoked medicinal cannabis, appetite and quality of life scores increased. When regarding cachexia in the context of HIV there have also been positive outcomes.
Discrepancies in efficacy abound in the medical cannabis landscape. Specifically, in the case of cachexia-anorexia, this may be due to dosage regimes not considering variables between individuals or the need for individual dose titration. Additionally, age and metabolic rate may have pertinent implications in the use of medical cannabis for cachexia.
The role of the endocannabinoid system
The endocannabinoid system (ECS) is a physiological system much like our immune or nervous systems. Endocannabinoids both interact with and regulate human immunity and impulses derived from the central nervous system, amongst a plethora of other actions.
The ECS is also known to have receptors in the gastrointestinal tract. Here cannabinoids and endocannabinoids (particularly anandamide) have the capacity to interact with cannabinoid receptors that send messages to the hypothalamus. The hypothalamus is the part of the brain that regulates hunger and instigates the cascades of hormones that tell us if we are full or hungry.
By stimulating the ECS through cannabinoid medicines or antagonists for cannabinoid receptors there is great potential to the manipulate mechanisms behind appetite that are impaired in CACS.
ACR launches appetite stimulation study
Applied Cannabis Research has launched recruitment for a new study investigating the effects of THC dominant medications on appetite in those with cachexia. The study will recruit and assess patients through CA Clinics across Australia.
There are hopes that this initial research will bode well for future investigations into the use of THC dominant formulations to increase appetite and quality of life among CACS patients.