by Gaurav Dubey (Clinical Researcher in Pediatric Cardiothoracic Surgery @ Rush University Medical Center; Co-Founder/President @ Karmik, LLC)
What is Cachexia?
The term “wasting syndrome” is as bleak as the name makes it sound. Also known as cachexia, it refers to the depletion of muscle and fat tissue in people who often have a severe and chronic illness, such as HIV/AIDS, Cancer, Crohn’s Disease, Tuberculosis and Multiple Sclerosis, among others.1 These patients lose interest in food as tastes become altered, and they lack the sensation of hunger, as treatments like chemotherapy cause considerable amounts of nausea and GI distress.1,2 It is in these patients, however, that the benefits of cannabis and cannabis extract could be particularly noteworthy.
Cannabis Therapy: Strong Rationale, Lackluster Clinical Trial Results
The beneficial effects of cannabis in treating cancer and chemotherapy-induced nausea from cancer is well established.3 The metabolic pathways modulated by cannabis are known to stimulate hunger, heighten the senses of taste and touch and produce anti-emetic properties.3 Thus, the rationale predicting that cannabis would be effective in the treatment of Cachexia is strong; however, recent trials failed to show better results from cannabis extract over the current treatment or placebo.1,2 Why wouldn’t cannabis, an appetite stimulant, help in this situation? It may have to do with the fact that cachexia patients experience an entirely different mechanism of weight loss than the typical, calorie-deficient individual.
The Disease Mechanisms Causing Cachexia are Poorly Understood
The type of weight loss as presented by cancer-induced Cachexia is much different than typical weight loss secondary to caloric deficiency.1 Currently, Cachexia is recognized as a byproduct of severe, chronic illness and it’s insidious modulation of physiologically normal metabolic processes.
A 2015 study defined Cachexia in the following manner: “…Cachexia is a complex metabolic syndrome, resulting in the loss of muscle, but not always fat mass, arises in connection with the development of severe chronic systemic inflammation…”4 Given that we also don’t fully understand the endocannabinoid system and how the phytocannabinoids from cannabis interacts with it, the mechanisms causing cachexia might actually interfere with the efficacy of cannabinoid delivery.
The Role of the Endocannabinoid System in Disease
Research has established the role of the endocannabinoid system (eCS) in a plethora of pathologies, many of them chronic (e.g. IBS, Migraines & Fibromyalgia).5 If a patient’s endocannabinoid system is significantly compromised, they are at risk of being unable to effectively battle illness and restore optimal health. Such a disorder where levels of internal cannabinoids are deficient and lead to disease is called “clinical endocannabinoid deficiency” or CED.5 Indeed, of the two primary receptors that comprise the eCS (CB1 & CB2), the CB2 receptors are densely located in cells and tissues of the immune system. More specifically, CB2 receptors are localized in lymphatic tissues and lymph nodes such as in “thymus, tonsils, B lymphocytes, T lymphocytes, macrophages, monocytes, natural killer (NK) cells, and polymorphonuclear cells”.6 Therefore, it is clear that our innate endocannabinoid signaling has a lot to do with our immune system and how we fight disease. However, it is not clear how this knowledge can be exploited to develop a more effective treatment for Cachexia using cannabinoid therapy.
To learn more about CED (Clinical Endocannabinoid Deficiency) and how it relates to chronic illness, click here!
The “Munchies” May Make You Hungry, But That Doesn’t Mean Added Pounds
While the concept behind using an appetite stimulant to treat a disorder characterized by unexplained weight loss seems like a no-brainer, it’s a bit more complex than that. In fact, several studies have demonstrated a link between heavy cannabis use and lower average BMI compared to the infrequent or non-cannabis user.7,8 A recent article I published investigating the effects of Cannabis in treating diabetes helps unravel some of these strangely paradoxical findings entailing cannabis and it’s effects on human metabolism. It could very well be that some of the very same reasons cannabis is beneficial to diabetics and other more traditional metabolic dysfunctions are why it has not been established or proven effective in the treatment of Cachexia.
Further Research is Necessary to Go Beyond the Realm of Speculation
Unfortunately, until we better understand the mechanisms behind cachexia, along with those involved in the endocannabinoid system, we’re still in the realm of speculation. Medical cannabis might provide some relief, despite this uncertainty, but Cachexia still remains a debilitating and daunting reality for those suffering with life-threatening disease.
About the Author: Gaurav Dubey holds his Master’s in Biotechnology, and has publications in the field of stem cell research and transplant medicine. Combining his experience as a scientist with his passion for creative writing and medical cannabis, he actively contributes for several clients in the cannabis industry, including: The Medical Cannabis Community, Green Flower Media, Midwest Compassion Care, and Bloom Medicinals. Recently, he launched his first company, Karmik, LLC, which provides high-quality, evidence-based content marketing solutions. Karmik aims to restore credibility to the internet by publishing resourceful and trustworthy content that empowers the reader with enlightening, science-based information.
- Reuter, S. E. & Martin, J. H. Pharmacokinetics of Cannabis in Cancer Cachexia-Anorexia Syndrome. Clin. Pharmacokinet. 55, 807–812 (2016).
- Tazi, E. & Errihani, H. Treatment of Cachexia in Oncology. Indian J. Palliat. Care 16, 129–137 (2010).
- Badowski, M. E. A review of oral cannabinoids and medical marijuana for the treatment of chemotherapy-induced nausea and vomiting: a focus on pharmacokinetic variability and pharmacodynamics. Cancer Chemother. Pharmacol. 80, 441–449 (2017).
- Ballyuzek, M. F., Mashkova, M. V. & Stepanov, B. P. [CACHEXIA AS A COMPLEX METABOLIC SYNDROME AND OTHER CAUSES OF WEIGHT LOSS IN ELDERLY]. Adv. Gerontol. Uspekhi Gerontol. 28, 344–353 (2015).
- Russo, E. B. Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuro Endocrinol. Lett. 25, 31–39 (2004).
- Cabral, G. A. & Griffin-Thomas, L. Emerging Role of the CB2 Cannabinoid Receptor in Immune Regulation and Therapeutic Prospects. Expert Rev. Mol. Med. 11, e3 (2009).
- Beulaygue, I. C. & French, M. T. Got Munchies? Estimating the Relationship between Marijuana Use and Body Mass Index. J. Ment. Health Policy Econ. 19, 123–140 (2016).
- Danielsson, A. K. et al. Cannabis Use as Risk or Protection for Type 2 Diabetes: A Longitudinal Study of 18 000 Swedish Men and Women. J. Diabetes Res. 2016, (2016).