The ability of cannabis medicines to encourage appetite is part of popular culture. “The munchies” is a phrase known nationwide. Cachexia (also known as wasting syndrome) is characterized by skeletal muscle loss with or without loss of fat tissue. Cachexia is much more than a loss of appetite, as body mass is lost and responsible for the drastic change in the appearance of patients with late-stage cancers and AIDS. In 2014, there were no FDA-approved drugs to treat cancer cachexia, although several candidate drugs were undergoing clinical trials. One key to successfully treating cachexia is to reverse the loss of muscle mass.
Cachexia was once the least controversial medicinal benefit of cannabis but not always the best understood. Cannabis effectively treats cachexia, but some forms of cachexia, especially those associated with advanced cancer, may not respond to cannabis.
The cardinal clinical points of this syndrome are5:
- Progressive and relentless weight loss (more than 5% of loss compared with normal weight).
- Loss of muscle mass.
- Loss of fat tissue.
- Minimal or no response at all to usual therapies such as nutritional supplementation.
- Difficulties in routine daily activities.
- Marked fatigue or asthenia.
- Loss of appetite.
- Progressive deterioration.
- Reduced cancer treatment tolerance.
- Reduced length of life. (There is a correlation between weight loss, rate of weight loss and survival.)
- The reduction in food intake alone does not explain the metabolic changes found.
- Resting energy expenditure (basal metabolic rate) is increased in some cancers but not in others that also produce cachexia.
- Associated with insulin resistance.
- Associated with acute-phase inflammatory reactants.
At high doses, cannabis tolerance will develop, and the ability of cannabis to treat cachexia will decline.
The endocannabinoid system is the principal regulator of food intake. Cannabinoids stimulate receptors in the hypothalamus and structures in the hindbrain responsible for appetite regulation.
“The munchies” are a response to a high dose of cannabis, typically occurring 90 minutes after ingestion. This may be because larger doses of cannabis exceed the “sweet spot” of appetite stimulation, and the metabolism must wait for the dose to be metabolized. Appetite stimulation requires a minimal dose of cannabis. Marinol (a synthetic form of THC) treats cachexia in small sub-psychoactive doses of 2.5 milligrams before meals. THCV molecules should be avoided as they have been shown to curb appetite.
Molecules to target appetite disorders
Strains that are high in beta-caryophyllene are recommended. THC dominant varieties are most commonly used for appetite stimulation and cachexia treatment. Alternative cannabinoids such as CBD have provided mixed results. THCV varieties will retard appetite and should be avoided. CBDV varieties are promising but as yet unstudied. High CBG strains may also be of interest. GW Pharmaceuticals has applied for a patent to use CBG for simultaneous agonism of the CB1 and CB2 receptors in conditions such as cachexia.
Methods of ingestion
Both sublingual and swallowed cannabis medicines are effective, and if there are no accompanying lung issues, vaporization of cannabinoids can be very effective at quickly stimulating the appetite in small doses.