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During the advanced stages of severe and life-threatening illnesses, the body may undergo cachexia, an extreme reduction in weight. Cachexia, also known as “wasting syndrome,” is different from other eating disorders. It is caused by metabolic changes resulting from chronic conditions like HIV/AIDS, COPD, and cancer. Indications of cachexia include diminished appetite, significant weight loss, as well as fatigue.
This condition affects patients in the final stages of their lives. But it can be deadly for individuals battling cancer. There is a growing sense of optimism about the potential of medical marijuana in alleviating its symptoms. This is because the endocannabinoid receptors in the Endocannabinoid System (ECS) play a role in regulating appetite and managing pain.
The Three Stages of Cachexia and Their Symptoms
The three stages of cachexia include pre-cachexia, cachexia, and refractory cachexia. Each stage of cachexia exhibits distinct symptoms. The following is a detailed explanation of each stage of cachexia and its corresponding symptoms:
1. Precachexia
Precachexia occurs when a person experiences a decrease in appetite, changes in metabolism, and inflammation. This condition arises when a patient undergoes a weight loss of up to 5% due to any of the mentioned factors.
2. Cachexia
Cachexia is a condition where individuals experience a reduction of over 5% in their body weight within a year. Common indications of this condition include decreased appetite, exhaustion, inflammation, and muscle frailty.
3. Refractory cachexia
Refractory cachexia pertains to individuals with cancer who have reached a point where their bodies no longer respond to treatment. This resulted in a decline of muscle mass and diminished functional capabilities. The identification of the refractory cachexia phase is based on the patient’s underlying illness. Diagnosis of this stage indicates a low World Health Organization (WHO) performance status score and a projected survival period of less than three months.
Medical Marijuana Treatment for Cachexia
Although there is no effective treatment available to prevent, slow down, or reverse the progression of cachexia. Medical professionals are using various approaches to address the condition. These approaches involve using medications to stimulate the patient’s appetite. Patients can use medications like megestrol acetate (Megace) and Medroxyprogesterone Acetate (MPA). Less than 30% of patients who take Megace experience short-term improvements in appetite. Corticosteroids are another type of medication used to reduce inflammation. But they come with many long-term side effects. Extra interventions include dietary changes and the use of Dronabinol. Dronabinol is the active component of Marinol. Marinol is a synthetic cannabinoid designed after THC. FDA approved Marinol (dronabinol) in 1985 for the treatment of chemotherapy symptoms
Treating Cachexia with Cannabinoids
A 2015 issue of the journal Nature provides evidence that medical marijuana can enhance the appetite in mice’s brains. The study conducted on animals found that an increase in cannabinoid receptor 1 triggers an increase in appetite. A previous study from 2014 published in the journal Innovations in Clinical Neuroscience had also confirmed this. The study mentioned that the immediate use of marijuana can lead to a phenomenon known as the “munchies,” which is a well-known effect of cannabis.
Medical Marijuana and Appetite Stimulation
According to a publication by the Institute of Medicine in 1999 titled “Marijuana and Medicine: Assessing the Science Base,” the effects of cannabinoid drugs show promise in treating wasting syndrome in AIDS patients. Symptoms such as nausea, appetite loss, pain, and anxiety, which are associated with wasting, can be reduced by marijuana.
A study was conducted in 2018 on the use of oral dronabinol in HIV/AIDS patients with severe weight loss. It was found that there was a positive impact on weight gain. This led to further studies with cancer patients, but those studies didn’t achieve their primary goals. But, dronabinol was associated with improved taste, smell, and enjoyment of food. A systematic review published in JAMA in 2015 also found weak evidence supporting the use of cannabinoids for weight gain in HIV-related cachexia.
It is evident that delta-9 THC has the potential to increase food intake and promote weight gain in patients. It’s not surprising that clinicians were interested in exploring the use of cannabinoid treatments for appetite-related conditions. Several studies with delta 9-THC have been conducted to examine its effectiveness in improving appetite and reducing wasting in clinical populations with cancer cachexia or HIV. One of the earliest trials, conducted by Regelson et al. in 1976, found that oral doses of up to 15 mg/day of 9-THC stimulated appetite and resulted in significant weight gain in advanced cancer patients.
Medical Cannabis and Inflammation
The body’s response to a harmful stimulus, known as the inflammatory process, aims to restore balance in the body. Although anti-inflammatory drugs (NSAIDs) are effective, they are associated with various negative effects. Herbal medicine and its derivatives have gained attention due to their effectiveness and safety. Ongoing research is revealing the potential of cannabinoids as innovative anti-inflammatory drugs.
An analysis of six studies conducted between 1980 and 2019. The study investigated the relationship between cannabis and inflammatory mediators. The study concluded that cannabis appeared to reduce inflammation levels in healthy individuals. But, its impact on patients with severe inflammatory symptoms was not significant.
A more recent review was published in 2021, titled “The Effects of Cannabinoids on Pro- and Anti-Inflammatory Cytokines: A Systematic Review of In Vivo Studies”. The study found that the administration of cannabigerol (CBG), or CBD in combination with delta-9-THC resulted in a decrease in the levels of at least one inflammatory cytokine in 22 studies. Additionally, 24 studies showed some improvements in disease or disability. The study also suggested that future clinical studies should focus on CBD and CBG for their potential effects as compared to THC alone.
Recent Research on Cachexia and Medical Marijuana
In 2006, a clinical trial involving patients with cancer-related cachexia conducted a double-blind, phase III study. The purpose of this study is to compare the effects of cannabinoids with a placebo and a standardized cannabis extract, known as CE. The researchers discovered that there were no notable differences among the three groups during the 6-week treatment period. They also found no significant variations in cannabinoid-related toxicity. But, the study had limitations. Additionally, the dosage used—2.5mg taken twice daily for only 6 weeks—may have been too low to observe large effects.
A pilot study published in 2019 sought to test the impact of controlled-dosage cannabis capsules on cancer anorexia-cachexia syndrome (CACS). Findings indicated that three patients (50% of those who completed the study) experienced a weight increase of at least 10%. The remaining patients maintained stable weights. Moreover, all patients who participated in the study for 4.5 months reported an improvement in appetite.
While 83% of those who completed the study experienced increased appetite. Half of the patients who completed the study reported reduced pain and improved sleep. 83% of the patients who completed the study reported a significant decrease in complaints related to appetite loss. But, it is worth noting that these results are based on small sample size.
These small studies present promising results. But in 2021, a systematic review was published in the Journal of Cannabis and Cannabinoid Research. This study recognized the need for more robust data before making recommendations.
Conclusion
Although research on cancer anorexia-cachexia syndrome and cachexia is still in its early stages. But there is evidence that medical marijuana could be used as part of the treatment for patients experiencing muscle mass loss and weight loss.
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