CannaMed Cannabis: A Tool in Controlling Metabolic Syndrome

Story by Cheryl K. Smith

     Those of us who have worked in the medical marijuana industry know of the many claims that are made regarding its effectiveness in a variety of conditions. I have met people who claimed to have lost a tremendous amount of weight once they started using cannabis, despite its reputation for causing “the munchies.”
     In the clinic where I was director, we saw a man in his 80s who was using medical cannabis for chronic pain. Only after a number of meetings at the clinic, did it come out that since he had started taking cannabis capsules his blood sugar had somewhat stabilized. No longer did he need the two injections of insulin that his wife had been giving him every day for years—he needed only one on some days and none on others. The association was intriguing, and called for further research.
     In 2013, the American Journal of Medicine published a retrospective study of 4,657 patients, which indicated that those who reported using cannabis in the past month had 16 percent lower fasting insulin levels, 17 percent lower insulin resistance levels, high levels of “good” cholesterol (HDL-C) and smaller waist circumference. (All of these are components of what is known as “metabolic syndrome.”) It appeared that our one-person case study was not so far off after all.
     Metabolic syndrome affects about a third of the population, and is predictive of future heart disease and diabetes. The risk factors for metabolic syndrome include high blood pressure, abnormal cholesterol levels, high blood sugar, and a larger waist. Evidence is accruing of cannabis use associated with a lower risk of metabolic syndrome.
     As far back as 1940 studies showed weight loss associated with regular use of high-potency cannabis, as well as a decrease in blood pressure in users. Studies of the general population are now indicating a connection between cannabis use and lower insulin levels and diabetes, lower body mass index (BMI), and higher levels of good cholesterol.
     The population of people who have psychotic illness are at greater risk of metabolic syndrome. This means that in addition to their psychiatric issues, they are more likely to eventually have heart disease and diabetes. Part of the reason for this is due to a variety of risk factors, including being inactive, having a poor diet, using atypical antipsychotic drugs (which have been implicated in weight gain and other problems), and smoking tobacco. According to a study published in March 2016 in Psychological Medicine, about one-third of this population also uses cannabis.
     That study looked at a national survey in Australia of people with psychotic illness, including schizophrenia, bipolar illness and others, with the intent of determining whether users of cannabis had a lower rate of metabolic syndrome than non-users. The researchers randomly selected 1,813 patients out of the national population of approximately 1.5 million people in that country with psychotic illness.

     Patients comprised three groups: non-users of cannabis (over the prior 12 months); occasional users (less than once a week over the prior 12 months); and frequent users (at least once a week over the prior 12 months). They did not consider the mode of use or potency.
     Of the overall study participants, 57.7% met the criteria for metabolic syndrome. Among non-users, 63% did, while only 51.7% of occasional users did and—even fewer—only 43.5% of frequent users did. In fact, among the frequent users, the odds of meeting all the criteria for metabolic syndrome was reduced.
     Non-users had a much greater chance of having diabetes, at 76.6%, versus the 12.7% among frequent users. The same was true for the risk of being overweight or obese, with 53.7% in non-users and 28.7% among frequent users.
     As the researchers pointed out, this is not enough to suggest that everyone with a psychotic disorder begin frequently using cannabis to avoid metabolic syndrome. Other studies have suggested some possible adverse effects, including poorer clinical outcomes, more cognitive decline and respiratory symptoms. (I wonder about the last one, in light of the fact that nearly 92% of those in this study were also tobacco smokers, a known factor in respiratory problems. )
     This study, along with other studies and anecdotal evidence does suggest areas for further research. What is clearly needed is a teasing out of what is driving these outcomes—whether flavonoids, specific cannabinoids, interaction of cannabinoids, or something else entirely.