To Eat Or Not To Eat? CBD Is The Answer

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Once George Bernard Shaw said that there is no sincerer love than the love of food, but what if this love is pathological and doesn't bring you any joy? When we eat something that we like, our brain releases endorphins creating a feeling of euphoria; however, for some people eating causes fear and anxiety, hence, leading to eating disorders.

An eating disorder does not have to be linked exclusively to a lack of appetite, as most people used to think. It can also be triggered by any abnormal eating habits that, if left untreated, can have fatal consequences.

An eating disorder is a severe condition related to persistent eating patterns that can interfere with your health, emotions, and daily ability to function negatively. According to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), the most recognized eating disorders nowadays are :

  • Anorexia nervosa
  • Bulimia nervosa 
  • Binge-eating disorder

Statistics of the National Eating Disorder Association show that from a total of 7.8 billion of the planet population, about 30 million people in the United States alone and 70 million people worldwide experience various eating disorders. Even more, significant numbers are not taken into account because some people do not come forward for diagnosis due to feelings of embarrassment, confusion, or denial. 

How did we get there?

It is essential to understand that people who experience any eating disorders in most cases have underlying issues that drive the condition:

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  • Intense fear of gaining weight
  • Disturbed representation of body image
  • Post-Traumatic Stress Disorder (PTSD)
  • Obsessive-Compulsive Disorder (OCD)
  • Social anxiety disorder
  • Fear of rejection in society
  • Depression
  • Bullying
  • History of psychological and physical abuse
  • Social isolation
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How to spot first signs?

Before the actual disorder begins to show its symptoms, some particular behavioral patterns of unhealthy eating can be noticed:

  • Missing out meals or making excuses for not eating;
  • Superfluous focus on different diets and "trendy" healthy lifestyle;
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  • Excessive physical exercise;
  • Adopting an overly restrictive vegetarian diet;
  • Frequent glances into the mirror for checking up flaws;
  • Avoiding family dinners and gatherings around the table;
  • Regular "toilet leaves" during meals;
  • Withdrawing from normal social activities;
  • Constant anxiety and complaining about being fat, hence, frequent talk about losing weight;
  • Eating large amounts of sweets and high-carb foods "because of stress";
  • Use of dietary supplements for weight loss, like laxatives or herbal products;
  • Calluses on the knuckles from inducing vomiting;
  • Teeth enamel problem (can be due to repeated vomiting);
  • Excessive eating, constant hunger (more than it is considered to be optimal);
  • Hiding food and eating secretly;
  • Expressing depression signs;
  • Feelings of disgust, shame or guilt about own eating habits.

The Signs & Symptoms Of Anorexia

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Among all mental diseases, anorexia nervosa has one of the highest death rates of them all, with an estimated mortality rate of 10%. It is a potentially life-threatening eating disorder characterized by abnormal (low) body weight and distorted perception of own weight and appearance. Usually, such deranged self-representation is driven by the intense fear of gaining weight and "becoming fat." Such extreme eating restriction and weight control significantly interfere with health and life activities. By self-limitation, the human body does not intake enough vitamins, carbohydrates, and proteins, which, if so-called, are organism building blocks. This condition makes people see themselves as overweight when, in reality, they are severely underweight and malnourished. Treatment of anorexia should tackle both psychological and physical problems.

Such unhealthy behavioral patterns can start from counting and limiting calories and give rise to other obsessive activities, such as excessive physical training, use of laxatives, diet aids, or vomiting after a meal. 

Even if perfect weight is achieved, it still seems not good enough. Also, being underweight, further efforts to reduce body mass can end up in severe health problems (described below) and reach the point of deadly self-starvation.

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  • Amenorrhea (absence of a period)
  • Anemia
  • Brittle nails
  • Constipation
  • Dehydration
  • Dizziness
  • Dry skin
  • Fatigue
  • Hair loss
  • Heart conditions
  • Kidney failure
  • Liver damage
  • Low blood pressure
  • Osteoporosis
  • Poor immune function
  • Poor wound healing
  • Seizures
  • Severe weight loss

Bulimia nervosa

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Bulimia nervosa — commonly called bulimia — is another type of eating disorder. In most cases, being affected by bulimia means experiencing episodical binge eating and purging. From patients' descriptions, it involves feeling a lack of control over your food. Many people with bulimia also restrict their consumption during the day, which often leads to more binge eating and purging later or during night time.

During such obsessive eating seizures, a person usually eats a large amount of food in a short time. Then, experiencing a feeling of guilt, he forces himself to get unnaturally rid of extra calories.

Feelings of guilt, shame, and an intense fear of gaining weight from overeating lead to such unhealthy actions - a person may provoke vomiting, or you may exercise too much or use other methods, such as laxatives and herbal medicines. 

If looking at bulimia from a psychological point of view, it can be noticed that affected people are very harsh on themselves. The fear of getting extra calories raises extreme anxiety, wrong perception of reality, and incorrect judgemental conclusions.

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Signs that can help to spot a bulimic person:

  • Throat swelling (excessive vomiting can cause pain and swelling)
  • Red eyes (a result of forceful vomiting)
  • Bloody vomit (ruptured esophagus)
  • Feeling faint (light-headed weakness)
  • Hemorrhoids
  • Dry skin
  • Irregular heartbeat
  • Facial swelling
  • Scarred hands (if hands are in contact with teeth while provoking vomit)

Binge eating

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When you have binge-eating disorder, you regularly overeat food (binge) and feel a lack of control over your diet. You may swallow food like a snake or eat more amount than intended, even when you don't feel hungry and long after you are painfully full.

Similarly, after bulimia, you may feel guilty, sick, and disgusted by your previous behavior and ashamed for the amount of food eaten. Binge eating usually happens at least once a week. 

Even though the mechanism of uncontrollable eating is similar in binge eating and bulimia, there are still some differences. After feeling shame and guilt for excessive food intake, you don't try to compensate and loose obtained calories with extreme exercises or purging. (like in case of bulimia). Circle of anxiety- binge eating- guilt- stress is tough to break. Usually, it leads to distancing and keeping your bingeing in secret from everyone. The feeling of embarrassment makes people eat alone, for example, instead of eating during lunch break with your friends, you hide in the toilet and eat your snack there. 

Restrictive food intake disorder

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This disorder is characterized by failing to meet your minimum daily nutrition requirements because you don't have an interest in eating; you avoid food with specific sensory characteristics, such as color, texture, smell or taste; or you're concerned about the consequences of consumption, such as fear of choking. Food is not avoided because of fear of gaining weight.

The disorder can result in significant weight loss or failure to gain weight in childhood, as well as nutritional deficiencies that can cause health problems.

Rumination disorder

Rumination disorder is repeatedly and persistently regurgitating food after eating, but it's not due to a medical condition or another eating disorder such as anorexia, bulimia, or binge-eating disorder. Food is brought back up into the mouth without nausea or gagging, and regurgitation may not be intentional. Sometimes regurgitated food is rechewed and swallowed or spit out.

The disorder may result in malnutrition if the food is spat out or if the person eats significantly less to prevent the behavior. The occurrence of rumination disorder may be more common in infancy or in people who have an intellectual disability.

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Less known eating disorders

Drunkorexia

Restricting and reserving food calories for alcohol, excessive exercising to burn alcohol calories, over-drinking to purge food.

Orthorexia Nervosa

Obsession with a healthy diet to the point where it endangers one's health.

Pregorexia

Excessive dieting and exercising to control pregnancy weight

Risk factors and causes

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By 2015 it was counted that in 5-12 years, the ratio of girls to boys diagnosed with AN or BN was 5:1, whereas, in adolescents and adults, the rate is much higher – 10 females to every one male. Teenage girls and young women are more likely than to have anorexia or bulimia than, for instance, adolescent boys and young men. It was incorrectly believed that such eating disorders affect only women, but men can have it too. Despite different gender and a broad range of ages among sufferers, teenagers are within the most significant risk group. 

Certain factors may contribute to the risk of eating disorder development, such as the following:

  • Family history. If parents or siblings who have ever experienced eating disorders, the chances of their relative or child to acquire it, are significantly higher 
  • Other mental health disorders. It is more likely that having a history of anxiety disorder, depression, or obsessive-compulsive syndrome can cause another anxiety related to eating habits. According to the International OCD (Obsessive-Compulsive Disorder) Foundation estimations, 64% of people with eating disorders also experience an anxiety disorder, and 41% of those have OCD.
  • Dieting and starvation. Most people want to look good, but what is the cost price? Dieting is one of the most significant risk factors for developing an eating disorder. Fasting, hence, malnutrition, affects cognitive functions, imbalances mood state, increases anxiety level, and, as a result, leads to an appetite reduction. There is strong evidence to believe that many of the symptoms of an eating disorder are an outcome of starvation. Hunger and weight loss may change the way how the brain works on a molecular level. Such systematic behavior turns into a settled pattern, which makes it even more challenging to return to regular eating habits.
  • Stress. Unfortunately, pressure and tension in life is an inevitable consequence, whether it's heading off to college, moving, getting a new place of job, or relationship issues. Any emotional changes, which a person can not overcome, can bring stress, which may increase the risk of an eating disorder.

It is essential to understand that no matter what type of behavior is observed-not eating the bare minimum or overeating and purging. Such disorders are related to a particular cause, which provoked such a body reaction. Even if a person is at high risk of inheriting such a behavioral pattern, not everybody will be anorexic or bulimic. It is more about emotional instability and low resistance to stress, which is a very individual approach. 

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Can it happen to you?

The exact cause of eating disorders is unknown as there is a complicated interplay between biological, psychological, and social factors. As with other mental illnesses, there may be many causes, such as:

  • Genetics and biology. Certain people may have genes that increase their risk of developing eating disorders. Biological factors, such as changes in brain chemicals, may play a role in eating disorders.
  • Psychological and emotional health. People with eating disorders may have mental and emotional problems that contribute to the dysfunction. They may have low self-esteem, perfectionism, impulsive behavior, and troubled relationships.

Current ways of treatment

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Regulation of healthy eating habits is the key and the endpoint of the successful treatment. There are several therapies, which have previously shown significant results:

  • Individual therapy (insight-oriented);
  • Cognitive analytic therapy;
  • Cognitive-behavioral therapy – better for adult-onset Anorexia;
  • Enhanced cognitive-behavioral therapy;
  • Cognitive remediation therapy -suitable for motivated people;
  • Medications to help reduce stressful conditions, antidepressants;
  • Plant-based remedies such as CBD oil.

As was shown above in this article, eating disorders are prevalent. Unfortunately, there is no "specific cure" for treating all cases. It leads us to the point where we should look for alternative methods of self-aid.  

All you need to know about CBD

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First of all, it's important to note that CBD is not that wicked marijuana, as most of us used to think. It's one of the many phytocannabinoid constituents found in the cannabis plant, which constitutes up to 40% of its extracts. 

Most studied and popular among all cannabinoids are CBD (cannabidiol) and THC( Δ9-tetrahydrocannabinol), but it is less common to meet THC food or drinks due to its psychoactive effects, than CBD. Studies show that CBD has a meaningful impact on many neurologic pathways, which control feelings of well-being, mood, nausea, pain, and appetite.

Before we get deeper into how CBD can help in eating disorders 

symptomatology, it is essential to understand the fundamental mechanisms of how our body reacts to the cannabis plant in general. 

The endocannabinoid system (ECS) located in most parts of our body (brain, skin, GI tract, liver, pancreas, heart and immune cells) is a big network of receptors, enzymes, and endocannabinoid molecules that maintain homeostasis, or a range of healthy functions in the body.

In 2019 researchers from New York State Psychiatric Institute at Columbia University found preliminary evidence of a possible key role of the body's endocannabinoid system in OCD. Three patients from case reports were prescribed dronabinol ( cannabinoid drug) in order to reduce compulsive behavior. One patient, who displayed treatment-resistant OCD symptoms, showed good response to dronabinol, which further allowed him to participate in cognitive behavioral therapy (CBT) and eventually recovered from the Psychiatric Department. It is worth saying cannabis derived products affect each person with an eating disorder differently.

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Besides, a 2005 study showed that patients with anorexia and binge eating symptoms have a higher level of the endocannabinoid anandamide (ligand to CB1 receptors), but not in patients with bulimia. One of the possible treatment alternatives could be the use of THC as it shows resemblance to anandamide (an endocannabinoid ligand) in the way it attaches itself primarily to CB1 receptors. Such observation leads to the conclusion that modulating the endocannabinoid system gives a possibility to treat certain eating disorders. 

One of the first studies which brought some light into the cannabis area was a human study conducted by A W Zuardi et al. in 1982, which involved only eight volunteers. They were given different dosages of THC, CBD, and Valium. As it turned out, CBD blocked the anxiety caused by THC by being its antagonist. 

Despite the small study group of participants, it came to some remarkable results. The research team came to the conclusion that there were actually opposing effects between the two most abundant cannabinoids.

Conveniently enough, studies found that CBD (second most prominent cannabinoid in marijuana) can also positively influence our serotonin receptors, thus producing similar effects to antidepressants.

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By simply not being as psychoactive as THC, CBD will not make the user stoned, but it will instead create a calming and soothing effect.

As was previously said, THC and CBD are the two most common components found in marijuana. Even more, they have a very similar molecular structure, but still, they depict two opposite effects in the case of anxiety. Most cannabis strains contain both of these cannabinoids, but their levels tend to vary, hence, creating a wide variety of effects. If CBD consumption produces a calming effect, on the contrary, THC can even increase the feeling of paranoia and anxiety. So THC is unlikely to be your choice if you are looking for tension relief. It can be explained with simple activation mechanisms- THC stimulates the amygdala, the brain area, which is responsible for fear. This might explain why cannabis can both worsen and relieve anxiety — it all depends on the dosage and the strain being used.

Treating Anorexia with CBD

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There are two ways of how marijuana can help. First, after using cannabis extract, it excites and stimulates a specific brain region called the insula. Merely speaking, "pot" makes food smell and taste sharper and more seducing. You know the saying, appetite comes with eating. 

Second, marijuana treats anorexia on a psychological level. The same brain region- insula, which is responsible for sensory experience and related emotions, plays a vital role in anxiety alleviation. For those with anorexia, anxiety about eating is a stumbling block. When cannabis stimulates this part of the brain, it activates those limited CB1 receptors in someone with an eating disorder. So interference with those receptors can turn eating into pleasurable and not an anxious experience.

One long-term study by Andries A. et al., 2017 discovered a link between cannabinoids and weight gain. Throughout three-year triple-blinded research, anorexic patients were given synthetic THC or a placebo.

After four weeks, patients who were taking THC gained a pound and a half more than the placebo group. 

Treating bulimia with CBD

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Stress and obsession over the process of eating are central in both bulimia and anorexia. However, self-control in bulimia can be a tough one. 

Often the disease compels the patient to want that control back, and it results in purging everything they have eaten. 

So CBD consumption, which stimulates appetite, might not be the best idea? More eating- more purging? Well, the answer is no. 

Besides a feeling of hunger, cannabis still gives that sense of pleasure in eating by activating those same receptors in the insula. So by introducing joy from a meal, cannabis can break the cycle of eating- vomiting. A bulimic suffering person will less likely to purge. They start to enjoy the process of eating instead of feeling guilty. Also, the act of possessing marijuana distracts from the mental chokehold of eating disorders. Use of marijuana for bulimia treatment, patterns of bingeing and purging can be replaced with the ritual of marijuana consumption and the calming effects of the drug. Already this reduction in anxiety may take a person closer to recovery.

Important to say that there is still a low risk of not avoiding possible purging. Maybe that's why cannabis is prescribed for eating disorders in only five US states — however, only for anorexia and not bulimia.

Treating bingeing with CBD

As previously explained, marijuana helps in cases of restriction to purge, but does it help in the total absence of food consumption control?

The answer is definite. Cannabis works the same way as it does with other eating disorders. There is always a risk of eating high carb food, having a fizzy drink, or eating a whole pizza at once, but the right strain high in CBD and low in THC should tackle the problem of unnecessary "munchies." Correctly prescribed medical cannabis treatment can lower fat and BMI, reduce the risk of diabetes in those with a binge-eating disorder.

Furthermore, research shows that cannabis users have:

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  • A lower body mass index 
  • Lower fat percentage
  • Lower fasting insulin levels

The CB1 and CB2 receptors in the brain boost your metabolism when you supplement with additional CBD. When you have your metabolism working optimally, your body will utilize energy better; you will store less fat on your body.

It was studied that omega-3 fatty acids, also found in fish oils, are the precursors to the body-produced cannabinoids. If there is a low level of fatty acids, then the body will not be able to manufacture the necessary number of cannabinoids needed to maintain a healthy endocannabinoid system. 

Omega 3s contributes to the growing and healing processes of the two central cannabinoid receptors -CB1 and CB2. 

CB1 is primarily found in the brain when CB2 is located in the immune system cells. And, CBD oil activates various receptors that delay or reduce the uptake of hormones or neurotransmitters.

So what is the use of CBD?

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The primary benefit of cannabidiol is an indirect stimulation of the endocannabinoid system, which promotes homeostasis within the body. As well known, homeostasis regulates all possible processes within the human body - from core temperature, fluid balance, glucose level to hormones, and neurotransmission. 

The research is highly suggestive that any alterations in the actions of these hormones may play a pivotal role in causing eating disorders by providing a possible link between motivation, the reward center, cognitive functions, and energy levels.

Studies by Bergamaschi MM. et al., 2011 showed a CBD possession of a wide range of therapeutic abilities, including antipsychotic, analgesic, neuroprotective, anti-nausea, antioxidant properties. There is a myriad of groundbreaking research made in the light of CBD and common mental disorders like PTSD, phobias, and social anxiety disorder. 

A potential side effects review found that humans tolerated CBD well, even across a wide range of dosage, up to 1500 mg/day (orally), with no reported psychomotor slowing, adverse mood effects, or vital sign abnormalities noted.

In 2017 The World Health Organization declared CBD as a non-toxic, safe, and no addiction-risk compound. However, as with any things that we consume, there are potential side-effects of CBD products. Fortunately, there are just minor unwanted side reactions like low blood pressure, dry mouth, and drowsiness.

There is a groundswell of interest in the endocannabinoid system as a target for trauma and stress-related disorders based on an extensive and ever-expanding preclinical and clinical literature that supports a relationship between the ECB system and fear, nervousness, and stress.

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Most abundant CBD strains for managing eating disorders

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Cannatonic

This strain is one of the most common medical strains and has the best overall score in reducing anxiety.

less than 6% of THC

between 6- 17% of CBD

ACDC

This strain has one of the highest CBD levels. ACDC strain is not psychoactive due to low THC content, so it will not make you “high.”

20:1 CBD to THC ratio, which can reach up to almost 19% CBD and only 1% THC.

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Harlequin

CBD to THC ratio is 5:2 (4 to 7% THC and 8 to 16% CBD).

Harle-Tsu

It is usually used as an ingredient in cannabis oils. Besides its anxiety-relieving effects, Harle-Tsu helps you to focus and release the stress.

20 times more CBD than THC (in a 5:2 ratio).

CBD Shark

It turns out that Shark is mighty in treating anxiety because of its cannabinoid balance. It does not show any cognitive changes; in fact, it clears the mind and relaxes the body. Also, THC is well-known for its pain reduction and sleep regulation properties. Such abilities can have a significant impact on treating side symptoms of anxiety, like insomnia and eating disorders, which are triggered by stress. 

1:1 CBD to THC ratio

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Bottom line

There is no miraculous cure, but it seems that cannabis can reduce some of the most significant barriers to treatment like exhaustion, physical discomfort, and food-related anxiety. CBD treatment sounds very promising, which leaves researchers to focus on recovery and further investigation. 

Verified by a Healthcare Professional

Anastasiia Myronenko

Anastasiia Myronenko

Anastasiia Myronenko is a Medical Physicist actively practicing in one of the leading cancer centers in Kyiv, Ukraine. She received her master’s degree in Medical Physics at Karazin Kharkiv National University and completed Biological Physics internship at GSI Helmholtz Centre for Heavy Ion Research, Germany. Anastasiia Myronenko specializes in radiation therapy and is a fellow of Ukrainian Association of Medical Physicists.