Cannabis and Metabolic Syndrome
As we all know, metabolic syndrome and diabetes are responsible for the vast majority of ailments encountered in the modern world. Heart attacks, stroke, and cancer show marked increases in our new world of abundance. Humanity has spent most of its evolutionary history living near starvation and, as a result, we are extremely efficient at turning calories into fat and we burn far fewer calories than the average mammal of our same size. According to Harman Pontzer, the lead author of the above study, "Humans, chimpanzees, baboons, and other primates expend only half the calories we'd expect for a mammal. To put that in perspective, a human -- even someone with a very physically active lifestyle -- would need to run a marathon each day just to approach the average daily energy expenditure of a mammal their size."
Another fact inherent to our humanity is that our big brains burn a lot of fat and we need about 27-50% more calories than our nearest primate relative. A cost of our big brains is a higher tendency to eat fat and meat and our greater tendency towards a higher adiposity. So what does this have to to do with cannabis?
As a medical cannabis practitioner, I encountered many with metabolic syndrome and diabetes who were being treated for a variety of conditions with medical cannabis. Many were afraid that they would gain weight and worsen diabetes if they started on cannabis "because of the munchies." At the start, we pharmacists thought it might be a potential problem too and many patients were scared off due to a history of weight problems. To our surprise, we discovered two main things: increased appetite was a short-lived effect notably reduced by tolerance and an improvement in diabetic lab results with no changes in other medications or habits.
Although this is anecdotal clinical evidence, it is compelling. No patient I treated had a worsening of diabetic lab results but many of them had an improvement. It was common to see about a lowering of A1C of about 0.5 to 1%. This is similar to the results seen with treating patients with many high quality diabetes medications such as sulfonureas, thiazolinediones, and metformin.
There are pharmacologic reasons for this, including the fact that THC activates PPAR alpha and gamma, which results in improved lipid and glucose metabolism as well as reduced inflammation. CBD also activates PPAR gamma.
Although the evidence I experienced clinically is only anecdotal and not a part of a double-blinded, placebo controlled trial, it is compelling and at least interesting. Since it is illegal to conduct those studies due to government restrictions, it is hard to generate compelling data. However, some research shows significant promise with regards to cannabis and its effects on metabolic syndrome. For example, in the paper "Metabolic Syndrome Among Marijuana Users in the United States: An Analysis of National Health and Nutrition Examination Survey Data" published in the journal Public Health Sciences, Pediatrics, scientists discovered some interesting results.
For example, "Among emerging adults, current marijuana users were 54% less likely than never users to present with metabolic syndrome. Current (AOR 0.49; 95% CI, 0.25-0.97) and past (AOR 0.61; 95% CI, 0.40-0.91) middle-aged adult marijuana users were less likely to have metabolic syndrome than never users." In addition, current cannabis users (13.8%) were substantially less likely to present with metabolic syndrome as compared to never users (19.5%).
These trends seen in population data are similar to what I observed clinically and there is compelling pharmacologic and meta-data to suggest cannabis' use in treating metabolic syndrome and certainly that it is a healthier alternative to alcohol. Until the US government allows us to conduct real studies on cannabis in humans, however, there is no way to scientifically prove its medicinal use beyond a reasonable doubt.