CBD for Appetite Loss | Cannabis Research on Cancer Cachexia + Nausea
Apr 15, 21
One of the most common experiences of ingesting or inhaling high-THC cannabis is fondly known by regular pot users as the “munchies”. This effect of an increase in hunger follows closely after another common experience, euphoria. Cachexia is a complex metabolic syndrome generally caused by an underlying illness and is characterized by the loss of skeletal muscle with or without loss of fat mass.  Due to the fact that the body’s endocannabinoid system (ECS) regulates appetite, medicinal cannabis has been used to help treat cachexia by helping to stimulate the patient’s hunger, in the hope of trying to prevent the loss of lean body mass. Note, this article is primarily focused on the high-THC form of cannabis and the general research, and not cannabidiol (CBD). For more detailed information on CBD, see our articles listed at the bottom of this one.
Cachexia often accompanies the later stages of many chronic illnesses, including cancer, HIV/AIDS, liver, heart, and kidney failure, dementia, tuberculosis, chronic obstructive pulmonary disease, rheumatoid arthritis, and neurodegenerative disorders. Medical cannabis has been shown to relieve many underlying symptoms of these diseases, such as anxiety, pain, insomnia, or nausea, all of which may lead to loss of hunger and subsequent weight loss; for more information, see our article on cannabinoids in diabetes and weight loss.
The Endocannabinoid System
The endocannabinoid system is now understood to be the most important system of physiology inside the body, vital for regulating the healthy functioning of every other major bodily system, from the lymphatic and respiratory, to the cardiovascular and reproductive. The ECS is integral to how our bodies regulate energy balance, appetite, and weight loss or gain. Extensive animal studies of endocannabinoids and the regulation of appetite and body weight were reviewed and summarized by researchers in 2005; further animal studies have not changed their conclusions that endocannabinoids increase eating motivation by enhancing the perceived importance of hunger signals and pleasurable cues associated with food.  From these animal studies, researchers noted that, “The net effect of CB1 agonists is typically to promote food intake, and of CB1 antagonists to decrease or inhibit food intake.” 
History of Use
Cannabis has a long and well documented history of use in ancient Chinese and Indian medical traditions, especially related to the stimulation of hunger. Cited in Indian Ayurvedic medicinal texts as increasing the “digestive fire.”  Cannabis was also found in 19th-century British patent medicines intended to stimulate appetite. The modern medical marijuana movement started in the early 1980s, when it was noted that cannabis use by those suffering from AIDS-related nausea improved their hunger, often even experiencing weight stabilization or gain as a result.
Cannabis products have been discovered as effective in treating the cachexia associated with AIDS. An early trial of oral THC to address cachexia in AIDS patients utilized a dose of 2.5-mg THC with some success in maintaining patients’ hunger signals over the seven months of the study.  In a 2013 study, researchers reviewed the available research that teased out the results of symptom changes in HIV/AIDS patients into three main categories; changes in food intake, appetite, and weight.  In each of the categories researchers concluded that the quality and completeness of data presented in the published studies were inadequate for meaningful analysis.
CBD and THC
Research focused on cancer-related cachexia show mixed results. A study of cannabis involving advanced cancer patients was discontinued when cannabis showed little advantage over the placebo.  This study of cancer patients, which is often cited, discovered that low doses of a THC-CBD extract or THC were no better than placebo for increasing hunger and produced more side effects. That same study trialled 2.5 mg of THC or a combination of 2.5 mg THC with 1 mg CBD. This study is often cited as evidence that cannabis doesn’t have much use in cancer cachexia, though this remains disputed in a number of other high quality studies. The study researchers later concluded that an effective formulation may require a higher dose of THC than the 2.5 mg twice a day method typically used to improve hunger signals, also, the addition of some CBD to help control the side effects of the higher THC dose.
Two additional studies later on, which also addressed the weight loss seen in cancer patients and using smoked cannabis as the chosen administration method, found that; the first 2013 study, from Israel, showed that a wide range of cancer patients reduced their weight loss when smoking cannabis as a palliative treatment over the eight week study period.  Interestingly, almost all of the cancer and anticancer treatment-related symptoms improved in the study participants. Conversely, inhaled cannabis was shown to be less effective in reviews of other studies, which could be connected to weight maintenance noted among regular cannabis users.  The second study from 2016, researchers discovered after reviewing the literature on cannabis use in cancer cachexia anorexia syndrome noted both the special nature of this patient population and the limited oral bioavailability of cannabinoids, suggesting that other methods of cannabis administration are worth investigating. With advances in non-smoked cannabis administration, alternative delivery methods such as tinctures, sprays, vaporizers, and edibles were recommended.
It is a reasonable expectation then, that medical cannabis can improve the appetite of patients with illnesses that cause a loss of hunger. Actual weight gain is less likely to occur; weight stabilization is more likely. But the evidence base for cannabis utility in treating cachexia remains fair (HIV/AIDS) to poor (cancer-related) in quality, according to the 2017 National Academy report, though recent emerging research is changing this stance.
The information contained in this article is intended to be used for informational purposes only and does not constitute medical advice. Prior to making changes to your lifestyle or treatment plan, always consult with a licenced medical professional.
The ECS and Hunger
Appetite is a normal function of the body’s homeostatic mechanism for maintaining a healthy normal body weight, and the endocannabinoid system plays a crucial role.  Pivotal to understanding the action of cannabinoids underlying appetite, is the nucleus accumbens, an area in the midbrain that causes overeating (“wanting”) and increases food palatability (“liking”), when stimulated either by endocannabinoids (such as those found in breast milk: anandamide and 2-AG; which help facilitate normal suckling response, feeding behavior, neurological development, plus much more), or administered cannabinoids, such as CBD or cannabis. For more information, see our articles on reproduction or visit the health conditions section of our blog.
Stimulation of “liking” can overcome satiety signals, which essentially causes a person to continue to eat, even though they’re no longer hungry. Cannabis also relieves many of the physical and psychological symptoms that may underlie anorexia (loss of hunger) and may also increase hunger in those suffering from nausea.
Dosage for Increasing Hunger
Just very small doses of THC are required to stimulate hunger, as proven by the pharmaceutical Marinol, the prescription form of THC to treat cachexia in doses of 2.5 mg before meals. On top of that, varieties of cannabis that are high in the terpene beta-caryophyllene can stimulate hunger and could be beneficial in improving the immune system and corresponding responses that may underlie cachexia. During the day, maintain a slowly escalating dose over a two-week period, beginning at 2.5mg of THC taken under the tongue (sublingually) or swallowed, taken one to two hours before meals. Then increase the dose to 10 mg of THC twice daily, supplemented by 5 mg of a 10:1 or higher CBD:THC tincture twice daily, but before 5pm (especially if anxiety or stress may be a contributing factor of the condition, and because CBD can often promote wakefulness).
How to Take
Cannabis products that are consumed orally or inhaled could be effective in increasing hunger and decreasing nausea. A combination of inhaled and oral cannabis dissolved in the mouth and swallowed may be of value. Smoking or vaporizing small amounts of cannabis flowers before meals to increase their “wanting and liking” of food. Smoked or vaporized cannabis has the advantage of delivering terpenes, especially beta-caryophyllene and myrcene, which may potentially not survive stomach passage. The Iraeli studies using mostly small doses of inhaled cannabis flowers, and their improved results over pharmaceutically designed research that utilized orally administered THC, could be due to the more complex synergy of action that increases potency and the effectiveness of cannabinoids, known as the entourage effect. For more information, read our Ultimate Guide to Terpenes, and The Entourage Effect.
Best strains for hunger
Any of the high-THC strains that contain measurable levels of myrcene or beta-caryophyllene are of value, including Purples, OG Kush, and Bubba Kush, are ideal.
What cannabinoids help with hunger?
THC is the main psychoactive cannabinoid in cannabis responsible for creating the "munchies" in most people, and is often used to help treat cachexia in cancer patients suffering from chemotherapy related nausea. CBG has also been found to be of value in increasing hunger. CBD on the other hand, has recieved mixed results, both increasing and decreasing in some people; more research is needed.
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3. H. Kalant, “Effects of Cannabis and Cannabinoids in the Human Nervous System,” in The Effects of Drug Abuse on the Human Nervous System, San Francisco:Academic Press, 2014 pp.387– 422.