The American Psychiatric Association offers a 128-page document outlining guidelines for treating patients with eating disorders, which rattles off an extensive list of psychiatric medications that might aid in recovery—benzodiazepines, SSRIs, anti-psychotics, topiramate, lithium. Marijuana is not on the list. Of the medications listed, the guide acknowledges a litany of possible problems: Malnourished patients tend to have worsened side-effects from antidepressants and anti-psychotic medications, both of which are commonly prescribed. Patients taking anti-psychotic medication need to be monitored for akathisia, a type of corollary distress from the meds. Certain antidepressant (like bupropion) come with a black-box warning because in underweight people, there is an increased risk of seizure. Benzodiazepines can become highly addictive. Other medications can cause "insulin resistance, abnormal lipid metabolism, and prolongation of the QTc interval," which can lead to heart problems.
Other experts disagree. Dr. Kim Dennis, CEO and Medical Director of Timberline Knolls, a leading residential treatment center and partner with the National Association of Anorexia Nervosa and Associated Disorders, pointed out that while marijuana may be seen as a more natural alternative to psychotropic drugs, marijuana is also virtually unregulated compared to the pharmaceutical drug industry, meaning it's hard for patients to choose the right dose or the right strain. She also said that 50 percent of those with eating disorders also have substance abuse problems, and worries about creating dependency on the drug. A mental health counselor in a well-known center for the treatment of eating disorders in Massachusetts added that "with a lot of these kids, their cardiac system is compromised. When you smoke weed, your heart rate can spike." She says there was a 14-year-old in her center who was sent to the hospital for symptoms of a heart attack—something that would only be exacerbated with weed."Which is worse—the benzodiazepine or the marijuana? I guess medical research would have to show that." - Dr. Beth Braun
One of the few researchers who's studied the relationship between marijuana and eating disorders fairly extensively is Dr. Alin Andries, a physician at the University of Southern Denmark. Dr. Andries has so far published three peer-reviewed studies about the relationship between cannabinoids and anorexia—one looking at changes in physical activity, another measuring changes in body weight, and another tracking hormonal changes."There are many studies revealing the appetitive effect of cannabis and its synthetic derivates. This effect occurs rapidly after ingestion and is known as 'the munchies,'" Dr. Andries told me via email. "We thought that this aspect could be further investigated in anorexic patients, due to the impaired relationship between appetite and weight gain"—that is, anorexia patients won't eat or gain weight, even if they're hungry. Plus, anorexia nervosa offered the "purest study environment," since the disease's causes are exclusively psychiatric, unlike previous research on cannabinoids and weight gain among cancer, AIDS, or Alzheimers patients.Can Weed Really Help Addicts Recover from Alcoholism and Hard Drug Use?
When you're starving, weird things happen to your brain. A famous study, known as the Minnesota Starvation Experiment, found that when people lost 25 percent of their body weight, they experienced severe emotional distress and depression, but also severely compromised cognitive abilities. Participants were unable to concentrate, their judgment was poor, and some experienced hallucinations or a desire to self-harm. (Diagnostically, anorexics are more than 15 percent below normal body weight.)When your body is in a period of starvation, it uses the fattiest tissue first—which, in the absence of body fat, is the brain. The brain is literally broken down, piece by piece, causing mental fogginess, lack of concentration, and an inability to focus. For eating-disordered patients, this can feed into the cycle of body dysmorphia and the strange logic of eating disorders. As little as five pounds can make a huge difference in how people think—especially about themselves and their disorders.When your body is in a period of starvation, it uses the fattiest tissue first—which, in the absence of body fat, is the brain.
So if cannabis can help patients keep a few extra pounds on their bodies, it makes sense that some people credit it as their gateway to recovery. In the course of reporting this story, I spoke to over a dozen people who had self-medicated their eating disorders with marijuana—and while their stories included varying degrees of success, many of them told me that weed was the one thing that made them believe they could get better.On MUNCHIES: Coming out about eating disorders might not be cathartic, but it's important
One man in his mid-20s, who struggled with restrictive eating throughout his teenage years, said he turned to weed for a "necessary cognitive break from the misery I felt." He toked up when things got really bad, and found that it could provide the relief he needed. "Of course, this was no magic solution, but it really helped in those stupefied hours," he said. Smoking weed was "subversive enough to demonstrate that another life was both possible and desirable."One person remembers how, the first time she was high, she forgot how many calories she had eaten that day—something that she had tracked compulsively. Forgetting felt like a burden was lifted off her shoulders, and reminded her that a life without constantly tracking her nutrition was possible. Another person told me that "it was probably a combination of things that helped me get back to a healthy weight, but I always figured smoking pot is what tipped the scales and made me [hungry] those two or three first times.""Marijuana opened parts of my mind that allowed me to find control."
It's been five years since Anna Demarco smoked for the first time, and she now considers herself in recovery from her eating disorder. She smokes about three times a day—before meals, and before bed—and she's able to eat normally.Dr. Kim Dennis, the Medical Director at Timberline Knolls residential treatment center, does not consider this to be true recovery. "If a person becomes dependent on marijuana to manage her eating disorder, she doesn't have the freedom that a person in recovery has. The person in recovery has done work to uncover and heal the underlying issues."Anna also worries that she's become dependent on the drug. "I can't eat without smoking, because my anxiety is constant and my stomach is always in knots," she said. She's gone through periods where she tries to smoke less, but whenever she does, she loses her appetite and her anxiety spikes. Once, when she quit smoking for three weeks, she caught herself "obsessively watching my figure everyday and weighing myself any place I found a scale."With marijuana, Anna says she feels more normal. "Without it, I am not a functioning person."Marijuana isn't a "cure" for her eating disorder, and she knows that weed is not a permanent fix. But she says it's part of what's keeping her alive, and there's no shame in surviving.If you are suffering from an eating disorder, please visit the National Eating Disorder Association.Follow Arielle Pardes on Twitter.We have an entire video series dedicated to marijuana. Watch Weediquette here.