Study: Marijuana in the treatment of diabetes

reference

Penner EA, Buettner H, Mittleman MA. The Effects of Marijuana Use on Glucose, Insulin, and Insulin Resistance in US Adults.Am J Med. 2013;126(7):583-589.

design

Data collected from the National Health and Nutrition Examination Survey (NHANES) cross-sectional surveys from 2005 to 2010 were examined to examine the association between regular marijuana use and measurements of fasting glucose and insulin levels, insulin resistance, blood pressure, body mass index, waist circumference, and high density Lipoprotein cholesterol. Blood samples were collected after a 9-hour fast. Marijuana use was reported even in a private space.

Participant

The study involved 4,657 men and women aged 20 to 59; 578 were current marijuana users and 1,975 were former users.

Primary outcome measures

Fasting glucose and insulin levels, insulin resistance (HOMA-IR), blood pressure, body mass index (BMI), waist circumference and high-density lipoprotein cholesterol

Evaluated study parameters

From 2005 to 2010, 11,335 subjects ages 20 to 59 completed the NHANES Illicit Drug Use Survey. Data were self-reported in a private room. Of these, 4,657 also provided fasting blood samples that were used to calculate these values.

Key findings

Past and current marijuana use was associated with lower fasting insulin, glucose, HOMA-IR, BMI, and waist circumference levels.

comment

The medical use of marijuana almost completely disappeared in the early 20th century^ThCentury after the introduction of the Marijuana [sic] Tax Act of 1937 and its subsequent removal from the United States Pharmacopoeia in 1942.¹Therapeutic uses were rediscovered by chance as societal use of marijuana rapidly increased in the 1960s and 1970s.^2.3The Marijuana Tax Act was replaced by the Controlled Substances Act of 1970, which categorized marijuana as a substance that "has no current accepted medical use," "has a high potential for abuse," and "has a lack of accepted safety for the use of the drug." Substance under medical supervision.” Marijuana has been placed in the strictest prescription drug category, Schedule I. This designation made conducting clinical research extremely difficult.

Marijuana's active molecules, cannabinoids, were isolated in the early 1960s and the first cannabinoid receptor (CB1) was identified in 1988.⁵Soon another cannabinoid receptor (CB2) was discovered, and this was followed by the discovery of endocannabinoids, endogenous substances that influence the activity of these receptors. These discoveries facilitated preclinical research into the activities of cannabinoids in the various diseases for which marijuana has been used therapeutically. Clinical research continued to be hampered by federal laws and regulations.

Partly because of marijuana's connection to appetite stimulation, researchers began studying the substance and its effects on calorie expenditure and metabolism. Researchers discovered a paradox: Marijuana smokers consume more calories than non-users, but are less likely to suffer from obesity.^6-8Studies using mouse models of diabetes found that the most common cannabinoids found in marijuana, delta-9-tetrahydrocannibinol (THC) and cannabidiol (CBD), inhibit the severity and onset of the disease, respectively.^9.10Another study found that a cannabis extract significantly protected rats' insulin-producing pancreatic cells from the harmful effects of obesity.¹¹

Due to the unique hurdles that exist in researching the benefits of cannabis in humans, another source of data must be used to confirm trends observed in animals or animalsin vitroModels. Large epidemiological studies can provide evidence that strengthens or weakens preclinical observations. Data from the National Health and Nutrition Examination Survey (NHANES) from 4,657 participants found that “marijuana use was associated with a reduced prevalence of diabetes mellitus.”¹²The current study takes a closer look at the NHANES data to better understand the paradox of increased calorie intake leading to lower weight and lower diabetes incidence.

The researchers used fasting serum insulin and fasting plasma glucose values ​​to calculate the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), an indicator of insulin resistance. They found that regular, monthly marijuana users had significantly lower fasting insulin, glucose, HOMA-IR levels, and waist circumference than never users. The frequent marijuana smokers also had higher levels of high-density lipoprotein cholesterol (HDL-C), a marker of heart health. Still, smoking marijuana is unlikely to be widely promoted for its health benefits, due in part to the deleterious effects of the harmful byproducts of combustion. However, before the passage of the marijuana tax law, cannabis was commonly used in the form of tinctures or pills. This route of administration could also allay concerns about undesirable mind-altering effects. The cannabinoid CBD reduces the psychoactive effects of THC; Therefore, taking a combined cannabinoid agent could provide health benefits without cognitive effects.¹³The protective dose can also be much lower than the psychoactive dose. Researchers in Israel found that an extremely low dose of THC, three to four orders of magnitude lower than a psychoactive dose, provides significant protection for the heart, brain and liver from ischemic damage.¹⁵This may also apply to the pancreas.

The potentially significant benefits of low-risk but illicit cannabis use place the dedicated physician in an uncomfortable position, even in states where marijuana is used medically. A doctor's freedom to inform patients about the benefits of cannabis was established by a Supreme Court case, but there is little education about the medical use of cannabis. Due to the lack of knowledge and published evidence base, many physicians are hesitant to recommend cannabis as a medicine to their patients or even discuss it with them. The difficulties in conducting clinical research to evaluate the potential medical benefits of cannabis have already been noted and cannot be overemphasized.¹⁶The number of regulatory hurdles a researcher must overcome to obtain all the permits necessary to study cannabis can be daunting.

What then are the clinical implications of this NHANES data analysis? Can cannabis use reduce diabetes, insulin resistance and obesity? Can diabetics add cannabis as an adjunct to their blood sugar-lowering medications to achieve synergistic benefits? Recognizing that the plural of “anecdote” is not evidence, we report the effects of a cannabis extract on a personal friend's diabetes treatment. This 50-year-old woman is an insulin-dependent diabetic who had difficulty controlling blood sugar despite a normal body mass index. She added a daily dose of cannabis extract to her insulin regimen. She reports that her blood sugar levels are much better controlled and have dropped by 90 to 100 points after taking it.

This single anecdote, combined with the strength of the NHANES results, suggests that further research is needed. We applaud Dr. Alpert, editor-in-chief ofThe American Journal of Medicinewhich calls for collaboration between the National Institutes of Health and the Drug Enforcement Administration to facilitate the development of scientific research and provide physicians with the data they need to assist them in “the use and prescription of THC in its synthetic or herbal form.”^16,17Hopefully, increasing awareness of marijuana's chemistry and potential benefits will soon help remove political barriers to scientific investigation.