This past weekend, I attended the Academy of Nutrition and Dietetics Annual Food and Nutrition Conference & Expo (FNCE). It was a great conference this year – including the academy’s centennial celebration, record breaking attendance (over 12,000 RDs, NDTRs, students and interns), and many innovative educational sessions.
One of the sessions that encouraged “thinking outside of the box” included a lecture called “Going Green: Use of Medical Cannabis in Medical Nutrition Therapy (MNT)”. The most recent research and practical applications were presented by a pharmacists and fellow registered dietitian, that both recommend medical marijuana use with some of their patient populations; when nothing else has worked. The room where this educational session was held was HUGE, and it was about half full; indicating that this topic is of increasing interest to physicians, pharmacists, dietitians, and other health care professionals. The attention, statements, and questions from attendees also exemplified that clinicians are seeking alternative methods of managing acute and chronic disease, rather than the traditional prescription drug approach.
During the FNCE session, the presenters discussed the endocannabinoid system in the human body, the cannabinoid receptors in our brain, immune system, and gut, and how tetrahydrocannabinol (THC) and cannabidiol (CBD) interact with these receptors. The also talked about the safety and efficacy of the different products on the current market, the preferred CBD:THC ratio for management of different illnesses, and explained that there are some conditions that warrant medical marijuana use for bodily homeostasis. What are some of these conditions?
In Michigan specifically, medical use of marijuana has been legal since 2008 and there are certain qualifying conditions, including Alzheimer’s disease, cancer, cachexia, chronic pain, Crohn’s disease, glaucoma, HIV/AIDS, nausea, PTSD, and more. But what is the literature showing? Unfortunately, research on marijuana’s potential for medicinal use has been hampered for years by federal restrictions, even though nearly half of the states and the District of Columbia have legalized medical marijuana in some form. In fact, 29 states have legalized the use of medical marijuana, and 8 states have legalized marijuana for recreational use. Most recently, the World Anti-Doping Agency (WADA), the foundation initiated by the International Olympic Committee to coordinate and monitor drug use in sports, will be removing CBD from its list of banned substances in 2018. Wow.
There is conclusive or substantial evidence that cannabis or cannabinoids are effective for:
Why not give something else a try?
Corey-Bloom, J., Wolfson, T., Gamst, A., Jin, S., Marcotte, T. D., Bentley, H., & Gouaux, B. (2012). Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. Canadian Medical Association Journal, 184(10), 1143-1150.
Fraser, G. A. (2009). The use of a synthetic cannabinoid in the management of Treatment‐Resistant nightmares in posttraumatic stress disorder (PTSD). CNS neuroscience & therapeutics, 15(1), 84-88.
Heslin, K. C., & Weiss, A. J. (2015). Hospital readmissions involving psychiatric disorders. Healthcare Cost and Utilization Project, 1-17.
Hill, K. P. (2015). Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review. Jama, 313(24), 2474-2483.
Machado Rocha, F. C., Stefano, S. C., De Cassia Haiek, R., Rosa Oliveira, L. M. Q., & Da Silveira, D. X. (2008). Therapeutic use of Cannabis sativa on chemotherapy‐induced nausea and vomiting among cancer patients: systematic review and meta‐analysis. European journal of cancer care, 17(5), 431-443.
National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. National Academies Press.
Warning – major rant ahead!
I have to tell my readers about something that happened today. Something so frustrating and enraging that I cannot stop thinking about it. This something is a conversation I had. Here is an overview of what went down:
I saw an adolescent patient today that presented with severe disordered eating – restricting most days by only drinking water and sometimes milk, with one large binge per week, followed by purging. This patient reports a 25 pound weight loss since July and that these behaviors have been going on for several months. The complicating factor is that this patient is a normal weight/a bit overweight. The only difference between this patient and the other patients I see struggling with eating disorders is the fact that she has a normal BMI. The conversation that I mentioned above, involves my being asked my reasoning for wanting to treat the disordered eating. When I explained what was relayed to me by the patient, this person said, “I don’t know why you’re worried about her weight. Patients like this are okay not eating for a couple weeks” ...
I was flabbergasted! Of course, I am not worried about her weight; I don’t focus on weight! What I am worried about is her severely disordered and dangerous behaviors around food. Letting this continue and not helping her through her struggles with food and body image is setting her up for an extremely harsh and difficult relationship with food for a long time. My question is, why is everyone so focused on weight? Why can’t we help people of all shapes and sizes that struggle with disordered eating and a poor body image? Here are just a few examples of some of the patients I have worked with that have developed eating disorders due to weight-related issues:
The most important thing to realize about weight bias and judging others because of their body size is that it makes you judgmental about yourself and robs you of your compassion and connection with others. Just stop it already. Also, please understand that people of all shapes and sizes suffer from eating disorders; not just thin, white women. And they all deserve help.
Total daily energy expenditure or TDEE is the total energy or calories used in a day. There are four components that make up TDEE: resting metabolic rate (RMR), thermic effect of food (TEF), non-exercise activity thermogenesis (NEAT), and exercise energy expenditure (ExEE).
Resting metabolic rate is the energy used by an individual for all cellular processes necessary to maintain life while lying around all day. AKA, the amount of energy or calories burned just to lay around and do nothing. For a 5’2”, 100-pound women, this is somewhere around 1200 calories. For sedentary individuals, RMR accounts for approximately 70-75% of their daily energy expenditure. RMR is different for everyone and changes based on weight, height, age, sex, and lean body mass.
Thermic effect of food is the increase is energy expenditure above RMR in response to the ingestion of food, which includes digestion, absorption, transport, and cell assimilation. Quite literally, we are using energy/calories when we eat food – energy is needed for digestion, absorption, and the transport of food through our GI tract.
Exercise energy expenditure is the energy used during exercise or activity. Exercise is defined as movements done for the purpose of improving or maintaining health or performance related physical fitness. Exercise is the most variable component of daily energy expenditure and changes based on the intensity, duration, mode, and frequency. On any given day, the expenditure from exercise can range from zero calories (for the non-exerciser or on rest day) to several thousand calories (think marathon or triathlon training).
Non-exercise activity thermogenesis is the energy expenditure resulting from activity or movement that is not considered exercise. These movements may include fidgeting and activities of daily living, like walking, talking, gardening, or doing the laundry. One of the reasons sitting has been deemed the new smoking is because maintaining posture is considered a component of NEAT, and we maintain posture more regularly when we are standing. Sitting expenditure is lower than standing, as standing requires muscle contractions to maintain balance, which uses energy.
You can think of RMR, TEF, ExEE, and NEAT as the components that make up your metabolism. So, what are some ways to increase TDEE and ultimately metabolism?
Allison Tropf, MS, RD, CSSD
Allison is a Sports Dietitian in Michigan. She enjoys helping others reach their nutrition and fitness goals through reliable and trustworthy recommendations.
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