Efectos del consumo de marihuana en adultos sobre la ingesta y el metabolismo de los nutrientes: una revisión
DOI:
https://doi.org/10.14306/renhyd.21.3.328Palabras clave:
Cannabis, Cannabinoides, Estado nutritional, DietaResumen
La marihuana es uno de los psicoactivos más consumidos en Colombia y el mundo. Se ha observado que tiene efectos sobre el sistema nervioso central y, en consecuencia, podría afectar al metabolismo y el estado nutricional de los individuos consumidores. Este artículo pretende evaluar si el consumo de marihuana y la activación del sistema cannabinoide tienen la capacidad de activar mecanismos fisiológicos mediante los cuales se afecte la ingesta de alimentos, el metabolismo de los nutrientes y el estado nutricional de los adultos adictos. Como resultado se encuentra que el consumo de la marihuana puede incrementar los estímulos orexigénicos y disminuir los anorexigénicos, incidiendo en el aumento de la ingesta y en cambios sobre la producción de enzimas importantes para el metabolismo de las grasas. Además, influye en la aparición de alteraciones del estado nutricional de los consumidores relacionadas con una disminución del índice de masa corporal (IMC), lo cual contrasta con los resultados observados a nivel de la ingesta, por lo tanto se resalta la importancia de efectuar estudios profundos que expliquen este cuestionamiento.
Citas
(1) Rodríguez R. Los productos de Cannabis sativa: situación actual y perspectivas en medicina. Salud mental. 2012;35(3):247-56.
(2) United Nations Office on Drugs and Crime. World Drug Report 2016 [Internet]. Vienna: United Nations; 2016. Report No.: E.16.XI.7. Disponible en: http://www.unodc.org/doc/wdr2016/WORLD_DRUG_REPORT_2016_web.pdf
(3) Richards BL, Whittle SL, Buchbinder R. Neuromodulators for pain management in rheumatoid arthritis. Cochrane Database Syst Rev. 2012;1:CD008921.
(4) Smith LA, Azariah F, Lavender VTC, Stoner NS, Bettiol S. Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane Database Syst Rev. 2015;(11):CD009464.
(5) Marshall K, Gowing L, Ali R, Le Foll B. Pharmacotherapies for cannabis dependence. Cochrane Database Syst Rev. 2014;(12):CD008940.
(6) Gates PJ, Sabioni P, Copeland J, Le Foll B, Gowing L. Psychosocial interventions for cannabis use disorder. Cochrane Database Syst Rev. 2016;(5):CD005336.
(7) Krishnan S, Cairns R, Howard R. Cannabinoids for the treatment of dementia. Cochrane Database Syst Rev. 2009;(2):CD007204.
(8) Dujourdy L, Besacier F. A study of cannabis potency in France over a 25 years period (1992-2016). Forensic Sci Int. 2017;272:72-80.
(9) Jager G, Witkamp RF. The endocannabinoid system and appetite: relevance for food reward. Nutr Res Rev. 2014;27(1):172-85.
(10) Paragano AJ, Abdala A, Vilariño JO, Magallanes CH, Grasiosi JC, Alasia D, et al. Sistema endocannabinoide, obesidad y síndrome metabólico. Rev CONAREC. 2006;22(87):224-37.
(11) Netzahualcoyotzi-Piedra C, Muñoz-Arenas G, Martínez-García I, Floran-Garduño B, Limón-Pérez ID. La marihuana y el sistema endocanabinoide: De sus efectos recreativos a la terapéutica. Rev Biomed. 2009;20(2):128-53.
(12) Pagotto U, Marsicano G, Cota D, Lutz B, Pasquali R. The emerging role of the endocannabinoid system in endocrine regulation and energy balance. Endocr Rev. 2006;27(1):73-100.
(13) Horcajadas FA. Sistema cannabinoide y regulación de la conducta alimentaria. Adicciones. 2008;20(2):171-84.
(14) Riggs PK, Vaida F, Rossi SS, Sorkin LS, Gouaux B, Grant I, et al. A pilot study of the effects of cannabis on appetite hormones in HIV-infected adult men. Brain Res. 2012;1431:46-52.
(15) Yoshida R, Ohkuri T, Jyotaki M, Yasuo T, Horio N, Yasumatsu K, et al. Endocannabinoids selectively enhance sweet taste. Proc Natl Acad Sci USA. 2010;107(2):935-9.
(16) Matias I, Gonthier M-P, Orlando P, Martiadis V, De Petrocellis L, Cervino C, et al. Regulation, function, and dysregulation of endocannabinoids in models of adipose and beta-pancreatic cells and in obesity and hyperglycemia. J Clin Endocrinol Metab. 2006;91(8):3171-80.
(17) Silvestri C, Di Marzo V. The endocannabinoid system in energy homeostasis and the etiopathology of metabolic disorders. Cell Metab. 2013;17(4):475-90.
(18) Valenzuela C, Aguirre C, Castillo V, Ronco AM, Llanos M. Participación del sistema endocanabinoide en el desarrollo de obesidad. Rev Med Chil. 2010;138(5):621-9.
(19) Ting C-H, Chi C-W, Li C-P, Chen C-Y. Differential modulation of endogenous cannabinoid CB1 and CB2 receptors in spontaneous and splice variants of ghrelin-induced food intake in conscious rats. Nutrition. 2015;31(1):230-5.
(20) Al Massadi O, López M, Tschöp M, Diéguez C, Nogueiras R. Current Understanding of the Hypothalamic Ghrelin Pathways Inducing Appetite and Adiposity. Trends Neurosci. 2017;40(3):167-80.
(21) Monteleone P, Piscitelli F, Scognamiglio P, Monteleone AM, Canestrelli B, Di Marzo V, et al. Hedonic eating is associated with increased peripheral levels of ghrelin and the endocannabinoid 2-arachidonoyl-glycerol in healthy humans: a pilot study. J Clin Endocrinol Metab. 2012;97(6):E917-924.
(22) Senin LL, Al-Massadi O, Folgueira C, Castelao C, Pardo M, Barja-Fernandez S, et al. The gastric CB1 receptor modulates ghrelin production through the mTOR pathway to regulate food intake. PLoS ONE. 2013;8(11):e80339.
(23) Orio L, Crespo I, López-Moreno JA, Reyes-Cabello C, Rodríguez de Fonseca F, Gómez de Heras R. Additive effects of cannabinoid CB1 receptors blockade and cholecystokinin on feeding inhibition. Pharmacol Biochem Behav. 2011;98(2):220-6.
(24) Di Marzo V, Ligresti A, Cristino L. The endocannabinoid system as a link between homoeostatic and hedonic pathways involved in energy balance regulation. Int J Obes. 2009;33 Suppl 2:S18-24.
(25) Zbucki RL, Sawicki B, Hryniewicz A, Winnicka MM. Cannabinoids enhance gastric X/A-like cells activity. Folia Histochem Cytobiol. 2008;46(2):219-24.
(26) Cruz AM, González B, Cendejas NM, Mancilla JM, Florán B, Escartín RE. Inhibición de la saciedad alimentaria inducida por activación de receptores CB1 hipotalámicos. Rev Mex Anál Conducta. 2010;36(2):39-51.
(27) Kirkham TC. Cannabinoids and appetite: food craving and food pleasure. Int Rev Psychiatry. 2009;21(2):163-71.
(28) De Luis DA, Armentia A, Muñoz PL, Dueñas-Laita A, Martín B, De la Fuente B, et al. Ingesta dietética en un grupo de pacientes fumadores de marihuana. Nutr Hosp. 2010;25(4):688-91.
(29) Tibiriça E. The multiple functions of the endocannabinoid system: a focus on the regulation of food intake. Diabetol Metab Syndr. 2010;2:5.
(30) DiPatrizio NV, Simansky KJ. Activating parabrachial cannabinoid CB1 receptors selectively stimulates feeding of palatable foods in rats. J Neurosci. 2008;28(39):9702-9.
(31) Kirkham TC, Tucci SA. Endocannabinoids in appetite control and the treatment of obesity. CNS Neurol Disord Drug Targets. 2006;5(3):272-92.
(32) Cortés-Salazar F, Ortíz S, Omar J, Trejo C, Mónica N, Mancilla-Díaz JM, et al. Efectos de la activación del receptor cannabinoide CB1 en el núcleo accumbens shell sobre la conducta alimentaria. Act Colom Psicol. 2014;17(2):61-8.
(33) Morgan CJA, Freeman TP, Schafer GL, Curran HV. Cannabidiol attenuates the appetitive effects of Delta 9-tetrahydrocannabinol in humans smoking their chosen cannabis. Neuropsychopharmacology. 2010;35(9):1879-85.
(34) Schroeder F, McIntosh AL, Martin GG, Huang H, Landrock D, Chung S, et al. Fatty Acid Binding Protein-1 (FABP1) and the Human FABP1 T94A Variant: Roles in the Endocannabinoid System and Dyslipidemias. Lipids. 2016;51(6):655-76.
(35) El Amrani L, Porres JM, Merzouki A, Louktibi A, Aranda P, López-Jurado M, et al. Changes on metabolic parameters induced by acute cannabinoid administration (CBD, THC) in a rat experimental model of nutritional vitamin A deficiency. Nutr Hosp. 2013;28(3):857-67.
(36) Galve-Roperh I, Chiurchiù V, Díaz-Alonso J, Bari M, Guzmán M, Maccarrone M. Cannabinoid receptor signaling in progenitor/stem cell proliferation and differentiation. Prog Lipid Res. 2013;52(4):633-50.
(37) Teixeira D, Pestana D, Faria A, Calhau C, Azevedo I, Monteiro R. Modulation of adipocyte biology by δ(9)-tetrahydrocannabinol. Obesity. 2010;18(11):2077-85.
(38) Reichenbach V, Ros J, Jiménez W. Cannabinoides endógenos en la enfermedad hepática: muchos dardos para una sola diana. Gastroenterol Hepatol. 2010;33(4):323-9.
(39) Pagano C, Pilon C, Calcagno A, Urbanet R, Rossato M, Milan G, et al. The endogenous cannabinoid system stimulates glucose uptake in human fat cells via phosphatidylinositol 3-kinase and calcium-dependent mechanisms. J Clin Endocrinol Metab. 2007;92(12):4810-9.
(40) Bermudez-Silva FJ, Romero-Zerbo SY, Haissaguerre M, Ruz-Maldonado I, Lhamyani S, El Bekay R, et al. The cannabinoid CB1 receptor and mTORC1 signalling pathways interact to modulate glucose homeostasis in mice. Dis Model Mech. 2016;9(1):51-61.
(41) Muniyappa R, Sable S, Ouwerkerk R, Mari A, Gharib AM, Walter M, et al. Metabolic effects of chronic cannabis smoking. Diabetes Care. 2013;36(8):2415-22.
(42) Matias I, Vergoni AV, Petrosino S, Ottani A, Pocai A, Bertolini A, et al. Regulation of hypothalamic endocannabinoid levels by neuropeptides and hormones involved in food intake and metabolism: insulin and melanocortins. Neuropharmacology. 2008;54(1):206-12.
(43) Ngueta G, Bélanger RE, Laouan-Sidi EA, Lucas M. Cannabis use in relation to obesity and insulin resistance in the Inuit population. Obesity. 2015;23(2):290-5.
(44) Sophocleous A, Robertson R, Ferreira NB, McKenzie J, Fraser WD, Ralston SH. Heavy Cannabis Use Is Associated With Low Bone Mineral Density and an Increased Risk of Fractures. Am J Med. 2017;130(2):214-21.
(45) Sidney S. Marijuana Use and Type 2 Diabetes Mellitus: a Review. Curr Diab Rep. 2016;16(11):117.
(46) Ceccarini J, Weltens N, Ly HG, Tack J, Van Oudenhove L, Van Laere K. Association between cerebral cannabinoid 1 receptor availability and body mass index in patients with food intake disorders and healthy subjects: a [(18)F]MK-9470 PET study. Transl Psychiatry. 2016;6(7):e853.
(47) Penner EA, Buettner H, Mittleman MA. The impact of marijuana use on glucose, insulin, and insulin resistance among US adults. Am J Med. 2013;126(7):583-9.
(48) Zárate A, Manuel-Apolinar L, Basurto L, De la Chesnaye E, Saldívar I. Colesterol y aterosclerosis. Consideraciones históricas y tratamiento. Arch Cardiol Mex. 2016;86(2):163-9.
(49) Nayak P, Panda S, Thatoi PK, Rattan R, Mohapatra S, Mishra PK. Evaluation of Lipid Profile and Apolipoproteins in Essential Hypertensive Patients. J Clin Diagn Res. 2016;10(10):BC01-BC04.
(50) Bleda S, de Haro J, Varela C, Ferruelo A, Acin F. Elevated levels of triglycerides and vldl-cholesterol provoke activation of nlrp1 inflammasome in endothelial cells. Int J Cardiol. 2016;220:52-5.
(51) Danielsson A-K, Lundin A, Agardh E, Allebeck P, Forsell Y. Cannabis use, depression and anxiety: A 3-year prospective population-based study. J Affect Disord. 2016;193:103-8.
(52) Wilcockson TDW, Sanal NEM. Heavy cannabis use and attentional avoidance of anxiety-related stimuli. Addict Behav Rep. 2016;3(Supplement C):38-42.
(53) Kalinkovich A, Livshits G. Sarcopenic obesity or obese sarcopenia: A cross talk between age-associated adipose tissue and skeletal muscle inflammation as a main mechanism of the pathogenesis. Ageing Res Rev. 2017;35:200-21.
(54) Patiño-Masó J, Gras-Pérez E, Font-Mayolas S, Baltasar-Bagué A. Consumo de cocaína y policonsumo de sustancias psicoactivas en jóvenes universitarios. Enfermería Clín. 2013;23(2):62-7.
(55) Isorna M, Amado BG, Cajal B, Seijo D. Perfilando los consumidores de cannabis que autocultivan a pequeña escala. Anal Psicol. 2016;32(3):871-8.
(56) Li J, Yang C, Davey-Rothwell M, Latkin C. Associations Between Body Weight Status and Substance Use Among African American Women in Baltimore, Maryland: The CHAT Study. Subst Use Misuse. 2016;51(6):669-81.
(57) McIlwraith F, Betts KS, Jenkinson R, Hickey S, Burns L, Alati R. Is low BMI associated with specific drug use among injecting drug users? Subst Use Misuse. 2014;49(4):374-82.
(58) Tang AM, Forrester JE, Spiegelman D, Flanigan T, Dobs A, Skinner S, et al. Heavy injection drug use is associated with lower percent body fat in a multi-ethnic cohort of HIV-positive and HIV-negative drug users from three U.S. cities. Am J Drug Alcohol Abuse. 2010;36(1):78-86.
(59) Ignatowska-Jankowska B, Jankowski MM, Swiergiel AH. Cannabidiol decreases body weight gain in rats: involvement of CB2 receptors. Neurosci Lett. 2011;490(1):82-4.
(60) Meertens L, Ruido T, Díaz N, Naddaf G, Rodríguez A, Solano L. Relación entre lípidos séricos y estado de las vitaminas C y E como antioxidantes en adultos mayores venezolanos. Arch Latinoam Nutr. 2008;58(4):363-70.
(61) Rojas-Barquera D, Narváez-Cuenca C-E. Determinación de vitamina C, compuestos fenólicos totales y actividad antioxidante de frutas de guayaba (Psidium guajava L.) cultivadas en Colombia. Química Nova. 2009;32(9):2336-40.
(62) Mata C, Pestana C, Lares M, Porco A, Giacopini MI, Brito S, et al. Relación entre la ingesta de antioxidantes, factores nutricionales e indicadores bioquímicos en voluntarios sanos. Arch Latinoam Nutr. 2016;66(3).
(63) Harrison R, Rucklidge JJ, Blampied N. Use of micronutrients attenuates cannabis and nicotine abuse as evidenced from a reversal design: a case study. J Psychoactive Drugs. 2013;45(2):168-78.
(64) Zaiden N, Yap WN, Ong S, Xu CH, Teo VH, Chang CP, et al. Gamma delta tocotrienols reduce hepatic triglyceride synthesis and VLDL secretion. J Atheroscler Thromb. 2010;17(10):1019-32.
(65) Nadeem N, Woodside JV, Kelly S, Allister R, Young IS, McEneny J. The two faces of α- and γ-tocopherols: an in vitro and ex vivo investigation into VLDL, LDL and HDL oxidation. J Nutr Biochem. 2012;23(7):845-51.
(66) Mafra D, Santos FR, Lobo JC, de Mattos Grosso D, Barreira AL, Velarde LGC, et al. Alpha-tocopherol supplementation decreases electronegative low-density lipoprotein concentration [LDL(-)] in haemodialysis patients. Nephrol Dial Transplant. 2009;24(5):1587-92.
(67) Gómez Candela C, López B, M.ª L, Loria Kohen V. Importancia del equilibrio del índice omega-6/omega-3 en el mantenimiento de un buen estado de salud: Recomendaciones nutricionales. Nutr Hosp. 2011;26(2):323-9.
Esta revista ha conseguido la validación para ser 