Cannabis use associated with quadrupled risk of developing type 2 diabetes | Hacker News Reader

Cannabis use associated with quadrupled risk of developing type 2 diabetes

medicalxpress.com

161 pointsgeox98 comments

After reading the article and the comments on this page, I also think it's unclear what exclusion criteria were used to select the cannabis using and control cohorts. Controlling for likely and unlikely confounding variables is essential in this kind of study. Obesity is a notoriously heterogenous condition with a great number of inheritable and environmental contributors which makes the task especially difficult.

However, a connection of particular interest concerns ADHD, a disorder identified as having a strong link to obesity, including common genetic predisposition [0]. Furthermore, individuals with ADHD are also more likely than non-ADHD peers to develop drug dependence, including cannabis-use disorder [1,2]. If ADHD was not among direct or indirect exclusion criteria, the results of the recent study could be misleading or at least incompletely characterized.

    [0] https://pmc.ncbi.nlm.nih.gov/articles/PMC6097237/ 
    [1] https://pmc.ncbi.nlm.nih.gov/articles/PMC5568505/  
    [2] https://pmc.ncbi.nlm.nih.gov/articles/PMC8025199/

I think the issue I have is simpler. My understanding is those that were obese and have lost weight still have a higher chance of getting type 2 diabetes than those that were slim throughout their lives. If your chance of getting diabetes is 70% while obese, and 2.2% (or 15% or whatever it actually is) after losing weight, how is that not a win?

It is indeed a win. It's long been established that for obese individuals even 5% weight loss reduces comorbidity of obesity-related conditions. Of course greater weight loss, 10-15%, gives better outcomes. Typically the difficulty is maintaining lower weight for the long haul. For those who can do it the payoff is substantial.

> The researchers found that new cases of diabetes were significantly higher in the cannabis group (1,937; 2.2%) compared to the healthy group (518; 0.6%).

We know there's a path from obesity to diabetes. I think it would be interesting to see if there's a path from cannabis to obesity.

> a path from cannabis to obesity

I believe the technical term is "the munchies"

You would think that's the mechanism, but there seems to be evidence that points to lower BMI with cannabis use.

Mouse study: https://medschool.uci.edu/news/new-research-may-explain-why-...

Human study: https://www.liebertpub.com/doi/10.1089/can.2024.0069

Many people might have removed alcohol intake with cannabis use, to reduce overall caloric intake.

Very interesting conclusion directly from the human study you linked: "Marijuana use is correlated with lower BMI. As legalization and prevalence of the drug in the U.S. increases, the prevalence of obesity may decline. However, clinicians should view this outcome along with the known health risks associated with marijuana use."

Speaking from personal experience I went from a BMI of 24 (healthy) to a BMI of 31 (obese) because of daily cannabis use that gave me insane munchies.

This may be genetic, I had friends that didn't get them nearly as badly as I did.

(I have since quit weed and lost the weight.)

feeling like i need to throw my anecadata on here. i used cannabis daily and went from a BMI of 34 to 26. Turns out I like getting stoned on the exercise bike and just tracking my diet for a month pointed out a few big, easy wins that I took in order to get my daily calories below maintenance.

I wonder if this is skewed by the states where marijuana was legal/more accessible during that time window. Colorado was the first state to legalize it and is also the state with the lowest BMI.

It has to be said that Colorado is a state known for outdoors culture and people are naturally more inclined to be physically active with more exuberant nature outings nearby.

Washington was the first state to legalize because of the time difference

Wouldn't it be the opposite? 9 AM in Colorado is 8 AM in Washington.

Depending on the level of pedantry you want you could argue for either. Washington's measure went into effect first, on Dec 1st, 2013 while Colorado's went into effect on Jan 1st, 2014. Colorado opened retail shops that same day though while the first shops didn't open until July 2014 in Washington and they had a lot of initial issues around licensing leading to slower expansion.

Sure, but in reference to the comment "because of the time difference" it seems pretty obvious he was referring to time zones, not the dates the laws took effect.

Anyway, it doesn't actually matter. Cheers.

I'm saying polls closed sooner. Haha yeah I know it doesn't matter

I don't know why this isn't talked about that often, but a lot of people who smoke weed end up needing to smoke weed to be able to eat. Which probably is part of the thing that leads to reduced BMI.

> I don't know why this isn't talked about that often, but a lot of people who smoke weed end up needing to smoke weed to be able to eat.

As someone with a pretty drug-friendly friend group… I’m surprised to hear that happens ‘a lot’ because I have never heard of that, or experienced it myself.

In my experience, you eat food because it tastes good - and while being stoned might make some foods more satisfying texturally (ice cream when you have cotton mouth is rad) or lower your inhibition to try weird stuff, or to alter your perception in a way that exposes you to new avenues to appreciating familiar foods - I really can’t imagine that not transferring to being sober. Peanut butter and pickles still taste good sober, even if you develop an appreciation for them while stoned.

Are you saying a lot of people just stop experiencing hunger? Like does their stomach not growl and feel empty unless they’re high? Really having trouble thinking of what you could be describing, and squaring jt with what I know.

Are they drug friendly, or are they stoners? In my experience it's not so much needing to be high to eat as it is the craving to get high outweighs that for food, then when you get high you forget to eat. Then when it begins to wear off all the hunger hits you and you eat a whole pizza and a bag of Doritos right before falling asleep.

When the first thing on your mind when you wake up is smoking weed and that's your primary activity throughout the day, food just becomes secondary, so the idea of eating without smoking first is just not realistic.

It's a pretty common mechanism in humans to replace one craving with another. AA (e.g.) doesn't necessarily care if you have a two pack a day smoking addiction -- that's not what they're "optimizing" for.

> Are you saying a lot of people just stop experiencing hunger? Like does their stomach not growl and feel empty unless they’re high?

I think maybe a better way is to understand what the best solutions are. Right now it seems to be replacing one craving with another. People who stop cigarette smoking often gain weight -- that's been well documented for decades now. Knowing that, is type 2 diabetes better or worse than smoking and risking lung cancer?

People who run get a lot of endorphins from the exercise. People who haven't run and start running get a lot of pain from it at first. Maybe after a few months they get endorphins.

GLP-1 agonists (wegovy, zepbound) do reduce food cravings, but they also are being studied for alcoholism. I've heard it could affect gambling addiction as well. The real question is, why would a GLP-1 agonist affect a gambling addiction at all?

I have never heard of this but cannabis has a powerful effect on ghrelin.

It wouldn't be shocking that at extreme use ghrelin stops acting without stimulation from cannabis.

The problem with discussion on these things is everything is dose dependent.

If you drink a glass of wine once a month the state of the extreme alcoholic is not going to line up with your experience from "drinking alcohol."

Yeah in my experience real heavy users of weed don't get munchies anymore and actually just smoke instead of eat pretty frequently. Eating kinda kills your high.

Source: was a burnout in college for 4 years

My personal hypothesis, is that cravings (drug, sugar, food, sex, alcohol, socializing, etc) fill a need for stimulation. Most people get that through maybe watching sports, reading books, or if you can, mental stimulation (math, science, programming, 3d printing, juggling, etc). Or maybe some combination of all of them. If you didn't have very many friends growing up, it felt agonizing with a deep desire to fit in -- that was the "social" craving kicking in early in life.

Some of those cravings exist to extend life and to help the species multiply. Some of them were artificial (drugs, alcohol, gambling, computer gaming).

GLP-1 agonists (wegovy, zepbound) are prescribed for certain addictions other than obesity. This shows that we don't understand addiction at all.

My wife is, in clinical terms, morbidly obese and, since the pandemic, has become more and more reliant on weed to cope with stress.

While Wegovy hasn't helped her lose significant weight or meaningfully enough reduced her reliance on food to deal with stress (yes, she vomits a lot), she has stopped smoking weed.

She claims quitting weed has nothing to do with the Wegovy, but before starting it, she wouldn't even acknowledge it was a problem.

  but a lot of people who smoke weed end up needing to smoke weed to be able to eat.

A negative side effect of weed abuse is that you get so dependent on it, you have no appetite to eat unless you're high.

> Many people might have removed alcohol intake with cannabis use, to reduce overall caloric intake.

A regular topic of conversation at college (in the 70s!) was, if you were stranded on a desert island and could only have one - demon rum or the evil weed - which would you choose ?

There’s also something to cannabis potentially messing with your metabolism because anecdotally potheads usually aren’t particularly fat.

Also "couch lock", i.e., reduced physical activity.

I actually would like to see a study about this. I am starting to think that the stereotype of lethargic potheads chilling on a couch comes mostly from portrayals in movies. Anecdotally, I encounter many people casually using cannabis while engaged in varying levels of physical activity, ranging from just hanging out in the city, to going on hikes, to outright partying or dancing late into the night. I even heard a couple folks use it as a "pre-workout" for long runs or lifting.

I'm sure it depends on the dosage, but the relationship between usage and physical activity seems to be more nuanced than is generally understood.

It's shockingly accurate. Sure people get high and do other stuff but the amount of people just sitting on couches passing weed around for hours is huge.

This poses a confirmation bias issue though, no? People obviously taking marijuana and sitting around: something you look for because of the stereotype/expectation, and relatively obvious if you’re around them. People doing activities not stereotypically associated with marijuana: less obvious.

Unless they are publicly consuming it (which I suspect is a bit rarer due to restrictions on and stigma about consumption in public), how would you count people who aren’t engaging in expected stoner behavior?

I don’t have a dog in this fight or suspected conclusion. Just seems like it might be harder than you think to truthfully assert “everyone knows most people who take pot just sit around”.

How does it compare to the number of people just sitting on couches doing things other than smoking marijuana, and how are we comparing?

pre-workout gummy enjoyer checking in

Which is interesting to me because, ironically, I use sativa strains to (very successfully) overcome ASD-related social anxiety so that I can go rock climbing in a gym. I use sedating indicas for the evening wind-down and sleep.

Could be, but from my own (and witnessing some others similar experiences) anecdotical evidence I think it's something else, more complicated.

Maybe related to the large and fast swings in blood sugar energy drinks, or other strongly sweetened sodas produce.

"The munchies" is what comes after, sometimes, but not at all necessarily. Depending on the composition of the stuff, I don't get them at all, and have to remind myself to eat and drink. Sometimes for days after.

What I always do is to ingest some grape sugar like https://dextro-energy.com/en/products/cube-classic before using any THC, no matter which form.

Because when I'm not doing that, I tend to get at least a strong fit of hiccups, but more likely a case of cannabis induced emesis and dizziness.

That OFC sucks.

IF prophylactically countered by using some sort of grape-sugary thing right before THC use, that never ever happens to me. And some others neither.

So what I'm saying is, independently of "the munchies" which come after using anything THCish, it does something to your blood-sugar, fast.

At least for some people, with certain metabolic settings.

Used repeatedly, over longer timeframes, I wouldn't be surprised that this is causing some maladaption, leading to some form diabetes.

Again, indepent of "munchies", or not.

This should be nothing new, because I didn't discover this by myself, but got it as a tip by experienced users, almost 40 years ago.

edit: maybe some form of https://en.wikipedia.org/wiki/Hypoglycemia

>I believe the technical term is "the munchies"

Needs to be more Latin for academia to accept it.

In all seriousness, though, the common thread is a need for coping mechanisms and lacking healthy ones.

Appetitus Cannabinicus.

The munchies eventually go away if you use THC on a daily basis, some users actually end up needing THC to be able to eat normally.

I always wonder about connection and correlation in these studies. Does the cannabis do something to the body to cause diabetes or is the type of person who would indulge in cannabis also the type of person that would indulge in some cake?

You can easily eat entire cakes every single day if you are high all the time.

Doesn't it boost appetite? It's traditionally fed to underweight kids in india.

Or a path from cannabis to diabetes such as declined insulin production

Part of research work is removing extraneous variables.

This is not a great "study" if you can call it that. Let me be specific by pointing a passage that's doing a lot of the heavy lifting:

```

After controlling HDL and LDL cholesterol, uncontrolled high blood pressure, atherosclerotic cardiovascular disease, cocaine use, alcohol use and several other lifestyle risk factors, the researchers found that new cases of diabetes were significantly higher in the cannabis group (1,937; 2.2%) compared to the healthy group (518; 0.6%), with statistical analysis showing cannabis users at nearly four times the risk of developing diabetes compared to non-users.

```

Note "nearly four times the risk of developing diabetes" -- this feels like a dangerous exaggeration of "four times the correlation of having developed diabetes." No controls for diet, exercise, etc. In comparison to a gold standard clinical trial this is about as far as you can go on the other end.

That's not to say that I think that a prospective link doesn't merit deeper research -- far from it. In fact, Novo Nordisk has an anti-obesity drug in phase 2a trials, monlunabant [1], that serves as a CB1 (cannabinoid receptor 1) inverse agonist which has a mechanism of action inverse to THC. The clinical trials are showing that it creates modest weight loss, so it seems that there's likely something to how that receptor is activated that could cause weight gain. What's not clear to me is whether all the other receptors that THC activates create a compound effect at a population health level that leads to net weight gain and the development of diabetes, the inverse, or non-correlated outcomes, and whether those occur across the board or differentially based on genetic makeup.

[1] https://en.wikipedia.org/wiki/Monlunabant

very confusing results around this the last few years

https://www.veriheal.com/blog/study-women-who-consume-a-lot-...

there needs to be a paper that reconciles conflicting findings.

This is a sketchy article about a study which is not even named because it has not yet been presented. It will be presented in the next week. I would take this entire thing with a grain of salt.

The website also has a bunch of other sketchy articles playing up the alleged “dangers” of cannabis, usually by the classic approach of conflating correlation with causation.

I'll refrain from suggesting this to be deliberate on the authors' part, but there's obviously some bias at play here.

From my experience regular stoners eat less and less. Yes at first the munchies might cause issues but quickly with the developed tolerance it gets so intense that these people will barely eat without having consumed which usually causes them to loose weight.

Also someone at age 18 already being a regular stoner to age 25 being a regular stoner is vastly different.

occasional use makes me gain weight like crazy.

I believe this. I also believe that it's an indirect cause.

Curious how many people who use both cannabis AND amphetamines develop type 2 diabetes.

I suspect it's a smaller number.

Cannabis causes obesity in some, due to its impact on appetite. Do we need to draw out links to everything that we already know obesity causes and act like this is somehow interesting information?

In my experience regular cannabis use drastically reduces appetite and weight to the point it's like a weight loss drug. I've met others who have the same experience.

This does not appear to be particularly surprising (?).

I think it is widely recognized that exercise and an active lifestyle can lower the risk of type 2 diabetes.

Remembering my cannabis consumption days, being under the influence of cannabis is not exactly a state that encourages an "active lifestyle".

Depends on your circles. Marijuana use is super prevalent amongst climbers (even while climbing, for better or worse) and it's a very active lifestyle. Same for surfers in my area. I don't think it's a given that people who smoke are less active.

Jui Jitsu also has a reputation for being a smoker friendly activity

Anything in excess is bad for you. Even water.

Alcohol (and tobacco) is bad for you even after one sip, though.

Not sure you can have a vegetables or fruits overdose or even be addicted to them, but you cannot have too much of those.

And to drown yourself by drinking water, you would need to drink around 7 liters in a day. You will start to feel really bad a few liters before that.

Depending on the fruit, sugar content can also lead to diabetes, and the sugars and acids are also generally bad for dental health.

Generally speaking we accept those for the other benefits of vitamins / fibre intake, et cetera. This study is quite weak, and if the upside in some cases is improved mental health, and the risks of diabetes can be mitigated with exercise, then perhaps we need to view cannabis the same way.

Sure but the fibers and high sucrose would make you satisfied before you have any risk of becoming obese.

Small quantities of alcohol of cannabis are worse than water and oxygen though.

Wonder if cannabis triggers blood sugar level changes which causes the munchies.

I have funky blood sugar issues, and I can certainly see the overlap in how the cravings feel but never made the connection until now. Very interesting.

There does seem to be an effect on blood sugar levels, but apparently not in a simple way because studies struggle to get consistent results. It seems like it lowers it a little bit, atleast at first, but many people spend far more time with excess sugar levels, possibly due to eating in response.

Anecdotally it always seemed to me that it didn't make you that hungry straight out, but it did depress the feeling of satiation after eating so it is much easier to binge on food once you start eating something.

I have never found a study that supports this.

The research is pretty clear this is from ghrelin stimulating appetite and at the same time altering levels of leptin so a person feels less full.

It is not from a blood sugar crash.

While some studies link lower BMI, meta analysis shows cannabis is kind of a disaster if you are trying to lose weight.

It is hard to make generalizations though because it is so different if you smoke once a month, once a week or once a day.

Seems to me that that would have been known/measured by now if it was the case. Fairly easy to measure.

This doesn't make sense as causation. Cannabis stimulates insulin-sensitizing hormone.

It makes sense for the same reason that prediabetic people feel better with cannabis

Everything fun is always bad :(

Plenty of bad things that are no fun (microplastics, air pollution, pesticides in food, ...) that are near impossible to escape, so don't deprive yourself of the fun stuff (with moderation).

I occasionally use CBN for sleep, never THC, so maybe it's different, but I quickly develop a tolerance, like within a week of daily use and have to cease for many days or a few weeks to get any further benefit at all.

As I read, the endocannabinoid system in the brain is pretty homeostasic.

Does something similar happen with cannabis munchies subsiding to people who ingest THC or whole leaf products daily?

Anecdotally yes. I'm a very occasional user now and get insane munchies but when I was using it differently I felt that tolerance built quickly and I stopped having munchies once it did. Not even quite daily use either like 3-4/week. Another comment elsewhere in here describes the same experience.

I've been taking CBD daily in the evening for sleep (can't find a quality source if CBN where I live - I am interned tho, the research is compelling for sleep) and I find it can act almost like an appetite suppressant.

I took CBD twice and both times it worsened my sleep, so I really wanted a pure CBN product.

Not sure where you live, but this is what I use for CBN: https://www.charlottesweb.com/products/stay-asleep-cbn-gummi...

One gummy (10mg) works for about 2-3 nights, then I get another 2-3 nights effect with 20mg. Then I have to cease taking it for several days.

Alas, they won't ship that product to where I live.

Yes, but it remains a good anti-emetic.

Once you become a heavy user it no longer reliably triggers appetite, maybe because you get better at recognizing the hunger is fake and focus on other aspects of the high.

Is there a link somewhere to the actual scientific contribution? (Or at leadt an abstract?)

"While the authors note that more research is needed to fully explain the association between cannabis and diabetes, it may come down to insulin resistance and unhealthy dietary behaviors." Too much chocolate I'd guess.

I wonder if this is connected to the appetite the cannabis consumption brings about. I personally experienced appetite from consuming it but learned that not acting on it is equally pleasant. Maybe I have more self control or something...

You can’t claim that with effect sizes this small

The effect size is from 0.6 to 2.2 percent.

That's 4x.

That seems quite large to me.

1% ABV is 10× as much as 0.1% ABV, but neither are gonna get you drunk particularly quick.

Effect size needs to be relativized by the error present from the study. There’s a probability distribution over multiplicative increases which probably has a decent amount of mass below 4x

https://archive.ph/kmLlt

People in the dispensary look better (slimmer) than in the wallmart.

Comparing them with the People of Walmart is not setting the bar very high.

You’re also interfacing with folks in a niche service industry here. If you’re a sales rep, you’re definitely being screened to represent what people want to be perceived with using the product.

If anything, I’d wager that a lack of impulse control in some folks leads them to eat junk food and consume THC. Correlation, not causation.

There are a number of impulse control disorders that I feel are all related, in the sense that if you’ve got a lack of impulse control you’re more likely to overeat, consume drugs and alcohol, get addicted to video games, gamble, have risky sex, etc. I have gone down a few of these paths personally due to to my own problems with impulse control and have seen similar patterns in others.

the munchies

> Cannabis use associated with quadrupled risk of developing type 2 diabetes

Sugar has nothing to do with diabetes. Regards, Nestle. /s

Munchies joke?

The munchies....

"The munchies" have unpleasant sequelae...

Exactly what is going on here appears to be more complicated than that. For example: https://www.medicalnewstoday.com/articles/325050

Title: Marijuana users less likely to be overweight or have obesity

Opening line: New research finds that, despite the common phenomenon of having “the munchies” after using marijuana, cannabis users tend to weigh less and are less likely to be obese.

This involved 33k participants in the US, so at least one order of magnitude smaller and in a different context.

without reading this study in depth my immediate thoughts are: - cannabis is not the direct link with diabetes - cannabis urges munchies > overeating - overeating causes obesity - obesity causes diabetes

> The authors note that more research is needed on the long-term endocrine effects of cannabis use and whether diabetes risks are limited to inhaled products or other forms of cannabis such as edibles.

This study did not differentiate between edibles, which are loaded with sugar, and inhaled cannabis usage. And, since they are not a food product, edibles do not carry the same onus as food for labeling, nor similar regulatory oversight.

This seems a significant flaw in the data gathering and could change the ultimate conclusion of the study.

Edibles wouldn't have enough sugar to singularly cause diabetes.

Thats ridiculous, 50 calories worth of edible is enough to get you high as balls for like 8 hours.

Tell me youre not a edible user without twlling me youre not an edible user

Not all edibles have sugar, but most seem to be pure candy. It's dangerous too because if the edible tastes so amazing you want to eat another one and then you get way too high. That's why when I used to make "magic brownies" I would make two batches, one of them "plain", so I could eat those after eating the magic one.

Level Protabs are pretty amazing, so clean and zero sugar. It's literally just THC and a little bit of corn starch pressed into a pill. I break them in half and it gives me a focused creativity boost.

Is it really possible to get diabetes from eating one piece of candy every day?

When you frame it that way, it almost brings the study's findings into question!

I wonder if it was truly a flaw or if it was a calculated omission.

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