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ORLANDO, Florida — Cannabis users may have a “healthier inflammatory cytokine profile, better insulin sensitivity, and higher levels of physical activity than nonusers,” all of which could potentially lower the risk for diabetes, according to ongoing research.
The findings stem from the ongoing SONIC trial led by Angela Bryan, PhD, professor and co-director of CUChange at the University of Colorado, Boulder. Bryan and her colleagues hypothesized that “those inflammatory profiles would improve over the course of 4 weeks, particularly for those using a CBD [cannabidiol] as opposed to a THC [tetrahydrocannabinol] product.” These insights were presented at the 2024 annual American Diabetes Association 84th Scientific Sessions.
In other research, Bryan’s team has explored the public health implications of cannabis legalization. One study examined the acute effects of legal-market cannabis on regular users’ subjective responses while running. They found that cannabis use prior to exercise may enhance enjoyment and runner’s high symptoms, although it also led to feelings of greater exertion. Bryan suggested that these positive effects could make exercise more appealing to individuals — including those with or at risk for diabetes — who might otherwise avoid it.
Another study found that CBD-dominant forms of cannabis were associated with acute tension reduction, potentially leading to longer-term reductions in anxiety. Bryan noted that these findings could be significant in the context of diabetes distress.
‘Complicated’ Connection to Diabetes
In the SONIC study, participants who were regular cannabis users had an average age of 30 years and maintained a healthy body mass index (BMI). The majority (86%) were White individuals, and 59% were men. They were compared with a similar group of individuals who had not used cannabis for at least a year. At baseline, participants’ NSDR Healthy Eating Index score was 51.24, indicating a need for dietary improvement.
“Folks were maybe not killing it in the dietary domain,” Bryan acknowledged. “However, they were absolutely killing it in the physical activity domain.”
The researchers conducted oral glucose tolerance tests to calculate participants’ Matsuda index of insulin sensitivity and measured inflammatory markers, including tumor necrosis factor alpha, interleukin 6 (IL6), IL1 beta, IL12, interferon gamma, IL4, and monocyte chemoattractant protein 1 (MCP-1). In a “randomized encouragement” design, users were assigned to purchase and use a flower product for 4 weeks, using as much as they wanted. Daily assessments tracked their cannabis use, alcohol use, diet, and physical activity.
Eating patterns between the groups were similar over the 4 weeks, with cannabis users reporting “marginally” more servings of salty snacks compared to nonusers. None of the daily associations were influenced by which cannabis product was used.
After 4 weeks, the team repeated the tests and found no change in participants’ inflammatory markers. However, there was a significant difference between users and nonusers, with users having lower levels of inflammatory biomarkers and circulating cytokines.
An exception was MCP-1, which increased over time in users but didn’t change in nonusers. Bryan found this perplexing, especially since MCP-1 levels are positively associated with diabetes.
After controlling for BMI and inflammation, “we saw absolutely no effects of group or group by time interaction on the Matsuda index of insulin sensitivity,” Bryan said. “Seemingly, there are no chronic effects of cannabis use on insulin sensitivity.”
Regarding limitations, Bryan noted that the study involved “a very healthy sample of individuals who exercise a lot,” which might influence the results, particularly on insulin sensitivity. The inability to use “gold standard” randomization due to the schedule-1 status of cannabis and the MCP-1 findings’ complexity were also mentioned as limitations.
Bryan concluded, “I think all of this put together shows us that the relationship between cannabis use and potential implications for diabetes is a lot more complicated than just couch to couchlock [very deep relaxation/sedation] or runner’s high.”
Bring On the CannaVan
The next step for the research team, currently underway, involves assessing the acute response to cannabis with an oral glucose tolerance test immediately after product use. Since cannabis is a schedule-1 drug, it can’t be taken into the laboratory. Instead, the researchers are using a CannaVan — a mobile lab. “We drive it to their homes, they come out, we draw blood, and we send them back into their homes to use as much of their product as they want,” Bryan explained. “They come back out to the van. They do all the follow-up assessments. We take blood again to verify their exposure. And that’s how we collect those data.”
“Invite me back next year, and I will tell you what we found,” she quipped.
