Endocannabinoids: Part III, What the Blocking Drugs Might Do

April 02, 2006

Endocannabinoids:  Part III,  What the Blocking Drugs Might Do 

 Competency # 1 RISK                          Reference: Clin Cornerstone. 2006;8 Suppl 4:S24-35 

 In part I and II, we learned that the endocannabinoid system, (ECS) has a lot to do with our appetite.  The ECS system has a major presence in our brains, in our intestines and in our fat cells. The ECS system seems to be all intertwined with the metabolic syndrome which is the combination of factors that include being slightly overweight, having slightly elevated blood pressure, lipids, inflammatory markers and sugar and having a much higher risk for vascular disease.  

We believe the “reason” for the ECS system is that it may be part of our body’s ability to respond to stressful situations with relaxation, intake of food, storage of calories.  All that is good, in moderation.  In a world of excess calories, it all runs amuck. There is good science to show that ECS activation makes appetite and food intake go up.   Turning it on makes you eat.  What does turning it off do?   What happens when you get a blocking drug?  These blocking drugs are coming later this year.  

Here is what happens.  Preliminary research shows that one of the ECS blockers, rimonabant does the following:  (American Heart Association Meeting, New Orleans 2004, on 3045 patients) At one year:  9% sustained weight loss.  9% decrease in waist circumference.  25% increase in HDLs (the good cholesterol), 10% reduction in LDLs.   That’s all great data.  (% weight loss for me would be 18 pounds.  I’ve struggled for 6 months now to lose 4 pounds, only to gain it back in a weekend of riotous living.   Grrrrrr. 

 Is this controversial?  You bet.  I’m sure any of us can out eat any drug given to us to try and make us lose weight.  But the negative effects of cycling up and down with unsuccessful weight loss are possibly worse.  Diet, exercise and avoiding the 9:30 pm ice cream are probably the mainstay of our efforts.  But you need to know about these drugs.  They may offer a dramatically new and reasonable approach where everything else has failed. A word of caution: the last time we had a wonder weight loss drug, we ended up with a lot of folks with damaged heart valves.  I want to watch and see where this goes before I jump on board.  What is new is that we now understand the physiology.  Knowing the big picture will allow us to judge with sensible insight how this story unfolds.  And I believe there will be a nitch.  It may not be rimonabant, but there are others in the pipeline.  And you will be hearing more about it. So:  the ECS system.  You heard it first on "News in Nutrition"

This column is written by Dr. John E. Whitcomb, MD,Brookfield Longevity, Brookfield, WI. (262-784-5300)