Sex, Drugs and... Exercise? Caffeine, Alcohol, Marihuana and Nicotine - Do All Our Favorite Addictions Clash With Being Healthy, Lean and Athletic?

The only truly ergogenic addiction is a SuppVersity addiction ;-)

I am not sure if you remember my detailed elaborations on the effects of sexual intercourse on exercise performance from May 30, 2012 [see "Will Sex Before a Competition Hamper Your Performance?" | more], but if you don't I'd suggest you start out with this SuppVersity Classic before you devote yourself to Rock'n'Roll by reading up on that in my article "Acoustic Gear" [read more] and return here for the missing third part of the triumvirate: Drugs!

Drug #1: Caffeine - From your coffee mug to the doping list

I am actually 100% confident that 99% of you have already trained "on drugs". Most of you probably do it regularly. Either with caffeine, about which Tony Chou reported in a 1992 paper that it is consumed on a daily basis by ~90% of the adult population (Chou. 1992). With average amounts of "only" 200 mg or 2.4 mg/kg/day (about 2 cups of coffee).

Why are you laughing? Caffeine was on the WADA's list of banned substances from 1962 to 1972 and again from 1984 to 2003. Whether the average coffee consumer will ever achieve concentrations of 12 μg/ml+ in the urine and thus fail a doping test is obviously a whole different question, but during the second banned period from 1984-2003, a whole host of athletes passed the magic 12 µg/ml line and were tested positive for caffeine. The sanctions ranged from warnings up to

2 year suspensions (maximum penalty, usually only 2–6 months; cf. Pesta. 2013).
In view of the fact that its ergogenic effects are so well established as with hardly any other substance, I will stick to a very brief overview of the surprising benefits the world's "drug" #1 will have on preformance:

• Antagonism of adenosine ➲ analgesic effects (reduced perception of pain; Derry. 2012)
• Increased fatty acid oxidation ➲  higher endurance (Spriet. 1992)
• Decreased respiratory ration ➲ increased use of fat, decreased use of glycogen (Rush. 2001)
• Increases cAMP by inhibiting phospodiesterase ➲ increase lipolysis = more fuel (Umemur. 2006)
• Activation of protein kinase A ➲ s. above + increase in gluconeogenesis = more fuel (Graham. 2001)
• Increases glycogen storage ➲ faster recovery (Pedersen. 2008; learn more)
• Modulation of muscular calciusm flux ➲ increase contractile forces (Tarnopolsky. 2000)

In view of it's various beneficial health effects and the insufficient evidence of significant side-effects, when it is consumed in moderation, exercise performance should thus not be a reason to give up drinking coffee (and as you remember, contrary to the claims of certain "fad brands" the same is true for mycotoxins, as well).

Drug #2: Alcohol - From the track to the bar and into the gutter

While caffeine made it from everyone's coffee mug onto the WADA list of prohibited substances for all sports, alcohol is prohibited in-competition only and only in the following sports: aeronautic, archery, auto mobile, karate, motorcycling and powerboating (until 2010, modern pentathlon was also included in this list; Pesta. 2013).

Alcohol is a killer: According to WHO, morbidity attributable to alcohol in countries with an established market economy (10.3% of disability adjusted life years) comes second only to that of tobacco (11.7%; Murray. 1997). According to a very recent study by published in the scientific journal Addiction by the Pan American Health Organization, a branch of the World Health Organization alcohol was a 'necessary' cause of death (i.e., death would not have occurred in the absence of alcohol consumption) in an average of 79,456 cases per year in 16 North and Latin American countries (Gawryszewski. 2014).

In view of its effects on exercise performance and the generally reckless approach to the #2 on the list of the most diligent killers among all, not just the freely available drugs the decision of the World Anti Doping Association appears not reasonable, but at least consequent.

For many cyclists at the Tour de France, it was common practice to drink one, two or three glasses, sometimes even a bottle of wine before during and after a race, but that was in the (good?) old days and its ergogenic effects are certainly questionable. Nevertheless, it took some time until the wine that was often laced with strychnine to help ease the pain and decrease the feeling of fatigue (Fife. 2000) got replaced by EPO, glucocorticoids & co [note: the cyclists also used cocaine or sympathomimetic drugs in order to attenuate the feeling of fatigue associated with such a prolonged exercise; cf. Lucia. 2003].

Now, aside from certain analgesic (=pain reducing) effects, alcohol has little to offer to the average athlete. It may still be the "the most commonly consumed drug in athletic communities" (Pesta. 2013), but in moderation and certainly not for ergogenic purposes.

Table 1: Summary of the effects of alcohol on performance (adapted from Pesta. 2013)

It has after all been shown to adversely affects psychomotor skills and exercise performance. The beneficial reductions in maximal oxygen consumption (~greater muscular efficiency), on the other hand are pathetic, so that the American College of Sports Medicine (ACSM) rightly recommends that "if an athlete must consume alcohol, that they should refrain from alcohol consumption for at least 48 hours prior to competition." (ACSM)

Remember the irony in the article " Ultimate Post-Workout Testosterone Booze" [more] - Don't use hard liquor to increase your post-workout testosterone levels by almost 100%,  unless figures on a lab report are more important to you than health & performance.

If you stick to this recommendation even on training days, this will probably eliminate alcohol from your diet altogether or restrict its consumption on the weekend; and that's certainly a good thing. Chronic alcohol abuse will after all

• lead to significant impairments in cardiac and skeletal muscle structure and function in 99% of the cases
• slow down post-exercise recovery, and 
• inhibit protein synthesis 

There is obviously no debating: Alcohol is a uniformly ergolytic agent, It has significant detrimental effects on exercise performance and it's use must be minimized not just for performance, but also, and more importantly, for health reasons.

Apropos health! I am sure all of you will be aware that the government of Colorado believes that marijuana should be part of a healthy lifestyle... ah, I mean medical protocol to deal with pain and other issues and decided to legalize the renown preparation of the Cannabis plant that's intended for use as a psychoactive drug and as medicine.

Drug #3: Cannabis, Mariuhana, Pot, Weed

As we have learned from the Tour de France athletes of the past, pain obviously is a major issue for athletes. So, wouldn't it make sense to switch from wine + strichnine to marijuana? Ok, you can't consume it "intra-workout", but maybe before and after the Queen's stage at L’Alpe d’Huez?!

Cannabis is everywhere and has been used for ages: While the legalization of cannabis in Colorado may be innovative, the sue of cannabis and its principal active ingredient, tetrahydrocannabinol (THC  is only one of 483 known compounds in the plant, including at least 84 other cannabinoids, such as cannabidiol, cannabinol, tetrahydrocannabivarin, and cannabigerol) is not. It has been used for generations by people all over the world (see table to the left, cf. Chopra. 1969). Whether it is "paleo" or not is yet something I can't tell you for sure ;-)

To answer that question, it may be useful to take a closer look at the structure of THC, which enables it to dock with the cannaboid receptors in the central nervous system (CNS). As Anand et al. point out (Anand. 2009):

• The centrally expressed CB1 receptors trigger the psychotropic effects of marijuana.
• The CB2 receptors in the periphery (spec. the sensory tissue) mediate the analgesic effects.

For the average Tour de France cyclist a selective CB1 receptor modulator (a "SCBRM", so to say ;o) could thus be the drug of choice. In view of the fact that some of the beneficial effects of exercise are also mediated by endogenous cannabinoid receptor antagonists (Hill. 2010), the analgesic effects could potentially be complemented by additional physiological benefits or side effects that are unrelated to the psychotropic effects of marijuana.

If these effects exist is yet probably almost as uncertain as the general usefulness of marijuana as an ergogenic, of which Pesta et al. write that if there were any, they would yet have to be established (Pesta. 2013).

• You don't have to smoke the weed to mess yourself up: Bird et al. demonstrated in 1980 that the previously mentioned detrimental effects on other aspects of performance occur with orally administered THC (215 µg/kg), as well. So don't even think of it ;-)
  Reduced work capacity of the heart at elevated heart rates -- Steadward and Singh (Steadward. 1971) were probably among the first scientists to test the effects of marijuana on exercise performance. In their study that was published as a dissertation at the University of Alberta in 1971 they found significant elevations in resting heart rate and both systolic and diastolic blood pressure at rest after marijuana consumption compared to both control and placebo. This lead to a highly significant decrease in physical work capacity at a heart rate of 170 (-25%) 
• Decrease in time to exhaustion -- Renaud's and Cormier's finding from a 1986 study appear to confirm the earlier results Steadward and Singh present in their thesis paper. The researchers  tested subjects 10 min after smoking a marijuana cigarette (containing 1.7% of Δ9-THC) of 7 mg/kg of body weight, and noted a slight, but significant decrease in cycle ergometry time to exhaustion. Avakian et al. [156] demonstrated that double.

In 1977, already Tashkin et al. (1977) hypothesized that the decrease in exercise performance may be due to itschronotropic effects, which would lead to achievement of maximum heart rate at reduced workloads.It goes without saying that - as long as you dig long enough - you will always find studies with conflicting results. The beneficial effects Tashkin et al. (1975) report in their paper, for example, occured in patients with asthma benefit from the bronchodilating effects of cannabis. For healthy individuals similar benefits are thus more than unlikely.

If there even is a benefit for pot-heads, it's probably a psychological one that could be brought about by anxiety reducing and euphorigenic effects of cannabis... but let's be honest: Isn't a healthy amount of pre-competition anxiety a necessary prerequisite for world-class performance?

Drug #4: Nicotine - Better smoke tobacco than pot?

If alcohol doesn't help and pot is downright bad for you what else could you add to your beloved caffeine? Of course! Cigarettes. I mean, nicotine and caffeine that does even sound alike! Plus: Some "experts" say that they synergistically promote weight loss (which is a non-verified hypothesis that is often supported by a single short-term human trial by Jessen et al. (2003) and entails the risk of developing diabetes; cf. Attvall. 1993).

A note on different deliver routes: Both snus and nicotine gums enable nicotine to diffuse across the mucous membranes and are taken up by the bloodstream. The effects are yet still not necessarily identical to what we see, when it is inhaled and diffuses across the alveolar membrane - particularly if the source of the nicotine is a carcinogen-packed cigarette.

With its CNS stimulating and dopaminergic effects 3-(1-methyl-2-pyrrolidinyl)pyridine aka nicotine does at first appear to be a very likely candidate for every pre-workout supplement. Unfortunately, it does also enhance the effect of serotonin and opiate activity and will thus override its own stimulatory with a calming and depressing effect (Silvette. 1962). Against that background it sounds funny that nicotine will still increase the heart rate and blood pressure (Narkiewicz. 1998), as well as cardiac stroke volume and output and coronary blood flow (Bargeron. 1957).

The question is thus: Which effects prevail? The stimulatory or the the sedating effects? The WADA apparently doesn't believe that nicotine doping is worth it. 3-(1-methyl-2-pyrrolidinyl)pyridine is currently on the watch list, but it's neither banned or officially tested for. That does yet not mean that  it cannot yield small but significant benefits for endurance athletes (17% improvement in time to exhaustion in Mündel et al. 2006) or sports where dexterity / skills play an important role (improvement in the degree in a real-life motor task, Tucha et al. 2004; positive effect on fine-motor abilities, West et al. 1986; cf. Martin. 2009). None of these effects was observed with cigarettes, though, but with a 7mg nicotine patch, a  2mg nicotine chewing gum and 2mg intranasal nicotine, respectively.

Figure 1: Cigarette smoking and risk of diabetes among 41 810 men during six years follow up (Rimm. 1995)

Whether the 17% endurance increase in the Mundal study qualifies as an incentive to "go on the patch" is yet questionable. Nicotine is not just addictive (Stolerman. 1995), going off of it will also trigger declines in motor performance that won't come handy for any athlete (Burtscher. 1994). This as well as the previously cited potential of developing insulin resistance that has been reported for both cigarettes and nicotine gums (Taskinen. 1996; the downside of the Taskinen study is that the increased diabetes risk may be a result of previous cigarette smoking - we can thus not be totally sure that chewing nicotine gums regularly increases your diabetes risk).

Nicotine + caffeine = heart damage, w/ and without ephedra | more

Bottom line: If you take a look at the results of this mini-summary, caffeine addiction isn't just the only scientifically proven "ergogenic addiction", it's also the only one without certain (alcohol and pot) and almost certain (nicotine) negative side effects.

 If I had to pick my poison I would thus always go for caffeine and ignore alcohol, pot and even nicotine; and that in spite of the fact that the latter may exert (mainly neurological) benefits in certain sports.

References:

• Anand, Praveen, et al. "Targeting CB2 receptors and the endocannabinoid system for the treatment of pain." Brain research reviews 60.1 (2009): 255-266.
• Attvall, S., et al. "Smoking induces insulin resistance—a potential link with the insulin resistance syndrome." Journal of internal medicine 233.4 (1993): 327-332. 
• Burtscher, M., et al. "Motor symptoms similar to parkinsonism in heavy smokers." International journal of sports medicine 15.04 (1994): 207-212.
• Margeron, L., et al. "Effect of cigarette smoking on coronary blood flow and myocardial metabolism." Circulation 15.2 (1957): 251-257.
• Bird, K. D., et al. "Intercannabinoid and cannabinoid-ethanol interactions and their effects on human performance." Psychopharmacology 71.2 (1980): 181-188.
•  Chopra, Gurbakhsh Singh. "Man and marijuana." Substance Use & Misuse 4.2 (1969): 215-247.
• Chou, Tony. "Wake up and smell the coffee. Caffeine, coffee, and the medical consequences." Western Journal of Medicine 157.5 (1992): 544.
• Derry, Christopher J., Sheena Derry, and R. Andrew Moore. "Caffeine as an analgesic adjuvant for acute pain in adults." Cochrane Database Syst Rev 3 (2012). 
• Fife W, eds. Tour de France – The History, the Legend, the Riders, Vol. 100. Edinburgh and London: Mainstream Publishing, 2000: 1–255.
• Graham, Terry E. "Caffeine and exercise." Sports medicine 31.11 (2001): 785-807. 
• Gawryszewski V.P., and Monteiro M.G. "Mortality from diseases, conditions, and injuries where alcohol is a necessary cause in the Americas, 2007-2009". Addiction (2014) [ahead of print].
• Jessen, Anna B., Søren Toubro, and Arne Astrup. "Effect of chewing gum containing nicotine and caffeine on energy expenditure and substrate utilization in men." The American journal of clinical nutrition 77.6 (2003): 1442-1447.
• Hill, Matthew N., et al. "Endogenous cannabinoid signaling is required for voluntary exercise‐induced enhancement of progenitor cell proliferation in the hippocampus." Hippocampus 20.4 (2010): 513-523.
• Lucia, Alejandro, Conrad Earnest, and Carlos Arribas. "The Tour de France: a physiological review." Scandinavian journal of medicine & science in sports 13.5 (2003): 275-283.
• Martin, Laura F., Deana B. Davalos, and Michael A. Kisley. "Nicotine enhances automatic temporal processing as measured by the mismatch negativity waveform." Nicotine & Tobacco Research 11.6 (2009): 698-706.
• Mündel, Toby, and David A. Jones. "Effect of transdermal nicotine administration on exercise endurance in men." Experimental physiology 91.4 (2006): 705-713.
• Murray, Christopher JL, and Alan D. Lopez. "Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study." The Lancet 349.9063 (1997): 1436-1442.
• Narkiewicz, Krzysztof, et al. "Cigarette smoking increases sympathetic outflow in humans." Circulation 98.6 (1998): 528-534.
• Pesta, Dominik H., et al. "The effects of caffeine, nicotine, ethanol, and tetrahydrocannabinol on exercise performance." Nutrition & metabolism 10.1 (2013): 71.
• Pedersen, David J., et al. "High rates of muscle glycogen resynthesis after exhaustive exercise when carbohydrate is coingested with caffeine." Journal of Applied Physiology 105.1 (2008): 7-13. 
• Renaud, A.M., and Cormier, Y. "Acute effects of marihuana smoking on maximal exercise performance." Medicine and science in sports and exercise 18.6 (1986): 685-689. 
• Rimm, Eric B., et al. "Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men." Bmj 310.6979 (1995): 555-559.
• Rush, James WE, and Lawrence L. Spriet. "Skeletal muscle glycogen phosphorylase akinetics: effects of adenine nucleotides and caffeine." Journal of Applied Physiology 91.5 (2001): 2071-2078. 
• Silvette, H., et al. "The actions of nicotine on central nervous system functions." Pharmacological reviews 14.1 (1962): 137-173.
• Spriet, L. L., et al. "Caffeine ingestion and muscle metabolism during prolonged exercise in humans." American Journal of Physiology-Endocrinology And Metabolism 262.6 (1992): E891-E898.
• Steadward, R. D-, and Singh M. The effects of smoking marihuana on physical performance. Diss. University of Alberta, 1971. 
• Stolerman, Ian P., and M. J. Jarvis. "The scientific case that nicotine is addictive." Psychopharmacology 117.1 (1995): 2-10.
• Taskinen, Marja-Riitta, and Ulf Smith. "Long-term use of nicotine gum is associated with hyperinsulinemia and insulin resistance." Circulation 94.5 (1996): 878-881.
• Tarnopolsky, Mark, and Cynthia Cupido. "Caffeine potentiates low frequency skeletal muscle force in habitual and nonhabitual caffeine consumers." Journal of applied physiology 89.5 (2000): 1719-1724. 
• Tashkin, Donald P., et al. "Effects of smoked marijuana in experimentally induced asthma." Am Rev Respir Dis 112.3 (1975): 377-86.
• Tashkin, D. P., et al. "Cannabis, 1977." Annals of Internal Medicine 89.4 (1978): 539-549. 
• Tucha, Oliver, and Klaus W. Lange. "Effects of nicotine chewing gum on a real-life motor task: a kinematic analysis of handwriting movements in smokers and non-smokers." Psychopharmacology 173.1-2 (2004): 49-56.
• West, R. J., and M. J. Jarvis. "Effects of nicotine on finger tapping rate in non-smokers." Pharmacology Biochemistry and Behavior 25.4 (1986): 727-731.
• Umemura, Takashi, et al. "Effects of acute administration of caffeine on vascular function." The American journal of cardiology 98.11 (2006): 1538-1541.

Cannabis for Diabetes Prevention? A 1 + 5-Point Information Leaflet to Read Before Smoking Your First Medicinal Reefer

Weedy discoveries: Diabetes protection or just another addiction?

"Good news everyone! Smoking weed is going to solve all your problems." I guess, most of you will already know that, after all the results from a recent study that comes out of the leave no question: Cannabis is the answer to why we get fat... or rather, not smoking it is the reason we are becoming fatter and fatter, year after year. How the scientists know? Well, they have the cunning of the average epidemiologist who knows very well how to get publicity. And as you can see, they really know what they are doing - why else would something that's about as diametrically opposed to physical culture like smoking weed make the headlines on the SuppVersity?

Let the statistical shenanigan begin!

When you are pro Marijuana you got the support of the majority of the US citizens. Not only has smoking weed been legalized (for medical purposes, of course ;-) in 19 states and the District of Columbia following California's lean in 1996, according to a 2010 ABC poll, "81% of Americans favored medical marijuana use and its decriminalization for this purpose." In fact, "[...t]hese citizens argue that marijuana should be  regulated, sold, and taxed in a manner similar to tobacco and alcohol products." Studies saying that "cannabis is good for you" and the subtle message of "we should all smoke some weed from time to time" (Alpert. 2013) do thus fall on fertile grounds - not just in the outskirts of Hollywood.

I guess that was about enough sarcasm for the day, so let's get to the facts, or rather statistics the scientists derived from a re-analysis of the data from theh National Health and Nutrition Survey between 2005 and 2010. Penner et al. studied data from 4657 patients, of whom 579 were current users of cannabis, 1975  used cannabis in the past, but were now - according to what they told the scientists - "clean" and 2013 bores who had never inhaled or ingested marijuana. The researchers measured the patients fasting insulin and glucose levels and tested their subjects insulin resistance and what they found made the headlines:

Figure 1:Adjusted mean/percent differences in measures of glucose metabolism & BMI/WC according to marijuana use among participants from the national health and nutrition examination survey, 2005 to 2010(Penner. 2013)

Fasting insulin levels were reduced in current cannabis users but not in former or never users. Furthermore, the waist circumference of the users was lower, the high density lipoprotein cholesterol (HDL) levels were higher and the insulin sensitivity was slightly improved.

As Joseph S. Alpert, Professor of Medicine University of Arizona College of Medicine in Tucson and the Editor-in-Chief of The American Journal of Medicine, obviously a highly influential man who says about himself that he was "pleased" (his own words) to finally see the little we we know about cannabis from folktales and limited clinical observation, points out in his editorial (still ahead of print), "these are indeed remarkable observations that are supported [...] by basic science experiments that came to similar conclusions" (Alpert. 2013)

But Alpert is already thinking one step further. Well-versed as he obviously must be how the pharma industry functions, he is already foreseeing a great future for THC-based drugs, which

"will be commonly prescribed in the future for patients with diabetes or metabolic syndrome
alongside antidiabetic oral agents or insulin for improved management of this chronic illness" (

Now at first this may sound hilarious, but after reading the rest of the article you may well realize that the synthesize of pure or slightly modified spin-offs of "regular" THC could in fact turn out to be a viable and not that side-effect ridden tool in the battle against the obesity epidemic. 

Even if all that is true, there are still a couple of strings attached...

Now that the good news are delivered let's come to the not so good and actually not so new stuff about smoking weed:

• Marijuana makes you dumb - The evidence for the detrimental effects of chronic cannabis consumption on cognition is overwhelming, particularly in younger weed-headz. Examples?
  

  "Marijuana users demonstrated poorer verbal learning (p<.01), verbal working memory (p<.05), and attention accuracy (p<.01) compared to controls. Improvements in users were seen on word list learning after 2weeks of abstinence and on verbal working memory after 3weeks. While attention processing speed was similar between groups, attention accuracy remained deficient in users throughout the 3-week abstinence period." (Hanson. 2010)

  In adolescents the cognitive impairments appear to be particularly pronounced and last for at least 6 weeks (Schweinsburg. 2008) The longer the chronic exposure to cannabis, the more severe the changes will become (Meier. 2012)

• Cannabis increases the incidence of psychotic episodes - Obviously psychotic episodes are part of the kick, users expect from cannabis consumption. I am yet not sure if the following items with the highest frequencies of occurrence in a 2007 study (frequency in brackets), i.e.
  

  "Items with highest frequencies were unusual thought content (100%), excitement (75%), grandiosity (75%), hallucinatory behavior (70%) and uncooperativeness (65%). The least common symptoms were anxiety (5%), guilt feeling (5%), depressive mood (10%), motor retardation (10%) and blunted affect (30%). Nine subjects (45%) presented with cognitive dysfunction " (Kulhalli. 2007)

  ... is something anyone looking to improve his / her glucose metabolism would be happy about - what about you? And what about the voices you are hearing already (cf. Ruiz-Veguilla. 2013)

• 

  If you are deciding to smoke weed, you better make sure avoid at least all the other anti-androgens on the SuppVersity exclusive "Natural Hormone Optimization Cheat Sheet" Otherwise you may well be in trouble soon. What are you waiting for - go learn them by heart your fertility and sexual satisfaction will depend on it!

  Smoking weed will mess with your endocrine health - THC dose-dependently reduces testosterone levels (-57% in heavy users; Kolodney. 1974)
  

  "Data from human and nonhuman species converge on the ephemeral nature of THC-induced testosterone decline."  (Gorzolka. 2010)

  From rodent studies we also know that the consumption of low levels of marijuana lead to shrinkage of tubular diameter and detrimental changes in seminiferous epithelium of testis with resulting lowered serum testosterone and pituitary gonadotropins (follicular stimulating [FSH] and luteinizing hormones [LH]) levels (Mandal. 2010). It also reduces sperm count and induces infertility (Banerjee. 2011)

• Cannabis causes endothelial dysfunction and a lame dick- And as if that was not already enough it can also lead to anorgasmia, which is - as you have probably already guessed - the inability to achieve an orgasm irrespective of your erectile function, by the way  (Saso. 2002; Aversa. 2008; Shamloul. 2011)

• 

  Learn more about other factors involved in the development of gynecomastia and how to battle it.

  Marijuana will give you breast cancer, gyno and germ cell / testicular tumors  -The growth promoting effects of cannabis are mediated by THC directly at a cellular level via COX-2 (Dardick. 1993; Takeda. 2009).
  
  In men cannabis use is associated with the development of gynecomastia (Harmon. 1972). The mechanisms are not fully elucidated, but they possibly involve elevated prolactin levels (Olusi. 1980) and in the end you are probably better off with gyno than with a malignant germ cell tumor, which is something frequent marijuana users are 2x more prone to develop than their non-smoking peers (Trabert. 2010; Lacson. 2012) .

I guess, I could find a couple of dozen additional references and continue this list of potential unwanted side effects, but I am not going to waste any further time I could invest on relevant SuppVersity news...

---

The 70s, that was a time! A time, when the average American still had a 20% lower BMI, being normal weight was still the norm and models like those in the photo above did not have to be anorexic all because of the weed?

Bottom line: While you may escape becoming a dumb, impotent home to various forms of cancer as a consequence of developing diabetes, you better be careful with your cannabis use or you just take another route towards the same detrimental outcomes - a route from which you cannot escape by healthy dieting and working out. If that's a risk you are willing to take - go ahead, but don't forget that the "cannabis vs. diabetes" study does not provide any evidence for a causal relationship between the reduced incidence of insulin resistance and obesity and smoking weed. It's the same statistical shenanigan that will tell you that eggs cause heart disease (learn that they don't) and that eating fat will make you fat.

In the end, cannabis is a drug - a drug with effects and side effects... or, as we should finally admit for "regular" drugs as well dietary supplements with effects we classify as desirable (classic effects) and undesirable (side effects). Against that background you may consider today's SuppVersity article as the patient information leaflet that goes with the "diabetes drug cannabis". Now you decide if you feel that the potential advantages outweigh the way better researched potential side effects.

References:

• Aversa A, Rossi F, Francomano D, Bruzziches R, Bertone C, Santiemma V, Spera G. Early endothelial dysfunction as a marker of vasculogenic erectile dysfunction in young habitual cannabis users. Int J Impot Res. 2008 Nov-Dec;20(6):566-73. 
• Banerjee A, Singh A, Srivastava P, Turner H, Krishna A. Effects of chronic bhang (cannabis) administration on the reproductive system of male mice. Birth Defects Res B Dev Reprod Toxicol. 2011 Jun;92(3):195-205. 
• Dardick KR. Holiday gynecomastia related to marijuana? Ann Intern Med. 1993 Aug 1;119(3):253.
• Gorzalka BB, Hill MN, Chang SC. Male-female differences in the effects of cannabinoids on sexual behavior and gonadal hormone function. Horm Behav. 2010 Jun;58(1):91-9.
• Hanson KL, Winward JL, Schweinsburg AD, Medina KL, Brown SA, Tapert SF. Longitudinal study of cognition among adolescent marijuana users over three weeks of abstinence. Addict Behav. 2010 Nov;35(11):970-6. 
• Harmon J, Aliapoulios MA. Gynecomastia in marihuana users. N Engl J Med. 1972 Nov 2;287(18):936. 
• Kolodny RC, Masters WH, Kolodner RM, Toro G. Depression of plasma testosterone levels after chronic intensive marihuana use. N Engl J Med. 1974 Apr 18;290(16):872-4.  
• Kulhalli V, Isaac M, Murthy P. Cannabis-related psychosis: Presentation and effect of abstinence. Indian J Psychiatry. 2007 Oct;49(4):256-61. 
• Lacson JC, Carroll JD, Tuazon E, Castelao EJ, Bernstein L, Cortessis VK. Population-based case-control study of recreational drug use and testis cancer risk confirms an association between marijuana use and nonseminoma risk. Cancer. 2012 Nov 1;118(21):5374-83.
• Mandal TK, Das NS. Testicular toxicity in cannabis extract treated mice: association with oxidative stress and role of antioxidant enzyme systems. Toxicol Ind Health. 2010 Feb;26(1):11-23.
• Meier MH, Caspi A, Ambler A, Harrington H, Houts R, Keefe RS, McDonald K, Ward A, Poulton R, Moffitt TE. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl Acad Sci U S A. 2012 Oct 2;109(40):E2657-64.
• Olusi SO. Hyperprolactinaemia in patients with suspected cannabis-induced gynaecomastia. Lancet. 1980 Feb 2;1(8162):255.
• Penner EA, Buettner H, Middleman MA. The impact of marijuana use on glucose, insulin, and insulin resistance among US adults.Am J Med. 2013;126:XX-XX
• Ruiz-Veguilla M, Barrigón ML, Hernández L, Rubio JL, Gurpegui M, Sarramea F, Cervilla J, Gutiérrez B, James A, Ferrin M. Dose-response effect between cannabis use and psychosis liability in a non-clinical population: Evidence from a snowball sample. J Psychiatr Res. 2013 May 16. 
• Saso L. Effects of drug abuse on sexual response. Ann Ist Super Sanita. 2002;38(3):289–96 .
• Schweinsburg AD, Brown SA, Tapert SF. The influence of marijuana use on neurocognitive functioning in adolescents. Curr Drug Abuse Rev. 2008 Jan;1(1):99-111.
• Shamloul R, Bella AJ. Impact of cannabis use on male sexual health. J Sex Med. 2011;8(4):971–5.
• Takeda S, Yamamoto I, Watanabe K. Modulation of Delta9-tetrahydrocannabinol-induced MCF-7 breast cancer cell growth by cyclooxygenase and aromatase. Toxicology. 2009 May 2;259(1-2):25-32.
• Trabert B, Sigurdson AJ, Sweeney AM, Strom SS, McGlynn KA. Marijuana use and testicular germ cell tumors. Cancer. 2011 Feb 15;117(4):848-53. doi: 10.1002/cncr.25499. Epub 2010 Oct 5.