Cannabis Mouth Spray Did Not Increase Calorie Intake in Older Adults With Poor Appetite | Research

The takeaway

In a triple-blind crossover trial of 17 older patients with poor appetite, an oromucosal spray containing THC and CBD did not increase caloric intake compared to placebo, though it was generally well tolerated.

Geriatricians, clinical nutritionists, older adults considering cannabis for appetite, medical cannabis prescribers.

THC/CBD spray produced only a 10 kcal difference from placebo in older adults with poor appetite

What the researchers found

No statistically significant difference in mean caloric intake was observed between cannabis-based medicine and placebo (10 kcal difference, CI -55 to 75 kcal, favoring CBM). Of 16 possibly-related adverse events, 5 occurred during placebo conditions. All adverse events were mild and transient with no serious related adverse events.

Why it matters

Anorexia of aging is a significant problem with limited effective treatments. While cannabis has long been associated with appetite stimulation ("the munchies"), this RCT found no meaningful effect in older adults with poor appetite at the tested dose and formulation.

The numbers in context

n=17 patients aged 65+; 8.1 mg THC + 7.5 mg CBD per dose, two doses per trial day; mean difference of 10 kcal (CI -55 to 75); 36 unrelated adverse events; 16 possibly-related adverse events (5 during placebo); all adverse events mild and transient.

How the study worked

Investigator-initiated, single-center, triple-blinded, randomized, placebo-controlled, superiority, crossover trial with 17 patients aged 65+ with poor appetite. Two doses of oromucosal spray (8.1 mg THC + 7.5 mg CBD per dose) or placebo on two separate trial days with two-week washout. Caloric intake measured via controlled feeding study with standardized meals.

What this study cannot tell us

Very small sample (n=17). Single-day dosing may not capture effects of repeated use. Buccal spray delivery may not be optimal for appetite stimulation. Fixed dose may have been too low for some patients. Controlled meal setting may not reflect real-world eating behavior.

How to read the evidence

Preliminary: Well-designed triple-blind crossover RCT, but very small sample (n=17) and single-day dosing protocol substantially limit conclusions.

When this study was published

Published in 2025.

The bigger picture

This negative result is important for clinical practice. Despite widespread belief in cannabis as an appetite stimulant, this trial suggests that a single-day buccal spray at this dose does not meaningfully increase food intake in older adults. However, the very small sample size and single-day dosing protocol leave room for different results with different approaches.

Questions still open

Would multiple days of dosing produce different results? Is a higher THC dose needed for appetite effects in older adults? Would a different delivery method (oral capsule, edible) be more effective? Do certain subgroups of older adults respond better than others?

Common questions

Doesn't cannabis increase appetite?

While cannabis is commonly associated with increased appetite, the evidence is more nuanced than popular belief suggests. This trial found no meaningful appetite increase in older adults from a THC/CBD mouth spray, suggesting that dose, formulation, delivery method, and patient population all affect whether appetite stimulation occurs.

Was the cannabis treatment safe for older adults?

In this small trial, the THC/CBD spray was generally well tolerated. All possibly-related adverse events were mild and transient, and no serious related adverse events occurred. However, the small sample size means rare adverse effects may have been missed.

Read the original research

The appetite stimulating effect and safety of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in older patients with poor appetite: A triple-blinded, randomized, placebo-controlled, cross-over trial.

Clinical nutrition (Edinburgh, Scotland), 47, 248-257

View on PubMed ↗Publisher’s paper ↗

Citation

Nielsen, Rikke Lundsgaard; Bornæs, Olivia; Christensen, Louise Westberg Strejby; Juul-Larsen, Helle Gybel; Storgaard, Ida Klitzing; Kallemose, Thomas; Jørgensen, Lillian Mørch; Jawad, Baker Nawfal; Altintas, Izzet; Lund, Trine Meldgaard; Rasmussen, Henrik Højgaard; Munk, Tina; Andersen, Ove; Houlind, Morten Baltzer; Andersen, Aino Leegaard. (2025). The appetite stimulating effect and safety of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in older patients with poor appetite: A triple-blinded, randomized, placebo-controlled, cross-over trial.. Clinical nutrition (Edinburgh, Scotland), 47, 248-257. https://doi.org/10.1016/j.clnu.2025.02.024