Phytotherapy as an adjunctive tool in the treatment of anorexia nervosa:a review of potential neuroregulatory and appetitogenic plants
DOI:
https://doi.org/10.12923/2353-8627/2025-0014Keywords:
anorexia, cannabinoids, phytotherapy, Angelica archangelica, Artemisia absinthiumAbstract
Introduction: Anorexia nervosa (AN) is a serious eating disorder. Globally, eating disorders affect 25% of the population over the course of a lifetime and occur significantly more often in women than in men. AN is associated with high mortality, complications. The comorbidity of AN and depression highlights the need for a holistic therapeutic approach.
Material and methods: This literature review was conducted on the basis of scientific articles published from 2013 to 2025. As sources were used:PubMed, Scopus, Google Scholar using the following keywords: norexia nervosa, phytotherap, cannabinoids, Angelica archangelica, Artemisia absinthium.
Results: Phytotherapy may support recovery and improve quality of life in patients with AN, which remains a therapeutic challenge despite the growing treatment options. This article explores phytotherapy as an adjunct to conventional therapy, offering clinicians guidance on natural supplements. Cannabinoids can stimulate appetite and mood, Angelica archangelica may help manage anemia and cognitive impairment, while Artemisia absinthium alleviates anorexia-related symptoms caused by zinc deficiency. These approaches highlight phytotherapy’s potential role in enhancing treatment effectiveness and supporting patient outcomes.
Conclusions: Phytotherapy including cannabinoids, A. archangelica, and A. absinthium offers promising support in the treatment of AN. Cannabinoids may improve appetite and mood, A. archangelica supports the treatment of anemia and cognitive impairment, while A. absinthium helps alleviate symptoms of anorexia resulting from zinc deficiency.
References
1. Hebebrand J, Gradl-Dietsch G, Peters T, Correll CU, Haas V. The diagnosis and treatment of anorexia nervosa in childhood and adolescence. Dtsch Arztebl Int. 2024;121(5):164-174.
2. Silén Y, Keski-Rahkonen A. Worldwide prevalence of DSM-5 eating disorders among young people. Curr Opin Psychiatry. 2022;35(6):362-371.
3. Costa J, Krantz MJ, Mehler PS. Medical complications of anorexia nervosa. Cleve Clin J Med. 2020;87(6):361-366.
4. Frederiksen TC, Christiansen MK, Østergaard PC, Thomsen PH, Graff C, Clausen L, et al. QTc interval and risk of cardiac events in adults with anorexia nervosa: a long-term follow-up study. Circ Arrhythm Electrophysiol. 2018;11(8):e005995.
5. Sen T, Samanta SK. Medicinal plants, human health and biodiversity: a broad review. Adv Biochem Eng Biotechnol. 2015;147:59-110.
6. Scherma M, Muntoni AL, Riedel G, Fratta W, Fadda P. Cannabinoids and their therapeutic applications in mental disorders. Dialogues Clin Neurosci. 2020;22(3):271-279.
7. Sarris J, Sinclair J, Karamacoska D, Davidson M, Firth J. Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review. BMC Psychiatry. 2020;20(1):24.
8. Hoch E, Niemann D, von Keller R, Schneider M, Friemel CM, Preuss UW, et al. How effective and safe is medical cannabis as a treatment of mental disorders? A systematic review. Eur Arch Psychiatry Clin Neurosci. 2019;269(1):87-105.
9. Pagano C, Navarra G, Coppola L, Avilia G, Bifulco M, Laezza C. Cannabinoids: therapeutic use in clinical practice. Int J Mol Sci. 2022;23(6):3344.
10. Lu HC, Mackie K. Review of the endocannabinoid system. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021;6(6):607-615.
11. National Academies of Sciences, Engineering, and Medicine. The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. Washington (DC): National Academies Press; 2017.
12. Tsatsou I, Bartzi D. Use of medicinal cannabis in the treatment of symptoms in cancer patients. Novel Approaches in Cancer Study. 2025;8:813-822.
13. Hardy J, et al. Phase IIb randomized, placebo-controlled, dose-escalating, double-blind study of cannabidiol oil for the relief of symptoms in advanced cancer (MedCan1-CBD). J Clin Oncol. 2023;41:1444-1452.
14. Kumar D, Bhat ZA, Kumar V, Shah MY. Coumarins from Angelica archangelica Linn. and their effects on anxiety-like behavior. Prog Neuropsychopharmacol Biol Psychiatry. 2013;40:180-186.
15. Johannes CM, Musser ML. Anorexia and the cancer patient. Vet Clin North Am Small Anim Pract. 2019;49(5):837-854.
16. Raafat BM, Gamal-Eldeen AM, Almehmadi MM, El-Daly SM, Faizo NL, Althobaiti F. Angelica archangelica and Ginkgo biloba extracts recover functional blood hemoglobin derivatives in rabbits exposed to high altitude. Curr Pharm Biotechnol. 2022;23(11):1377-1382.
17. Kaur A, Bhatti R. Understanding the phytochemistry and molecular insights to the pharmacology of Angelica archangelica L. (garden angelica) and its bioactive components. Phytother Res. 2021.
18. Kudoh C, Hori T, Yasaki S, Ubagai R, Tabira T. Effects of ferulic acid and Angelica archangelica extract (Feru-Guard®) on mild cognitive impairment: a multicenter, randomized, double-blind, placebo-controlled prospective trial. J Alzheimers Dis Rep. 2020;4(1):393-398.
19. Kaur A, Garg S, Shiekh BA, Singh N, Singh P, Bhatti R. In silico studies and in vivo MAOA inhibitory activity of coumarins isolated from Angelica archangelica extract: an approach toward antidepressant activity. ACS Omega. 2020;5(25):15069-15076.
20. Redmer B, Schargus P, Karthikeyan S, Nestler B, Müller S. Determination of hemoglobin derivatives in unaltered whole blood samples using support vector regression in the spectral range from 450 to 700 nm. Proc SPIE. 2020;11247:112470A.
21. Paslakis G, de Zwaan M. Clinical management of females seeking fertility treatment and of pregnant females with eating disorders. Eur Eat Disord Rev. 2019;27(3):215-223.
22. Anna J, Elżbieta Ś, Elżbieta M-I, Katarzyna G-J, Katarzyna B-D, Katarzyna Z. ZAG (zinc-alpha 2 glycoprotein) serum levels in girls with anorexia nervosa. J Clin Med. 2023;12:4245.
23. Gautam K, Raina R, Dikshit N. Current knowledge on sustainability and conservation of endangered Himalayan medicinal herb Angelica glauca Edgew.—a review. J Herb Med. 2023;42:100764.
24. Hbika A, Daoudi NE, Bouyanzer A, Bouhrim M, Mohti H, Loukili EH, et al. Artemisia absinthium L. aqueous and ethyl acetate extracts: antioxidant effect and potential activity in vitro and in vivo against pancreatic α-amylase and intestinal α-glucosidase. Pharmaceutics. 2022;14:481.
25. El-bakry KAEM, Bahnasawy MH, Deef LE, Ahmed-Farid OAH, El-Naeli SSB. Tolerability of Artemisia absinthiumin anorexia: targeting of neuronal appetite and satiety in zinc deficiency diet rat model. Sci Afr. 2024;24:e02162. doi:10.1016/j.sciaf.2024. e02162.
26. Ekiert H, Klimek-Szczykutowicz M, Rzepiela A, Klin P, Szopa Artemisia species with high biological values as a potential source of medicinal and cosmetic raw materials. Molecules. 2022;27(19):6427.
27. Baghban Taraghdari S, Nematy M, Mazidi M, Kamgar M, Soukhtanloo M, Hosseini M, et al. The effect of hydro-alcoholic extract of Artemisia absinthium on appetite in male rats. Avicenna J Phytomed. 2015;5(2):78-83.
28. Moacă EA, Pavel IZ, Danciu C, Crăiniceanu Z, Minda D, Ardelean F, et al. Romanian wormwood (Artemisia absinthiumL.): physicochemical and nutraceutical screening. Molecules. 2019;24:3087.
29. Koyuncu I. Evaluation of anticancer, antioxidant activity and phenolic compounds of Artemisia absinthium L. extract. Cell Mol Biol. 2018;64(3):25-34.
30. Mohajeranirad M, Saeidi N, Nejad MK, Akbari A, Mahmoodi SA, Almasi-Hashiani A, et al. Effects of Artemisiasupplementation on anorexia in hemodialysis patients: a randomized, double-blind placebo-controlled trial. J Basic Clin Physiol Pharmacol. 2022;33(2):169-174.
31. Batiha GE, Olatunde A, El-Mleeh A, Hetta HF, Al-Rejaie S, Alghamdi S, et al. Bioactive compounds, pharmacological actions, and pharmacokinetics of wormwood (Artemisia absinthium). Antibiotics (Basel). 2020;9(6):353.
32. Bieńkowski P. Pharmacological properties of serotonin and norepinephrine reuptake inhibitors: the case of duloxetine. Psychiatry. 2017;14(2):75-77. Polish.
33. Attia E, Walsh BT. Eating disorders: a review. JAMA. 2025;333(14):1242-1252.
34. Sandhya LS, et al. Randomized double-blind placebo-controlled study of olanzapine for chemotherapy-related anorexia in patients with locally advanced or metastatic gastr
35. Clemente-Suárez VJ, Ramírez-Goerke MI, Redondo-Flórez L, Beltrán-Velasco AI, Martín-Rodríguez A, Ramos-Campo DJ, et al. The impact of anorexia nervosa and the basis for non-pharmacological interventions. Nutrients. 2023;15:2594.
36. Ng T, Keshock MC. Tetrahydrocannabinol (THC). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
37. Alves P, Amaral C, Teixeira N, Correia-da-Silva G. Cannabis sativa: much more beyond Δ9-tetrahydrocannabinol. Pharmacol Res. 2020;157:104822.
38. Nethengwe M, Maphosa Y, Ahiante BO, Oyenihi AB. Cannabis for medicine and food: a benefit vs risk critical appraisal. S Afr J Bot. 2024;175:15-31.
39. Sabeel Z, Liang Y, Hao M, Ying L, Guo R, Chen R, et al. A comprehensive review of antitumor properties of Angelica species and their antitumor-responsible constituents and the underlying molecular mechanisms involved in tumor inhibition. Phytother Res. 2023.
40. Ma J, Huang J, Li T, Dong L, Fu X. The ethnopharmacology, phytochemistry and pharmacology of Angelica biserrata – a review. J Ethnopharmacol. 2019;231:152-169.
41. Kumar B, Pandey HK. Phytochemical profiling, antioxidant capacity, acute toxicity, and gastroprotective potential of Angelica glauca root: a promising high-altitude medicinal herb. J Ethnopharmacol. 2021;273:113979.
42. Thakur P, Kumari R, Kumar A, Bhatia A, Sharma U, Chaudhary Uncovering the mechanisms of Angelica glaucaEdgew. in breast cancer: a combined in vitro and in silico approach. Chem Biodivers. 2024.
43. Jeng SS, Chen YH. Association of zinc with anemia. Nutrients. 2022;14:4918.
44. Stiles LI, Ferrao K, Mehta KJ. Role of zinc in health and disease. Clin Exp Med. 2024;24:38.
45. Magham K, Han J, Eilbert W, Bunney EB. Severe copper deficiency anemia caused by zinc supplement use. Am J Emerg Med. 2023;72:222.e1-222.e2.
46. Rashidi R, Akaberi M, Gholoobi A, Ghazavi H, Forouzanfar F. Artemisia absinthium extract attenuates the quinolinic acid-induced cell injury in OLN-93 cells. Curr Drug Discov Technol. 2023;20(4):e300323215213. doi:10.2174/15701638206662303 30105331. PMID: 36998142.
47. He M, Yasin K, Yu S, Li J, Xia L. Total flavonoids in Artemisia absinthium L. and evaluation of its anticancer activity. Int J Mol Sci. 2023;24:16348.
48. Talbert EE, Guttridge DC. Emerging signaling mediators in the anorexia-cachexia syndrome of cancer. Trends Cancer. 2022;8(5):397-403.
49. Sirufo MM, Magnanimi LM, Ginaldi L, De Martinis M. Anorexia nervosa and autoimmune comorbidities: a bidirectional route? CNS Neurosci Ther. 2022.
50. Ries A, Schelch K, Falch D, Pany L, Hoda MA, Grusch M. Activin A: an emerging target for improving cancer treatment? Expert Opin Ther Targets. 2020;24(10):985-996.
51. Bozzola E, Barni S, Marchili MR, et al. Anorexia nervosa in children and adolescents: an early detection of risk factors. Ital J Pediatr. 2024;50:221.
52. Alsherbiny MA, Li CG. Medicinal cannabis – potential drug interactions. Medicines (Basel). 2018;6(1):3.
53. Patel R, Wilson R, Jackson R, et al. Association of cannabis use with hospital admission and antipsychotic treatment failure in first episode psychosis: an observational study. BMJ Open. 2016;6(3):e009888. doi:10.1136/bmjopen-2015-009888.
54. Brzozowska NI, de Tonnerre EJ, Li KM, Wang XS, Boucher AA, Callaghan PD, et al. The differential binding of antipsychotic drugs to the ABC transporter P-glycoprotein predicts cannabinoid – antipsychotic drug interactions. Neuropsychopharmacology. 2017;42(11):2222-2231. doi:10.1038/npp.2017.50.
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Copyright (c) 2025 Oliwia Burdan, Natalia Picheta, Julia Piekarz, Filip Gajewski, Grzegorz Kurec, Katarzyna Szklener (Autor)

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