Does CBD Cause Liver Damage?
Dec. 17 2019, Published 2:35 p.m. ET
Excuse the cliché, but unless you live under a rock, there is almost no avoiding CBD lately. The stuff is everywhere — from gas stations pedaling vapes to kiosks in the mall pushing CBD-infused lotions, it’s almost impossible to ignore how popular the cannabidiol industry has gotten recently. This is largely in part to last year’s passing of the 2018 Farm Bill, which legalized the production of hemp and therefore, the production of CBD as well.
But despite the seemingly overnight increase in popularity of CBD, much still remains unknown about the phytocannabinoid and most importantly, its long-term effects. In the short-term, CBD has been heralded as a miracle catch-all treatment for most physical (and even sometimes emotional or mental) ailments. But despite the benefits of CBD, a recent study found a correlation between CBD hepatoxicity and liver damage in mice. It begs the question — does CBD cause liver damage and if so, do its benefits outweigh its potential negative side effects?
What Is CBD?
CBD is the moniker for cannabidiol, a phytocannabinoid discovered in 1940. Cannabidiol is derived from the cannabis plant, making up about 40 percent of the cannabis plant’s extract. So, why is a plant so popular?
CBD is one of the many compounds that make up the cannabis plant — aka marijuana — but this compound cannot get you high. Tetrahydrocannabinol — or THC — is the chemical compound in cannabis that causes psychoactive effects. Despite its inability to cause a high, CBD has still been making headlines for its potential healing properties as more and more people turn to it to help treat symptoms of anxiety, pain, movement disorders, and cognitive function. It also comes in many forms — oil, tincture, cream, vape, edible, and pill.
According to Medical News Today, CBD oil is commonly used in treating chronic pain, epilepsy, Huntington’s disease, glaucoma, Parkinson’s disease, and a myriad of sleep disorders. Studies have noted its ability to help mitigate pain associated with cancer, as well as its use as an anti-cancer drug. A review published in Neurotherapeutics found a link between the reduction of anxiety-related behaviors in people with anxiety disorders and CBD. It also found CBD could potentially reduce symptoms for people with related anxiety disorders including general anxiety disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, and social anxiety disorder.
Now, if CBD is derived from the cannabis plant — a substance that is not legalized in all 50 states — then is CBD also illegal? Quite the contrary. CBD-derived products that contain less than 0.3 percent THC are federally legal. Some states, however, may have local-level laws in place that declare marijuana-derived CBD products illegal. If you’re wondering where your state stands on CBD, you can brush up on your state medical marijuana laws (which may also contain restrictions on marijuana-derived CBD products) here.
Are CBD and Hemp the Same Thing?
It’s actually a complicated answer. In short, CBD is derived from hemp, so there are a few key differences. According to CStore Decisions, “Hemp is a strain of the ‘cannabis sativa’ plant species.” Hemp has a lower concentration of THC, which is why it doesn’t provide the psychological high that marijuana does. While it may have lower quantities of THC, hemp actually contains higher concentrations of cannabidiol — also known as CBD.
Hemp is also a multi-faceted substance, as it can be used as a material; clothing, biofuel, rope, insulation, textiles — you name it, and you can make it out of hemp. Hemp even grows quickly and sustainably, making it the ideal option for a plastic alternative. “Plastic” made from hemp is often referred to as “bioplastic.” If you’re wondering why the plastic industry hasn’t been completely taken over by the healthier, more sustainable option of bioplastic, you can thank the plastic lobbyists for that. (At least, this far.) That’s not to say that it won’t eventually. According to Florida Agriculture Commissioner Nikki Fred, whose speech was picked up by Politifact, “What most people don’t understand is that hemp has 25,000 to 35,000 known usages. That means it is going to be something that is going to replace plastics, and Styrofoam, and concrete.”
You may have also heard of hemp seeds, which can be eaten raw, used for baking, added to beverages like smoothies, or made into an oil. They’re totally edible and are more and more being made into an oil to make use of hemp in the beauty industry. (Think CBD face masks, serums, shampoo, conditioner, body lotions, soap, etc.)
Much like hemp, CBD also can’t get you high. CBD is actually derived from hemp and is a chemical compound called “cannabinoids” originally found in the cannabis plant. The key difference in hemp versus CBD is that CBD is made by extracting the oil and diluting it with a carrier oil. Carrier oils could be coconut, hemp seed oil, avocado, almond, etc.
Are CBD Oils FDA-Approved?
Because the 2018 Farm Bill was recently placed, not much regulation is currently in place for the manufacture and sales of CBD or hemp. Both were previously considered “controlled substances” and since the Farm Bill legalized them, subsequent regulation laws have had a hard time keeping up.
As it stands, the Food and Drug Administration has approved a drug called Epidiolex. According to FDA, “The FDA has approved Epidiolex, which contains a purified form of the drug substance CBD, for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome in patients two years of age or older.” It’s worth noting that in order to gain approval from the FDA, the drug would have had to go through controlled clinical trial testing and a review process.
The FDA adds, “There are no other FDA-approved drug products that contain CBD. We are aware that some firms are marketing CBD products to treat diseases or for other therapeutic uses, and we have issued several warning letters to such firms.”
The FDA also states that “under the FD&C Act, any product intended to have a therapeutic or medical use, and any product (other than a food) that is intended to affect the structure or function of the body of humans or animals, is a drug. Drugs must generally either receive premarket approval by FDA… or conform to a ‘monograph’ for a particular drug category.”
Can CBD Cause Liver Damage?
Despite studies showing the advantages of CBD treatment for certain issues, a recent study from the University of Arkansas for Medical Science found “that CBD may be damaging to our livers in the same way that alcohol and other drugs are,” according to Lab Roots.
The study involved the aforementioned Epidiolex — the FDA’s only approved CBD drug. Researchers found mice treated with the epilepsy drug were at an increased risk for liver toxicity, despite using the recommended dosage and adhering to safety recommendations on Epidiolex’s label. According to Lab Roots, “When examining the mice with various doses of CBD in their system, it appeared that mice that had consumed the higher doses of CBD showed signs of liver damage in as short as 24 hours.” Those mice died or “were near death” within days.
It’s also worth noting that the label on Epidiolex explicitly states that liver damage could be a side effect of taking this epilepsy medication. According to an interview with Dr. Igor Koturbash, Ph.D., the Epidiolex label “clearly states a warning for liver injury. It states that you have to monitor the liver enzyme levels of the patients. In clinical trials, 5 percent to 20 percent of the patients developed elevated liver enzymes.”
How Does CBD Affect Your Liver?
According to information amassed from clinical trials (on humans) and also the June 2019 study done by researchers at the University of Arkansas for Medical Science, high doses of CBD can adversely affect the liver. In fact, in clinical trials, anywhere from 5 percent to 20 percent of patients involved in the clinical trial experienced elevated liver enzymes. While it’s stated on the label that patients’ liver enzymes should be monitored while taking Epidiolex, the effects on the mice who received high concentrations of CBD are a cause for concern for many people.
Per the Mayo Clinic, elevated liver enzymes are an indicator of damage to liver cells or alternatively, inflammation. While temporarily elevated levels aren’t life-threatening, levels that do not even out could cause a health issue. This is because inflamed or injured cells leak those liver enzymes into the bloodstream. The most commonly elevated enzymes found in the liver include Alanine transaminase (ALT), Aspartate transaminase (AST), Alkaline phosphatase (ALP), and Gamma-glutamyl transpeptidase (GGT). According to Medical News Today, if the liver is very seriously damaged, it could ultimately result in liver failure in some cases.
CBD has a lot of benefits — but it could also cause some problems, like liver damage.
Can cbd cause liver damage
The high popularity of CBD and other cannabinoids have helped the people to think they are safe and non-intoxicating.
Despite several CBD benefits, consumers should understand the risks and learn how to use CBD-related products properly.
One of the most important issues is CBD influence upon the liver. This again became urgent due to the review published by the US Food and Drug Administration in November 2019 that CBD use carries “real risks” – some of them potentially unknown. The agency revised recommendations for the consumers concerning the safety of CBD products 1 .
Let’s break down what we already know and answer the questions every patient is interested in:
CBD liver in mice
To study CBD hepatotoxicity, researchers conducted two experiments. The first experiment looked at acute toxicity from a single dose. The second one examined lower CBD doses over a more extended period, that means the mice got daily doses for 10 days.
In the single mega dose experiment, the mice became slow, lost their appetite and showed significant increases in liver-to-body weight ratios. This group was found to have higher levels of enzymes ALT and AST which are markers for liver damage.
The mice getting the lower doses daily showed changes in body weight, increase in liver-to-body weight ratio and exhibited smaller increases in the liver enzymes ALT and AST. 2 out of 10 mice taking lower doses didn’t show any signs of toxicity over the course of the experiment.
This experiment helped to reach to the conclusion that some CBD users taking high doses may suffer from liver toxicity 2 .
It is worth noticing that there are not many studies regarding the effect of CBD on the liver. Further, experiments on mice have limited importance for humans as people use CBD in much lower doses. As one can guess, giving mega doses to mice in a lab is not challenging – and extremely high doses can have completely different kind of effects.
Nonetheless, the studies do indicate a need for caution; it is especially true for those living with liver diseases or already taking multiple medications.
How to avoid liver damage for CBD users
To feel safe and obtain the best results on CBD-related products, the users should follow the following recommendations:
- Avoid CBD interactions with prescription medications. The main concern with CBD is its potential interaction with other drugs. CBD and other cannabinoids are metabolised by an enzyme called CYP3A4. There are prescription drugs that hinder CYP3A4 which can slow the breakdown of CBD and increase its rate of physiological activity. If you take CBD while on medication, choose a high-quality CBD product, determine safe dosage and schedule.
- Do not overdose. Much does not mean better. For most health conditions, small doses may help equally better and increasing the dose may not provide any additional benefit.
- Think of topical CBD products. Keep in mind that topical CBD-related products like lotions, creams, and salves may also be an option. Topicals do not enter the bloodstream in large amounts, and so do not harm the liver.
- Quality matters. Verification of the product quality is very important. If you choose CBD from a well-established company, you are less likely to have health problems or face side effects as high-quality products contain natural substances without unwanted chemicals.
To conclude, one study does show that CBD may cause liver damage. However, these findings have limitations and no other researches make similar suggestions. However, you must be careful about which product you choose and what dose you take.
Can cbd cause liver damage The high popularity of CBD and other cannabinoids have helped the people to think they are safe and non-intoxicating. Despite several CBD benefits, consumers should