Marijuana Study Finds CBD Can Cause Liver Damage
Hemp oil, Hand holding bottle of Cannabis oil against Marijuana plant, CBD oil pipette. . [+] alternative remedy or medication,medicine concept
There is no denying that cannabidiol, more commonly referred to as CBD, is rapidly becoming more popular in the United States than sliced bread. It is a hot trend that got started several years ago after Dr. Sanja Gupta showed the nation in his documentary ‘Weed 2’ just how this non-intoxicating component of the cannabis plant was preventing epileptic children from having seizures.
Since then, CBD, a substance often touted as being safer than popping pills, has become highly revered as an alternative treatment for a variety of common ailments from anxiety to chronic pain. But a new study suggests that CBD may spawn its fair share of health issues. Specifically, scientists have learned that this substance could be damaging our livers in the same way as alcohol and other drugs.
Researchers at the University of Arkansas for Medical Sciences recently rolled up their sleeves to investigate CBD hepatotoxicity in mice. What they found was while this cannabis derivative is gaining significant recognition as of late in the world of wellness, people that use CBD are at an elevated risk for liver toxicity.
The findings, which were published earlier this year in the journal Molecules, suggest that while people may be using CBD as a safer alternative to conventional pain relievers, like acetaminophen, the compound may actually be just as harmful to their livers.
It is the methods used in this study that makes it most interesting.
First, researchers utilized all of the dosage and safety recommendations from a CBD-based drug known as Epidiolex. If this name sounds familiar, it should. Last year, the U.S. Food and Drug Administration approved it as a treatment for certain kinds of childhood epilepsy. It was a development that marked the first time in history that a cannabis-based medicine was approved for nationwide distribution in the United States.
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Researchers then spent some time examining mice under the influence of various doses of CBD. Some of the animals received lower doses, while others were given more. The dosage is said to have been “the allometrically scaled mouse equivalent doses (MED) of the maximum recommended human maintenance dose of CBD in EPIDIOLEX (20 mg/kg).”
Shockingly, researchers discovered that the mice given higher doses of CBD showed signs of liver damage within 24 hours. To that end, 75 percent of these animals in the sub-acute phase had either died or were on the verge of death within a few days.
Regardless of your feelings on this particular study, it is hard to argue with dead mice – even if you are an all-knowing marijuana expert.
The photo of liver is on the man’s body against gray background, Liver disease or Hepatitis, Concept . [+] with body problem and male anatomy
Liver toxicity is an adverse reaction to various substances. Alcohol, drugs and even some natural supplements can all take their toll on liver function – even in healthy individuals. But this is the first study of its kind indicating that CBD might be just as detrimental to the human liver as other chemicals.
But come to find out, there has been evidence of CBD’s havoc wreaking ways on the liver for some time.
Lead study author Igor Koturbash, PhD, recently told the health site Nutra Ingredients USA that the risk of liver damage from CBD is a nasty side effect printed in black and white on GW Pharma’s Epidiolex packaging.
“If you look at the Epidolex label,” he said, “it clearly states a warning for liver injury. It states you have to monitor the liver enzyme levels of the patients. In clinical trials, 5% to 20% of the patients developed elevated liver enzymes and some patients were withdrawn from the trials,” he added.
In other words, anyone taking CBD regularly and in higher doses might unwittingly find themselves on the road to liver disease.
Previous studies have also suggested that certain components of the cannabis plant may be harmful to the liver. Although one study found that marijuana may actually help prevent liver damage in people with alcoholism, in some cases it worsened the condition.
“Patients with hepatitis C who used cannabis had way more liver scarring than those who didn’t and more progression of their liver disease. Something in the cannabis could actually be increasing fatty liver disease,” Dr. Hardeep Singh, gastroenterologist at St. Joseph Hospital in Orange, California, told Healthline.
But wait, it gets worse.
The latest study also finds that CBD has the potential for herbal and drug interactions. “CBD differentially regulated more than 50 genes, many of which were linked to oxidative stress responses, lipid metabolism pathways and drug metabolizing enzymes,” the study reads.
However, Dr. Koturbash was quick to point out that the CBD products coming to market may not pose this particular risk. What he is sure of, however, is that more research is needed on CBD to evaluate its overall safety.
As it stands, none of the CBD products being sold in grocery stores and malls all over the nation have received FDA approval. And the only CBD-based medicine that has been approved, Epidiolex, is apparently stamped with a big, fat warning of potential liver damage.
Although CBD is often revered as a miracle drug, a new study finds that it could be causing liver damage.
How Cannabis Affects Your Liver
Research on how cannabis affects the human liver is still quite limited, but from the studies that have been done, we know that the relationship between the two can be somewhat complicated and can vary depending on the liver condition involved.
For most healthy individuals, cannabis use shouldn’t cause liver complications and may even potentially play a protective role against developing alcoholic liver disease and nonalcoholic fatty liver disease.
For those with more severe liver conditions, however, or those who are taking other medications, care should be taken to ensure that you are helping and not hurting your liver.
Although medicine still has many questions on medical marijuana and the liver, here is what science can tell us.
How cannabis interacts with the liver
To understand the effects of cannabis on the liver, we have to start with an explanation of how the liver is affected by the endocannabinoid system (ECS). The ECS modulates many of the human body’s most crucial functions — like sleep, energy, memory, hunger, inflammation, and mood, to name just a few — and helps keep them in homeostasis or internal balance.
The endocannabinoid system can be activated by common cannabinoids found in the cannabis plant, like THC and CBD, but our body also naturally produces its own cannabinoids (endocannabinoids) — and they also activate the ECS.
Studies show that activation of certain endocannabinoid receptors may worsen cirrhosis, enhancing factors like fibrogenesis, fibrosis, ascites, and steatosis. Activating a different endocannabinoid receptor, however, seems to have the opposite effect, counteracting fibrosis, steatosis, collagen deposition, and inflammation — promoting a healthy liver.
Endocannabinoids have also been shown to impact cirrhosis of the liver. Some can even act against fibrogenesis, improving liver health. So researchers are looking to further explore endocannabinoids as a potential target for the treatment of liver disease.
The benefits of cannabis for liver health
Existing research on the endocannabinoid system shows that activating its receptors via endocannabinoids may have a big impact on the liver — either helping or harming its progress. So how does cannabis, a plant that activates these same receptors, impact the liver?
First of all, it’s important to note that research on medical marijuana and the liver is still in its early stages, and the effects of cannabis on the liver have mostly been studied in populations with liver disease of different kinds — not healthy livers. That said, one small study did look at the influence of chronic cannabis use on liver function in general.
In this study, researchers found no significant differences in liver function for those with higher levels of THC markers in their blood — but they did find slightly better liver function for those with higher THC-OH levels. This research was limited due to a small sample size but suggests that chronic medical marijuana use doesn’t negatively impact liver health for healthy individuals.
Other research looks at cannabis and liver health relative to specific conditions or symptoms. For example, one condition that the effects of cannabis have been investigated is alcoholic liver disease (ALD). ALD is caused by heavy, long term alcohol use, and cannabis just might serve a protective role for this disease.
One very broad study found that those with the highest levels of medical marijuana use had significantly lower levels of ALD at all stages of the disease. These heavy cannabis users saw a 45% reduction in steatosis, or alcoholic fatty liver disease, a 40% reduction in steatohepatitis, or alcoholic hepatitis, a 55% reduction in alcoholic cirrhosis and fibrosis and an impressive 75% reduction in hepatocellular carcinoma, or liver cancer.
Another study, which tied lower levels of ALD to CBD use, seems to suggest that cannabis use (or even just CBD) may actually be protective against the deadly long term effects of alcohol use.
But it’s not just alcohol-induced liver disease that cannabis may help. marijuana may also protect against non-alcoholic fatty liver disease. One study found that cannabis use was tied to lower levels of this condition, in addition to ALD. So medical marijuana may be protective for our livers in general, not just as a protection against drinking.
Cannabis may also play a protective role in other specific conditions.
One study found that cannabis can protect the livers of patients suffering from psychosis — lowering the risk of steatosis.
Animal models also show evidence that cannabis use can improve symptoms of hepatic encephalopathy, likely via the anti-inflammatory properties of cannabis. Unfortunately, there have been no human studies on this condition to confirm the results.
Risk factors for cannabis and the liver
For other liver related conditions, however, cannabis use may have more complicated interactions. Chronic hepatitis C virus, for example, may be worsened by cannabis use. Animal studies show cannabis can actually worsen liver fibrosis and steatosis in hepatitis C. Human studies show that marijuana use can lead to suppression of anti-viral immunity in hepatitis C patients. In addition, studies on hepatitis C patients found that steatosis risk was predicted by daily cannabis smoking.
On the other hand, other studies have reported positive effects for hepatitis C patients using cannabis. One 2018 study found cannabis using hepatitis C patients had lower levels of cirrhosis and lower total health costs than nonusers. Another study found hepatitis C patients who used cannabis were better at adhering to their antiviral treatment and thus had better virologic outcomes. So for patients with this condition, cannabis could be helpful or harmful.
Beyond studies on hepatitis C, other worries for cannabis and the liver come from a study on CBD and mice. In this study, a high dosage of CBD led to fatalities for some of the mice subjects. Researchers noted elevated liver enzymes and increased liver size in the mice who died and concluded they died from liver issues. Other researchers, however, have pointed out some methodological problematic issues in the study.
For one thing, the dose of CBD administered was extremely high — a dose 100 times higher than the maximum recommended dose for Epidiolex, the only FDA approved CBD-based medicine for humans. But more importantly, the CBD was extracted using hexane — a solvent with known neurotoxic properties. It’s unclear whether the hexane was a factor in the mice’s death.
Beyond this, the sample size was only six mice, which is too small to have much statistical significance. Researchers on the study reported that 75% of the mice died — which would mean 4.5 mice died. Since this is an impossibility, we might wonder what other errors were made in this study. More research is needed to confirm or discredit these findings.
Another important area of risk management related to cannabis and the liver is drug interactions. Cannabis can interact with the drug metabolizing enzymes in the liver, which, if taken with certain medications, can cause them to become more or less potent and efficacious. In addition, certain drugs may make cannabis more or less potent.
While there has been little study on these drug interactions, we can deduce from what we know about pharmacology that certain drugs are more likely to have these interactions. For example, fluoxetine, fluvoxamine, fluconazole, clarithromycin, verapamil, itraconazole, voriconazole, and ketoconazole are all more likely to increase the concentration of THC and CBD in the blood by inhibiting its elimination from the body. In the other direction, the drug rifampin has been reported to reduce THC levels in the blood by 20-40% and CBD levels by 50-60%.
In conclusion, cannabis use is growing in popularity, and that should be no surprise considering its wide range of health benefits. Still, while the research is still limited, there are some interesting studies showing both risks and benefits of cannabis use on the liver. For healthy individuals, cannabis should not have a significant impact on liver function — it may even serve a protective role against developing alcoholic liver disease and nonalcoholic fatty liver disease. Still, for those with hepatitis C, or those using certain medications, cannabis use can cause complications.
If you do have a liver condition, it is advisable to work with a cannabinoid specializing physician to ensure you are taking the best steps for your liver health.
Cannabis use shouldn’t cause liver complications and may even potentially play a protective role against developing alcoholic liver disease. Read more