The Truth About CBD and Liver Damage

Over the past year, CBD has been touted as something of a miracle elixir. Last summer, the FDA approved Epidiolex, a plant-derived CBD medicine to treat intractable seizures. But that was just the beginning. Since then, the beverage industry has also embraced this super plant — the maker of Budweiser is even developing CBD-infused beer! At your neighborhood cafe, you might find an option to add a shot of CBD to your morning latte. And that’s not even talking about the CBD beauty industry where you can find everything from CBD bath bombs to toothpaste to face masks. Sephora even sells CBD mascara for thicker, longer lashes! 

But as with anything that becomes an outsized trend, a correction usually takes place. As such, the backlash for CBD has begun. 

A recent research study published in the journal Molecules suggests CBD may be as toxic and dangerous to the human liver as alcohol and acetaminophen (Tylenol). The researchers made their own CBD extract and took findings from GW Pharmaceutical’s Epidiolex clinical trials to give equivalent dosages to mice to observe the short-term effects. In this experiment, the mice, who were given very high doses of CBD, exhibited lethargy, loss of appetite, and changes in body weight and abnormal liver enzymes. Keep in mind; these were doses that were 3 to 10 times the recommended amount by the GW Pharmaceutical clinical trials. None of the mice taking lower doses showed any visible signs of toxicity over the course of the experiment. Although reported side effects from CBD is rare, some patients do experience them. The most common side effects of CBD are mild and include decreased appetite, GI upset, diarrhea, and nausea. These adverse effects usually disappear after you stop consuming CBD.

Should Consumers Worry? Is CBD Poison to Our Livers?

It is possible to “overdose” on certain natural supplements. Just because something is a natural, plant-based remedy, it doesn’t mean it’s without adverse effects. Vitamin A and niacin (Vitamin B) is extremely harmful when taken in excessive amounts. It can lead to dizziness, confusion, liver and nerve damage, hair loss, and in severe cases, can lead to coma and death. Overdosing on iron supplements increases your risk of cancer and heart disease. Acetaminophen toxicity is one of the most common causes of acute liver failure in the U.S., right behind alcohol poisoning. Over the counter medicines, vitamins and herbal supplements can be toxic when taken in large dosages.

Similar to Vitamin A and B, CBD medication resulting in liver toxicity is unlikely if you take only the amount prescribed by your doctor. The scientists in this study do not believe that the results of this study imply any immediate danger for people currently taking CBD medication, or using CBD products. They are using the results of this study to encourage further exploration of the safety profile of CBD at various doses and to emphasize that more studies are needed to investigate the long term implications of CBD use.

When patients come to my clinic asking about integrating CBD medication into their health and wellness routine, I evaluate everything from prescription medications, recent blood work, imaging, and take a full history and physical exam. I perform medical cannabis evaluations in the context of a full-scope general and holistic medical practice. There is a reason why we say “start low and go slow.” It is helpful for patients to work with healthcare providers and to keep track of their symptoms in a journal. The goal is to find their optimal therapeutic dosage through a gradual micro-dosed titration. The right dose gives you the effect you want, using the lowest possible amount. Dosage is the key factor in achieving the most benefits and least adverse effects of cannabis.