CBD is all the rage across the U.S. and around the world. It seems like everyone, from pro athletes and Hollywood celebrities to soccer moms and senior citizens, is using some form of the plant extract. Researchers and many physicians tote the oil as a safe way to relieve pain, ease anxiety, and even sleep better. But is it safe? Some studies warn that specific doses of CBD are toxic to the liver.
CBD & How it Interacts with the Body
The hemp plant contains over 500 known chemicals, including more than 100 cannabinoids, such as CBD. These are the only known compounds in nature that work directly with the Endocannabinoid System. Also known as the ECS, it’s a complex cell-signaling system that’s found in all mammals, which is why CBD may work for your anxiety, as well as your dog’s.
Experts have been studying the system since the 1990s. Research suggests that it works to maintain symmetry throughout the body. Studies show it plays a role in all major bodily processes, including memory, mood, stress, sleep, metabolism, appetite, pain, and reproductive and immune function.
The ECS includes endocannabinoids, or endogenous cannabinoids, cannabinoid receptors (CB1 and CB2), and enzymes. Endocannabinoids share many of the same properties of phytocannabinoids, which are better known as cannabinoids.
CBD interacts with the ECS by activating the cannabinoid receptors. Unlike THC, researchers know it doesn’t directly attach to the receptor, which may be why THC causes a psychoactive result, and CBD doesn’t. However, it’s interesting to note that the endocannabinoids bind to the receptors.
So is CBD Oil Bad for the Liver?
CBD metabolizes in the liver by cytochrome P450 isoenzymes. This process breaks down the CBD and other drugs into smaller pieces, so it’s easier for the body to pass them. Several studies show that it decreases liver enzymes temporarily. When you mix CBD and other medications that can reduce liver function, it’s possible to cause damage. These drug-to-drug interactions are why it’s essential to always speak to your doctor before starting to take CBD as a supplement.
The Side Effects of CBD
Some people may say that CBD is 100% harmless. However, it has some mild side effects, such as drowsiness, irritability, and stomach upset. Most agree the benefits of CBD outweigh these minor adverse reactions, including many medical experts.
Many over the counter, everyday medications can damage the liver. NSAIDs are an excellent example. Taking them occasionally for sore muscles, a headache or fever has been found to be safe for most people. Problems can arise when you use these daily.
Besides the harm they can cause the liver, people with high blood pressure must be careful when taking NSAIDs. Other concerns with aspirin and ibuprofen are ulcers, kidney injury, and increased bruising.
Studies Involving CBD & Liver Enzymes
As mentioned, several studies have found elevated liver enzymes. The one that everyone is talking about is an open-access article in the publication, Molecules, “Hepatotoxicity of a Cannabis Extract in the Mouse Model.” The alarming study prompted scary headlines from magazines, such as Forbes, “Marijuana Study Finds CBD Can Cause Liver Damage.”
According to the study,
“In conclusion, the results of these studies demonstrate that, despite the beneficial effects of CBD in the treatment of certain therapy-resistant seizures, it poses a risk for liver injury. Furthermore, the probability of CBD-drug interactions appears quite high. Therefore, additional studies are needed to examine the toxicity of chronic low-dose CBD exposure as well as explore CBD’s potential to interact with other medications.”
There are a few other studies and reports from top institutions about CBD and its effects on the liver.
The Mayo Clinic Proceedings, “Clinicians’ Guide to Cannabidiol and Hemp Oils,” notes the multiple occurrences of elevated liver function test results. The manual also explores Epidiolex treatment and the recommendation for liver function tests before starting the medication and repeating them after a month and three months.
Additionally, the FDA lists this information on their warnings and precautions on the Epidiolex drug datasheet. The FDA also suggests another liver function test at the six-month mark.
Did Scientists Debunk One Study?
Yes, and no. Experts agree that CBD decreases liver enzymes. But they are pointing out the study’s use of extremely high doses of CBD. These levels were toxic for the small mice in the model and were excessive for the average consumer. Yes, patients using Epidiolex can use high doses. But they prescribe these for two very rare forms of epilepsy to stop seizures.
The average consumer is only using a fraction of that amount. CBD doesn’t have one-size-fits-all dosing, but the average consumer isn’t taking more than 50mg daily. At most, pain patients might use upwards to a 100mg.
Analytical Cannabis, a scientific publication for hemp and cannabis, found an error in the Molecule study.
“As the study says, the doses chosen were calculated to reflect the mouse equivalent of the maximum recommended human dose. But here, the dose equivalent to the maximum human dosage was actually the lowest of the CBD dosages in each experiment, at 246 mg/kg and 61.5 mg/kg, respectively. The other dosages were chosen to reflect 3x, and 10x the maximum recommended dose for Epidiolex in humans.”
Patients and consumers wouldn’t be taking doses this high. This is misleading. The study also points out that there was no sign of damage in lower doses, which is extremely important for the consumers that rely on CBD.
As many experts have said about CBD, the mild side effects and interactions are part of the plant extract’s appeal. Many other medications and treatments that patients seek for pain, anxiety, and sleeping have much more severe and even deadly adverse reactions.
CBD & Quality Control
Although scientists have shown why the liver study may be bunk, they can’t account for CBD’s quality control issue. Experts in the group that use Epidiolex as the example for safety are missing what the FDA and other researchers are saying about CBD regulations. Specifically, there really isn’t any oversight. Epidiolex is highly regulated and comes from a single source.
The CBD market, at this point, is loosely regulated. Each state has different rules, some require quality, third-party testing. But there’s no government watchdog checking batches, and no one is tracing products from the field to the shelf like they do with Epidiolex. Many inside the industry have referred to it as the “Wild West” of CBD products.
Despite the negatives, there are plenty of good brands, companies, and distributors out there doing the right thing.
Dr. Yasmin Hurd, the director of the Addiction Institute at the Mount Sinai Behavioral Health System, told ABC News in December 2019,
“The good companies are companies that … have third-party verification of what’s in that product, that they’ve done safety test … to the very bad with companies not caring what they’re really putting in the CBD. In fact, they don’t even have CBD, so I think that, unfortunately, the public have to do their own due diligence because the legislation, the regulations have not been strong enough.”
What Impurities in CBD are Bad for the Liver?
Any impurity in CBD has the potential to be bad for the liver and the body overall. However, some that can occur during the cultivation and extraction method when not completed correctly can be highly toxic. Examples include pesticides, fungicides, chemical fertilizers, heavy metals found in contaminated soil, and solvents left from extraction. Without proper controls and oversight, there’s no way to verify what’s in each product.
How Much CBD is too Much for the Liver?
Some researchers claim that you can’t overdose on CBD. People often joke that if they drank a bottle of oil, they’d sleep for a week. Others suggest that physicians don’t know enough about the hemp flower and its vast assortment of compounds to say definitively that the plant extract is 100% safe without the risk of overdose or adverse reactions.
Who is right? With many of the questions revolving around CBD, that’s the million-dollar question. Everyone’s body responds differently to the hemp extract. As explained, scientists disagree with the Molecules’ study because the dosing is unrealistic. However, it disproves the statement that CBD is 100% harmless. At the same time, too much water, sleep, and food can also cause harm and even death. While more research is necessary, most can agree that many things are safe in moderation, including CBD.