Posted on

does cbd oil affect the liver

6 Ways CBD Oil Can Help in Liver Diseases [Science Backed]

CBD oil or cannabidiol oil is the term given to the yellowish fluid derived from the industrial hemp or marijuana plant (Cannabis sativa).

This compound has been shown to exhibit several beneficial and therapeutic properties in diseases such as migraines, anxiety, schizophrenia, PTSD, back pain, fibromyalgia, rheumatoid arthritis, cancer, epilepsy, etc.

CBD oil is free of terahydrocannabinol (THC), which is the psychoactive component of the marijuana plant.

Due to the absence of THC in CBD oil, it does not result in intoxication or euphoria that is generally associated with marijuana. This makes it suitable for all people of all age groups.

The biological properties of CBD are stimulated because of its indirect interaction with the endocannabinoid system including the CB-1 receptor, CB-2 receptor and endogenous cannabinoids such as anandamide, etc.

Table of Contents

Liver and its Common Diseases

The liver is an important organ and involved in many functions including detoxification, metabolism of medications and drug, digestive aid, bile secretion, activation of enzymes, storage of nutrients, synthesis of important serum proteins, etc.

The diseases that affect the liver are termed as hepatic diseases. The liver can be affected by various endogenous and environmental agents. Common infectious diseases include viral hepatitis, jaundice, etc.

The liver can also suffer from cancer, hepatic encephalopathy, cysts, cirrhosis, autoimmune hepatitis, storage diseases, deficiency diseases, etc.

It is important to maintain good liver health and prevent the hepatic diseases, as the liver is an essential organ required for survival and optimal functioning of the body.

Benefits of CBD Oil in Liver Diseases

Endocannabinoid system and its receptors have been shown to be a potential target for treatment of liver diseases. CBD interacts with the endocannabinoid system and therefore it can have therapeutic properties. CBD also exhibits anti-inflammatory, anti-oxidant, anti-ischemic, immune-modulatory properties, which can be helpful in liver diseases.

1. CBD could have therapeutic activity in viral hepatitis

Hepatitis is the disease characterized by inflammation of the liver. Viral hepatitis is one of the most serious infectious diseases of the liver caused by five different types of viruses.

Hepatitis A, B, and C are the reason for many deaths globally. Hepatitis can eventually result in liver cancer and cirrhosis as well.

It has also been reported that global burden of hepatitis is on a rise. Hepatitis C has no vaccine at the moment and thus it lacks any effective preventive methods.

It is also the most common and dangerous kind of hepatitis. It most often results in cirrhosis and liver cancer.

It is important to find novel therapeutics for viral hepatitis and reduce the burden on the global health system.

CBD has been shown to have therapeutic potential in viral hepatitis especially Hepatitis C. In a study published in the journal ‘Pharmacognosy Research’ the effect of CBD on hepatitis B and hepatitis C viruses was evaluated.

The cells carrying the viruses were subjected to CBD treatment and then its activity against the virus was determined. It was observed that CBD (at a single concentration of 10 micromoles) could inhibit the replication of hepatitis C virus by nearly 87%.

CBD showed a dose-dependent inhibition of the virus with little toxicity towards the cells.

CBD did not inhibit the hepatitis B virus but induced death in the infected cells carrying the hepatitis B virus.

The study also reported that CBD is effective in both viral and autoimmune hepatitis because of its effect on the CB-2 receptors.

CBD shows indirect interaction with the CB-2 receptor and induces death in immune cells (splenocytes), which in turn inhibits the growth and proliferation of T cells responsible for an autoimmune attack on the liver cells.

Thus attenuation of immune response helps in alleviating autoimmune hepatitis.

Thus the in-vivo study reported that CBD exhibits anti-viral activity against hepatitis C virus. The researchers also concluded that CBD could be used as combination therapy along with existing therapies for viral hepatitis.

Medication for hepatitis C can have many adverse effects in some people. Use of CBD as an alternative could be helpful in such cases.


Viral hepatitis is a major liver disease with many deaths and complications. CBD was shown to inhibit the growth of hepatitis C virus in a dose-dependent manner.

This indicates its potential use in the treatment of hepatitis C.

2. CBD can protect against hepatic ischemia/reperfusion injury

Ischemia/reperfusion injury is a very common injury that occurs during most liver surgeries and liver transplantations.

It is responsible for deaths in case of transplants and graft rejections. It is characterized by inflammation as large number of neutrophils is directed towards the liver.

Major inflammation is caused by the activation of leukocytes, kupffer cells, etc. present in the liver on arrival of neutrophils and production of pro-inflammatory mediators.

There is also the involvement of oxidative and nitrative stress.

CBD is known to exhibit potent anti-inflammatory and anti-oxidant properties and therefore it could be useful in attenuating the inflammatory response and prevent Ischemia/reperfusion injury.

A study analyzed the effect of CBD in mouse models of Ischemia/reperfusion injury based on inflammatory, oxidative, and cell death markers.

It was observed that CBD could effectively reduce the inflammation, oxidative stress and cell death in the liver. Neutrophil infiltration was also reduced on treatment with CBD.

There was a reduction in the levels of pro-inflammatory mediators such as NF-κB and TNF-α.

Thus the inhibition of inflammation, nitrative stress, oxidative stress and cell death caused by CBD could make it a useful option in preventing Ischemia/reperfusion injury. Visible improvement in liver histology was also observed.

A similar study was conducted in rat models of ischemia/reperfusion liver injury. Induction of ischemia/reperfusion liver injury was associated with increased levels of tumor necrosis factor-α and nitric oxide in the serum along with a reduction in the level of anti-oxidant glutathione.

On administration of CBD to the rats, it was seen that there was significant attenuation of liver damage associated with ischemia/reperfusion liver injury.

There was also a reduction in the levels of pro-inflammatory and oxidative species including cyclooxygenase-2, nuclear factor-κB, etc.

The study concluded that CBD has a potential therapeutic role to play in prevention and treatment of hypoxia-reoxygenation injury (ischemia/reperfusion injury).


Ischemia/reperfusion injury is responsible for many deaths in case of liver transplant rejections.

It is characterized by inflammatory and oxidative damage. CBD has been shown to prevent ischemia/reperfusion injury by attenuating inflammation, oxidative stress, nitrative stress, cell death, etc.

3. CBD can help against hepatic encephalopathy

Hepatic encephalopathy is characterized by a change in consciousness due to damage and failure of the liver.

This is due to the buildup of harmful substances in the blood, which are generally removed by the liver. Some symptoms include movement problems, altered personality, confusion, etc. It can result in a coma in the advanced stages.

Cirrhosis is the most common cause of hepatic encephalopathy and most patients with cirrhosis end up developing it. It can be observed in cases of both acute and chronic liver injuries.

Inflammation (including neuroinflammation) is observed in the pathogenesis of hepatic encephalopathy.

CBD has been shown to exhibit anti-inflammatory properties. It also acts as a neuroprotective agent and reduces neuroinflammation.

It is also an established agonist of 5-HT1A receptors. Thus CBD could be instrumental in the treatment of hepatic encephalopathy.

A study conducted in mice model of hepatic encephalopathy reported positive results. It was observed that administration of CBD could restore the altered cognitive and neurological functions in the mice.

Hepatic encephalopathy is due to the buildup of ammonia as the liver is responsible for its removal. It was observed that CBD administration led to a reduction in the levels of ammonia in the blood as it restored liver function.

The levels of liver enzymes were also normalized.

Another study, which analyzed cognitive and motor impairment, caused in mice due to bile duct ligation (used as a model of chronic liver disorder) reported similar results.

It was seen that CBD administration over a month could reserve the cognitive and motor impairment. This was attributed to the down-regulation of A(2)A adenosine receptor.


Hepatic injury can result in neurological impairment due to an accumulation of toxic substances in the blood.

This is called hepatic encephalopathy. Studies have shown that CBD can effectively reverse the cognitive and motor damage associated with hepatic encephalopathy.

4. CBD could have therapeutic properties in autoimmune hepatitis

Autoimmune hepatitis is an inflammatory disease of the liver. It is characterized by heightened inflammation and increased inflammatory markers in the liver.

It has been reported that activation of TRPV1 vanilloid receptors can activate myeloid-derived suppressor cells (MDSCs). These cells, in turn, inhibit inflammation and autoimmune hepatitis.

A study showed that myeloid-derived suppressor cells (MDSCs) play an important role in attenuating inflammation.

Their activation is a way to protect the liver from hepatitis. CBD is capable of activating these cells by activating the TRPV1 vanilloid receptors.

The myeloid-derived suppressor cells (MDSCs) activated by CBD were shown to effectively inhibit the proliferation of T cells and attenuate inflammation.

Therefore it can be concluded that CBD could have a potential therapeutic role in hepatitis and liver inflammation owing to its interaction with the TRPV1 vanilloid receptors.


CBD has been shown to activate TRPV1 vanilloid receptors and induce the activation of myeloid-derived suppressor cells (MDSCs), which can help alleviate liver inflammation and protect against autoimmune hepatitis.

5. CBD can protect against liver fibrosis and alcohol-induced liver injury

Liver fibrosis is characterized by the accumulation of extracellular matrix protein such a collagen in the liver during chronic liver damage and diseases.

These include excess alcohol use, hepatitis infection, etc. Fibrosis can progress and result in cirrhosis, liver failure, etc.

Major collagen-producing cells such as activated hepatic stellate cells, portal fibroblasts, etc. are responsible for deposition of collagen in the liver.

CBD exhibits anti-oxidant and anti-proliferative properties. It has been shown to prevent the growth of many cancerous cells.

On investigation, it was found that CBD causes death in activated hepatic stellate cells. These cells are responsible for production and secretion of excess collagen, which eventually results in live scarring and fibrosis.

CBD induces death in these cells by activating pathways responsible for cell death (pro-apoptotic). It also enhances ER stress, which in turn causes ER-stress induced apoptosis.

Therefore it can be concluded that CBD could be a therapeutic agent in liver fibrosis by inducing death in cells responsible for deposition of collagen.

Long-term consumption of alcohol can cause a lot of damage to the liver tissue. It can lead to accumulation of fat and eventually induce cirrhosis.

CBD was shown to attenuate alcohol-induced liver injury in mice models that were fed alcohol.

It also reduced the accumulation of fatty acids in the liver and restored other expression-based and metabolic irregularities caused by alcohol intake.


Liver fibrosis is a common occurrence in chronic liver damage. It can result in cirrhosis and liver failure.

CBD has been shown to exhibit anti-fibrosis properties by inducing death in cells that secrete collagen and cause fibrosis. It also reverses changes associated with alcohol-induced injury.

6. Endocannabinoid system is a potential therapeutic target for liver diseases

Endocannabinoid system is involved in many functions in the body. It is distributed throughout the body and brain and has an impact on various organ systems.

The signaling molecules (CB-1 and CB-2 receptors and endogenous cannabinoids) are therapeutic targets for many disorders due to their systemic influence.

It has been reported by studies that the endocannabinoid system undergoes alteration in many liver diseases including non-alcoholic fatty liver disease, an onset of cirrhosis from fibrosis, cirrhotic cardiomyopathy, hyperdynamic circulatory syndrome, etc.

Endocannabinoid system is also involved in chronic liver injuries. It also has an impact on the inflammatory and cell damage caused to the liver during stress situations and diseases.

Endocannabinoid system also involved in the fatty liver diseases (non-alcoholic) and might be a good target for treatment of those ailments.

Therefore molecules that directly or indirectly affect the endocannabinoid system and its receptors could be potential targets for the treatment of various liver diseases.

CBD is known to show indirect interaction with the CB-2 receptors. CB-2 receptors are known to be involved in inflammatory and immune response (especially during ischemic response which occurs during liver surgeries).

This could help in case of immune-related and chronic liver diseases.

The antagonists of CB-1 receptors have been shown to alleviate the fat accumulation in patients with the non-alcoholic fatty liver disease.

These antagonists are also useful in treating liver cirrhosis by slowing down fibrosis and ameliorate the cardiovascular complications associated with it.

CBD is known to inactivate the CB-1 receptors and act as a potent antagonist. CBD also reverses the activating effect of THC on CB-1 receptors.

Therefore CBD could be useful in attenuating the symptoms of fibrosis, cirrhosis, etc. which involve the activation and up-regulation of CB-1 receptors.


Endocannabinoid system is involved in the pathogenesis of many chronic liver disorders. CBD is known to show indirect interaction with the CB-1 receptor, CB-2 receptor, and endogenous cannabinoids.

This could make CBD a potential therapeutic agent in preventing the progression of liver diseases and their treatment.

Dosage and Usage

There is a lot of variation in the dose depending on the person and the disorder along with the strength of the tincture.

tinctures available in the market have a strength varying from 100-600mg.

Based on case studies and personal account of users, it can be concluded that most commonly used dose is 600-1200mg/day.

Doses up to 1500mg/day are well tolerated for short-term consumption and don’t result in side effects.

Users should start with the lowest effective dose and slowly work the dose up over the course of a few weeks.

This can be done by consuming CBD oil and closely monitoring the symptoms for improvement.

Common ways of consumption are sublingual (oil), inhalation (by vaping), topical (creams/patches), oral (candy and other edibles). The usage should depend on the comfort of the user.


CBD users seldom report major side effects.

Regular use over an extended period can cause minor discomfort such as dry mouth, faintness, drowsiness, low BP, change in appetite, etc. More than 1500mg/day of CBD can have other major side effects in the long run.

CBD shows interaction with certain commonly used medications such as beta-blockers, anesthetics, anti-anxiety, anti-epileptics, antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), anti-depressants, etc. due to its impact on the liver enzyme.

Users should always use a high-quality product obtained from good sources. Cheap oils can be adulterated and result in toxicity.

It is necessary to consult the doctor before starting the use of CBD to prevent unwanted side effects due to dose and drug interaction.

Pregnant and breastfeeding women should use CBD only if prescribed by the doctor. Patients with major disorders such as Parkinson’s and Alzheimer’s should also seek help before consuming CBD.


The liver is an essential detoxifying organ with many important functions in the optimum functioning of the body. It plays a role in metabolism and digestion, detoxification, drug metabolism, etc.

There are many ailments that affect the liver as it is constantly exposed to various environmental agents such as pollutants, drugs, alcohol, medications, etc. It is also affected by infectious agents and autoimmune diseases.

CBD has been shown to have therapeutic potential in many major liver diseases including fibrosis, cirrhosis, autoimmune hepatitis, viral hepatitis, ischemia-reperfusion injury, fatty liver diseases, etc.

Pure and high-quality CBD could be beneficial in a myriad of liver disorders and might help replace the long-term use of other medications.

Patients should seek medical consultation before starting the use of CBD to avoid unwanted side effects.

CBD has been shown to have therapeutic potential in many major liver diseases including fibrosis, cirrhosis, autoimmune hepatitis, viral hepatitis, ischemia-reperfusion injury, fatty liver diseases, etc.

MarketWatch Site Logo A link that brings you back to the homepage.

  • Account Settings
  • Log In
  • Sign Up

64 million Americans have tried CBD and now the FDA says it could cause liver damage

Meera Jagannathan

‘Hopefully it stands up — because otherwise, we’re kind of all owed an explanation for why this was pushed on us’

The FDA issued a warning to consumers about potential health effects from CBD, including liver damage.
  • Email icon
  • Facebook icon
  • Twitter icon
  • Linkedin icon
  • Flipboard icon
    Print icon Resize icon

Referenced Symbols

Brandon Warne, a Minnesota Twins beat reporter for the sports news outlet Zone Coverage, started taking cannabidiol (CBD) in August after growing increasingly frustrated with his depression and anxiety medications over the past four years.

“I was just at a point where nothing was working for me,” Warne, 33, of Minnesota’s Twin Cities area, told MarketWatch. “I was just trying to branch out because I was just so upset [and] distraught with my lack of progress towards mental health.”

Under the guidance of his psychiatrist and therapist, Warne started taking CBD and pared down his medication list. He tapered off the antidepressants bupropion GSK, +0.53% and Effexor PFE, -0.21% , but continued to take his anti-anxiety medication, buspirone TEVA, +0.35% , after experiencing “wicked side effects” from trying to go off of it. He now takes CBD in the form of a 0.5-ml dose of Clean Remedies full-spectrum hemp extract oil every morning, and plans to eventually try to taper the buspirone as well.

Warne, who received his diagnoses after his grandfather’s death, wonders whether he was misdiagnosed. But the results he has seen since taking CBD, he said, have been “moderately positive.” “I’ve been feeling great since I got off my meds,” he said.

“ ‘We remain concerned that some people wrongly think that the myriad of CBD products on the market, many of which are illegal, have been evaluated by the FDA and determined to be safe, or that trying CBD ‘can’t hurt.’ ”

— — Amy Abernethy, FDA principal deputy commissioner

Warne isn’t entirely sure whether it’s the CBD oil or being off his meds that’s causing the improvement, but he is willing to continue trying CBD when he’s done with his current bottle. He said he still has “research” to do on the matter — and a new FDA warning backs him up.

The Food and Drug Administration said late Monday that what you don’t know about CBD might hurt you and warned that it could cause serious health problems, including liver damage.

The warning comes as millions of consumers have jumped on board with the non-psychoactive cannabis compound for reasons relating to health, wellness and recreation, and CBD has popped up on restaurant menus, in post-workout salves and in bath bombs.

The FDA sent letters warning 15 companies for illegally selling CBD-containing products. The federal agency also updated its position to clarify that the substance increasingly infused in pills, lotions, food products and wellness beverages “has the potential to harm you, and harm can happen even before you become aware of it.”

“We remain concerned that some people wrongly think that the myriad of CBD products on the market, many of which are illegal, have been evaluated by the FDA and determined to be safe, or that trying CBD ‘can’t hurt,’” Amy Abernethy, the FDA’s principal deputy commissioner, said in a statement.

The only CBD product approved by the FDA is the prescription drug Epidiolex, which treats pediatric epilepsy. It’s illegal to market CBD as a dietary supplement.

The compound can cause liver injury, interact with other drugs, and increase the risk of drowsiness and sedation when used with alcohol, the FDA said. Studies using lab animals have also shown negative impacts on the male reproductive system, though the takeaway for human patients remains unclear, the FDA said.

The agency also provided a list of potential side effects related to CBD, including sleepiness, diarrhea and/or a decrease in appetite, and mood changes such as agitation and irritability.

Many questions, not many answers

Scientists still don’t know what happens if a person consumes CBD daily for sustained time periods; the compound’s effect on children who take CBD, growing fetuses or breastfed newborns; its interactions with herbs and botanicals; and whether it leads to the same male reproductive problems in men as observed in animals, the FDA said.

What’s more, the FDA is concerned about “a lack of appropriate processing controls and practices”: Many products tested by the FDA have contained different CBD levels than what manufacturers claimed, and there have been reports of products containing unsafe levels of pesticides, heavy metals and THC, the agency said.

“I still don’t think it’s so harmful that I shouldn’t use what I have,” Warne said in response to the new FDA warning. “But it certainly makes me question how settled the science is … and maybe it’s not as ironclad as I thought it was before.”

64 million Americans have tried CBD

Research published this year by the consumer-data firm MRI-Simmons estimated that 3.7 million U.S. adults were CBD consumers, with a median age of 45. Even more appear to have dabbled in the substance: Some 64 million Americans — 26% of the country — report having tried CBD in the last two years, according to a nationally representative Consumer Reports survey of more than 4,000 people conducted in January. One in seven of those respondents reported daily use.

And many CBD users use the compound for its health potential, though their outcomes tend to be mixed.

More than a third of respondents to the Consumer Reports survey said they used CBD to reduce stress or anxiety or promote relaxation; 63% of those people said the compound was “extremely or very effective” at doing so, while 16% said it was not at all or only slightly effective. Nearly one in four respondents said they used CBD to help with joint pain, with 38% calling it “extremely or very effective” and 27% saying it was slightly or not at all effective.

The Mayo Clinic says that “although some research appears to indicate that CBD might hold benefit for treating anxiety-related disorders, more study is needed.” And physician Peter Grinspoon, writing on the Harvard Health Blog, noted that an animal study had shown that applying CBD to the skin could help lower arthritis-related pain and inflammation. “More study in humans is needed in this area to substantiate the claims of CBD proponents about pain control,” he added.

Warne is not alone in using CBD to replace or supplement a medication: 30% of respondents to the Consumer Reports survey said they had taken CBD in addition to a prescription or over-the-counter medication, while 22% said they replaced the medication with CBD entirely. A third of those who replaced a medication with CBD said that the drug was a prescription anti-anxiety drug.

Still, Warne called the FDA’s words of caution “prudent” and agreed that more research should be conducted on CBD’s benefits and risks.

“Hopefully it stands up — because otherwise, we’re kind of all owed an explanation for why this was pushed on us for the past year or however long this has been popular,” he said. “Hopefully we get an explanation one way or the other.”

‘Hopefully it stands up — because otherwise, we’re kind of all owed an explanation for why this was pushed on us.’