Can CBD cause liver damage? This question was brought to us by a customer who had read a recent statement by the FDA that made her question whether or not she should continue to use CBD for pain management. On November 25th, 2019, the FDA did release a statement that said, in part, that CBD products “can cause liver injury”, and “may interact with certain drugs”, so we wanted to explain why we believe that this vague and overgeneralized statement should be retracted, or at the very least, clarified to reflect the reality of CBD products and the industry in general.
In order to understand the nature and potential effects of this statement, consider the circumstances behind another FDA statement on the liver safety of a fantastic natural anti-anxiety supplement: Kava Kava. In 2002, the FDA released a blanket statement that claimed this supplement, used traditionally for hundreds of years (sound familiar?), had the potential to cause liver injury. This announcement sparked an international uproar, with several countries actually banning products containing kava from the marketplace, nearly destroying the market for this plant based, natural anti-anxiety supplement. Almost immediately, several individuals who were familiar with the plant’s traditional uses asked the same question: “Were the kava products that caused liver injury made from just the roots of the kava plant, or the entire thing, leaves and all?” It turns out that some shady manufacturers, eager to jump on the kava “trend”, had been using the leaves and stems of the plant as well, which contained a hepatoxic compound not present in the roots. Because of this oversight, a useful plant that could have helped millions of people combat their anxiety and depression was now something that people were afraid to use. If we don’t combat the misinformation contained in the FDA’s CBD statement, we risk the same thing happening to the CBD industry that happened to the kava industry.
As was the case with the kava statement, the problem with the liver damage claim in regards to CBD products stems from a lack of attention to detail, as well as an overgeneralized statement that fails to take into account a wide variety of factors. Most importantly, human and animal studies have actually show that CBD can potentially cause liver damage… when taken in in extremely large pharmaceutical doses that are far greater than those contained in CBD supplements. For example, studies that reported liver damage were based on the maximum recommended dosage of a drug called Epidolex, a CBD-based prescription drug used to treat seizures. The maximum recommended dosage is 20 milligrams PER KILOGRAM OF BODY WEIGHT. For a 175 lb. individual, this equates to 1600 mg of CBD. Just for reference, the average supplemental dose of CBD is usually between 5-50 milligrams TOTAL. So just for reference, to reach the levels of CBD that potentially caused liver damage in some patients, you would need to consume:
107 of our 15 mg Creating Better Days cannabidiol (CBD) edible gummies
64 of our 25 mg Creating Better Days cannabidiol (CBD) capsules
160 POTS of our of Nano CBD Coffee
And keep in mind that the 1600 mg CBD doses of Epidolex are routinely prescribed and taken by many patients, albeit under the care of their physician, who monitors liver enzymes for signs of liver trouble. If you are eating 107 of our 15 mg Creating Better Days cannabidiol (CBD) edible gummies every day, then please do get your liver enzymes tested and be on the lookout for signs of liver damage, but if you are using CBD products in reasonable amounts, you don’t have anything to worry about.
For the record, CBD can affect certain medications that are also affected by grapefruit juice, because they are metabolized through the cytochrome P450 liver enzyme pathway. We absolutely know that to be true, and do everything that we can to make sure that everyone who buys our products knows it too. The problem is that the FDA statement didn’t mention grapefruit juice/cytochrome P450 interaction at all. It only gave a blanket statement that it can affect some medications. This alone could be enough to scare away someone who doesn’t want to “take a chance” on having a medication interaction. We think that the statement should, at the very least, be modified to include a list of medications that can interact with CBD, information which is readily available numerous places online, such as: https://www.projectcbd.org/medicine/cbd-drug-interactions/p450
Is CBD safe for the liver? For the vast majority of users, the answer is a resounding YES! If you aren’t taking medications that interact with grapefruit juice, then you can absolutely use CBD products in a responsible manner that doesn’t involve drinking several bottles of CBD tincture on a daily basis.