CBD-induced liver damage? All nonsense or a real risk?

CBD (Cannabidiol), a cannabinoid from the hemp plant, is gaining increasing popularity for treating a wide variety of symptoms. Especially for alleviating anxiety and stress, but also for treating pain and inflammation, taking CBD is becoming part of everyday life for more and more people.

However, results from a 2019 study in mice suggested that CBD can be harmful and even toxic to the liver. Many users are therefore skeptical: Is CBD really as safe as it is always claimed to be? Could I potentially do more harm than good by taking it? And is there possibly a form of administration that is less harmful to the liver? This article clarifies all questions concerning CBD & the liver.

The liver is one of our largest organs and, at approx. 1.5 kg, the heaviest internal organ. It performs many vital functions in the body, all of which are in some way related to filtering and detoxifying. It filters toxins from the blood (including alcohol), produces bile for fat digestion, and stores certain nutrients (primarily fats and sugars) for lean times.

Liver damage can make detoxification of the body more difficult, disrupt digestion and metabolism, impair hormone production, and much more. In the worst case, liver damage can lead to death.

A study in mice caused quite a stir in 2019: Researchers investigated the liver toxicity of a CBD-rich cannabis extract in mice and found that liver damage occurred in male mice, especially at high doses. (1)

Already after a single administration of 2460 mg/kg and repeated administration of 615 mg/kg, significant increases in certain liver enzymes, bilirubin ("gall dark," an indicator of liver damage), and liver-specific gene changes were observed. The results indicate possible liver-damaging effects and potential interactions with medications, as CBD apparently interacts with certain detoxification enzymes.

Of course, it didn't stop with this one study. After all, the benefits and effectiveness of CBD are obvious. Researchers asked themselves and investigated what needs to be considered when using CBD products and how to ensure their safe application.

A 2024 review study summarizes the research since 2019 well. (2) It states the following:

CBD is predominantly metabolized in the liver by the cytochrome P450 enzyme system. At high doses (> 300 mg/day) or in combination with other medications, this can increase the production of certain liver enzymes (ALT/AST). Data from animal and clinical studies show dose- and interaction-dependent hepatotoxic effects of CBD, while low doses (< 300 mg/day) without concomitant medication are generally considered safe.

Essentially, CBD is not harmful to the liver, but liver function should be monitored when taking high doses of CBD. Caution is also advised for possible interactions with certain medications metabolized by the cytochrome P450 enzyme system. These include certain blood thinners, painkillers, antidepressants, and antacids – their effects can be reduced or amplified. Therefore, it is essential to discuss with your doctor if you are taking such medications and want to start with CBD.

But: If you use CBD products for everyday use (20-50 mg active ingredient per day) and do not take any other medications, the risks of liver damage are minimal. To reach the dosage from the mouse study, you would have to consume more than 1,300 mg of CBD per day for a body weight of 70 kg – and that is more than unlikely.

As is sometimes the case in science, there are also studies that point in a completely different direction. In these, CBD is not a (potential) danger to the liver, but its savior!

For example, a 2021 study demonstrated that CBD significantly reduced liver damage caused by alcohol and high-fat, high-cholesterol (HFHC) diets in mice. (3)

CBD reduced liver inflammation markers, liver fibrosis (tissue changes), fat accumulation, and cell changes. According to the researchers, the therapeutic effect is primarily based on the inhibition of the NLRP3 inflammasome pyroptosis pathway, a central mechanism in inflammatory processes. Additionally, oxidative stress and pro-inflammatory cytokines were reduced. CBD stabilized liver structure and improved certain liver function markers.

In short: CBD could be a real game changer for alcohol-related fatty liver, especially when unhealthy eating is also involved. CBD is also considered a great hope in medicine for other liver diseases. However, further, especially clinical studies in humans, as well as user experiences, are urgently needed to weigh the safety and possible effects of CBD against each other.

Full-spectrum CBD oils from Hanfgeflüster

Various other studies have also shown that cannabidiol can help with various liver diseases. CBD reduces inflammation and oxidative stress in both the brain and the liver and can thereby positively influence the course of the disease. This offers hope for acutely ill liver patients, but requires further research.

If you want to play it safe and avoid CBD side effects on your liver, you should pay attention to a few points.

First, the dose should be kept as low as possible. Studies show that low to moderate amounts (under 200–300 mg per day) are generally well tolerated, while high doses (over 600 mg daily) can be associated with an increased risk of liver damage and elevated liver values – especially with long-term use. Start with a low dose (5-10 mg per day) – e.g. our 5% CBD oil – and only increase it until the desired effect occurs.

It is also advisable to have your liver values (ALT, AST, GGT, bilirubin) checked regularly by your doctor, especially if you take CBD for a long period or in combination with other medications.

Speaking of other medications: Since CBD inhibits certain liver enzymes (e.g. CYP3A4, CYP2C9, CYP2C19), it can affect the action of other drugs. If you are already taking medication, be sure to ask your doctor before taking CBD.

Important: To protect your liver, avoid alcohol and other hepatotoxic substances. This is of course sensible anyway, but all the more so if you use CBD.

People with existing liver diseases such as fatty liver, hepatitis or liver cirrhosis should only use CBD under medical supervision.

Pay close attention to the quality of your CBD products. Many online shops are not reputable and offer you inferior hemp products that may contain pesticides, heavy metals or solvent residues. This, of course, harms your liver (and the rest of your body!).

CBD oil from organic hemp produced in Europe is optimal. Regular laboratory analyses prove that no contaminants are present.

Attention: CBD oils (especially full-spectrum oils) are a natural product. The contained amounts of the various cannabinoids can fluctuate, and THC may also be present (Hanfgeflüster products are guaranteed to contain less than 0.2% THC). If your body reacts particularly strongly to THC or if you want maximum safety when taking it, pure CBD extracts are an option.

CBD is becoming increasingly popular for treating symptoms such as anxiety, stress, or pain. Earlier studies in mice showed possible liver damage at very high doses, which unsettled some (potential) users.

However, current reviews confirm that CBD in usual, low doses (up to 300 mg daily) is not liver-damaging in healthy people. Risks arise primarily with very high doses, prolonged use, or in combination with certain medications, as CBD affects enzymes in the liver. In fact, CBD can even protect the liver, for example from alcohol-related damage. Its anti-inflammatory properties also make it a promising candidate for the treatment of various liver diseases.

For people with existing liver diseases or when taking other medications, medical advice is still very important. For safety, you should only use high-quality, laboratory-tested CBD products and have your liver values checked regularly if used long-term.

Medical disclaimer