Liver Diseases

There are various liver diseases (also known as hepatic diseases), including:

• Hepatitis A, B, and C
• Non-alcoholic fatty liver disease
• Alcohol-related liver disease
• Hemochromatosis
• Cirrhosis
• Fascioliasis
• Gilbert’s syndrome
• Primary biliary cirrhosis.

Liver damage leads to cirrhosis (scarring) of the liver.

What are Liver Diseases?

According to the Centers for Disease Control and Prevention (CDC), there are 3.9 million adults in the U.S. with diagnosed chronic liver disease and cirrhosis (2015), which led to 38,170 deaths (2014). The most common form of liver disease is hepatitis A, B, or C, which is usually a result of obesity, viral infection, or drinking too much alcohol. Globally, 325 million people live with a hepatitis infection. Non-alcoholic fatty liver disease, alcohol-related liver disease, hemochromatosis, and primary biliary cirrhosis are other liver diseases.

Common symptoms of liver disease include:

• Jaundice (yellowing of the skin, eyes, and mucous membranes due to a high bilirubin level, a yellow-orange bile pigment).
• Altered consciousness and confusion due to hepatic encephalopathy (brain damage due to hepatic damage).
• Thrombocytopenia (abnormally low levels of blood platelets) and coagulopathy (inability of blood to coagulate, can lead to excessive bleeding.
• Gastrointestinal (GI) bleeding.

Brief Summary of Current Treatments

The best advice for those managing liver disease due to alcohol intake is to stop drinking. Other lifestyle modifications, such as exercise and losing weight are also recommended. Medications like ursodiol (Actigall, Urso) may be prescribed for primary biliary cirrhosis.

For advanced liver disease and damage, a liver transplant may be necessary. Organ transplant patients need to take immunosuppressants like calcineurin inhibitors (CNIs).

How Might Medical Cannabis Help?

The endocannabinoid system (ECS) is highly up-regulated during chronic liver diseases. The ECS also “influences the mechanisms responsible for cell damage and inflammatory response during acute liver injury.” Targeting CB1 and CB2 receptors may prevent fat accumulation, slow fibrosis progression, and help attenuate any significant cardiovascular alterations associated with late-stage liver disease.

Tetrahydrocannabinol (THC), cannabidiol (CBD), and beta-caryophyllene may help prevent and reduce liver damage. Cannabis use was associated with a decreased prevalence of nonalcoholic fatty liver disease (NAFLD).

Cannabinoids

• CBD has anti-inflammatory and antioxidative properties, which could be “useful in reducing the inflammatory response and protecting the liver against oxidative damage.” CBD could be considered hepatoprotective.
• Cannabidiolic acid (CBDA) and tetrahydrocannabinolic (THCA) may also be helpful for their anti-inflammatory properties.
• THC may help beat pain and inflammation.
• Cannabigerol (CBG), cannabinol (CBN), and cannabichromene (CBC) may be helpful for their anti-inflammatory properties.

Cannabinoid Ratios

• THC:CBD 1:20
• THC:CBD 1:18
• THC:CBD 1:3
• THC:CBD 1:1

Terpenes and Terpenoids

• Beta-caryophyllene may help reduce inflammation associated with liver disease, as well as reduce alcohol intake.

One study found that a mixture of the following terpenes has hepatoprotective properties:

• Borneol
• Linalool
• Pinene
• Cineole

Flavonoids

Flavonoids that could help protect against liver disease and damage include:

• Cannflavins A, B, and C
• Quercetin
• Apigenin
• Catechin
• Naringin

Effective Ways of Taking Medical Cannabis for Liver Diseases

Routes of Administration

• Inhalation
• Sublingual
• Ingestion
• Transdermal

Special Formulations

A CBD, CBG, CBN, CBC, beta-caryophyllene, linalool, borneol, and cineole-rich cannabis product may be ideal. Some THC and THCA may increase other cannabinoids’ and terpenes’ anti-inflammatory properties via the entourage effect.

Dosing Methods

• Vaporizer
• Inhaler
• Oil-based tincture
• Edibles
• Drinkables
• Transdermal patches

What are the Pros and Cons of Taking Medical Cannabis for Liver Diseases?

Potential Pros

• CBD may improve brain and liver function.
• CBG has potential anti-inflammatory and hepatoprotective effects.
• Beta-caryophyllene may reduce inflammation, hepatotoxicity, and voluntary alcohol intake.
• Terpenes like borneol, linalool, and cineole may also protect against liver damage.
• Cannabis use is associated with a reduced prevalence of progressive stages of alcoholic liver disease.

Potential Cons

• There is some concern that consuming large doses of CBD regularly may cause liver damage, although meta-analyses suggest otherwise.
• Some animal and lab studies have shown worsening liver fibrosis and steatosis.

Useful Anecdotal Information

Lennon, Annie. “How Does Cannabis Affect the Liver?” LabRoots. Jan. 04, 2021

“Medical Cannabis.” GI Society: Canadian Society of Intestinal Research

Scientific Data Overview and Studies

• Total Studies = 76 (including alcoholic liver disease, fatty liver disease, liver disease, fibrosis and cirrhosis of the liver, liver failure, and toxic liver disease)
• Positive Studies = 61
• Inconclusive Studies = 5
• Negative Studies = 10
• 28 Meta-Analyses (19 positive, 3 inconclusive, 6 negative); 29 Animal Studies (26 positive, 1 inconclusive, 2 negative); 1 Human Trial (positive); 18 Lab Studies (15 positive, 1 inconclusive, 2 negative)
• 10 studies include CBD (8 positive, 1 inconclusive, 1 negative); 11 studies include THC (9 positive, 2 inconclusive); 1 study includes CBC (positive); 1 study includes CBN (positive); 1 study includes THCA (positive); 1 study include a CBD:THC ratio of 1:1 (positive)
• Possible Overall Efficacy: Moderate

Quotes from Studies

“The expressions of the cannabinoid receptors, CB1 and CB2, which make up the endocannabinoid system, are up-regulated in the course of progressive liver disease (11), particularly in myofibroblasts and vascular endothelial cells, allowing more significant interaction between cannabis and the abnormal liver in comparison to the healthier liver (12).”

Source: Zhu, Julie. “Cannabis and the liver: Things you wanted to know but were afraid to ask.” Canadian Liver Journal. Feb. 22, 2019.  https://doi.org/10.3138/canlivj.2018-0023.

“Cannabinoid receptors 1 (CB1) and cannabinoid receptor 2 (CB2) are two G-protein receptors identified within the endocannabinoid system that may play a role in liver disease [17]. CB1 and CB2 are activated by highly lipophilic ligands called endocannabinoids [17]. CB1 is predominantly found in the brain and is accountable for the psychotropic and behavioral effects manifested by cannabinoid use [17]. CB2 is expressed in the peripheral tissues functioning in the modulation of innate immunity and bone mass with some antitumor properties [17]. Within the liver, CB1 has been detected in endothelial cells and hepatocytes whereas CB2 has been detected in Kupffer cells and is prominently expressed in the cirrhotic liver [17,18].”

Source: Dibba P, Li AA, Cholankeril G, et al. “The Role of Cannabinoids in the Setting of Cirrhosis.” Medicines (Basel). 2018;5(2):52. Published 2018 Jun 9. doi:10.3390/medicines5020052

Conclusion

There is moderate evidence that medical cannabis can help reduce inflammation and damage associated with liver diseases. However, some studies have noted adverse effects, so more clinical trials need to take place to determine medical cannabis’ efficacy for different kinds of liver damage.

Related Articles

Hepatitis and Medical Cannabis

Alcoholism/Alcoholic Liver Disease and Medical Cannabis

Fatty Liver Disease and Medical Cannabis

Fibrosis and Cirrhosis of the Liver and Medical Cannabis

Please note: the information in this article does not constitute medical advice

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