Some people believe CBD oil is safe and well-tolerated. Read about the side effects you can expect and what to be aware of. <span><b>Introduction:</b> Previous studies have suggested that prescribed cannabidiol (CBD) products may cause elevations in liver tests (LT). This study compared the prevalence of elevated LT in an adult population self-administering CBD with the normal and general adult population prevalences. <b>Mater</b></span> … One study on mice has led to some scrutiny over whether CBD oil could be harmful. So, should you be worried? Is CBD oil bad for your liver?
7 CBD Oil Side Effects You Should Watch Out For
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CBD oil is believed to be generally safe and well-tolerated, but it is not free of side effects. Read on to learn which adverse effects you should watch out for when using CBD oil, how the delivery form influences them, and what you can do to reduce your risk.
CBD Oil Side Effects
First, it is important to remember that CBD oil is considered experimental and investigational and far more clinical studies are needed before we can make any firm conclusions about its supposed benefits .
Similarly, it’s an insufficiently investigated supplement with a relatively unknown safety profile. The list of side effects listed in this article is, therefore, not a definite one.
So, make sure to speak with your doctor before starting on a CBD oil regimen.
With the recent legalization of CBD oil in many states worldwide, its popularity is booming and people are taking it for not only its FDA-approved use for seizures, but also conditions such as :
An advantage of CBD oil is that it’s considered generally safer and causes fewer adverse effects than the drugs typically used for these conditions. Chronic doses of up to 1500 mg/day were tolerated well in multiple studies [3+, 4].
Unlike THC, CBD doesn’t cause behavioral and psychological side effects. What’s more, it may even reduce some of them such as anxiety, psychosis, and memory loss [5, 6, 7, 8].
CBD oil is believed to cause fewer side effects than THC and most prescription drugs, even at high doses.
Nevertheless, there are some potential side effects of CBD oil that you should watch out for. Below is a detailed overview of the most common ones.
1) Dry Mouth
Whether you use them for recreational or medicinal purposes, cannabis products will often make your mouth feel as if it were stuffed with cotton balls. Almost 12% of 1500 people responding to a survey about CBD use experienced dry mouth, making it the most common adverse effect .
Stimulation of the CB1 and CB2 receptors in the salivary glands reduces saliva secretion, which makes the mouth feel dry. The well-known cannabis compound THC activates these receptors directly. In turn, CBD raises the levels of an activator naturally produced in the body – the cannabinoid anandamide [9, 10, 11, 12].
2) Digestive Issues
Both CBD oil supplements and the FDA-approved CBD medicine Epidiolex have been reported to cause digestive issues such as [2, 4]:
- Nausea and vomiting
- Increased or reduced appetite
- Weight loss or gain
Because preliminary research suggests that CBD improves rather than causes nausea and diarrhea, these effects most likely result from the irritating effects of other ingredients (e.g., carrier oils) on the bowels [13, 14, 15].
Alternatively, the loose regulation of supplements may allow for excessive CBD levels in products or harmful contaminants such as pesticides, heavy metals, and solvents [16+, 17].
In turn, the endocannabinoid system has a role in promoting appetite. The mixed effects of CBD on appetite and weight seen in different studies may be due to its dual effect: it blocks the CB1 and CB2 receptors but boosts the levels of their activator anandamide [18, 19, 11].
If you experience digestive issues from using CBD oil, tell your doctor. He or she may recommend reducing the dose or shifting to another brand.
Contaminants and additives are likely responsible for the digestive side effects of low-quality CBD oil: nausea, vomiting, diarrhea, and appetite and weight changes.
3) Drowsiness and Fatigue
People taking CBD oil often report feeling sleepy and tired. Indeed, this side effect was observed in early clinical trials and one of the most common uses of CBD oil is to improve sleep disorders [20+].
If the symptoms are very severe, you shouldn’t drive or operate heavy machinery.
The effect of CBD on sleep seems to be biphasic: high doses may increase sleeping time, lower amounts may promote wakefulness. Additionally, levels of endocannabinoid receptors depend on the circadian rhythm. This may explain why CBD tends to cause drowsiness later in the day but has the opposite effect in the morning [21, 22, 23].
CBD oil may make you feel sleepy, especially if you take high doses at night. Low morning doses, on the contrary, seem to increase wakefulness.
High doses of CBD lowered blood pressure in a small trial on 9 people. In turn, THC seems to have a more complex effect: it slightly raises blood pressure in people lying down but increases the risk of sudden blood pressure drops when standing up [24, 25+].
As a result, a common adverse effect of CBD – both alone and with equal amounts of THC (nabiximols) – is feeling dizzy and light-headed [26, 27, 28].
If your blood pressure drops too much, you may faint. The risk is especially high in people diagnosed with low blood pressure or on blood pressure medications – such as diuretics, ACE inhibitors, and beta-blockers. These people should be especially cautious with CBD oil and never try it out without discussing it with their doctor.
CBD oil, alone or with THC, may reduce blood pressure. This can make you feel dizzy and light-headed, especially if you are prone to blood pressure drops.
5) Possible Liver Damage
Several trials testing CBD for seizures found possible liver damage (high transaminases ALT and AST) in 9-25% of the people. The risk increased with the dose and was highest in people also taking the anti-seizure drug valproate, which is known to cause liver injuries [29+, 30, 31, 32, 33, 34].
Similarly, CBD caused signs of liver toxicity (high transaminases, alkaline phosphatase, and bilirubin) in mice and dogs. However, the doses were generally higher than those used in human trials [35, 36, 37].
Make sure to talk to your doctor, especially if you are taking valproate, and never exceed the recommended CBD oil dose to reduce your risk of liver damage.
CBD oil may cause liver damage at very high doses and in people prescribed the anti-seizure drug valproate.
CBD is often used to curb anxiety, although research suggests it has “inverted U-shaped” effects: moderate doses, but not low or high amounts, may be effective for a range of anxiety disorders and stressful situations [38, 39].
In contrast, very high doses may even trigger anxiety and irritability. This was the case in 7-9% of the children in 2 clinical trials using CBD for seizures and autism [40, 41].
The effect probably involves the TRPV1 receptor, the activation of which increases the brain’s response to stressful situations .
CBD boosts the naturally-produced cannabinoid anandamide. While moderate anandamide levels activate CB1 receptors and curb anxiety, high amounts may worsen it by binding to TRPV1. CBD also activates this receptor directly, further contributing to the potential anxiety-triggering effects [43, 44, 11, 45].
7) Immune Suppression
CBD may reduce the immune response. It prevents T cells from dividing, migrating to inflammation sites, and producing pro-inflammatory cytokines. This may be beneficial in people with autoimmune conditions such as rheumatoid arthritis or multiple sclerosis [46, 47, 48, 49, 50, 51, 52].
The downside of blocking the immune response is that it may make people with weakened immune systems more prone to infections. Thus, people on immunosuppressants or with conditions such as HIV, diabetes, and Down syndrome might want to avoid it .
CBD oil seems to reduce the immune response, which may make people with a weak immune system more prone to infections.
CBD didn’t damage the kidneys in clinical trials. In fact, researchers believed it protected against kidney injury and inflammation in numerous animal studies [54, 55, 56, 57, 58]. Remember that larger and better designed clinical trials are needed before these findings are conclusive.
Though more clinical trials are needed, the current evidence suggests CBD oil will not harm your kidneys at normal doses.
On the other hand, people with kidney disease should probably avoid THC-containing medical marijuana without consulting a doctor.
According to a recent review, THC may worsen kidney health and increase urination by activating CB1 receptors. Remember that, unlike THC, CBD blocks these receptors. However, CBD may indirectly activate them by increasing anandamide levels in the body [59+].
Lastly, avoid synthetic cannabinoids at all costs (products like “spice” and “K2” sold in smoke shops). These chemicals caused sudden and severe kidney injury in several cases [59+].
Unlike THC and synthetic cannabinoids, CBD oil probably does not cause side effects on the kidneys; some researchers believe it might even be protective.
Are You at Risk of CBD Oil Side Effects?
CBD altered the levels of two drug transporters in placental cells. This suggests that taking CBD oil during pregnancy may increase the exposure of the fetus to any drugs that the mother takes. Pregnant women should avoid CBD oil in any case, since safety data are lacking .
Taking THC-containing CBD oil during pregnancy and breastfeeding is particularly dangerous, since THC may reduce growth and cause brain developmental anomalies in babies [61+].
Because there are no studies testing its safety in children below 2 years old, it’s better to avoid giving them CBD oil unless prescribed by a doctor.
CBD is thought to be safe in older children, but they may be more sensitive to THC and toxic contaminants such as heavy metals and pesticides than adults. Be sure to use high-quality, THC-free CBD in children and consult the doctor first.
Pregnant women and children under 2 years old should avoid CBD oil due to the lack of safety data; THC during pregnancy is known to be dangerous.
Most drugs are broken down by liver enzymes. Among them, cytochrome (CYP) P450 plays a key role. A single CBD dose blocks several CYP enzymes, such as:
By doing so, it may slow the breakdown of several drugs and enhance their effects [62, 63, 64, 65, 66].
Indeed, CBD reduced the breakdown of the sedative hexobarbital, the anti-seizure drug clobazam, and the blood thinner warfarin in humans. It had the same effect on the immunosuppressant cyclosporin and the cannabis compound THC in cells [67, 68, 69, 70].
On the other hand, repeated CBD doses can increase the levels of some enzymes of this group and reduce the effects of the drugs they break down [71, 72, 73, 74].
Plus, CBD itself is broken down by CYP enzymes, especially by CYP34A and CYP2C19. Drugs that block these enzymes (such as ketoconazole and ritonavir) will enhance its effects, while those that activate them (such as phenobarbital and rifampicin) will have the opposite effect [75, 4].
If you are on prescription medication and plan to use CBD oil, ask your doctor about potential interactions and dose readjustment. Additionally, avoid combining CBD oil with grapefruit or other supplements that block the same liver enzymes (such as St John’s wort or watercress).
CBD oil can block or activate liver enzymes that metabolize drugs. This may increase the side effects of both CBD oil and the medication you’re taking.
How Does the Delivery Form Influence CBD Oil Side Effects?
While rapid-release forms (mouth sprays and oil tinctures) deliver CBD directly into your bloodstream, slow-release forms (capsules, edibles, and teas) have to pass your digestive system first. This means their ingredients may irritate your bowels and give you nausea and diarrhea [76+, 77].
However, rapid-release forms will release CBD faster, so you may experience both wanted and unwanted effects sooner [76+, 77].
And since tinctures and sprays are directly applied in the mouth, they will quickly reach the salivary glands and cause dry mouth. Mouth sprays may also cause a stinging sensation and even burns, especially if they contain alcohol [9, 78].
Capsules and edibles are more likely to cause digestive side effects, while mouth sprays and tinctures more frequently cause dry mouth.
Vapes bypass the digestive system without irritating your bowels, but they may trigger the other adverse effects faster [76+, 77].
Vaping is considered safer than smoking cigarettes or joints because the oil is heated at lower temperatures that produce fewer toxic byproducts [76+ 79].
However, the additives used as flavorings and thinning agents in vaping oils may still pose some hazards. Although they are normally food-grade, they may release harmful compounds (including the cancer-causing formaldehyde) when vaporized. Their heavy use may lead to [80, 79, 81+]:
- Dry throat
- Lung injury
- Fat particles entering the lungs (lipoid pneumonia – rare)
For instance, one man developed severe lung damage from vaping CBD oil [82+].
Creams & Gels
Creams and gels act locally on the application site and don’t release CBD into the gut or bloodstream. This means they will not cause most of the adverse effects previously described [76+].
However, they may cause allergic reactions with itching, redness, and rashes on the skin. It’s important to note that the reactions can be caused by either CBD or other ingredients in the formulation [83+, 84+].
How to Reduce Your Risk of Side Effects from CBD Oil
1) Drink More Water
The best way to reduce dry mouth when using CBD oil is to drink plenty of water and other hydrating liquids before, during, and after consumption.
2) Find Additive-Free Products
You can reduce the risk of digestive issues by choosing forms that bypass the gut and directly release CBD into your bloodstream such as vapes, mouth sprays, and oil tinctures. High-quality oils without additives may also irritate your bowels less.
3) Take it Before Sleep
If you feel drowsy or light-headed after taking CBD oil, you may need to reduce the dose or take it only before sleep.
4) Increase Wakefulness Naturally
Drinking coffee or tea will help you both stay awake and raise your blood pressure, but it also causes many side effects. Try to get more sunlight first thing in the morning, as it will energize you and help you get better sleep at night. We talk about other natural ways to increase wakefulness in this post.
5) Support Your Liver
Avoid combining CBD with the anti-seizure drug valproate. Additionally, make sure not to exceed the dose and regularly monitor your liver function to reduce your risk of liver damage. Eggs (choline), artichokes, NAC, and probiotics also support liver health. Read more foods and supplements that are good for the liver here.
6) Don’t Take Megadoses
Only very high CBD doses may cause irritability. Make sure not to exceed the dose and try reducing it if you notice this symptom.
7) Monitor Your Immune Response
If you have a weakened immune system, you should consult your doctor before taking CBD oil. You may need to avoid CBD or take a lower dose.
Additionally, you may also want to look into balancing your Th1/Th2 immune response. If you have a slightly weaker immune system and are prone to allergies, you are probably Th2-dominant.
To reduce your risk of CBD oil side effects, avoid products with additives, drink plenty of water, get sunlight during the day, and support your liver and gut health.
Always make sure to speak with your physician before starting on a CBD oil regimen.
CBD oil is thought to be safe and most people seem to tolerate it well.
Low-quality products may contain additives and toxins that can irritate the lungs when vaped and the gut when taken orally. Choose high-quality products to reduce your risk.
Additionally, CBD oil can make you feel drowsy and lightheaded. If you feel tired after taking CBD oil, lower your dose or use it only before sleep. Look to also increase your wakefulness naturally by getting more sunlight during the day.
High doses may damage the liver, but likely only in people taking the anti-seizure medication valproate. Monitor your liver enzymes and look into natural ways to protect your liver.
Avoid CBD oil if you have a weak immune system, as it might make you more prone to infection.
If you take prescription drugs, consult your doctor. Many drugs can interact with CBD oil and increase the risk of side effects.
Pregnant women and children should avoid CBD oil until more safety data are available.
Some people have genes that make them more likely to experience inflammation. Check out SelfDecode’s Inflammation DNA Wellness Report for genetic-based diet, lifestyle, and supplement tips that can help reduce inflammation levels. The recommendations are personalized based on YOUR DNA.
About the Author
Carlos spent 9 years in the laboratory investigating mineral transport in plants. He then started working as a freelancer, mainly in science writing, editing, and consulting. Carlos is passionate about learning the mechanisms behind biological processes and communicating science to both academic and non-academic audiences. He strongly believes that scientific literacy is crucial to maintain a healthy lifestyle and avoid falling for scams.
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Observed Impact of Long-term Consumption of Oral Cannabidiol on Liver Function in Healthy Adults
Introduction: Previous studies have suggested that prescribed cannabidiol (CBD) products may cause elevations in liver tests (LT). This study compared the prevalence of elevated LT in an adult population self-administering CBD with the normal and general adult population prevalences. Materials and Methods: Adults 18-75 years of age across the United States taking CBD orally for a minimum of 30 days were recruited from 12 individual CBD product companies in this decentralized, observational study and sent their standard CBD regimen from the company of their choice. An app-based, 21CFR Part 11 decentralized clinical study platform (ValidCare Study) was used to securely automate consent inclusion/exclusion criteria and collect all the data for this study, including: demographic information, medical history, reasons for taking, dosage, current medications dosage, adverse effects, and efficacy. At the end of 30 days, LTs were obtained. Follow-up LTs were offered to all individuals with elevated alanine transaminase (ALT) values. Results: A total of 28,121 individuals were invited to participate in this study, 1475 enrolled, and 839 (female: 65.3%, male: 34.7%) completed the study. Full-spectrum hemp oil was used by 55.7%, CBD-isolate by 40.5%, and broad spectrum by 3.8%. The mean±SD daily dose of CBD was 50.3+40.7 mg. The prevalence of elevated ALT was 9.1%, aspartate aminotransferase (AST) 4.0%, alkaline phosphatase 1.9%, total bilirubin 1.7%, with 85.5% of the ALT elevations 3× ULN. The prevalence of ALT and AST elevations (9.1% and 4.0%) were not significantly different from known adult general population prevalences (8.9% and 4.9%). There was no significant association between CBD dosage and LT values. Thirty-three individuals with elevated ALT levels had follow-up LT performed with 21 having normal LT, 8 having the same severity of ALT elevation, and 4 having an increase in severity, 1 of which ultimately became normal. Conclusions: Self-medication of CBD does not appear to be associated with an increased prevalence of LT elevation and most of the LT elevations are likely due to the conditions/medications for which the individuals are taking CBD.
Keywords: ALT; AST; CBD; LT; cannabidiol; liver function test.
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Is CBD Oil Bad For Your Liver? Here’s What You Need To Know
Any new supplements you are considering adding to your diet should be looked at carefully. Do they fit with your lifestyle? Will they interact with any prescription medications you’re on?
Our extensive research – and that of scientists across the globe – has proven that CBD oil is well tolerated by the human body and that it has very few, if any, side effects.
Taken by itself, there is no negative impact on core functions such as digestion, heart rate or glucose levels, even with higher doses of CBD oil (up to 1,500mg per day).
But one lone study on mice has led to some scrutiny over whether CBD Oil could be harmful to the liver, affecting how it functions.
So, should you be worried? Is CBD oil bad for your liver?
What Is CBD?
CBD is short for cannabidiol, the non-psychoactive chemical compound found inside the cannabis plant. It’s used as a supplement to help support a balanced diet and a healthy lifestyle, and is most commonly taken as oil drops under the tongue, but can also come in other forms such as absorption drinks and creams.
Despite its roots in the cannabis plant, CBD oil is legal to buy in the UK and in many other countries across the globe, and many consumers claim it’s effective for pain relief, combating nausea, stress, with more than a third of CBD oil users claiming it helps with their anxiety.
Cannabidiol interacts with and supports the human endocannabinoid system by binding to the receptors found in the body’s nervous system.
These receptors pass messages through pathways in the human body to keep the body well balanced, and the endocannabinoid system helps to regulate hormones, sleep patterns and mood, as well as things like appetite and immune response.
What Does Your Liver Do?
The liver is a metabolically active internal organ in the human body. It holds more than 10% of your total blood supply and actually has more than 500 different functions. The three main functions are that it cleans the blood, produces a digestive liquid known as bile and stores energy.
Bile aids digestion in the small intestine by breaking up fats into fatty acids. The liver works to transform all the nutrients we ingest into something the body can use, stores these substances and then distributes them around the body when and where they are required. It also converts toxins into harmless waste products that the body can then get rid of.
To keep your liver healthy you should eat a balanced diet, keep to a moderate alcohol consumption, exercise regularly, maintain a healthy weight and avoid recreational drugs.
The liver is the only organ in the human body that can regenerate itself. If the liver is healthy and a quarter of its tissue remains in place, it can regrow to its original size within just a few weeks.
Excessive intake of alcohol, fatty food, sugar and salt can all be damaging for your liver. Overindulging in these things can result in numerous problems, including liver failure.
Signs that your liver isn’t working properly include yellow skin or eyes, known as jaundice, abdominal pain or bloating and swelling of the legs and feet.
Will CBD Oil Hurt Your Liver?
Following a single study on mice last year, there have been concerns about CBD oil possibly being damaging to your liver if it is used in high quantities.
However, in the study in question, the doses used for the mice were much higher than humans would take, so the small daily drop of CBD oil which is advised for people is highly unlikely to cause the same effect. Therefore the study doesn’t mimic the typical intake of a CBD user. Scientists have instead said the findings can give an indication of the consequences of a potential CBD oil overdose.
It is the same with any drug or supplement. If you take more than the recommended dose there are always possible consequences, whether it be an excessive dose of grapefruit extract or ibuprofen. Studies have shown that using more than the recommended dose of ibuprofen, for example, can cause stomach ulcers and other gastrointestinal problems as well as greater risk of cardiovascular concerns.
And – obviously – a mouse is not a human being. Although they share very similar genes, which is why mice are frequently used for testing purposes, they are physiologically very different and this must be taken into consideration.
Further research into the findings has shown that using the correct dosage of CBD oil is safe for widespread use, and is well tolerated by the vast majority of people.
This is backed up by the World Health Organisation, no less. Not only that, but conflicting research has shown that the therapeutic properties of CBD oil could actually help improve liver function because of the way it interacts with endocannabinoids to create anti-inflammatory and antioxidant effects.
Can CBD Cause Liver Failure?
As CBD Oil is so new to the market, there is still much research to be done into what it can do, how it can potentially help users and any undiscovered risks involved.
However, initial findings suggest that side effects are minimal and it is only if you take a comparably huge dose of CBD Oil that your liver could be affected.
There are three main things to cause liver failure – obesity, alcohol misuse and hepatitis. CBD is not one of these and nor is it currently deemed to be a contributory factor.
The Bottom Line
Taking the correct, recommended dose of good quality CBD pil as part of a general wellness routine is unlikely to cause any side effects, including liver damage. Any side effects reported in humans up to now are very rare – and very mild if they do occur.
Vitally, if you are a CBD consumer, ensure you buy from a reputable source with lab certified products who can verify their contents. If you are already taking any form of medication we advise that you consult your doctor or healthcare professional before taking any CBD Oil or related products.