Cannabis Use May Protect Liver from the Effects of Drinking
By Alexander Beadle
Published: Oct 08, 2018
Considering the popularity of both alcohol and cannabis, it is unsurprising that many people are choosing to use the drugs together in a practice known as “crossfading”. Simultaneous use of both drugs exploits the body’s endocannabinoid system and changes how alcohol is absorbed into the bloodstream. The change, which leads to lower blood alcohol levels but higher THC absorption, reportedly leaves users with intense feelings of calm and bliss.
However, everybody responds to these drugs differently, and too much of either can cause sweating, severe nausea and vomiting. As a result, the official advice from many in the cannabis industry is to exercise caution when crossfading: better still is to avoid it completely. In the interest of consumer safety, California has recently decreed that intoxicating drinks such as beers cannot be infused with, or sold in the same venue as, cannabis products.
While using cannabis and alcohol simultaneously can have unforeseen intoxicating effects, regular use of both alcohol and cannabis independently from one another has been found to exhibit some interesting physiological effects on the body.
Cannabis and alcoholic liver disease
In January 2018, a research team led by Dr. Terence Bukong of the University of Massachusetts Medical School and the INRS-Institut Armand-Frappier Research Centre conducted a study of nearly 320,000 people with a history of alcohol abuse and varying levels of cannabis use to identify any potential effects of concurrent use on liver health.
This large sample group was broken down into recorded incidences of alcoholic steatosis, steatohepatitis, cirrhosis and hepatocellular carcinoma of the liver (all conditions that characterize alcoholic liver disease, or ALD), and then into three further groups based on cannabis use and exposure. Symptoms of ALD were seen in all cannabis exposure groups: non-cannabis users (90.39%), non-dependent cannabis users (8.26%) and dependent cannabis users (1.36%). By accounting for the survey methodology and estimating adjusted odds ratios for each of the associated ALD conditions, the researchers showed that individuals who use cannabis showed significantly reduced odds of developing each of the four ALD-related conditions. Dependent cannabis users also had lower odds of developing ALD than non-dependent cannabis users.
It is important to note, however, that this study is just a population-based correlation study and so more rigorous medical examination and clinical study is needed before it is possible to make any firm conclusions or to elucidate any mechanisms that could explain why this is the case.
Additionally, this study only observes the health effects of cannabis use on those who meet criteria for alcohol abuse. Similar studies across cannabis exposure groups for populations with different drinking habits may also bring researchers closer to discovering the origin of this observed protective effect.
This section of this article was updated on October 18, 2018, to better reflect the ALD survey methodology used in the research.
Cannabis and non-alcoholic liver disease
It isn’t just alcoholic liver disease that cannabis looks to be able to prevent; there have been additional studies that indicate potential links between cannabis use and lowered rates of non-alcoholic fatty liver disease.
Non-alcoholic fatty liver disease (NAFLD) is usually most common in people who are obese or overweight; type 2 diabetes, high blood pressure and high cholesterol are also risk factors. It is also more prevalent in the over-50 age demographic and among regular smokers. Early-stage NAFLD is rarely symptomatic, but severe NAFLD can lead to liver inflammation, cirrhosis, and eventually liver failure or cancer.
A study of records from patients with suspected NAFLD concluded that cannabis use provided a varying degree of protective effects from NAFLD. The protection was also observed to be dose-dependent, with heavy users of cannabis having a NAFLD prevalence of 28%, versus the 40.7% observed in populations with no history of cannabis use and 30.5% for light cannabis users.
These results were in spite of the cannabis users profiled having generally worse diets than non-cannabis users with respect to calories, sugar, and alcohol intake - all of which contribute as risk factors for NAFLD.
Proposed explanations for this effect
The research team investigating NAFLD noted that increased cannabis use was often linked to lower levels of fasting insulin. Given the proven link between liver disease and insulin resistance, the manipulation of insulin levels appears to be the leading theory in explaining why cannabis can protect against NAFLD.
Interestingly, insulin resistance is also linked to a number of other conditions such as diabetes, hypertension, and cardiovascular disease. If the full mechanism by which cannabis alters insulin levels in the body could be described, there is certainly potential for cannabis to be effective in managing these other health risks.
For ALD, the beneficial effects seem to be intrinsically linked to the endocannabinoid system and agonism of the CB1 and CB2 receptors in the body. The anti-inflammatory effect of cannabis is well-documented, and it is thought that the presence of CB1 and CB2 receptors in the liver could be reducing the inflammation that is typical in early-stage liver diseases, in turn stopping the disease from progressing to the usual levels of severity. However, CB1 receptors have also been shown to actually promote inflammation in liver tissue, in direct contrast to the action of CB2 receptors.
“The principle is creating a balance between the CB-1 and CB-2 agonism,” said Dr. Terence Bukong, the author of the major ALD study, in an interview with Tonic.
“How do we create a balance where cannabis use is actually having a therapeutic effect against detrimental effects? I don't have an exact mechanism for how that balance is happening. I think that we need to go further and know exactly what the detailed molecular mechanisms are and also what the potential side effects are.”
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