Cannabidiol (CBD) is often marketed as natural, non-addictive, and safe—but new research suggests otherwise. A recent has found that low doses of CBD can cause liver injury in otherwise healthy people, often without any symptoms. A liver specialist at Rambam Health Care Campus (Rambam) comments on the study, urging caution and routine monitoring for CBD users.
Cannabidiol (CBD) is a chemical compound found in the cannabis plant (marijuana). In recent years there has been an explosion of CBD use worldwide. In the United States alone, more than 30% of Americans reported using products such as gummies, foods, oils, creams, and pain relief replacements that contain the compound in 2023. The global CBD market was valued at $9.14 billion in 2024, and it is expected to reach $22.05 billion by 2030. In Israel, the benefits of CBD are considered to be so significant that it is moving toward less regulated, broader consumer use in the near future.
However, CBD may not be as beneficial as people think. A recent randomized, double-blind trial published in JAMA, tracked 201 healthy adults over four weeks while receiving 5 mg of CBD per kilogram of body weight—a dosage comparable to many commercial products—or a placebo. Among those who received CBD, eight patients (5.6%) developed elevated liver enzymes, indicative of drug-induced liver injury. As a result, seven participants were withdrawn from the study.
Discussing the results of the study, Dr. Tarek Saadi, director of Rambam’s Liver Diseases Unit, points out that the silent nature of the liver damage is particularly dangerous. “Only one patient in the study had symptoms. The rest felt fine, but bloodwork showed active liver inflammation. If not identified early, this can worsen and lead to liver failure,” he says.
Dr. Saadi further explains that in most cases, stopping CBD use reversed the damage within two weeks. However, he emphasizes that the study revealed possible allergic reactions: seven of the eight affected participants also had elevated eosinophils, which suggests an immune-response to CBD use. Furthermore, the study indicated that women are disproportionately affected. Five of the eight liver injury cases were women, highlighting the need for more targeted risk assessment.
Although CBD is not yet available over the counter in Israel, there have been efforts to deregulate its use. For now, CBD is available alongside prescribed cannabis products. “Regulation here reduces public exposure, but it doesn’t eliminate the risk,” notes Dr. Saadi. “People with preexisting liver conditions, like hepatitis or fatty liver, are especially vulnerable.”
The current study does not demonstrate that CBD is a definitive cause of serious liver injury. Furthermore, the liver usually adapts to short-term stress without lasting effects. However, as CBD products become more widely available and their potency increases, there may be greater risks, particularly for more vulnerable individuals. Dr. Saadi’s advice is clear: anyone using products containing CBD, especially regularly, should undergo routine liver function tests even if they have no symptoms. “The liver doesn’t always send a warning,” he says. “By the time you feel pain, the damage may already be serious. Monitoring saves lives.”
Based on an article in Hebrew that appeared on Ynet
