Cannabis and Fatty Liver Disease: A Complex Relationship Under Scientific Review And It’s Looking Good

As the legalization and normalization of cannabis use continues to expand across the United States and globally, scientists are increasingly exploring its potential health effects—both positive and negative. One area of growing interest is the relationship between marijuana use and non-alcoholic fatty liver disease (NAFLD), a condition that affects nearly 30% of the global population.

NAFLD is characterized by an excessive accumulation of fat in liver cells in individuals who consume little to no alcohol. If untreated, it can progress to non-alcoholic steatohepatitis (NASH), cirrhosis, or even liver cancer. The disease is closely linked to obesity, insulin resistance, and metabolic syndrome.

In recent years, multiple studies have examined how cannabis use may impact the progression or prevention of NAFLD—with surprising and sometimes conflicting results.

What the Research Says
A study published in PLOS ONE in 2017 analyzed data from the National Health and Nutrition Examination Survey (NHANES) and found that marijuana users had a significantly lower prevalence of NAFLD compared to non-users, even after adjusting for metabolic risk factors such as BMI and diabetes. The authors suggested that cannabinoids may influence lipid metabolism and reduce inflammation in the liver, potentially offering some degree of protection against fatty liver disease.

A 2019 article in Clinical Gastroenterology and Hepatology echoed similar findings. It concluded that current cannabis use was associated with a lower risk of NAFLD among adults in the United States. The study proposed that this could be due to the anti-inflammatory properties of certain cannabinoids, particularly cannabidiol (CBD).

However, not all research paints a completely positive picture. A systematic review published in Cureus in 2021 highlighted that while some evidence suggests a protective association, the overall body of research remains limited and heterogeneous, with varying methods of cannabis exposure measurement and lack of longitudinal data.

Mechanisms at Play
The endocannabinoid system (ECS), which includes cannabinoid receptors (CB1 and CB2), plays a significant role in lipid regulation, insulin sensitivity, and inflammation. THC (tetrahydrocannabinol), the psychoactive compound in cannabis, can activate CB1 receptors, which have been linked to increased fat accumulation in the liver. In contrast, CBD may have an opposing effect by modulating these receptors and reducing inflammation.

This biochemical tug-of-war underscores the complexity of cannabis’s role in liver health: the impact may depend on the type of cannabinoid consumed, the dosage, the duration of use, and the user’s overall metabolic profile.

The Bottom Line
While early findings are intriguing and suggest a possible protective role of cannabis in the development of fatty liver disease, medical professionals caution against interpreting these results as a green light for unsupervised use. More high-quality, controlled clinical trials are needed to determine whether cannabis or its components can be considered a legitimate therapeutic option for NAFLD.

As public interest grows and cannabis reform advances, understanding the nuanced relationship between marijuana and liver health remains a priority for researchers and clinicians alike.

References:

Kim, D., Kim, W. R., & Kim, H. J. (2017). Cannabis use and the risk of non-alcoholic fatty liver disease: A population-based study. PLOS ONE. https://doi.org/10.1371/journal.pone.0176416

Adejumo, A. C., Ajayi, T. O., Adegbala, O. M., et al. (2019). Cannabis use is associated with reduced prevalence of non-alcoholic fatty liver disease: A cross-sectional study. Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2018.04.040

Janakiraman, H., Vasnani, J., Rao, H., & He, X. (2021). Marijuana Use and the Risk of Nonalcoholic Fatty Liver Disease: A Review. Cureus. https://doi.org/10.7759/cureus.13213