Though it may not be as widely discussed as other major health concerns like heart disease or cancer, liver disease is a common health condition that affects millions of people. According to the Centers for Disease Control and Prevention (CDC), there are currently 4.5 million adults who have been diagnosed with liver disease living in the US. And the Journal of Hepatology reports that liver disease is responsible for 2 million deaths annually, or 4% of deaths worldwide. Nearly two-thirds of those deaths occur in men.
Liver disease is not a singular thing; rather, it is a variety of conditions that affect the organ’s health and function, from viral infections to metabolic or alcohol-induced conditions like fatty liver disease, and genetic diseases like hemochromatosis and cancers.
While we inherit or naturally develop some of these conditions and cannot control them, others develop directly from how we treat our bodies. Factors like diet or substance consumption can cause or worsen certain liver conditions. Which leads us to the question, which is worse for your liver: cannabis or alcohol?
The Function Of The Liver
To answer that question, we need to quickly touch on the role of the liver in the body. Dark reddish brown and shaped like a cone, the organ rests just below the diaphragm and right above the stomach. At any given time, your liver is holding around one pint of blood, or 13% of the body’s total supply.
According to Johns Hopkins, over 500 vital functions are connected to the liver. These include clearing the blood of toxins and drugs, preventing blood clotting, producing bile for digestion, storing iron, and metabolizing many of the nutrients our bodies need.
Because of its major role in so many of the body’s processes, a functioning liver is necessary for survival. Northwestern Medicine Hepatologist, Justin R. Boike, told Northwestern Medicine’s HealthBeat, “…you can’t live without a liver, and you can’t live with liver failure. There is no machine like the dialysis machine for people with kidney failure that can replace the function of the liver.”
Alcohol and Your Liver
Alcohol metabolism occurs in several steps. When you drink alcohol, an enzyme in your liver called alcohol dehydrogenase breaks that alcohol down into a compound called acetaldehyde. Acetaldehyde is extremely toxic to the liver, so another enzyme (aldehyde dehydrogenase 2) then goes to work breaking acetaldehyde down into another compound called acetate, which is similar but less reactive, and the body can eventually turn acetate into carbon dioxide and water.
Every time you drink—whether you enjoy a glass of wine with dinner or take shot after shot on a night out—your body goes through this two-step process. And every time your liver encounters alcohol and produces acetaldehyde, both toxic compounds, it causes damage to your liver cells that may become irreversible if the insults are prolonged.
As a result of that damage, alcohol-related liver disease (ALD) occurs when too much alcohol is ingested over time. The amount of alcohol it takes to trigger ALD varies from person to person and is dependent on several factors. The University of Michigan reports that in the US, 21,000 people die annually from ALD, and while the vast majority of them are men, women typically develop the disease after less exposure to alcohol.
Alcohol Related Liver Disease
While not everyone who drinks will develop alcohol related liver disease, it’s far more common than you may think, especially in chronic drinkers. Yale Medicine reports that ALD is rarely found in occasional drinkers, and more typically occurs in those who have consumed alcohol excessively for several years.
There are three stages of ALD: alcohol-related fatty liver disease, alcohol-related hepatitis, and alcohol-related cirrhosis. The early stages can typically be reversed completely by abstaining from alcohol, but the later stages are irreversible and can lead to death and an increased risk of serious complications like liver cancer.
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Cannabis and Your Liver
Like with alcohol, your liver is responsible for breaking down cannabis. Different groups of enzymes work to metabolize the THC and CBD compounds, eventually leading your body to excrete 80-90% of its metabolites as waste within 5 days.
Unlike with alcohol, however, there is currently no evidence that this process, or any of the chemicals it creates, are directly toxic to an already healthy liver.
However, if fibrosis or chronic liver disease (CLD) is already underway, then activating CB1 receptors at that time may advance liver scarring. THC activates CB1, so avoiding this in CLD patients may be best.
Instead, THCV’s opposite effects on CB1 are more promising than THC itself. Also, targeting CB2 and other anti-inflammatory receptors with beta-caryophyllene and nonintoxicating cannabinoids (e.g., CBD, THCA) presents an overall more potentially therapeutic approach.
Some studies have even found that smoking cannabis might protect your liver, but keep in mind that this clinical data is small and isn’t strong enough yet. To date, there isn’t any clinical research on cannabinoids and alcohol-related liver disease. Still, preclinical studies on related conditions are supportive.
One such study finds that increased cannabis consumption was consistent with lower prevalence of nonalcoholic fatty liver disease (the most prevalent form of liver disease in the US). Essentially, frequent cannabis use lowers inflammation, which decreases the risk of the metabolic-induced condition.
Another study finds correlations between better outcomes for chronic HCV patients (or those who have been infected with the HCV virus for long periods of time and are at risk for liver damage) and increased cannabis consumption. Here, cannabis use is associated with decreased incidence of liver cirrhosis in these patients, but no effect on mortality is seen yet.
The Bottom Line
Alcohol is known as the root cause of liver disease for decades. While there is currently no evidence that cannabis leads to liver conditions, it may be best to avoid THC in favor of hemp-derived THCA, CBD, CBDA, THCV, and beta-caryophyllene.
This doesn’t necessarily mean that consuming cannabis is completely safe and drinking alcohol is always dangerous. Drinking infrequently and in small amounts is reasonable, but the WHO emphasizes that abstinence from alcohol is your best bet when it comes to protecting your liver and overall health. The evidence suggests that general health risks are well-documented, and there is truly no safe amount of alcohol for health.
Additionally, there simply isn’t enough research surrounding cannabis and its impact on the liver to say that it’s necessarily the better choice. Some research suggests that cannabis use may exacerbate or accelerate existing liver conditions, while specific cannabinoids may target the approach better. A lack of evidence is not necessarily conclusive.
Like with anything else, cannabis and alcohol use will impact each person differently. Speaking with your doctor about any concerns and staying on top of your health are your best bets when it comes to staving off liver disease. If you have a family history of liver conditions or a genetic predisposition to these conditions, you may also consider speaking with a medical professional about screening for liver disease. And as always, it’s better to exercise caution when it comes to substance use of any kind, if you are feeling uneasy about your mental or physical well-being.
