Liver Functions , Crohns Disease, and Marijuana use

[dmunny]

I have Crohns disease, and for about a year am having some abnormal liver tests. The Dr. is changing my medications a bunch, and I have abstained from alcohol, but my liver counts have not decreased significantly. I am wondering if my Marijuana smoking could be causing the elevated liver functions. I am trying to do research, and am finding mixed (poor) results. Anyone have any input for me?

[Journal_OC]

If the only reason to take cannabis was for recreation, then it would make sense to stop and see if the liver enzymes improve. But the original poster said they have crohn's disease --  and cannabis has been shown to be of use in reducing the severity of that disease.  Would cannabis cessation increase the odds of a crohn's relapse or flare, requiring that steroids or methotrexate be used? That increased disease activity and the prescription medications have many obvious risks ... how do we weigh that against a general (non-specific) suspicion that cannabis is the cause of the liver problem?

I am not aware of any studies that show cannabis frequently elevates the liver enzymes or otherwise cause damage to the liver. (Doctors usually pick up on liver damage when a blood test shows elevated enzymes, though elevated enzymes do not always indicate serious damage). We have good evidence that alcohol does cause problems, that acetominophen does, etc etc. But not cannabis.  

There are studies showing that in general, cannabinoids are anti-fibrotic, althought in the specific case of hepatitis C, THC seems to accelerate fibrosis
https://www.ncbi.nlm.nih.gov/pubmed/27435265

The cannabis molecule Cannabidiol (CBD) actually shows evidence of inhibiting the virus and protecting the liver in cases of hepatitis C infections. Most recreational cannabis is high THC and low in CBD, but there are some strains that contain only CBD (ie, "hemp"), and other strains with a fairly even mix of the two compounds.
https://www.ncbi.nlm.nih.gov/pubmed/28250664

Cannabis use is associated with a lower incidence of fatty liver disease.
https://www.ncbi.nlm.nih.gov/pubmed/28441459

Cannabinoids have been suggested as a possible therapy for autoimmune hepatitis.
https://www.ncbi.nlm.nih.gov/pubmed/19647124

Cannabinoids improve liver function after chemical injury.
https://www.ncbi.nlm.nih.gov/pubmed/19086956

Cannabinoids improve liver function after the bile ducts are closed-up.
https://www.ncbi.nlm.nih.gov/pubmed/20128798

Is it possible that your elevated liver enzyme levels are due to a rare, idiosyncratic reaction to cannabis? Perhaps - it cannot be ruled out, things like that do happen. But there is evidence that Many people experience elevated liver enzymes due to Crohns disease itself ... that seems more likely than cannabis. https://www.ncbi.nlm.nih.gov/pubmed/28651460

Or they could be elevated due to some other factor that has not been mentioned or considered here.

Unfortunately, science cannot currently answer your question with any certainty.  

The general research that has been done does not speak to the specifics you presented. We do not have any diagnostic tests that will tell us exactly what is going on inside you with a high degree of confidence. Any decisions must be made using limited, incomplete information.  

[mikesimon]

See:  http://www.hepatitis-central.com/mt/archives/2007/06/the_pros_and_co.html

June 20, 2007

Pros and Cons of Medical Marijuana with Hepatitis C

                                                    Cons

"Ever since the results of the 2006 California study were published, experts have been expressing concern about the health implications of Hepatitis C patients using marijuana. A French study of untreated individuals with Hepatitis C (those not taking interferon therapies) showed that, compared with occasional or non-users of the drug, people who used marijuana daily were:

· more likely to have severe liver fibrosis
· at a higher risk for rapid fibrosis progression.

At the 2007 42nd Annual Meeting of the European Association for the Study of the Liver in Barcelona, Spain, the same French research team reported on a study linking marijuana use and liver steatosis. These researchers noted that marijuana binds to two receptors, CB1 and CB2. Recent experimental data suggests that activation of CB1 receptors increases steatogenesis (liver fat accumulation). Stimulation of the CB1 receptor is assumed to be the reason daily marijuana smoking is associated with the development of significant hepatic fibrosis.

In addition to the discovery that smoking marijuana accelerates liver fibrosis, concerns remain about its impact on the immune system. Experts explain that the use of marijuana may suppress immune function. Cannabinoid receptors are confirmed to be present on the surface of immune cells, and when the cannabinoid molecules from marijuana bind to these receptors, the person’s resistance to disease is compromised. Therefore, various studies have concluded that using marijuana can enhance the disease process......"

[Journal_OC]

There is a real concern with the use of THC in people with Hepatitis C. The evidence indicates that cannabis makes this worse, and should be avoided in such cases.

But I disagree with the idea that cannabis is generally dangerous because of its effects on the immune system.

There are several areas related to the immune system worth considering: 1) Infectious diseases, 2) Inflammation and auto-immune diseases, and 3) Cancer.

The cannabinoids (THC, CBD) are not clearly associated with an overall increase in infectious diseases. Smoking cannabis is associated with bronchitis - the hot gasses, particulates, and 'tars' are not good for health. But vaping, taking capsules or edibles or topicals does not cause an immune deficiency and increase in infectious disease. There are some documented cases of aspergillosis - inhaling spores from moldy cannabis is a real risk factor. But if the herb is tested to avoid mold (as it is in some states), or if it is not smoked and inhaled, this risk drops to non-significance.

Cannabis is useful for lowering inflammation and treating a wide variety of auto-immune conditions. But where steroids have immediate, powerful effects (and strong side-effects), cannabinoids work more as normalizing agents - not so strong, but they do not impair the immune system the way that other prescription drugs do.

There is a large body of research showing that Cannabis slows the growth of many different types of cancers. Not saying it is a cure-all for cancer, most of the data is pre-clinical and we don't have evidence that a person should forgo chemo and just use cannabis. But there is evidence that cannabis is useful for the side effects of chemo, and it does not interfere with the benefits (and sometimes makes the chemo more effective).  If Cannabis was a terrible immuno-suppressant, we would not have thousands of studies that show that cannabinoids slow the growth of cancer cells.  

[reenie315]

re marijuana effects on liver functioning. I just had a blood test for hemochromatosis, an elevated iron storage problem that could effect liver functioning. I am wondering the same, as you are, if smoking pot has a deleterious effect on liver and other organs. No info in Zimmer and Morgan's book. Does anyone have any info on this?reenie315