Could Cannabis Offer a New Treatment Option for NAFLD?
Non-alcoholic fatty liver disease (NAFLD) is a condition in which fat accumulates in the cells of the liver (hepatocytes). It affects more than 20-30% of adults in North America and is becoming increasingly common. Many people with this condition have no symptoms and medical professionals might diagnose them as a part of an investigation into the cause of other abnormal lab tests or after they have had imaging of their abdomen for unrelated reasons. NAFLD is likely caused by metabolic factors, such as obesity, diabetes or pre-diabetes, high cholesterol, high blood pressure, sedentary lifestyle, and the use of certain medications.
While NAFLD is typically asymptomatic in its early stages, and might seem like a relatively harmless condition, it can lead to serious damage in the liver over time. The presence of fat in the liver can trigger inflammation, which can lead to scarring of the liver tissue, known as cirrhosis, at advanced stages. Once the liver develops cirrhosis, a number of other complications can occur, as the liver is unable to perform normal processes. These can include worsening fatigue, fluid accumulation in the abdomen (ascites), bleeding from veins in the esophagus or stomach (varices), and confusion (encephalopathy).
Typically, treatment for NAFLD focuses on dietary and lifestyle changes such as improved diet and increased exercise in order to lose weight and reverse the metabolic factors, such as high cholesterol and diabetes. There are no approved medications to treat NAFLD, and lifestyle modifications can be very difficult to maintain. With the need for more treatments – and the fact that NAFLD rates will likely increase over the coming years, as obesity and diabetes are becoming more prevalent – researchers are looking into pharmacological options.1
One particular area of interest is cannabis. Scientists suggest that our bodies naturally produce a family of neurotransmitters called endocannabinoids, which interact with specialized receptors located in the brain, muscles, fat, and digestive tract, called cannabinoid receptors. This array of interactions between the body’s trigger substances and receptors is known as the endocannabinoid system. Cannabis contains similar molecules, cannabinoids, which include delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), that also interact with these receptors.
Researchers have found an inverse correlation between NAFLD and cannabis consumption, meaning that individuals who use (or previously used) a lot of cannabis are less likely to develop NAFLD than those who abstain, and those with the highest consumption rates were the least likely to develop NAFLD.1,2,3 Studies have also found that cannabis use also correlates with lower rates of obesity and diabetes, two known risk factors for NAFLD, and posited that this might be the cause of the reduced risk of NAFLD in cannabis users.3 However, the apparent benefit remained present when the researchers adjusted the data for body mass index, diabetes, and hypertension, which are known risk factors for NAFLD, as well as other variables such as education level, economic status, and use of alcohol, cocaine, heroin, and/or amphetamine, which could possibly affect the rate of NAFLD.1 This correlation has not yet been proven as a cause and effect, which means that it has not been demonstrated that cannabis use will prevent or reduce the risk of obesity and diabetes, only that an association was found.
They suggest that cannabinoids might have a therapeutic benefit in NAFLD, possibly because of the way that they influence the endocannabinoid system. At this time, researchers are still unsure exactly how cannabis could reduce the rate of NAFLD and recommend further research into the precise methods. However, they suggest that including cannabinoids to the current NAFLD treatment plan could offer another method to reverse the fat build-up in the liver and prevent further complications.