A woman who ingested large doses of hemp oil and another plant compound to relieve stress had to be hospitalized in what may be a cautionary tale for people taking herbal supplements.
The unnamed 56-year-old patient experienced dizziness in the weeks before, fainted and had a life-threatening abnormal heart rhythm when she was admitted to the emergency department, Swiss doctors wrote this month in the journal Heart Rhythm Case Reports.
She later told the medical team that she had been taking hemp oil containing CBD (cannabidiol) and CBG (cannabigerol) — two of the many chemical compounds found in hemp — three to four times daily for four months “because of a stressful work-life balance,” according to the report.
The woman had been taking up to six times the recommended dose of hemp oil supplements, doctors wrote. To this routine, she had also recently added extra herbal supplements containing berberine — a compound found in some plants that is possibly effective for high blood pressure, according to the National Library of Medicine.
The patient stopped taking all supplements during her six-day hospital stay and her heart rhythm returned to normal, the case report noted. When doctors followed up three months later, she had no new episodes of fainting or dizziness, and her heart beat normally.
It’s believed to be the first documented case of this type of cardiac arrhythmia after a person used CBD/CBG-containing supplements, the doctors wrote, noting these products should be used with caution.
“More and more people are taking herbal supplements for their potential benefits. Yet their ‘natural’ character can be misleading, since these preparations can have serious adverse side effects on their own or if combined with other supplements or medications,” said Dr. Elise Bakelants, co-author of the case report and a cardiologist at the University Hospital of Geneva in Switzerland, in a statement.
“Their use should not be taken lightly, and dosing recommendations should always be respected.”
What to know about CBD
Advocates say cannabidiol can help with anxiety and pain relief, and has other benefits, but clinicians say more research needs to be done, as TODAY previously reported. It doesn't produce a high and is different from medical marijuana.
CBD is pretty safe, even at relatively high doses, said Dr. Leigh Vinocur, an emergency doctor in Baltimore, Maryland, and a national spokesperson for the American College of Emergency Physicians.
But Vinocur would never recommend taking more than the suggested dose. She also urged consumers to find a reputable CBD company that publishes its certificate of analysis to show the product label is accurate. Vinocur pointed to a 2017 study in JAMA that found less than a third of the CBD products tested contained the concentration listed on the label.
The company should also have third-party verification to ensure there are no heavy metals, bacteria, pesticides, mold and other contaminants in the supplements, she said, noting hemp and cannabis tend to soak up heavy metals from the ground.
“The biggest issue with all these CBD products on the market is that they are untested, unregulated,” Vinocur, who is a member of the Society of Cannabis Clinicians, told TODAY.
“I recommend medical cannabis as a medicine, including CBD products, but I make sure that my patients are using products from a reputable company.”
The U.S. Food and Drug administration was more critical, noting it has seen “only limited data about CBD’s safety and these data point to real risks,” including potential liver injury, side effects from drug interaction and changes in alertness, it warned on its website. The agency was “concerned that people may mistakenly believe that using CBD ‘can’t hurt.’”
The FDA has approved only one product that contains CBD — Epidiolex, a prescription drug to treat two rare forms of epilepsy.
‘Don’t try and self-medicate’
When it came to the woman in the case report, Vinocur wondered whether the berberine was more to blame for the patient’s heart issues since it seems to have more cardiac effects, she said.
In general, always let your doctor know if you’re taking supplements because there can be drug interactions, Vinocur advised.
Follow the recommendations on the label and look for third-party verification, like the USP verified seal, which means the formulation meets the requirements of the U.S. Pharmacopeial Convention — a scientific nonprofit organization that sets quality standards for dietary supplements.
The FDA regulates dietary supplements, but the rules are less strict than those for medications. The agency generally doesn’t take regulatory action on dietary supplements until something goes wrong with a product that’s on the market, according to the Congressional Research Service.
Consumers should also remember that “natural” doesn’t necessarily mean safer or better when it comes to supplements or medicines, the National Center for Complementary and Integrative Health cautioned. Natural products can still come with side effects and some are ineffective, it noted.
“Thinking that ‘Oh, it’s natural, it’s safe’ is ridiculous,” Vinocur said, noting poisonous mushrooms and plants are also “natural” but harmful.
If you are feeling dizzy, lightheaded, nauseated or unwell and the symptoms seem to be related to the supplements you’re taking, get checked out, she advised.
“Speaking as an emergency physician and a cannabis physician, it’s important that you talk with a physician about this and don’t try and self-medicate,” Vinocur said.