Should You Take CBD While Taking Metformin?

Over 37.3 million Americans (11.3%) have diabetes. Nearly 1 in 2 are on non-sulfonylureas drugs to treat diabetes, which include metformin [2,12]. Of these numbers, some may have wondered if it’s safe to take CBD with metformin.

Well, the answer is a bit more complicated than a simple yes or no.

Taking CBD and metformin at the same time may cause your blood sugar levels to drop suddenly. You’d feel lightheaded and dizzy. It may even trigger a headache.

However, taking them hours apart may still benefit you.

Let’s go into detail and see what happens when you take CBD with metformin. We’ll also address whether CBD may be a good alternative to metformin.

Is It Safe to Take CBD Oil With Metformin?

Yes, you can take CBD oil with metformin, as there’s a low risk of drug interaction. CBD goes through hepatic metabolism, while metformin does not [19,18]. Taking both won’t significantly affect how they’re metabolized. It also won’t increase their blood concentration to dangerously high levels.

However, taking them at the same time may boost their blood sugar-lowering effects. This can result in a lower-than-normal blood sugar level, which isn’t good for people with diabetes. Their combined effects may also worsen their side effects.

If you’re interested in taking CBD oil with metformin, then do so with caution. Better yet, seek medical advice, especially if you’re taking other medications. Both compounds are known to interact with liver enzymes like the CYP3A4.

What are the Risks of Taking CBD Oil with Metformin?

The combined effects of CBD oil and metformin may increase the risk of hypoglycemia. It’s a condition where your blood sugar drops below normal (< 70 mg/dL or 3.9 mmol/L for diabetics).

Both compounds lower our blood sugar levels. Metformin controls it by reducing the [8]:

• Blood glucose amount produced by the liver
• Blood glucose absorbed by the stomach and intestine

According to a study, CBD may help lower blood sugar levels by [16]:

• Lowering insulin resistance and making adipose or fat cells more sensitive to insulin
• Reducing low-grade chronic inflammation, which increases a cell’s insulin resistance

Taking them at the same time might amplify their blood sugar-lowering effects. This can make you feel dizzy, lightheaded, and irritable. It’s also common to develop a headache from a sudden drop in blood sugar.

Their combined effects might also worsen their common adverse reactions. These include [7,14]:

• GI upset like diarrhea or constipation
• Nausea
• Dizziness or lightheadedness
• Fatigue
• Decreased appetite

Of note, no formal study has yet been conducted to examine the effects of the two drugs when taken together. We still lack research on CBD’s interaction with antidiabetes drugs.

However, both compounds can interact with the liver enzymes. This effect can potentially affect your other medications.

Drug Interactions of CBD and Metformin with Other Meds

CBD and metformin inhibit the CYP3A4 enzyme [3,17]. CYP3A4 is a part of the cytochrome P450 liver enzymes. It metabolizes and breaks down almost 50% of the medications we’re taking [13]. This includes blood pressure medications like calcium channel blockers and other drugs such as anxiolytics and blood thinners. For example, CBD’s interaction with Coumadin may increase its anticoagulant effects. This can result in bleeding problems [1].

If you’re on these drugs, know that CBD and metformin may boost their concentrations in your body. This can increase the risk of toxicity. Not only will they stay longer in the system, but their effects (and even side effects) may also last longer. It may take your body longer to process and eliminate them.

They may also cause the opposite effect and decrease the drug concentration. This means losing some of its potency, with the medication becoming subtherapeutic. Ultimately, you won’t get the same expected results from the drug. It won’t effectively control your symptoms or delay disease progression.

We always recommend speaking with your doctor before adding CBD to your regimen. It’s better to exercise caution when changing your treatment routine, as soem drugs may interact with metformin and CBD.

Can CBD Oil Help With Diabetes?

Yes, CBD has many properties that may help with diabetes. As mentioned earlier, it can lower fasting blood sugar levels in several ways.

CBD also works on the endocannabinoid system (ECS). Its activation may benefit people with diabetes by [6]:

• Regulating food intake
• Promoting energy homeostasis
• Helping reduce weight
• Controlling A1c levels
• Reducing inflammation
• Acting as an antioxidant

One case study showed CBD may have helped keep a diabetic patient’s A1C level and weight stable despite discontinuing his insulin degludec [6]. The patient was on metformin twice daily when he replaced insulin degludec with CBD. He noted no adverse effects like hypoglycemia on both compounds. His A1C level also remained relatively stable. This level would have spiked when he discontinued his degludec.

Research shows CBD’s anti-inflammatory effects can help reduce diabetic complications. One of these is atherosclerosis [10]. High blood sugar and cholesterol levels can lead to atherosclerosis. As the arteries thicken and harden, they prevent blood from flowing properly. They also increase plaque buildup along the artery’s lining. These contribute to an increased risk of stroke and heart attacks.

CBD is also a neuroprotective agent that may help with diabetic retinopathy [5]. The high sugar levels damage the retina’s blood vessels, causing visual problems. CBD works by reducing retinal inflammation and protecting healthy neurons.

A study done on mouse models found that CBD helped reduce insulitis [6]. Insulitis is a condition caused by inflammation of the islets of Langerhans. These endocrine tissues not only regulate blood sugar levels but also produce insulin. According to the study, CBD’s anti-inflammatory effect decreased cytokine production. It also delayed the progression of destructive insulitis.

Another study on mice found that a daily dose of 5 mg/kg of CBD for ten weeks lowered their chances of getting diabetes. The study suggests CBD may help decrease pancreatic inflammation [4].

People with long-term diabetes have a higher risk of chronic cerebral hypoperfusion comorbidities. The reduced cerebral blood flow affects several cognitive functions like memory. A study showed that CBD reduced neuroinflammation and improved cognitive functioning of diabetic rats with chronic cerebral hypoperfusion [11].

CBD also promotes fat-browning, says a study published in the Molecular and Cellular Biochemistry Journal [9]. Brown fat is a good kind of fat that takes up less space, burns energy, and keeps us warm. Higher brown fat levels are associated with improved metabolic profiles.

Please note that most CBD and diabetes studies were done on animal models. Its effects on animals may not necessarily be the same on humans. We need more human studies to determine CBD’s safety and efficacy for diabetic people.

Can I Take CBD and Metformin Together?

The case study mentioned earlier suggests it’s safe to take CBD and metformin together [6]. The patient was on 1000mg of metformin and 18mg of CBD twice daily. He didn’t notice any significant side effects while on both.

He did have an episode of hypoglycemia, but he associated it with his indulin degludec use. It’s one of the reasons why he discontinued degludec and switched to CBD.

If you decide to take CBD and metformin together, try spacing out their doses to reduce side effect risks. Better yet, only take CBD together with metformin under the guidance of a physician. This is especially important if you’re also on maintenance or prescription medication.

Can I Replace Metformin With CBD?

Again, there’s no straightforward answer to this question. CBD does have health benefits. It would also seem like a good alternative to avoid metformin-associated lactic acidosis risk. It’s a rare metformin side effect that causes a buildup of lactic acid in the blood. Anecdotally, some people benefited from switching to CBD from metformin. Some also controlled their diabetes by taking CBD with metformin with no ugly side effects [6].

But whether CBD can stand alone as a treatment for diabetes remains to be seen. We have very limited data on CBD for diabetes treatment. We suggest seeking advice from a medical professional before replacing metformin with CBD.

Are There Limitations to Using CBD for Blood Glucose Control?

The most significant limitation to using CBD for diabetes is individual differences in endocannabinoid systems. People can respond differently to the effects of CBD. One person may have a drastic lowering of blood sugar levels after CBD, which can be dangerous. Another might improve on CBD, while one might experience no effect at all.

Remember, there’s no Recommended Daily Intake (RDI) for CBD yet. It’s mostly trial and error and finding your sweet spot. If you’re going to use CBD for diabetes, monitor your blood sugar levels and record how your body reacts to CBD.

Stephan De Rouck, M.D. also warns of the potential effects of improper CBD use. He points out it can increase the risk of medication non-adherence [6]. Favoring CBD instead of guideline-recommended diabetes therapy may pose health risks to diabetics. Those with uncontrolled diabetes have the highest risk.

He also cautions that CBD may increase intraocular pressure. This can be detrimental to people with glaucoma [1].

We should also note CBD hasn’t received any FDA approval for diabetes management, says Dr. De Rouck. There are only about two FDA-approved cannabis-based products in the market. And both are not used for diabetes treatment [15].

One of them is Nabiximols. An oromucosal spray, Nabiximols makes use of the whole cannabis plant, not just CBD. With a ratio of 1:1 THC to CBD, it’s given for chronic pain and spasticity caused by multiple sclerosis. Unfortunately, this isn’t available in the US yet, only in the UK and Canada.

The only cannabis-based medicine available in the US is Epidiolex. Although it’s a CBD-only medicine with no traces of THC, it’s mainly used for epilepsy and seizure, not diabetes.

When the 2018 Farm Bill passed, CBD became widely available to US residents. This law legalized industrial hemp and all its parts (including CBD and other cannabinoids) as long as its THC content falls under 0.3% on a dry weight basis.

This, of course, caused another issue. CBD’s popularity led to the proliferation and widespread availability of substandard products. Using such products can put your health at risk.

How to Use CBD and Metformin Together

We suggest taking CBD and metformin at least a couple of hours apart. This way, you avoid their adverse effects. You also reduce the risk of these compounds affecting your other prescription drugs.

Find Your “Sweet Spot”

You have to do some trial and error to find a CBD dose that works for you. The rule of thumb in CBD dosing is to take 1mg (for milder symptoms) to 6mg (for more severe symptoms) of CBD per 10 pounds of body weight. To be safe, we suggest taking a low-dose CBD at first. You’ll need to stay on that dose for at least three days. If you see no changes, then increase the dose.

Keep Notes

Keep records of the CBD doses and how you reacted to them. Be sure to keep track of your blood sugar measurements as well. This makes it easier for you to monitor your progress and symptoms.

Remember, it can take some time for the body to adjust to CBD. You’ll sometimes need to adjust your dose several times before you find one that works well for you.

If you develop adverse reactions, stop CBD and get in touch with your doctor. Watch out for any hypoglycemia symptoms as well. These include:

• Headaches and nausea
• Extreme hunger
• Shakiness and fatigue
• Breaking out in cold sweats
• Irregular or fast heartbeats

Coordinate with Your Physician

Consult your doctor before starting CBD for diabetes. This also includes any chronic medical condition, for that matter. This is especially important if you have uncontrolled diabetes. Your doctor can help you find the right dosage for your symptoms. He can also help you monitor your health, especially your glycemic and lipid parameters.

Tips for Choosing CBD for Diabetes

Not all CBD oils are created equally. Always get your CBD products from trustworthy brands that offer organic CBD. See to it that its CBD comes from industrial hemp with no more than 0.3% THC.

Choose Lab-Tested CBD Oils

Look for companies that provide third-party testing. Ensure, too, that their CBD product comes with a certificate of analysis. Check if the product is accurately labeled and dosed.

Read Customer Feedback

Read reviews made by customers. Don’t just rely on the feedback found on the brand’s website. Instead, visit other sites and forums. Check out the brand’s social media pages and see what customers say about them.

CBD and Metformin: Final Thoughts

Metformin is a prescription drug for diabetes treatment. Although it may cause some side effects, most users say the benefits outweigh the risks.

CBD also has the potential to help regulate insulin levels through its action on the endocannabinoid system. Studies also show it may help lower insulin resistance.

Due to CBD’s health benefits, there’s an interest in combining it with metformin or replacing metformin entirely. If you want to try this route, we recommend practicing caution as they may interact with each other and may produce unwanted side effects.

Should you take CBD while taking metformin?

To be safe, we suggest consulting your doctor before using CBD, especially if you’re taking a prescription medication like metformin. Drug interactions with blood pressure drugs and blood thinners should also be considered.

More work is needed to determine whether CBD is an effective stand-alone treatment for diabetes, but it appears to have great potential.

References:

1. CBD & Diabetes | ADA. (2023). [1]
2. Julia, N. (2023, January 9). Diabetes statistics: Facts & latest data in the US (2023 Update) – CFAH. CFAH. [2]
3. Krausová, L., Stejskalová, L., Wang, H., Vrzal, R., Dvořák, Z., Mani, S., & Pávek, P. (2011). Metformin suppresses pregnane X receptor (PXR)-regulated transactivation of CYP3A4 gene. Biochemical Pharmacology, 82(11), 1771–1780. [3]
4. Lehmann, C., Fisher, N. B., Tugwell, B., Szcześniak, A., Kelly, M. E., & Zhou, J. (2017). Experimental cannabidiol treatment reduces early pancreatic inflammation in type 1 diabetes. Clinical Hemorheology and Microcirculation, 64(4), 655–662. [4]
5. Liou, G. I. (2010). Diabetic retinopathy: Role of inflammation and potential therapies for anti-inflammation. World Journal of Diabetes, 1(1), 12. [5]
6. Mattes, R. G., Espinosa, M. L., Oh, S. S., Anatrella, E. M., & Urteaga, E. M. (2021). Cannabidiol (CBD) use in Type 2 diabetes: a case report. Diabetes Spectrum, 34(2), 198–201. [6]
7. Metformin: MedlinePlus drug information. (2023). [7]
8. Nasri, H. (2014, July 1). Metformin: Current knowledge. PubMed Central (PMC). [8]
9. Parray, H. A., & Yun, J. W. (2016). Cannabidiol promotes browning in 3T3-L1 adipocytes. Molecular and Cellular Biochemistry, 416(1–2), 131–139. [9]
10. Rajesh, M., Mukhopadhyay, P., Bátkai, S., Haskó, G., Liaudet, L., Drel, V. R., Obrosova, I. G., & Pacher, P. (2007). Cannabidiol attenuates high glucose-induced endothelial cell inflammatory response and barrier disruption. American Journal of Physiology-heart and Circulatory Physiology, 293(1), H610–H619. [10]
11. Santiago, A. N., Mori, M., Guimarães, F. S., Milani, H., & De Oliveira, R. M. W. (2018). Effects of cannabidiol on diabetes outcomes and chronic cerebral hypoperfusion comorbidities in Middle-Aged rats. Neurotoxicity Research, 35(2), 463–474. [11]
12. Saydah, S. H. (2018, August 1). Medication use and Self-Care practices in persons with diabetes. Diabetes in America – NCBI Bookshelf. [12]
13. Shannon, M. (2007). Drug interactions. In Elsevier eBooks (pp. 97–104). [13]
14. Substance Abuse and Mental Health Services Administration: Cannabidiol (CBD) – Potential Harms, Side Effects, and Unknowns. Publication No. PEP22- 06-04-003. Rockville, MD: National Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services Administration, 2023.[14]
15. Urits, I., Borchart, M., Hasegawa, M., Kochanski, J., Orhurhu, V., & Viswanath, O. (2019). An update of current Cannabis-Based Pharmaceuticals in pain medicine. Pain and Therapy, 8(1), 41–51. [15]
16. Wiciński, M., Fajkiel-Madajczyk, A., Kurant, Z., Gryczka, K., Kurant, D., Szambelan, M., Malinowski, B., Falkowski, M., Zabrzyński, J., & Słupski, M. (2023). The Use of Cannabidiol in Metabolic Syndrome—An Opportunity to Improve the Patient’s Health or Much Ado about Nothing? Journal of Clinical Medicine, 12(14), 4620. [16]
17. Yamaori, S., Ebisawa, J., Okushima, Y., Yamamoto, I., & Watanabe, K. (2011). Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol: Role of phenolic hydroxyl groups in the resorcinol moiety. Life Sciences, 88(15–16), 730–736. [17]
18. Zheng, J., Woo, S. L., Hu, X., Botchlett, R., Chen, L., Huo, Y., & Wu, C. (2015). Metformin and metabolic diseases: a focus on hepatic aspects. Frontiers of Medicine, 9(2), 173–186. [18]
19. Zhu, J., & Peltekian, K. M. (2019). Cannabis and the liver: Things you wanted to know but were afraid to ask. Canadian Liver Journal, 2(3), 51–57. [19]