CBD Gummies Explained: How They Work, Benefits and Side Effects

CBD gummies are the format most first-time buyers in India reach for, and it is easy to see why: they look familiar, taste pleasant, need no dropper and come with a number printed on the pack that seems to tell you exactly what you are taking. What the pack rarely explains is how slowly a gummy works, how little of the cannabidiol (CBD) you swallow actually reaches your bloodstream, what "broad spectrum" means, or how thin the human research still is. This guide covers those basics in plain English, so that you can read a label, read a lab report and have a sensible conversation with a doctor before you spend your money.

This is the foundation piece in our edibles series. If you already understand the basics and want brand comparisons and a buying checklist, go straight to our complete buyer's guide to edible gummies in India. If you are starting from zero, read on.

What Are CBD Gummies?

A CBD gummy is a chewable sweet, usually made with pectin or gelatin, sugar or a sweetener, flavouring and a measured amount of cannabidiol. CBD is one of more than a hundred cannabinoids found in the cannabis plant. Unlike tetrahydrocannabinol (THC), CBD is not intoxicating: it does not produce the "high" associated with cannabis.

The gummy itself is only a carrier. What matters is the extract inside it, and extracts differ a great deal. Some gummies contain purified CBD and nothing else from the plant. Some contain a hemp extract with several cannabinoids but no THC. Others, including many Indian products made under an Ayurvedic licence, contain a whole Vijaya (cannabis leaf) extract in which CBD and THC are both present. These are three different products with different effects, different legal handling and different risks, even though they may sit on the same shelf in the edibles and gummies collection.

So the first question to ask about any pack is not "how many gummies?" but "what exactly is the extract, and how many milligrams of which cannabinoid are in each piece?"

How Do CBD Gummies Work in the Body?

CBD interacts with the endocannabinoid system, a network of receptors and signalling molecules involved in regulating sleep, mood, appetite and the perception of discomfort. It also acts on several non-cannabinoid targets, including serotonin receptors. Researchers do not yet have a complete picture of how these actions translate into effects that a person can feel, and anyone who tells you the mechanism is fully understood is overselling.

What is well understood is the route a gummy takes. You chew and swallow it. It passes through the stomach into the small intestine, where CBD, which is fat-soluble, is absorbed. From there the blood carries it to the liver before it reaches the rest of the body. The liver breaks down a large share of the CBD on this first pass. This is the single most important fact about any edible form, and it explains almost everything that surprises new users.

Slow Onset and Low Bioavailability: Why a Gummy Is Not Instant

Bioavailability means the fraction of a substance that reaches the bloodstream in active form. For CBD taken by mouth it is low. In a phase I trial of purified oral CBD in healthy volunteers, Taylor and colleagues (2018) described the compound as having low absolute bioavailability because of extensive metabolism in the liver, with one inactive metabolite accounting for the vast majority of drug-related material measured in plasma.

The same trial tells us about timing. After a single oral dose, blood levels of CBD peaked roughly four to five hours later. That figure comes from a pharmaceutical oral solution at doses far above anything in a gummy, so it should not be read as a precise prediction for a sweet. The direction is what matters: swallowed CBD is slow. Many people notice nothing for an hour or more, and the peak may arrive well after that.

Two practical consequences follow.

• Do not take a second gummy because the first "did nothing" after thirty minutes. This is the most common mistake with every edible. With a product that also contains THC, it is the usual reason people end up with an unpleasant experience.
• Effects linger. The trial reported an effective half-life of roughly 10 to 17 hours, so CBD taken in the evening may still be in your system the next morning.

Should You Take CBD Gummies With Food?

Food makes a large difference. In the Taylor trial, taking CBD with a high-fat meal increased peak blood concentration about 4.85-fold and total exposure about 4.2-fold compared with taking it on an empty stomach. Food did not change how long the peak took to arrive.

For a buyer this means the same gummy can behave very differently on different days. A gummy after a ghee-rich dinner and a gummy on an empty stomach before a morning commute are not the same dose in practice. It is neither necessary nor wise to eat a heavy meal in order to "boost" a gummy. The useful lesson is consistency: take it the same way each time, so that you and your doctor can judge what it is actually doing.

Isolate vs Broad-Spectrum vs Full-Spectrum CBD Gummies

These three terms describe what else came along with the CBD when the plant was extracted. They are trade terms, not definitions fixed in Indian law, so always confirm them against the lab report.

Type	What it contains	THC	Who usually considers it	Points to check
Isolate	Purified CBD only	None expected	People who want CBD alone, or who must avoid THC entirely	Lab report should show CBD and no other cannabinoid
Broad-spectrum	CBD plus other cannabinoids and plant compounds	Removed, or below the lab's detection limit	People who want a wider plant profile without THC	Confirm the THC line on the report reads "not detected"
Full-spectrum	The fuller range of plant compounds, including some THC	Present, in an amount that varies by product	People advised by a doctor that a product containing THC is appropriate	THC per piece, prescription requirement, drug-testing and driving implications

You will often read that full-spectrum extracts work better because the compounds act together, sometimes called the entourage effect. It is a reasonable hypothesis with some laboratory support, but it has not been established in well-controlled human trials. Do not pay a premium on that claim alone.

In India, a fourth label is common: Vijaya leaf extract. Products described this way are generally whole-leaf extracts in the Ayurvedic tradition, and they usually contain THC as well as CBD. Our explainer on what Vijaya gummies are covers that category, and the Vijaya leaf page explains the plant's place in Ayurveda.

How to Read a CBD Gummies Label

A well-labelled pack answers five questions without making you guess.

1. Milligrams per gummy. This is the number that matters. A pack may advertise a large total, but the per-piece figure is what you actually take. For example, a pack labelled "1500 mg, 60 x 25 mg" contains sixty gummies of 25 mg each.
2. Milligrams of what. "25 mg CBD" and "25 mg hemp extract" are different statements. An extract figure tells you the weight of the whole extract, not the cannabinoid content. If the label gives only an extract weight, the lab report is the place to find the CBD and THC content.
3. Spectrum and THC. Look for isolate, broad-spectrum, full-spectrum or Vijaya leaf extract, and a stated THC content.
4. Licence and manufacturer. Indian cannabis-leaf products are typically made under an AYUSH manufacturing licence. The licence number, manufacturer's name and address, batch number and expiry date should all be printed on the pack.
5. Other ingredients. Sugar content, gelatin (not vegetarian) or pectin (vegetarian), colours, flavours and any added herbs or melatonin. People managing blood sugar should count the sugar.

Be cautious with packs that give a total with no per-piece figure, name no manufacturer, or make promises about curing an illness. Indian advertising rules do not permit disease-cure claims for these products, and a brand that ignores those rules may be careless elsewhere too.

How to Read a Lab Report (Certificate of Analysis)

A certificate of analysis, or COA, is a test report from a laboratory for a specific batch. A serious brand will share it on request or through a QR code. Four parts deserve your attention.

• Batch number. It should match the batch printed on your pack. A report for a different batch tells you little about yours.
• Cannabinoid profile. This lists CBD, THC and other cannabinoids, usually in mg per gram or mg per unit. Compare the CBD figure with the label claim. A result close to the claim is normal; a large gap in either direction is a warning sign.
• THC content. For a broad-spectrum or isolate product this should read "not detected" or "below the limit of quantification". For a full-spectrum or Vijaya product, note the actual amount per gummy.
• Contaminants. Cannabis plants readily take up what is in the soil. Look for results on heavy metals (lead, arsenic, cadmium, mercury), pesticide residues, residual solvents from extraction, and microbial contamination. Each should show a pass or a value below the stated limit.

Also check who performed the test. An independent, accredited laboratory carries more weight than an in-house result. If a seller cannot produce any report at all, treat the milligram figure on the pack as unverified.

CBD Gummies Benefits: What Human Research Actually Shows

Most marketing around CBD gummies benefits runs well ahead of the evidence. It helps to separate what has been studied in people from what has only been seen in cells or animals. Note, too, that almost none of the human research used gummies. It used oils, capsules or pharmaceutical solutions, often at doses much higher than a typical gummy provides.

Sleep

The evidence is mixed and currently weak. In a randomised, placebo-controlled pilot trial, Narayan and colleagues (2024) gave 150 mg of CBD nightly for two weeks to adults with moderate to severe insomnia, with 15 people in each group. Insomnia severity, time taken to fall asleep and time awake after falling asleep did not differ from placebo. The CBD group did report greater well-being, and showed better objective sleep efficiency at the end of the two weeks. The authors concluded that CBD was similar to placebo on most sleep outcomes and called for larger trials.

That is an honest summary of where the science stands: CBD may help some people feel better about their rest, but it has not been shown to work as a reliable sleep aid. If poor sleep is your main concern, a doctor can help you look for the cause, and you can see what is available in the Vijaya for sleep collection once you have that advice.

Anxiety and stress

Here the early signals are more encouraging, but the quality of evidence is limited. Shannon and colleagues (2019) reviewed the records of 72 adults at a psychiatric clinic who were given CBD alongside usual care. Anxiety scores fell within the first month in 79.2 per cent of patients and stayed lower. Sleep scores improved in 66.7 per cent in the first month but fluctuated afterwards.

This was a case series with no placebo group. People who expect to feel calmer often do, and the study design cannot separate that from a real effect. The authors themselves said controlled trials were needed. Small experimental studies of single CBD doses before a stressful task exist, but long-term controlled data in anxiety disorders remain sparse. CBD should not be seen as a substitute for treatment prescribed by a psychiatrist or physician. Products that people commonly ask about are grouped in the Vijaya for anxiety collection.

Discomfort and pain

This is the weakest area for CBD on its own. Much of the human research on cannabinoids and pain used preparations that combine THC with CBD, so the results cannot simply be credited to CBD. Controlled trials of CBD alone for pain are few, small and inconsistent. Many users report that it helps them, and that experience is worth discussing with a doctor, but it is not the same as proof. The Vijaya for pain collection lists products in this category, several of which contain THC and need a prescription.

CBD Gummies Side Effects

CBD is generally well tolerated at the modest amounts found in consumer products, but "natural" does not mean free of side effects.

Chesney and colleagues (2020) pooled twelve randomised trials with 803 participants. Compared with placebo, CBD was associated with decreased appetite, diarrhoea and sleepiness. The sleepiness finding came mainly from childhood epilepsy trials, where CBD was taken with other medicines such as clobazam and sodium valproate. When those studies were set aside, diarrhoea was the only adverse effect clearly linked to CBD.

Effects that users commonly report include:

• Drowsiness or tiredness, particularly at higher amounts or with other sedating substances
• Loose stools, stomach upset or a change in appetite
• Dry mouth
• Light-headedness

If the gummy contains THC, the list is longer and includes impaired coordination, a racing heart, anxiety and altered perception. Our Vijaya leaf extract side effects guide covers these in detail.

CBD and the liver

Raised liver enzymes are the most important laboratory finding linked to CBD. In a randomised trial published in JAMA Internal Medicine, Florian and colleagues (2025) gave healthy adults 5 mg of CBD per kg of body weight per day for 28 days. Liver enzyme levels rose to more than three times the upper limit of normal in 5.6 per cent of the CBD group and in none of the placebo group. The elevations reversed after CBD was stopped.

That dose is considerably higher than one or two typical gummies a day, and no symptoms of liver injury are implied by the finding. Still, it is the reason people with liver disease, heavy alcohol use or medicines that affect the liver should speak to a doctor first, and why long-term daily use deserves medical oversight.

Drug Interactions: Medicines That May Not Mix With CBD

CBD is broken down by liver enzymes in the cytochrome P450 family, and it can also slow those enzymes down. Many common medicines depend on the same enzymes. Taking CBD alongside them may raise or lower the level of the other medicine in your blood.

Groups of medicines that call for particular caution include:

• Sedatives and sleep medicines, including benzodiazepines, some antihistamines and opioid pain medicines. Drowsiness may add up. Alcohol belongs on this list as well.
• Anti-seizure medicines such as clobazam and valproate. Interactions with these are the best documented.
• Blood thinners such as warfarin. Interactions have been reported, and a change in clotting control can be serious.
• Medicines that affect the liver, and medicines with a narrow safe range where small changes in blood level matter, such as some immunosuppressants and heart-rhythm medicines.

This list is not complete. If you take any regular prescription medicine, show your doctor the exact product and its lab report before you start, and never stop or reduce a prescribed medicine because you have begun taking gummies. You can speak to a panel doctor who is familiar with these products.

Who Should Avoid CBD Gummies?

Some people should not use CBD gummies, or should use them only if a doctor specifically advises it.

• Pregnant or breastfeeding women. Safety has not been established, and cannabinoids can cross to the baby.
• Anyone under 18. These products are for adults only.
• People with liver disease or raised liver enzymes.
• People taking interacting medicines, especially those listed above.
• People with a history of psychosis or serious psychiatric illness, particularly where a product contains THC.
• Anyone who needs to drive or operate machinery and feels drowsy. Do not drive if a product makes you sleepy, and do not drive at all after a product that contains THC.
• People subject to drug testing. Full-spectrum and Vijaya products contain THC, and even small amounts may show up on a test.

Keep gummies away from children. They look and taste like ordinary sweets, and a child cannot tell the difference. Store them in the original container, out of sight and out of reach, ideally locked away, and never leave a pack in a bag, on a bedside table or in the fridge door. If a child swallows a cannabis product, seek medical help immediately.

CBD Gummies vs CBD Oil vs Capsules

The CBD gummies vs CBD oil question comes up in almost every consultation. None of the three formats is "stronger" by nature. They differ in convenience, flexibility and cost.

Feature	Gummies	Oil or tincture	Capsules
How it is taken	Chewed and swallowed	Drops held under the tongue or swallowed	Swallowed whole
Onset	Slow; goes through digestion and the liver	May be somewhat faster if held under the tongue, though human data are limited; slow if swallowed	Slow; similar to gummies
Duration	Several hours	Several hours	Several hours
Dosing precision	Fixed amount per piece; hard to take less than half a gummy	Adjustable drop by drop; needs care with the dropper	Fixed amount per capsule; cannot be split
Taste	Sweet and flavoured	Earthy and often bitter	None
Portability	Easy; can soften or melt in Indian summer heat	Glass bottle; may leak	Easy and heat-stable
Sugar	Usually contains sugar	None	None
Cost per mg	Often higher	Often lower in larger bottles	Varies

In short, gummies suit people who value convenience and a fixed, repeatable amount. Oils suit people whose doctor wants to adjust the amount in small steps. Capsules suit people who want no taste and no sugar. For a deeper comparison, see our guide to Vijaya oil versus gummies, or browse the CBD oil collection for the alternatives.

Are CBD Gummies Legal in India?

India has no single statute written specifically for CBD. The legal position comes from three sets of rules read together.

The NDPS Act, 1985. The Narcotic Drugs and Psychotropic Substances Act defines cannabis as the resin (charas) and the flowering or fruiting tops of the plant. It excludes the seeds and leaves when they are not accompanied by the tops. This exclusion is why leaf-based preparations fall outside the Act's definition of cannabis, while resin and flower remain prohibited outside licensed medical and scientific use.

The AYUSH route. Vijaya is a recognised ingredient in classical Ayurvedic texts. Medicines containing cannabis leaf extract are manufactured under licences issued by state AYUSH licensing authorities under the Drugs and Cosmetics Act, 1940. Because Vijaya appears in the schedule of ingredients that must be used under medical supervision, many of these products are sold only against a prescription from a registered practitioner. This is the route most cannabinoid gummies in India take, and it is why reputable sellers ask for a prescription before dispatch.

The FSSAI hemp notification. In November 2021 the food regulator recognised hemp seed, hemp seed oil and hemp seed flour as food. The same notification set tight limits on THC and CBD content in those foods and does not allow nutrient or health claims about CBD. In other words, it opened the door to hemp-seed nutrition products, not to CBD-rich sweets sold as ordinary food.

Put together: a CBD or Vijaya gummy sold in India should come from a licensed manufacturer, carry its licence details and, where the product requires it, be supplied against a valid prescription. State excise rules also differ. For product-specific detail, read our explainer on how the NDPS Act and AYUSH rules apply to gummies, and if you travel, our guide on carrying gummies on a flight in India. This section is general information, not legal advice.

How Much Do CBD Gummies Cost in India?

Prices depend on total cannabinoid content, extract type and brand. Among the products featured in this article, gummy packs sit between ₹3,600 and ₹4,720, and CBD oils run from ₹2,799 for a 10 ml bottle to ₹8,260 for a 30 ml bottle.

Pack price alone is a poor guide. Cost per milligram is the fairer comparison, and you can work it out from the label:

• A ₹4,720 pack of gummies labelled 1500 mg works out to about ₹3.15 per mg, or roughly ₹79 per 25 mg gummy.
• A ₹8,260 oil labelled 5000 mg works out to about ₹1.65 per mg.
• A ₹5,000 oil labelled 1500 mg works out to about ₹3.33 per mg.
• A ₹2,799 oil labelled 500 mg works out to about ₹5.60 per mg.

Two lessons follow. Larger, more concentrated formats usually cost less per milligram, and gummies are not always the expensive option that people assume. Add the cost of a consultation where a prescription is needed. Be wary of prices that seem far too low for the stated strength: without a lab report, a cheap pack may simply contain less than it claims.

How to Choose CBD Gummies: A First-Time Buyer's Checklist

If you are working out how to choose CBD gummies for the first time, go through these steps in order.

1. Be clear about your reason. "General wellness" is vague. A specific concern, such as trouble winding down at night, gives your doctor something to work with.
2. Decide whether THC is acceptable. If you face workplace drug testing, drive for a living or simply do not want any intoxicating effect, choose isolate or broad-spectrum and confirm it on the lab report.
3. Check the mg per gummy. A lower-strength gummy gives you more room to adjust than a high-strength one.
4. Ask for the certificate of analysis. Match the batch number, and check the cannabinoid and contaminant results.
5. Check the licence and the seller. Buy from a seller that verifies prescriptions and names the manufacturer.
6. Read the other ingredients. Look at sugar, gelatin and any added actives.
7. Start low, go slow, and confirm with a doctor. Labels state the amount per gummy; the right amount for you depends on your weight, health, other medicines and the product itself. We do not suggest a personal dose here. A doctor consultation is the place for that.
8. Give it time and keep notes. Take it the same way each day, and record what you notice over a couple of weeks before judging it.

For side-by-side brand comparisons, we maintain a separate brand comparison of edible gummies, and the edible gummies buyer's guide walks through the wider category, including hemp edibles.

Products to Consider on THC Store

The six products below cover the main formats discussed in this guide. They are described from their product names only; check each product page and its lab report for full composition, and note that products containing Vijaya or THC may require a prescription.

• Broad Spectrum CBD Gummies - 1500 Mg - 60 x 25 mg - Hemp Hub (₹4,720). A broad-spectrum gummy from Hemp Hub with sixty pieces of 25 mg each, 1500 mg in total. The per-piece figure is stated clearly, which makes it a useful reference point for learning to read a label.
• Medicann Cannabis Leaf Extract 350mg Gummies (₹3,600). A gummy made with cannabis leaf extract from Medicann, with 350 mg stated on the pack. This is a leaf-extract product, not a CBD-only gummy, so check the cannabinoid breakdown and the prescription requirement before ordering.
• Broad Spectrum CBD Oil - 5000 MG - 30 Ml - Hemp Hub (₹8,260). A broad-spectrum oil in a 30 ml bottle labelled 5000 mg. It is the lowest cost per milligram in this list and far more concentrated than a gummy, so it calls for careful measuring.
• Pure CBD Oil Natural 1500mg | 30ml | Cannavedic (₹5,000). A natural-flavour CBD oil from Cannavedic, 1500 mg in 30 ml. It carries the same total as the Hemp Hub gummies, which makes for a direct format comparison. Our Cannavedic brand guide has more on the range.
• Cannarma Full Spectrum Hemp Extract Oil | 500mg 10ml (₹2,799). A full-spectrum hemp extract oil in a small 10 ml bottle labelled 500 mg. It has the lowest pack price here, though not the lowest cost per milligram.
• Full Spectrum Capsules - 10 Pc (₹499). A pack of ten full-spectrum capsules, for those who prefer a format with no taste and no sugar. As a full-spectrum product, expect THC to be present and confirm the content per capsule.

You can see the wider range in the CBD products collection and the prescription category in the Vijaya and medical cannabis collection. If you are unsure which format suits you, book a consultation before you order.

CBD Gummies and THC Gummies Are Not the Same Thing

Search results and shop listings often mix the two, so it is worth being explicit. A CBD gummy made with isolate or broad-spectrum extract is non-intoxicating. A THC or Vijaya extract gummy can be intoxicating, takes just as long to act, and is where most accidental over-consumption happens, because people take more while waiting.

If the product you are considering contains THC, read our guides to Vijaya extract gummy bears and the effects and legal status of Vijaya extract edibles first. These products are intended for supervised wellness use, not for recreational intoxication. Gummies are also only one kind of edible: our guide to CBD and Vijaya chocolate covers another.

Where to Buy and What to Expect on Delivery

Because this article is a primer, we have kept buying logistics short. Our other posts cover them properly:

• Finding and ordering legal gummies near you
• How gummy delivery works across India
• A city example: buying gummies in Bangalore

In general, expect a licensed seller to ask for a prescription where the product needs one, to ship in sealed and labelled packaging, and to be able to share a batch lab report. More background reading is available in the Learning Hub and across the THC Store blog.

Frequently Asked Questions About CBD Gummies

What are CBD gummies used for?

People most often take them hoping for help with winding down, sleep, everyday stress or physical discomfort. Early research gives some support for effects on anxiety, mixed results for sleep and weak evidence for pain when CBD is used alone. They are not a treatment for any disease and should not replace prescribed care.

How long do CBD gummies take to work?

Longer than most people expect. A gummy must be digested and pass through the liver, so many people notice nothing for an hour or more, and blood levels may peak later still. Food, especially a fatty meal, changes how much is absorbed. Wait before deciding a gummy has not worked, and do not take another in the meantime.

Will CBD gummies make me high?

CBD itself is not intoxicating. A gummy made from isolate or broad-spectrum extract should not cause a high. Full-spectrum and Vijaya leaf extract gummies contain THC and can be intoxicating, depending on the amount. The lab report is the only reliable way to know.

Can I take CBD gummies every day?

Some people do, but long-term daily safety data in healthy adults are limited, and a 2025 trial found raised liver enzymes in a small share of participants taking a relatively high daily amount for four weeks. Daily use is best done with a doctor's knowledge, particularly if you take other medicines.

Are CBD gummies addictive?

CBD has not shown the pattern of dependence associated with intoxicating substances in the human research available so far. Products that contain THC are a different matter and can be habit-forming with regular use. In either case, a growing need to take more is a reason to talk to a doctor.

Do I need a prescription for CBD gummies in India?

It depends on the product. Many cannabinoid gummies in India are Ayurvedic medicines containing Vijaya leaf extract and are supplied against a prescription from a registered practitioner. Check the product page, and consult a doctor online if a prescription is required.

The Bottom Line

CBD gummies are a convenient, pre-measured way to take cannabidiol, but they are slow to act, only partly absorbed and supported by research that is still thin. The most useful skills for a first-time buyer are simple: read the milligrams per gummy, confirm the extract type and THC content on a batch lab report, understand that Indian products often need a prescription, and tell your doctor about every medicine you take.

When you are ready to compare specific products and brands, continue with our guide to cannabis and hemp edible gummies in India.

Sources & References

1. Taylor L, Gidal B, Blakey G, Tayo B, Morrison G. A Phase I, Randomized, Double-Blind, Placebo-Controlled, Single Ascending Dose, Multiple Dose, and Food Effect Trial of the Safety, Tolerability and Pharmacokinetics of Highly Purified Cannabidiol in Healthy Subjects. CNS Drugs. 2018;32(11):1053-1067. https://pmc.ncbi.nlm.nih.gov/articles/PMC6223703/
2. Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. The Permanente Journal. 2019;23:18-041. https://pmc.ncbi.nlm.nih.gov/articles/PMC6326553/
3. Narayan AJ, Downey LA, Rose S, Di Natale L, Hayley AC. Cannabidiol for moderate-severe insomnia: a randomized controlled pilot trial of 150 mg of nightly dosing. Journal of Clinical Sleep Medicine. 2024;20(5):753-763. https://pmc.ncbi.nlm.nih.gov/articles/PMC11063694/
4. Chesney E, Oliver D, Green A, et al. Adverse effects of cannabidiol: a systematic review and meta-analysis of randomized clinical trials. Neuropsychopharmacology. 2020;45(11):1799-1806. https://pubmed.ncbi.nlm.nih.gov/32268347/
5. Florian J, et al. Cannabidiol and Liver Enzyme Level Elevations in Healthy Adults: A Randomized Clinical Trial. JAMA Internal Medicine. Published online 7 July 2025. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2836271