CBD for athletes: what you should know about cannabidiol
Chronic use of over-the-counter painkillers (such as ibuprofen) poses a greater health risk than previously known; for example, the US is currently in the midst of an epidemic of opioid addiction and subsequent overdose that kills tens of thousands of Americans each year. In such a situation, athletes are rightly interested in the potential use of cannabidiol (CBD) for pain relief and reduction of inflammatory processes without the risks associated with opioids.
Is it legal for athletes to use CBD?
Yes. Since the beginning of 2018, the World Anti-Doping Agency (WADA) has removed CBD from the list of banned substances - in or out of competition. There is an important caveat: ONLY CBD has been removed from the list of banned substances. The psychoactive component of marijuana, THC, is still banned in competition, as are synthetic cannabinoids. The specific wording is: "All natural and synthetic cannabinoids are banned, such as those contained in hemp (hashish, marijuana) and cannabis products. Natural and synthetic tetrahydrocannabinols (THC), synthetic cannabinoids that mimic the effects of THC, are prohibited. Except cannabidiol."
Interestingly, WADA has set the limit for THC at 150 nanograms per millilitre of urine, which is considerably more lenient than the previous limit of 15 nanograms per millilitre. The higher limit is designed to reduce the risk of an athlete testing positive due to accidental use out of competition. In an article published in USA Today in 2016, WADA spokesman Ben Nichols was quoted as saying: "Our information suggests that in many cases the use is not during competition or on competition day. The new cut-off level is an attempt to ensure that use is detected during competition and not in the days and weeks leading up to competition."
As for legality outside of sport, that's a whole other issue. The laws around cannabis and related products are constantly evolving. So read the current laws and regulations.
CBD basics
Athletes can legally use cannabidiol, but what does it actually do and why take it? Let's start with the fact that cannabinoids already exist in your body. Scientists have discovered the existence of the endocannabinoid system (ECS), which modulates the activity of neurons. Cannabidiol (CBD) is a phytocannabinoid that occurs naturally in the cannabis plant. Unlike THC, which is also found in cannabis, CBD is not psychoactive. In addition, understanding how the ECS works and how CBD affects it is still under research.
In the nervous system, two endocannabinoids are produced in postsynaptic neurons and released into the synapse. They bind to CB1 and CB2 receptors on the presynaptic neuron and act by inhibiting the release of certain neurotransmitters. For example, when CBD is used to treat epilepsy, it can reduce seizure activity by partially limiting the accumulation of glutamate, an excitatory neurotransmitter.
CB1 receptors are found in the brain, spinal cord and other tissues. CB2 receptors are also found, but more are found in tissues of the immune system. CBD binding to CB1 receptors has a greater effect on the central nervous system, and CBD binding to CB2 receptors has a greater effect on dampening inflammation.
The primary purpose of the ECS seems to be to maintain homeostasis, which is done by keeping neurotransmitter levels under control. The use of CBD can be thought of as supplementing or enhancing the activity of the body's existing endocannabinoid system.
The athlete puts more stress on the body, leading to more pain and inflammation than the endocannabinoid system can handle. Adding exogenous CBD can help this overloaded system get the neurotransmitters back under control and help athletes maintain homeostasis.
6 benefits for athletes
Pain relief
Studies have shown that cannabis (mostly THC and, to a much lesser extent, CBD) is effective in relieving pain, including musculoskeletal pain during exercise, and stiff joints. There is little research on CBD alone or cannabis with a 1:1 THC:CBD ratio. Despite the lack of evidence, CBD appears to be effective in relieving pain in many athletes.
Alternative to anti-inflammatory drugs
Athletes have been consuming over-the-counter non-steroidal anti-inflammatory drugs such as ibuprofen for decades, but they may not be as safe as we thought. In particular, endurance athletes are advised to avoid these drugs during long training sessions and competitions due to the increased risk of kidney damage. But even when training and competitions are short, prolonged or frequent use of anti-inflammatory drugs can increase the risk of heart attack and stroke.
Some athletes have found that the pain-relieving effect of CBD can reduce or eliminate the need to take exercise-related painkillers with only minimal side effects. According to The Essentials of Pain Medicine, "There are no documented deaths due to the use of cannabis or cannabis-based products. In a systematic review of studies of cannabis use for various medical conditions, most reports of adverse effects were considered to be non-serious (96.6%)."
Alternative to opioids
According to the CDC, opioid use was linked to more than 42,000 deaths in the US alone in 2016. Painkillers (morphine, codeine, oxycontin) are highly effective in treating pain but pose a significant risk of addiction, overdose and death. Cannabinoids are not as effective as opioids for acute, high-intensity pain relief, but they can be effective for long-term pain management - either alone or in conjunction with other drugs - with much less risk of addiction or sudden death.
Relief of inflammation
Mild inflammation can be beneficial to the athlete and can stimulate positive adaptation to training. However, too extensive inflammation impedes healing and brings pain. There are CB2 receptors in the brain and periphery, but they are more concentrated in immune tissues. Cannabinoids binding to CB2 receptors may have an anti-inflammatory effect by reducing the production of cytokines (cellular messengers). In other words, CBD bound to CB2 receptors helps to suppress the response when the immune system sounds the alarm after a hard workout.
Calm your insides
Inflammation of the small and large intestine causes discomfort and anxiety is one of the main reasons endurance athletes drop out of races. CBD won't solve stomach problems from dehydration and overheating (the two leading causes in athletes), but if you have underlying inflammatory issues that contribute to gut problems during or after exercise, CBD can be effective for relieving symptoms. There are CB1 and CB2 receptors in the colon. Colitis symptoms were inhibited (in mice) when CB1 and CB2 receptors were activated.
Improving sleep quality
Better quality sleep is one of the most effective ways an athlete can achieve better training results. Athletes who consume CBD report falling asleep easier and getting a more restful night's sleep. One possible reason could be the inhibition of adenosine reuptake.
When your brain burns carbohydrates for energy, Adenosine Triphosphate (ATP) is broken down and adenosine gradually builds up in the brain. Greater binding of adenosine to neurons inhibits the release of neurotransmitters, slows brain activity, helps a person feel calmer, and induces sleep. The body metabolizes adenosine when the person is asleep, and a little later, low concentrations of adenosine help wake up and the whole process begins again.
By binding to the same receptors that adenosine would bind to, CBD can inhibit the reuptake of adenosine, helping it to accumulate faster and this makes the athlete feel sleepy sooner. CBD can also have a strong anti-anxiety effect in some people, which can help them sleep and have a more restful sleep.
How to take CBD
New products containing CBD are constantly coming to market. You can take CBD through capsules, pills or in oil form. You can inhale it as a vapour. It's in sports drinks, recovery drinks and all sorts of edibles. There are also creams and lotions that contain CBD oil, as well as tinctures/drops that can be dosed under the tongue. How you consume CBD can affect how quickly its effects take effect. The capsules, oil, and ingestibles must be digested, so the onset may take a little longer. External creams are said to act faster than ingestibles, and sublingual drops/tinctures are said to be the fastest (aside from inhaling the vapor).
CBD is available as "full spectrum" or "isolate". Full-spectrum CBD products contain CBD and other compounds found in the original plant and may include small amounts of THC. If the CBD has been obtained from industrial hemp, the THC content of the original plant should be less than 0,3 %. Products that contain CBD isolate should contain only CBD. CBD isolate and CBD produced from industrial hemp should be a better choice from an anti-doping perspective and also for anyone undergoing zero tolerance drug testing at work (e.g. pilots).
How much CBD to take
This is a topic where things get complicated. There is no standard dose that provides a consistent effect for everyone. CBD products are not well regulated, so there can be inconsistencies in how much CBD a product contains. And depending on how you take CBD (oil, gummy bears, cookies, recovery drinks, tinctures, vapor), it can be difficult to dose it accurately. The most accurate way to consume CBD is probably through capsules or by calculating how many milligrams of CBD are in a given volume (i.e., 1 milliliter) of tincture. Companies that manufacture and sell CBD products recommend starting with a low dose and gradually increasing it based on the effects you notice.
Conclusion and Warning
Cannabidiol could provide a turning point in how athletes recover from training stress and manage occasional and chronic pain. The huge, glaring caveat is that right now, the use of CBD and the way it is delivered is far ahead of science and its research. There is still much to learn about how CBD works and how to best use it in athletes. However, this is not uncommon. When carbohydrate-rich sports drinks first emerged, it was clear that they helped improve performance, although the patterns of use were not perfect and the mechanisms of action were unknown.
Although it is not a banned substance for athletes in or out of competition, there is a potential risk to them if the product they purchase does not contain what it says on the label. If it does indeed contain a significant amount of THC or other prohibited substance, there is a risk of a doping violation. As with anything else, it's about testing and finding a reputable brand.
With what we currently know, CBD offers good potential benefits and few risks. If it improves recovery as a pain reliever, counteracts inflammation and aids sleep, it has great potential to improve athletic performance. And if it gets athletes to reduce their consumption of opioids and prescription sleep aids, that's an even bigger win.
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