What athletes need to know about cannabidiol
Athletes put a lot of strain on your body, with positive and negative effects. Training stress stimulates adaptation and performance improvement, but physical trauma and prolonged wear and tear also lead to injuries and pain. Current methods of pain treatment are effective, but they are also fatal. In the search for improved sports recovery and safe pain relief, many people ask for cannabidiol or CBD for athletes. Should you be doing this?
The chronic use of over-the-counter painkillers (i.e. NSAIDs such as ibuprofen and naproxen sodium) poses a greater health risk than previously known, and we are in the middle of an epidemic of opioid dependence and overdoses that kills tens of thousands of Americans every year. In such a landscape, athletes are rightly curious and eager to learn about the promise of cannabidiols (CBDs), pain relief and anti-inflammatory drugs without the risks associated with NSAIDs or opioids.
Are CBD products right for you? There’s a lot to unpack and think about, so make yourself comfortable and read on.
Is CBD legal for athletes?
Yes, at the beginning of 2018 the World Anti-Doping Agency (WADA) has removed the CBD from the list of banned substances – in or out of competition. (Here is WADA’s Prohibited List for 2020.) The US Anti-Doping Agency (USADA) did the same, and it provides a “Marijuana FAQ” page to clarify the rules. There is one important caveat: ONLY the CBD has been removed from the banned list. The psychoactive component of marijuana, THC, is still banned in competition, as are synthetic cannabinoids. The exact wording is: “All natural and synthetic cannabinoids are prohibited, e.g: In cannabis (hashish, marijuana) and cannabis products. Natural and synthetic tetrahydrocannabinoids (THCs). Synthetic cannabinoids that mimic the action of THC. Excluded: cannabidiol”.
Interestingly, WADA has set a urine limit value for THC of 150 nanograms per millilitre, which is much more lenient than the previous limit of 15 nanograms per millilitre. The higher threshold is intended to reduce the risk of an athlete’s test result being positive due to occasional ingestion outside competitions. In a 2016 article in USA Today, Ben Nichols, a WADA spokesman, was quoted as saying: “Our information suggests that in many cases there is no consumption on the day of the match or event. The new threshold is an attempt to ensure that consumption is detected during a competition and not consumed during the days and weeks preceding the competition”.
As far as legality outside sport is concerned, this is a very different matter. The legality of cannabis and related products at federal, state and local level is constantly evolving. Check the laws in your region.
Athletes can legally use cannabidiol, but what is it, what does it do and why should you use it?
First of all, cannabinoids are already present in your body. Scientists have identified what is called the endocannibinoid system (ECS), which modulates the activity of nerve cells. (9) Cannabidiol (CBD) is a phytocannabinoid that occurs naturally in the cannabis plant. Unlike THC, which also occurs in cannabis, CBD is not psychoactive.
In addition, scientists’ understanding of how the ECS works and how the CBD affects it is still developing. For a long time, research in this area was difficult to complete because of the legal status of marijuana. However, based on more recent studies and the fourth edition of The Essentials of Pain Medicine, published in 2018, The Essentials of Pain Medicine, you will find the basics here (5).
Inside your nervous system, two endocannabinoids (2-AG and EAE) are produced in postsynaptic neurons (downstream) and released into the synapse. They bind to the CB1 and CB2 receptors on the presynaptic neuron (upstream) and inhibit the release of certain neurotransmitters. For example, when CBD is used to treat epilepsy, it can reduce seizure activity by – partially – reducing the accumulation of glutamate, an excitatory neurotransmitter.
CB1 receptors are found throughout the brain, spinal cord and other tissues. There are also CB2 receptors, but more of them are found in tissues of the immune system. The binding of CBD to CB1 receptors has a greater effect on the central nervous system
6 benefits of CBD for athletes
Studies have shown that cannabis (mostly THC and far less CBD) can be effective in relieving pain, including musculoskeletal pain during exercise, as well as stiff joints. (5) There is little research on CBD alone or a 1: 1 ratio of THC to CBD. This is an area where anecdotal evidence and biological plausibility are the best we have until research catches up. Despite the lack of hard evidence, CBD appears to be effective in providing pain relief for many athletes.
Alternative to NSAIDs
Athletes have been using over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen sodium (Aleve) for decades, but they may not be as safe as we once thought. Ultra-distance athletes in particular are usually advised to avoid NSAIDs during long training sessions and events due to the increased risk of kidney damage. But even if your workouts and events are short, taking NSAIDs long-term or frequently can increase your risk of heart attack and stroke.
Some athletes have found that the pain relieving effects of CBD can reduce or eliminate the use of NSAIDs for exercise-related pain, with minimal side effects. The Essentials of Pain Medicine, Fourth Ed., States, “There are no documented deaths from cannabis or cannabinoid-based products. In a systematic review of studies of oral and oral cannabis in various diseases, the majority of reports were undesirable Events classified as not serious (96.6%) “.
Alternative to opioids
According to the CDC, opioids were involved in more than 42,000 deaths in the United States in 2016. Opioid pain medication (i.e. morphine, codeine, oxycontin) are very effective in treating pain, but carry a significant risk of addiction and death from overdose. Cannabinoids are not as effective as opioids at relieving acute, high-intensity pain (5), but can be effective for long-term pain management, either alone or in conjunction with other drugs, with a far lower risk of addiction or accidental death.
A little inflammation can be good for athletes and encourage positive training adaptations. Too much inflammation hampers recovery and damages performance. There are CB2 receptors both in the brain and in the periphery, but they are more concentrated in the immune tissues. Cannabinoids that bind to CB2 receptors can have anti-inflammatory effects by reducing the production of cytokines (cell messengers). (8) In other words, CBD bound to CB2 receptors help shut down the response when your immune system sounds the alarm after hard exercise.
Calm your bowels
Inflammation in the small and large intestines causes a lot of complaints, and GI exposure is one of the main reasons endurance athletes drop out of a race. CBD doesn’t solve stomach problems due to dehydration and overheating (two main causes for athletes), but if you have underlying inflammation problems that contribute to bowel problems during or after exercise, CBD can be effective at reducing your symptoms. There are CB1 and CB2 receptors in the large intestine. Colitis symptoms were inhibited (in mice) when the CB1 and CB2 receptors were activated. (8th)
Improve sleep quality
Getting more and better sleep is one of the most effective ways for an athlete to make greater exercise gains. Anecdotes suggest that athletes who consume CBD report falling asleep easier and getting a more restful night’s sleep. One possible reason for this could be the CBD, which inhibits the reuptake of adenosine. (7)
Adenosine triphosphate (ATP) breaks down when your brain burns carbohydrates for energy, and adenosine gradually builds up in the brain. Stronger binding of adenosine to neurons inhibits the release of neurotransmitters, slows brain activity, makes you feel calmer, and leads to sleep. Your body metabolizes adenosine while you sleep, and some time later, low levels of adenosine help you wake up and the process starts all over again.
By binding to the same receptors that adenosine would bind to, the CBD can inhibit adenosine reuptake, which will help the adenosine build up faster and make you feel sleepy sooner. CBD can also have a powerful anti-anxiety effect in some people, which can help them fall asleep and get a more restful sleep.
New products containing CBD hit the market every week. You can take CBD through capsules, pills, or as an oil. It can be inhaled as vapor. It has been poured into sports drinks, recreational drinks, and all kinds of edibles. There are also topical creams and lotions that contain CBD oil, as well as tinctures / drops that can be placed under the tongue.
The way you consume the CBD oil can have an impact on how quickly you experience its effects. Capsules, oil and edibles need to be digested, so it may take a little longer. It is said that topical creams are faster than edibles, and sublingual drops / tinctures are said to be the quickest to work (besides inhalation via vaping).
The CBD is available as “full spectrum” or “isolate”. Full-spectrum CBD products contain CBD and other compounds found in the original plant that may contain small amounts of THC. If the CBD was extracted from industrial hemp, the THC content of the original plant is legally estimated to be less than 0.3% (in Colorado). Products containing CBD isolate should only contain CBD. CBD isolate and CBD isolate made from hemp would be better choices from an anti-doping perspective for anyone who conducts zero tolerance drug testing in the workplace (i.e. pilots).
How Much CBD Should I Use?
This is where things get tricky. There is no one standard dose that works consistently in all people. CBD products are not well regulated, so there may be disagreements about how much CBD is in a product. And depending on how you consume CBD (oil, gummy bears, cookies, recovery drink, tincture, steam) it can be difficult to be specific. Probably the most accurate way to consume CBD is through capsules, or by calculating how many milligrams of CBD are in a given volume (i.e. 1 milliliter) of tincture.
Companies that make and sell CBD products recommend starting with a low dose and gradually increasing it based on the effects you experience.
Conclusion and reservation
The advent of cannabidiol could mark a major turning point in the way athletes recover from exercise stress and manage both occasional and chronic pain. The huge, blatant caveat is that at the moment, the uses of CBD and the way in which it is used is ahead of science. There is still a lot to learn about how CBD works and how it can best be used in athletes. However, this is not unusual. Back when high-carb sports drinks first hit the market, it was clear that they would help improve performance, even if the formulas weren’t perfect and the mechanisms weren’t all known.
While it is not a prohibited substance for athletes in or out of competition, there is a potential risk to athletes if the product you buy does not contain what it says on the label. If it actually contains a significant amount of THC or other prohibited substance, there is a risk of a doping violation. As with anything else, it is up to you to research and find a reputable brand.
With what we know at this point, the CBD offers good potential benefits and few risks. If it improves recovery as a pain reliever, anti-inflammatory, and sleep aid then it has great potential to improve athletic performance. And if it gets athletes to cut back on NSAIDS, opioids, and prescription sleeping pills, then those are even bigger wins.
CEO / Head Coach of CTS
References and resources
Booz, George W. “Cannabidiol as a New Therapeutic Strategy for Alleviating the Effects of Inflammation on Oxidative Stress”. Free radical biology and medicine, Volume 51, No. 5, 2011, pp. 1054-1061., Doi: 10.1016 / j.freeradbiomed.2011.01.007.
Elman, Igor, and Scott E. Lukas. “Effects of Cortisol and Cocaine on Plasma Prolactin and Growth Hormone Levels in Cocaine-Addicted Volunteers”. Addictive Behaviors, Volume 30, No. 4, 2005, pp. 859-864., Doi: 10.1016 / j.addbeh.2004.08.019.
Filippis, Daniele De, et al. “Cannabidiol reduces intestinal inflammation by controlling the neuroimmune axis”. PLoS ONE, Volume 6, No. 12, 2011, doi: 10.1371 / Zeitschrift.pone.0028159.
Gorzalka, Boris B., et al. “Regulation of Endocannabinoid Signaling by Stress: Implications for Stress-Related Affective Disorders”. Neuroscientific and behavioral review articles, Volume 32, No. 6, 2008, pp. 1152-1160, doi: 10.1016 / j.neubiorev.2008.03.004.
Halawa, Omar I., et al. “The role of cannabinoids in treating pain”. Basics of pain m