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  • CBD and Sports

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    Dr Ed
    Dr Ed

    THC & Cannabidiol

     Currently, studies looking at the effects of cannabidiol specifically within the context of sports/exercise/fitness are incredibly sparse.

    More evidence surrounds cannabis use in exercise as a whole.  A meta-study of all 17 available cannabis exercise studies conducted in 2017 found that THC does not enhance aerobic exercise or strength.

    There are of course a few caveats here. The first is that there are more measures of fitness or exercise than aerobic efficiency or strength. For example, we could also investigate measures of endurance as well as exercise recovery. Secondly, this meta-study places focus on THC, the psychoactive element of cannabis. Thirdly, when investigating each paper that was analysed as part of this larger meta-study, the route of administration, the dose and even the treatments differ quite largely. Some studies for example asked cohorts to smoke cannabis, others were given oral solutions and so on. Measures of exercise also differ widely ranging from grip strength to step tests.

    One of the main take-aways is that isolated CBD was not given to any participant in any of the 17 studies. There simply isn’t any equivalent literature regarding CBD and exercise. What we do have is either whole-plant or THC-extract studies. This knowledge gap will likely be addressed in the near future due to the growing demand for CBD in the UK.

    As with most things CBD-related, high-quality clinical evidence is currently lacking. What we do have is a growing body of pre-clinical and experimental data as well as a wealth of anecdotal evidence that suggests CBD may be useful in combating health disorders or supporting certain aspects of health.

    The use of CBD in sports and fitness is one of the fastest growing markets outside of pet CBD which we have talked about before. CBD, rather than being promoted as an ergogenic aid i.e. something which enhances more performance, is more commonly promoted as a recovery aid in the form of balms, lotions and muscle rubs. So is there evidence that topical CBD (or even oral perhaps) aids in overall fitness by helping reduce inflammation and aches/pains.

    Potential benefits for athletes

    As mentioned previously, the clinical data surrounding CBD and fitness/sport is lacking. Instead, we can look to the literature surrounding CBD and infer from these results the potential benefits that athletes and fitness enthusiast might gain from CBD.

     

    Pain Relief

    We know from previous work that CBD does appear to be an effective aid in cases of chronic pain and some cases of acute pain which could translate to CBD being useful for athletes during recovery from injury. Multiple rodent studies have shown an analgesic effect of CBD and the limited human studies we have also point towards this.

    This is an area in particular where anecdotal evidence and biological plausibility are the best we have until clinical research catches up. Despite the lack of hard clinical evidence, CBD does appear to relieve pain effectively for many athletes.

     

    A Safer Alternative

    Athletes and sports enthusiasts have been consuming over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen for decade as too do the general population. However, they may not be as safe as thought back when they were approved. Endurance athletes, especially, are often advised to avoid NSAIDs during long training sessions and events, due to increased risk of kidney damage. Athlete or not, long-term or frequent use of NSAIDs may increase your risk for heart attack and stroke.

    Some athletes have found the pain-relieving effect of CBD can reduce or eliminate their use of NSAIDS for exercise-related pain, with minimal side effects. Additionally, toxicology studies suggest CBD is safe and well tolerated even in large quantities.

    “There are no documented deaths from cannabis or cannabinoid-based products. In a systemic review of studies of oral and oral-mucosal cannabis for various medical conditions, the majority of adverse events reports were considered non-serious (96.6%).”

    The Essentials of Pain Medicine, Fourth Ed

    Although opioid-related deaths are much more of an issues in the USA, they do still occur in the UK. Opioid pain medications (i.e. morphine and codeine) are highly effective for pain management but carry a significant risk of addiction and death by overdose. Cannabinoids are not as effective as opioids for relieving acute pain  but may be even more effective for long-term pain management either alone or in conjunction with other medications. This, coupled with a much less serious adverse effect profile makes CBD an exciting prospect for the management of pain.

     

    Inflammation

    Inflammation is a natural response to damage or infection and is a sign of greater blood flow and immune cell presence at the area. In small quantities, inflammation is helpful and a key step in repair but too much inflammation hinders recovery and hurts performance. CBD has fairly potent anti-inflammatory effects based on work conducting using animal models of inflammation (typically thinks like arthritis etc).

    Cannabinoid Receptor 2 is expressed particularly heavily in immune tissues and this receptor may be one of the ways in which cannabinoids like CBD influence immune cell function and inflammation. We know, for example, that CBD modulates the production of TNF-a, an inflammatory cytokine that plays a wide role in the immune/inflammatory response. By dampening production of this molecule, CBD may dampen the extent of inflammation after a particularly rigorous event or training session.

     We also know from various rodent studies that CBD can be absorbed through the skin when prepared in a certain way. This suggests that CBD may potentially be used as a topical lotion to help reduce local inflammation but may also found utility when taken as an oral oil as systemic CBD may target inflammation throughout the body.

     

    Sleep 

    Many trainers, especially in the world of strength training and body building, would argue that quality sleep is as important as good diet when it comes to achieving your best performance. Anecdotally, athletes who consume CBD report greater ease going to sleep and a more restful night’s sleep. One potential reason for this could be CBD inhibiting the reuptake of adenosine as well as its influence on the serotonin system. Rodent studies also show that acute dosing with cannabidiol increases time spent asleep. However, the effects of CBD may be location specific. Microinjections of CBD into the lateral hypothalamus of rodents, an area known to regulate arousal, actually increased alertness and reduced instances of sleep.

    CBDs effects on sleep patterns and sleep in general may be due to adenosine as the endocannabinoid anandamide modulates adenosine levels in the brain to help regulate sleep. A large case study published only this year that involved subjects self-reporting on how CBD application affected their anxiety and sleep showed interesting results, but which should be approached cautiously. While CBD did improve ‘sleep quality’ in the majority of respondents, this fluctuated quite widely after a month of taking the compound.

    As endocannabinoids play a role in the regulation of sleep it is perhaps no surprise that phytocannibinoids also interact with the sleep/circadian system BUT we really do not understand how cannabidiol achieves these effects or if it even does effect sleep directly or just modulates something else that provides a knock on effect.

     

    Legality

    At the beginning of 2018, the World Anti-Doping Agency (WADA) removed CBD from the list of prohibited substances – in or out of competition. This means CBD is not a banned substance for any athlete. An important detail to remember is that only CBD was removed from the list. THC, the psychoactive component of cannabis is still very much a banned substance. This make it incredibly important for athletes to choose a 0% THC brand with independent, clear lab reports to back this claim up.

    If you are interested, the specific wording used in the prohibited substance document is:

    “The following cannabinoids are prohibited: Natural cannabinoids, e.g. cannabis, hashish and marijuana. Synthetic cannabinoids e.g. Δ9-tetrahydrocannabinol (THC) and other cannabimimetics.”

    Legality outside of sports competition is entirely different and can vary from country to country.

     

    Conclusions

    CBD is a well-tolerated and safe compound which has a range of purported health benefits, each supported to differing degrees by the literature. Some reported benefits are utter nonsense others do have a basis in science and fit with our understanding of the endocannabinoid system and human physiology. Of note, CBD does seem to have real effects on mood (anxiety) as well as aspects of pain and inflammation.

    While there is no evidence that CBD is any sort of performance enhancer, athletes and active people may find utility in CBDs anti-inflammatory and analgesic properties.

    If you are thinking of using CBD and are a drug-tested athlete BE VERY CAREFUL about how you proceed. Many brands on the market contain illegal or at least detectable levels of THC in their products which may or may not be openly advertised. Always purchase your CBD from a reputable brand that knows their product inside and out.

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