This article was written by Yigal Kotin
Athletes are known to put considerable strain on their bodies, and the effects of this can be both beneficial and detrimental. While training stress can result in physical adaptation and improved performance, it can also cause physical trauma, prolonged wear and tear, and associated pain and injury. The existing methods for treating pain are effective, but they can also be associated with unwanted side effects.
Chronic use of over-the-counter pain relievers (ie NSAIDs like ibuprofen and naproxen sodium) is a major health risk, and we are in the midst of an opioid addiction epidemic. All this leads to tens of thousands of overdose cases per year.
As a result, there is growing interest in the potential use of cannabidiol (CBD) in sports recovery and pain relief.
Many athletes are intrigued by the promise of cannabidiols (CBD) to relieve pain and reduce inflammation without the risks associated with NSAIDs or opioids.
Is this a realistic possibility?
Is CBD legal for athletes?
Yes. Starting at the beginning of 2018, the World Anti-Doping Agency (WADA) removed CBD from the list of prohibited substances – in competition or out of competition. (Here is the 2020 WADA banned list). The United States Anti-Doping Agency (USADA) has done this, and they provide a “Frequently Asked Questions About Marijuana” page to clarify the rules.
Important to note : Only CBD has been removed from the banned list. Marijuana’s psychoactive ingredient, THC, is still banned in competition, as are synthetic cannabinoids.
The specific wording is: “All natural and synthetic cannabinoids are prohibited, for example: in cannabis (hashish, marijuana) and cannabis products. Natural and synthetic tetrahydrocannabinols (THC). Synthetic cannabinoids that mimic the effects of THC. But: cannabidiol.”
As for legality outside of the sport, that’s another matter entirely. The federal, state and local legality of cannabis and related products is constantly evolving and being updated.
*It is important to check the laws in your area.*
The basics of CBD
First, cannabinoids already exist in your body . Scientists have identified what they call the endocannabinoid system (ECS) that regulates neuronal activity. (9) Cannabidiol (CBD) is a phytocannabinoid found naturally in the cannabis plant. Unlike THC, which is also found in cannabis, CBD is not psychoactive, that is, it does not “get high”.
Within your nervous system, two endocannabinoids (2-AG and EAE) are produced in postsynaptic (downstream) neurons and released into the synapse. They bind to the CB1 and CB2 receptors on the presynaptic (upstream) neuron and act to prevent the release of certain neurotransmitters. For example, when CBD is used to treat epilepsy, it may reduce seizure activity by – among other things – reducing the accumulation of glutamate, an excitatory neurotransmitter.
CB1 receptors are found throughout the brain, spinal cord and other tissues. CB2 receptors are too, but more of them are found in the 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 reducing inflammation.
The main purpose of the ECS appears to be maintaining homeostasis, which is done by maintaining neurotransmitter levels. CBD consumption can be thought of as supplementing or increasing the activity of the existing endocannabinoid system in your body.
As athletes we put more stress on our bodies, which leads to more pain than the endocannabinoid system can handle. Adding exogenous CBD may help this busy system restore your neurotransmitters and help athletes maintain homeostasis.
5 benefits of CBD for athletes
- An alternative to non-steroidal anti-inflammatory drugs (NSAIDs)
Athletes have been taking over-the-counter anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen sodium (Aleve) for decades, but they may not be as safe as we once thought. Especially for athletes who run long distances, it is recommended to avoid NSAIDs during training and long events, because of the increased risk of kidney damage. But even if the training and events are for short or long-term use, the use of NSAID drugs may increase the risk of heart attack and stroke.
Some athletes have found that the pain-relieving effect of CBD can reduce or eliminate their use of NSAIDS for exercise-related pain, with minimal side effects. According to The Essentials of Pain Medicine, 4th edition, “There are no documented deaths from cannabis or cannabinoid products. In a systematic review of studies of oral and mucosal cannabis in various medical conditions, the majority of adverse event reports were considered non-serious (96.6%).”
- Alternative to opioids
According to the CDC, in 2016 opioids were involved in more than 42,000 deaths in the US. Opioid pain medications (ie, morphine, codeine, oxycontin) are very effective for pain management, but they carry a significant risk of addiction and death by overdose. Cannabinoids are not as effective as opioids for acute, high-intensity pain relief (5), but may be effective for long-term pain management—alone or in combination with other drugs—with much less risk of dependence or accidental death.
- Reduce inflammation
A little inflammation can be good for athletes and help induce positive adaptations to training. Too much inflammation delays recovery and impairs performance. There are CB2 receptors both in the brain and in other parts of the body, but they are more concentrated in the immune tissues. Cannabinoids that bind to CB2 receptors may have an anti-inflammatory effect by reducing the production of cytokines (cell messengers). (8) In other words, CBD binding to CB2 receptors helps dial in the response when your immune system sounds the alarm after hard workouts.
- Calming the bowels
Inflammation of the small or large intestine causes great discomfort, and digestive distress is one of the leading reasons why endurance athletes drop out of races. CBD won’t solve stomach problems from dehydration and overheating (two major causes for athletes), but if you have underlying inflammatory issues that contribute to gut problems during or after exercise, CBD may be effective in reducing your symptoms. There are CB1 and CB2 receptors in the colon. Colitis symptoms were inhibited (in mice) when CB1 and CB2 receptors were activated. (8)
- improving the quality of sleep
Sleeping more and better is one of the most effective ways in which an athlete can achieve efficiency in training. Anecdotally, athletes consuming CBD report greater restfulness in their sleep and a more restful night’s sleep. One potential reason for this could be that CBD inhibits the reabsorption of adenosine. (7)
Adenosine triphosphate (ATP) breaks down when your brain burns carbohydrates for energy, and adenosine gradually builds up in the brain. More adenosine binding to neurons inhibits the release of neurotransmitters, slowing brain activity, such a situation helps to feel more relaxed and induces sleep. The body metabolizes adenosine while you sleep, and after a while, low concentrations of adenosine help you wake up and the process starts over.
By binding to the same receptors that adenosine would bind to, CBD may inhibit the reabsorption of adenosine, which helps it build up faster and makes you feel sleepy sooner. CBD may have a strong anti-anxiety effect for some people, which can help them fall asleep and sleep better.
How to use CBD as an athlete?
New products containing CBD hit the market every week. You can ingest CBD via capsules, pills or as an oil. It has been infused into sports drinks, health drinks and all kinds of foods. There are also topical creams and lotions that contain CBD oil, as well as tinctures/drops that can be placed under your tongue.
How you consume CBD may affect how quickly you experience its effects. Capsules, oil and food need to be digested, so the time until you feel their effect may be longer. Topical ointments are said to be faster than edibles, and sublingual drops/solutions are said to be the fastest (apart from vapor inhalation).
CBD is available as “full-spectrum” or “isolate” or “broad-spectrum.” Full-spectrum CBD products contain CBD and other compounds found in the original plant, which can include small amounts of THC. If the CBD is derived from industrial hemp, the THC content of The original plant should by law be less than 0.3% on average. Products containing isolated CBD should only contain CBD. Isolated CBD and CBD produced from the hemp plant would be a better choice, from an anti-drug point of view, for anyone passing drug tests.
What is the recommended dosage for using CBD oil?
This is where things get complicated. There is no standard dose that provides a consistent effect for all people. CBD products are not well regulated, so there can be discrepancies in the amounts of CBD in the product. And depending on how CBD is consumed (oil, candy, cookie, recovery drink, solution, vapor), it can be difficult to be precise. The most accurate way to consume CBD is probably via capsules, or by calculating how many milligrams of CBD are in a given volume (ie 1 milliliter) of solution.
A recommended way is to consult with a therapist/doctor in order to receive treatment-oriented advice.
Companies that manufacture and sell CBD products recommend starting with a low dose and gradually increasing it based on the effects you experience.
Summary and main points of using CBD as an athlete
The advent of cannabidiol (CBD) oil may mark a major turning point in the way athletes recover from training stress and manage occasional and chronic pain.
If so, there is much more to learn about how CBD works and how best to use it with athletes. This is not unusual. Back when carbohydrate-rich sports drinks first came out, it was clear that they helped improve performance even if the formulas weren’t perfect and the mechanisms were unknown.
Although it is not a banned substance for athletes in competition or out of competition, the potential risk to athletes is if the product they buy does not contain what it says on the label. If it does contain a significant amount of THC or another prohibited substance, they will be at risk of violating drug laws. As with anything else, they will have to research and find a reputable brand.
With what we know at this point, CBD offers good potential benefits and few risks. If it improves recovery as an analgesic, anti-inflammatory and sleep aid, then it has great potential to improve athletic performance. And if it causes athletes to reduce their use of nonsteroidal anti-inflammatories, opioids, and prescription sleep aids, those are even bigger wins.
References & Resources
- Booz, George W. “Cannabidiol as an Emergent Therapeutic Strategy for Lessening the Impact of Inflammation on Oxidative Stress.” Free Radical Biology and Medicine , vol. 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-Dependent Volunteers.” Addictive Behaviors , vol. 30, no. 4, 2005, pp. 859–864., doi: 10.1016/j.addbeh.2004.08.019 .
- Filippis, Daniele De, et al. “Cannabidiol Reduces Intestinal Inflammation through the Control of Neuroimmune Axis.” PLoS ONE , vol. 6, no. 12, 2011, doi: 10.1371/journal.pone.0028159 .
- Gorzalka, Boris B., et al. “Regulation of Endocannabinoid Signaling by Stress: Implications for Stress-Related Affective Disorders.” Neuroscience & Biobehavioral Reviews , vol. 32, no. 6, 2008, pp. 1152–1160., doi: 10.1016/j.neubiorev.2008.03.004 .
- Halawa, Omar I., et al. “Role of Cannabinoids in Pain Management.” Essentials of Pain Medicine , 2018, doi: 10.1016/b978-0-323-40196-8.00056-5 .
- Hammell, DC, et al. “Transdermal Cannabidiol Reduces Inflammation and Pain-Related Behaviors in a Rat Model of Arthritis.” European Journal of Pain , vol. 20, no. 6, 2015, pp. 936–948., doi: 10.1002/ejp.818 .
- Murillo-Rodriguez, Eric, et al. “Anandamide Enhances Extracellular Levels of Adenosine and Induces Sleep: An In Vivo Microdialysis Study.” Sleep , vol. 26, no. 8, 2003, pp. 943–947., doi: 10.1093/sleep/26.8.943 .
- Nagarkatti, Prakash, et al. “Cannabinoids as Novel Anti-Inflammatory Drugs.” Future Medicinal Chemistry , vol. 1, no. 7, 2009, pp. 1333–1349., doi: 10.4155/fmc.09.93 .
- Pacher, P. “The Endocannabinoid System as an Emerging Target of Pharmacotherapy.” Pharmacological Reviews , vol. 58, no. 3, 2006, pp. 389–462., doi: 10.1124/pr.58.3.2 .
- Patricia H. Reggio, “Endocannabinoid Binding to the Cannabinoid Receptors: What Is Known and What Remains Unknown”, Current Medicinal Chemistry (2010) 17: 1468. https://doi.org/10.2174/092986710790980005
Xiong, Wei, et al. “Cannabinoids Suppress Inflammatory and Neuropathic Pain by Targeting α3 Glycine Receptors.” The Journal of Experimental Medicine , vol. 209, no. 6, 2012, pp. 1121–1134., doi: 10.1084/jem.20120242 .
