Athletes bodies undergo immense stress to both positive and negative effect. The purpose of training is to put your body under stress so that it is fatigued and better prepared for the next training session. Training stress is well documented as encouraging adaption and enhancing physical performance; however, trauma and prolonged wear and tear can also result in injuries and chronic pain. Nowadays, many athletes are using cannabidiol (CBD) products for safer pain relief and effective sports recovery therapeutic.
At present, the main treatment for sports-related injuries is non-steroidal anti-inflammatory drugs (NSAIDs) -like ibuprofen- which can be purchased over the counter. Only in recent years has evidence began to emerge on the harmful effects of long-term NSAID use on organ function. There is now an overwhelming amount of data on the adverse effects of NSAIDs, from several placebo-controlled trials and meta-analyses studies, in causing gastrointestinal, cardiovascular, hepatic, renal, cerebral and pulmonary complications. In addition, opioids – like morphine, fentanyl and tramadol-are often prescribed for serious injury and chronic pain (pain lasting longer than 3 months), however, prolonged use of these drugs can lead to opioid dependence and other health issues. According to the World Health Organization (WHO), approximately 0.5 million death is attributable to drug use, globally – with over 70% related to opioids and 30% of those deaths caused by overdose. Hence, it is understandable that CBD is becoming more renowned in the athletic world due to its proven pain-relieving and anti-inflammatory effects.
Can Athletes Legally Use CBD?
Since 2018, CBD has been excluded from the list of prohibited substances by the World Anti-Doping Agency (WADA); although, cannabis, tetrahydrocannabinol (THC) and synthetic cannabinoids that mimic the psychoactive effects of THC remain illegal. This means all CBD products are permitted to use in sport.
The UK Anti-Doping’s position on CBD use is that it is at an athletes own risk. CBD use is regarded in the same light as any other dietary supplements. Therefore, if an athlete chose to use CBD and it led to an Adverse Analytical Finding for THC, their use of the CBD product would not exempt them from fault.
Fundamentals of CBD
In the past decade, a vast amount of literature has been published regarding the body’s endocannabinoid system (ECS) and its role in the regulation of tissue inflammation and pain.
The human body possesses its own naturally occurring cannabinoids. For instance, the nervous system possesses two endocannabinoids ( 2-arachidonoylglycerol (2-AG) and experimental autoimmune encephalomyelitis (EAE)), which are synthesised in postsynaptic neurons and released into the synapse. They bind to CB1 and CB2 receptors in the presynaptic neuron and either stimulate or block the release of particular neurotransmitters.
CBD is a phytocannabinoid which the Cannabis sativa plant naturally produces and which binds to numerous receptors and molecular targets within the body. For example, at elevated concentrations, CBD has been shown to directly stimulate the 5-HT1A (hydroxytryptamine) serotonin receptor, producing an anti-anxiety effect. This G-coupled protein receptor has been linked to numerous biological and neurological processes including anxiety, depression, sleep, pain perception and nausea.
CB1 receptors are located throughout the central nervous system (CNS) and various other tissues. CB2 receptors are also found in the brain and spinal cord, however, the majority of CB2 receptors are located within immune system tissues. Initial studies investigating cannabinoids and the ECS determined CBD binding with CB1 receptors to have the greatest effect in the CNS and CBD binding to CB2 receptors has the most significant effect in reducing inflammation.
The main function of the endocannabinoid system is to maintain homeostasis by regulating neurotransmitter levels. Hence, introducing CBD into your diet could serve as a supplement which enhances the activity of the bodies existing ECS. Training athletes are more prone to suffer pain and inflammation which may result in the ECS struggling to regulate homeostasis, and so, the addition of CBD could potentially aid the ECS in ensuring normal neurotransmitter levels and homeostasis are maintained.
The Main Benefits of CBD for Athletes
Many studies have provided evidence on the therapeutic benefits of CBD ranging from anti-inflammatory to neuroprotective, antipsychotic, analgesic, anticonvulsant, antiemetic, antioxidant, anti-arthritic, and anti-neoplastic properties. The main benefits for athletes are discussed below.
Two notable systematic reviews of cannabis or CBD use in chronic mixed-pain analysed 18 randomised control trials and 11 published clinical trials. Overall, the quality of each trial was excellent. The 29 trials involved approximately 2000 participants in total, with a mean duration of treatment of 2.8 weeks (range 6 hours - 6 weeks). A total of 22 trials showed a significant reduction in pain following CBD treatment, with many also
reporting positive effects in secondary outcomes, such as sleep and spasticity. Any adverse effects were reported as mild and well-tolerated.
Another systematic review has evaluated the benefits and side effects of orally administered CBD and inhaled cannabis for a variety of ailments. Chronic pain was analysed in 28 studies, with a total of 2454 participants who were treated for up to 15 weeks. This review provided preliminary evidence to suggest CBD as an effective therapy for chronic pain management.
The majority of studies highlighting cannabis as a significant agent in reducing pain, including musculoskeletal pain from exercise, have administered mostly THC and far less CBD. In fact, few studies have administered only CBD and so further research is required to fully determine the effects of this cannabinoid in pain relief. Nonetheless, CBD does seem to work for many athletes in reducing pain.
CBD Reduces Inflammation
Moderate levels of inflammation can be beneficial to athletes for encouraging positive training adaptions. However, excessive levels of inflammation are known to interfere with recovery time and can affect an athletes performance. As previously mentioned, the majority of CB2 receptors are located within immune tissues. The anti-inflammatory effect resulting from the binding of CBD to CB2 is thought to occur due to the suppressed production of small proteins, known as cytokines, which are important in cell signalling processes throughout the body. Thus, CBD reduces inflammation by binding to CB2 and reducing the response of the immune system to intense workouts.
CBD Reduces Inflammation of the Gut
Inflammation of the small and large intestine can result in extreme pain and discomfort, with gastrointestinal issues being one of the predominant reasons for endurance athletes to pull out of competitions.
During periods of inflammation, various cellular pathways are activated in the gastrointestinal (GI) tract resulting in a pathological state. CB1 receptors are known to exist in the colon and the amount of CB1-expressing cells has been shown to significantly increase following inflammation. There is evidence of CBD modulating the tissues response to inflammation of the gut and colon, by regulating both dampening smooth-muscular irritation caused by inflammation and inhibiting pro-inflammatory cytokine production, therefore, regulating the cellular pathways responsible for inflammatory responses.
Thus, modulation of the physiological activity of the ECS during inflammation using CBD could be an effective treatment for athletes in reducing gut pain and discomfort during or after exercise sessions.
CBD in Regulating Sleep Patterns
Maintaining a regular sleep pattern is crucial for achieving greater training goals. Nowadays, several athletes use CBD to fall asleep quicker and to have a more restful sleep.
A clinical trial evaluated the acute effects of 300mg of CBD in the sleep patterns of healthy individuals. Overall, CBD did not interfere with the sleep cycle in comparison to individuals using anxiolytic and antidepressant drugs. Individuals administered with CBD also reported falling asleep quicker than usual. One reason for this could be that adenosine triphosphate (ATP) is broken down as the brain uses its carbohydrate supply for energy, leading to adenosine gradually building in the brain. Binding of adenosine to neurons is known to block the release of neurotransmitters, encouraging the body to relax and inducing sleep. As the body sleeps, it metabolises adenosine levels and once levels are significantly decreased, the body is encouraged to wake up. CBD is thought to bind to the same adenosine receptors which block adenosine uptake. This results in increased levels of adenosine in the brain and helps the body feel sleepier. Thus, CBD could be a safe and effective treatment for achieving better sleep whilst maintaining REM sleep architecture.
CBD as an NSAID Alternative
As previously mentioned, the main treatment for pain relief in athletes is over-the-counter NSAIDs, however, evidence is now emerging of these drugs having detrimental effects on health and organ function. Nowadays, ultra-distance athletes are advised to avoid NSAIDs during extensive training programmes and events, due to the proven risk to kidney function. There is also evidence of NSAIDs increases the risk of heart disease and stroke.
To date, there are no documented deaths from cannabis or CBD products. Furthermore, a systematic review of studies administering oral cannabis sprays for various clinical conditions, showed 96.6% of adverse effects caused by CBD use to be non-serious. Thus, CBD products could serve as a safer pain-relieving therapeutic for athletes.
CBD is available in a variety of forms such as transdermal CBD patches, CBD capsules, CBD oils and topical CBD skin care products. There is no standard dose that delivers the desired effect for all people, however, most companies that produce CBD products recommend starting with a low dose and gradually increasing. Most CBD products have the recommended daily dose printed on the packaging which should not be exceeded.
Possible Side Effects
The majority of people will tolerate CBD, however, it is important to be aware of possible side effects caused by CBD. Side effects can include; tiredness, diarrhoea, changes in appetite, dry mouth, loss of appetite or gain in appetite. Interestingly, the full effects of long-term CBD use on hormones are yet to be fully elucidated.
Before using CBD for the first time, it is recommended to first consult your GP or a medical professional. Especially if you are taking any other medications as CBD can make these drugs more or less effective. Consulting a doctor first will facilitate monitoring and adjustments to be made accordingly.
CBD products could provide athletes with a safe and effective way to recover from intense training sessions and programmes, whilst also relieving both occasional and long-lasting pain. Research is ongoing to fully determine the full effects of cannabidiol within the body and the most efficient way to administer it to athletes.
It is extremely important to purchase any CBD product from a well-renowned online CBD shop. Although CBD is no longer a banned substance for athletes, using any CBD products is at the athlete’s own risk. If CBD is not extracted from the cannabis plant correctly, the resulting product may not contain what it claims on the label. If the CBD product contains a significant amount of THC or other banned substance, the athletes may violate doping regulations.
Overall, CBD offers an exciting alternative with fewer risks to conventional drugs. It could be beneficial for athletes in reducing pain and inflammation whilst improving sleep patterns and improving overall performance.