Potential Role of Cannabidiol on Sports Recovery: A Narrative Review This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, Here, we will take a look at the role of CBD in sports and its potential benefits for athletes. What athletes should know about cannabidiol (CBD) for recovery, pain relief, anti-inflammation, and as an alternative to NSAID and opioide pain killers.
Potential Role of Cannabidiol on Sports Recovery: A Narrative Review
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
The use of cannabidiol (CBD) among athletes is becoming extensive and frequent. This could be due to the elimination of CBD from the list of prohibited substances by federations and international institutions of sport. The legalization and resulting production, and commercialization of CBD, could increase its intake in sports professionals. This commercialization of cannabinoids has fueled a race to study their properties, benefits, and risks for health and performance in athletes. Although there is evidence that suggests some beneficial properties such as anxiolytics, antidepressants, anti-inflammatory, and antioxidants among others, the evidence presented so far is neither clear nor conclusive. There are significant gaps in knowledge of the physiological pathways that explain the role of CBD in sports performance. This mini-review examines evidence suggesting that CBD has the potential to be used as a part of the strategies to recover from fatigue and muscle damage related to physical and cognitive exertion in sports.
Recovery has become a crucial topic in recent sports research and could determine physical (Trecroci et al., 2020b), physiological (Rojas-Valverde et al., 2018), and cognitive (Trecroci et al., 2020a) performance, considering the high frequency and density of competitions. This has led the researchers, coaches, and athletes making plans and managing recovery strategies as part of the general exercise prescription (Martínez-Guardado et al., 2020). The physical, physiological, and cognitive effort usually provoke a cascade of structural and functional adjustments that need to be identified, monitored, and controlled to optimally recover the functional capacities of the athlete (Ament and Verkerke, 2009). Commonly, central and peripheral fatigue related to physical exercise manifests itself as pain, weakness, inflammation, loss of functional mobility, decreased force generation, feeling of tiredness, alteration of vital signs, and reduced concentration, among others.
Over the last few years, many methods and means of recovery from fatigue have been tested (Rawson et al., 2018). One of the best known strategies is the intake of plant-derived products such as ginseng (Rojas-Valverde et al., 2020), green tea (Machado et al., 2018), cherries (Bell et al., 2014), curcumin (Fernández-Lázaro et al., 2020), spinach (Bohlooli et al., 2014), and beetroot (Rojas-Valverde et al., 2020). These organic products have shown anti-inflammatory, antioxidative, and analgesic properties as other cognitive benefits that promote recovery from exercise-related fatigue (Bongiovanni et al., 2020).
Recently, the World Anti-Doping Agency has removed some products from their list of prohibited substances for athletes. This is the case of cannabidiol (CBD), a phytocannabinoid clustered among the cannabinoids extracted from the Cannabis sativa plant (Campos et al., 2012). Unlike tetrahydrocannabinol (THC), CBD does not cause psychotomimetic and psychotropic reactions (WHO, 2017) for which there is no evidence of dependence or abuse, but causes mild and infrequent side effects (Stout and Cimino, 2014). On the contrary, CBD use is not only extensive among athletes (Docter et al., 2020), but it has been shown to have specific properties that help to treat chronic pain, spasticity, mood and sleep disorders, immunodepression, inflammation, oxidant effects, and anxiety in clinical patients (McPartland et al., 2015; Whiting et al., 2015; Nichols and Kaplan, 2019; Pinto et al., 2020). These effects could improve and accelerate recovery caused by a prolog or intense physical, physiological, and cognitive efforts as in sports (Higgins et al., 2017).
Considering that CBD has gained wide acceptance for medicinal and recreational use, its use among athletes is imminent (Docter et al., 2020) even though its the physiological, physical, and cognitive effects are not fully understood (Nichols and Kaplan, 2019), and it seems premature to make specific recommendations and to award all the above mentioned benefits (Gamelin et al., 2020). Consequently and considering the need to clarify these issues, this narrative review aims to present the scientific evidence around the potential benefits of CBD as an ergogenic aid to promote a better and faster recovery between efforts related to physical exercise and sport. Given the absence of evidence directly exploring the CBD potential in sports recovery, this review synthesizes the preclinical and clinical findings that support its use and testing in future research protocols. This narrative review was performed considering the scale for assessment of narrative review articles (Baethge et al., 2019).
Prevalence in the Use of CBD Among Athletes
With the exclusion of CBD from the prohibited substances in 2018, and even before, the use of CBD among athletes has considerably increased and is still accelerating (Leas et al., 2019). Cannabinoids are considered the second most commonly used substance among contact sports athletes replacing nicotine (McDuff et al., 2019). Evidence has shown that a third of cyclists, triathletes, and runners are or have been cannabinoids users (mostly ≥ 40 years of age, male, THC + CBD consumers ≤3 times weekly, and exercise 5–7 days per week) (Zeiger et al., 2019). Also, a quarter of university athletes report using cannabis-related products (Docter et al., 2020). Especially in contact sports like rugby, the use rate of CBD is 28%, increasing with age, and reporting pain relief and sleep quality improvements as perceived benefits (Kasper et al., 2020).
Despite the extensive use of CBD and the fact that international sports organizations have now allowed for it to be used, some CBD products have been shown to contain significant levels of other banned cannabinoids, like THC (Lachenmeier and Diel, 2019). Besides, there is evidence of the use of synthetic cannabinoids, such as JWH-018 and JWH-073, with limited regulation (Heltsley et al., 2012). Athletes require more information and advice, as product labels can be misleading about whether they contain THC, meaning there are risks in terms of violating anti-doping rules (Mareck et al., 2021).
Physiological Mechanism Framing CBD
The effects of CBD on physiological and cognitive functions are mediated by the endocannabinoid system, which has regulatory functions to maintain homeostasis (VanDolah et al., 2019). During exercise, the cannabinoid system mediates some central and peripheral effects of exercise as bliss, peacefulness, and euphoria (Carek et al., 2011). Endocannabinoids [e.g., anandamide and 2-arachidonyol (2AG)] as cannabinoids activate the type-1 (CB1) and type-2 (CB2) cannabinoid receptors, such as N-acylethanolamines (De Petrocellis and Di Marzo, 2009), leading to appetite-suppression, anti-inflammatory, anxiolytic, and antiproliferative effects as exercise do. CBD inhibits the degradation and uptake of endocannabinoids as anandamide, leading to an increase in endocannabinoid–receptor binding. CB1 and CB2 are present mostly in the central nervous and peripheric nervous system, respectively.
Also, cannabinoids and endocannabinoids are involved in brain-derived neurotrophic factor release (e.g., neurogenesis and neuronal plasticity), glucocorticoids release (e.g., mood control by suppressing depression and anxiety), dopamine release (leading to rewarding), and fatty acid amide hydrolase release (e.g., analgesic effects). All these responses overlap with the positive benefits of exercise (Tantimonaco et al., 2014). These effects are provoked by stimuli of TRPV1 ions canals (Vanilloid receptors) leading to antinociceptive effects, stimuli of CB1 and CB2 receptors causing relaxing effects via neurodepression and inhibition of cytokines release, respectively, and activation of 5HT1A receptors promoting serotonin caption in the postsynaptic neuron causing mood state regulation.
Inflammation and Proliferation
Inflammation and oxidative stress underlie many human chronic and acute health conditions and pathologies. In this sense, and considering that exercise-related damage and fatigue mediate inflammation, proliferation, and oxidative stress in most cases, it is hypothesized that CBD-related inhibitions in oxidative stress and neuroinflammation could have some therapeutic potential in sports research (Gamelin et al., 2020). This statement is based on evidence suggesting that CBD could induce changes in cortisol release, regulating inflammatory response to injury (Zuardi A. et al., 1993; Yeager et al., 2010). This mediation is due to the interaction between CBD CB1, and CB2 cannabinoids and adenosine receptors, leading to reduced cytokine levels and downregulating overreactive immune cells (Booz, 2011; Hill et al., 2012; Burstein, 2015). Also, CBD intake seems to mediate processes associated with gastrointestinal damage protection, due to inflammation, and promote healing of skeletal injuries (McCartney et al., 2020).
During exercise, mainly those actions with a high component of eccentric contraction are potentially and particularly damaging to the sarcolemma. This damage is fetterless in response to a disruption of the permeability of muscle cell membrane and basal lamina, allowing Ca 2 + to reduce fiber electrochemical gradient. If the damage in the sarcolemma is relatively low, ATPase pumps attract Ca 2+ and the damage is still reversible. Besides, if there is a Ca 2+ overload, a degradation of the structural and contractile proteins could be provoked. The subsequent event is called the inflammatory cascade, recognized by the activation of macrophages and other phagocytic cells during the first 2–6 h after injury and prolonged for days (Armstrong et al., 1991; Burstein, 2015).
Additionally, CBD (300 mg) has been shown to induce changes in glucocorticoids as cortisol in humans (Zuardi A. W. et al., 1993), one of the primary homeostatic regulators of the inflammatory response to injury (Yeager et al., 2010). This is supported by a recent narrative review in sports, suggesting the potential anti-inflammatory effect in humans and the possible role in the performance of the athletes (McCartney et al., 2020). This affirmation is theoretically based on the suggested CBD capacity to interact with receptors involved in controlling inflammation as CB1 cannabinoid, CB2 cannabinoid, adenosine A2A, and also in reducing the levels of some cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor α (TNFα), and downregulating overreactive immune cells reducing the impact of collateral inflammatory damage of tissues (Booz, 2011; Hill et al., 2012; Burstein, 2015). There is also evidence suggesting the CBD potential to promote the release of arachidonic acid, leading to greater healing capacity as a result of core regulation of growth signals mediated by proresolving substances, such as lipoxin A4 and 15d-PGJ2 (Burstein, 2015).
It is also known that the interplay between inflammation and oxidative stress underlies many human diseases due to tissue and organ damage. In this regard, in sports, it is hypothesized that CBD-related inhibitions in oxidative stress and neuroinflammation could have some therapeutic potential in sports research (Gamelin et al., 2020).
Pain and Soreness
Cannabidiol has been commonly used for its analgesic properties (Kogan and Mechoulam, 2007) in a variety of pain disorders (Starowicz and Finn, 2017). CBD consumption could exhibit a beneficial effect over edema and hyperalgesia (Burstein, 2015; Hill et al., 2017), acting directly on the central nervous system and leading to sedative effects (Zuardi A. W. et al., 1993). The idea of considering CBD as an antinociceptive agent is based on the efficiency of treating the pain associated with proinflammatory cytokine release due to the activation of Vanilloid receptors, provoking antinociceptive effects and reducing the perception of pain (Booz, 2011). CBD could inhibit presynaptic neurotransmitters and neuropeptide release, modulate postsynaptic neuronal excitability, activate the descending inhibitory pain pathway, and reduce neuroinflammatory signaling (Starowicz and Finn, 2017).
Cannabidiol (300–400 mg) intake seems to have sedative effects on humans apparently acting directly on the central nervous system (Zuardi A. W. et al., 1993), supported by the idea that CBD exhibited a beneficial action over edema and hyperalgesia (Burstein, 2015; Hill et al., 2017). In this regard, drugs and substances such as Sativex, THC, and CBD are approved for the treatment of both central and peripheral neuropathic pain. This pain syndrome is associated with microglia activation and subsequent cascade of proinflammatory cytokines such as IL-6, IL-1β, and TNF (Booz, 2011). This evidence supports the idea of CBD use as an antinociceptive agent. Together with a neuroprotective quality, this effect was also found in a recent systematic review on the outcome of CBD intake in relation to its potential use as a sport-enhancing performance substance (McCartney et al., 2020). It still is unclear how CBD acts in relation to the pain cascade and pathways (Anthony et al., 2020). CBD has shown its potential to treat and manage pain in diseases and pain disorders, and based on this evidence CBD seems to have a potential effect on treating swelling and preventing soreness after strenuous exercise, but more evidence is required to make a clear statement.
Overreaching and overtraining are often presented in athletes due to high training loads accompanied by subsequent insufficient recovery between efforts (Fox et al., 2020). These abovementioned states are usually accompanied by sleep disorders and higher sleep disturbance, leading to poor sleep quality (Hainline et al., 2017). CBD consumption could stimulate the endocannabinoid system modulating sleep disorders and the sleep–wake cycle (Murillo-Rodríguez et al., 2020). Promising, but no specific, evidence suggests using cannabinoids like CBD to reduce sleep disorders in athletes or even in healthy or pathologic humans. Endocannabinoid system receptors as anandamide and type-1 are associated with sleep-promoting effects, but the physiological mechanism is not fully understood and is based mainly on preclinical studies (Suraev et al., 2020).
Cognition and Mood
Evidence has shown that acute and single administration of CBD could have anxiolytic (Zuardi A. et al., 1993) and antidepressive effects through the activation of 5-HT1A receptors (Booz, 2011). Although the reported results are promising for sports recovery, evidence suggests no long-term impact on cognition or mood state due to prolonged use of CBD (Allendorfer et al., 2019; Martin et al., 2019). Also, the link between CBD consumption and the possible effect on exercise-related recovery is primarily clinical and preclinical studies, mostly in participants with background pathology (McCartney et al., 2020). In this sense, more in-depth analysis is needed in the population of athletes to reach a conclusive statement.
Future Research and Limitations
As interest in the use of CBD in athlete recovery continues to grow, more research is required to better understand the physiological mechanism. The potential benefits, efficacy, and purported safety profile when consuming CBD prior to, during, and after training or competition should be explored. Future research in the field of sports science and medicine must focus on understanding the role of CBD in physiological mechanisms such as inflammatory cascade, neuroprotection, analgesic and anxiolytic pathways, muscle enhancement, and neuromechanical function.
New randomized placebo-controlled studies should consider the different etiologies of fatigue and damage, individualities and disciplines, and special needs and characteristics. Other potential research areas are, but are not limited to, optimal dosing depending on physical and physiological load; effectiveness regarding administration timing; chronic and acute effects; cumulative responses with other recovery strategies; differences in tolerance and effectiveness by sex, professional level, and fitness level; and other individual conditions and situational factors. Besides, more information is needed around the understanding of CBD inflammatory signaling as an essential factor in the recovery process. The effectiveness of CBD vs. conventional medications should be assessed.
This narrative review must be analyzed in light of some limitations. Though the main evidence about the use of CBD in sports was reviewed, this systematic review lacks explicit criteria for article selection and inclusion. In this sense, a systematic review could strengthen the actual conclusions and better present the preclinical and clinical evidence supporting the use of CBD in sports recovery. In this sense, a systematic review could better present settings of tests, study designs, demographics of participants, and main conclusions of the recent evidence.
Evidence supporting the potential use of CBD as an ergogenic aid to improve the efficacy and efficiency of recovery processes during exercise and sport-related fatigue seems promising. Still, there is not enough information to be conclusive. CBD appears to have some properties that could boost exercise recovery as an anti-inflammatory, neuroprotective, analgesic, anxiolytic, and pain reliever. Still, due to the lack of studies in elite athletes, there is a need for a better understanding of the effects of CBD as a physiological, physical, and cognitive recovery agent.
More evidence and higher-quality studies are required in populations related to sports science and exercise medicine to be able to give recommendations regarding the dose and frequency of consumption as well as the specific prescribing of CBD according to the intensity and duration of the effort, as well as the role of essential characteristics such as body composition, general health, and other situational factors in its effect. Also, considering the lack of regulations in CBD production and indiscriminate consumption, athletes must be cautioned due to the high risk of testing positive in the doping tests.
Cannabidiol seems to have anti-inflammatory, neuroprotective, analgesic, anxiolytic, and pain-relieving properties which can be potential mediators of recovery in athletes during regular training and competition. To confirm these effects, more scientific evidence in specific sport-related populations is necessary. There is a need for confirmatory analyses using randomized, placebo-controlled trials testing acute, and chronic effects of different dosing prescriptions. This study must consider some fundamental particularities of sports as a great variety of biological and situational conditions that promote fatigue, the characteristics of each discipline during training and competition, as well as the individual peculiarities of athletes, their tolerance and response to CBD intake, and the combined effect of CBD administration with other physical and nutritional aids.
Since training and competition leads to a structural and functional imbalance due to strenuous effort, CBD intake could potentially promote restoration of physical performance. The CBD physiological mechanisms of action, mixed with other recovery protocols, could help to reduce the accumulated fatigue evident over a tournament of consecutive efforts. The above may depend on pointing to multiple mechanisms to provoke global functional recovery in sports. Much evidence is needed to support this conclusion, but the proposed evidence looks promising.
Considering the relatively common use of both cannabis and CBD alone among athletes, there is a clear need to improve scientific understanding of the effects of CBD use on the fatigue, damage-related recovery, and performance of athletes. Greater scientific progress is needed, mostly on the execution of experimental trials, allowing a greater understanding of both critical positive and negative outcomes for the final benefit of the athletes in exercise-related recovery and performance. Also, the evidence resulted could give new clinical guidance to prescribe CBD during the recovery process of an athlete and other possible applications. The potential therapeutic benefits of CBD administration have been downplayed for years but, the actual scenario could facilitate the boost of the knowledge around this natural compound and its effects. Besides, from an administrative point of view, clearer and overarching policy for the use of cannabis in sports need to be considered and adopted.
Finally, athletes have to create an optimal internal environment to increase the function of endocannabinoids. In this sense, besides regular exercise, athletes must control weight, manage stress and competition-related anxiety, and minimize environmental exposure to contaminants and other toxic substances. These cannabimimetic practices would create the ideal environment for improving the endocannabinoid action in recovery.
DR-V carried out the original idea conceptualization, literature search and systematization, writing the original draft, critically revising the manuscript, funding, and approving the final manuscript.
Conflict of Interest
The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
CBD for Athletes & Sports
Athletes are always looking for better, more natural ways to boost their performance and recover from intense training sessions. Current options for post-workout pain relief and recovery are more harmful than beneficial. Some are even downright addictive! So when an all-natural product like CBD shows up with big promises for athletes, it turns many heads. Up to the point that even the World Anti-Doping Agency removed CBD from its list of prohibited substances in 2018. Now, many have tried CBD and consistently incorporate it into their wellness routines.
But is it as effective as people claim? Keep reading if you’re an athlete and curious about what this compound can do for you. Here, we will take a look at the role of CBD in sports and its potential benefits for athletes.
WHAT IS CBD?
CBD, or cannabidiol, is a phytocannabinoid found in both hemp and cannabis plants. Unlike its sister cannabinoid, THC, CBD is a non-psychoactive compound, meaning it won’t get you high. According to the World Health Organization, it’s also generally safe and well-tolerated by most people. Research on the uses of CBD for athletes is still ongoing, but the available studies all point to its potential role in alleviating various conditions.
WHAT ARE THE POTENTIAL BENEFITS OF CBD FOR ATHLETES?
MAY REDUCE PAIN & INFLAMMATION
Pain and inflammation are a part of every athlete’s bodily responses. While they can have positive effects on training, if they become too severe, they can prevent recovery and limit performance. CBD may be the answer to this problem as those who have tried it swear by its effectiveness in relieving their discomfort.
Recent studies on CBD for athletes confirm its ability to reduce pain and inflammation caused by nerve and tissue damage. A possible explanation for this can be the interaction between CBD and CBD receptors in the brain which signals the immune system and more effectively modulate the inflammatory response to intense workout sessions.
A POSSIBLE HOLISTIC REPLACEMENT FOR NSAIDS & OPIOIDS
NSAIDs (non-steroidal anti-inflammatory drugs) have been athletes’ go-to pain-relieving remedies for a long time. Simple medications like Advil are not as safe as we once though. Reports show that they can cause heart problems and renal failure. Opioids are even worse! While they mange to reduce the pain significantly, they are very addictive and can cause fatal overdoses.
Those searching for healthier alternatives found that CBD can replace NSAIDs for athletes. Natural products like CBD Tincture Oils can be much safer than synthetic solutions since they are non-addictive. Some new studies on CBD in sports suggest that CBD may be able to help athletes quit opioid addictions.
MANAGING SLEEP & STRESS
Getting enough sleep is crucial for every athlete’s recovery and performance process. On the other hand, there may be nights when you need to stay awake longer than your normal routine allows. Studies show that lower doses of CBD for athletes may help in inducing sleep, while higher doses can help keep you awake.
One of the causes of sleep difficulties is stress. Studies show that CBD may help in potentially reducing anxiety to then help people achieve a more restful sleep, easier. This benefit of CBD for athletes can also be helpful in stressful situations. The right dose of CBD before a big event may be effective in calming the mind and improving focus.
MUSCLE RECOVERY & BONE HEALTH
The potential anti-inflammatory and pain-relieving effects of CBD for athletes can also help with muscle recovery. Intensive workout sessions can tear your muscle tissues and cause inflammation. This inflammation can help you build stronger muscles. On the other hand, too much of it can have adverse effects. A CBD muscle cream might be able to balance this out and help your sore muscles recover at a sustainable rate.
Another way CBD can benefits athletes is with bone structure. Studies show that CBD may help bone fractures heal and improve bone deposition. This benefit of CBD in sports is promising for athletes who are more prone to bone injuries.
A SOLUTION FOR GASTROINTESTINAL PROBLEMS
Inflammation can also happen in the intestines, cause discomfort, and prevent athletes from performing at their best. Here is where the potential anti-inflammatory properties of CBD for athletes come into play again. By interacting with both the CB1 and CB2 receptors in the intestines, CBD may be able to fix these gastrointestinal issues, recover the intestines’ permeability and rid you of the inflammation-induced gut problems.
FAMOUS ATHLETES WHO USE CBD
Many use CBD to level up their wellness routines. Some of the most famous athletes endorsing CBD are professional golfer Rickie Fowler, NFL player Rob Gronkowski, and MMA fighter Nate Diaz. NBA player Klay Thompson, heavyweight boxer Shannon Briggs, and soccer player Megan Rapinoe are other professional athletes who use CBD in sports.
TRY OUT CBD FOR YOURSELF!
Considering the potential benefits of CBD for athletes, this natural substance can be a safer solution for recovery and better performance. Many athletes have already jumped on the CBD train, and its time you do too! Make sure to check in with your doctor beforehand and start with low doses so your body can acclimate itself to it. Try out different types of CBD to figure out which one suits your needs better. You can visit Envy CBD’s shop to choose from a vast collection of 100% pesticide-free, broad spectrum CBD products with superior quality.
If you’re an athlete and already using CBD, leave us a comment and tell us how it has helped you!
CBD for Athletes: What You Need to Know About Cannabidiol
Athletes put a lot of stress on our bodies, to positive and negative effect. Training stress stimulates adaptation and increased performance, but physical trauma and prolonged wear and tear also lead to injuries and pain. Current methods of pain management are effective, but they’re also killing people. In search of improved sports recovery and safer pain relief, many people are asking about cannabidiol or CBD for athletes. Should you?
Chronic use of over-the-counter pain relievers (i.e. NSAIDs like ibuprofen and naproxen sodium) poses greater health risk than previously known, and we are in the midst of an epidemic of opioid addiction and overdoses that kill tens of thousands of Americans annually. In such a landscape, athletes are rightly curious about and eager for cannabidiols’ (CBD) promises of pain relief and reduced inflammation without the risks associated with NSAIDs or opioids.
Are CBD products right for you? There’s a lot here to unpack and consider, so get comfortable and read on.
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 or out of competition. (Here is the 2020 WADA Prohibited List.) The US Anti-Doping Agency (USADA) did the same, and they provide a “Marijuana FAQ” page to clarify the rules. There is an important caveat: ONLY CBD was removed from the prohibited list. The psychoactive component of marijuana, THC, is still prohibited in competition, as are synthetic cannabinoids. The specific wording is: “All natural and synthetic cannabinoids are prohibited, e.g.: In cannabis (hashish, marijuana) and cannabis products. Natural and synthetic tetrahydrocannabinols (THCs). Synthetic cannabinoids that mimic the effects of THC. Except: Cannabidiol.”
Interestingly, WADA set a urinary threshold of 150 nanograms per milliliter for THC, which is substantially more lenient than the previous limit of 15 nanograms per milliliter. The higher threshold is designed to lower the risk of an athlete testing positive due to casual use outside of competition. A USA Today article in 2016 quoted Ben Nichols, a spokesperson for WADA as saying, “Our information suggests that many cases do not involve game or event-day consumption. The new threshold level is an attempt to ensure that in-competition use is detected and not use during the days and weeks before competition.”
As for legality outside of sports, that’s a whole different matter. The federal, state, and local legality of cannabis and related products is constantly evolving. Check the laws in your area.
Athletes can legally consume cannabidiol, but what is it, what does it do, and why would you use it?
To begin with, cannabinoids already exist in your body. Scientists have identified what they call the endocannibinoid system (ECS) that modulates the activity of neurons. (9) Cannabidiol (CBD) is a phytocannabinoid found naturally in the cannabis plant. Unlike THC, which is also found in cannabis, CBD is not psychoactive.
Beyond that, scientists understanding of how the ECS works and how CBD influences it is still evolving. For a long time, research in this area was hard to complete due to the legal status of marijuana. However, based on recent studies and 2018’s The Essentials of Pain Medicine, Fourth Ed., here are the basics (5).
Within your nervous system, two endocannabinoids (2-AG and EAE) are produced in postsynaptic neurons (downstream) and released into the synapse. They bind to CB1 and CB2 receptors on the presynaptic neuron (upstream) and act to inhibit the release of certain neurotransmitters. For instance when CBD is used to treat epilepsy, it may reduce seizure activity by – in part – reducing the buildup of glutamate, an excitatory neurotransmitter.
CB1 receptors are found throughout the brain, spinal cord, and other tissues. CB2 receptors are as well, but more of them are found in immune system tissues. CBD binding to CB1 receptors has a greater effect the central nervous system, and CBD binding to CB2 receptors has a greater effect on reducing inflammation.
The primary purpose of the ECS appears to be maintaining homeostasis, which it does by keeping neurotransmitter levels in check. Consuming CBD could be thought of as supplementing or increasing the activity of your body’s existing endocannabinoid system.
As an athlete you apply greater stress to your body, leading to pain and inflammation greater than what your endocannabinoid system can handle. Adding exogenous CBD may help this overloaded system get your neurotransmitters back under control and help athletes maintain homeostasis.
6 Benefits of CBD for Athletes
Studies have shown cannabis (mostly THC and far less CBD) is effective for reducing pain, including musculoskeletal pain from 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 does appear to relieve pain effectively for many athletes.
Alternative to NSAIDs
Athletes have been consuming over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen sodium (Aleve) for decades, but they may not be as safe as we once thought. Ultradistance athletes, in particular, are typically advised to avoid NSAIDs during long training sessions and events, due to increased risk of renal damage. But even if your workouts and events are short, 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. According to The Essentials of Pain Medicine, Fourth Ed., “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%).”
Alternative to Opioids
According to the CDC, in 2016 opioids were involved in more than 42,000 deaths in the US. Opioid pain medications (i.e. morphine, codeine, oxycontin) 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, high-intensity pain (5), but may be effective for long-term pain management – either alone or in conjunction with other medications – with far less risk of dependence or accidental death.
A little bit of inflammation can be good for athletes and help stimulate positive training adaptations. Too much inflammation hinders recovery and hurts performance. There are CB2 receptors in both 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 cytokine (cell messengers) production. (8) In other words, CBD bound to CB2 receptors help dial down the response when your immune system sounds the alarm after hard workouts.
Settle your gut
Inflammation in the small and large intestines causes a lot of discomfort, and GI distress is one of the leading reasons 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 inflammation issues that contribute to gut problems during or after exercise, CBD may be effective for 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)
Improve Sleep Quality
Getting more and better sleep is one of the most effective ways an athlete can achieve greater training gains. 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. (7)
Adenosine triphosphate (ATP) breaks down as your brain burns carbohydrate for energy, and adenosine gradually accumulates in the brain. More adenosine binding to neurons inhibits the release of neurotransmitters, slowing down brain activity, helping you feel calmer, and inducing sleep. Your body metabolizes adenosine as you sleep, and some time later, low concentrations of adenosine help you wake up and the process starts again.
By binding to same receptors adenosine would bind to, CBD may inhibit adenosine reuptake, which helps it accumulate more quickly and makes you feel sleepy sooner. CBD may also have a potent anti-anxiety effect for some people, which can help them get to sleep and have more restful sleep.
How to use CBD
New CBD-containing products hit the market every week. You can get ingest CBD through capsules, pills, or as an oil. You can inhale it as a vapor. It has been infused into sports drinks, recovery drinks, and all manner of edibles. 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 edibles have to be digested, so they may take a bit longer. Topical creams are said to be quicker than edibles, and sublingual drops/tinctures are said to be the most rapid (besides inhalation via vaping).
CBD is available as “full spectrum” or “isolate”. Full spectrum CBD products contain CBD and other compounds found in the original plant, which could include small amounts of THC. If the CBD was derived from industrial hemp, the THC content of the original plant is legally supposed to be less than .3% (in Colorado). Products that contain CBD isolate should only contain CBD. CBD isolate and CBD produced from hemp would be a better choice, from an anti-doping standpoint, for anyone with zero-tolerance drug testing at work (i.e. pilots).
How much CBD to use
Here’s where things get tricky. There is no standard dose that delivers a consistent effect for all people. CBD products are not well regulated, so there can be inconsistencies in how much CBD is in a product. And depending on how you consume CBD (oil, gummy bear, cookie, recovery drink, tincture, vapor), it can be difficult to be precise. The most precise 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 a tincture.
Companies that produce and sell CBD products recommend starting with a low dose and gradually increasing it based on the effects you experience.
Conclusion and Caveat
The emergence of cannabidiol could mark a major turning point in how athletes recover from training stress and manage both occasional and chronic pain. The giant, glaring caveat is that right now the use of CBD and the ways it’s being delivered are ahead of the science. There is a lot still to learn about how CBD works and how to best utilize it with athletes. That is not unusual, though. Back when carbohydrate-rich sports drinks first came out, it was clear they were helping improve performance even if the formulas weren’t perfect and the mechanisms weren’t all known.
Although it is not a banned substance for athletes in or out of competition, the potential risk for athletes is if the product you buy doesn’t contain what it says on the label. If it actually contains a significant amount of THC or other prohibited substance, you are at risk for a doping violation. As with anything else, it will be up to you 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 a pain reliever, anti-inflammatory, and sleep aid, then it has great potential to improve athletic performance. And if it gets athletes to reduce consumption of NSAIDS, opioids, and prescription sleep aids, those are even bigger victories.