Does CBD Actually Work for Athletes?

Does CBD Actually Work for Athletes?

Many endurance athletes and coaches are interested in the potential powers of CBD oil. Is it all smoke or is there actually fire?

The cannabis plant is a source of many chemical compounds and a fair amount of controversy. When Canada’s Ross Rebagliati was temporarily stripped of his Olympic gold medal in 1998 for having the chemical THC in his blood (the active compound in marijuana) much of the viewing public was incredulous. Indeed, because THC was not on the WADA list of banned substances at that time, the medal was restored, but in 2004 WADA addressed that oversight by adding THC to that list. 

Other non-intoxicating compounds in cannabis are purported to have beneficial properties and athletes began exerting pressure to get them allowed. Finally in 2018, WADA removed cannabidiol (CBD) from the banned list of substances and ever since there has been an explosion of interest and use of CBD products by athletes.

Why all the hype?

As a chemical compound, CBD has a lot of promise. Lab studies have demonstrated numerous intriguing potential benefits including anti-inflammatory properties, modulation of metabolism in injured brain tissue and changes in pain perception in lab animals. 

Unfortunately, very little research has been done to evaluate the efficacy of these effects in human trials. However, this hasn’t stopped a budding industry from developing with a veritable cornucopia of CBD products flooding the market. These products make all manner of promises about the benefits to athletes and non-athletes alike.

So what do we really know about CBD and how it can impact athletic performance? Much of what we know is extrapolated from tissue or animal experiments, but in some cases, small human trials have been conducted. Here is what we currently know (or think we know) about CBD and its use cases.

Anti-Inflammatory Effects

One of the most popular reasons that CBD is recommended to athletes is for its purported effects on decreasing inflammation. Tissue and animal studies do indeed show that CBD has properties on par with non-steroidal anti-inflammatory drugs (NSAIDs) in these regards. There is also evidence to suggest that CBD may be beneficial in treating delayed onset muscle soreness (DOMS). However, despite these indications, human trials are for the most part lacking and the studies that do exist are inconclusive. 

Certainly no current research provides results to warrant the marketing hype associated with CBD products. Also, there are no studies that address the fact that other anti-inflammatory agents are often associated with an attenuation in the benefits of training, without influencing muscle function or soreness. It obviously would be very important to know if CBD has similar effects before broadly advocating for its use.

Pain relief (Analgesia)

Both CBD and THC have been investigated as analgesics and to date have shown some early promising results. However, because of the paucity of human data, these results have been inconsistent.

CBD has been shown to have some benefits for managing certain types of pain but often only in very high doses. The type of pain being treated seems to be relevant. Additionally, certain types of pain require higher doses than others in order for there to be any noticeable benefit.

Thermoregulation

CBD is occasionally advertised as an agent that can be beneficial to athletes who train and race in warmer environments as an aid to help with thermoregulation. There is some theoretical and lab animal data to support the notion that CBD may have effects in this regard but to date, no clinical or human study has been published that supports the claims that CBD has any significant influence on thermoregulation.

Illness Prevention and Immune Function

A number of web pages selling CBD products claim their products’ utility in fighting viral infections like colds and flu. However, research supporting such protective effects is extremely limited. Worse, CBD could potentially weaken host defense against invading pathogens because of its tendency to modify the function of various immune cells.

A preliminary study in mice suggested a protective effect of CBD against the cytokine storm seen in patients with severe COVID infection but this early research has not been advanced to human trials yet. This has not stopped the CBD manufacturers from seizing this information and promoting their product as a potential treatment for the serious infection.

Sports Performance Anxiety

A number of small studies have been done to investigate the effects of CBD to decrease stress in individuals with known generalized anxiety disorder. Overall, results have shown that CBD displays little effect on low-stress events. But, in moderate-to-high doses it does have a role in reducing anxiety for high stress situations.

No studies have been done to look at CBD specifically for sports performance anxiety but it stands to reason that it may have benefits in this area. I await the results of such studies before making any recommendations for its use for this purpose.

Sleep

Among the more heavily promoted reasons for using CBD, sleep quality and duration are at the forefront. The best quality study on this subject found that in fact CBD had no effect on either promoting or lengthening sleep in healthy individuals. Lesser quality studies have suggested a possible role for CBD in people who suffer from comorbidities that prevent sleep such as post-traumatic stress disorder but this question is far from settled.

Collectively, the current evidence on CBD and sleep, endorses the need for further research in clinical populations and athletes.

Concerns for Coaches

As a coach, one of the most concerning issues related to athletes using CBD products is the potential for contamination with banned substances. Very few manufacturers of CBD are regulated or label their products as NSF Certified for sport. Furthermore contamination in THC is common. One study found 10 of 28 CBD products had detectable THC in them that could result in an athlete testing positive and receiving a doping related ban.

Given the fact that there is so little compelling evidence or reasoning to use CBD, athletes and coaches must seriously consider this risk before using these products. Should they make the decision to do so, they should only use products that are properly tested and labeled either as medicinal products or as NSF Certified for sport.

Do you have questions about this or about any other subjects related to health and wellness and triathlon? Send me an email at tri_doc@icloud.com

Sources

  1. Wang B, Kovalchuk A, Li D, Ilnytskyy Y, Kovalchuk I, Kovalchuk O. In Search of Preventative Strategies: Novel Anti-Inflammatory High-CBD Cannabis Sativa Extracts Modulate ACE2 Expression in COVID-19 Gateway Tissues. April 2020. doi:10.20944/PREPRINTS202004.0315.V1

2. McCartney D, Benson MJ, Desbrow B, Irwin C, Suraev A, McGregor IS. Cannabidiol and Sports Performance: a Narrative Review of Relevant Evidence and Recommendations for Future Research. Sport Med – open. 2020;6(1):27. doi:10.1186/s40798-020-00251-0

3. Lachenmeier DW, Diel P. A Warning against the Negligent Use of Cannabidiol in Professional and Amateur Athletes. Sport (Basel, Switzerland). 2019;7(12). doi:10.3390/sports7120251

4. Gamelin F-X, Cuvelier G, Mendes A, et al. Perspective Cannabidiol in sport: Ergogenic or else? 2020. doi:10.1016/j.phrs.2020.104764

Dr. Jeff Sankoff

Jeff Sankoff is an Emergency Physician, long time triathlete and IRONMAN University Certified coach. He has completed 6 IRONMAN races (including Kona) and more than fifty races at the 70.3 distance including 5 World Championships. He produces the TriDoc Podcast that can be found on most popular podcast platforms and is the owner of TriDoc Coaching.