Cannabidiol (CBD) – Hype or Hope?

Cannabidiol (CBD) – Hype or Hope? Key Points :
  1. There are a number of potential physiological, psychological and biochemical effects of Cannabidiol (CBD) supplementation which could benefit athletes, is Cannabidiol (CBD) – Hype or Hope?
  2. The vast majority of this evidence is pre-clinical, meaning it hasn’t really been studied in humans.
  3. There’s a big need for research in humans, and specifically athletes
  4. Cannabidiol (CBD) supplementation still represents a major risk for athletes competing in drug tested sports
Introduction

Cannabidiol (CBD) and tetrahydrocannabinol (THC) are the two most abundant cannabinoids found in the cannabis plant. Whilst cannabis is prohibited in sport by WADA, in 2018 CBD was declared as safe to use so long as the THC content was <0.3%. This has sparked interest in athletes about the therapeutic potential of CBD, and in particular whether it can augment recovery in sports. 

The claims from supplement companies, and anecdotal reports from athletes, are that the effects of CBD are many including improvements in sleep and recovery from exercise, and reductions in anxiety and pain. This, in combination with The European Commission’s decision to classify CBD-containing products as a ‘novel food’, has led to massive interest from commercial companies to produce CBD supplementation for athletes and general population, the global CBD market reached $5bn in 2019, a 700% increase on 2018, and will soon be a $22bn industry.

But is it all hype or is there anything to substantiate the claims made by these companies (and their sponsored athletes)? 

What is Cannabidiol (CBD) ?

CBD is a cannabinoid which is found in the cannabis plant, of which there are at least 144. Along with THC, it is one of the most abundant cannabinoids in the plant, and it is mainly extracted from the cannabis sativa plant (hemp). THC is the main psychoactive compound which typically results in the “high” experienced from cannabis (see Amsterdam). In contrast, CBD does not result in a high from consumption, and can actually counter some of the psychotic effects of THC by leading to reductions in anxiety.

Under EU regulation, CBD products can only be sold if the THC content is below 0.3% (though some countries there are exceptions), and there are many Cannabidiol (CBD) products ranging from vapes, oils, tinctures, capsules and even CBD food items. This may actually be important, because the different forms in which we consume CBD may have a profound effect on how our body responds. 

CBD and Sports

At the moment, there is only one study which has been conducted in athletes as it relates to CBD supplementation, although there are also 2 PhDs in this area (1 in Liverpool and 1 in Loughborough). This study surveyed 517 rugby union and league players to try find out about whether athletes had been using CBD supplements, and for what reason.

The survey found that 26% of players were either currently using CBD supplementation or had previously used, with the majority (80%) reasoning behind supplementation being improved recovery, pain and sleep. Given rugby is a game where you have players >100kg involved in multiple collisions, managing pain and recovery can be critical not only to performance but also athlete health (both physical and mental). 67% of these players perceived a benefit from the Cannabidiol (CBD) supplementation, so is there Cannabidiol (CBD) – Hype or Hope for this supplement after all?

There are a number of proposed benefits for CBD supplementation based on animal and cell work, but the ones we will zone in for today are some of the more common ones mentioned:

  • Exercise-Induced Muscle Damage—Muscle Function, Soreness, and Injury
  • Sports Performance Anxiety (SPA)
  • Sleep
  • Form & Dose of Supplementation
  • Doping Risks
Exercise Induced Muscle Damage

Intense physical activity, such as that involved in match play, can cause structural damage to the muscle. This exercise induced muscle damage (EIMD) impairs muscle function and initiates an inflammatory response. While inflammation is integral to EIMD repair, regeneration, and adaptation, excessive inflammation may contribute to prolonged muscle soreness and delayed functional recovery. Historically, players would often consume alcohol following matches, but with the introduction of alcohol bans by teams in sports, we can see that the use of painkillers by athletes is far higher than general population. As such, if there are safe and effective supplements that can help accelerate the recovery process, it would be beneficial to the athlete. 

There are a number of studies now showing the anti-inflammatory effects of CBD in cell work (so not in humans), in addition to the inhibition of reactive oxidant species (Free radicals), however, we really need to see if the same occurs when applied to the human body. CBD supplementation has been studied a lot using rodents as a model for research. In this research, there seems to be a repeatable effect of reducing inflammation, promoting anti-inflammatory effects and reducing pain. Signs for hope. However, there are some limitations here, notably the model often used. The researchers generally tend to inject the rats to induce a form of arthritis, and then treat it with CBD. So, whether the effects of this model can be translated to EIMD is debateable, let alone whether we can translate it to humans. 

That said, there is some research showing that when THC is present (which is not legal), there are reductions in pain noted in human research. 

Further, while consuming anti-inflammatory effects may be desirable after an intense match or after an injury, this may have counterproductive effects when it comes to adapting to strength training as observed with other anti-inflammatories such as ibuprofen.

Verdict: Hope – unclear

Sports Performance Anxiety (SPA)

Anxiety research is probably the area where CBD has the most support in terms of its use in humans. High levels of pre-competition stress, or sports performance anxiety, can be detrimental to athletic performance. Under normal conditions, CBD seems to have very little effect on anxiety, however, when researchers give participants CBD and then place them in stressful situations (eg presenting at a conference), CBD appears to have a significant anxiolytic effect, meaning it reduces anxiety in people. This is also why researchers in London are experimenting using higher ratios of CBD:THC in their medicinal cannabis trials to counter some of the anxiety and paranoia that some people experience when consuming cannabis. 

This has potential applications for sports, particularly if the goal is to stay calm and focused, and managing anxiety & arousal can be a significant factor in performing. Potential sports that come to mind may be golf, snooker, darts and maybe even some forms of racing.

Verdict: Hope – beneficial

 

Sleep

In addition to recovery more generally, sleep is an area which has received a lot of anecdotal report when it comes to CBD supplementation. This is particularly pertinent given the emergence of evidence on the role of sleep for athletic performance and recovery. 

There have actually been a few studies in humans which have aimed to examine the effects of CBD supplementation on sleep, however with mixed reports. The first placebo-controlled trial found that CBD supplementation increased self-reported sleep duration in individuals with insomnia. In another trial of healthy individuals found that low-dose CBD counteracted some of the sedative effects of co-administered 

i.e. increasing overnight wakefulness. 

However, the best study to date has found no effect of CBD on sleep architecture. In this study they used the “gold standard” polysomnography, which involves placing electrodes on your head so that you can measure the electrical activity of the brain to not only find out how much you sleep, but also the different durations in different stages of sleep (truly assessing the quality of your sleep). Given this type of study is the gold standard, I think at present the evidence would not support the effects of CBD on sleep.

Verdict: Hype – no apparent benefit

Form & Dose

Up to now I’ve deliberately left out the dosage and form of CBD. One of the major issues with translating CBD research from rats to humans is the dosage used. Further to this, all of the studies in humans are using different doses, in different forms, and for different reasons. This makes it very hard to compare the effects of CBD.

For example, doses of 15mg (spray) of CBD were used to show that it had wakefulness effect in terms of sleep, while 160mg (oral) was used to demonstrate it improved sleep. The dose used in the gold standard study was 300mg (oral).

With regard to anxiety, the optimal dose seems to be 300mg (when using oral form).

And for the anti-inflammatory effects, the doses being used are >10mg/kg, which for a 100kg rugby players is <1,000mg of CBD PER SERVING.

Does anybody know what the dose of a typical CBD oil is? About 5mg. The entire bottle, which can cost up to €100, is about 1,000mg. So for a potentially effective dose, you’d require an entire bottle.

But wait, there’s more. And this is why it’s difficult.

Pretty much all of this research has been the acute effects of one dose. So what happens if you consume smaller doses like in the oil (5mg 2-3x per day) over longer term? Do you start to build up a chronic effect like with Vitamin D supplementation? The answer is, we really don’t know. Nobody has looked at this. 

Further, these studies using high doses often use oral form (capsule) of CBD, which may have poorer bioavailability. Consuming CBD with food, for example, increases the bioavailability (how much gets into your blood) by 5 times. So does this mean we can get away with 5x lower dose?

And finally, and not to confuse you, but could you get away with lower doses with sublingual sprays or vapes? CBD is a lipophilic drug, so it goes through first pass metabolism when you ingest it. This means your liver starts breaking it down as soon as you consume it. If you can “bypass” first pass metabolism by using a sub lingual spray or vaping, you may again get away with lower doses. The truth is we don’t know, and while there will be a rush to get performance research out there, we really first need fundamental scientific research on the pharmacokinetics of CBD supplementation before we should even begin attempting human trials (as we’d be guessing what dose to give them). 

Doping Risk 

In the interest of time, I’m sure you’re bored of reading by now, I’ll try to keep this brief.

Even though supplement companies claim to be “THC free”, there still may be trace amounts of THC contained in the supplement. Furthermore, as we said earlier, there are at least 142 other cannabinoids in the cannabis sativa plant and CBD is the only one which has been taken off the WADA prohibited list. 

As such, there is currently no informed sport product giving a guarantee that your CBD supplement is safe for use in drug tested sports. UKAD are currently advising against the use of CBD supplementation for this reason and there has been at least 1 case where someone has been sanctioned for a doping violation. 

Summary

CBD has gained a lot of interest in recent years, however, the evidence currently supporting its use is very limited. Despite there being some very early animal research suggesting some effects which may benefit human performance, aside from anxiety, the effects of CBD alone in humans is lacking. In addition to the lack of human research, there is also a significant degree of uncertainty as to what dose and form of supplementation is necessary IF any effect is to be exerted, and this may come at a significant financial cost to the consumer. Finally, CBD is a major red flag when it comes to doping violations. There’s significant risk that any CBD supplement could contain other cannabinoids which can result in a positive test & ban from playing sport. 

This article was kindly written by Mark Germaine who has extensive knowledge on this subject. Mark is a Performance Nutritionist and researcher in Exercise Physiology and Sports Nutrition. For more evidence- based nutrition information check out his Instagram and Twitter !

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