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Can Athletes Benefit From CBD?

In 2017, the World Health Organization came to the decision that “CBD does not appear to have abuse potential or cause harm.”[1] In 2018, the World Anti-Doping Agency stopped prohibiting CBD. In 2020, the NFL reached a new collective bargaining agreement that players will no longer be suspended for testing positive for marijuana. And even in the conservative world of professional golf, players are becoming increasingly vocal about how they are using CBD to recover after competing.

These shifts prompt the question: should athletes and active adults use CBD to enhance their recovery and improve their athletic performance?

To answer this question, researchers at the University of Sidney, School of Psychology published a narrative review in July of 2020, assessing all of the presently available evidence on how CBD could potentially impact sports performance.

Due to federal prohibition on cannabis, there is not much scientifically rigorous research on cannabis or CBD, and no studies directly examining how CBD impacts sport performance.

This gap in the research is concerning, given that many elite and community-based adult athletes are using CBD to improve sleep, manage pain or reduce anxiety. Due to the limited research on this important topic, the authors of the review drew on “preclinical studies involving laboratory animals and a limited number of clinical trials involving non-athlete populations.”

Their review focused on twelve areas of research where CBD could have an impact on athletic performance or recovery: exercise-induced muscle damage, concussions, pain, exercise-induced gastrointestinal damage, bone health, cardiovascular and metabolic function, thermoregulation, dietary intake and feeding, illness and infection, sports-related anxiety, sleep, and cognitive or psychomotor function.

CBD and Exercise-Induced Muscle Damage (EIMD)

Exercise, particularly strenuous or new forms of exercise, causes “damage to skeletal muscle myofibrils and the surrounding extracellular matrix.” This damage initiates an inflammation response that is an important part of the “repair, regeneration and adaption” process. However, excessive inflammation can lead to “prolonged muscle soreness and delayed functional recovery.”

NSAIDs and other over-the-counter anti-inflammatories are often the first line of defense for EIMD and the delayed-onset muscle soreness that often accompanies it. But these drugs have been shown to “attenuate exercise-induced skeletal muscle adaption.” CBD may have the potential to reduce pain and inflammation without influencing muscle adaption.

Research has demonstrated that CBD has a marked anti-inflammatory effect in animals and in in vitro experiments, however the research into how CBD affects inflammation in humans is “limited and inconclusive.”

In animal models, higher doses of CBD typically produce stronger anti-inflammatory responses than lower doses. For example, in a mouse model of Duchenne muscular dystrophy, CBD led to “improvements in muscle strength and coordination, as well as reductions in tissue degeneration,” while lower but still relatively high doses of CBD provided no benefit. The researchers note that exercise-induced muscle damage is fairly different from the mouse model of Duchenne muscular dystrophy, so these findings may not be relevant.

Further studies on humans are needed, but the preliminary evidence is encouraging.

CBD and Concussion Recovery

Concussions are a serious issue for both elite and casual athletes, with an estimated 6-36% of high school and college athletes experiencing more than one concussion. While the initial injury may not be preventable, concussions are marked by a second phase of injury “sustained through a complex cascade of events, including head injury, cerebral oedema, increased intracranial pressure, and hydrocephalus.” CBD has the potential to help with this second phase of the concussion.

Could CBD Help Heal Concussions?

Only one study has explored the biochemical and neurophysiological effects of CBD in an animal model of traumatic brain injury. CBD attenuated the concussed mice’s behavioral abnormalities, and improved some of the concussion-induced biochemical abnormalities, although neuronal damage was not measured.

Some studies found benefit from a single dose of CBD post-concussion, whereas others did not. However, when CBD is given repeatedly in a short period of time, it appears to be neuroprotective. The researchers note that humans at risk of TBI could prophylacticallydose CBD.

The mechanisms “underpinning the neuroprotective effects of CBD are not completely understood, but may involve decreased inflammation, oxidative stress and excitotoxicity and increased neurogenesis.”

CBD and Pain

CBD has been shown to help with both nociceptive pain, which is typically from tissue damage, and neuropathic pain, which “typically results from a lesion or disease in the somatosensory nervous system.”

While THC’s pain relieving effects are well established in the scientific literature, CBD also seems to have a significant analgesic effect. The researchers note that the analgesic effect of CBD seems to depend on the dose. A low dose of CBD does not consistently relieve pain, while higher doses are sometimes more effective and sometimes less effective than a moderate dose of CBD for relieving pain. More research is needed to determine the ideal therapeutic dose for pain relief.

Exercise-Induced Gastrointestinal Damage

Strenuous exercise reduces blood flow to the GI tract, decreasing oxygen and nutrient levels. When the exercise is prolonged, it can lead to “GI ischemia,” as well as inflammation and oxidative stress, which can negatively impact “exercise performance, post-exercise recovery…[and] nutritional uptake.”

Potentially, the antioxidant and anti-inflammatory effects of CBD could have some benefit for individuals managing exercise-induced GI damage, however there is currently no evidence that CBD has a therapeutic effect on GI damage in humans.

CBD and Bone Health

While exercise (particularly high-impact exercise) is known to improve bone health, athletes are particularly vulnerable to traumatic injuries or “low energy availability” that may reduce bone health.

Could CBD Help Heal Broken Bones?

The authors of the review found one noteworthy study demonstrating that CBD improved the healing of femoral fractures in rats. Frequently dosing CBD over a short period of time (chronic dosing) led to “decreased callus size 4-weeks post-fracture and enhanced the biomechanical properties of the bone at 8-weeks.”

Research has not yet clarified how CBD improves bone health, but there is some evidence that it may work to suppress bone resorption and decrease “the production of pro-inflammatory cytokines at the site of injury.”

CBD and Cardiovascular and Metabolic Function

Studies looking at CBD and cardiovascular function have produced inconsistent results. Some studies have shown that CBD has no effect on resting heart rate, while others have shown that CBD may reduce resting systolic blood pressure.

Most studies that measured human cardiovascular response in “stress-inducing” situations found that CBD had no effect on heart rate or blood pressure.

Fascinatingly, there is some initial data that CBD may affect mitochondrial function. In vivo CBD treatment has been found to increase mitochondrial biogenesis and increase the activity of mitochondrial complexes in a variety of tissues (brain, liver, etc.) and animal models of disease.

The researchers indicate that CBD seems to exert some effect on CV function, however “the implications…in regards to exercise performance are unclear.” That said, CBD’s effect on mitochondrial function “could have implications for energy metabolism during exercise.”

CBD and Thermoregulation

Any compound that affects core body temperature or how the body loses heat has the potential to have a significant impact on exercise performance.

While THC has been shown to induce hyperthermia at low doses and hypothermia at high doses, the available evidence indicates, “CBD is unlikely to have a major influence on…thermoregulatory processes.”

CBD, Dietary Intake and Feeding

While THC is well known to cause the “munchies,” CBD has been shown to have the opposite effect.

Low doses of CBD have been shown to have no influence on food intake, but high doses of CBD or chronic CBD treatment seem to suppress appetite in both humans and rodents.

CBD, Illness and Infection

The researchers note that they found many websites touting the ability of CBD to cure viral infections, but “research supporting such ‘protective effects’ of CBD is extremely limited.” The authors called for more research to understand if and how CBD impacts the “development and progression of illness and infection in both athlete and non-athlete populations.”

Sports Related Anxiety

While cognitive behavioral therapy is the preferred treatment for sports related anxiety or general anxiety, “a combination of pharmaceutical and psychological interventions may be indicated in some cases.”

A small number of clinical trials have explored the effects of CBD on subjective anxiety in healthy individuals and individuals with social anxiety disorder. The evidence suggests that moderate doses of CBD may reduce anxiety in stressful situations.

A 2019 study on CBD and anxiety indicated that there might be an inverted U-shaped relationship between CBD dose and subjective anxiety. For example, 300mg had a “stronger anxiolytic effect than 150mg or 600mg.”

CBD and Sleep

Several studies have explored the effect of CBD on human sleep. The first placebo-controlled, double-blinded crossover trial found that the sleep improving effects of CBD were dose dependent. The researchers found that 160mg of CBD—but not 40mg or 80mg of CBD—increased self-reported sleep duration in individuals with insomnia. However, the participants did not report any change in sleep quality or time to sleep onset.

A placebo-controlled, double-blinded crossover trial is a longitudinal study in which subjects receive either real treatment or a placebo for a period of time, after which the groups are switched to the opposite treatment.

Another recent placebo-controlled, double-blinded crossover trial found no effect of 300mg of CBD on “sleep architecture measured via polysomnography in healthy adults.”

The authors state “CBD seems unlikely to directly influence sleep in healthy humans.”

CBD and Cognitive or Psychomotor Function

The authors found various studies that suggest that CBD has minimal influence on cognitive or psychomotor function. For example, vaporized CBD produced no change in balance or coordination, and a more recent investigation found that both orally ingested CBD and vaporized CBD had no effect on cognitive function.

Is CBD Right For You?

The authors concluded their review with the central observation that “studies directly investigating CBD and sports performance are lacking, and until these are conducted, we can only speculate in regards to its effect.”

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[1] https://www.openaccessgovernment.org/who-perspective-on-cannabidiol/80838/

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