Cannabis and sports are becoming a somewhat unexpected partnership as Cannabis gains more and more acceptance worldwide. Athletes around the world have begun partnering with Cannabis companies to promote products that they claim help them with things like endurance, exercise recovery, pain relief, and more. But what’s really going on here? And how does CBD fit into the picture?

As I often have the displeasure to share – with this topic, like many, there is not much human clinical research. While we have some basic information about how CBD affects things like sleep, anxiety, and pain – there is very little data available, beyond personal stories, about how CBD affects exercise. So, I’ll just start with that. A recent 2020 review of CBD use in exercise, which I predominately leaned on for writing this blog post, concluded,

“Preclinical studies suggest that CBD could be useful to athletes due to its anti-inflammatory, analgesic, anxiolytic, neuroprotective properties and its influence on the sleep-wake cycle. Unfortunately, almost no clinical data are available on CBD in the context of exercise…” (Gamelin, Cuvelier, Mendes, etc., 2020)

Now that we have acknowledged the lack of human clinical data available regarding CBD and exercise, we can dive into some of the preclinical and possibly relevant clinical research that is available that indicates how CBD may affect issues related to exercise and athletics. We will focus on several primary areas of interest including inflammation reduction, modulation of anxiety and fear, effects on sleep, treatment of concussion or traumatic brain injury (TBI), and treatment of chronic traumatic encephalopathy (CTE).

Inflammation Relief

As mentioned in many other articles I have written about Cannabis, cannabinoids are well-documented for their inflammatory modulation effects. The United States government held a patent on the antioxidant and neuroprotective effects related to these anti-inflammatory properties. (USPTO US6630507B1) Additionally, more and more research studies are coming out that show how CBD can modulate inflammation through interactions with TRPV1, PPAR-gamma, and adenosine receptors.(Gamelin, Cuvelier, Mendes, etc. 2020) Many of the therapeutic benefits that cannabinoids provide are often traced back to their anti-inflammatory effects. After all, inflammation is the underlying problem associated with many different debilitating diseases and conditions. Overexertion in athletics or exercise can certainly lead to inflamed joints and muscles, where anti-inflammatory agents, like cannabinoids, may be beneficial.

Pain Relief

A common issue that athletes deal with on a regular basis is pain – often in the form of sore muscles or joint pain. This ties back into the issue of inflammation. As joints or muscles are repeatedly stressed, they become inflamed, and this inflammation can directly cause pain. By reducing inflammation, it is possible to reduce pain.

Another source of pain that athletes frequently deal with is nerve pain, or neurological pain, sometimes caused by repeated injuries that damage nerves in the body. CBD’s pain-relieving qualities have been and are still being explored with promising results. CBD interacts with a number of chemical receptors that are involved in how the body senses pain, also known as nociception. (Costa, Trovato, Comelli, etc. 2007) Some of these receptors include serotonin receptors and TRPV1 receptors. (Mallet, Daulhac, Bonnefont, etc. 2008) (Project CBD. 2020) CBD also modulates neurotransmitters in the brain responsible for pain signaling. So, from multiple angles, CBD may be able to change the way the body senses pain, and to modulate the “volume” of those pain signals in the brain. (Pretzsch, C.M., Freyberg, Voinescu, etc. 2019)

Sleep and Wakefulness

Sleep may not be something that we pay much attention to when thinking about athletic performance, but it is highly relevant. Sleep impacts how our bodies function when we are awake. Additionally, someone’s level of alertness or wakefulness can have direct impacts on their athletic performance in the moment. (Fullagar, Skorski, Duffield, etc. 2015) I have written about research around CBD’s effects on sleep in several other articles, but to briefly summarize – CBD exhibits unique effects on wakefulness depending on dose. Low doses tend to be more stimulating, and higher doses tend to be more sedating. However, there is no dose amount that has been clearly identified as the “tipping point” that differentiates these effects, and it can be very unique person-to-person.

To make things ever more complicated, CBD comes in many different forms. How CBD is formulated or consumed can dramatically impact the resulting experience of effects. Nano or pico-emulsified CBD may be much more active at lower doses due to enhanced bioavailability, compared to a CBD-rich Cannabis extract, for instance. But in general, if an athlete needs to get good rest before an event, higher doses of CBD may possibly help that effort. If an athlete needs to be more alert and less anxious during an event, it may be that a low dose of CBD could help.

Protecting the Brain

One of the most serious issues facing athletes, especially North American football athletes and professional fighters, is brain injury. Traumatic brain injury, or TBI, can cause a number of immediate symptoms like headache, confusion, emotional disturbances, and of course pain – to name a few. But there are also long term effects associated with TBI, and can change the way the brain functions.

After multiple TBIs, a condition called chronic traumatic encephalopathy, or CTE, can develop. CTE is classified as a neurodegenerative disease and can present very serious physiological and psychological symptoms which can be life threatening. CTE can also cause dementia in athletes at premature ages. Unfortunately, CTE is usually only diagnosed after an autopsy when the brain can be carefully examined directly, and there is no known cure. (Mayo Clinic)

So how might CBD impact TBI and CTE?

One thing that occurs in TBI is a dysregulation of glutamate in the body. Glutamate is an excitatory neurotransmitter, and when it gets out of whack, it can be toxic to the brain. Preclinical research with rodents has shown that CBD can downregulate glutamate signaling and upregulate GABA, which is an inhibitory neurotransmitter. (Belardo, Iannotta, Boccella, etc. 2019) Essentially CBD may be able to tell the signaling systems in the brain to calm down. This could indicate that, at least for mild concussions, CBD might help protect the brain and reduce symptoms of brain injury.

However, there is no research available that indicates that CBD can fully protect the brain from injury or reverse neurological damage in a human brain after traumatic injury. The preclinical data that does exist is at best applicable to mild concussions, not serious brain injuries. That doesn’t mean that CBD or other cannabinoids don’t have a role to play – we just need more data to understand how a cannabinoid like CBD can be best used and when it may or may not be effective.

The symptoms of CTE can be very similar to TBI, to a degree. If CBD can be effective in treating TBI, it may also be helpful at treating, or at least partially alleviating the symptoms of, CTE. But this is a new and very unexplored area of research, so it is important to be cautious.

Conclusion

Besides the fact that CBD has not been well studied in the context of exercise, there is another glaring gap in the research – it has not been carefully compared to other drugs or natural products that are already being used to treat issues like inflammation, pain, sleep, or brain injury. It is important to understand how CBD compares to other therapies, as well as how CBD performs when administered in combination with other therapies. Perhaps CBD is more effective than other therapeutic options for some or all of these conditions – or maybe it is less effective. Perhaps CBD is more effective when administered by itself, versus in combination with other therapies, or vice versa. It is difficult to say at this time, and it is likely that CBD’s effects on exercise will vary person-to-person. As is the case for the therapeutic use of Cannabis broadly, it is a highly personalized issue and should be handled in conjunction with a knowledgeable healthcare provider.

Despite all of these gaps in our scientific knowledge, it is clear that the issue of CBD’s use in exercise warrants further research, and the scientific research that has been published to date seems to lend some validity to the anecdotal reports that many athletes have been sharing about their experiences using CBD and other cannabinoid products.