Thoughts on CBD
In January of 2018, the World Anti-Doping Agency (WADA) removed cannabidiol (CBD) from its list of banned substances. Immediately, my phone and email blew up! Athletes were asking whether they should start taking CBD and how they should use it.
Now, a year and a half later, questions are still swirling around the utility and legality of CBD. It is a common question I receive, and one that has arrived in the Podium Q&A mailbox. So, here we go…
What is CBD?
CBD is one of many chemicals called cannabinoids present in cannabis. In fact, there are over 100 cannabinoids in the cannabis plant, the most abundant of which is tetrahydrocannabinol (THC). THC is the element which provides a high when smoking or consuming marijuana. CBD does not cause any such psychoactive effects. While THC has been shown to offer some health benefits, it is not practical to use a medication which keeps the patient in a psychologically altered state. As you might imagine, if CBD can provide such health benefits without the high, that could lead to groundbreaking treatment. But that’s a big “if”!
Is CBD legal?
There are two issues here. The first, and most important, is determining whether your local government has legalized CBD. Last December, the federal government’s Farm Act legalized hemp, from which CBD can be obtained. Though CBD can now be purchased in most of the US, there are still some legal uncertainties. It’s in a bit of a gray area at the moment. There are very specific conditions under which hemp-derived CBD is considered legal by the FDA.
Confusing the issue further, each state has its own laws governing CBD. The short answer to this question is that you need to do your own research, based on where you live and what product you wish to use, to determine whether you are falling afoul of any applicable laws. To be fair though, CBD use is widespread and fairly commonplace. Outlets selling CBD are popping up coast to coast, so you should have numerous resources for determining your local regulations.
Once it has been determined that CBD is legal for use, it is then important for some athletes to understand WADA’s rules. If you are a tested athlete or if you enter any number of sanctioned events (USA Cycling, USA Triathlon, USA Track & Field, etc.), then you are governed by WADA’s rules. Unfortunately, the answer here is much less clear. THC is banned when in-competition. CBD is not banned in-competition. That part is simple. However, there are over one hundred other cannabinoids that remain on the list of banned substances, and these can be contaminants in CBD products. It is unclear whether WADA is testing athletes for these other cannabinoids, but that’s beside the point. There are some CBD producers who offer in-house or third-party testing of their products for banned substances. This is great, but they typically test for 20-30 cannabinoids. I have not seen anyone testing for the presence of every single cannabinoid. Because of this, I do not recommend the use of CBD by anyone who might find themselves subjected to in-competition testing by WADA or an affiliated agency.
Is CBD safe?
Probably. It seems that short-term use is safe for most people. Data on long-term use is lacking, so this is a question that will not be answered for many years.
What does CBD do?
A little bit of everything, it would seem. If you look at some products’ claims, you might gather that it will cure your pain, squash inflammation, ensure a good night’s sleep, treat cancer, abolish anxiety, improve concentration, treat skin conditions, and on and on. In my opinion, the hype around CBD has far outpaced the science.
That said, it is reasonable to think there may be some benefits to the use of CBD. Most of the research thus far is in animal models, primarily mice. Please note, humans are not mice! (There is a great Twitter account called @justsaysinmice where a scientist points out flawed headlines in the lay press which overstate the findings of scientific papers. If you’re a nerd like me, you’ll love it!) The majority of research findings in mice DO NOT translate to similar effects in humans. Rodent research is a valid and necessary first step, but it does not constitute rationale for human implementation. Instead, mice studies give us information on if and how we should proceed with human studies. At the moment, CBD is frantically being studied in humans, but the results are not yet back.
The only condition for which there seems to be solid evidence of CBD’s utility is a rare form of seizure. In fact, the FDA has approved a CBD pharmaceutical called Epidiolex for this use.
Aside from seizures, sufficient human data is not available. That said, it appears that there are a few things for which CBD may be helpful.
Anxiety - there are a handful of human studies which suggest that CBD may be helpful for decreasing anxiety. The data is not robust, but more studies are under way currently.
Pain - there is reason to think CBD may help with pain, though there are very few human studies to back this up.
Sleep - there are multiple reports of CBD improving sleep. In fact, I can say that my deep sleep increases significantly when using CBD at night. However, the research is not yet there to support this. In fact, studies would suggest that CBD does not impact sleep at all, positively or negatively.
Inflammation - a few studies have shown decreased inflammation with CBD use…in mice.
With all of this in mind, my take on CBD is this.
CBD is likely safe for most people when used intermittently for specific purposes. (As always, you should talk to your doctor before using any new medication or supplement. CBD can exacerbate some conditions and interfere with some medications.)
CBD is not recommended for anyone who may be subject to in-competition testing. Use out-of-competition may be worthwhile. The definitions for these terms (“in-competition” and “out-of-competition”) are very specific and dictated by WADA. You should have a detailed understanding of how this applies to your situation when deciding if and when to use any supplement or medication.
It is reasonable to think that CBD may have some effect on anxiety, pain, sleep, and inflammation. It is important also to understand that research may show that there is no effect or even adverse effect! The jury is out.
If you decide to try CBD, it is important to understand what you are trying to achieve. Don’t just take it to see what happens. For instance, I mentioned that I have used it myself and with some of my patients to help with sleep. When doing so, we also measure the effect. I use an Oura Ring to measure my sleep and to look at sleep stages. When I take CBD, my deep sleep is notably improved. This effect is not something I see across the board, in all of my patients who use CBD. There are individual responses. This type of experimentation, with measurement of effect, is a useful pursuit.
When choosing a CBD product, it is crucial to pick one that is pure and includes only what you expect to purchase, in the amount you think you are getting. Many products are poorly regulated, contaminated, and vary greatly in the amount of CBD contained. I recommend looking for batch-tested products. Even better, find products which are tested by third-parties (ie - not the manufacturer). The Feed is a great online resource providing food and supplements for athletes and those interested in general health and wellness. As far as I know, they are the only such store which performs third-party testing on every batch of CBD products sold! (Disclaimer: I am about to announce a partnership and advisory role with The Feed, so this is not an unbiased endorsement.)
Again, my assessment is that the hype of CBD has currently outpaced the research. There is reason to think that CBD may prove to be a useful supplement, but at the moment that proof is simply lacking. Keep an eye on the research though! In the coming years, there will be many studies published on the topic. Stay tuned…
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