ONCE RESERVED FOR dispensaries, cannabis products are becoming increasingly mainstream. Popping up on supermarket and health store shelves as well as holistic wellness websites, CBD oils, tinctures and salves promise major health benefits. The latest wellness fad: improved exercise results.
To understand how CBD is believed to impact workouts, it's important to recognize what CBD is. Short for cannabidiol, CBD is one of more than 100 compounds called cannabinoids contained in cannabis. Similar in structure to endocannabinoids, which the body naturally produces (and may be responsible for runner's high), cannabinoids are most well-known for their feel-good effects, explains registered dietitian Donna Shields, co-founder of the Holistic Cannabis Academy, an online education program for health professionals interested in the medical use of cannabis.
However, unlike tetrahydrocannabinol, or THC, not all of cannabis's cannabinoids cause a psychoactive effect or "high," Shields says. CBD counteracts these effects and may trigger multiple health benefits. The most intriguing advantage for exercisers is reduced inflammation, she says.
The Link Between Exercise, Inflammation and CBD
Any workout, especially a rigorous one, causes microscopic damage to the body's muscles and tissues, explains Dr Alan Beyer, sports medicine doctor and executive medical director of the Hoag Orthopedic Institute in California. It's this inflammation that triggers the body's repair processes, allowing tissues to grow back stronger and fitter. However, too much inflammation left unchecked can contribute to excessive muscle damage and poor workout results. Inflammation is also a hallmark of exercise injuries including strains and sprains, he says.
For this reason, exercises commonly integrate anti-inflammatory measures – such as eating antioxidant-containing foods and taking ice baths – into their workout routines to aid the workout process. They also try to curb achy muscles and joints through the use of non-steroidal anti-inflammatory drugs, or NSAIDs, like ibuprofen, Beyer says.
While studies currently debate exactly when exercisers should try to curb inflammation and when they should just let the body recover on its own, they also suggest that CBD is a powerful anti-inflammatory compound. For example, a 2018 review published in Frontiers in Neurology concluded that CBD is an effective way of improving pain and mobility in patients with multiple sclerosis since it reduces inflammation.
"CBD for exercise-induced inflammation is absolutely the next big area we need to explore," says Thorsten Rudroff, an exercise scientist and director of the Integrative Neurophysiology Laboratory at Colorado State University, and the Frontiers in Neurology study co-author. "However, most of what we know about CBD and exercise is based on anecdotal reports," he says. "There's basically no research on the topic. We need to investigate CBD's effects on inflammatory biomarkers [compounds like C-reactive protein in the body that occur with inflammation] in athletes and exercise recovery."
He explains that he has seen a dramatic increase in the number of older adults and collegiate and professional athletes consuming CBD edibles and oils. By taking them immediately after exercise, they aim to recover quickly and effectively. Some believe that CBD reduces the body's tendency to break down tissues and promotes muscle growth.
Meanwhile, Beyer posits that CBD is most promising as a way to help patients recover from exercise-related injuries. He often recommends that his patients apply CBD salves to the injured area.
"CBD penetrates transdermally to reduce inflammation in the injured tissues," Beyer explains, noting that overuse of NSAIDs, especially in conjunction with exercise, can damage the kidneys. For example, in a 2017 Emergency Medical Journal studying ultramarathoners, those who took ibuprofen every four hours during a 50-mile race were about 18 percent more likely to finish the race with acute kidney damage.
"I always want my patients to start with interventions that have the fewest side effects," Beyer says. However, he also adds that a lack of research exists on the long-term effects of CBD products. "We don't have data to know if it's efficacious or safe over the long term," he says.
When CBD Products Work, Maximizing Benefits Can Be a Challenge
"Right now, CBD is a real quagmire for the consumer," Shields says. For example, while many products contain CBD in its isolated form, full-spectrum varieties that contain other natural compounds from the cannabis plant are believed to be more beneficial, thanks to an "entourage effect." Experts currently disagree as to whether CBD in edibles, tinctures, oils and salves are equally absorbed and used by the body.
CBD products are also notorious for advertising inaccurate levels of CBD, says Dr Jordan Tishler, a Harvard-trained physician, president of the Association of Cannabis Specialists and CEO of InhaleMD, a Boston-area practice specializing in cannabis therapeutics.
A 2017 Journal of the American Medical Association study of 84 CBD commercial extracts found that only 31 percent of them contained the amount of CBD they advertised. Tishler notes that most CBD studies involve dosages of roughly 1,000 milligrams per day, and it's unknown if lower doses will provide any benefit apart from a placebo effect.
Even more concerning, though, is that the Journal of the American Medical Association study also found that one-fifth of the products contained THC. While the exact amount of THC required to trigger psychoactive effects varies from person to person, any THC could prove problematic to anyone undergoing drug testing, either for work or athletics, Rudroff says.
CBD can come from one of two cannabis plants: marijuana or hemp, Shields says. Hemp is legal in all states, as long as its THC content does not exceed 0.3 percent. Marijuana, however, is not legal in all states, and even if a marijuana-derived CBD product contains less than 0.3 percent THC, it still may not be legal, depending on individual state laws.
Third-party testing, in which laboratories measure CBD products' levels of different compounds, including CBD, THC and even contaminants such as mold and heavy metals, does exist, Shields explains. However, many companies advertise the fact that they are third-party tested without providing any proof of testing. She recommends asking to see a product's third-party lab report before buying a CBD product. If the company won't share it, it's time to look into other brands.
No matter what CBD product you choose, it's also important to discuss it with your primary care physician, especially if you are taking other medications or supplements, Tishler says. While research on CBD is promising, it is still a compound with potentially wide and powerful effects in the human body – and many of these effects are still being explored.
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