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Nickel: Are CBD oil and athletes a good mix?

Milwaukee Journal-Sentinel 12/1/2022 Lori Nickel, Milwaukee Journal Sentinel
A sign displayed at the Milwaukee Bucks' training facility cautions players about nutritional supplements that might cause health problems or run afoul of NBA drug policies. © Lori Nickel / Milwaukee Journal Sentinel A sign displayed at the Milwaukee Bucks' training facility cautions players about nutritional supplements that might cause health problems or run afoul of NBA drug policies.

In 2018, former Green Bay Packer Cullen Jenkins had surprising news: He was taking CBD oil to help relieve his pain and inflammation and help him sleep. It was, he believed, a much healthier alternative to the alcohol dependency he’d developed just to get a good night’s rest, after years of destroying his body playing in the NFL.

Back then, at least in Wisconsin, most of us were not well versed in this extracted part of the cannabis plant.

Four and a half years later?

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"Now you can buy it at the gas station,” said Dr. Cecilia Hillard, an expert in the area of cannabinoids.

With the acceptance and availability of CBD oil, what about its use in the sports world, both for professional and recreational athletes? Is CBD oil beneficial?

Hillard is the associate dean for research and director of the Neuroscience Research Center at the Medical College of Wisconsin. Her expertise is in this field, and she said that while there is scientific research that points to benefits of CBD oil use, there are also very stern warnings for the athletes who use them – specifically, athletes who are tested for banned substances.

A lot has changed since Cullen Jenkins' revelation

A lot has changed since Jenkins’ story ran in 2018. The CBD market accounted for $4.7 billion in total sales in 2021, according to Major League Baseball, which recently became the first major professional sports league to form a sponsorship agreement with a CBD company.

CBD is a chemical that is extracted from the cannabis plant. CBD doesn't – or shouldn't – contain tetrahydrocannabinol (THC), the psychoactive ingredient found in marijuana that makes people feel high.

People most often use CBD by ingesting the oil, but CBD is also sold as an extract, a vaporized liquid for vaping pens and an oil-based capsule. Food, drinks and beauty products are among the many CBD-infused products available online. It’s even marketed for pets.

What hasn't changed since 2018

Some things haven’t changed at all since 2018. CBD oil is still not regulated by the FDA. It is very difficult to know what to trust.

From the Mayo Clinic: The only CBD product approved by the Food and Drug Administration is a prescription oil called Epidiolex to treat epilepsy. "While CBD is being studied as a treatment for a wide range of conditions, including Parkinson's disease, schizophrenia, diabetes, multiple sclerosis and anxiety, research supporting the drug's benefits is still limited.”

Just as with other supplements that can be bought at Walmart and Target and online with ease, there isn't a good oversight body that tests and verifies this product on a widespread basis, specifically to see what exactly is in it. And that can be serious, from allergic reactions or unwanted ingredients, such as pesticides or mold. Anything found on the plant can, potentially, be found in the CBD product. And even THC.

What athletes should know

And yet, the appeal for a product like this is great. Manufacturers of CBD say it can help treat pain, anxiety and insomnia, despite the lack of support from major medical organizations citing lack of data and research. So is the help real, or a placebo?

“People say, ‘CBD helps me sleep.’ It may not be that it's really helping you go into the sleep phases better, but it's reducing your anxiety and that's helping you sleep,” Hillard said.

In a direct question to about a dozen athletes, from the University of Wisconsin, Green Bay Packers, Milwaukee Bucks – college to pro – on whether or not they use CBD oil, the answer was universal: no. And the reason was also simple: Why take the chance?

"I've definitely heard of it before and I definitely know people that used it, but I've never used it," Bucks center Bobby Portis said. "So I really don't know what it does. I do Epsom salt; Epsom salt does wonders for me.

"I'm particular about what I put in my body and at the same time, I work hard and I don't want to hear I am banned for something. I don't want to take it and come back and they say I'm banned. So I take precautionary measures to not get in trouble.

"The best way is to go to the training staff, just to make sure everything's OK. Don't put something in your body and take a drug test, and something shows up. Now you have to explain what you're putting in. Even if you explain it, you might get suspended.”

Who can blame him? The names of the substances of marijuana and its byproducts banned by the NBA and WNBA – 5-(1,1-dimethylheptyl)-2-[(1R,3S)-3-hydroxycyclohexyl]-phenol (also called CP-47,497) and 5-(1,1-dimethyloctyl)-2-[(1R,3S)-3-hydroxycyclohexyl]-phenol (also called Cannabicyclohexanol or CP-47,497 C8-homolog), for example – are mindboggling.

Although the NBA is not randomly testing for marijuana for the third straight year, Portis' view may be good to adopt for all pro, college and Olympic-level athletes who are tested for banned substances. Here's why:

"You want to know your CBD truly has CBD in it. That's No. 1,” Hillard said. “No. 2 is to know that the Delta-9 THC is below 0.3%, so that you aren't inadvertently giving yourself the THC that will have the effects on you. More to the point, that could result in a positive drug test."

To make sure the CBD product is legit, it's best to look for certificate of analysis that shows an outside party testing of the product. But this is difficult and confusing. Better products that are certified to contain what they claim to contain are expected to cost more, but there it is very difficult to vouch for a reputable and reliable independent testing agent.

"I'm a little suspicious,” Hillard said. “You want to make sure it isn't something where they are just paying a fee and then getting this 'seal of approval.' You want a facility that's really analyzing every batch and is giving a certificate of analysis for how much CBD is present or how much there is of any THC variety – that's Delta-8 and Delta-9."

Be wary of marketing jargon, such as: “We sell the legal THC Delta-8….”

“That is just as psychoactive as Delta-9 THC,” Hillard said.

That's what's illegal in Wisconsin, where CBD products cannot contain more than 0.3% Delta-9 THC, Hillard said.

A hemp extract supplement is among the CBD products available from Charlotte's Web, a CBD company that has a marketing deal with Major League Baseball. © Lori Nickel / Milwaukee Journal Sentinel A hemp extract supplement is among the CBD products available from Charlotte's Web, a CBD company that has a marketing deal with Major League Baseball.

NSF certified for sport

All of this is why the MLB sponsorship deal with a CBD oil company, Charlotte's Web, is so fascinating.

First, remember that in 2019, MLB made this change: "Natural cannabinoids (e.g., THC, CBD, and Marijuana) will be removed from the Program’s list of Drugs of Abuse. Going forward, marijuana-related conduct will be treated the same as alcohol-related conduct ... which provides for mandatory evaluation, voluntary treatment and the possibility of discipline by a Player’s Club or the Commissioner’s Office in response to certain conduct involving Natural Cannabinoids."

So it's safe to assume that baseball players can use Charlotte's Web CBD products, because they are verified by NSF Certified for Sport. NSF is a highly reputable independent company that tests supplements.

Charlotte's Web says, in a news release, its SPORT Daily Edge tinctures, gummies, topical gels and creams and oral sprays can "support recovery, help keep calm under pressure, and help sleep cycles and focus." It went on to say that "Daily Edge underwent strict independent testing." NSF should give consumers confidence.

“It's very much different from when we buy aspirin or we get a drug from the pharmacist, where we don't have to think about this stuff,” Hillard said. “We know that the FDA and other consumer protections are there making sure that every time I buy a bottle of ibuprofen it's the same amount. 

“This is not the case in the cannabinoid industry.”

More:Why does WADA ban marijuana? Making sense of Sha'Carri Richardson's suspension 'a frustrating enterprise'

The risks of marijuana

CBD is different from marijuana, and if athletes are using marijuana for pain, anxiety and sleep, it’s likely that they’ve changed their habits from smoking to vaping it. Or using edibles.

These are very different delivery methods of delivering THC, so first-time user beware. Vaporization reaches the brain in less than a minute, Hillard said; edibles take a while, so there’s the potential of taking too much too early, and overdosing.Hillard said individuals who are using cannabis products in a responsible manner – and not bingeing and not taking super high doses of THC – have about the same risk of developing a dependence as those who drink wine or beer. About 10-12% of cannabis users go on to develop a cannabis use disorder.

The adverse effects are pretty well known: Don't drive because reaction times aren't good. Don’t do much that requires a lot of postural control, because you're more likely to fall.

But unlike CBD oil, there are studies that show THC reduces pain and settles down the sympathetic nervous system, which helps with the anxiety and maybe sleep.

"There are definitely objective placebo controlled studies that show that THC does reduce pain," Hillard said. "There's pretty good evidence that it can reduce anxiety and it certainly settles down the sympathetic nervous system, which is what you're talking about in terms of adrenaline and all that synthetic activation.”

It's also on many banned substances lists, so athletes need to know that guessing how long it is in the system is a very complicated question and it depends on a lot of factors.

"If you take like a single single dose of THC, the effect of that administration on your brain is gone within maybe an hour, hour and a half. It doesn't last long in the brain," Hillard said. "The problem is that it loves to sit in the fat.

“So when you use it, it causes the changes or settles down the sympathetic nervous system. Then it comes out of the brain and hangs out in your fat and then it is slowly released out of your fat over the next – it can be as much as 24 hours if you are just taking one dose. But if you have been using it daily, you actually will build up more and more in the fat and and the whole time course can be even longer after that.

"Urine drug screen tests don't differentiate. They can't tell when you actually used the product. They're not related to how much is in your brain. So it doesn't really tell you whether you're impaired or not. All that really can say is that at some time in the past you were using or exposed to enough THC to get this positive result.”

A side note about edibles: Kids should not take them, including teenagers.

"There's enough evidence out there to make me as a parent concerned (about) any adolescents' exposure especially to high doses of THC, and especially when the child is younger," Hillard said. "It isn't like (using) cannabis is going to cause schizophrenia or bipolar disorder. But there is an association with individuals who already might have had a risk factor for developing those horrible, lifelong problems. That exposure to high doses of THC in adolescents may increase that risk.

“I just don't think we want to expose children of any age. We just know so little about the developmental consequences of either THC or CBD.”

Hillard is far from the only one.

"Another cause for concern is the unreliability of the purity and dosage of CBD in products," according to an article from the Cleveland Clinic. "A recent study of 84 CBD products bought online showed that more than a quarter of the products contained less CBD than labeled. In addition, THC was found in 18 products."

More:Sports leaders need to catch up to science, society and the needs of athletes when it comes to marijuana

So with so many risks and rewards to THC, it makes sense that so many people are searching and hoping for the rewards of CBD instead, without the downside. But how effective is it?

Debra Thomson Mulberry of Delafield, a triathlete – and podium finisher in her 65-69 age group for the Michigan half Ironman this year – uses CBD, including some Charlotte's Web products.

"I use the gummies every night to aid in sleep, along with a glass of wine and some magnesium pills, and I am out like a light within 30 minutes," Mulberry said. "I use the relief stick on any area that is hurting. I've been blessed with very few issues this past training session so I didn't use it much, however, this offseason, I have used the relief stick on my knees and shoulders."

Mulberry said when she researched CBD companies, she was advised that there was a possibility of trace amounts of THC in any CBD product.

A pain relief stick is typical of a CBD product an athlete might find helpful. © Lori Nickel / Milwaukee Journal Sentinel A pain relief stick is typical of a CBD product an athlete might find helpful.

"But it is minimal," she said. "The gummies are strictly for sleep. There is a small amount of melatonin in them. There may be some anti-inflammatory as well. The oil was for pain relief as well as sleep aid."

For Mulberry, who hires her own coach, follows a swim, cycling and running plan, sticks to specific nutritional regimen and devotes countless hours to training, practice, and physical therapy if needed, CBD is just a small part of recovery so she can continue to race and compete.

Many believe in CBD's benefits to help with so much, from anxiety to arthritis. Forbes recently surveyed 2,000 CBD users for a story and its excerpt on treating arthritis will interest any 40-year-old-and-over masters class amateur athlete. But, in addition to well-cited sources, Forbes also promotes brands of CBD within the posted article.

So the debates continue even among the medical experts.

"It's trendy," Hillard said. "I think a lot of it is expectancy, which we would say is placebo effect. And I don't think we have enough information yet about whether or not it's safe.”

For as lot of us, there's still a whole lot of confusion.

We are drowning in conflicting expert opinions and contrasting reports. Like Bucks coach Mike Budenholzer, who has been recovering from ankle surgery all season and joked, maybe: "Where the hell is this question going … " when asked if he's ever tried CBD.

"I do not use it," Budenholzer said after a recent practice, with a chuckle. "I’m about to go to my PT right now and ask why it hasn’t been suggested."

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This article originally appeared on Milwaukee Journal Sentinel: Nickel: Are CBD oil and athletes a good mix?

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