All the As to your Qs about CBD.

What is CBD? Is CBD the next wonder drug? With products claiming to do everything from healing inflammation to boosting the quality of sleep, it’s natural that athletes are curious about CBD. But navigating the CBD landscape is complicated: CBD comes in a dizzying array of formulations, and a standard set of dosing recommendations do not exist. Further adding to the complexity is the legality of such products – CBD’s reputation is often entangled with marijuana and all the fear that comes with it: Will I be arrested for taking CBD? Is this going to make me high? I don’t want to get a doping ban. It’s enough to leave athletes confused about just what it is they should be shopping for – and if they should even be using CBD at all.

To break it all down, we’ve recruited Joanna Zeiger, former professional triathlete, Olympian, and Ironman 70.3 world champion. These days, she goes by another title – Dr. Zeiger – and spends her days researching the use of cannabis in athletic applications with the Canna Research Group and Athletes for CARE.

What exactly is CBD?

Cannabis plants, such as the marijuana or hemp plant, contain more than 115 cannabinoids, each one with a unique chemical structure. CBD is one of those cannabinoids, alongside its more famous cousin, THC.

“THC is the one that can make you high, while CBD usually does not,” Zeiger explains. “Marijuana generally refers to cannabis that is high in THC, but also has some CBD. CBD can also come from hemp, which is also a member of the cannabis family.”

Is CBD the same thing as medical marijuana?

No. CBD products on the market today tend to come from hemp, Hemp is very low in THC, measuring at less than .3 percent. Medical marijuana, by comparison, contains 5 to 10 percent THC. Because hemp has a low THC content, is not considered a controlled substance by the federal government. This is different from medical marijuana, which is not federally legal but is legal in some states. Unlike medical marijuana, which must come from a licensed dispensary, CBD products are available for purchase in a variety of settings, including online, at grocery stores, and over the counter at pharmacies.

What does CBD cure?

The short answer: No one can say for sure.

“CBD has flooded the market and has been touted for all sorts of uses,” Zeiger says. “The truth is, though, that many of the claims made by CBD proponents have not been rigorously studied.” In fact, the proliferation of CBD companies making unsubstantiated claims has resulted in the FDA sending out warning letters.

Other than one prescription drug product to treat rare, severe forms of epilepsy, the FDA has not approved any other CBD products, and there is very limited available information about CBD, including its effectiveness for treating physical or mental ailments.

That’s not to say that CBD should be dismissed entirely. An emerging body of research on CBD indicates it might decrease various types of anxiety and pain; Zeiger’s research has also found that CBD may improve sleep quality in some athletes. But at the moment, there simply isn’t enough research to definitively declare the best uses for CBD.

Are there side effects from CBD use?

While CBD is generally considered safe, side effects can occur. “There are always ways to misuse any product, and cannabis is no different,” Zeiger says. “Athletes can take too much, which can lead to unpleasant adverse effects such as dizziness or drowsiness. In some cases, CBD can cause liver issues.” In Zeiger’s own studies on CBD in athletes, the top three adverse effects from CBD use were difficulty concentrating, increased appetite, and increased anxiety.

Should athletes use CBD for ___________?

Because there are no established treatment plans for CBD use, it’s on the athlete to establish their own, says Zeiger. It starts with being clear and purposeful: “When an athlete starts to consume cannabis, it is important to define what the goal is from cannabis. Is it pain relief? Improved sleep? Decreased anxiety? Recreational? Muscle soreness? Understanding the why of cannabis use will help the athlete to the proper type of product.”

Zeiger warns that CBD cannot do everything, and it is not for everyone. Some people simply do not respond, and others find they can’t tolerate CBD. “In addition, using CBD for health and wellness is not a magic bullet, and will not undo poor training habits,” Zeiger warns

What kind of CBD product is best for me?

A variety of products are available, but the most common forms for health-motivated consumers are topical applications (like creams) and oral routes, including oils, tablets and capsules. Your motivation for CBD use should dictate the route of administration – a topical will likely work best for a muscle strain, but an oral route of administration will work better for something like anxiety or sleep. Vaping, a method of CBD administration in which a liquid CBD product is heated (or “vaporized”) and inhaled using an e-cigarette, is perhaps the riskiest route of administration – multiple public health warnings have been issued due to adverse effects of CBD vaping, including headaches, nausea, disorientation, agitation, and heart irregularities.

What is the best dose of CBD for athletes?

According to Zeiger, the best dose of CBD is the lowest dose possible. “When athletes start to use CBD, they should start with a dose of less than 5 milligrams, slowly working their way up to a dose that provides relief for the stated goal. The ideal situation is finding the lowest dose that offers the best relief with the fewest side effects. The mantra in the cannabis world is ‘start low, go slow.’”

Will CBD get me in hot water with anti-doping agencies in my sport?

It’s possible. Though CBD is approved by the World Anti-Doping Association to consume in-competition, all other cannabinoids are not. Because it’s nearly impossible to extract only CBD from the cannabis plant, athletes should assume that CBD products are probably mixtures of CBD and other prohibited cannabinoids, including THC. No matter what is said on the bottle about the THC content, CBD oils and tinctures extracted from cannabis plants can still contain THC, and even low levels could result in a positive test for a prohibited cannabinoid.

Since CBD does not have to go through the rigorous testing required of FDA-approved medical products, the consumer may not have full information on what they are purchasing. A 2017 study published by the American Medical Association found 69 percent of CBD products examined contained different levels of CBD than what was reported on the label. Furthermore, THC was detected in 21 percent of the products tested, and the THC content in some of those products was enough to produce intoxication or impairment.

Even if the manufacturer is at fault for shady business practices, the principle of strict liability still applies under the World Anti-Doping Code – that is, an athlete is solely responsible for any prohibited substances found to be present in his or her body. To minimize the risk of contaminated product, Zeiger advises athletes purchase CBD products from companies that are transparent about their testing protocol, and disclose a Certificate of Analysis. She also recommends cross-referencing products with Consumer Labs, which conducts independent testing of CBD products.

The ABCS of CBD for Athletes

CBD products have their own lingo. Here’s what those terms mean:

Formulations:

Broad Spectrum: A cannabis product that contains CBD and other cannabinoids, but not THC.

Full Spectrum: A cannabis product that contains CBD and other cannabinoids, including THC.

Isolate: A cannabis product that should contain only CBD.

RSO: An acronym for Rick Simpson Oil, a form of cannabis oil that contains a high THC percentage.

Terpenes: A broad term to describe the natural compounds responsible for the flavors and scents of the CBD product.

Administration:

Dabbing: A method of administration where potent cannabis concentrates are flash vaporized and inhaled using a rig that resembles a water pipe.

Gummies: CBD products provided in candy form – one or two gummies usually contains the recommended dosage, much like a multivitamin gummy.

Lozenges: A tablet containing CBD that is placed under the tongue to dissolve.

Microdosing: Consuming very small doses of CBD throughout the day, as opposed to one or two larger doses per day.

Oil: A liquid containing CBD that is consumed either in capsule form or using a dropper, sublingually (under the tongue).

Tincture: Traditionally used to describe alcohol-based products, but now sometimes used on labels for oil-based products as well.

Topical: A CBD product applied to the skin, but does not enter the bloodstream.

Transdermal: A CBD product applied to the skin, but does enter the bloodstream.

Vaping: A method of administration where cannabis tinctures are heated, turning into vapor which is then inhaled.