Cheech and chain rings: inside dirt on cannabidiol (CBD)

After an enduro last year at Red Hill in Victoria, Lachlan McKillop had crashed pretty hard, and when the race was said and done, he was feeling pretty beaten up. In search of relief, he didn't pop a few Ibuprofen or reach for a tube of Voltaren; instead, he put a few drops of cannabidiol (CBD) oil underneath his tongue to dull the soreness.

McKillop is no stranger to managing pain; he's undergone two major knee surgeries – one to repair damage to his ACL and another for a shattered patella.

"I used Voltaren for quite some time, and it worked — it took the pain away and didn't make you groggy or anything. But, it really messed with my gut, and I had borderline irritable bowel syndrome." McKillop says. "I would also try to keep on top of it with Nurofen when the pain would come up, but there was quite a bit of swelling."

At 29, McKillop didn't want to be reduced to regularly popping pills that helped with the pain but left him feeling like crap, and then he discovered CBD. The difference was night and day.

"The big thing that really amazed me beyond just the pain relief and reduction in swelling; before they (his knees) would feel really rough, and now they just feel better lubricated," he said.

In the US and Canada, CBD is everywhere, and big-name riders from Thomas Vanderham to Cam McCaull are using the stuff as natural alternatives to painkillers and anti-inflammatories — disgraced Tour de France winner Floyd Landis even has his own brand of CBD products for cyclists.

CBD is shorthand for cannabidiol. It's an active compound extracted from some species of the cannabis plant which interacts with the serotonin and vanilloid receptors in the brain, which among other things affect the perception of pain. But CBD does not have any of the psychoactive effects of tetrahydrocannabinol, or THC.

Dr Perry Fine is a Professor of Anesthesiology in the Division of Pain Medicine at the University of Utah, and has been researching the therapeutic value of cannabinoids and CBD for nearly a decade.

"Just like our bodies make our own opioids to interact with the endogenous opioid system, our bodies also produce cannabinoids which interact with the endocannabinoid system. As with other systems in the body they are for homeostatic purposes to maintain our health or to respond to stress, injury or disease," Fine explains. "Cannabidiol which is not manufactured in the body, is one of the cannabinoids found in hemp and marijuana — usually in low concentrations."

One hundred and thirteen cannabinoids can be derived from the various parts of the cannabis plant. Because CBD is derived from plants in the cannabis genus both from THC free hemp and marijuana, it's often considered guilty by association with its psychedelic family member — for what it's worth, the hops used in the beer you drink are also a card-carrying member of the cannabis genius.

According to the World Health Organisation, there are no known adverse health outcomes from the use of CBD, and studies have shown it's an effective treatment for children suffering from Dravet Syndrome, a severe form of paediatric epilepsy. It has also been shown to offer relief to cancer patients dealing with the side effects of chemotherapy, and those who have multiple sclerosis and chronic pain conditions. A study published by researchers at the University of Auckland in February of this year auditing New Zealand’s first round of CBD prescriptions, showed patients living with non-cancer chronic pain and mental health conditions presented noticeable improvements to their quality of life.

There is also evidence which shows that CBD is effective at combating pain and inflammation; a 2016 study conducted at the University of Kentucky showed CBD significantly reduced inflammation, including joint swelling and immune cell activity in arthritic rats.

"There is some decent data that CBD reduces some of the biomarkers of inflammation, one of which being TNF alpha, or tumour necrosis factor-alpha. TNF is what's called a cytokine, and it's associated with inflammation, and inflammation is often times associated with pain," explains Fine.

When talking about pain specifically, Fine also notes it's especially tricky because pain is subjective, and of course, there’s the placebo effect.

"If somebody says 'oh, I did get relief, after taking CBD' we can say, well, it's one of two things. It's actually reducing inflammation or interacting at certain receptor sites, or secondary transmitters, and there are interactions that would predictably minimise pain," he says. "But, we can't say that it's not simply a placebo effect — the placebo effects are very powerful."

As a researcher himself, Fine is the first to admit there is still a lot of work to be done to cement the therapeutic niches for CBD. But, at 67-years old, he also told us he regularly takes CBD, because he sees it as a better solution for aches and pains.

"I gotta say, I'm taking a lot less in the way of anti-inflammatories; you know Advil and ibuprofen and Naproxen, those sorts of things. If you have pain that's keeping you from doing stuff you need them (anti-inflammatories) on the other hand, they are not without some significant problems especially with prolonged use," says Fine.

Even the World Anti Doping Administration is on board with CBD, officially removing it from its list of banned substances in January 2018.

McKillop is one of a growing contingent of athletes moving away from ibuprofen and paracetamol for relief from the aches and pains that come as part of training and crashing, and says he’s stopped taking anti-inflammatories for soreness and swelling all together.

David Nieman is a professor of exercise science at Appalachian State University and is the Directory of the University's Human Performance Lab. In his research, Nieman has found that while Ibuprofen may initially reduce pain and inflammation, regular use can have the opposite effect.

"Ibuprofen is the drug of choice for endurance athletes because people think it will decrease pain, muscle soreness and inflammation. What we have actually found, if you chronically use it during training, there is mild damage to the lining cells of the intestine which allows bacteria to escape into the bloodstream," Nieman explains.

"The presence of this bacteria in the blood, even in low levels actually amplifies exercise-induced inflammation, oxygen stress and induces mild kidney damage," he continues. "There really is no good physiological effect of ibuprofen for athletes."

With the commercial side of CBD vastly overtaking the research end, there have been a few hiccups when it comes to quality control because the regulations aren’t standardised, due in part to mixed legal status. According to a 2017 study published in the Journal of the American Medical Association found 69-percent of the CBD products it tested didn't contain the amount of cannabidiol as stated on the label.

"The bioavailability at least for oral use is very poor, and it's not uniform. There is true expertise that is required for manufacturing cannabidiol in addition to the quality control measures that are necessary not only for extraction but creating admixtures and determining concentration." Fine says.

It's clear that CBD is beneficial not only for mountain bikers (and average Joes) looking to take the edge off if their post-ride aches and pains among a host of other things, with fewer adverse effects than over the counter anti-inflammatories. Dr Fine tells us there is no abuse liability and even WADA is on board, but the Australian Federal Government isn't, and CBD sits in a legal grey area. But things are changing.

As of January 31, 2020, it is no longer a criminal offence to possess a marijuana plant in the ACT but, it's still illegal to consume what you grow — because a giant ‘pot’ plant (pun intended) looks great in your front yard as a decorative piece, duh. In the US, Colorado passed a similar 'you can have it, but you'd better not use it' legislation before cannabis became available for medicinal and recreational use. Now CBD products ranging from oils to topical creams can be purchased over the counter without the need for a prescription.

As it stands, CBD products are available in the majority of the US, Canada and 14 European countries. It's hard to say if Australia will follow suit, but we sure hope so.