Fiji's Koli Sewabu and the All Blacks' Leon MacDonald are left sprawled on the ground after a big head clash.
Traumatic Brain Injury (TBI) is one of the leading causes of death worldwide in individuals under the age of 45. Triggered by concussions from car accidents, falls, violent contact sports. It is the most commonly identified cause of epilepsy among adults
Chronic Traumatic Encephalopathy (CTE), a particularly severe form of TBI, is caused by the accumulation of numerous concussions, which increases the risk of neurological problems later in life and hastens the progression of dementia. Rugby players, boxers and mix material artiest are particularly vulnerable given the violent nature of the sport.
Although, concussion, Traumatic Brain Injury (TBI) and Chronic Traumatic Encephalopathy (CTE) awareness in contact sports has increased dramatically in recent years, with all major sporting bodies setting out clear guidelines on returning to play after a concussion. England rugby guide can be found here.
The efficacy of treating concussions with CBD-rich cannabis has only recently been a part of the discussion this is due to the benefits of CBD products slowly starting to be embraced by the mainstream with large high street stores starting to sell various CBD products.
The pace of change in legislation may seem slow but CBD products have exploded onto the marketplace worldwide and for good reason.
In America where each state has been legalising the use of the cannabis plant in varying degrees from medical to recreational use over the last few years culminating in the successful passing of the 2018 farm bill.
It has become apparent that the use of CBD can have neurological implications that may improve quality of life, especially in individuals who may have experienced trauma, whether it is physiological or psychological.
CBD and WADA
It’s not just government bodies who are starting to reassess their stances on this powerful natural supplement. The World Anti-Doping Agency (WADA) Removed CBD from its List of Prohibited Substances in 2018, up until this point many athletes across a variety of sports have been unable to use CBD because of the Prohibited Substances list. This turned out to be a watershed moment for all professional athletes, unlike opioid pain medications, CBD has not been found to be addictive. In fact, some research has found that CBD can actually help decrease addictive use of cannabis as well as opioids like morphine by blocking the reward pathways that lead to addiction.
“Athletes have sworn by the results of the product”
However, it is important to note that tetrahydrocannabinol (THC), the better known psychoactive component of cannabis and its derivatives are still on the prohibited list for 2018. As a result, athletes who wish to use CBD must ensure any products they use don’t contain any THC.
Professional and serious amateurs alike in this past year have been some of the biggest consumers and advocates for the use of CBD, although the research and literature on usage is relatively new, athletes have sworn by the results of the product.
Promising Scientific Break Through
A recent study published in the Journal of the American Medical Association (JAMA) in November of 2015 spoke on the impacts that concussions have on the hippocampus. The hippocampus is a region of the brain that is responsible for memory, specifically long-term, emotions, spatial navigation and regulation of the autonomic nervous system. The study looked to determine through magnetic resonance imaging (MRI) if concussions caused shrinkage of the total mass of the hippocampus (Singh et al., 2015). The results published in JAMA indicated that American football players with and without a history of concussion showed smaller hippocampal volumes relative to the healthy control.
An additional study published in 1998 by The Proceedings of the National Academy of Sciences published a groundbreaking report on the neuroprotective properties of cannabidiol (CBD) and tetrahydrocannabinol (THC), two major components of marijuana. Co-authored by a team of researchers (AJ Hampson, M Grimaldi, D Wink and Nobel laureate J Axelrod) at the National Institutes of Mental Health, this preclinical study on rats would form the basis of a U.S. government-held patent on “Cannabinoids as antioxidants and neuroprotectants.”
The patent indicates that CBD and THC were found “to have particular application as neuroprotectants … in limiting neurological damage following ischemic insults, such as stroke or trauma.” These plant cannabinoids were also deemed useful for treating other neurodegenerative conditions, “such as Alzheimer’s disease, Parkinson’s disease and HIV dementia.”
Whereas TBI results from an external blow to the skull, a stroke is caused internally by an arterial blockage or rupture. But TBI and stroke share many of the same pathological features and aberrant molecular mechanisms.
TBI and stroke are both acute and potentially lethal injuries, involving a primary ischemic insult that interrupts cerebral blood flow and destroys brain tissue. This is followed by a secondary injury cascade that, if unchecked, can ricochet for several weeks or months, resulting in more brain damage, motor impairment and other adverse “downstream” effects, such as poor concentration, irritability, and sleep problems.
Whether the cause is an occluded blood vessel or blunt external force, the initial trauma triggers a complex sequence of molecular events characterized by the massive release of glutamate (an excitatory neurotransmitter) and the overproduction of reactive oxygen species (free radicals) and other inflammatory compounds. Excessive glutamate and oxidative stress, in turn, lead to microvascular injury, blood-brain barrier breakdown, swollen brain tissue, mitochondrial dysfunction, calcium ion imbalance, neurotoxicity and cell death. The secondary injury cascade is associated with the development of many of the neurological deficits observed after a TBI or a stroke.
How does CBD, benefit neuroprotective effects?
Plant cannabinoids such as THC and CBD mimic and augment the activity of endogenous cannabinoids that all mammals produce internally. Endogenous cannabinoids are part of the endocannabinoid system (ECS). The ECS regulates many physiological processes that are relevant to TBI, such as cerebral blood flow, inflammation, and neuroplasticity.
A 2011 article in the British Journal of Pharmacology describes the ECS as “a self-protective mechanism” that kicks into high gear in response to a stroke or TBI. Co-authored by Israeli scientist Raphael Mechoulam, the article notes that endocannabinoid levels in the brain increase significantly during and immediately after a TBI. These endogenous compounds activate cannabinoid receptors, known as CB1 and CB2, which protect against TBI-induced neurological and motor deficits.
CB1 receptors are concentrated in the mammalian brain and central nervous system. Preclinical research involving animal models of TBI and stroke has shown that heightened CB1 receptor transmission can limit harmful excitoxicity by inhibiting glutamate release. CB1 receptor activation also dilates blood vessels, thereby enhancing cerebral blood flow (and oxygen and nutrient supply to the brain).
But these beneficial physiological changes were not evident in genetically-engineered “knock out” mice that lack CB1 receptors. Without these crucial receptors, an animal is less able to benefit from the neuroprotective properties of endogenous cannabinoids and plant cannabinoids.
“Cannabinoid receptors play an important role in neuroprotection”
In 2002, the Journal of Neuroscience reported that the impact of induced cerebral ischemia is much more severe in CB1 knockout mice than in “wild type” mice with cannabinoid receptors. The absence of CB1 was shown to exacerbate TBI-related brain damage and cognitive deficits, indicating that cannabinoid receptors play an important role in neuroprotection.
Powerful Natural Supplement
Saracens Welsh rugby union player Dominic Day
With many professional athletes becoming aware of the side effects of taking prescription anti-inflammatories and painkillers most of their professional lives to get them to match day. Many have become aware of the benefits short and long-term of taking a more plant-based approach to their health, wellness, and recovery. Dominic Day rugby union player for Saracens has openly talked about his use of CBD as a recovery supplement, praising the benefits he and fellow teammates have experienced. Along with crediting it for allowing him to move away from a dependency on prescription alternatives.
"I was probably taking prescription anti-inflammatories and painkillers four or five times a week just to get to the weekend to play," says Day. "It wasn't where I wanted to be at all. I just don't take that stuff now, I stick with the CBD oil."
Day initial started supplementing with CBD as a knee surgery and was blown away with the results, "The first thing I noticed was my sleep was amazing. The inflammation in my knee also went down and it relieved the pain. I was sold from then on."
Tranquil all natural CBD sleep aid
Complementary Recovery Program
It is important to remember that CBD like many other great supplements is just that, a supplement. A pathology as complex as a stroke or a traumatic brain injury can benefit from a multifaceted treatment regimen that encompasses a combination of healing modalities, including:
- CBD-rich extracts LINK TO PRODUCTS
- Diet. A high fat/low carbohydrate/low sugar diet with plenty of leafy greens, omega 3 oils (DHA, EPA), and fermented foods (probiotics).
- Nutritional supplements and antioxidants. Magnesium, vitamin D, curcumin, glutathione – and Valerian root to restore circadian rhythms and sleep.
Ancient therapies. Acupuncture, exercise, and caloric restriction (fasting), which increase endocannabinoid levels.
Modern therapies. Neurofeedback, low-level laser therapy (photobiomodulation), hyperbaric oxygen, traßnscranial direct current stimulation, flotation tank therapy, and hypothermia (cooling).
With these findings serving to inform the current debate regarding
the therapeutic application of cannabinoids, it seems that CBD maybe a worthwhile addition to anyone who’s serious about their health and wellbeing.
More and more studies are stating that CBD may provide preventative care or potentially restore hippocampal integrity after injury. This is huge not just for professional athletes who compete in contact sports, who are experiencing similar cognitive impairments in the hippocampal region as a result of multiple sub-concussive and full concussive impacts over time (Yucel et al., 2015). But also anyone who’s serious about their health and wellbeing. We can only hope that these findings serve to inform the current debate regarding the therapeutic application of cannabinoids and can only open up an interesting avenue for further research in human trials given the safety and efficacy of the CBD.
Singh R, Meier TB, Kuplicki R, et al. Relationship of collegiate football experience and concussion with hippocampal volume and cognitive outcomes. JAMA - J Am Med Assoc2014;311(18):1883–8.
Yücel M, Lorenzetti V, Suo C, et al. Hippocampal harms, protection and recovery following regular cannabis use. Transl Psychiatry2016;6(November 2015):e710.
World Anti-Doping Agency. “Prohibited List: January 2018”. The World Anti-Doping Code International Standard. (https://www.wada-ama.org/sites/default/files/prohibited_list_2018_en.pdf)
Shannon, S., Opila-Lehman, J. Cannabidiol Oil for Decreasing Addictive Use of Marijuana: A Case Report. Integr Med. 2015 Dec; 14(6): 31–35.
Markos JR, et al. Effects of Cannabidiol on Morphine Conditioned Place Preference in Mice. Planta Med. 2017 Aug 9. doi: 10.1055/s-0043-117838.
United States Anti-Doping Agency. “Marijuana and Cannabinoids”. (https://www.usada.org/substances/marijuana-faq/)
Increased severity of stroke in CB1 cannabinoid receptor Knock-out Mice
The Proceedings of the National Academy of Sciences
Arain M, Khan M, Craig L, Nakanishi ST. Cannabinoid agonist rescues learning and memory after a traumatic brain injury. Ann Clin Transl Neurol. 2015 Mar;2(3):289-94. doi: 10.1002/acn3.163. Epub 2015 Feb 16. PubMed PMID: 25815355; PubMed Central PMCID: PMC4369278.
Biegon A. Cannabinoids as neuroprotective agents in traumatic brain injury. Curr Pharm Des. 2004;10(18):2177-83. Review. PubMed PMID: 15281893.
Bittigau P, Sifringer M, Felderhoff-Mueser U, Hansen HH, Ikonomidou C. Neuropathological and biochemical features of traumatic injury in the developing brain. Neurotox Res. 2003;5(7):475-90. Review. PubMed PMID: 14715432.
Bravo-Ferrer I, Cuartero MI, Zarruk JG, Pradillo JM, Hurtado O, Romera VG, Díaz-Alonso J, García-Segura JM, Guzmán M, Lizasoain I, Galve-Roperh I, Moro MA. Cannabinoid Type-2 Receptor Drives Neurogenesis and Improves Functional Outcome After Stroke. Stroke. 2017 Jan;48(1):204-212. doi: 10.1161/STROKEAHA.116.014793. Epub 2016 Nov 29. PubMed PMID: 27899748.
Butti E, Bacigaluppi M, Rossi S, Cambiaghi M, Bari M, Cebrian Silla A, Brambilla E, Musella A, De Ceglia R, Teneud L, De Chiara V, D’Adamo P, Garcia-VerdugoJM, Comi G, Muzio L, Quattrini A, Leocani L, Maccarrone M, Centonze D, Martino G. Subventricular zone neural progenitors protect striatal neurons from glutamatergic excitotoxicity. Brain. 2012 Nov;135(Pt 11):3320-35. doi: 10.1093/brain/aws194. Epub 2012 Sep 24. PubMed PMID: 23008234.
Ceprián M, Jiménez-Sánchez L, Vargas C, Barata L, Hind W, Martínez-Orgado J. Cannabidiol reduces brain damage and improves functional recovery in a neonatal rat model of arterial ischemic stroke. Neuropharmacology. 2017 Apr;116:151-159. doi: 10.1016/j.neuropharm.2016.12.017. Epub 2016 Dec 21. PubMed PMID: 28012949.