Cannabis and Its Potential in The Treatment of Brain Disease

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He sprints across the field, head down, shoulders hunched forward. He’s only feet from the wide receiver now. He braces. Or at least as much as one can brace for impact with a 200+lb wall of muscle.

He tackles his opponent. The same as he’s done a million times before. Both land hard on the ground. His head bounces off the astroturf, his brain slamming hard against his skull. He feels dizzy and nauseous. Jut like before. His vision darkens, and he feels like throwing up. For the millionth time.

It’s okay. “Probably just a little rattled” coach will say.  At least he forced the fumble. And nothing feels better than the crowd cheering for him. The ringing in his head will only last a couple of minutes, but people will be talking about that hit all night.  

It doesn’t though. Stop, I mean. 

Sure, the ringing subsides, but long after the cheers of the crowd fade the silent disease manifests itself. Subtle, barely noticeable symptoms at first. But they grow. They get steadily worse as the years pile on.

Little headaches turn into severe migraines. Minor forgetfulness turns into constant confusion, memory loss, and poor attention span. Behavioral changes and mood swings progressively worsen to dementia. Motor and speech problems, seizures and tremors, even suicidal thoughts only get worse with time.

What can be done? Is it just a ticking clock? And what is this affliction?

This is CTE or chronic traumatic encephalopathy, a brain disease that affects mostly professional athletes, especially those who play contact sports like football, rugby, boxing, and mixed martial arts.

The scary thing about CTE is that, at least until recently, it could only be diagnosed definitively in an autopsy, when the athlete is already gone and too late to help. Thankfully, new tests are showing the viability of testing live patients. For the most part, the only telling sign of CTE is the symptoms the person exhibits.

CTE has no known cure. There are no drugs that can reverse the disease process. There are medications that can, at least, control the symptoms. However, like most drugs, these prescription medications have their own set of adverse side effects.

Cannabis

Cannabis, according to new studies and prominent scientists such as Dr. Grinspoon, a psychiatrist from Harvard University, has neuroprotective properties that could benefit athletes suffering from the symptoms of CTE. While it can’t cure the disease, the cannabinoids can help reduce the symptoms and may help prevent future damage. 

As I publish this, MLB (Major League Baseball) has announced its removal of cannabis from its banned substances list. This is a huge step for sports as a whole.

While this is something to be celebrated, there is still a ways to go. Cannabis’ prohibition, both federally in the US and in major sports, is hindering the ability to effectively research the treatment of CTE with cannabis.

What is Chronic Traumatic Encephalopathy?

Chronic traumatic encephalopathy is a progressive degeneration of the brain resulting in neurological issues. The symptoms can range anywhere from debilitating headaches and motor and sensory problems to severe cognitive abilities, dementia, and seizures.

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The brain on the left is a healthy adult brain. The brain on the right comes from an adult with CTE.

The primary cause of CTE is repeated blows to the head. These blows often result in concussions and small brain injuries, which then result in frequent brain inflammation. The presence of chronic low-grade brain inflammation damages the neurons or brain cells. The widespread neuronal damage, in turn, causes structural changes in the brain tissues, including brain atrophy, which affects the way the brain normally functions. These brain changes cause the symptoms of CTE.

For a long time, people theorized that it was heavy impact leading to loss of consciousness that caused CTE, and while it is undeniable that heavy impact does significant damage, new data is coming out that suggests it is actually repetitive smaller-impact hits to the head that causes CTE in a lot of patients. As the person does not lose consciousness, they end up absorbing far more blows than if it were to be one concussive shot. 

Things like heading soccer balls, sparring in boxing practice and practicing tackles in football cause significant damage to the brain, despite their less dramatic immediate results. Where the disease was once referred to as ‘punch drunk’, alluding to its frequency in boxers, scientists now know that there are many sports that, while not as visibly damaging, can lead to long term damage and eventual CTE.  

The Long Game

As mentioned before, until recently, CTE could only be diagnosed conclusively post-mortem. The results, however, were staggering and incredibly concerning. CTE was found in 99% of the brain samples taken from deceased professional NFL players. It was also found in 91% of college players and 21% of high school players. This indicates that even comparably short careers of high school and college football players, spanning no more than the length of 4-5 years, can still lead to serious brain damage, even in a small amount of time. 

In recent years more and more attention has been paid to the extreme behavioral changes found in patients with CTE. Aaron Hernandez was a star NFL athlete before he was accused of murder. He eventually hung himself in his prison cell. Later tests done on his brain showed extreme CTE. Hernandez is not the only professional athlete to take a violent turn as a suspected result of CTE. Chris Benoit, a professional wrestler who murdered his family before taking his life was found to have such extensive CTE that his brain resembled that of an Alzheimer’s patient in their 80’s. Cases like these can be found time and time again in retired athletes from high contact sports. Obviously, only the person who committed the horrible acts knows the true reason, but the pattern of CTE found post mortem in their autopsies is alarming and suggests far more than mere coincidence.

Can Cannabis Help Patients with Chronic Traumatic Encephalopathy?

We still lack enough research on cannabis and its effects on CTE, but there have been multiple studies done on the effects of cannabis on brain diseases like dementia, traumatic brain injury, depression, and post-traumatic stress disorder, among others. And the results are undeniably promising.

Glutamate is one of the primary excitatory neurotransmitters in the brain. It “excites” the brain cells and facilitates action. When there is brain injury, there is a significant increase in glutamate levels. The increased glutamate level is toxic to the brain cells and contributes to the degeneration of the neurons and the progressive worsening of brain diseases.

Cannabis has neuroprotective properties. Cannabinoids like CBD and THC act as potent antioxidants that counteract the effects of glutamate toxicity. CBD and THC, as antioxidants, also help slow down neuronal death by neutralizing free radicals. Free radicals are normal byproducts of our cells, but their levels markedly increase when there is a high glutamate level. High levels of free radicals further contribute to brain cell damage and brain inflammation.

CBD and THC are also powerful anti-inflammatory agents and can help control the chronic low-grade brain inflammation associated with CTE. Cannabis’ anti-inflammatory effect can also help delay disease progression.

Symptom Control

Cannabis also has properties that can help control CTE-related symptoms such as headaches as well as nausea. It can also help the patient calm down and reduce anxiety and agitation. Cannabis can also help relieve insomnia, depression, memory loss, and dementia symptoms.

So while cannabis can’t cure CTE in athletes, it can help relieve several CTE related symptoms. It also can’t prevent concussions or protect athletes from repeated concussions which can lead to CTE, but with said, cannabis can help protect the brain from the damaging effects of concussions.

The only way to prevent concussions and CTE is to limit playing contact sports and wearing the right protective gear. Athletes who sustain a concussion should also get ample rest and be cleared by a healthcare professional before playing again. As mentioned, it is often the accumulation of many smaller impact blows that do just as much, if not more damage, than concussions. This also, however, is far harder to treat as there is no clear indication like when there is a full-on concussion. 

Can Athletes Use Cannabis?

This is a tricky area, as many sports have commissions set up to regulate the rules and gameplay. Relics from the days of cannabis prohibition, many STILL ban the use of the plant, despite strong evidence and pleas from prominent doctors for a reversal in policy.

Once retired from the sport, athletes are free to use the plant. In fact, many retired NFL players and MMA fighters use cannabis for their sports-related injuries and symptoms, including issues stemming from CTE. 

The World Anti-Doping Code technically prohibits the use of cannabis. In reality though, a good number of active and even prominent professional athletes have admitted to using medical cannabis for their sports-related injuries. Some athletes have even openly stated that they prefer medical cannabis over opioid-based drugs for pain control.

Red Tape

Be that as it may, under federal law, cannabis remains illegal in the US. Its illegality limits research on cannabis and sports-related injuries including CTE, as well as places a lot of restrictions on the use of medical cannabis as an alternative treatment for injuries and the prevention of CTE.

Despite this, support for medical cannabis is growing in sports as professional athletes openly advocate for legalization. There are also ongoing studies on CTE and cannabis, and these studies are supported by former NFL players. These may be the push the sports industry needs to rethink its stance on cannabis use among its athletes.

MMA

One sport that has openly dealt with cannabis use in the public eye is MMA. Like many sports, cannabis use was banned in and out of competition for a long time. Many prominent MMA fighters tested positive and received fines/ punishments for cannabis, however no one has embodied the struggle for cannabis acceptance more than beleaguered UFC welterweight Nick Diaz. 

Diaz faced multiple fines and suspensions for his cannabis use throughout his career. Due to mounting frustrations with regulatory bodies, Nick Diaz walked away from the sport. His younger brother, Nate Diaz, however, is still a huge figure in the sport. As society’s views have slowly changed towards cannabis, so has the UFC’s. Nate Diaz has caught a lot of attention for vaping CBD oil at a post-fight press conference, as well as smoking a large joint of CBD cannabis at a public open work-out the week of a fight. Where these actions by his brother would have previously been met with anger and condemnation by the UFC, the organization actually got behind Nate.

Jeff Novistky, famous for helping expose Lance Armstrong’s illegal doping, was brought on to help stop illegal doping in the UFC. He has publicly voiced his support for Diaz’s CBD use and has even fought successfully to allow athletes to use THC when not in competition. If the UFC’s blatant reversal on cannabis was not clear enough, they have recently partnered with Aurora Cannabis to conduct research on the efficacy of CBD for treating injuries.

 

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Nate Diaz smokes a CBD joint days before a title fight.

 

While this change in stance came too late for many fighters whose careers were cut short by unjust rules, it is encouraging and heartening to see a major organization make these steps towards protecting their athletes. Especially with the MLB joining them today. Now it is just a question of if other organizations will make the necessary decisions to protect their athletes, or continue to drag their heels with their fingers in their ears. 

Final Thoughts

Cannabis, according to multiple studies, has properties that can help athletes dealing with CTE. Its therapeutic effects can also help control CTE symptoms and delay disease progression.

As someone who both practices martial arts and considers themselves a massive MMA fan, I am constantly conflicted with my love for the sport. I admire the respect, technique and heart found in MMA, but when I see fighters beginning to slur their speech in interviews my heart drops. I wonder if I’m only helping to further the damage, all for the sake of entertainment. Obviously, I don’t want to cause any brain damage in anyone and I’d like to avoid it happening to myself, if possible.

At the same time, professional MMA and football, and other contact sports as a whole, are played by adults who have dedicated themselves to their craft and are not only willing but want more than anything to compete at the highest level. 

It is obviously not exclusive to just MMA either. Sports like football and boxing have been plagued with CTE for a long time and an increasing number of athletes from soccer and wrestling are showing signs of the disease.

Looking Forward

These are sports that children start at a young age. Participating in sports has so many benefits for kids, such as learning how to work as a team and trust others. What is the long term cost, though?

There is no right answer, as far as I know. No single solution. Fighting the prevalence of CTE requires action on all fronts. Educating coaches, parents and players about the dangers of head trauma is paramount. Reducing the impact, or at least raising the age at which kids start playing these sports in another solution. Research and studies on the efficacy of both CBD and THC for CTE need to continue and be expanded more broadly. 

Some people argue that we need to eliminate these sports altogether. Others argue that it’s a matter of free will. I’m not sure where the answer lies, but doing everything we can to protect ourselves and our loved ones from CTE should not even be a question. Cannabis holds a lot of potential in treating CTE, but until major sports organization, the US federal government and other responsible governing bodies stop the ‘ignorance is bliss’ approach to governance, the disease will continue to claim lives.  

 

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