What is ALS?

Amyotrophic lateral sclerosis, or ALS, is also referred to as Lou Gehrig’s Disease because of the famous baseball player who was forced to retire from the sport in 1939 after being diagnosed with the condition.

The disease involves gradual muscle paralysis as the neurons controlling the muscles break down. We each have millions of specialized nerve cells — called motor neurons — tasked with transmitting messages from the brain to the muscles and back again.

Eventually, as these motor neurons are destroyed, those affected are no longer able to walk, talk, eat, or drink. The disease ultimately becomes fatal when the motor neurons controlling the lungs fail.

Symptoms of ALS

• Tripping
• Dropping things
• Slurred speech
• Difficulty swallowing
• Weight loss
• Decreased muscle tone
• Shortness of breath
• Increased or decreased reflexes
• Uncontrollable periods of laughing or crying
• Feeling weak
• Fatigue
• Muscle cramping or twitching
• Muscle stiffness or rigidity
• Poor concentration
• Mood changes

There Are Two Different Types of ALS

1. Sporadic ALS

This form of ALS can affect anybody — regardless of their gender, ethnicity, or age. However, it is more common in men, caucasian people, and persons older than 60 years, with peak onset around 58 to 63 years.

2. Familial ALS

Familial ALS is an inherited form of the disease. It accounts for 5% to 10% of cases. Peak age at onset is 47 to 52 years.

Another Manifestation of ALS: Bulbar ALS

Bulbar ALS refers to the starting point for the neurons affected. People with both familial or sporadic ALS can have the bulbar form of ALS. With this type, the motor neurons in the corticobulbar region of the brainstem are affected first. Therefore, the muscles in the face, neck, and head to become paralyzed before other areas of the body. This is as opposed to limb onset ALS or respiratory onset ALS that begin in the limbs or diaphragm, respectively.

What Causes ALS?

The exact cause is unknown, but there are a few theories for contributing factors for the disease, including:

• Environmental factors, such as tobacco use and formaldehyde exposure
• Heavy metal exposure
• Genetic predisposition, such as superoxide dismutase (SOD1) mutation

Common Medications for ALS

There is no cure for ALS but there are a few treatments available, such as FDA-approved riluzole and edaravone. Riluzole, a glutamatergic neurotransmission inhibitor, does not provide relief from the symptoms of ALS, but it can extend life expectancy by two to three months.

Edaravone, an antioxidant drug, can slow the decline of daily functions and halt the progression of ALS. CBD interacts with some medications, so always check with your doctor before using it.

Other treatments for ALS include:

• Physical therapy
• Occupational therapy
• Rehabilitation
• Anti-depressants (fluoxetine, sertraline, citalopram)
• Anxiolytics (alprazolam, diazepam, lorazepam)
• Pain relievers (acetaminophen, asprin, ibuprofen)

Guide to Using CBD for ALS

It’s clear that more research is needed to investigate the effects of CBD on ALS in human subjects. However, the research we do have is very promising.

CBD and many of the other cannabinoids, including delta 9 THC and CBG, have been shown to offer significant benefits toward many of the uncomfortable symptoms involved with the condition. Therefore, they have been implicated as a potentially effective adjunct treatment for a series of other, related neurodegenerative disorders.

Both CBD and THC could offer support for the condition. Most of the case studies showing improvements in lifespan and symptoms were using marijuana containing both THC and CBD.

Therefore, we recommend opting for a full-spectrum CBD oil rather than a purified CBD extract with all other cannabinoids and terpenes removed. But depending on where you live, you may or may not have access to CBD products that contain THC in concentrations higher than about 0.3%.

In some places, patients with ALS can apply through a medical marijuana program to receive oils, tinctures, concentrates, or raw cannabis buds that contain high levels of both CBD and THC. The current research to date suggests this is the best option for ALS sufferers.

However, if you’re unable to get any hemp or marijuana products that contain THC, that’s okay. CBD is still likely to be effective for this condition and is generally better for relieving muscle tremors, insomnia, and anxiety than products containing THC.

However, as with any neurodegenerative disorder, it’s wise to speak with your physician before trying CBD or marijuana products for ALS symptoms because, in rare cases, CBD oils may have a negative interaction with other medication you might be taking, and you may also require liver enzyme monitoring . Therefore, it’s better to ask your doctor before assuming it’s 100% safe.

What the Research Says

Unfortunately, there are no clinical studies investigating the effects of CBD for ALS sufferers, despite years of case studies and promising research on related neurological disorders. However, there are a lot of case studies showing positive anecdotal impacts with both legal and illegal cannabis and CBD use [5].

Additionally, there is a growing body of evidence to suggest that THC is also beneficial for ALS.

An animal study published in 2004 investigated the role of THC — the primary psychoactive cannabinoid in the cannabis plant — on mice with ALS to measure any changes [6]. The results of this study reported that the mice who were given THC had significantly less severity with their symptoms than mice not given the THC treatments.

Other studies have found that THC protects the motor neurons in the spinal cord [8], which are critically involved with the development of ALS.

THC has also been shown to be “extremely effective” at reducing oxidative damage induced by a known neurotoxic oxidative compound known as tert-butyl hydroperoxide [9].

What’s the Recommended Dose of CBD?

Because there are no good clinical trials involving CBD for ALS, there are no specific dosages identified nor characteristic results to be expected. However, studies involving CBD and other neurodegenerative disorders often report that high dosages are needed to receive benefits. Therefore, it’s likely to assume that the dose for ALS is also higher than average.

We recommend starting with a low dose and building up gradually by adding 2 mg to 5 mg of CBD each day.

Once symptoms are alleviated, you’ve found the right dose. According to case reports, CBD can relieve symptoms such as insomnia, pain, and muscle tremors almost immediately, while the longevity-enhancing effects of the compound would take much longer and won’t be as noticeable. Further research would be needed to confirm these kinds of effects.

Therefore, for best results, it’s recommended that you aim for the high-strength dose of CBD, and take this dose consistently over the long term.

However, always consult with your doctor before taking CBD for ALS and always take your routine prescriptions as directed, never stop on your own.

Recommended strength for ALS: high strength

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Key Takeaways: CBD For ALS

The interaction between CBD and ALS is limited to animal studies and hypothesis — meaning there are no actual studies that explore the effects of CBD extracts with ALS.

CBD has been shown to offer powerful benefits towards other neurodegenerative conditions, such as Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis — which leaves promise that CBD can accomplish similar results for ALS.

The primary mechanisms CBD is likely to benefit ALS is through its muscle-relaxing, anti-inflammatory, and analgesic qualities.

Stay tuned as we continue to update this page as the research develops.

References

1. Martín-Moreno, A. M., Reigada, D., Ramírez, B. G., Mechoulam, R., Innamorato, N., Cuadrado, A., & de Ceballos, M. L. (2011). Cannabidiol and other cannabinoids reduce microglial activation in vitro and in vivo: relevance to Alzheimers′ disease. Molecular pharmacology, mol-111.
2. Chagas, M. H. N., Zuardi, A. W., Tumas, V., Pena-Pereira, M. A., Sobreira, E. T., Bergamaschi, M. M., … & Crippa, J. A. S. (2014). Effects of cannabidiol in the treatment of patients with Parkinson’s disease: an exploratory double-blind trial. Journal of Psychopharmacology, 28(11), 1088-1098.
3. Wade, D. T., Collin, C., Stott, C., & Duncombe, P. (2010). Meta-analysis of the efficacy and safety of Sativex (nabiximols), on spasticity in people with multiple sclerosis. Multiple Sclerosis Journal, 16(6), 707-714.
4. Carter, G. T., Abood, M. E., Aggarwal, S. K., & Weiss, M. D. (2010). Cannabis and amyotrophic lateral sclerosis: hypothetical and practical applications, and a call for clinical trials. American Journal of Hospice and Palliative Medicine®, 27(5), 347-356.
5. Karlsborg, M., Christophersen, A. K., Pontoppidan, C., & Kampmann, J. P. (2017). Self-medication with cannabidiol oil in a patient with primary lateral sclerosis. Ugeskrift for laeger, 179(7).
6. Raman, C., McAllister, S. D., Rizvi, G., Patel, S. G., Moore, D. H., & Abood, M. E. (2004). Amyotrophic lateral sclerosis: delayed disease progression in mice by treatment with a cannabinoid. Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders, 5(1), 33-39.
7. Mannucci, C., Navarra, M., Calapai, F., Spagnolo, E. V., Busardò, F. P., Cas, R. D., … & Calapai, G. (2017). Neurological aspects of medical use of cannabidiol. CNS & Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS & Neurological Disorders), 16(5), 541-553.
8. Abood, M. E., Rizvi, G., Sallapudi, N., & McAllister, S. D. (2001). Activation of the CB1 cannabinoid receptor protects cultured mouse spinal neurons against excitotoxicity. Neuroscience letters, 309(3), 197-201.
9. Abe, K., & Saito, H. (1998). Characterization of t‐butyl hydroperoxide toxicity in cultured rat cortical neurones and astrocytes. Pharmacology & toxicology, 83(1), 40-46.
10. Meyer, T., Funke, A., Münch, C., Kettemann, D., Maier, A., Walter, B., … Spittel, S. (2019). Real world experience of patients with amyotrophic lateral sclerosis (ALS) in the treatment of spasticity using tetrahydrocannabinol:cannabidiol (THC:CBD). BMC neurology, 19(1), 222. doi:10.1186/s12883-019-1443-y