Evidence based

CBD and ALS: Current Research & Understanding

Amyotrophic lateral sclerosis (ALS) and CBD — how it works, how to get started, how to dose effectively, and what the current research says.

Article By
Daily CBD , posted 2 months ago

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting the nerves responsible for muscle control.

Consequently, those affected are left unable to move, talk, and, eventually, breathe.

Stephen Hawking had the condition for most of his life but ultimately passed away at the age of 76.

No cure exists for this condition. There are medications available may slow neuronal cell death and improve daily functioning. However, the majority of treatment remains largely supportive — addressing significant symptoms and providing increased levels of support as those affected lose their ability to walk, talk, and take care of themselves. Patients may also experience many unpleasant effects such as painful muscle spasms and excess drooling.

Rapidly emerging evidence is suggesting cannabinoids such as CBD and THC may reduce neurological and oxidative damage associated with ALS.

Here, we’ll explore the potential use of CBD in ALS and offer some insight into how you can get the most out of your CBD supplementation.

  • MEDICALLY REVIEWED BY

    Abraham Benavides, M.D.,Medical Doctor

    Updated on November 08, 2019

  • Table of Contents

Summary: Using CBD for ALS

CBD may be useful for a range of other neurodegenerative disorders, including Alzheimer’s disease [1], Parkinson’s disease [2], and multiple sclerosis [3]. Current CBD research related to these conditions is limited, but promising enough to be looked into further.

These conditions are independent of each other but have similar underlying mechanisms.

They all involve some degree of inflammation and oxidative damage in the brain that either causes the breakdown of nerves directly or serve as sustaining factors for the condition.

CBD produces well-known anti-inflammatory, antispasmodic, neuroprotective, and antioxidant effects within the body. It’s through these effects that CBD is, therefore, thought to be useful for a spectrum of neurological disorders — including ALS.

However, aside from a clinical report on spasticity [10], there are unfortunately no clinical trials involving the use of CBD for ALS to confirm these effects conclusively. Therefore, all we have to go off at the moment are case studies, animal studies, in vitro research, and correlation studies.

A review of CBD and ALS was recently published [4] calling for more research in this area.

The study highlighted a list of hypothetical benefits CBD is believed to offer ALS patients, including:

  • Pain relief
  • Muscle relaxation
  • Bronchodilation
  • Saliva reduction
  • Appetite stimulation
  • Sleep induction
  • Antioxidant support
  • Inhibition of inflammation in the brain

Tips to Getting the Most Out of Your CBD

  1. Look for full-spectrum CBD extracts. This is because other cannabinoids in the plant have also shown benefit toward neuroinflammation and side-effects of the condition.
  2. Always choose high-quality CBD products. This is because any contaminants in poor-quality CBD products can cause new problems or possibly make ALS progress even faster.
  3. Use the CBD consistently. This is because any benefits from CBD regarding ALS will likely take several weeks to develop. Be patient and persistent with CBD supplementation.
  4. Use CBD alongside other treatments, not all by itself. This is because ALS is a complex disorder involving many different factors. Therefore, it’s wise to use multiple forms of treatment to get the best results possible.
  5. Speak with your doctor before using CBD alongside other ALS medications. This is because some medications may interact negatively with CBD or the other cannabinoids in the bottle. Your doctor should continue monitoring your liver enzymes due to the standard ALS treatments.

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

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 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].

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

Daily Doses of CBD by Weight and Strength (in mg)

Weight (lbs)Low StrengthMedium StrengthHigh Strength

100 lbs

10 mg

30 mg

60 mg

125 lbs

13 mg

38 mg

75 mg

150 lbs

15 mg

45 mg

90 mg

175 lbs

17 mg

52 mg

105 mg

200 lbs

20 mg

60 mg

120 mg

225 lbs

22 mg

67 mg

135 mg

250 lbs

25 mg

75 mg

150 mg


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

Conditions that May Respond to Cannabidiol