In recent years, cannabis, or marijuana, has been assessed in amyotrophic lateral sclerosis (ALS) and has shown some beneficial effects for patients. ALS is complicated condition that can quickly degrade quality of life – learn how cannabinoids like CBD could help slow the progression of this disease.
Amyotrophic lateral sclerosis (ALS) is a disease characterized by extensive damage over time to motor neurons in the brain and spinal cord. Motor neurons are nerve cells that are responsible for the communication, the signals, taking place between the brain and the muscles.
Due to this damage, the brain is increasingly unable to control muscle movement, and patients progressively loses the ability to easily do activities that most people take for granted, like walk, swallow, or speak. There is currently no cure for ALS, but treatments can help manage its symptoms.
One potential treatment is cannabis sativa, otherwise known as marijuana. Cannabis, as medical marijuana, is being assessed in its various forms for its potential in easing ALS symptoms.
How cannabis works
The active ingredients in cannabis — tetrahydrocannabinol (THC) and cannabidiol (CBD) — are called cannabinoids. They are believed to work as antioxidants and as anti-inflammatory and neuroprotective agents, and for these reason might slow or prevent further damage to nerve cells in ALS.
Both CBD and THC mainly function by binding to the cannabinoid receptor proteins CB1 and CB2 of the endocannabinoid system. The endocannabinoid system is responsible for regulating brain function, hormone secretion, and the immune system. CB1 receptors are present on the surface of nerve cells in the brain and spinal cord, and regulate neurodevelopmental activities; CB2 receptors are predominantly present in immune cells, and modulate inflammation and immune cell function.
Binding of THC to the CB1 receptor activates the receptor’s anti-glutamatergic action, meaning it inhibits the release of excess glutamate by nerve cells. Glutamate is a neurotransmitter, and in excess can cause nerve cell damage or excitotoxicity. In ALS, excitotoxicity is thought to compound nerve cell damage and increase neurodegeneration.
Since THC prevents excitotoxicity via the CB1 receptors, treatment with THC may be neuroprotective for ALS patients. A study showed that neuronal cells obtained from the spinal cord of ALS mouse models and treated with THC were protected from induced excitotoxicity.
The cannabinoids exert an anti-inflammatory effect through the CB2 receptors, which regulate immune cells and the production of inflammatory proteins. In this way, they might slow further tissue damage.
Cannabinoids also function as an antioxidant, but in a CB receptor-independent manner. Other receptors, such as the transient receptor potential vanilloid receptor 1, have been found to be involved, but how they work in ALS is still unclear.
Medical marijuana in clinical trials
Cannabis-derived products are being, or were, evaluated for their potential in treating ALS in various clinical trials.
Sativex (nabiximols), being developed by GW Pharmaceuticals, is an oral spray containing the two active components of cannabis. A Phase 2 trial (NCT01776970) in Italy, called CANALS, evaluated the safety, efficacy, and tolerability of Sativex in ALS patients affected by spasticity, or muscle stiffness. A total of 59 patients, ages 18 to 80, were included in the study. Patients were randomly assigned to receive either Sativex (29 patients) or placebo (30 patients). The study’s findings showed that Sativex was well-tolerated with no serious side effects. Spasticity was significantly reduced in treated patients compared to those given the placebo, whose symptoms continued to worsen.
An earlier single-site study (NCT00812851) tested the efficacy of oral THC in alleviating cramps in ALS patients. This was a crossover study, meaning that all 27 patients enrolled, (mean age 57; with moderate to severe cramps) were given THC at some point during the trial. They were randomly divided into two groups, one receiving 5 mg THC twice daily for two weeks, followed by a placebo; and the other receiving placebo first followed by THC for two weeks. A two-week treatment-free, or washout, period preceded changes in treatment status, and patients were evaluated two weeks after their treatment period.
This trial’s primary goal was changes in cramp intensity. The number of cramps per day, the intensity of muscle twitches, change in appetite, depression, and patient’s quality of life and sleep were measured as secondary goals. Study findings failed to show effectiveness in these measures; THC at 5 mg did did not alleviate cramps in ALS patients, and no significant changes were observed in the secondary outcomes, its researchers reported.
An ongoing Phase 3 study (NCT03690791) is testing the effects of CBD oil capsules by CannTrust on slowing disease progression in ALS patients. The study aims to enroll 30 patients, ages 25 to 75, who will be randomly grouped to receive either the CBD oil capsules or a placebo. In this six-month study, changes in a patient’s motor abilities, lung function, pain and spasticity levels, and quality of life will be assessed to evaluate the efficacy of CBD capsules. Enrollment at this trial’s single site, the Gold Coast Hospital and Health Service in Australia, may still be underway; contact information is available here.
In an observational study (NCT03886753), researchers at Children’s Hospital of Philadelphia are evaluating the effects of four formulations of cannabis-based products — the medical marijuana products Dream, Soothe, Shine, and Ease — by Ilera Healthcare used as standard therapy by people with multiple diseases, including ALS. How this therapeutic moves within the body (its pharmacokinetics) and its chemical interaction in the body (pharmacodynamics) will be monitored, and reports of relief of symptoms collected. The study is enrolling patients, ages 2 and older.
Another large and observational study (NCT03944447) in people with multiple diseases, including ALS, aim to assess the safety and efficacy of cannabis use by up to 10,000 people in the more than 38 states that have legalized medical marijuana. As an observational study, medical cannabis as part of person’s standard therapy — regular use — is being evaluated through patient reporting of perceived relief and findings of side effects.
Called OMNI-Can, the study and its investigators will use an anonymous online questionnaire to assess the potential benefits and side effects of medical cannabis on participants, most of whom are expected to be current users. A separate cannabis-naive group, defined as no use in the past year, will also be enrolled. Participants will first be given the survey at a visit with a physician to establish their baseline (start of the study) characteristics. Subsequent surveys will be given follow-up visits every three months for up to five years.
The study’s primary goal is the perceived benefits of cannabis in treating chronic pain, and the safety of its use via reporting of adverse events. Its impact on patients’ quality of life will be also be recorded, as will preferences such as favored type for use (route of administration, like vaping or eating as a candy) and its formulation (THC/CBD ratio). Contact information is available here.
Cannabis use should be in consultation with a treating physician, who can monitor patients for behaviors that may indicate dependence.
CBD, one of the more than 100 pharmacologically active compounds (cannabinoids) that can be retrieved from the cannabis plant, is thought to hold the greatest therapeutic potential. This is largely because it does not have the psychoactive properties common to other cannabis-related compounds. psychoactive properties
In addition to dependence, side effects attributed to medical marijuana use include lung irritation (smoking or vaping), low or elevated blood pressure, anxiety, dry mouth, changes in appetite, and nausea.
ALS News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
ALS & CBD Oil: Promising Research on Cannabinoids & Buying Tips
Amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig’s Disease, is a neurodegenerative disease with no known cause and as of right now, no known cure.
It is a condition in which the nerve cells in the spinal cord, brain and motor cortex degenerate, leaving connections between the body and its muscles damaged, ultimately resulting in muscular atrophy. But, there is some good news: using CBD oil for ALS symptoms may provide sufferers with much-needed relief.
Benefits of Using CBD Oil for Amyotrophic Lateral Sclerosis (ALS)
It seems that ALS strikes randomly, but it primarily affects men between the ages of 40-70. Only 5-10% of cases are deemed to be familial, or hereditary, with the remaining 90-95% of all cases being classified as “sporadic” . Sporadic means the disease occurs without warning or any identifiable cause. It is a cruel, difficult, disease that researchers are working hard to understand, and significant resources are being put toward finding a cure.
At this point in time, the average lifespan for someone suffering from ALS is 3 to 5 years from the onset of symptoms. Unfortunately, the treatment which is currently available works only to slow down the cell deterioration, not stop it. Riluzole is the medication prescribed to slow deterioration, with other medications are typically prescribed in tandem to combat constipation, pain, sleep problems, depression, cramps, and muscle spasms. It is little wonder that people are looking to CBD oil for possible help.
While the research is still very early, cannabinoids may hold promise as a means for slowing the progression of ALS symptoms. However, at this point the research only consists of animal studies, making it yet to be proven as an effective treatment in humans.
If you’re considering trying CBD to help with your ALS, first speak with your doctor —there could be drug interactions or potential health risks you aren’t aware of. You can also reference this chart for a general idea of how taking CBD oil alone, or in conjunction with current ALS medications, could affect you.
|Riluzole (slows progression of ALS)||Weakness; drowsiness; nausea; decreased lung function; diarrhea; dizziness; muscle stiffness.||Cannabinoids like CBD may be able to slow progression of ALS without causing any of these same side effects based on animal studies.||Talk to your doctor before using CBD oil with Riluzole as there is an increased risk of liver damage when used together.|
|Edaravone (slows loss of daily function)||Bruising; hives; shortness of breath; gait disturbance; swelling.||CBD oil may be able to reduce pain and inflammation and muscle loss enough to maintain daily function without causing the same side effects.||There are no known interactions between CBD oil and Edaravone.|
|Baclofen or Diazepam (for muscle spasticity)||Sedation; dizziness; weakness; headache; insomnia; nausea; constipation; increased urination.||CBD oil may help reduce muscle spasticity without causing any of these same side effects.||Using CBD oil with Baclofen or diazepam may increase central nervous system and respiratory-depressant effects. Do not use together without being monitored by a doctor.|
|Gabapentin (for pain)||Dizziness; unsteadiness; drowsiness; memory loss; lack of coordination; tremors; viral infections; difficulty speaking.||CBD oil can relieve pain without causing any of these same side effects.||Using CBD oil with Gabapentin may increase central nervous system and respiratory-depressant effects. Do not use together without being monitored by a doctor.|
|Trihexyphenidyl (to help patients swallow saliva)||Blurred vision; dry mouth; drowsiness; dizziness; anxiety; upset stomach.||CBD oil may be able to reduce muscle stiffness without causing any of the same side effects.||Using CBD oil with Trihexyphenidyl may increase the potential of cognitive and psychomotor impairment; drowsiness; dizziness.|
While CBD oil is not a cure for ALS, it may offer some relief from the disease’s many symptoms.
There are numerous benefits in the use of CBD for ALS sufferers, the most predominant benefits include the slowing of the progression of the disease, pain relief, and the reduction of spasticity.
Effectiveness of Using CBD Oil for ALS
While research and studies are ongoing, it appears that cannabinoids , and CBD specifically, could play a role in treating ALS. CBD might provide symptom relief, but from the presented animal studies, one cannot yet conclude that CBD could treat ALS in humans. Read on for more information…
A study by the Institute of Neurology at University College London examined the effects of cannabinoids on SOD1 mice, which are test mice that have been modified to exhibit some ALS symptoms. The mice were displaying symptoms at the time of testing and were treated with a synthetic cannabinoid. This cannabinoid was shown to “significantly delay disease progression” and produced “significant neuroprotective effects in this model of ALS.”
Another study by the California Pacific Medical Center of San Francisco tested the effects of cannabinoids on excitotoxic and oxidative cell damage, both of which are thought to contribute to the neurodegenerative effects of ALS. Tetrahydrocannabinol (THC) was shown to be an effective treatment in mice if administered either before or after the onset of signs of ALS. If cannabinoids were administered at the onset of tremors, it was found that motor impairment was delayed and survival was prolonged. While this study did not include CBD, it is another example of the way in which these phytocannabinoids from cannabis and hemp plants can offer possible health benefits.
For fully conclusive results, more testing is needed but these results are exciting and promising for extending the quality of life for ALS sufferers.
CBD Oil for Pain
CBD works directly and indirectly with the endocannabinoid system to reduce the way in which pain is experienced in the body. Cannabinoid receptors can be found both within the brain (CB1 receptors) and throughout the body (CB2 receptors). The CB2 receptors are those which are responsible for regulating inflammation and pain. It’s believed that cannabidiol (CBD) works indirectly on CB2 receptors to reduce inflammation throughout the body.
CBD works on non-cannabinoid receptors as well.
Glycine receptors in the central nervous system have a major role in how the body perceives pain. Studies have shown that CBD can increase the effects of these receptors, causing a significant reduction in neuropathic pain.
One study by the University of California looked at the impact of vaporized cannabis on the treatment of neuropathic pain caused by spinal cord injury and disease. The findings showed that cannabis scored similarly to two commonly prescribed pharmaceuticals in terms of analgesic properties. This is significant because CBD and other cannabinoids do not carry the same side effects or risk for addiction as many prescription painkillers.
Finally, a review of CBD studies conducted between 1980 and 2007 found that CBD oil was effective at treating pain with very few side effects. This places CBD oil as a viable alternative to typical pain medications.
CBD Oil for Spasticity
While clinical trials are severely lacking when it comes to CBD and ALS, there is evidence to suggest that positive results can be expected in the treatment of spasticity.
The University of Washington School of Medicine conducted a survey on cannabis use in ALS patients. Of the 131 respondents, 13 said they used cannabis during the previous 12 months. While these numbers are small, the results indicated that cannabinoids may be effective in reducing the symptoms of “appetite loss, depression, pain, spasticity, and drooling.”
The University of Washington Medical Center supports these findings and because cannabis has shown potential for ALS symptoms by providing “muscle relaxation, bronchodilation, saliva reduction, appetite stimulation, and sleep induction,” they have called for more study and research immediately. The researchers even go so far as to say, “Based on the currently available scientific data, it is reasonable to think that cannabis might significantly slow the progression of ALS, potentially extending life expectancy and substantially reducing the overall burden of the disease.”
There may be a lack of research at the moment in relation to spasticity caused by ALS but there are plenty of published studies dealing with other spastic conditions. Numerous published studies point to the benefits of cannabinoids in treating the symptoms of conditions like Parkinson’s Disease and multiple sclerosis . In a 2014 study , for example, Parkinson’s sufferers who had been administered CBD saw a reduction in tremors and spasticity.
How to Use CBD Oil for ALS
The decision to use CBD oil for ALS symptoms is a personal one, and will look different for each person.
Some ALS patients will choose to add CBD oil to their daily routine as a way to keep symptoms under control in a consistent, holistic way, while others will prefer to use CBD oil when their symptoms appear or become problematic.
As an ALS patient, if you find that traditional ALS treatments are not working the way you’d like or you are suffering from the many possible side effects of pharmaceutical medications, CBD oil may be exactly what you’re looking for.
Before you decide how to take CBD oil for ALS, it is essential that you talk to your doctor first. There are risks associated with using CBD oil in conjunction with common ALS medications, and while CBD oil has very few side effects , and their appearance is rare, there is a possibility of fatigue, dry mouth, diarrhea, and liver damage. Talking to your doctor can help determine if CBD oil is the safest and most effective option.
Different CBD Oil Products
There are a few different ways to administer CBD oil. The CBD product that is most effective for you will depend on your preferences and severity of symptoms.
CBD oil inhalants: CBD vape oils and CBD flower are among the most popular ways to take CBD oil. These delivery methods are familiar and show their effects quickly. The CBD bypasses the digestive system and is absorbed into the bloodstream directly through the lungs. These methods are great for sudden pain or spasticity. But, the effects do not last long, meaning it may be necessary to take another dose an hour or so later. It should be kept in mind that vaping and smoking are not always accessible options and it can be difficult to get the dosage right. Typically, the dosage is calculated on a “per inhale” basis, but an inhale can vary widely from person to person.
CBD oil capsules: CBD oil capsules are easy and convenient delivery methods. Most people will be comfortable with capsules as they are another familiar delivery method and will provide a consistent dose. The same can be said for CBD oil edibles, like gummies. Unfortunately, they can also take a while to show effects. These methods have to be digested and processed by the liver so depending on stomach contents and metabolism, they can take up to an hour to work, but effects typically last 4 to 6 hours.
CBD Oil Drops or Tinctures : A CBD oil tincture or drops do not have to be digested in the same way as an edible or capsule. Taken under the tongue, the CBD is absorbed from there, going to work in about 30 minutes. They allow for maximum dosage control, with the ability to adjust up or down down to a single drop. In both capsules and drops, the effects can last between 2 to 4 hours.
CBD oil topicals: CBD oil topicals are an option best used for targeted pain relief. For muscle cramps, pain, and spasticity, CBD oil topicals can be applied directly to the site for targeted relief. While these methods can take a while to show effects, they will last the longest of all methods.
Again, it’s essential to consult your doctor before you begin using CBD oil. CBD is mostly safe but it can interact with some of your current prescriptions , including antidepressants and antibiotics. There is also a small percentage of the population that may be sensitive to cannabinoids so it is best to have a doctor monitor your efforts.
For a more in-depth breakdown of all the different CBD delivery methods, check out our Beginner’s Guide to CBD Oil .
Dosage of CBD Oil for ALS
Unless told otherwise by your doctor, always begin by following the recommended dosage on the information sheet included with your CBD product. There is no universal dose of CBD oil, and how it impacts you will depend on a variety of factors like the type of CBD product and your metabolism.
At CBD Oil Review, we have analyzed hundreds of products and come up with a standard serving suggestion to get you started, if you need further assistance:
The CBD Oil Review Serving Standard is 25mg of CBD, taken twice daily
If you are not getting results from this amount, we recommend increasing the serving size by 25mg every 3 to 4 weeks until you find relief.
To better understand how much CBD oil to take, check out our dosage tips here . You should also consider speaking to a naturopathic doctor for an ALS treatment plan that’s personalized for your needs.
Best CBD Oil for ALS
The best CBD oil products for ALS will be the ones that work for you.
Delivery methods should be considered carefully when it comes to ALS. Given that difficulty swallowing is one of the primary symptoms associated with the disease, a CBD oil capsule may only be an ideal format in the early stages of the illness. As it progresses, vapes or tinctures may be easier to administer.
When it comes to reaping the possible benefits of CBD oil, quality matters. It is important you buy the best products available. Here are some hints to help you narrow your search:
- Look for a Certificate of Analysis (COA): Reputable brands are transparent brands. They will test their extractions in an outside lab and post the results in a Certificate of Analysis. This analysis will tell you exactly what is in your product and allow you to verify the CBD and THC content, while also giving you insight to whether the product contains harmful chemicals, pesticides, or heavy metals.
- Buy Organic: Whenever possible, buy a product that has been sourced from organically grown hemp. This will ensure that your product is free of residues from herbicides and pesticides.
- Understand The Law: While the 2018 Farm Bill allows for the legal sale of CBD oil extracted from industrial hemp plants with a THC content of 0.3% or below, some states have restrictions around the sale and purchase of CBD oil. Be sure to know the law in your specific state before making any purchase.
While more research is needed to fully understand all the ways CBD oil can be used to treat ALS, the information currently available is promising. If you’d like to use CBD oil to treat ALS symptoms, remember to speak to your doctor. Together the two of you can work out a safe treatment plan.
- Sabrina Giacoppo et al. Can cannabinoids be a potential therapeutic tool in amyotrophic lateral sclerosis? – National Center for Biotechnology Information https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5270417/
- Lynsey G Bilsland et al. (2006) Increasing cannabinoid levels by pharmacological and genetic manipulation delay disease progression in SOD1 mice – National Library of Medicine https://pubmed.ncbi.nlm.nih.gov/16571781/
- Chandrasekaran Raman et al. (2004) Amyotrophic lateral sclerosis: delayed disease progression in mice by treatment with a cannabinoid – National Library of Medicine https://pubmed.ncbi.nlm.nih.gov/15204022/
- Wei Xiong et al. Cannabinoids suppress inflammatory and neuropathic pain by targeting α3 glycine receptors – National Center for Biotechnology Information https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371734/
- Barth Wilsey et al. (2016) An Exploratory Human Laboratory Experiment Evaluating Vaporized Cannabis in the Treatment of Neuropathic Pain from Spinal Cord Injury and Disease – National Center for Biotechnology Information https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007175/
- Ethan B Russo (2008) Cannabinoids in the management of difficult to treat pain – National Center for Biotechnology Information https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503660/
- Dagmar Amtmann et al. Survey of cannabis use in patients with amyotrophic lateral sclerosis – National Library of Medicine https://pubmed.ncbi.nlm.nih.gov/15055508/
- Gregory T Carter et al. (2010) Cannabis and amyotrophic lateral sclerosis: hypothetical and practical applications, and a call for clinical trials – National Library of Medicine https://pubmed.ncbi.nlm.nih.gov/20439484/
- Marcos Hortes N Chagas et al. (2014) Effects of cannabidiol in the treatment of patients with Parkinson’s disease: an exploratory double-blind trial – National Library of Medicine https://pubmed.ncbi.nlm.nih.gov/25237116/
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