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Can Cannabis Help ALS? Overview

The compounds in cannabis have promising potential for treatment of ALS, because of their ability to counter fight cell death and inflammation of the nervous system, elements in the disease process of ALS.  

ALS (Amyotrophic Lateral Sclerosis) is a terminal neurodegenerative disease that damages motor neurons leading to progressive muscle wasting, weakness, and death. 

Cannabis products have also been shown to alleviate some common ALS symptoms, including chronic pain.

How cannabis works on ALS

The endocannabinoid system (ECS) exists in all vertebrates and helps regulate crucial functions such as sleep, pain, and appetite. The human body produces its own cannabinoids, which modulate and activate its various functions, but as its name suggests, the endocannabinoid system can also be modulated and activated by cannabinoids found in the cannabis plant. 

A 2017 paper on cannabinoid pharmacology describes how the ECS has the ability to modulate the key traits contributing to neurodegenerative diseases such as ALS, and is “thus, emerging as a viable target for symptom alleviation or disease progression based on pharmacological modulation of endocannabinoid signaling.”  

Studies on ALS animal models and ALS patients show some ECS dysregulation in the brain and spinal cord. However, this may well be a sign of the ECS doing its neuroprotective work rather than the dysregulation itself being a cause of the disease.

Perhaps the most promising area of research in the development of drugs for ALS involves agents that bind with CB2 receptors in the body. In one study on ALS mice, daily administration of a CB2 agonist delayed motor impairment and increased survival by 56%.

Medical studies on cannabis and ALS

The cannabis plant contains at least 146 compounds called cannabinoids, most notably Tetrahydrocannabinol (THC) and Cannabidiol (CBD), as well as a host of other organic compounds such as terpenes and flavonoids.

THC directly bonds with the body’s two main cannabinoid receptors and has a neuroprotectant and anti-inflammatory effect. CBD doesn’t activate either receptor, but it blocks the enzyme (FAAH) that degrades anandamide. Commonly known as “the bliss molecule,” anandamide is a cannabinoid that plays a key role in maintaining the health of the ECS and can reduce anxiety and lower systemic inflammation, in addition to other benefits.  

Thus, compounds found within the cannabis plant may have therapeutic potential in the treatment of ALS through ECS modulation. Indeed, in one study, ALS mice were treated with THC before and after disease onset. Motor improvement was noted, and disease survival increased, which was thought to be due to a reduction in cell damage and death. Another study carried out on mice in 2008 found that altering CB1 expression can predispose motor neurons to cell death. 

Research on mice has found that daily use of an ECS receptor agonist (CB2) delayed motor impairment and increased survival by 56%. In particular, raised levels of endocannabinoids were found in ALS mice models, as well as increased CB2 receptor expression in astrocytes (the most common cell type in the central nervous system) located in damaged or altered tissue. They were also found in brain and spinal cord cells of grey and white matter (the two types of tissue in the central nervous system) in animal models and ALS patients.

CBD and ALS

CBD does not have the psychotropic effects of THC, and is thus often widely-available in jurisdictions where medical marijuana has not been legalized. A study performed on mice with ALS in 2010 found that small doses of CBD given to mice slowed down the progression of the disease. 

A clinical trial currently underway in Australia is testing the effect of a CBD dominant oil on 30 subjects with ALS.

CBD treatment can potentially ease some of the negative symptoms of the disease, including pain, muscle tension, and loss of appetite and sleep among others.

Side effects

Cannabis use can be habit forming and can make users more sluggish with decreased motor skills and reaction time when under the influence. Long-term effects can include cognitive impairment, a small risk of addiction, as well as an increased risk of developing a psychotic disorder. Further research is necessary to explore the potential interaction between other ALS medications and specific doses and forms of CBD and THC. 

Cannabis Side Effects

About ALS Overview

Overview

ALS (Amyotrophic Lateral Sclerosis) was discovered and named in 1896 by French neurologist Jean-Martin Charcot. ALS is also called Lou Gehrig’s Disease, after the baseball player Lou Gehrig, who was one of the most famous people to suffer from the disease. ALS is a motor neuron disease, meaning that it affects the nerve cells in the brain and the spinal cord that are responsible for controlling your muscles. 

ALS is progressive, which means that the symptoms get worse over time. When you have ALS, your motor neurons weaken and die, leaving you with no way to control your muscle movements. Without any control, your muscles get weaker too. They twitch uncontrollably, a process called fasciculations, and then waste away. Most patients ultimately die as a result of the disease.

There are two types of ALS:

  • Sporadic. This is the most common form of ALS. 90-95% of people who develop ALS have sporadic ALS. Sporadic ALS means that it affects someone without any apparent cause or warning.
  • Familial. Familial ALS  (FALS) is inherited. If you have familial ALS in your family, there’s a 50% chance that each child may inherit the disease. 

It’s estimated that 14-15,000 Americans have ALS, but the number could be higher. Another 5,000+ people are diagnosed with it every year.

Symptoms

Symptoms

The earliest symptoms of ALS are usually muscle stiffness, weakness, or twitches, which are easy to overlook. The first symptoms of ALS differ widely since they depend on which motor neurons are the first ones to be affected. 

Some of the first symptoms of ALS include:

  • Stiff fingers, hand, or arm muscles that make it difficult to button a shirt, write, or turn a key
  • Weakness in the legs or ankles, stumbling and tripping more often than usual, feeling awkwardness when walking or running
  • Slurred speech or difficulty swallowing
  • Tight, stiff, cramped muscles
  • Uncontrollable fasciculations (twitching) in your tongue, arms, legs, or other muscles

When ALS begins with slurred speech or trouble swallowing, it’s called Bulbar Onset ALS. 

When it begins with fasciculations, stiffness, or weakness in your arms or legs, it’s called Limb Onset ALS. 

Although the early signs of ALS are subtle and very similar to other, more benign health issues, as time goes on and more neurons die, the symptoms will grow more obvious. Weakness, fasciculations, and muscle atrophy will spread across the body. Over time, people with ALS can no longer stand, walk, get out of bed, or move their arms, legs, or head themselves. Most people with ALS lose the ability to speak, too, because the tongue muscles are also affected, and to chew and swallow.

Eventually, ALS affects the muscles that help you breathe. Most people with ALS end up needing a ventilator to keep them alive. 

It’s important to note that ALS spreads in a different way and at different speeds for each person, so it’s impossible to predict exactly what will happen to each person diagnosed with ALS.

ALS does not affect your mental or cognitive ability. If you have ALS, you are still able to:

  • Think, reason, and solve problems
  • Use all of your senses, so you can see, hear, taste, smell, and feel things the same as usual
  • Remember people, places, events, and experiences

A small percentage of people with ALS are also diagnosed with some form of dementia, language processing issues, or decision-making issues.

Causes

Causes

Familial ALS is a genetic disorder. In a family with a history of ALS, there’s a 50-50 chance that each child will develop the illness. But just having a single parent or family member who develops ALS doesn’t significantly raise your chances of getting it.

Researchers are still trying to identify what causes sporadic ALS. So far, the consensus is that it’s caused by a complicated combination of genetic and environmental factors.

Risk factors for developing ALS include: 

  • Age. The risk of ALS increases as you get older. Most people diagnosed with ALS are aged between 40 and 70. 
  • Gender. Men are slightly more likely to develop ALS than women, but as you age, the difference between the genders disappears.
  • Race and ethnicity. Caucasians and Hispanics develop ALS more than people from other backgrounds. 
  • Genetics. Some researchers have found genetic variations in the genomes of people with Familial ALS and sporadic ALS, which hints that there could be an underlying genetic cause for ALS.
  • Smoking. Smoking has been found to raise the risk of developing ALS, particularly in women who are post-menopausal.
  • Exposure to environmental toxins. There’s some evidence that exposure to lead or other substances could be linked to ALS, but no study has identified a single agent or chemical.

Military veterans are 1.5 to 2 times more likely to develop ALS. The reasons behind this connection are still not clear, but it’s been suggested that veterans are exposed to more lead, pesticides, and other environmental toxins than civilians. The U.S. Department of Veterans Affairs recignizes ALS as a service-connected disease.

Diagnosis

Diagnosis

Diagnosing ALS consists of a neurological exam and a careful history from the patient looking for telltale signs of ALS including muscle fasciculations, weakness and no change in sensation.  A full neurological exam will be accompanied by a nerve conduction study (EMG/NCS).  

There’s no single test to identify ALS. Other tests are often performed to rule out other conditions.

Tests that are used to help diagnose ALS include:

Muscle and imaging tests

Electromyography (EMG), Nerve Conduction Study (NCS), and Magnetic Resonance Imaging (MRI). 

  • An EMG test detects electrical activity in the muscle fibers. 
  • NCS tests assess whether a nerve can still send a signal to a muscle or along the nerve. 

These tests help rule out peripheral neuropathy, which is damage to the nerves outside of the brain and the spinal cord, and myopathy, which is a muscle disease. 

Imaging
An MRI test is used to rule out other causes like a tumor or cyst in the spinal cord, a herniated disk, or cervical spondylosis. People with ALS generally get normal results on their MRI scan. 

Lab tests

Depending on your symptoms and the results of other tests, your doctor might order blood tests and urine sample tests to check for other diseases. 

Tests for specific diseases and conditions

There are some infectious diseases which can cause symptoms that are very similar to ALS, so your doctor will consider them and test for them while making a diagnosis. These include HIV (Aids), West Nile virus, and human T-cell leukemia virus; multiple sclerosis, post-polio syndrome, multifocal motor neuropathy, and Kennedy’s disease.

Treatment

Treatment

There’s still no cure for ALS. Most people with ALS die within 3 to 5 years of diagnosis, usually of respiratory failure, although some people live with ALS for 10 years or more. 

However, there’s a huge amount of research going on into ALS, and researchers hope to eventually find a cure. For the moment, there are a number of ways to treat the symptoms of ALS, improve quality of life, and prolong survival. 

Multidisciplinary care

Studies have found that participating in a multidisciplinary ALS clinic can prolong survival and improve quality of life. These clinics are staffed by teams that include physical, occupational, and speech therapists; doctors and nurses; pharmacists; home care and hospice workers; social workers; and respiratory therapists. Multidisciplinary teams prepare individual treatment plans, therapeutic activities, and medication, and suggest the right equipment to help people with ALS remain independent for as long as possible. 

Medication

At the moment, 4 drugs have been approved to help treat ALS:

  • Riluzole (Rilutek)
  • Edaravone (Radicava)
  • Nuedexta
  • Tiglutik

None of them can reverse or cure ALS, but they can slow down muscle decline and prolong survival. Clinical studies are still ongoing, for these and other new drugs for ALS. 

As well as these four medications, physicians can also prescribe medications to help with the symptoms of ALS. Different drugs can be given to ease cramped and stiff muscles, reduce excess saliva and phlegm, deal with the depression and anxiety that often accompany ALS, treat constipation and insomnia, and prevent involuntary and uncontrollable crying or laughing. 

Therapies 

In the early and middle stages of ALS, physical, occupational, and speech therapy can help prolong independence and communication. 

Physical therapists design a course of low-impact aerobic exercise to strengthen muscles that haven’t yet been affected and combat depression. They can also guide you in a range of stretches to prevent muscles from getting painfully cramped and stiff. 

Occupational therapists guide people with ALS to choose the right equipment, like ramps, walkers, and wheelchairs, to help you remain mobile. 

Speech therapists can teach new strategies to help people with ALS to speak more loudly and clearly despite the degeneration of related muscles. As ALS becomes more serious, speech therapists can help you to communicate through advanced technology like computer-based speech synthesizer, eye-tracking technology, and non-verbal communication. 

Various alternative therapies like guided meditation can be used to help people with ALS ward off depression and anxiety, and maintain a positive state of mind.

Nutritional support

People with ALS burn calories faster. This can easily lead to malnourishment, especially since people with ALS have trouble chewing and swallowing as the muscle weakness progresses. Nutritionists help caregivers and individuals to prepare frequent small meals that are high in calories, to prevent malnutrition, and to choose foods that are easy to swallow. 

Breathing support

When the muscles that help you breathe start to get weaker, you’re likely to experience shortness of breath when exercising or find it difficult to breathe when lying down. 

As breathing becomes more difficult, non-invasive ventilation uses a mask to help you maintain the right levels of oxygen and carbon dioxide in your bloodstream. 

Therapists also help you try different techniques to cough, in order to keep your airways clear of phlegm and saliva. 

Eventually, breathing support might be delivered through a respirator or a tracheostomy. 

1132
10 min

Can Cannabis Help ALS?

by Mary Biles

Listen

Overview

The compounds in cannabis have promising potential for treatment of ALS, because of their ability to counter fight cell death and inflammation of the nervous system, elements in the disease process of ALS.  

ALS (Amyotrophic Lateral Sclerosis) is a terminal neurodegenerative disease that damages motor neurons leading to progressive muscle wasting, weakness, and death. 

Cannabis products have also been shown to alleviate some common ALS symptoms, including chronic pain.

How cannabis works on ALS

The endocannabinoid system (ECS) exists in all vertebrates and helps regulate crucial functions such as sleep, pain, and appetite. The human body produces its own cannabinoids, which modulate and activate its various functions, but as its name suggests, the endocannabinoid system can also be modulated and activated by cannabinoids found in the cannabis plant. 

A 2017 paper on cannabinoid pharmacology describes how the ECS has the ability to modulate the key traits contributing to neurodegenerative diseases such as ALS, and is “thus, emerging as a viable target for symptom alleviation or disease progression based on pharmacological modulation of endocannabinoid signaling.”  

Studies on ALS animal models and ALS patients show some ECS dysregulation in the brain and spinal cord. However, this may well be a sign of the ECS doing its neuroprotective work rather than the dysregulation itself being a cause of the disease.

Perhaps the most promising area of research in the development of drugs for ALS involves agents that bind with CB2 receptors in the body. In one study on ALS mice, daily administration of a CB2 agonist delayed motor impairment and increased survival by 56%.

Medical studies on cannabis and ALS

The cannabis plant contains at least 146 compounds called cannabinoids, most notably Tetrahydrocannabinol (THC) and Cannabidiol (CBD), as well as a host of other organic compounds such as terpenes and flavonoids.

THC directly bonds with the body’s two main cannabinoid receptors and has a neuroprotectant and anti-inflammatory effect. CBD doesn’t activate either receptor, but it blocks the enzyme (FAAH) that degrades anandamide. Commonly known as “the bliss molecule,” anandamide is a cannabinoid that plays a key role in maintaining the health of the ECS and can reduce anxiety and lower systemic inflammation, in addition to other benefits.  

Thus, compounds found within the cannabis plant may have therapeutic potential in the treatment of ALS through ECS modulation. Indeed, in one study, ALS mice were treated with THC before and after disease onset. Motor improvement was noted, and disease survival increased, which was thought to be due to a reduction in cell damage and death. Another study carried out on mice in 2008 found that altering CB1 expression can predispose motor neurons to cell death. 

Research on mice has found that daily use of an ECS receptor agonist (CB2) delayed motor impairment and increased survival by 56%. In particular, raised levels of endocannabinoids were found in ALS mice models, as well as increased CB2 receptor expression in astrocytes (the most common cell type in the central nervous system) located in damaged or altered tissue. They were also found in brain and spinal cord cells of grey and white matter (the two types of tissue in the central nervous system) in animal models and ALS patients.

CBD and ALS

CBD does not have the psychotropic effects of THC, and is thus often widely-available in jurisdictions where medical marijuana has not been legalized. A study performed on mice with ALS in 2010 found that small doses of CBD given to mice slowed down the progression of the disease. 

A clinical trial currently underway in Australia is testing the effect of a CBD dominant oil on 30 subjects with ALS.

CBD treatment can potentially ease some of the negative symptoms of the disease, including pain, muscle tension, and loss of appetite and sleep among others.

Side effects

Cannabis use can be habit forming and can make users more sluggish with decreased motor skills and reaction time when under the influence. Long-term effects can include cognitive impairment, a small risk of addiction, as well as an increased risk of developing a psychotic disorder. Further research is necessary to explore the potential interaction between other ALS medications and specific doses and forms of CBD and THC. 

Cannabis Side Effects

About ALS

Overview

ALS (Amyotrophic Lateral Sclerosis) was discovered and named in 1896 by French neurologist Jean-Martin Charcot. ALS is also called Lou Gehrig’s Disease, after the baseball player Lou Gehrig, who was one of the most famous people to suffer from the disease. ALS is a motor neuron disease, meaning that it affects the nerve cells in the brain and the spinal cord that are responsible for controlling your muscles. 

ALS is progressive, which means that the symptoms get worse over time. When you have ALS, your motor neurons weaken and die, leaving you with no way to control your muscle movements. Without any control, your muscles get weaker too. They twitch uncontrollably, a process called fasciculations, and then waste away. Most patients ultimately die as a result of the disease.

There are two types of ALS:

  • Sporadic. This is the most common form of ALS. 90-95% of people who develop ALS have sporadic ALS. Sporadic ALS means that it affects someone without any apparent cause or warning.
  • Familial. Familial ALS  (FALS) is inherited. If you have familial ALS in your family, there’s a 50% chance that each child may inherit the disease. 

It’s estimated that 14-15,000 Americans have ALS, but the number could be higher. Another 5,000+ people are diagnosed with it every year.

Symptoms

The earliest symptoms of ALS are usually muscle stiffness, weakness, or twitches, which are easy to overlook. The first symptoms of ALS differ widely since they depend on which motor neurons are the first ones to be affected. 

Some of the first symptoms of ALS include:

  • Stiff fingers, hand, or arm muscles that make it difficult to button a shirt, write, or turn a key
  • Weakness in the legs or ankles, stumbling and tripping more often than usual, feeling awkwardness when walking or running
  • Slurred speech or difficulty swallowing
  • Tight, stiff, cramped muscles
  • Uncontrollable fasciculations (twitching) in your tongue, arms, legs, or other muscles

When ALS begins with slurred speech or trouble swallowing, it’s called Bulbar Onset ALS. 

When it begins with fasciculations, stiffness, or weakness in your arms or legs, it’s called Limb Onset ALS. 

Although the early signs of ALS are subtle and very similar to other, more benign health issues, as time goes on and more neurons die, the symptoms will grow more obvious. Weakness, fasciculations, and muscle atrophy will spread across the body. Over time, people with ALS can no longer stand, walk, get out of bed, or move their arms, legs, or head themselves. Most people with ALS lose the ability to speak, too, because the tongue muscles are also affected, and to chew and swallow.

Eventually, ALS affects the muscles that help you breathe. Most people with ALS end up needing a ventilator to keep them alive. 

It’s important to note that ALS spreads in a different way and at different speeds for each person, so it’s impossible to predict exactly what will happen to each person diagnosed with ALS.

ALS does not affect your mental or cognitive ability. If you have ALS, you are still able to:

  • Think, reason, and solve problems
  • Use all of your senses, so you can see, hear, taste, smell, and feel things the same as usual
  • Remember people, places, events, and experiences

A small percentage of people with ALS are also diagnosed with some form of dementia, language processing issues, or decision-making issues.

Causes

Familial ALS is a genetic disorder. In a family with a history of ALS, there’s a 50-50 chance that each child will develop the illness. But just having a single parent or family member who develops ALS doesn’t significantly raise your chances of getting it.

Researchers are still trying to identify what causes sporadic ALS. So far, the consensus is that it’s caused by a complicated combination of genetic and environmental factors.

Risk factors for developing ALS include: 

  • Age. The risk of ALS increases as you get older. Most people diagnosed with ALS are aged between 40 and 70. 
  • Gender. Men are slightly more likely to develop ALS than women, but as you age, the difference between the genders disappears.
  • Race and ethnicity. Caucasians and Hispanics develop ALS more than people from other backgrounds. 
  • Genetics. Some researchers have found genetic variations in the genomes of people with Familial ALS and sporadic ALS, which hints that there could be an underlying genetic cause for ALS.
  • Smoking. Smoking has been found to raise the risk of developing ALS, particularly in women who are post-menopausal.
  • Exposure to environmental toxins. There’s some evidence that exposure to lead or other substances could be linked to ALS, but no study has identified a single agent or chemical.

Military veterans are 1.5 to 2 times more likely to develop ALS. The reasons behind this connection are still not clear, but it’s been suggested that veterans are exposed to more lead, pesticides, and other environmental toxins than civilians. The U.S. Department of Veterans Affairs recignizes ALS as a service-connected disease.

Diagnosis

Diagnosing ALS consists of a neurological exam and a careful history from the patient looking for telltale signs of ALS including muscle fasciculations, weakness and no change in sensation.  A full neurological exam will be accompanied by a nerve conduction study (EMG/NCS).  

There’s no single test to identify ALS. Other tests are often performed to rule out other conditions.

Tests that are used to help diagnose ALS include:

Muscle and imaging tests

Electromyography (EMG), Nerve Conduction Study (NCS), and Magnetic Resonance Imaging (MRI). 

  • An EMG test detects electrical activity in the muscle fibers. 
  • NCS tests assess whether a nerve can still send a signal to a muscle or along the nerve. 

These tests help rule out peripheral neuropathy, which is damage to the nerves outside of the brain and the spinal cord, and myopathy, which is a muscle disease. 

Imaging
An MRI test is used to rule out other causes like a tumor or cyst in the spinal cord, a herniated disk, or cervical spondylosis. People with ALS generally get normal results on their MRI scan. 

Lab tests

Depending on your symptoms and the results of other tests, your doctor might order blood tests and urine sample tests to check for other diseases. 

Tests for specific diseases and conditions

There are some infectious diseases which can cause symptoms that are very similar to ALS, so your doctor will consider them and test for them while making a diagnosis. These include HIV (Aids), West Nile virus, and human T-cell leukemia virus; multiple sclerosis, post-polio syndrome, multifocal motor neuropathy, and Kennedy’s disease.

Treatment

There’s still no cure for ALS. Most people with ALS die within 3 to 5 years of diagnosis, usually of respiratory failure, although some people live with ALS for 10 years or more. 

However, there’s a huge amount of research going on into ALS, and researchers hope to eventually find a cure. For the moment, there are a number of ways to treat the symptoms of ALS, improve quality of life, and prolong survival. 

Multidisciplinary care

Studies have found that participating in a multidisciplinary ALS clinic can prolong survival and improve quality of life. These clinics are staffed by teams that include physical, occupational, and speech therapists; doctors and nurses; pharmacists; home care and hospice workers; social workers; and respiratory therapists. Multidisciplinary teams prepare individual treatment plans, therapeutic activities, and medication, and suggest the right equipment to help people with ALS remain independent for as long as possible. 

Medication

At the moment, 4 drugs have been approved to help treat ALS:

  • Riluzole (Rilutek)
  • Edaravone (Radicava)
  • Nuedexta
  • Tiglutik

None of them can reverse or cure ALS, but they can slow down muscle decline and prolong survival. Clinical studies are still ongoing, for these and other new drugs for ALS. 

As well as these four medications, physicians can also prescribe medications to help with the symptoms of ALS. Different drugs can be given to ease cramped and stiff muscles, reduce excess saliva and phlegm, deal with the depression and anxiety that often accompany ALS, treat constipation and insomnia, and prevent involuntary and uncontrollable crying or laughing. 

Therapies 

In the early and middle stages of ALS, physical, occupational, and speech therapy can help prolong independence and communication. 

Physical therapists design a course of low-impact aerobic exercise to strengthen muscles that haven’t yet been affected and combat depression. They can also guide you in a range of stretches to prevent muscles from getting painfully cramped and stiff. 

Occupational therapists guide people with ALS to choose the right equipment, like ramps, walkers, and wheelchairs, to help you remain mobile. 

Speech therapists can teach new strategies to help people with ALS to speak more loudly and clearly despite the degeneration of related muscles. As ALS becomes more serious, speech therapists can help you to communicate through advanced technology like computer-based speech synthesizer, eye-tracking technology, and non-verbal communication. 

Various alternative therapies like guided meditation can be used to help people with ALS ward off depression and anxiety, and maintain a positive state of mind.

Nutritional support

People with ALS burn calories faster. This can easily lead to malnourishment, especially since people with ALS have trouble chewing and swallowing as the muscle weakness progresses. Nutritionists help caregivers and individuals to prepare frequent small meals that are high in calories, to prevent malnutrition, and to choose foods that are easy to swallow. 

Breathing support

When the muscles that help you breathe start to get weaker, you’re likely to experience shortness of breath when exercising or find it difficult to breathe when lying down. 

As breathing becomes more difficult, non-invasive ventilation uses a mask to help you maintain the right levels of oxygen and carbon dioxide in your bloodstream. 

Therapists also help you try different techniques to cough, in order to keep your airways clear of phlegm and saliva. 

Eventually, breathing support might be delivered through a respirator or a tracheostomy. 

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