Losing one's muscle control is a daunting prospect, however, it's a devastating reality for some. Can cannabis help ALS patients regain a little control?
We note that the subject contained in this article represents illegal activity in certain jurisdictions. Whilst we do not condone any acts which are contrary to any such laws, we understand that readers in those jurisdictions which have decriminalised cannabis may find this article of interest.
Commonly known as Lou Gehrig's disease, amyotrophic lateral sclerosis (ALS) affects roughly one in 50,000 people around the world. If you haven't heard of ALS, you're probably more familiar with its associations: Stephen Hawking, who remarkably lived with ALS for fifty-five years before his death in 2018; and the Ice Bucket Challenge to promote and raise awareness for the condition.
ALS is frustrating, painful, and debilitating, and is a qualifying condition in around 20 of the 33 U.S. states where medicinal cannabis is legal.
But why cannabis?
Research shows that cannabis can help relieve pain and spasms while increasing one's mood and mobility. It can also help with other neurodegenerative conditions like Alzheimer's and multiple sclerosis. When patients are struggling to walk, talk, and even breathe, is cannabis the solution to help patients regain their control?
What is ALS?
ALS is the degeneration of motor neurons in the brain and spinal cord. Amyotrophic translates to "no muscle nourishment"; lateral refers to the location of the spinal cord in which the signalling nerve cells are; sclerosis refers to the scarring and hardening of the region as the neurons degenerate.
Motor neurons are responsible for communication between the brain and the muscles. ALS is a progressive condition, meaning that the damage will get worse over time, severely impacting the brain's control over the muscles. ALS eventually impairs one's movements, including the ability to walk, talk, and even swallow.
When a person develops ALS, the degeneration leads the motor neurons to die off. When the neurons are no longer able to communicate with one another, the brain is unable to signal and control voluntary muscle movement.
There are two types of ALS: Sporadic and Familial. Sporadic ALS accounts for around 90-95% of cases. It can affect anyone and usually occurs between ages 40 and 70. Familial ALS, on the other hand, is inherited. Children of those who have ALS will have a 50% chance of inheriting the condition themselves and accounts for 5-10% of cases. The average life expectancy of an ALS patient is between 2-5 years, however, some patients can survive decades with the condition.
The onset of ALS usually occurs slowly and becomes more severe over time. The first signs of the condition may begin with muscle weakness, including struggling to pick something up, muscle fatigue, and changes in speech. In some cases, even one's ability to breathe will be impaired and will eventually require permanent ventilation as the condition worsens.
Every case of ALS is different, including different onset symptoms and paces of progression. Like other neurodegenerative conditions, there is no cure for ALS. Its treatment focuses on the management of symptoms.
How is ALS Treated?
ALS treatment is unique to every patient. A combination of physical, speech and psychological therapies are useful in providing patients with techniques, mobility aid, and coping strategies to maintain quality of life and independence.
There are currently two types of medication to aid the mobility of daily functioning and increase life expectancy. However, side effects include shortness of breath, gastrointestinal issues, damage to liver functioning, and dizziness.
Physicians can also prescribe additional medication to treat muscle spasms, depression, insomnia, and pain relief. However, these also have a risk of addiction, dependency, and heightened tolerance as the condition progresses.
Cannabis might not be able to cure ALS, however, it has been known to ease muscle spasms, slow the progression down and even stop nerve cells from developing further damage.
How does Cannabis Ease Symptoms?
Before we get into how cannabis can help, it's important to understand how the nerve damage occurs. Whenever we move, it's a result of neurons sending signals to one another. One particular neurotransmitter responsible for this action is glutamate.
Glutamate lives in the brain and spinal cord and releases when neurons 'fire' (or communicate with one another). When the right amount of glutamate releases, it results in a strong signal between nerve cells. This process is called excitatory functioning. If there is not enough glutamate releasing, it results in poor communication between cells.
Every time we speak or move it's a result of the right amount of glutamate releasing. However, you can have too much of a good thing.
When too much glutamate releases, it causes gradual damage to the nerve cells (called excitotoxicity). Nerve cells cannot be replaced, only strengthened or weakened, making any damage done to the nerve cells irreversible.
This is where cannabis can help.
When we consume, inhale, or topically apply cannabis, the plant's cannabinoids activate the CB1 and CB2 receptors in our endocannabinoid system (ECS).
The CB1 receptors live in the brain and the spinal cord and are responsible for our day-to-day functions like mood, pain perception, sleep, and appetite. THC binds itself to the CB1 receptors and activates them.
The CB2 receptors live within our immune system and regulate cell function and inflammation. The CB2 receptors react directly with CBD, which is why CBD can also ease spasms while reducing pain.
When ALS patients consume cannabis, THC reacts with the CB1 receptors and activates anti-glutamatergic properties. This means that THC can regulate the release of any excess glutamate.
As a result, the neuroprotectant properties of cannabis prevent the process of excitotoxicity and slow down the progression of ALS in patients.
Where is the evidence going?
While anecdotal evidence from ALS is overwhelmingly positive, the clinical research remains a little behind the times. Several studies have shown that cannabis is an effective resource for preventing the progression of ALS, however, these studies are based on animal models.
One study found that THC successfully protected nerve cells located in the spinal cord from induced excitotoxicity in mice.
A review in 2016 found that cannabinoids can delay ALS progression and prolong survival in animal studies. However, we need more human clinical research to confirm whether cannabis prevents the progression of ALS.
In the meantime, cannabis remains to be a popular treatment option for the chronic symptoms of ALS, specifically muscle spasms and pain.
A 2019 German study found that Sativex, a cannabis-derived product, is an effective treatment option for easing spasticity symptoms (characterized by pain, muscle stiffness, and involuntary spasms) in ALS patients.
CBD-based products can also help ALS symptoms due to its anti-inflammatory properties. Through this, it may also ease progressional damage.
While the research into cannabis as a preventative treatment for ALS is ongoing, it's a comforting thought to know that it can ease its symptoms. In the meantime, research will continue to develop and work towards a solution to this crippling condition.
If you're considering trying cannabis as a treatment option, please speak to your health care professional. In any case, cannabis may be a step in the right direction to help overcome this condition once and for all.
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