By Luke Sumpter

Research continues to judge the potential of cannabis in the realm of health and wellness. But can the herb help to tackle ALS? Unless you’ve been living under a rock (we’re not judging, that’s a personal choice) you probably remember the Ice Bucket Challenge. This viral sensation saw everybody from A-list celebrities to your second cousin John pour ice water over their heads in an effort to raise money for amyotrophic lateral sclerosis (ALS) research. Known commonly as Lou Gehrig’s disease, the condition currently has no cure.

However, ongoing studies are exploring the effect of cannabis and its constituents on the disease. Below, you’ll find out everything you need to know about ALS, what treatments are currently available, and how marijuana is examined for patients with the condition.

What Is ALS?

As a progressive neurodegenerative condition, ALS gradually destroys parts of the nervous system. More specifically, the condition takes a massive toll on nerve cells that control voluntary muscular contractions. Known as skeletal muscle (as opposed to the smooth muscle that makes up the blood vessels and various organs), we rely on this specialised tissue to simply move. Many of us often assume the skin holds the title as the biggest organ in the body, but in reality, skeletal muscle stands highest on the podium[1].

But we depend on muscle for much more than locomotion. Our skeletal muscle plays the role of a secretory organ. Upon contraction during exercise, our muscles release specialised chemicals that affect our bodies on a systemic level. These molecules are linked to a decreased risk of chronic health conditions, including metabolic diseases.

Muscle plays a critical role in human health and well-being. In the case of ALS, the components that the body relies on to move the muscles become damaged. Intentional muscular movement begins in the brain; electrical signals are transmitted through nerve cells called motor neurons, which cause skeletal muscles to contract. ALS causes these cells to die off.

ALS can affect the two categories of motor neurons. It inflicts damage on upper motor neurons responsible for transmitting signals throughout the brain, brainstem, and spinal cord, and also affects lower motor neurons that send impulses from the spinal cord to innervated muscles.

ALS has a poor prognosis. After a diagnosis, patients have an average life expectancy of 2–5 years. However, outliers such as the famous physicist Stephen Hawking go on to live more than 50 years following diagnosis.

What Is ALS?
  • What Causes ALS?

Researchers are still searching for the exact cause of ALS. Ongoing research continues to explore the role of genetics and environmental factors that trigger the death of motor neurons. So far, scientists believe various factors underpin the disease, including:

Free radical injury Mitochondrial dysfunction
Genetic defects Programmed cell death (apoptosis)
Viral infections Autoimmunity and inflammation
Accumulation of protein clumps
  • What Are the Symptoms of ALS?

The symptoms of ALS vary from patient to patient, and not everybody diagnosed with the condition experiences the same symptoms or pattern of progression. However, many ALS patients experience common symptoms that include:

Muscle twitches and cramping Weakness in the muscle that controls speech and swallowing
Slow or slurred speech Reduced function of arms and legs
Reduced hand, arm, and leg strength

What Are the Current Treatments for ALS?

No known cure currently exists for ALS, but some treatments do appear to slow the progression of the disease. For example, the FDA-approved drug riluzole may help to reduce the speed of progression by blocking the release of glutamate—an excitatory neurotransmitter that may damage nerve cells when produced in excess. A range of treatments and interventions also exist that help to improve the quality of life of ALS patients, including:

Proper body positioning Braces and splints
Feeding tubes Breathing devices
Customised wheelchairs Nutritional programmes

How Could Weed Help Lou Gehrig's Disease Patients?

Given that no cure exists, and treatments only help to delay the progression of the disease, what can the humble cannabis plant do in the face of such a devastating condition?

In truth, scientists aren’t sure. Studies remain incredibly early, but some findings offer a glimmer of hope. Cannabis produces around 500 molecules of interest, including a plethora of cannabinoids, terpenes, and flavonoids. The plant has garnered an incredible amount of interest for a wide range of health conditions because of how these constituents act in the body.

Although cannabinoids exist in numerous species of plants and fungi, cannabis contains over 100 of these interesting compounds. These molecules received their name because of their ability to bind to cannabinoid receptors of the endocannabinoid system (ECS).

Described as the “universal regulator” of the human body, the ECS plays a key role in the nervous system and immune system. There are two primary parts of the ECS. The classical ECS features CB1 and CB2 receptors, the endocannabinoids anandamide and 2-AG, and the enzymes that build and break down these signalling molecules.

Further research has uncovered the expanded endocannabinoid system, otherwise known as the “endocannabinoidome”, which consists of many other signalling molecules, enzymes, and receptors, including peroxisome proliferator-activated receptors (PPARs) involved in gene expression, and transient receptor potential (TRP) channels involved in pain detection.

  • What the Science Says About ALS and Marijuana

Studies are currently investigating the role of this expansive system in the causation of ALS. In human trials, researchers found an increase in immune cells possessing CB2 receptors in areas with motor neuron damage, suggesting an involvement of the ECS[2] in the condition.

Animal studies have also shed light on the potential role of the ECS in the pathology. Researchers found higher levels of anandamide and 2-AG in the lower spinal cord of mice, which points to some sort of defence mechanism[3]. Because cannabis contains so many chemicals that target the ECS, studies are presently determining their role in reducing symptoms and possibly targeting the root cause of ALS.

In particular, researchers are probing THC and the synthetic cannabinoid WIN 55,212-2 for their potential to delay the progression of the disease.

A paper[4] published in the American Journal of Hospice & Palliative Care discusses the idea of a multidrug regimen to target all of the underlying physiological aspects of ALS. The authors state that the lineup should include glutamate antagonists, antioxidants, an anti-inflammatory agent, microglial cell modulators, neurotrophic growth factors, and a mitochondrial function-enhancing agent. They then state that cannabis fits the bill perfectly, as it remarkably features activity in all of these areas.

As well as potentially working to slow the disease, research continues to explore the role of cannabis in ALS symptom management, including:

Pain management Muscle relaxation
Bronchodilation (widening the airways of the lungs) Saliva reduction
Appetite stimulation Sleep induction

Researchers are also exploring PPAR activation[5] in reducing neuroinflammation and blocking neurodegeneration. It just so happens that cannabis produces a fair few PPAR agonists (molecules that activate these receptors), including the cannabinoids CBD, THC, and CBG.

  • The Importance of CBD:THC Ratios

As research continues to unfold, we will likely discover unique benefits associated with individual cannabinoids, terpenes, etc. However, using cannabinoids in tandem is also an intriguing opportunity.

As THC and CBD are the main players at this point, we’re not far off from comprehensive human trials testing their isolated and synergistic effects. These cannabinoids have different mechanisms of action, with THC directly binding to CB1 and CB2 receptors, and CBD taking a more indirect route. As a result, THC produces psychotropic effects, while CBD’s influence is more understated.

Although CBD has a low affinity for traditional cannabinoid receptors, it does work as an allosteric modulator of the CB1 receptor, changing how it responds to THC. CBD also directly binds to endocannabinoidome receptors, including TRPV1 and PPAR receptors, and interferes with an enzyme called fatty acid amide hydrolase (FAAH), which breaks down anandamide.

As evidence builds for the entourage effect—a theory positing the potential of phytochemical synergy—ALS patients may find that they benefit from strains with varying levels of THC, CBD, other cannabinoids, and a host of terpenes.

Is Cannabis Safe for People With Amyotrophic Lateral Sclerosis?

Is Cannabis Safe for People With Amyotrophic Lateral Sclerosis?

Cannabis is generally safe and well-tolerated, and overdoses from cannabis use alone are virtually non-existent. The main side effects of medical cannabis include anxiety, confusion, and impaired cognition. Some cannabinoids, including CBD, also interact with a wide range of medications.

Overall, the research on medical marijuana and ALS remains incredibly early. A limited number of studies point toward potential symptom management and the augmentation of pain medications. However, we need more clinical trials to confirm the effectiveness and, most importantly, the safety of cannabis as a medicine for amyotrophic lateral sclerosis.

External Resources:
  1. Muscle as a secretory organ - PubMed
  2. COX-2, CB2 and P2X7-immunoreactivities are increased in activated microglial cells/macrophages of multiple sclerosis and amyotrophic lateral sclerosis spinal cord - PubMed
  3. The endocannabinoid system as a target for the treatment of neurodegenerative disease
  4. Cannabis and amyotrophic lateral sclerosis: hypothetical and practical applications, and a call for clinical trials - PubMed
  5. Preferential PPAR-α activation reduces neuroinflammation, and blocks neurodegeneration in vivo | Human Molecular Genetics | Oxford Academic
This content is for educational purposes only. The information provided is derived from research gathered from external sources.

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