Cannabidiol (CBD) oil is produced by the dilution of CBD extracts isolated from the Cannabis sativa plant with carrier oils such as hemp seed oil.
CBD is a phytocannabinoid which has the ability to moderate a variety of physiological responses by binding to specific receptors of the endocannabinoid system (ECS).
CBD is not psychoactive and has been proven to confer several neurological benefits.
Overview of Amyotrophic Lateral Sclerosis (ALS)
ALS, popularly known as Lou Gehrig’s disease, is a neurodegenerative disease that leads to the death of motor neurons which drive the voluntary muscles.
The symptoms worsen progressively from muscle twitches and stiffness to gradually diminishing in size.
The outcomes can be fatal as, in the end, patients experience difficulty in swallowing and even breathing. Currently, there is no cure for this disorder and medications simply extend life expectancies.
Benefits of CBD in Amyotrophic Lateral Sclerosis (ALS)
The major benefits of using CBD to combat ALS are linked with its nature a neuroprotective antioxidant. It helps in lowering inflammation in the central nervous system and also counteracts the oxidative damage caused by free radicals. Being a neuroprotective agent, it helps in preventing the death of cortex motor neurons as well as serotonin neurons.
CBD also acts as a muscle relaxant by stimulating neurotransmitter activity and reducing the severity of muscle spasticity that is induced by nerve cell damage. It is a bronchodilator and helps in opening up the airways in the lung to facilitate breathing and relieving the respiratory symptoms of ALS. It also acts as an analgesic and provides rapid pain relief.
1. CBD Is an Anti-inflammatory Antioxidant
The exact cause of ALS remains to be completely understood but the progressive motor neuron degeneration is a complex multifactorial process.
Several studies have provided evidence to bolster the claim that oxidative damage plays a key role in the process of nerve cell death. Oxidative stress is often caused by the presence of toxic free radicals which are mediators of the inflammatory response.
Inflammation forms a necessary part of the immune response which is primed to target and destroy any foreign substances that cause an infection in the body.
However, in certain cases, the inflammatory response becomes persistent even in the absence of a foreign threat and such a reaction causes tissue damage via mediators like complement proteins, free radicals, and pro-inflammatory cytokines.
Chronic inflammation and oxidative damage have both been identified as markers in the pathophysiology of Lou Gehrig’s disease.
The microglia, which are involved in clearing debris and dead cells in the nervous system, initiate the inflammatory process by getting unusually activated and releasing cytokines like the tumour necrosis factor (TNF)-α.
The consequent oxidative damage is caused by the generation of free radicals. Under normal circumstances, antioxidative enzymes like catalase and superoxide dismutase (SOD) scavenge and destroy such toxic products.
Recent studies on the aetiology of ALS have indicated the presence of a mutation in the SOD1 gene which might explain the failure of the antioxidant mechanism leading to the oxidative destruction of motor neurons.
Cannabis products have gained popularity as anti-inflammatory antioxidants and can, therefore, be potentially used to support the treatment of neurodegenerative disorders.
A 2011 review by The University of Mississippi Medical Center established that CBD diminishes the impact of inflammation and oxidative stress via the receptors of the endocannabinoid system (ECS) and can be used to treat several diseases like ALS, Alzheimer’s, and other inflammatory disorders.
As CBD helps to lower inflammation and combat oxidative stress, it can be used to lessen oxidative nerve damage in ALS.
2. CBD Is A Neuroprotective Agent
Amyotrophic lateral sclerosis (ALS) belongs to a rare group of neurological diseases that affects the nerve cells involved in the control of voluntary muscle movement.
These muscle groups are involved in activities like chewing, talking, swallowing, and walking.
Currently, there is no absolute cure for this disease which starts progressively killing neurons upon its onset.
Owing to the type of nerve cells it affects, ALS is classified as a motor neuron disease as it causes gradual deterioration and neuronal loss.
Nerve cells involved in motor function extend from the brain to the spinal cord and are distributed across all the muscle groups throughout the body.
These motor neurons are responsible for initiating and transmitting important communication links between the brain and the voluntary muscles.
The messages from the upper motor neurons found in the brain are conveyed to the motor neurons of the spinal cord grey matter and to the motor nuclei of the brainstem which are collectively referred to as the lower motor neurons.
These lower motor neurons are responsible for contractions of the skeletal muscles that bring about voluntary movement.
ALS affects both the upper as well as the lower motor neurons. However, each individual with ALS has a varying proportion of upper and lower motor neuron disease.
Primary lateral sclerosis (PLS) only affects upper motor neurons causing severe spasticity (stiffness) whereas progressive muscular atrophy (PMA) involves only lower motor neurons resulting in muscle atrophy and twitching.
Before their destruction, the cell bodies and axons of motor neurons develop protein-rich inclusions which are mostly caused by malfunctions in protein degradation.
The inclusions include ubiquitin and ALS-associated proteins like SOD1 and FUS.
Excitotoxicity has also been implicated in motor neuron death. Excessive levels of the excitatory neurotransmitter, glutamate, have been observed in the cerebrospinal fluid of ALS patients.
In order to combat this fatal disease, therapeutic strategies must aim to provide neuroprotection.
A 2016 review by the University of São Paulo established the role of CBD as a neuroprotective agent.
It was proved that CBD attenuates the damage caused by neurodegenerative conditions and enhances synaptic (nerve ending) plasticity as well as stimulates neurogenesis.
Phytocannabinoids like CBD exert a neuroprotective role and help in delaying the progression of ALS.
3. CBD Oil Acts as A Muscle Relaxant
Muscle spasticity is one of the major complications of ALS which severely degrades the quality of daily lives.
It denotes a medical condition wherein the skeletal muscles are consistently contracted causing stiffness or tightness of muscle that can affect speech, movement, and gait.
Spasticity in ALS is caused due to the death of upper motor neurons.
The nerve damage brings about a change in the balance of signals between the central nervous system and the skeletal muscles.
This imbalance initiates the increased activity of the muscles. Muscle spasticity negatively affects the muscles and joints, particularly at the extremities.
This condition is estimated to affect over 12 million people across the globe.
A 2017 study by Inserm has exposed that muscle spasticity in ALS is further aggravated by the degeneration of serotonin neurons located in the brain stem, rather than only that of the cortex motor neurons as was previously perceived.
In fact, the serotonin receptor 5-HT2B/C is actually involved in the onset of the inflammatory reactions that trigger nerve cell damage.
The serotonin neuron hypothesis was proved by the use of animal models of the disease wherein the neurodegeneration of the serotonin neurons was prevented by restoring the activity of the mutated SOD1 gene.
The results revealed a lack of spasticity in animal groups where serotonin neurons were healthy.
In order to relieve spasticity, therapies should focus on methods that allow muscle relaxation.
As cannabinoids are involved in modulating a wide range of physiological responses, alternative medical therapies with CBD have gained eminence as a muscle relaxant.
A study reviewed by the National Academy of Sciences proved that the regular use of the plant-derived CBD oil helps in combating muscle spasticity by relaxing the skeletal muscles.
It does so stimulating serotonergic transmission which helps in relieving the symptoms of ALS.
As CBD helps in relaxing the skeletal muscles, it helps in relieving the symptoms of muscle spasticity which is common in patients with ALS.
4. CBD Promotes Bronchodilation
One of the major causes of death in ALS patients is respiratory failure. Neurodegeneration gradually results in respiratory muscle atrophy and patients often need ventilatory support to prolong survival.
Respiratory symptoms include dyspnoea (laboured breathing) at rest or with exertion, dizziness, morning headaches, and marked fatigue.
Weakness in the respiratory muscles is the primary reason behind the development of breathing problems in individuals suffering from ALS.
Shortness of breathing is the primary symptom and the complications worsen with the progression of the disease.
Patients experience difficulty in breathing during sleeping because the muscles tend to relax too much to assist the REM (rapid eye movement)/dreaming phase of sleep.
As the respiratory muscles get affected by ALS, bronchoconstriction occurs wherein the airways in the lungs (bronchi) get severely narrowed due to smooth muscle contractions or spasms.
This condition further affects breathing and patients might feel a tightness in their chests and suffer from frequent and violent spells of coughing.
In order to relieve the respiratory problems, therapeutic strategies should target the bronchi of the lungs and induce bronchodilation or widening of the airways.
As cannabis products have increasingly become popular in treating breathing problems like asthma, they can also be used to relieve bronchoconstriction in ALS.
The use of phytocannabinoids such as CBD help in relieving muscular contraction. A 2007 review by the Hebrew University of Jerusalem confirmed the role of cannabidiol (CBD) in facilitating bronchodilation. E
xtensive surveys of marijuana smokers have reported much lower incidences of respiratory complications such as bronchoconstriction. As a result, CBD can help in providing respite to ALS patients.
As CBD helps in opening up the airways of the lungs, it helps in relieving respiratory symptoms in patients with ALS.
5. CBD Oil Relieves ALS Pain
With the progression of ALS, secondary symptoms begin to arise generating new complications for patients.
One of the most debilitating effects is a chronic neuropathic pain. While it might not be a primary outcome, pain occurs in a considerable number of individuals.
However, there is a dearth of studies which explore the mechanisms behind the onset of this pain.
Pain denotes an unpleasant sensation and emotional experience which commonly occurs in response to any form of noxious stimuli ranging from tissue injury to trauma. Depending upon the onset and duration, neuropathic pain can be acute or chronic.
It also depends on the presence of structural and/or functional anomalies that affect how nerves transmit nociceptive (pain-sensing) data to the central nervous system.
Both variants of chronic pain and transitory acute pain have been recorded in patients with ALS. This most commonly includes musculoskeletal pain that is experienced in the back, limbs, neck and shoulders.
The exact aetiology of pain in ALS is not well known but studies have indicated that it develops following muscle atrophy and decreased muscle tone.
Cramps and fasciculations (involuntary muscle twitch) often experienced at the onset of the disease can also result in severe pain. They are gradually succeeded by muscle weakness.
Muscle spasms also induce cramps and are indicators of clinical neuropathy.
Treating the pain associated with ALS will markedly improve the quality of living.
Therefore, ALS-associated pain therapies are also active areas of medical research. Cannabinoids have emerged as popular analgesic options to treat musculoskeletal pain.
A 2008 study by GW Pharmaceuticals showed that cannabinoids like CBD oil can be used to provide relief from chronic pain associated with several medical conditions, including neurological diseases.
It acts as an analgesic by mediating the nociceptors (pain-sensing cells) via the endocannabinoid system (ECS).
CBD oil helps in relieving ALS-associated pain by acting as an analgesic and mediating the pain receptors via the ECS.
It is prudent to consult a healthcare provider before consuming medications containing THC. The dosage depends on the mode of delivery as the CBD products can be orally ingested or inhaled by a vaporizer.
There is no prescribed dosage for using CBD oil to treat amyotrophic lateral sclerosis as it has no cure. However, to provide symptomatic relief, small doses of 40mg should be had per day in two servings.
In order to reach the optimum level, the dosage should be increased by 40mg every alternate day. A maintenance dose of 25mg should be followed afterwards.
Vaporizers containing CBD oil can be used to relieve muscular pain and respiratory symptoms. 6-8mg should be inhaled.
The phytocannabinoid CBD has very few known side-effects. Daily oral doses of 500mg can be had for up to half a year.
A 2011 review claimed that even substantially high doses of 1500mg can be tolerated per day for up to 3 months without producing any unwanted complications.
CBD products typically contain variable amounts of the psychoactive agent, tetrahydrocannabinol (THC), which is responsible for the side-effects.
While the quantity of THC permitted in medical products is quite inadequate but sensitive individuals might still experience cognitive dysfunction.
CBD obstructs the activity of cytochrome p450, a class of enzymes responsible for the metabolism of drugs in the liver.
Hence, CBD usage reduces the efficacies of certain medications.
Medicines containing an excess of THC might cause confusion, dizziness, disorientation, nausea, vomiting fatigue, impaired balance, hallucinations, paranoia, and other cognitive impairments.
They might also cause tachycardia, a condition wherein the heart rate gets rapidly raised for a short duration. Cannabis products which have a moderate amount of THC should not be accompanied by alcohol.
Pregnant and lactating women should consult a gynaecologist before consuming CBD-containing medicines. Caution should also be maintained while administering THC-containing products to children and adolescents as it might affect their CNS differently.
To summarize, it can be said that CBD provides a host of benefits for ALS patients.
It lowers the inflammatory response in the nervous system which, in turn, helps in attenuating the damage caused by free radicals.
It has a neuroprotective effect and prevents the motor neuron damage by stimulating synaptic transmission.
CBD oil acts as a muscle relaxant and helps to treat the severe muscle spasticity caused by the degeneration of serotonin neurons. Being a bronchodilator, CBD helps in widening the bronchi and preventing dyspnoea.
Finally, it relieves the severe musculoskeletal pain and cramps associated with ALS.