Amyotrophic Lateral Sclerosis (ALS) is a debilitating neurodegenerative condition for which treatment options are limited. There is a growing interest among researchers in exploring the potential of cannabis to modify the progression of the disease and alleviate ALS symptoms. This interest is fueled by the properties of cannabinoids, such as tetrahydrocannabinol (THC) and cannabidiol (CBD), which have shown promise in managing symptoms associated with ALS. These properties include analgesic effects, muscle relaxation, bronchodilation, reduction of saliva production, appetite stimulation, and sleep induction. Although clinical trials specifically evaluating the use of cannabis for ALS are currently lacking, optimism exists based on the observed benefits of cannabis in treating other neurodegenerative disorders.
What is ALS?
Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive neurodegenerative disorder that primarily affects the nerve cells (neurons) responsible for controlling voluntary muscles . ALS belongs to a group of disorders called motor neuron diseases. In ALS, motor neurons that transmit signals from the brain to the muscles gradually degenerate and die. This results in the gradual loss of voluntary muscle control, leading to muscle weakness, twitching, and eventually paralysis. As the disease progresses, individuals with ALS may have difficulty speaking, swallowing, and breathing. However, cognitive function and the senses (sight, hearing, touch, taste, and smell) generally remain unaffected.
The exact cause of ALS is not fully understood, and in most cases, it occurs sporadically with no clear genetic or environmental factors identified . However, a small percentage (5% to 10%) of cases are associated with inherited genetic mutations. Motor neuron degradation has also been attributed to mitochondrial dysfunction, neuroinflammation, growth factor deficiency, and glutamate excitotoxicity. Typical ALS treatment requires a regimen of several drugs along with supportive therapies. The progression of ALS varies from person to person, and the average life expectancy after diagnosis is typically around two to five years, although some individuals may live longer.
Medical Cannabis for ALS
Individuals with ALS may manifest various clinical symptoms, including weakness, spasticity, cachexia, dysarthria, drooling, and pain stemming from immobility . Cannabis exhibits noticeable clinical effects with a swift onset, such as analgesia, muscle relaxation, and dry mouth. Additionally, certain components of marijuana, like CBD, have demonstrated neuroprotective properties in laboratory studies, potentially aiding in the prolonged survival of neuronal cells over an extended period. For ALS pain management, the use of cannabis and narcotics simultaneously could be advantageous since it allows for more biological targets to be reached. The antiemetic properties of cannabis may also assist in alleviating the nausea occasionally associated with narcotic medications.
Studies of ALS patients using the 1:1 THC:CBD pharmaceutical Sativex demonstrated reductions in spasticity . However, a study of 10mg THC per day did not show improvement in ALS-related muscle cramps . While researchers believe that cannabinoids can delay ALS progression and prolong survival, they have yet to determine the best ratios of THC and CBD for treating the disease . Since the use of medical cannabis for ALS is an emerging option, it is important to work closely with a doctor. Researchers also recommend that patients start by using non-intoxicating CBD products and slowly and gradually increase the dosage, adding small amounts of THC only if needed .
Best Cannabis Strains for ALS
In the realm of medical marijuana for ALS, physicians are likely to suggest that patients initially explore prescription cannabinoid medications that have undergone clinical research. Among these, Sativex stands out as a notable choice, featuring a balanced 1:1 THC to CBD formula. If your healthcare provider deems the use of cannabis flower appropriate, ALS patients may also want to consider CBD-rich hemp flower. This non-psychoactive variety of cannabis is a great place to start. Hemp strains like Charlotte’s Web have also gained high acclaim for their ability to alleviate convulsions in epilepsy patients.
When it comes to leading medical marijuana strains, there are many classics such as Blue Dream, Girl Scout Cookies, OG Kush, and White Widow. However, you often don’t find these options at medical marijuana dispensaries, and dispensary options vary widely from state to state. By looking into a strain’s genetic heritage you can get an idea of what to expect. For example, Lemon Cherry Gelato is a hybrid cross of Girl Scout Cookies and Sunset Sherbet. Sunset Sherbet was also created from the Girl Scout Cookies Strain. This means that Lemon Cherry Gelato is actually about 75% Girl Scout Cookies genetics and is likely to carry similar benefits. You can also look for strains with similar traits like indica/sativa, THC potency, and terpene profile. With that in mind, here are some options to consider.
- Charlotte’s Web
Charlotte’s Web, a hemp strain celebrated for its elevated CBD and minimal THC levels, has an inspiring origin story rooted in the experiences of a young girl named Charlotte Figi, who grappled with the challenges of Dravet syndrome. Faced with limited success from various treatments, Charlotte’s parents turned to cannabis oil as a potential solution. However, their search for a product with minimal THC presented a significant hurdle.
In their time of need, the Stanley Brothers of Colorado intervened, introducing a strain initially dubbed “Hippie’s Disappointment.” Noteworthy for its remarkable 30:1 CBD-to-THC ratio and the absence of intoxicating effects, this strain was rightfully renamed “Charlotte’s Web.” The journey of Charlotte’s Web gained national attention, partly due to endorsements from Dr. Sanjay Gupta. His once skeptical views on cannabis shifted significantly, influenced by the effectiveness of low-THC strains like Charlotte’s Web. Success stories from both young patients and adults further highlighted the strain’s efficacy in reducing seizures and its potential therapeutic benefits.
Charlotte’s Web stands out for its versatility in addressing various conditions, including anxiety, stress, pain, inflammation, and seizures, owing to its high CBD content. Particularly cherished for its ability to induce a sense of calm and relaxation without the typical intoxicating effects associated with THC, Charlotte’s Web offers an earthy and herbal flavor profile that mirrors its aroma. When consumed, it delivers a gentle and pleasing taste, appreciated by those seeking a straightforward and uncomplicated experience. Dominant terpenes in the strain include myrcene, pinene, and caryophyllene.
- Berry Blossom
Berry Blossom, a hemp cultivar abundant in CBD, was developed by crossbreeding Cherry Kandahar and Chardonnay. Its buds display a gentle green hue highlighted by occasional purple accents, while the flavor profile carries floral tones accompanied by hints of candied raspberries and acai berries. The scent of Berry Blossom is truly exceptional, welcoming the senses with a sweet and fruity essence that conjures thoughts of ripe berries.
Upon consumption, Berry Blossom delivers a delightful blend of berry-like sweetness with subtle herbal undertones, resulting in a smooth and attractive flavor profile. This pleasing taste experience aligns seamlessly with the strain’s primary terpenes caryophyllene, limonene, and pinene, contributing to a well-rounded and enjoyable sensation.
Renowned for its elevated CBD content and minimal THC presence, Berry Blossom is celebrated for its ability to instill a sense of calm and relaxation without inducing disorienting effects. It has garnered attention from medical cannabis users seeking relief from conditions such as anxiety, stress, pain, and inflammation.
Pennywise, a hybrid cannabis strain recognized for its rich CBD content, stems from the genetic combination of Harlequin and Jack the Ripper. What distinguishes Pennywise is the intriguing manifestation of four distinct phenotypes, showcasing variations in bud shapes from elongated to rounded. With a consistent CBD-to-THC ratio of 1:1, Pennywise holds particular appeal for medical marijuana patients seeking relief from symptoms of arthritis, PTSD, epilepsy, neurological disorders, and cancer.
The harmonious interplay of these cannabinoids results in a milder, more tranquil psychoactive encounter. It provides a cerebral and focused high, accompanied by a rejuvenating sense of vitality. Pennywise’s terpene profile is predominantly influenced by myrcene, terpinolene, and pinene, crafting its flavor with earthy and herbal tones, complemented by subtle hints of citrus and spice. This unique strain is an attractive option for individuals in pursuit of the therapeutic benefits of cannabis while enjoying a calm and uplifting experience, catering to a diverse range of patients.
- Grandaddy Purple
Whether you refer to it as Grand Daddy Purp, Granddaddy Purple Kush, Granddaddy Purps, or simply GDP, the Granddaddy Purple cannabis strain has earned its fame. Created through a cross of Mendocino Purps, Skunk, and Afghanistan, this indica rose to prominence around 2003. Despite its seemingly moderate THC potency at around 17%, Granddaddy Purple delivers potent effects that seamlessly combine cerebral euphoria with profound body relaxation.
Known for its dreamy high in recreational circles, Granddaddy Purple offers medicinal users various benefits, including relief from pain, insomnia, increased appetite, and alleviation of muscle spasms. The purple-tinged buds of Granddaddy Purple burst with a delightful array of sweet and floral flavors reminiscent of grapes, berries, and flowers. Its terpene profile is prominently marked by myrcene, pinene, and caryophyllene.
- Larry OG
Larry OG originated as a medicinal marijuana strain resulting from the crossbreeding of OG Kush and San Fernando Valley OG (SFV OG). This indica-dominant hybrid delivers a potent body high, inducing profound relaxation for both the body and mind, with an average THC potency of around 20%. Despite its high THC content, Larry OG is known for providing a powerful experience without being overwhelming.
The terpene profile of Larry OG is predominantly composed of myrcene, limonene, and caryophyllene, contributing to its sensory profile characterized by tanginess and a subtle pungency, accompanied by vibrant notes of citrus and pine. Widely favored among medical marijuana patients, Larry OG is often sought after by those dealing with symptoms such as appetite loss, stress, pain, and depression. Although a relatively new cannabis strain, Larry OG has already given rise to a newer variation known as “Legendary Larry” (Larry OG x Legend OG).
Jager, also recognized as “Jagermeister,” “Jager Kush,” and “JGR,” stands as an indica marijuana strain. Although some suggest it’s a hybrid of LA Confidential and Blue Dream, it is more probable lineage traces back to Southern Oregon, descending from Hindu Kush. The name “Jager” is inspired by its sensory characteristics, marked by dominant notes of licorice, spice, and earth, complemented by sweet undertones.
The effects of Jager gradually envelop users in a state of profound relaxation, and its potential sedative qualities, coupled with typically elevated THC levels, make it well-suited for evening use. Among medical marijuana patients, Jager has shown efficacy in addressing chronic pain, inflammation, tremors, and muscle spasms. The strain’s distinct flavors, aromas, and effects are molded by its unique terpene profile, abundant in limonene, caryophyllene, and linalool.
Romulan, an indica cannabis strain, is the outcome of crossing an unidentified indica with White Rhino. Named after the extraterrestrial species in Star Trek, this strain is celebrated for its potent and therapeutic qualities. With a THC content ranging from 20% to 24%, Romulan is notably robust and can induce narcotic-like effects. Users can anticipate powerful cerebral effects evolving into profound sedation, creating a deeply relaxed body high akin to floating in a dreamlike state.
Medical marijuana patients often turn to Romulan for relief from symptoms associated with insomnia, loss of appetite, pain, muscle spasms, and nerve damage. In smaller doses, it may provide relief from stress and depression, but caution is advised, as its effects can be overwhelming. The likelihood of experiencing couch-lock is high with Romulan, making it best suited for late evenings or leisurely days at home. Romulan exudes a sweet earthy aroma and taste, with subtle floral undertones enriched by hints of pine and citrus. Its primary terpenes are myrcene, caryophyllene, and pinene.
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- Weber, M., Goldman, B., & Truniger, S. (2010). Tetrahydrocannabinol (THC) for cramps in amyotrophic lateral sclerosis: a randomised, double-blind crossover trial. Journal of Neurology, Neurosurgery & Psychiatry, 81(10), 1135-1140.https://flowermed.com.br/wp-content/uploads/2023/01/etrahydrocannabinol-THC-for-cramps-in-amyotrophic-lateral-sclerosis-1.pdf