Cannabis shows promise in bringing relief to many symptoms in patients suffering with neurodegenerative conditions, including amyotrophic lateral sclerosis (ALS), also referred to as Lou Gehrig's or Motor Neuron disease. It is known in recent research that medical marijuana can alter the course of some ALS symptoms, suggesting several neuroprotective effects, especially in relation to the use of cannabidiol (CBD) in being able to slow the progression.
ALS doesn’t show as a normal disease, but as a highly variable syndrome that encompasses different genetically distinct disorders.  Some 90 to 95 percent of ALS cases are not inherited, meaning they are manifesting as a result of the environmental impact of stressors brought on during gestation and childhood, with symptoms often manifesting later in adulthood. This is touched upon by one of the largest studies most people have never heard of, called the Adverse Childhood Experiences study following 50,000 children into adulthood. See the references section of this article for more information. 
A 2004 survey study discovered that around 10% out of 131 patients with ALS had used cannabis in the prior year to treat their health condition. Those patients who had used cannabis, found that it was moderately effective in helping to reduce symptoms of ALS, including depression, pain, appetite loss, spasticity, and drooling. Sexual dysfunction, speech, and swallowing difficulties were not relieved.  For more information on how cannabis assists with each symptom, visit the articles found inside the hyperlinks above.
The oral pharmacokinetics and tolerability were studied in nine ALS patients given single doses of 5 to 10 mg THC. Noticeable differences were found among the patients, noting that ALS patients could experience dose-limiting side effects when taking 10 mg; however, it must be noted that those conducting the study did not titrate doses, so their conclusions are unlikely to be of any help in clinical practice with a patient. 
The main model for animal studies of ALS is a transgenic mouse strain that expresses the human mutated autosomal dominant gene (SOD-1) found in 5 to 10 percent of cases of ALS. Studies using this mouse model (G93A-SOD1) do show that the endocannabinoid system is activated, and that CB2 receptors (which leads to anti-inflammatory effects) are significantly upregulated.  For more information, read The Endocannabinoid System Explained.
The pathogenesis of ALS has many similarities to diseases like multiple sclerosis (MS) in that it involves increased glutamate concentrations resulting in excitotoxicity, oxidative stress, mitochondrial dysfunction, neuro-inflammation, microglial activation, and the presence of inclusion bodies in dying and degenerating neurons. The multiple actions of endocannabinoids and administered plant-based cannabinoids encompass these pathological processes, and may prove to ameliorate (bring relief to), the progressively worsening symptoms of ALS.
Beginning in 2011, some preclinical studies have looked at the potential for using human stem cells to halt the early stage progression of neurodegenerative diseases. In 2016, pretreatment with CBD of stem cells derived from human tissues modulated several groups of genes associated with specific aspects of ALS, including genes in these stem cells linked to the development of ALS pathogenesis. Additionally, CBD appears to modulate the expression of oxidative stress-related genes in these stem cells associated with ALS, plus the genes linked to ALS-related mitochondrial dysfunction and ALS-related excitotoxicity. 
The information contained in this article is for informational purposes only and does not constitute medical advice. Prior to making changes to your lifestyle or treatment plan, always consult with a licenced medical professional.
The motor neuron level, the mechanism of ALS remains unclear, but disease mechanisms noted in other neurodegenerative disorders have been observed.  Given the fact that endocannabinoid dysfunction has been found to be involved with these disease mechanisms, there may be cannabinoid treatment options. A 2010 study by Dr Gregory Carter, noted the unique multiple actions of cannabis on the many symptoms of ALS - “Ideally, a multidrug regimen, including glutamate antagonists, antioxidants, a centrally acting anti-inflammatory agent, microglial cell modulators, an antiapoptotic agent, one or more neurotrophic growth factors, and a mitochondrial function-enhancing agent would be required to comprehensively address the known pathophysiology of ALS. Remarkably, cannabis appears to have activity in all of those areas.”  In other words, the many drugs required to act on each specific area of dysfunction, could be replaced by one plant - cannabis.
Medical cannabis products with a ratio of 1:1 CBD to THC seem to work well. Typically, higher doses of cannabidiol (CBD) in combination with average THC doses work well. This could mean a 2:1 or 3:1 CBD to THC ratio could also be of value. Keep in mind, these varying strains are different to the high-THC street strains of marijuana. Those with neurodegenerative disorders may be more susceptible to unsteadiness, psychiatric side effects, and falls, so caution must be taken when adjusting THC dosage protocols. Sticking with high-CBD strains and ratios would be advantageous. It is recommended to start with a microdose to test for sensitivity and slowly titrate your way up, starting low, and going slow, until any symptom relief is noticed.
Orally administered medicines with a goal of modification in mind, can refer to the CUPID   trial of cannabinoid use to counter the symptoms of MS may prove of assistance: 3.5 mg of THC twice daily orally, with doses increasing by 3.5 mg weekly to a maximum of 28 mg twice a day. Experienced clinicians have administered high doses of oral CBD, up to 300 mg per day, for antioxidant and potential neuroprotective effects. A 25 to 50 mg dose of the terpene beta-caryophyllene, a potent neuroprotective, anti-inflammatory compound produced by the cannabis plant, can be taken orally in enteric-coated form (it is unlikely to survive stomach passage otherwise)
Vaporized or smoked cannabis products can be of value for more instant relief, with strains and cultivars high in beta-caryophyllene being recommended.
Ideal strains and ratios would be CBD:THC cultivars that are beta-caryophyllene dominant. Currently these strains are scarce in locations where cannabis hasn’t reached mainstream legal status yet. A combination of a high caryophyllene cultivar, such as Cookies or Kryptonite, combined with a high-CBD strain like ACDC or Suzy Q, is recommended.
In our other article on ALS, we’ve included even more recent research and information on the promising health effects of medical marijuana with the disease, and how to bring relief to the symptoms of chronic pain, muscle weakness, and more. For more information, see our other article on ALS.
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