Complementary and Alternative Therapies in MND/ALS

Published online 2015 Sep 8

Synopsis

Given the severity of their illness and lack of effective disease modifying agents, it is not surprising that most patients with ALS consider trying complementary and alternative therapies. Some of the most commonly considered alternative therapies include special diets, nutritional supplements, cannabis, acupuncture, chelation and energy healing.

I’ve read the report and selected what appear to be the most promising alternative therapies for ALS/MND, as follows:-

  1. High Calorie Diet: there appears to be sufficient data to conclude that a diet high in calories provides benefit in ALS.
  2. Supplements
    Catechins: the health promoting constituent of green tea, blue berries, cocoa, prune juice, red wine, and Ginko Baloba to name a few. Studies have shown that catechins cross the blood brain barrier and are incorporated into brain tissue where they exert potent neuroprotective actions by modulating mitochondrial responses to oxidative insults.
    Creatine: a recent phase II study showed that high dose creatine supplementation is safe, tolerable, and may have some positive effects in Huntington Disease. We await further studies with high dose creatine in ALS patients to determine whether it is beneficial.
    L-Carnitine: a small pilot study of acetyl-L-carnitine, showed an increase in median survival and slower ALSFRS-R and FVC decline in the patients taking L-carnitine 3g/day. No significant side effects were reported and the authors concluded that a phase III trial is needed to confirm these preliminary findings
    Resveratrol: is a polyphenol found in the skin of grapes, blueberries, raspberries and mulberries. It is reported to have neuroprotective effects through cellular pathways.
    A few pre-clinical studies have been completed studying the effects of Resveratrol. All studies reported a delay in disease onset and statistically significant increases in survival. In addition, Resveratrol improved survival with post disease onset treatment in the SOD1 ALS mouse model.
    Vitamin D: In a retrospective study of 74 ALS patients, risk of death was significantly increased in those with severe vitamin D deficiency compared to patients with normal vitamin D. A small clinical study showed that patients with ALS tended to have low vitamin D levels and that oral vitamin D supplementation with 2000 I.U./day was safe and may be of benefit.
  3. Cannabis
    There is a growing body of evidence that that cannabis may hold a significant therapeutic benefit for patients with amyotrophic lateral sclerosis (ALS).
    Moreover, through manipulation of the endocannabinoid system, cannabis may hold disease-modifying potential in ALS.
    There is now good animal based evidence that that cannabinoids are capable of slowing disease progression of ALS in mice.
    Cannabis has also been reported to be useful in managing the symptomatology in ALS .
    -There are many symptoms of the disease, including pain, spasticity, loss of appetite, depression, and management of saliva that could be helped by cannabis use.
    -In a survey of 131 patients with ALS, those who were able to obtain cannabis found it preferable to prescription medication in managing their symptoms.However, this study also noted that the biggest reason ALS patients were not using cannabis was their inability to obtain it, either due to legal or financial reasons or lack of safe access.
    Thus there could be a potential dual role of cannabis for both clinical symptom management and a positive disease-modifying effect.

 

Clinical Uses of Cannabis in Patients with ALS
Patients with ALS previously have reported that cannabis is at least moderately effective at reducing symptoms of pain, spasticity, drooling, appetite loss, and depression.

  1. Cannabis may reduce pain sensation: There are now multiple, well-controlled clinical studies using cannabis to treat pain, showing ample evidence of analgesic efficacy.
    Use of cannabis may lower the need for opiate medications and may be safely used concomitantly as the opioid receptor system is distinct from the cannabinoid system. Additionally, the use of cannabis does not cause respiratory suppression or decreased gut motility, which are particularly helpful in this setting.
  2.  Ample clinical research demonstrates cannabis efficacy in reducing spasticity: Cannabis has an inhibitory effect on spasticity via augmentation of gamma-amino-butyric acid pathways in the central nervous system. This produces motor neuron inhibition at spinal levels in mice.
  3. Cannabis is a potent anti-salivary compound: Patients with ALS and bulbar symptoms also usually have difficulty controlling and swallowing the saliva that is normally present in the oral cavity. Cannabis swiftly dries the oral cavity and upper airway, potentially reducing the risk for aspiration pneumonia and increasing patient comfort.
  4. Cannabis increases appetite and may help prevent “ALS cachexia”: a phenomenon experienced by some patients where weight loss occurs in excess of that caused by muscle atrophy and reduced caloric intake.
  5. Cannabis may also help with mood state and sleep.
  6. The neuropotective porperties of Cannabis: Emerging evidence indicates that cannabinoids may play a role in slowing the progression of certain neurodegenerative diseases, such as Multiple Sclerosis, Parkinson’s disease, Alzheimer’s, and Amyotrophic Lateral Sclerosis (a.k.a. Lou Gehrig’s Disease).
    Recent animal studies have shown cannabinoids to delay disease progression and inhibit neurodegeneration in mouse models of ALS, Parkinson’s, and MS.
    As a result, the Journal of Neurological Sciences recently pronounced, “There is accumulating evidence … to support the hypothesis that the cannabinoid system can limit the neurodegenerative processes that drive progressive disease”.

 

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