Amyotrophic Lateral Sclerosis - Naturopathic Overview

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, is a neuromuscular disease that is characterized by progressive nerve cell death leading to muscle weakness, paralysis and severe physical dysfunction.^[1] Approximately 2,500-3,000 Canadians currently live with this fatal disease.^[3] ALS is a type of motor neuron disease that results in difficulty speaking, swallowing, breathing, and walking.^[2] The cause of ALS in most cases is unknown and usually affects people in their 60’s, however in 5 to 10% of the cases it affects people in their 50’s if they directly inherit the disease.^[1] Some of the early signs and symptoms include weakness in the legs, feet, ankles and hands, muscle cramps and twitching, slurred speech, and difficulty keeping a good posture, walking, and swallowing.^[3] The disease usually begins on the hands, feet, arms and/or legs and then spreads to other parts of the body. The muscles of the body progressively become weaker, however bladder and bowel control, sexual function and the senses are usually not affected.

Although the cause of ALS is unknown, some possible causes include a genetic mutation, chemical imbalance and an abnormal immune response.^[2] Gene mutations can lead to inherited ALS. Additionally, most people with ALS have an elevated level of a chemical messenger called glutamate,^[2] which can be toxic to some nerve cells leading to cell death. Further, ALS may be the result of a person’s immune system that begins to attack its own cells.^[2] Several risk factors exist that increase a person’s chance of developing ALS. These include inheritance, where children of parents with familial ALS have a 50% chance of developing the disease, being 40 to 60 years of age, being a male (under the age of 65), smoking, and lead exposure in the workplace.^[2] Within two to five years of diagnosis, 80 percent of the people with ALS die, and only 10% survive longer than 10 years.^[3] Every day, Canadians die from ALS.^[3] There are no current effective treatments or cure for ALS, and people with this disease ultimately die, most commonly due to respiratory failure.^[1] According to the World Health Organization, neurodegenerative diseases are predicted to surpass cancer as the second leading cause of death in Canada by 2040.^[3] This article will review conventional treatments for the symptoms of ALS, discuss mental emotional support, and review naturopathic options.

Conventional Treatment

Neurodegenerative disorders, such as ALS, are characterized by progressive and irreversible loss of neurons. Treatments are available to help manage symptoms of the disease in order to improve quality of life. The major drugs used in the treatment of ALS include Riluzole, Baclofen, Tizamidine and Benzodiazipines. The mechanism of action of Riluzole is largely unknown, but it is thought to act upon nerves to prevent damage from over excitation via glutamate by reducing the amounts present in the brain.^[4] Prolonged excitation is toxic to nerve cells. Glutamate is a neurotransmitter delivered from one neuron to another in order to induce the recipient neuron to activate. However, after this message is received glutamate is swiftly cleared away in order to prevent over excitation. Studies have shown Riluzole to have modest effects on survival for patients with ALS, extending life by approximately 60 days.^[5] The recommended dose is 50mg every 12 hours taken away from meals.^[5] Riluzole is generally well tolerated but symptoms of nausea, diarrhea, and/or damage to the liver may occur. Thus, thus regular blood tests to monitor liver function are required.^[5]

Symptomatic therapy may be provided to help alleviate discomfort from the muscle spasticity associated with ALS. Baclofen, a GABAB agonist can be used to relieve muscle stiffness in the limbs and throat. Initial dosages start at 5-10mg but may be increased up to 200mg daily.^[5] Tizamidine is an agonist of α2- adrenergic receptors widely used in the treatment of muscle spasticity for multiple sclerosis, post-stroke or ALS.^[5] Starting dosages are low at 2-4mg before bed and then gradually increased due to potential side effects. Adverse reactions such as drowsiness, weakness and dizziness may limit the amount taken by an individual.^[5] Benzodiazepines may be given as effective antispasmodic, but run the risk of the potentially life threatening side effect of respiratory depression in patients with advanced ALS. Furthermore, your doctor may provide medications to aid with other ALS associated symptoms such as fatigue, constipation, excess salivation or phlegm, pain, depression and/or insomnia. Treatments vary greatly among individuals, thus consultation with your doctor is necessary to determine the most appropriate treatment for you.

Mental Emotional Support

The neurological degeneration from ALS has enormous impact on person’s mental and emotional state. The condition causes the person to lose muscle control without suffering intellectual decline. Hearing that you have been diagnosed with ALS can be devastating to the person as well as his/her family members. The experience of powerful emotions such as denial, anger, frustration, loneliness, sadness, fear and loss are normal and natural signs of grieving. Grieving processes provides us with life lessons and skills that help us cope.^[6] The journey of the mental and emotional struggle is sometimes harder than the actual disease. Despite these negative feelings, people suffering with ALS and with the support of family and friends still found meaning in life that helped them to strengthen their will to live.^[7] Many times, life will present with difficulties that can negatively impact our emotions, but at the same time it allows the suffering person to revaluate his or her life. These experiences can further provoke deeper awareness that is necessary in order to recognize and learn to trust the internal perceptions. The family members of a person suffering with ALS are also experiencing grieving. Therefore, it is important to acknowledge that they also need time to cope with loss. Friends, support group members, or even naturopaths or professional counselors who offer support and understanding can be of value.

Naturopathic doctors can provide counseling sessions along with other forms of therapies that offer support not only for patients, but also their grieving family members. Naturopathic medicine uses holistic approach to patient care and thus incorporates physical, mental, emotional and spiritual aspects. The treatments are aimed to manage symptoms and slow down the progression of the disease. Naturopaths also guide and empower patients to maintain appropriate quality of life. Referrals to professional counselors are done when necessary. Reaching out to others and not being afraid to express emotions is a sign of strength, not a weakness. Fear of death, disability or losing control of your own body is very common amongst people suffering with ALS. Fear can be a barrier that prevents us to see a positive and thus experience love. People that were able to find meaning of life and strength to live are most probably the ones that conquered fear.

Naturopathic Options

Although there is no known cure for ALS, several naturopathic treatments have been used to help with diminishing symptoms, and slowing the rate of deterioration. However, there are a limited number of studies that have been done to assess the efficacy of naturopathic treatments. Therefore, it is important to consult your naturopathic doctor before initiating any of these treatments. Your naturopathic doctor will also be able to provide nutritional counseling as well as lifestyle advice and support as the disease progresses. A couple of studies have shown an association between ALS and exposure to environmental factors (such as heavy metals).^[8] Based on these associations, detoxification may be a potential treatment to help slow the progression of ALS. Several nutritional supplements have also shown to have some benefit. For example, one study showed that the regular use of vitamin E was associated with slowing the progression as well as a decreased risk of dying from ALS. Small studies have also shown that the combined use of Vitamin E, pancreatic enzymes, as well as following a diet with high protein, low fat and low carbohydrates were able to decrease the loss in muscle mass and strength.^[9] Since ALS has also been associated with oxidative stress (cell damage), powerful anti-oxidants such as vitamin C and glutathione injections may be beneficial therapies to help with slowing down the progression of ALS.

It is important to be monitored by your naturopathic doctor for proper nutritional status and to have a plan to prevent dehydration and malnutrition; especially because swallowing may become difficult as the disease progresses. Proper nutrition can also help prevent or delay the onset of ALS. Specific foods that are high in anti-oxidants (lutein and beta-carotene) include kale, collard greens, brussel sprouts, zucchini, egg yolks, sweet potatoes, spinach, cantaloupe and dark leafy greens. More recent research has also looked into the superfood spirulina as another potential antioxidant as well as neuroprotective food source. Finally, your naturopathic doctor will have recommendations on lifestyle changes to help to prevent and slow the progression of ALS as well as minimize pain. Exercising, in particular, is an important therapy for all patients, but needs to be prioritized based on individual needs. General current exercise guidelines recommend stretching to preserve and increase flexibility (versus strengthening to the point of fatigue) as well as range of motion exercises for all major joints. Hopefully the combination of all these symptomatic treatments, in conjunction with mental emotional support, can lead to improved quality of life.