An Integrative Medicine Approach to ALS Treatment

Around 1 in 400 adults will end up suffering from Amyotrophic Lateral Sclerosis (ALS) in their lifetime. Since the course of the illness is so devastating and there are no conventional cures, many turn to integrative therapies like vitamins and herbs.

Research is actively looking to better understand the reasons this disease develops and to evaluate the potential benefit of many therapies, including some alternative ones. At this time, we are learning about contributing factors, and functional medicine providers can use this knowledge to assist their clients in tailoring holistic treatments. While there are no clear cures, there may be ways to significantly slow the progression and possibly regain some degree of function. This article will describe ALS, its possible causes, functional medicine testing to evaluate the root causes and integrative treatment options.

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What is Amyotrophic Lateral Sclerosis (ALS)?

Amyotrophic Lateral Sclerosis (ALS) is a usually quickly progressing disease where the motor neurons in the brain, brainstem, and spinal cord degrade to the point of non-function, taking with them the ability for voluntary movement and even creating difficulty breathing on one's own. ALS is ultimately fatal, and death most often happens two to four years after the onset.

The exact mechanisms by which this degeneration occurs have yet to be fully understood, so standard therapy is to help with the quality of life and supportive care as possible. There are also no standards for prevention, and less than 10% of cases are of the familial form.

Is ALS The Same as Lou Gehrig's Disease?

ALS is the same as Lou Gehrig's Disease. This is because Lou Gehrig, a well-loved New York Yankee baseball player, had to retire from baseball in 1941 due to his illness with ALS. The disease had been known since it was identified in 1869 by French neurologist Jean-Martin Charcot. But the public status of Lou Gehrig meant that his diagnosis brought it into the public's general knowledge.

ALS Symptoms

ALS causes the deterioration of neurons responsible for movement, including upper motor neurons from the brain and lower motor neurons from the spinal cord and brainstem. Not all neurons are equally susceptible to degradation, so clear patterns may emerge depending on which neurons are first affected and which are most affected. Early symptoms may reflect the specific neurons which have been damaged. This can be either groups of upper or lower motor neurons or both. Three common clusters of neurons initially affected are those involving speech, chewing and swallowing (Bulbar onset), limb movement, or breathing.

Some common early-stage symptoms are:

• Muscle cramping and tightness and twitching in an arm or a leg
• Muscle weakness in an arm or a leg
• Challenges with chewing or swallowing
• Fatigue
• Poor balance/tripping while walking

As the disease progresses, the symptoms tend to include:

• Spread of symptoms to include more muscle groups and possible paralysis of more severely affected areas
• Twitching may continue
• May develop painful contractures of joints
• May have difficulty standing up from a fall
• Increased difficulty with eating (tend to choke) and managing saliva
• Weakening breathing muscles may cause inadequate breathing, especially when lying down
• Sometimes there are uncontrollable bouts of laughter or crying that do not associate with the actual emotions of joy or sadness.

With further progression to the late stages, the symptoms will include:

• Paralysis of most voluntary muscles
• Severe compromise of breathing muscles
• Extremely limited mobility and ability to care for one's personal needs
• As a result of poor breathing, many have headaches, fuzzy thinking, fatigue, or develop pneumonia
• Might no longer be able to speak or eat/drink by mouth

The final stages generally show a worsening of breathing, which is the most common cause of death from ALS. Another common late-stage issue is swallowing difficulties leading to malnutrition and dehydration.

Possible Causes of ALS

Due to the devastating nature of ALS, there has been a lot of research into possible causes, much of which has turned up negative. But though the entire disease process is not fully understood, some standout contributing factors have emerged.

Gene mutations in as many as 30 different genes are associated with only about 10% of cases of ALS. In cases that begin before age 25 (Juvenile ALS), there is an association with variants of the SPTLC1 gene. The remainder of the cases are considered sporadic.

Genetic studies show a significant association pattern with gene sets related to immune function, programmed cell death, lipid metabolism, neuron development, muscle cell function, and brain plasticity.

Glutathione is a very important antioxidant made and recycled in the body. Studies have shown a possible link between one or more defective enzymes in glutathione synthesis and the development of ALS. These defective enzymes would have two direct effects. First would be reduced levels of active glutathione, impairing antioxidant activity. Second, precursors (glutamate, cysteine, and sulfite), which would usually be incorporated into glutathione's structure, would build up, potentially causing toxicity.

Many lifestyle factors have been evaluated for association with the development of ALS. There are a few that consistently do show a positive association. These are living near water, specifically exposure to cyanotoxins from toxic blue-green algae blooms and smoking (likely by formaldehyde inducing lipid peroxidation, also possibly through exposure to cadmium and lead). In contrast to most medical conditions, carrying a higher percentage of body fat throughout one's life is protective from ALS.

Numerous environmental exposures are also associated with ALS. Elevated levels of inorganic selenium in drinking water increase risk, especially at the time of exposure. A study looking at heavy metals in the cerebrospinal fluid of ALS patients found elevated levels of cadmium, lead, and mercury. Another study suggests that cadmium, lead, and zinc may contribute to the development of ALS.

An Italian study found an increased risk from long-term (>10 years) work in agriculture, occupational exposure to pesticides and fungicides, occupational exposure to solvents and thinners, and exposure to metals and electromagnetic fields.

One study makes the connection that all of the reported environmental exposures have the potential to impact the gut microbiota, driving a common theoretical path of pathology. There is an association between higher total life antibiotic use and gut dysbiosis.

Testing for Root Cause of ALS with Functional Medicine

Common functional labs integrative practitioners may run on ALS patients include:

Genetics

Most often, ALS is not genetically inherited, but it can be. If you have multiple relatives with ALS or any relative with a diagnosis around age 45 or earlier, it might be worth speaking with a genetic counselor about the benefits and drawbacks of genetic testing.

Glutathione Metabolic Enzyme Dysfunction

To follow the potential mechanism of sulfite toxicity, those who do not have a mutation-caused case should be tested for sulfite toxicity (urine) and blood levels of cysteine, glutamate (glutamic acid, and glutathione (GSH). If these show a pattern consistent with poor enzyme function, they can be tracked while nutrition and supplementation address the imbalances.

Oxidative Stress

Especially if one is a smoker, testing oxidative stress can provide insight into how oxidative stress may be driving disease progression and suggest if increasing antioxidants and decreasing oxidative stress promoters may be particularly useful.

Cyanotoxins

If there is a concern about cyanotoxin exposure from a nearby body of water, testing the body of water itself may be most helpful.

Heavy Metals

Anyone with a diagnosis of or high genetic risk for ALS may benefit from testing for heavy metals and addressing any that are present at particularly high levels. This test is specifically helpful since it includes cadmium, lead, mercury, zinc, and selenium, which have known associations with ALS.  

Pesticides/Herbicides/Fungicides/Solvents

Given the increased risk to farmers and those exposed occupationally to pesticides, including herbicides and fungicides, testing these can show if further attention to reducing the body stores may be beneficial.

Microbiome and Dysbiosis

Given the association of ALS progression with antibiotic use, gut dysbiosis, and low gut microbial diversity, it is likely a good idea for all ALS or high-risk patients to have microbiome and gut dysbiosis testing initially and on a regular basis to track the impacts of treatments over time.

Endocrine Disorders

Endocrine disorders of all types may be associated with ALS, and when they are may hasten the progression or worsen the quality of life. A broad look at endocrine labs could help identify imbalances early. Here are some specific labs that may be useful.

Insulin Sensitivity

To evaluate for impaired insulin sensitivity, the Diabetes Panel tests for adiponectin and ferritin. The panel also includes GSP, HbA1C, Glucose, and Insulin, which can show current and recent trends in blood sugar levels.

Vitamin D

Vitamin D deficiency is common in ALS patients and is linked to a more severe loss of movement but not faster progression. It can be checked by testing for 25-OH Vitamin D. Closely linked to vitamin D is parathyroid hormone, which can also be abnormal in ALS.

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Conventional Treatment for ALS

As there is no specific cure for ALS, conventional treatment aims to manage symptoms and optimize the quality of life at every stage of the illness. ALS specialty care centers are superior to a piecemeal approach for comprehensive supportive care. Medications may help with anxiety and fear that result from breathing difficulties.

Treating the Root Cause of ALS with Functional Medicine

A Functional Medicine approach to ALS would address known risks and imbalances, including those identified by Functional Medicine laboratory testing.

Nutrition for ALS Patients

Much research has been done looking at nutrition as it relates to the onset and progression of ALS.

As far as prevention, there is significant evidence to suggest that a diet higher than average in fruits and veggies, omega-3 polyunsaturated fatty acids (from fish, flax, or chia), Vitamin E, carotenoids (β-carotene and lutein from colored vegetables) and flavonoids may prevent or delay the onset of ALS. It would logically follow that these may also slow the progression. However, more specific research on that must be done.

Dietary factors that seem to contribute to the development of ALS or speed its onset include heavy alcohol consumption, high intake of animal protein from meat and dairy, and an increased intake of glutamate-rich foods, such as cheese, meat, tomatoes, and mushrooms. If one has poor glutathione metabolic enzyme function (see testing), dietary intake of glutamate, cysteine (poultry, egg, beef, whole grains), and sulfite (beer, wine, baked goods, soup mixes) should be minimized.

In addition, for some neurological conditions, including ALS, medical ketosis has been proven beneficial. In the case of ALS, a medical ketogenic diet can reduce the rate of motor neuron degeneration and disease progression. This is a very strict, very low-carb diet that sacrifices some beneficial nutrients from otherwise healthy whole foods for the positive effects of ketosis on the brain. Ketosis may benefit the brain by providing an alternative fuel source if glucose metabolism is impaired. Ketone bodies also trigger anti-inflammatory and antioxidant processes.  In order to optimize the balance of positive nutritional effects (high plant polyphenols, low glutamate) while maintaining a medical ketogenic diet, consultation with a nutritional professional knowledgeable about ALS and ketogenic diets would be highly recommended.

Fruit polyphenols, found in blueberries, can reverse progression to some degree. There is some evidence for the benefit of folic acid, Vitamin E, Coenzyme Q10, Alpha Lipoic Acid (ALA), and Ginkgo in reducing the effects of ALS. Overall nutritional status is extremely important for survival time after diagnosis. However, one study shows that hydration might be even more important than nutrient status.

Supplements and Herbs for ALS Patients

Given the lack of treatment options, as many as 2/3 of patients with ALS try vitamins and herbal supplements. There has been a reasonable amount of research looking at which nutrients may be helpful in all phases, from prevention/delay of onset to slowing progression.

There is evidence that Vitamin D supplements can somewhat reduce the risk of dying of ALS. Other Vitamins shown to protect from ALS progression (in order of decreasing effectiveness) are Vitamin B12, Vitamin C, Vitamin B1, Vitamin B9, Vitamin B2, Vitamin B6, and Vitamin A. Treatment with catalase and l-carnitine has also been shown to be helpful. These vitamins can be taken orally in either pill or liquid forms daily. Weekly nutrient IVs with B vitamins and Vitamin C could be another option for those experiencing the later stages of illness.

If poor glutathione enzyme function has been found through testing, taking sublingual glutathione to increase body levels may be useful. In this case, NAC should be avoided due to concerns of cysteine levels and sulfite rising and causing toxicity.

Another approach that is currently showing much promise is stem cell therapy. This involves injecting stem cells that then go to damaged tissues, such as, in this case, motor neurons, and can reduce inflammation and, in some cases, bring a degree of repair.

Complementary and Integrative Medicine for ALS

Evidence is mixed on the benefits of exercise in general on the development or progression of ALS. One review found benefits from mild-moderate exercise but harm from intense exercise.

Meditation can also improve quality of life and psychological health in all stages of disease progression. Specific techniques may need to consider the specific physical needs of those with advancing ALS.

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Summary

ALS is more common than many may realize. The typical progression rapidly erodes one's ability to continue functioning fully in the life they have had to date. Finding ways to understand and treat the contributing causes helps move individuals into a path of slower, perhaps dramatically slower, progression, allowing more time to contribute their gifts to the world and spend meaningful time with loved ones.

Understanding potential contributing factors can also empower society to make changes that reduce the risk of collectively contributing to this and other disease burdens.