Our understanding of the wonders of cannabinoids is expanding. With researchers constantly uncovering new therapeutic avenues for CBD, it appears to hold promise in the treatment of countless health conditions.
The complexities of neurodegenerative diseases have puzzled researchers for years. But through its widespread effects on an array of biological systems, could CBD provide relief for the 2.5 million people worldwide who are living with multiple sclerosis?
Multiple sclerosis: an autoimmune disease
Multiple sclerosis, or MS, is a disease of the nervous system that affects 1 in every 500 people in the UK. With symptoms typically starting between 20-40 years old, it is one of the leading neurodegenerative disorders in young people.
Neurons communicate via electrical signals, called nerve impulses. Think of the nerve fibre as a wire; to keep the electrical impulses from escaping, they need to be insulated. This is the role of myelin, the nervous system’s insulating protein. In the healthy nervous system, myelin helps to transmit signals efficiently.
In MS, myelin is progressively lost. Nerve impulses are subsequently slowed, resulting in a decline in physical and cognitive function. Over time, demyelination makes nerves more vulnerable to damage and inflammation, and can even result in neuronal death.
But how is myelin lost? Multiple sclerosis is a condition of the immune system— more specifically, it is an autoimmune disease. Our immune cells wrongly perceive myelin proteins as a biological threat and begin to break them down.
What are the symptoms of MS?
The nervous system coordinates each and every process in our body, so its dysfunction has widespread consequences. Symptoms of MS include:
- Mobility problems
- Muscle spasticity
- Chronic pain
- Visual problems
- Cognitive impairment
- Low moods
As it stands, there is no cure for MS. Current treatments aim to manage symptoms and prevent relapses, but have little impact on disease progression. They are also limited by unpleasant side effects. In particular, prescription painkillers— such as opioids— commonly cause dizziness, nausea, and vomiting. They also have a high potential for dependence and tolerance, so there is an urgent need for more effective MS treatments.
Multiple sclerosis is characterised by dysfunction of both the immune system and the nervous system. These two systems are highly interconnected, intricately balanced by the endocannabinoid system (ECS).
So, could CBD, a substance known to modulate ECS activity, hold the potential to improve MS symptoms?
What is CBD?
Cannabidiol (CBD) is one of many cannabinoids found in the Cannabis sativa plant. Of the two major cannabinoids in cannabis, CBD and tetrahydrocannabinol (THC), both have been shown to possess potent therapeutic properties. The main difference between them, however, is that THC is psychoactive and CBD is not.
Due to the mind-altering effects of THC, it cannot be legally sold in the UK. But CBD— containing negligible amounts of THC— can, and it’s proving to be hugely popular.
How does it work?
CBD interacts with the ECS, which has knock-on effects on our mood, appetite, sleep, pain perception, memory, and much more. By coordinating immune activity with the nervous system, the ECS strives to keep us balanced. So, in times of immune dysfunction, modulating the ECS may yield great benefits.
The ECS contains two major cannabinoid receptors, CB1 and CB2. It is known that THC can directly activate both receptors, but CBD works a little differently. In some instances, CBD can activate cannabinoid receptors, but researchers have found that CBD tends to modulate the ECS through more indirect mechanisms.
Though scientists are still discovering exactly how it acts in the body, it is clear that CBD has powerful therapeutic action. Following extensive research, CBD has been revealed as a treatment for rare forms of epilepsy. It also shows promise in treating anxiety, sleep disorders, chronic pain, and now neurodegenerative disease.
Could CBD help people with MS?
Cannabinoids have been researched in the treatment of multiple sclerosis for nearly two decades. In 2010, England, Wales, and Northern Ireland approved the use of Sativex— an oral spray of a cannabis extract— for the treatment of MS on the NHS. Therefore, the existing research largely focuses on the whole cannabis plant, CBD and THC included.
Cannabis-based products are widely used amongst people with MS, so the anecdotal reports of their benefits are in abundance. A combination of CBD and THC appears to be hugely effective at reducing pain, muscle spasms and fatigue.
Sativex use, however, is limited by its side effects. In a long-term trial of Sativex, 92% of participants reported adverse effects over the 2 years— and 25% withdrew from the trial for this reason. But, interestingly, the majority of these side effects can be attributed to the psychoactive properties of THC.
CBD is not psychoactive and, unlike THC, it is not illegal to buy and sell in the UK. So, could CBD alone improve symptoms of MS?
When the immune system attacks myelin, nerve fibres become damaged. This triggers a process called neuroinflammation.
Under normal conditions, inflammation is beneficial; it clears the site of injury and helps the body to heal. In MS, inflammation becomes a danger to the nervous system. Immune cells (specifically T lymphocytes) enter the brain and trigger an overproduction of inflammatory molecules in the body, resulting in a sustained, self-perpetuating inflammation cycle.
CBD has a pronounced effect on the immune system; it has been shown to be anti-inflammatory and immunosuppressive. This has largely been investigated using an animal model of MS, called experimental autoimmune encephalitis (EAE).
A recent review of 26 studies identified that CBD is consistently effective at reducing the severity of EAE, and even halting disease progression. CBD has even shown to be just as effective as Capoxone— an immunomodulatory MS treatment— in managing symptoms.
CBD appears to lessen the severity of MS by limiting the body’s inflammatory response. In EAE models, it reduces the infiltration of T lymphocytes into the brain and significantly reduces the circulation of pro-inflammatory molecules.
When administered to EAE models, CBD dampens a biological pathway that is known to increase our susceptibility to autoimmunity. Therefore, CBD may even be able to prevent or reverse the onset of MS symptoms.
With the progressive nerve damage that occurs in MS, chronic neuropathic pain is a common symptom. Whilst cannabis-based products appear to be effective at treating pain, the effect of CBD alone is far less researched.
That being said, there is a growing body of evidence to suggest that CBD can reduce both inflammatory and neuropathic pain. In a survey of 131 people with chronic pain, 53% reduced or stopped using opioids for pain management, following 8 weeks of CBD use.
More research into the pain-relieving properties of CBD in people with MS is needed, but it seems highly likely that cannabinoids are an effective way to manage painful symptoms.
In a review published in the Frontiers in Neurology journal in 2018, researchers claimed that CBD’s ability to manage pain, reduce muscle spasticity, and combat fatigue, will likely improve the mobility of people living with MS— and there is indirect evidence to support this.
Whilst it is clear that this avenue needs to be explored through clinical trials, these findings suggest that CBD may be an effective supplementary therapy for MS.
Living with a debilitating condition is undoubtedly taxing on an individual’s mental health. According to the MS Society, 50% of people with MS also experience depression.
Unlike strong painkillers, which often provide pain relief at the expense of our mental wellbeing, CBD has been shown to improve symptoms of anxiety and depression. It does this through its action on serotonin receptors. Serotonin is known as the ‘happy hormone’; its presence in the brain helps to support our mood. By increasing the signalling of serotonin in the brain, CBD can help reverse mood problems.
CBD has not yet been trialled in people with depression, but it has been effective at reducing depressive activity in animal models. There have also been reports of CBD reducing perceived depression and anxiety in individuals with mental health conditions.
Existing trials of cannabinoids in managing MS symptoms are limited by small sample sizes, low drug doses, and a short duration of treatment. There is an urgent need for human clinical trials of pure CBD; it may be that CBD only benefits people with MS in combination with THC, due to the synergistic effects of these two cannabinoids.
But the early evidence suggests otherwise. CBD appears to be effective at managing a wide range of MS symptoms, and even shows promise in halting disease progression. The sooner researchers test this out in large-scale human trials, the better.
Is CBD safe for people with MS?
According to the World Health Organisation, CBD is a safe and well-tolerated substance, even at high doses. With prolonged use, there have been reports of nausea, appetite changes, and fatigue, but these side effects are rare and minor in comparison to many prescription drugs— and even THC.
Something to bear in mind, however, is that CBD has been shown to interact with certain medications, which can be pretty harmful to the liver. If you feel as though you, or someone close to you, would benefit from taking CBD, it is crucial that you discuss this with a medical professional or consult your doctor before giving CBD a go.
How to find the right CBD for you
There are countless ways to take CBD. Broad-spectrum, full-spectrum, CBD isolate. Oils, capsules, vapes. The list is near-endless, and this can be a little confusing to someone new to the world of cannabinoids. We suggest taking a look at our beginner’s guide to CBD to better understand the subtle differences between the CBD products on the market.
Here are just a few of the most popular ways to take CBD and why they might be useful to those living with MS:
CBD oil is typically taken by dropping it under the tongue. This method allows the CBD to enter the bloodstream quickly, so the benefits can be felt immediately. You have control over how much you take and how often you take it, which is ideal for managing MS flare-ups.
Most typically in the form of capsules or gummies, oral CBD gives you a consistent and convenient dose and, unlike CBD oil, there is no strong taste! CBD pills typically contain lower doses and take up to 2 hours to kick in; but, when taken daily, CBD accumulates in your system over time, allowing its beneficial effects to gradually build.
Vaping CBD also has a rapid onset. So, it can provide quick pain relief, even on the go. Vapes can administer high doses of CBD at any point throughout the day, so they may help on days where your MS symptoms are particularly uncomfortable. However, the long-term effects of vaping are poorly understood, so keep this in mind when shopping for your next CBD product.
Another important thing to consider is where you get your CBD. Frustratingly, there are many products on the market that don’t actually contain much CBD at all, and it looks as though high doses are the most effective at treating MS symptoms.
It is important to know exactly what cannabinoids you’re getting; be sure to buy from a trustworthy brand that discloses the potency of their product and provides detailed lab reports. Also, look out for traceability; if a CBD brand can’t say where their hemp plant was grown, this is a major red flag
There are still many more scientific hurdles to jump before we fully understand the effects of CBD in multiple sclerosis. Whilst the preliminary evidence appears to be hugely promising, it is important not to be eagerly optimistic. The clinical evidence is lacking, so we can’t say for certain whether these findings will translate into humans. But, in the meantime, CBD is available to buy if you so wish.
MS has widespread effects on the body, so symptom management often requires a cocktail of different medications— but CBD appears to work across the board. Unlike THC, it is a well-tolerated substance; so, for those seeking extra relief from their MS symptoms, it might be worth giving CBD a try.