ALSUntangled reviews alternative and offlabel treatments (AOTs) for people with ALS (PALS). Here we evaluate ayahuasca therapy for ALS in response to 113 requests (1). As with all our previous reviews, this article will focus on the specific possibility that ayahuasca treatment might slow, stop or reverse ALS progression. Reviews on potential symptomatic benefits (such as improved pain or energy levels) are outside the scope of our programme. Ayahuasca has interesting mechanisms that could potentially be useful in treating human ALS. We found one person who appears to have experienced an ALS reversal following exposure to a single dose of ayahuasca and several other AOTs. We do not believe that a single dose of ayahuasca could trigger a mechanism that would reverse ALS. There are more plausible explanations for this case, including an unrecognised ALS mimic syndrome. Importantly, there are several documented harms associated with ayahuasca use, including hospitalisation, intubation, and death. There are also serious theoretical risks, including hypertensive crisis, serotonin syndrome, and birth defects. Given this information, at this time, we do not endorse the use of ayahuasca to slow, stop or reverse ALS progression.