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MS Inflammation in Women: What’s the Connection?

Posted on March 14, 2023

Multiple sclerosis (MS) is an autoimmune disease affecting the central nervous system (CNS), including the brain, spinal cord, and optic nerve. Of the almost 1 million people living with MS in the United States, about 75 percent are women, according to the National Multiple Sclerosis Society. Although there’s a deep pool of scientific research about MS, scientists still don’t fully understand why women are more likely to develop the condition.

Inflammation in the body plays a key role in autoimmune diseases like MS — not only is it a risk factor for developing MS, but it also influences the disease progression. This article will help you understand why some people may be more likely to experience inflammation and how it’s connected to MS.

What Is Inflammation?

Inflammation is a normal and necessary part of your immune system. There are two types of inflammation — acute (short-term) and chronic (long-term).

Acute Inflammation

Acute inflammation is your immune system’s response to an irritant or damage to your body caused by:

  • Pathogens, such as bacteria, viruses, fungi
  • Physical injuries, such as cuts and scrapes
  • Chemicals
  • Radiation

When your body recognizes a threat or damage, it springs into action by releasing inflammatory mediators — chemicals and proteins that call your immune system to action. This process is responsible for the symptoms of inflammation you see and feel.

Inflammatory mediators cause redness, warmth, and swelling by dilating (widening) the blood vessels and making it easier for fluid and immune cells to seep out. This process allows more blood to flow where it’s needed. Inflammatory mediators also act on the nerves in the area, causing you to feel pain. In acute inflammation, pain tells your body to protect the area.

Other inflammatory mediators called cytokines — including tumor necrosis factor-alpha (TNF-alpha) and interleukins — call immune cells like T cells and B cells to the affected area. These cells make proteins called antibodies that help your body clear an infection.

Inflammation is helpful and protective when you have an acute injury or illness. But when inflammation occurs without an injury, it can become harmful to your body.

Chronic Inflammation

Chronic inflammation can result when your body sends inflammatory signals even when there’s no danger. Conditions associated with chronic inflammation include:

  • Autoimmune disorders (such as rheumatoid arthritis)
  • Diabetes
  • Heart disease
  • Allergies
  • Chronic obstructive pulmonary disease (COPD)

In chronic inflammation, immune cells continue to be called to the site of inflammation. When they get there, there’s no outside threat to fight, so they begin to attack the cells of the body. Immune cells like T cells and B cells may even make antibodies against the body’s own tissues.

Research has revealed several risk factors for chronic inflammation:

  • Older age
  • Obesity
  • High-fat or high-sugar diet
  • Cigarette smoking
  • Imbalance of sex hormones (estrogen and testosterone)
  • Stress
  • Sleep disorders

Chronic Inflammation in Multiple Sclerosis

MS is a chronic inflammatory disease in which the immune system attacks the myelin sheath (the protective insulation covering nerves), setting off a process called demyelination. Without the myelin sheath, nerve damage in the central nervous system occurs.

Inflammation in MS makes it easier for T cells and B cells to get through dilated blood vessels and enter the CNS, where they release more inflammatory mediators and cause damage.

Women and Inflammation

Overall, women experience more inflammation than men, according to findings published in The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. Research has found that women have stronger immune responses, according to a review article in Frontiers in Immunology. Men, however, have more neurodegeneration (permanent damage to the brain) with earlier progression to disability, according to a study in Neurology.

When your body is fighting off an infection, a strong immune response is beneficial. In fact, researchers noted in the journal Biology of Sex Differences that, compared with females, males are more susceptible to infections from viruses, bacteria, and parasites. However, a stronger immune response also puts females at an increased risk of autoimmune disorders. Scientists don’t fully understand why that is, but it could be linked to hormones and obesity.

Hormones

When scientists try to figure out why a medical issue affects people of different sexes in different ways, they usually look into hormones first. The primary hormones responsible for differences between sexes are estrogen for females and testosterone for males. In general, testosterone suppresses the immune system, whereas estrogen enhances the immune system. However, estrogen also has anti-inflammatory properties.

A person’s menstrual cycle makes estrogen rise and fall twice each month. Menopause also brings drastic hormone changes when hormone levels fall and the menstrual cycle stops. One study showed an increase in proinflammatory markers like TNF-alpha and interleukins after menopause.

Pregnancy also influences inflammation. The complex changes that occur in a person’s body and with hormones during pregnancy can reduce inflammation.

Obesity

Obesity is an accumulation of fat that results in a weight that is higher than considered healthy for a given height, according to a measure called body mass index (BMI). A BMI of 30 is considered obese, and a BMI from 25 to under 30 is considered overweight. A BMI from 18.5 to below 25 is considered healthy.

In general, women have more body fat than men, and a woman with the same BMI as a man typically has about 10 percent more body fat than that man. Additionally, obesity is more common in women than men, wrote the authors of a review article in Current Obesity Reports.

Fat cells release inflammatory mediators such as TNF-alpha and interleukins. If you have more fat cells, you generally have more inflammation. Obesity has also been linked with lower levels of vitamin D, a nutrient that has anti-inflammatory properties.

Multiple Sclerosis and Inflammation

MS is a disease of chronic inflammation. It makes sense that people who are more likely to experience inflammation are more likely to be diagnosed with MS and that their symptoms would be influenced by their hormones.

Inflammation Can Raise Your Risk of Developing Multiple Sclerosis

The cause of MS involves several genetic and environmental factors, but researchers have reported that some factors are specific to women.

Estrogen’s role in stimulating inflammation helps us understand why MS is more likely to occur during certain times of life. The condition generally occurs when estrogen levels are highest — during the so-called reproductive years after puberty and before menopause. Less than 5 percent of people with MS are diagnosed before puberty or after menopause.

Women with a BMI of 30 or higher at age 18 have more than double the risk of developing MS than those with a BMI from 18.5 to under 21, according to findings published in the Journal of Neurology & Neuromedicine. Childhood obesity is also a known risk factor for developing MS. It’s unclear exactly why obesity raises the risk of MS, but it is likely linked to increased inflammation and low vitamin D levels.

Inflammation Influences Multiple Sclerosis Symptoms

Inflammation all over the body may make it easier for inflammatory cells and chemicals to reach the CNS, cause symptoms, and worsen disease progression. MS symptoms in women can change depending on hormone levels.

Many people notice that their MS symptoms worsen right before and during their periods when estrogen levels drop. Some may also notice a change in MS symptoms when going through menopause. However, clinical trial results on the effect of menopause on MS have shown no definite conclusions.

Pregnancy causes many changes in hormones and inflammation. Researchers have found that these changes usually result in fewer MS flare-ups — also called MS relapses.

4 Ways To Reduce Inflammation

You can’t change some risk factors — like your family history — but you can make some lifestyle changes to reduce inflammation.

1. Eat a Healthy Diet

What you eat can have a big impact on inflammation. There isn’t a particular diet that people living with MS should follow. Instead, focus on eating fewer foods that can increase inflammation and eating more of those that offer anti-inflammatory benefits.

Examples of foods that you should try to avoid because they may increase inflammation are:

  • Processed foods
  • Refined sugars
  • Saturated fat (meat and butter)
  • Trans fats (fried food, packaged baked goods)

Eating more whole foods will give your body the nutrition and fiber it needs. Whole foods that may have anti-inflammatory benefits include:

  • Brown rice
  • Eggs
  • Fish
  • Fruit
  • Nuts
  • Oats
  • Vegetables

2. Stay Active

Exercise has been shown to decrease inflammation, regardless of whether you lose weight. The Centers for Disease Control and Prevention (CDC) recommends getting at least 150 minutes of exercise a week. This weekly total can be broken down into amounts that are doable and comfortable for you.

3. Maintain a Healthy Weight

Eating a healthy diet and staying active will help you maintain a healthy weight. Obesity increases inflammation, so staying at a healthy weight is important for reducing inflammation.

4. Stick to Your Treatment Plan

Talk to your doctor or neurologist about disease-modifying therapies (DMTs) that may slow the progression and limit the symptoms of your MS. Some MS treatments work by decreasing inflammation through the immune response. Your doctor may also recommend that you take certain vitamins or supplements.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 196,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Do you have questions about the association between hormones, obesity, and MS? Have you made any lifestyle changes to help reduce inflammation? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Definition of Multiple Sclerosis — National Multiple Sclerosis Society
  2. Who Gets Multiple Sclerosis? Epidemiology of MS — National Multiple Sclerosis Society
  3. What Is an Inflammation? — InformedHealth.org
  4. Inflammation — Cleveland Clinic
  5. Mediators of Inflammation and the Inflammatory Process — The Journal of Allergy and Clinical Immunology
  6. Chronic Inflammation — StatPearls
  7. Inflammation in Multiple Sclerosis — Therapeutic Advances in Neurological Disorders
  8. What Is an Immune-Mediated Disease? — National Multiple Sclerosis Society
  9. Sex Differences in Age Trajectories of Physiological Dysregulation: Inflammation, Metabolic Syndrome, and Allostatic Load — The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
  10. Glucocorticoids, Sex Hormones, and Immunity — Frontiers in Immunology
  11. Mechanisms of Sex Hormones in Autoimmunity: Focus on EAE — Biology of Sex Differences
  12. Sex Hormones Determine Immune Response — Frontiers in Immunology
  13. The Complex Role of Estrogens in Inflammation — Endocrine Reviews
  14. Proinflammatory and Anti-Inflammatory Cytokine Changes Related to Menopause — Menopause Review
  15. Inflammation and Pregnancy: The Role of the Immune System at the Implantation Site — Annals of the New York Academy of Sciences
  16. Defining Adult Overweight and Obesity — Centers for Disease Control and Prevention
  17. Sex Differences in Human Adipose Tissues —The Biology of Pear Shape — Biology of Sex Differences
  18. Sex/Gender Differences in Obesity Prevalence, Comorbidities, and Treatment — Current Obesity Reports
  19. Obesity and Inflammation: The Linking Mechanism and the Complications — Archives of Medical Science
  20. Vitamin D Effects on Selected Anti-Inflammatory and Pro-Inflammatory Markers of Obesity-Related Chronic Inflammation — Frontiers in Endocrinology
  21. Autoimmune Disease in Women: Endocrine Transition and Risk Across the Lifespan — Frontiers in Endocrinology
  22. Obesity and Multiple Sclerosis Susceptibility: A Review — Journal of Neurology & Neuromedicine
  23. Estrogen Treatment in Multiple Sclerosis — Journal of the Neurological Sciences
  24. Menopause and MS — Multiple Sclerosis Society
  25. Pregnancy and Reproductive Issues — National Multiple Sclerosis Society
  26. Why and How To Start an Anti-Inflammatory Diet — Cleveland Clinic
  27. How Much Physical Activity Do Adults Need? — Centers for Disease Control and Prevention
  28. Medications — National Multiple Sclerosis Society
  29. Significant Gender Differences in Clinical Disease Activity and Severity of Multiple Sclerosis: A Danish Nationwide Cohort Study — Neurology
    Posted on March 14, 2023
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    Luc Jasmin, M.D., Ph.D., FRCS (C), FACS is a board-certified neurosurgery specialist. Learn more about him here
    Amanda Jacot, PharmD earned a Bachelor of Science in biology from the University of Texas at Austin in 2009 and a Doctor of Pharmacy from the University of Texas College of Pharmacy in 2014. Learn more about her here

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