PHOENIX, AZ—Just a few years ago, Kathryn Simpson was bed-ridden, in constant pain, and unable to manage even basic daily tasks. Multiple sclerosis had all but claimed the life of this once vibrant biotech executive.

Today, at 54 years old, she’s completely symptom free, highly active, and dedicating her considerable energies to helping others with MS, especially women.

What enabled her to bounce back from a disease most physicians deemed untreatable? Comprehensive hormone balancing therapies aimed at re-calibrating the endocrine system, normalizing glucose/insulin metabolism, and reducing inflammation. Speaking at the annual meeting of the American Association of Naturopathic Physicians, Ms. Simpson told her story and outlined the hormone-based strategies she discovered through her own diligent research.

“This is not a cure. It’s a set of treatments that can resolve symptoms,” explained Ms. Simpson. “If I stop treatment the symptoms come roaring back. So this is not a definitive therapy. But it is very effective for reducing symptoms.” It is also a testament to what a motivated, science-minded patient can do for herself when conventional medicine has little to offer.

If it strikes you as far-fetched that MS—the quintessential neurodegenerative disease—is related to hormone dysregulation, consider the epidemiology. MS has a 4-fold higher prevalence among women versus men. The mean age of onset in women is around 32 years, just at the time that thyroid and sex hormones begin to decline. Further, symptoms tend to abate during pregnancy, when there’s a big hormone surge, and then rebound post-partum.

Symptoms also stabilize and progress very slowly from the mid 30s, to the early 50s, at which point there’s an accelerated progression right around menopause. “The disease moves to the ‘secondary progressive’ phase in the same general time frame as hormone levels decline,” said Ms. Simpson. Roughly 50% of all cases become progressive within 10 to 15 years of diagnosis, with an additional 40% progressing within 25 years of onset.

Further, many MS symptoms are also symptoms of hormone deficiency: numbness and tingling; chronic fatigue; bladder/bowel problems; balance loss; decreased coordination; vision abnormalities; cognitive impairment; sleep problems; reflux; emotional problems; mood swings; depression; sexual dysfunction; muscle stiffness; cramps; and neuralgia. “All of this points to a hormonal connection,” she suggested.

Various Doctors, Various Diagnoses

Ms. Simpson’s personal saga began in her early 30s, with debilitating hand numbness. Various physicians came up with various diagnoses: carpal tunnel syndrome; degenerative arthritis; “the effects of aging.”

After the birth of her second child she developed severe low back pain, disruptions of balance, and difficulty walking. The neuromuscular problems were accompanied by stomach cramps and visual disturbances, which were seldom considered by the specialists, none of whom could provide effective therapies.

The crisis came in her early 40s, when the right side of her face grew numb, and she nearly choked on a piece of steak. At this point, a neurologist told Ms. Simpson she had MS. The diagnosis was confirmed by MRI, which showed multiple brain and spinal cord lesions.

Ms. Simpson began thinking holistically. “My father had just died from progressive supranuclear palsy, another slow neurological disease. So I started thinking about family history and environmental toxins.” Heavy metal testing showed very high mercury and cadmium, which Ms. Simpson attributes to having grown up in Manila, where heavy metal exposure is widespread. Chelation and replacement of amalgam fillings helped a bit, but not significantly.

Thinking Holistically

Applying a scientific acumen she’d honed in the biotech world, she studied everything she could find about the epidemiology and pathogenesis of MS. That’s when the hormone connection jump out at her.

“I decided to get my hormones tested.” Initially, her primary care doctor thought the idea was crazy, but given what little conventional medicine has to offer for MS, he was open-minded enough to take a look.

“It turned out I had very, very low estrogen, progesterone, testosterone, and thyroid hormones.” Many other aspects of her endocrine profile were out of balance. In researching her family history, she found out that her mother had been taking thyroid hormone since she was in her mid-40s; her grandmother and sister were all hypothyroid, too.

A trial of estrogen and thyroid hormone replacement led to “a huge symptom improvement,” and this opened a pathway to recovery, one she’s followed ever since. In the interest of helping others with MS, Ms. Simpson published her story, and her therapeutic protocols in, The MS Solution: How I Solved the Puzzle of My Multiple Sclerosis (Los Olivos Publishing, 2008).

Inflammation & Demyelination

How do hormones affect nerve function? Why does hormone replacement attenuate MS? The answers aren’t entirely clear, but Ms. Simpson stressed that, “The neurological system does not exist independent of the rest of the body.”

Histologically, MS is defined by gradual myelin degeneration, leading to scar tissue and plaque formation. This ultimately impairs nerve impulse propagation. Myelin deterioration is driven in part by genetic and environmental factors, but the process is fueled by inflammation. She hypothesized that the decline of thyroid and sex hormones with age predisposes people to chronic, systemic inflammation, which speeds demyelination. “Inflammation begets inflammation.”

Widespread inflammation is fostered by high glycemic diets, excess insulin production, abdominal adiposity, high arachidonic acid levels, and elevated cortisol, all of which are common among women with MS.

Ms. Simpson described four core goals of MS management: normalization of insulin and glucose metabolism; normalization of cortisol levels, elimination of infections; and restoration of optimal hormone levels. There are many different therapeutic tools that can be brought into play in a given case, but hormone modulation is key, she said.

Estrogen & Testosterone

With estrogen, “it’s very important for women to have enough and for men to not have too much,” she said. Several studies of estriol in women with MS showed marked resolution of symptoms as the hormone increases (Zych-Twardowska E, Wajgt A. Med Sci Monitor. 2001; 7(5): 1005–12. Soldan SS, et al. J Immunol. 2003; 171(11): 6267–6274. Sicotte NL, et al. Ann Neurol. 2002; 52(4): 421–428). Animal studies show exogenous estriol can even reverse CNS lesions analogous to those in humans with MS (Polanczyk M. American Journal of Pathology. 2003; 63: 1599–1605).

Men with MS typically have very high estrogen levels, often greater than 30 ng/ml, and very low testosterone, a very pro-inflammatory situation. Chronic estrogen elevation in men increases sex hormone binding globulin, which binds testosterone, creating a vicious cycle of hormonal imbalance.

Elevated estrogen “tricks” the hypothalamus, which stops telling the pituitary to stimulate testosterone production. Estrogen also attaches to testosterone receptors, effectively blocking testosterone’s action.

Low testosterone is also common among MS women, and it correlates with more inflammation and increased CNS lesions (Tomassini V. J Neurol, Neurosurg & Psych. 2005; 76: 272–275). Overly high levels of testosterone can also be problematic. “You don’t want too much or too little,” said Ms. Simpson.

One of the challenges is that the “normal” range in standard lab assays is very wide, typically from 230–1,200 ng/ml. “A level of 260 is read as ‘normal’ though it’s not enough testosterone to keep a bird going,” Ms. Simpson said. “Don’t just look at total testosterone, look at free T levels. That’s how you get a sense of the androgenic effect. Dihydrotestosterone is the active metabolite. You need to look at that.”

Progesterone Is Protective

In both women and men, progesterone is neuroprotective. There’s a wealth of recent data to suggest it preserves and restores myelin integrity, and may actually regenerate nerves even after lesions have developed, by promoting myelin formation and increasing neuronal survival (Schumacher M, et al. Endocrine Reviews. 2007; 28(4): 387–439. Ghoumari AM, et al. J Neurochem. 2003; 86: 848–859).

Ms. Simpson said MS in women tends to break out when ovulation slows down, in part because loss of ovulation means loss of the progesterone-rich luteal phase. Men have lower baseline progesterone levels, but still need this hormone. “I encourage you to measure progesterone in both men and women with MS.”

Thyro-centricity

Many MS patients are hypothyroid, and the “soft” symptoms accompanying MS such as visual abnormalities and bladder dysfunction are also common in non-MS hypothyroid patients. It is interesting that MRI studies have shown more brain lesions in hypothyroid versus euthyroid MS patients.

“I’m very thyrocentric,” said Ms. Simpson, pointing to a study showing that mean T3 levels were markedly lower in MS patients versus matched non-MS individuals. Interestingly, thyroid disorders are roughly three times more common in women versus men with MS (Zych-Twardowska E, Wajgt A. Med Sci Monitor. 2001; 7(5): 1005–1012).

Hypothyroidism slows liver function, which in turn slows clearance of estrogen and estrogen levels build up. That may not be a problem for MS women, but it can be detrimental to MS men.

Good thyroid function is essential for neural health. Many common complaints like “sciatica” and low back pain are strongly associated with low thyroid, and usually improve with thyroid therapy. If a patient does not respond to T3, check reverse T3; if that is high, it can block responsiveness to the exogenous T3.

“If the problem is ‘upstream’ in the sense that it is between the pituitary and the thyroid, it won’t show up as a T4 or TSH abnormality,” Ms. Simpson explained. “You really need to look at levels of free T3, the active metabolite. Low T3 is very common among MS women.”

Ridged nails and loss of eyebrows are common and very suggestive signs of functional hypothyroidism. “These people will show nice normal T4 and TSH levels, but if you look at free T3, it will be very, very low.”

Thyroid dysfunction can be caused by many of the same things that cause pituitary-hypothalamic dysfunction, including chronic stress, toxin exposures and physical trauma. “My symptoms started within a year of a severe whiplash injury,” Ms. Simpson said.

Hypothyroidism often precedes adrenal fatigue and vice versa, because the endocrine glands are interrelated. “If you are trying thyroid treatment and you get either no response or a hyper-response, it is usually due to adrenal dysfunction. The exogenous thyroid hormone is trying to increase metabolism, which puts pressure on the adrenals. But if the adrenals are burnt out, they cannot step up properly.” In this situation, it is very important to get the patient on an adrenal support program with vitamins, minerals, adrenal glandular formulas and low dose cortisol. “MS patients are almost always going to need low dose cortisol.”

There are many aspects and nuances of hormonal therapy for MS, and almost by definition, treatment must be individualized. When done right, it can make a world of difference in restoring MS patients to more or less normal life. “I have a lot of energy and I’m in much better shape than most of my girlfriends,” said Ms. Simpson, who now works a solid 12–14 hours per day.

This approach requires considerable patient effort, and it is not cheap. Hormone testing may be covered by insurance, but the bioidentical hormone treatments and other ancillary supplements can cost patients over $300 per month. Still, that’s not bad given that conventional immunomodulatory drugs cost roughly $1,500 per month, have many side effects, and little disease-modifying benefit.

Ms. Simpson, along with Dr. Barney Van Valin, established the Hormone Research Center, a clinic in Solvang, CA (tel. 805-693-8700) specializing in hormone-based treatment of MS and other neurodegenerative diseases. She is currently a co-investigator on a study of the impact of bioidentical estrogen (E2) and progesterone (P4 ) in women with MS.