Understanding Premenstrual Syndrome This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to: Frankp@chiro.org
From the Nutrition Science News
by Joan Friedrich, Ph.D., C.C.N.Current research shows that good nutrition and supplementation can relieve many of the symptoms of PMS
Premenstrual syndrome (PMS) and related conditions have long been known to have a significant impact on the quality of life for many women. The symptoms resulting from hormonal alterations that occur during this time are universally known and have been discussed in medical writings since the time of Hippocrates.
Statistics today indicate that as many as 30 percent to 40 percent of menstruating women commonly experience some symptoms of PMS during the premenstrual period. In recent years it has been observed that PMS symptoms occur in definable clusters, leading to four distinct medical classifications. [1] Most women experience one or a combination of these symptom clusters:
PMS-A: Anxiety, irritability, nervous tension, insomnia, depression;
PMS-H: Hyperhydration, water and salt retention, abdominal bloating, breast congestion and tenderness, edema of face and extremities, headaches, weight gain;
PMS-C: Cravings for sweets, food bingeing, increased appetite, sugar ingestion followed by heart palpitation, fatigue, fainting spells, headaches, shakiness;
PMS-D: Depression, withdrawal, insomnia, forgetfulness, confusion, lethargy.
Fortunately, current research is making new strides in determining the causes of these symptoms. Diet is being linked to PMS, and good nutrition and supplementation have been found to help relieve many of its symptoms.
The Working Body
In order to understand how diet can affect PMS, it is important to look at how the female reproductive system works, especially the functions of estrogen and progesterone -- two major hormones involved in the menstrual cycle. In women, both of these originate primarily from the ovaries.
During the first half of the menstrual cycle, estrogen levels begin to increase. Acting as a central nervous system stimulant, high estrogen levels can be linked to the irritability associated with PMS. At ovulation, when estrogen levels start to decline, the lowering of the estradiol (one form of estrogen) is believed to contribute to the irritation and depression common before the menses. [2] Changes in estrogen levels may also alter aldosterone-renin functions involving regulation of sodium and potassium in the blood, potentially leading to fluid retention, another PMS symptom.
For its part, progesterone tends to have low concentrations in the blood stream during the follicular (first) phase of the menstrual cycle. However, during the second half of the cycle -- from ovulation to menses -- levels increase dramatically. During this later phase, progesterone acts as an antagonist to estrogen, but when cycles are disturbed or imbalanced, or if progesterone levels are insufficient, estrogen "dominates" and PMS symptoms can be more pronounced. The natural decline of progesterone near the end of the second phase prompts the menses to begin.
Following are some signs and symptoms of estrogen dominance:
- Edema (water retention)
- Breast swelling (fibrocystic breasts)
- PMS mood swings and depression
- Loss of libido
- Heavy or irregular menses
- Uterine fibroids (noncancerous tumors of the smooth muscle in the uterus)
- Cravings for sweets
- Weight gain (especially hips and thighs). [3]
Progesterone offers many benefits to the PMS sufferer. Progesterone helps by acting as a natural anti-depressant, restoring libido, normalizing blood sugar, facilitating thyroid hormone, serving as a natural diuretic, restoring proper cell oxygen levels, protecting against fibrocystic breasts, helping use fat as fuel and normalizing zinc and copper levels. [4]
While numerous theories exist regarding the causes of PMS, no single explanation suffices. Many theories blame the syndrome on various conditions: elevated estrogen or hyperestrogenism, hormonal imbalances, alterations in brain amines (serotonin and dopamine), elevated free luteinizing hormone levels (prompted at ovulation), emotional and physical stress, and excess prolactin. Two key theories, however, emphasize the roles of prostaglandin balance and nutrition.The Prostaglandins Theory: Prostaglandins are modified forms of unsaturated fatty acids that are synthesized in virtually all cells of the body and which act as chemical messengers. PMS could result from a disturbance in the body's production of prostaglandins and a consequent imbalance of the various female hormones.
Prostaglandins are intimately linked to the composition and balance of fatty acids in the body. Conversely, proper balance and conversion of dietary and supplemental fatty acids, such as omega-6 oil, promotes prostaglandin balance.
In particular, the prostaglandin E-series (PGE1, PGE2) conversions are involved in maintaining normal composition and balanced fatty acids in the body. Both PGE1 and PGE2 are end-products of omega-6 fatty acids when they are converted into prostaglandins. PGE2, however, is derived more directly from arachidonic acid (AA) conversion, e.g. from the ingestion of beef and most other animal fats. Since excessive amounts of PGE2 may be produced from excessive intake of AA, meat intake may worsen some PMS symptoms by promoting decreased pain threshold, vasodilation and increased capillary permeability.
The theory linking prostaglandin and PMS suggests the importance of promoting a healthier balance of prostaglandins leading to more efficient PGE1 and PGE2 creation. Supplementation with plant oils rich in omega-6 fatty acids appears to promote PGE1 and to relieve PMS. A deficiency of PGE1 can produce fatigue, headache and sweet cravings. [5] Therapeutic or dietary measures that promote prostaglandin production from di-homo-gamma-linolenic acid (DGLA), an unsaturated omega-6 fatty acid found in linseed and other oils, achieve greater PGE1 levels relative to PGE2 and are therefore promising means of PMS management. [5]
In order to receive sufficient PGE1, the delta-6-desaturase (D6D) system must make proper conversions. Good health, proper nourishment and a toxin-free lifestyle ensure the greater likelihood of this conversion. Disturbances in the D6D conversion process can occur, however, if any number of blocking factors exist.
Potential D6D blocking factors include:
- Genetic tendency
- Stress
- Excess sugar intake
- Decreased zinc levels
- Decreased magnesium levels
- Decreased pyridoxine (B6) levels
- Alcohol intake
- Elevated cholesterol
- Dietary trans-fats
- Smoking
- Caffeine intake
- Excess saturated fats
- Decreased vitamin C levels
- Decreased vitamin B3 levels
Nutritional Influence Theory: Several nutrients also are believed to be involved in fatty acid balance and PMS symptomatology. Magnesium, for example, plays a role in fatty acid PGE1 conversion and magnesium deficiency is therefore implicated in mood, fluid balance and cravings symptoms.
Research indicates that magnesium deficiency can cause a depletion of dopamine levels in the brain, alter the adrenal cortex, elevate aldosterone levels and increase extracellular fluids. [7] Even minor magnesium deficiency can provoke symptoms including anxiety, irritability, insomnia and depression.
Since chocolate is high in magnesium, it is often deduced that the characteristic cravings for chocolate occurring during the premenstrual period are a result of magnesium deficiency. Many clinicians find that magnesium supplementation often helps reduce cravings for sweets in PMS patients.
Zinc is also a cofactor required for prostaglandin conversions. Additionally, zinc deficiency is associated with reduced secretion of progesterone and "feel good" endorphins. [8] Therefore, zinc appears to play an important role in PMS-related depression and irritability. Since vegetarians are susceptible to having insufficient zinc intake, special attention to zinc levels may be needed when evaluating overall dietary nutrient levels in vegetarian women.
Pyridoxine (B6) may assist in the normalization of magnesium levels [9] and act as a coenzyme in the metabolism of several mood-related neurotransmitters, including dopamine. Pyridoxine can also play a role in fluid balance due to its diuretic action.
Other nutrients that are believed to assist in the alleviation of PMS include vitamins C, B3, E and calcium.
PMS And Dietary Culprits: Several dietary factors have been implicated in the symptomatology of PMS. Of particular concern is sugar consumption. [10] Consuming large amounts of sugar appears to have many harmful effects on the body including increased insulin secretion and the suppression of ketoacid formation (factors that reduce fluid retention). Both of these effects promote weight gain. In addition, sugar has been shown to increase magnesium urinary loss. [11]
Caffeine consumption has also been linked to PMS. This is especially evident as dose levels increase. [12] Not only is caffeine well known as a nervous-system stimulant, but excessive caffeine can prompt increased urination, thereby promoting nutrient losses that can further aggravate PMS symptoms.
Alcohol consumption can in particular be a contributor to PMS-C symptoms, such as cravings for sweets, fatigue and headaches. Alcohol inhibits gluconeogenesis (the formation of glucose from fatty acids and proteins rather than from carbohydrates), promoting reduction of blood sugar. [13] Furthermore, the increase in stomach acid that follows alcohol ingestion can cause cellular responsiveness that leads to glucose fluctuations and excessive insulin release. [14]
As noted earlier, PMS-H symptoms have been linked to hyperhydration or fluid retention. Salt therefore can aggravate cravings, since it enhances glucose-induced insulin production through greater glucose (sugar) absorption. [15]
The Importance Of A Healthy Diet
Various nutritional recommendations for the management of PMS are commonly accepted. Besides avoiding the culprits outlined above, strategic restructuring of the diet provides physiological changes that eliminate or reduce many PMS symptoms.
Fiber-rich foods are particularly important in maintenance or restoration of healthy estrogen levels. In one study comparing 10 vegetarian women (eating 25 to 33 g food/ day) and 10 omnivorous women (eating 11 to 13 g food/day), blood estrogen levels were significantly lower in the vegetarian women than in the omnivorous women. [16] Hyperestrogenism may also be improved with the addition of Lactobacillus acidophilus. [17] This "friendly flora" appears to help metabolize estrogen properly in the bowel.
The best sources of fiber are whole grains, legumes, root and leafy vegetables, fresh fruits, nuts and seeds. Cruciferous vegetables, in particular, contain an important substance called indole-3-carbinol (I3C), a compound that can actually alter estrogen metabolism in a positive manner. [18] Eating organically produced foods can also ensure that pesticides, which can upset estrogen balance, are excluded from that diet. And protein sources that are hormone- and pesticide-free are sensible dietary choices.
Research also indicates that soy is an excellent source of phytoestrogens, plant-derived estrogens which have weaker effects in the body but which can reduce the body's need to manufacture its own human estrogens. [19]
Reducing animal protein in the diet also helps to shift dietary fat composition. Animal fats may help increase populations of bacteria in the intestine that can hydrolyze conjugated estrogens into active free estrogens--thus, instead of being eliminated, they can be reabsorbed. [20] A diet lower in animal fats and higher in omega-3-rich fish and vegetarian proteins may also help reduce the likelihood of an overabundance of AA and PGE2.
Dietary fats should include the essential fatty acids and can be obtained from using a mixture of various natural oils and oil-containing foods from the omega-6 (e.g., sesame, sunflower and soy) and omega-3 (e.g., cold-water fish, pumpkin seed and flaxseed) varieties. Many of these foods and oils also contain a combination of the fatty acids.
Natural Remedies For PMS
Current research on PMS focuses on natural progesterone. The most common form of natural progesterone is found in the wild yam. This yam contains a sterol called diosgenin, which can be converted into progesterone. Currently many nutritionally oriented physicians are recommending natural progesterone creams not only in the treatment of PMS, but within protocols for other hormone-related conditions including menopause and osteoporosis.
A number of popular herbs are also helpful tonics. They include:Dong quai (Angelica sinensis): Contains phytoestrogens, substances that have regulatory action on estrogen activity. [21]
Black haw (Viburnum prunifolium) and Cramp bark (V. opulis): In their beneficial actions, both can act as antispasmodics, uterine sedatives and an emmenagogue (helps promote menstrual flow).
Raspberry leaf (Rubus idaeus): A traditional strengthening and tonifying herb, it can help relax uterine muscles. [22]
Black cohosh (Cimicifuga racemosa): Another estrogenic herb that promotes healthy menstruation; soothes irritation and congestion of the uterus, cervix and vagina; and acts as an anti-inflammatory agent. [23] NSNJoan A. Friedrich, Ph.D., C.C.N., an independent health care consultant, holds board certifications in clinical nutrition and biofeedback therapy. She is a widely published author and serves on the advisory board of Nutrition Science News.
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