PREMENSTRUAL SYNDROME, PMS

PMS, OR PREMENSTRUAL SYNDROME, first described in the medical literature in 1931, has gotten a great deal of attention in the past decade and has been viewed as everything from an illusion to a defense for murder. PMS is sometimes controversial because it’s so complex: Some researchers recognize over 150 different complaints women can suffer from in the week or two before their period. It’s difficult to isolate these complaints and to come up with a single medication that will make them all go away. Indeed, the one drug that’s been most commonly prescribed for PMS, progesterone, has recently been found to be ineffective.

The natural approach to treating PMS is, I’m convinced, more effective and certainly safer than any drug on the market. In fact, many research articles have pointed to hormone imbalance, prostaglandin imbalance, and vitamin and mineral imbalances as the causes of PMS, and a natural approach seeks to correct these imbalances rather than mask the symptoms. I’ve had success with patients using an approach that combines diet, supplements, and exercise. And one supplement in particular, the amino acid DL-phenylalanine, has been, for some of my patients, little short of a miracle in helping them combat the mood swings of PMS.

Many of my patients who complain of PMS describe symptoms such as tension, mood swings, irritability, anxiety, weight gain, bloating, breast tenderness, and various food cravings, especially for sweets. Only after discussion and evaluation do some women realize that these symptoms are related to their menstrual cycle and occur one to two weeks before their period.

Diet plays a crucial role in the treatment of PMS, and I’ve found that many women experience exacerbated symptoms of PMS when their blood sugar is not under control. In fact, controlling blood sugar is a crucial step in eliminating PMS. Many of my patients are relieved to learn that their sugar cravings are not the result of a weak character but have an actual physiological cause. After ovulation, which occurs about two weeks before a period, the insulin-binding capacity of the body’s cells change, affecting the response to sugar in the diet. Also, certain vitamin and mineral deficiencies, especially a chromium deficiency, can contribute to sugar cravings.

To relieve sweet cravings, you should eliminate sugar from your diet. In addition, to keep insulin levels steady and thus eliminate cravings, it’s important to have regular meals at regular times and make sure you have enough protein in your diet-fish, chicken, or turkey-at lunch and dinner.

Chromium is also quite helpful in stabilizing blood sugar and eliminating sweet cravings. Though not many people are seriously deficient in chromium, many have a marginal deficiency. Regular exercisers, people who drink lots of coffee or tea, or people who eat a lot of sugar are more likely to have chromium deficiencies. This means that people who have a sweet tooth are often the least able to metabolize sugar effectively because of insufficient chromium stores. Many of my patients have found chromium to be extremely helpful.

Dietary fat is also a factor in contributing to PMS. Studies have linked dietary fat with prostaglandin levels and plasma estrogen levels. If you reduce the fat, the prostaglandin and estrogen levels go down, which helps to relieve symptoms. There are some good fats: olive, safflower, and linseed oil all contribute to the production of certain prostaglandins that can help ameliorate many PMS symptoms.

Salt in the diet will cause fluid retention and thus contribute to weight gain, breast tenderness, swelling, and a generally bloated feeling. There’s also recent information that sodium elevates the plasma glucose response. What this means is that excess salt in the diet creates a stronger reaction to the sugar and can contribute to low blood sugar, making you feel weak and irritable.

Most women don’t realize the role that fiber plays in PMS. It has recently been recognized that fiber increases the intestinal clearance of estrogen. Too much estrogen is thought to be a contributing factor to the development of certain PMS symptoms. An increase of fiber, particularly in the two weeks preceding the period, can help to cut down on unwanted symptoms as well as contribute to overall good health.

Two interesting studies, one involving women in China and another involving college students in Boston, report the definitive link between the amount of caffeine consumed and the severity of PMS. Women who had the most troublesome symptoms consumed more caffeine-containing drinks per day than those with no PMS.

Caffeine affects PMS in several ways. First, it’s known that caffeine affects adenosine receptors in the brain. It’s also known that progesterone and other hormones affect these receptors as well. With the double action of both hormones and the caffeine working on the brain, symptoms are exacerbated. Caffeine is also a major contributor to fluctuations in blood sugar. Changes in blood-sugar levels can lead to food cravings as well as fatigue, weakness, headaches, and irritability. Caffeine, which also stimulates the body to produce anti-stress hormones, creates a stress on the body and thus contributes to PMS.

In addition to dietary changes, taking specific supplements can help. It seems that every day there’s increasing evidence that certain vitamins and minerals help to alleviate PMS symptoms. It really isn’t news that many women are deficient in so many vitamins and minerals: according to a 1985 USDA study, 87 percent of women were below the RDA in vitamin E, 74 percent in calcium, 56 percent in iron, and 46 percent in folacin. Perhaps PMS is so widespread in part because of these deficiencies.

B6 has been reported to help relieve fluid retention. In addition, the whole B complex can be helpful in fighting PMS symptoms, by stabilizing hormone levels and fighting stress.

Vitamin A has been shown to be very effective in treating PMS, but unfortunately the studies used it in doses higher than considered safe in an unsupervised atmosphere.

Vitamin E can be very helpful for breast complaints including swelling and tenderness and even fibrocystic disease. In one study, up to 85 percent of patients treated with vitamin E saw improvement. Vitamin E enhances formation of certain prostaglandins, which inhibit prolactin. Elevated levels of prolactin can promote symptoms similar to those of PMS.

There’s strong evidence that calcium and magnesium supplements can help reduce PMS symptoms including depression, irritability, headaches, mood swings, abdominal bloating, and back pain, as well as cramps. In one study, patients reported a 50 percent reduction of these symptoms when supplemented with calcium.

Zinc is another helpful mineral. It has been reported that women who suffer from PMS consume half the zinc that unaffected women consume. This is further evidence that certain PMS symptoms are the result of deficiencies that supplements correct. Zinc supplementation, by the way, has been shown to be particularly helpful for women who have premenstrual acne.

Evening primrose oil, a nutritional supplement, has been very helpful in lessening certain symptoms including cramping in particular as well as irritability, breast discomfort, anxiety, tiredness, and swollen fingers and ankles. One study found that while sufferers had a significant decrease in symptoms after their first cycle, the best results with the supplement came after the fifth cycle. My patients have found it very helpful for abdominal cramping.

Vitamin C, which helps regulate estrogen clearance from the body, helps combat PMS symptoms.

One of the most exciting PMS treatments I’ve found is the use of DL-phenylalanine, an amino acid, for moodiness and depression. Many of my patients have found the use of this supplement “something of a miracle” as one woman told me after suffering from years of terrible depression before her period. Phenylalanine is crucial to the body’s production of various neurotransmitters that have an effect on moods. In my experience phenylalanine is not effective in fighting mood swings but rather the kind of severe depression and moodiness that can precede a period.

There are certain lifestyle factors that have been proven to contribute to PMS, most notably lack of exercise.

Exercise has long been recommended as a treatment for PMS, but until very recently there was no documented study that validated it. But many women noticed that exercise “seemed to help” and that women athletes and ballerinas, for example, seemed to suffer much less frequently from PMS. A recent study finally confirmed the anecdotal evidence. Women who exercised moderately for a full cycle experienced decreases in fluid retention, breast symptoms, and premenstrual depression. It is believed that the neurotransmitter endorphin is associated with both exercise and mood symptoms and that endorphin withdrawal causes the PMS symptoms. One of my patients who had suffered with troubling PMS told me that she noticed that when she began walking for about a half hour five or six days a week, she had the first cycle she could remember that wasn’t heralded by five days of depression, irritability, and tender breasts. Other patients have told me of similar occurrences.

There’s so much material available on exercise these days that I won’t go into great detail here except to say that exercise, which will be beneficial to every aspect of your health, doesn’t have to be strenuous or demanding. A simple program of walking is what I recommend to patients who find it difficult to exercise regularly at a gym.

NATURAL PRESCRIPTION FOR PMS

DIET:

• Follow a low-fat diet.
• Eliminate sweets.
• Eat regular meals at regular times.
• Eat protein at lunch and dinner (fish, chicken, tuna, turkey).
• Limit alcohol:
• Limit salt.
• Limit dairy products,
• Limit caffeine to no more than one caffeinated drink per day.
• Increase complex carbohydrates including green leafy, vegetables, legumes, whole grains, and cereals to increase fiber.
• Increase intake of olive or safflower oil

LIFESTYLE:

• Adopt a regular exercise program.

IN ADDITION TO YOUR DALLY BASIC VITAMIN/MINERAL SUPPLEMENTS, TAKE THE FOLLOWING FOR THREE MONTHS (IF THERE IS NO IMPROVEMENT IN SYMPTOMS, DISCONTINUE):

• Vitamin A: 10,000 I,U. daily.
• Vitamin Bi: 100 mg. three times a day for two weeks prior to period.
• Vitamin C: 1,000 mg. daily.
• Vitamln E: 400 to 600 I.U. dailY.
• Calcium: 1,200 mg. daily (best taken at bedtime).
• Magnesium: 400 mg, daily.
• Chromium: 100 mcg. of trivalent chromium three times a day.
• Zinc: 50 mg. daily.
• Evening primrose oil: four 500-mg. capsules in the morning and four 500-mg. capsules in the evening. (Take evening primrose oil for five cycles and if no improvement, discontinue.)