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Ladies, Don’t Let PMS Cramp Your Style: Nutrition and lifestyle modifications can help!

By Monique Richard MS, RDN, LDN

Ladies, Don’t Let PMS Cramp Your StyleIs premenstrual syndrome (PMS) literally cramping your style month after month? Do you often feel overwhelmed by how your menstrual cycle affects your mood, sleep, appetite, cravings and energy level? Nutrition, physical activity, and sleep transcends into all facets of our life—positively or negatively enhancing it. The intricate hormonal cascade and physiological changes during the reproductive cycle is no exception and can be especially affected. The often painful and uncomfortable side effects women with PMS may experience, such as cramping, bloating, breast tenderness, weight gain, cravings, fatigue, irritability, headaches, nausea (just to name a few), can range from mild to moderate intensity or for some can be severe and possibly debilitating. The good news is high quality nutrition, physical activity, and sleep can positively affect these symptoms, oftentimes alleviating them, making that dreaded time of the month nothing more than a normal part of life. Keep these dietary and lifestyle tips in mind to explore how you may benefit from using food and movement as medicine.

Maintain physical activity
Movement and exercise can improve mood and lift fatigue.1 The flood of feel-good endorphins and increased circulation of fresh blood and oxygen may be beneficial in reducing pain; although exercise may not be a specific PMS treatment, it can help the body in self-regulation and stress management.

Yoga asanas (postures)—such as forward fold, bow pose, bridge, seated or standing twists and cobra—can be helpful in stimulating blood flow and oxygen to the abdominal area and promote more calming and release of tension by opening up the chest and heart areas and massaging the internal organs.

Sleep hygiene and stress management
It is not only important to get enough sleep, but quality and consistency also matter. Is your room dark, cool, and inviting or do you fall asleep on the couch with the TV on and still in your daytime clothes? Think about the smells you enjoy from essential oils, candles, or incense that can help lure you to sleep and create an environment that fosters a relaxing nighttime ritual. Often lavender and rose induce calming, while eucalyptus and peppermint are uplifting and clarifying. Chamomile tea or a bubble bath before bed may also help. Playing soothing music may allow your body to be calmer, physiologically allowing for less discomfort, tension and pain through the menstrual process. Also, getting adequate sleep will help with foggy brain and reduce the irritability you may already be fighting.

Managing stress is critically important to overall health and may be especially essential during this time of the month. Along with sleep and exercise, are you able to find some time to take care of your needs? Do you carve out time in your schedule to read your favorite book, watch a TV show, have a meal or coffee with a friend, go for a walk in nature, or dance around with your pet or child? Releasing stress and firing up the endorphins that bring renewed joy and energy into your body is something that should be practiced on a regular basis. When we are calmer and energized, we can let the small things go and physically can feel lighter, brighter and more able to cope with whatever life throws at us.

Decrease or eliminate the SACS (sugar, alcohol, caffeine and sodium)
Simple carbohydrates, or refined carbohydrates, are those highly processed items typically high in sodium, saturated fat, sugar, or all three. Items such as chips, white breads, snack foods, baked goods, fast food, sugar-sweetened beverages, or cereals could possibly exacerbate PMS symptoms by fluid retention, bloating, blood glucose lows or spikes, general energy lags, or irritability.1-3 Alcohol and caffeine can further contribute to dehydration and detract from nutrients needed for other cellular pathways at this time of hormone fluctuation or possibly extend the time one experiences cramping. If these types of foods can be decreased or even eliminated a week or so in advance of the menstrual cycle, PMS symptoms may be less prominent or intense.

Try to eat small, balanced meals with complex carbohydrates (whole grains, vegetables, beans and lentils), healthy fat, and lean protein. Reevaluate caffeine and alcohol intake during this time and drink water, unsweetened beverages, or herbal teas.

Nutrients to note
Calcium and Vitamin D
The relationship and function that the micronutrients calcium and vitamin D have to estrogen may be the reason they are associated with reduced PMS symptoms.2-6 Estrogen has a role in supporting calcium levels in the bones but also allows calcium to be readily absorbed in the gastrointestinal tract. A lack of estrogen may impair calcium absorption. This impairment leads to an increase in bone resorption in order to meet the body’s needs, simultaneously detracting from the other physiological needs, hence the cascade of symptoms that may result. Postmenopausal women or those with anorexia nervosa are particularly affected by lower estrogen levels, but other conditions can also affect estrogen.

A study found that the equivalent of 1,200 mg of calcium carbonate and approximately 400 IU daily of vitamin D from food sources may be beneficial in preventing PMS.5,6 A 41% decreased risk of developing PMS has been linked to higher vitamin D levels as well.6 Foods rich in Vitamin D include:  salmon, trout, tuna, mushrooms, eggs, and fortified foods.  Foods rich in calcium include:  dairy products, dark green leafy vegetables, nuts, grains, beans, canned salmon and sardines.

B Vitamins
The family of B vitamins converts carbohydrates from food to fuel for the body; supports metabolization of fat and protein; are critical to the functioning of the nervous system; and help maintain healthy skin, hair, and nails. Vitamins B12, B6, thiamine, riboflavin, niacin, and folate are all involved, in various ways, with the metabolism of neurotransmitters. Neurotransmitters, such as serotonin and dopamine, are synthesized through a cascade of steps with B vitamins; if a change in the availability of B vitamins occurs, a difference in neurotransmitter stability and regulation occurs possibly leading to a reduction or contribution in PMS or the severity. Before you start popping the B supplements, be aware that those taking supplements in some studies have had a higher risk of developing PMS than did those not taking supplements. Researchers believe this could be related to the bioavailability of the B vitamins in whole foods or how easily the vitamin can be absorbed by the body. The benefits of other nutrients also found in these foods may also be the reason they are more effective in a whole food.7

Foods rich in riboflavin include: fortified cereals, almonds, whole grains, wheat germ, mushrooms, soybeans, eggs, and dark green vegetables.

Thiamine: fortified cereals, legumes, nuts

Vitamin B6: soybeans, fatty fish, whole grains, fortified cereals, avocados, baked potato with skin, bananas, and peanuts

A more recent double-blinded, randomized controlled study specifically looking at B6 supplementation found that 80 mg of vitamin B6 taken daily (it did have to be taken over three cycles) was associated with a reduction in several PMS symptoms including moodiness, irritability, forgetfulness, bloating, and especially anxiety.8

Iron
Iron is involved in the formation of serotonin from the amino acid tryptophan. One study found that high intake of non-heme (non-animal sources) iron through supplements or plant sources was associated with a lower risk of PMS.9 As with the B vitamins, it may again have to do with the other nutrients accompanied to this mineral in these foods.

Foods rich in (non-heme) iron include: beans, peas, lentils, nuts, seeds, dried fruit, whole grains, leafy greens, molasses, and fortified foods.

Magnesium
Magnesium may be helpful in reducing fluid retention associated with PMS with some studies showing elevated mood, and decreased water retention, breast tenderness, and insomnia with a 200 mg supplement of magnesium oxide. Supplementation has not become a standard recommendation, but it is a possible tool in our toolbox of options as we look at individual nutritional needs and health conditions.

Foods rich in magnesium include: dark leafy greens, nuts, seeds, fish, beans and legumes, whole grains, avocados, and low-fat dairy.

Herbal Supplements
Many herbal supplements from ginkgo biloba to St. John’s Wort have been touted as possible PMS symptom reducers, but continued research and meta-analyses are inconclusive of the effectiveness of these. One possible herbal helper was found to be Chasteberry (Vitex agnus-castus). In extract form it could possibly stimulate a domino effect starting in the pituitary gland that ends in normalizing the ratio of progesterone to estrogen and thus relieving PMS-related symptoms, such as bloating, irritability, and depression.10 Twenty mg of Chasteberry showed a 50% decrease in PMS symptoms such as irritability, mood swings, anger, headache, and breast tenderness.10

The inconvenience, discomfort, pain, and frustration of PMS-related symptoms can be addressed to be significantly altered or possibly eliminated. An integrative registered dietitian nutritionist (RDN) can customize a plan specific to an individual’s needs based on nutrient deficiencies, lifestyle modifications, and current health condition. Evaluating stress management, activity levels, and sleep hygiene, an integrative RDN is well positioned to make lifestyle recommendations, exploring supplemental needs and dietary modifications necessary to influence positive changes and make those symptoms a thing of the past.

Please call 423-794-5520 to schedule an appointment with our registered dietitian.

State of Franklin Healthcare Associates
301 Med Tech Parkway, Johnson City, TN  37604
423-795-5520 | www.sofha.net

Sources:
1. Jarvis CL, Lynch AM, Morin AK. Management strategies for premenstrual syndrome/premenstrual dysphoric disorder. Ann Pharmacother. 2008;42(7):967-978.
2. ACOG Committee on Practice Bulletins — Gynecology. ACOG Practice Bulletin: No 15: Premenstrual syndrome. Obstet Gynecol. 2000;95(4):Suppl 1-9.
3. Rapkin A. A review of treatment of premenstrual syndrome and premenstrual dysphoric disorder. Psychoneuroendocrinology. 2003;28(Suppl 3):39-53.
4. http://www.todaysdietitian.com/pdf/courses/PitmanPMScourse.pdf.  Accessed January 19,2017.
5. Bertone-Johnson ER, Hankinson SE, Bendich A, Johnson SR, Willett WC, Manson JE. Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med. 2005;165(11):1246-1252.
6. Bertone-Johnson ER, Chocano-Bedoya PO, Zagarins SE, Micka AE, Ronnenberg AG. Dietary vitamin D intake, 25-hydroxyvitamin D3 levels and premenstrual syndrome in a college-aged population. J Steroid Biochem Mol Biol. 2010;121(1-2):434-437.
7. Chocano-Bedoya PO, Manson JE, Hankinson SE, et al. Dietary B vitamin intake and incident premenstrual syndrome. Am J Clin Nutr. 2011;93(15):1080-1086.
8. Kashanian M, Mazinani R, Jalalmanesh S. Pyridoxine (vitamin B6) therapy for premenstrual syndrome. Int J Gynaecol Obstet. 2007;96(1):43-44. 15.
9. Chocano-Bedoya PO, Manson JE, Hankinson SE, et al. Intake of selected minerals and risk or premenstrual syndrome. Am J Epidemiol. 2013;177(10):1118-1127.
10. Atmaca M, Kumru S, Tezcan E. Fluoxetine versus Vitex agnus castus extract in the treatment of premenstrual dysphoric disorder. Hum Psychopharmacol. 2003;18(3):191-195.

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