Kathleen M. Zelman, MPH, RD, LD
Premenstrual syndrome (PMS) is such a regular occurrence for many women that they consider it a normal part of getting their period. About 8% to 20% of women get moderate to severe symptoms a week or two before their monthly cycle begins.
These symptoms include a range of physical and emotional changes. The biggest complaint is often mood-related, such as feeling extremely grouchy or unhappy, often to the point where family members know when your period is coming, says gynecologist Rebecca Kolp, MD, medical director of Mass General West in Waltham, Mass. Abdominal bloating, breast tenderness, and headache are other frequent gripes she hears from patients.
Although the causes of PMS aren't well understood, fluctuating levels of hormones and brain chemicals are thought to play a role. What a woman eats and drinks can also have an effect.
"There's evidence that diet is involved in either the development of PMS or contributes to the severity of symptoms," says Elizabeth Bertone-Johnson, ScD, an associate professor of epidemiology at the University of Massachusetts in Amherst, who has studied nutrition's role in PMS.
With that in mind, here are eight diet-related suggestions to help ease PMS symptoms.
In studies of college-aged women and nurses, women with the highest intakes of calcium and vitamin D were less likely to develop PMS, Bertone-Johnson tells WebMD.
"With calcium, those results were stronger when it came from foods than from foods plus supplements or a supplement alone," she says. Her research found a food benefit from calcium at about 1,200 milligrams a day (RDA for women 19-50 is 1000 mg) and at 700 IU of vitamin D (RDA for women is 600 IU aged 70 and below.)
To get these amounts, aim for at least three servings of calcium-rich foods a day, such as low-fat milk, cheese, yogurt, fortified orange juice, or soy milk. It's difficult to get enough vitamin D from diet alone (salmon and fortified milk are good sources), but women can make up the difference with a daily multivitamin or a supplement. Many calcium supplements also contain vitamin D.
As for why these nutrients may ease PMS, Bertone-Johnson suspects that calcium works in the brain to relieve depressive symptoms or anxiety, and vitamin D may also influence emotional changes.
Of course, you need adequate calcium and vitamin D for many other health reasons, including the health of your bones. Curbing PMS may be a fringe benefit.
"The hormone storm from PMS can lead to a domino effect on appetite," says Elizabeth Somer, an Oregon-based dietitian and author of Eat Your Way to Happiness.
To avoid becoming overly hungry, eat regular meals and snacks throughout the day. If you're feeling blue from PMS, then skipping a meal will only make you more irritable as blood sugar levels plummet.
Eating well all month long is a better approach to PMS than tweaking your diet when you have symptoms. So enjoy plenty of colorful, fiber-packed fruits and vegetables, as well as whole grains, such as brown rice, oatmeal, and rye bread.
Fortified breads and cereals also supply B-vitamins. Recent research found that women with higher intakes of thiamine (vitamin B-1) and riboflavin (vitamin B-2) had a significantly lower risk of PMS. This was true for women who got B-vitamins from food, but not from supplements.
"If you're craving sugar, you're craving it for a reason," Somer says. That reason is shifting levels of the hormones estrogen and progesterone, which can also decrease levels of the chemical serotonin in the brain. These changes may affect a woman's mood and trigger PMS symptoms.
In fact, studies have shown that some women with PMS may take in 200 to 500 more calories a day. Those additional calories typically come from fats, carbohydrates, or sweet foods.
Rather than turning to sugar to boost serotonin levels, Somer advises eating whole grains instead.
Some, but not all, studies have revealed that alcohol use is more common in women who are experiencing PMS or Premenstrual Dysphoric Disorder (PMDD), perhaps as an attempt to self-treat symptoms. PMDD is a more severe form of PMS, in which emotional symptoms are more predominant. It affects fewer women than PMS.
Although women are often advised to cut back on alcohol and even caffeine, there's not a lot of evidence these steps are necessarily beneficial, Bertone-Johnson says. Her own research did not find that alcohol increased PMS risk. Still, she says, there's no downside to easing up on alcohol and caffeine, and doing so may ease breast tenderness and bloating.
Somer likes to remind women to drink plenty of water to reduce bloating. This may sound counterintuitive, but she says a bloated body is holding on to too much water, likely because of too much salt.
Since nearly everything that comes in a bottle, bag, package, or can is loaded with salt, it's almost impossible to eliminate sodium. But slashing some of it may reduce the uncomfortable bloating and water retention from PMS, Somer says.
To halt the salt, focus on whole foods, rather than overly processed or convenience foods, because sodium is often added during manufacturing. "And if you can't cut back enough, drink lots of water," Somer says, so your body can get rid of the excess sodium.
Besides encouraging her patients to eat a healthy diet, Kolp also recommends that they first treat PMS symptoms with a combination of exercise, stress reduction, and some supplements.
She suggests a daily multivitamin, 100 milligrams of vitamin B-6 a day, 600 milligrams of calcium carbonate with vitamin D daily, along with at least one calcium-rich food serving, as well as 400 milligrams of magnesium oxide.
Taking B-6 and magnesium at these levels may temper mood changes, and magnesium may reduce water retention.
As always, tell your doctor about any supplements you're taking to avoid any possible drug interactions, and let her know if PMS is causing you a lot of problems.
There's some evidence that maintaining a healthy body weight may help prevent PMS, and that overweight or obese women are more likely to have symptoms. Being physically active helps keep your waistline in check and works wonders to release stress.
"Stress plays a huge role in the intensity of PMS symptoms," Kolp tells WebMD. So find ways to relax your mind, whether it's exercising, deep breathing, or doing yoga.
Feeling tired is yet another sign of PMS, so you might need more sleep than usual. Lastly, ditch the butts: A recent study showed that smoking, especially in your teens or early 20s, may increase a woman's risk for moderate to severe PMS.
SOURCES:Elizabeth R. Bertone-Johnson, ScD, associate professor of epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst.Rebecca Kolp, MD, ob-gyn, medical director, Mass General West, Waltham, Mass.Elizabeth Somer, MA, RD, Salem, Ore.; author, Eat Your Way to Happiness, Harlequin, 2009.American Congress of Obstetricians and Gynecologists patient education pamphlet: "Premenstrual Syndrome."Mayo Clinic: "Premenstrual Syndrome."National Women's Health Information Center, WomensHealth.gov: "Premenstrual Syndrome: Frequently Asked Questions."Bertone-Johnson, E. American Journal of Epidemiology, 2008; vol 15: pp 938-945.Bertone-Johnson, E. Archives of Internal Medicine, 2005; vol 165: pp 1246-1252.Bertone-Johnson, E. Journal of Steroid Biochemistry and Molecular Biology, 2010; vol 121: pp 434-437.
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