Nutritional Influences on Illness: Premenstrual Syndrome & Diet

Nutritional Influences on Illness: Premenstrual Syndrome & Diet

Several dietary factors have been implicated as playing a role in premenstrual symptomatology -- each of which has also been implicated in a number of other disorders.

In a study of 853 university students, the prevalence of premenstrual syndrome was associated with their consumption of foods and beverages that are high in sugar content or taste sweet.( 1) Large amounts of sugar could cause symptoms of fluid retention by provoking insulin secretion, suppressing ketoacid formation. Since ketoacids help the kidney to clear excess sodium and water, sodium and water retention occurs, causing weight gain and symptoms such as breast congestion and tenderness, abdominal bloating, and edema of the face and extremities.( 2) Sugar also increases the urinary excretion of magnesium.( 3) A marginal magnesium deficiency, in turn, may provoke emotional symptoms, such as anxiety, irritability, insomnia and depression, perhaps by increasing insulin secretion( 4) or by reducing brain dopamine levels.( 5)

Unrefined foods rich in complex carbohydrates, such as cereal grains, should be emphasized as should other sources of dietary fiber. Food fiber appears to increase the clearance and fecal excretion of estrogens. Since high premenstrual estrogen levels appear to have an activating effect, fiber may reduce symptoms such as irritability, anxiety and insomnia.( 2) Also, in a study of women suffering from severe premenstrual depression, consumption of a carbohydrate-rich, protein-poor evening test meal during the late luteal phase significantly improved their scores for depression, tension, anger, confusion, sadness, fatigue, alert and calmness, perhaps by increasing brain serotonin levels.( 6)

Much has been written about the relationship between high fat intake and degenerative diseases, but few people realize that high fat intake may also encourage premenstrual fluid retention. One group of 30 women followed a diet with 40% of calories derived from fat for four menstrual cycles; then they were switched to a diet with only 20% of calories derived from fat for another four cycles. When their symptoms during the premenstrium and menses were compared, there were significant decreases in weight gain, bloating, and breast tenderness on the low-fat diet.( 7)

Minimizing the intake of salt at least three days prior to the usual onset of symptoms may be helpful. Salt enhances glucose-induced insulin production by facilitating glucose absorption( 8) and thus can foster symptoms such as sugar craving, increased appetite, and `hypoglycemic' symptoms following sugar ingestion. Moreover, women with a tendency to premenstrual fluid retention have a relative deficiency of dopamine at the renal level.( 9) Since dopamine is natiuretic (i.e. promotes sodium excretion) and diuretic (promotes urine excretion), this deficiency makes these women unusually prone to salt and water retention.( 10)

A number of studies have found a dose-dependent relationship between caffeine intake and the prevalence of premenstrual syndrome.( 11) Alcohol ingestion may like sugar, facilitate the development of sugar craving, increased appetite, and `hypoglycemic' symptoms following sugar ingestion. One possible mechanism is its ability to inhibit gluconeogenesis and promote a fall in plasma glucose;( 12) another is its ability to increase gastric acidity. This latter effect may increase the release of gut secretagogues which augment beta-cell responsiveness to glucose fluctuations, leading to excessive insulin release.( 13)

In summary, it appears that women can reduce premenstrual symptoms by following a diet that is low in fat, sugar and salt, while high in complex carbohydrates and fiber. Alcohol and caffeine intake should be minimized. While most of the evidence fails to prove whether these dietary changes are effective, the suggested dietary regimen is not only safe, but is far healthier. Therefore, I suggest that every woman suffering from premenstrual symptoms should consider giving it a trial.

References
(1.) Rossignol AM, Bonnlander H. Prevalence and severity of the premenstrual syndrome. Effects of foods and beverages that are sweet or high in sugar content. J Reprod Med 36(2):131-6, 1991

(2.) Abraham GE. Management of the premenstrual tension syndromes: rationale for a nutritional approach, in J Bland, Ed. 1986: A Year in Nutritional Medicine. New Canaan, CT, Keats Publishing, 1986

(3.) Seelig M. Human requirements of magnesium: Factors that increase needs, in J Durlach, Ed. First International Symposium on Magnesium Deficiency in Human Pathology. Paris, Springer, Verlag, 1973:11

(4.) Curry DL et al. Magnesium modulation of glucose-induced insulin secretion by the perfused rat pancreas. Endocrinology 101:203, 1977

(5.) Barbeau A et al. Deficience en magnesium et dopamine cerebrale, in J Durlach, Ed. First International Symposium on Magnesium Deficit in Human Pathology. Paris, F. Vittel, 1973:159-52

(6.) Wurtman JJ et al. Effect of nutrient intake on premenstrual depression. Am J Obstet Gynecol 16(5): 1228-34, 1989

(7.) Jones DV. Influence of dietary fat on self-reported menstrual symptoms. Physiol Behav 40(4):483-7, 1987

(8.) Ferrannini E et al. Sodium elevates the plasma glucose response to glucose ingestion in man. J Clin Endocrinol Metab 54:455, 1982

(9.) Kuchel D et ed. Catecholamine excretion in `idiopathic' edema: decreased dopamine excretion, a pathologic factor. J Clin Endocrinol Metab 44:639, 1977

(10.) McDonald RH et al. Effects of dopamine in man: Augmentation of sodium excretion, glomerular filtration rate and renal plasma flow. J Clin Invest 43: 1116, 1964

(11.) Rossignol AM, Bonnlander H. Caffeine-containing beverages, total fluid consumption, and premenstrual syndrome. Am J Public Health 80(9): 1106- 11, 1990

(12.) Rabin D. Hypoglycemia: Physiologic and diagnostic considerations, in GE Abraham, Ed. Radioassay Systems in Clinical Endocrinology. New York, Marcel Dekker, 1981:60924

(13.) Freinkel N, Getzger BE. Oral glucose tolerance curve and hypoglycemias in the fed state. N Engl J Med 280:820-8, 1969

Reprinted with permission from the International Journal of Alternative and Complementary Medicine, Green Library, Homewood NHS Trust (DHQ, Guildford Road, Chertsey, Surrey KT16 OQA, United Kingdom.

Townsend Letter for Doctors & Patients.

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By Melvyn R. Werbach

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