therapeutic considerations:
General findings concerning the diets of PMS patients:
- 63% higher in refined carbohydrates
- 275% higher in refined sugar
- 79% higher in dairy products
- 78% higher in sodium
- 53% lower in iron
- 77% lower in magnesium
- 52% lower in zinc (Marz, p. 427, 1997)
Treat the liver: The liver conjugates estrogens and is involved in estradiol and estrone production.
Work on digestion
eating principles:
Vegan diet of 75% complex carbohydrates, 15% protein, 10% fat
Increase consumption of complex carbohydrates to 70+% (Abraham, Guy. J. Repro. Med. 28:446-64, 1983)
Decrease consumption of saturated fats: especially red meats and dairy products. PMS patients in one study were found to eat 79% more dairy products than normals. For PMS-A, where there is an excess of estrogen, decrease any endogenous estrogens. Overweight patients must shed the extra pounds. (Marz, p. 427, 1997)
High fiber diet: increased fiber associated with increased binding and excretion of estrogens (Golden, B. N. Eng. J. Med. 307:11542-47, 1982)
Decrease caffeine (Rossignol, A. Am. J. Public Health 75(11):1335-37, 1985; Rossignol, A. Am J. Public Health 79:67-9, 1989.)
Decrease salt intake: to 3 g per day or less, especially for PMS-H.
Decrease sugar intake
therapeutic foods
Citrus peel, garlic, onions, legumes, kelp, apples, sesame seeds, brewer's yeast, alfalfa tablets
Liver-cleansing foods: beets, carrots, artichokes, lemons, parsnips, dandelion greens, watercress, burdock root
Dark green leafy vegetables: beet, radish, mustard, dandelion, collard greens, kale, spinach, chard
Foods rich in Magnesium, Calcium, Vitamin B-complex
Increase omega-3 and omega-6 fatty acids: vegetable, nut, seed oils, salmon, herring, mackerel, sardines, walnuts, flaxseed oil, evening primrose oil, black currant oil
» Stagnant Liver Qi or Stagnancy in the Liver channel:
Foods that invigorate Qi, soothe the Liver, sour foods, Dispersing foods, foods that open channels, and invigorate Xue (Blood)
Ginger, green onions, fennel, orange peel, spinach, walnuts, hawthorn berries, cinnamon (Ni, p. 152)
fresh juices:
Carrot (Walker, p. 146)
Carrot and spinach (Walker, p. 146)
Carrot, beet, and cucumber (Walker, p. 146)
Lemon juice in warm water (Shefi)
specific remedies:
Tea from ginger, green onions, fennel, black pepper and orange peel, boil for 10 minutes. Drink three times daily starting one week before premenstrual symptoms (Ni, p. 152)
Spinach soup boiled for 30 minutes (Ni, p. 152)
Tea from hawthorn berries and cinnamon (Ni, p. 152)
avoid:
Estrogenic foods: animal products, apples, cherries, olives, plums, carrots, yams, nightshade family (eggplant, peppers, tomatoes, potatoes, tobacco), peanuts, soy products, coconut, brown rice, barley, oats, wheat (See Materia Medica: Foods that contain estrogen-like sterols)
Animal fats stimulate the growth of certain intestinal bacteria, which can hydrolyze conjugated estrogens thus rendering them active again. (Marz, p. 427, 1997)
Arachidonic acid from animal fats is a precursor to PGF2, which is leuteolytic in women (decreases progesterone). (Dennefors, B., Sjogren, A., Hamberger, L. J. Clin. Endocrin. and Metab. 55:102-107, 1982)
Meat, alcohol, spicy foods, fried foods, fatty foods, rich foods, salt, salty foods, sugar and sweet foods, chocolate, cold and raw foods in excess, excess fruit, shellfish, coffee, black tea, cola drinks, caffeine, dairy products, processed and refined foods
Cabbage, cauliflower, broccoli, brussel sprouts, kale, sweet potatoes, turnips
supplements
Vitamin B6: 100 mg three times daily, use two weeks before period.
(Doll, H., et al. Pyridoxine and the PMS: A randomized crossover trial. J Royal College of General Practitioners 39:326, 364-68, Sept. 1989; Abraham, G., Hargrove, J Infertility, 3(2):155-65, 1980)
Vitamin B complex
Vitamin E: 200-600 IU per day; 300 IU per day 2 month trial (London RS, et al. J Am Coll Nutr 1983;2(2):115-122.; London RS, et al. J Reprod Med 1987 Jun;32(6):400-404; London RS et al. J Am Coll Nutr 1984;3(4):351-356)
Brewers Yeast complex: A recent double-blind clinical study of forty women suffering from mild or moderate premenstrual syndrome (PMS) found significant benefits from a nutritional supplement containing brewers yeast (1,000 mg), magnesium (400 mg), vitamin B6(1.5 mg), vitamin E (12 mg), folic acid (0.2 mg), iron (20 mg), and copper (4mg). Over the span of six consecutive menstrual cycles, the Brewers Yeast complex was significantly more effective than the placebo, as measured by reduction of premenstrual symptoms. This beneficial effect became more pronounced as the study progressed; by the sixth month premenstrual symptoms were reduced by an average of 82%, compared with a reduction of only 27% in the placebo group. (Facchinetti F, et al. Gynecol Obstet Invest 1997;43: 120-124.)
Progesterone (orally or topically)
Flax oil or EPO: evening primrose oil 500 mg three times daily OR flaxseed oil 1 tbsp. twice daily
Lipotrophic factors: cysteine, methionine, choline, and inositol
Calcium: 1200 mg per day In a 1998 three month long prospective double-blind, randomized, placebo-controlled multicenter trial involving 466 women a daily dose of 1200 mg of elemental calcium, in the form of calcium carbonate, appeared to relieve key premenstrual symptoms such as mood swings, food cravings, aches and pains, and bloating. Researchers have postulated that PMS represents a clinical manifestation of functional hypocalcemia and secondary hyperparathyroidism due to inadequate levels of calcium consumption.
(Thys-Jacobs S, Alvir MJ. J Clin Endocrinol Metab 1995 Jul;80(7):2227-2232; Thys-Jacobs S, et al. Am J Obstet Gynecol 1998 Aug;179(2):444-452; Wilson SA. J Fam Pract 1998 Dec;47(6):410-411.)
Magnesium: 400-800 mg per day (preferably aspartate). Cofactor for PGE 1. Magnesium levels are usually normal in the serum, but intracellular erythrocyte magnesium is usually found to be lower in PMS women. Dairy and calcium interfere with magnesium absorption while sugar increases its excretion (Abraham, G. Magnesium Bulletin 1:68-73; Nicholas, A. First Int. Sympos. on Magnesium Deficiency in Human Pathology.)
Tryptophan: 1-2 g per day, without food
Tyrosine: 500 mg twice daily, especially for PMS-D. Tyrosine may help catecholamine synthesis
Vitamin A 100,000-300,000 IU per day (2nd half of cycle) TOXIC DOSE! MONITOR CLOSELY (Block, 1960, p. 586ff)
Consider thyroid
Vitamin B3: Cofactor for PGE 1
Zinc: Cofactor for PGE 1
Digestive enzymes
footnotes
Abraham, G., Hargrove, J. Effect of Vitamin B6 on PMS symptoms in women affected: A double blind crossover study. Infertility, 3(2):155-65, 1980.
Abstract: 25 patients with moderate or severe PMS symptoms were studied for 6 cycles. For 3 months half received either placebo or 500mg time release B6. They were then switched. During this time a symptom diary was kept recording 19 total symptoms. 21 of the 25 did better on the B6 than the placebo. In each of the cases the differences were statistically significant.
Abraham, G. Magnesium deficiency in PMS. Magnesium Bulletin 1:68-73
Abstract: It was found that women with PMS-A consume 2.5X more refined sugar than women without or with mild PMS.
Abraham, Guy. Nutritional factors in the etiology of the PMS syndromes. J Reprod Med. 28:446-64, 1983.
Abstract: PMS patients were compared to normals and it was observed that PMS women ate 63% more refined carbohydrates, and 275% more refined sugar.
Dennefors, B., Sjogren, A., Hamberger, L. Progesterone and cAMP formation by isolated human corpora lutea of different ages: influence of HCG and prostaglandins. J Clin Endocrin Metab. 55:102-107, 1982.
Abstract: It was found, in vitro, that PGF2 had a net effect of decreasing progesterone secretion. Thus animal fats should be avoided as much as possible.
Doll, H., et al. Pyridoxine and the PMS: A randomized crossover trial. J Royal College of General Practitioners 39:326, 364-68, Sept. 1989.
Abstract: 63 women ages 18-49 were enrolled in a random double blind cross-over trial. The women received either 50mg/day B6 or placebo for 3 months. Symptoms included depression, irritability, tiredness, headache, breast tenderness, swollen abdomen/hands, etc. At this dose depression, irritability and tiredness were the only symptoms to respond and they were reduced by 50%.
Facchinetti F, Nappi RE, Sances MG, Neri I, Grandinetti G, Genazzani A. Effects of a yeast-based dietary supplementation on premenstrual syndrome. A double-blind placebo-controlled study. Gynecol Obstet Invest 1997;43(2):120-124.
Abstract: A dietary approach has proven to be effective in alleviating symptoms of premenstrual syndrome. In our previous studies, magnesium improved premenstrual irritability and mood swings. In this double-blind, placebo-controlled study, we evaluated the effects of a new dietetic preparation (Sillix Donna, Giuliani) in 40 patients affected by mild to moderate premenstrual syndrome. Premenstrual symptoms were scored in both follicular and luteal phases, at baseline, at 2nd, 4th and 6th month of treatment by using the Menstrual Distress Questionnaire (MDQ). Twenty patients were randomised to receive the active preparation and 20 placebo. MDQ scores at baseline were similar in the two groups. Five patients of the placebo group dropped out because of treatment failure. No side effects were observed. Both treatments reduced symptoms already in the 2nd month, but the active preparation was more effective at all time controls (p < 0.05); at the 6th month it significantly reduced premenstrual MDQ scores to 18% of baseline values, placebo only to 73%. These data demonstrate that Sillix Donna is effective in reducing premenstrual distress.
Golden, B. Estrogen excretion patterns and plasma levels in vegetarian and omnivorous women. N Eng J Med. 307:11542-47, 1982.
Abstract: Fecal excretion of estrogen in 10 vegetarian and 10 omnivorous menstruating women was performed. The omnivorous women consumed an average of 12 gms fiber/day while the vegetarian women consumed an average of 29 gms/day. It was found that there was a positive correlation between fecal estrogen and fiber intake. An inverse relationship existed between blood estrogen levels and fiber intake.
London RS, Murphy L, Kitlowski KE, Reynolds MA. Efficacy of alpha-tocopherol in the treatment of the premenstrual syndrome. J Reprod Med 1987 Jun;32(6):400-404. Abstract: In a preliminary study, alpha-tocopherol supplementation was effective in reducing specific symptoms of the premenstrual syndrome (PMS). To confirm these findings, we performed a randomized, double-blind study using d,alpha-tocopherol and placebo in a carefully screened population of women with PMS. Standardized PMS questionnaires were administered in the luteal phase of the menstrual cycle to all subjects, before and after daily treatment with 400 IU d,alpha-tocopherol or placebo for three cycles. Of the 46 subjects enrolled, 41 completed the clinical trial. A significant improvement in certain affective and physical symptoms was noted in subjects treated with d,alpha-tocopherol.
London RS, Sundaram GS, Murphy L, Goldstein PJ. The effect of alpha-tocopherol on premenstrual symptomatology: a double-blind study. J Am Coll Nutr 1983;2(2):115-122. Abstract: In a double-blind, randomized dose-response study, 75 women with benign breast disease were administered a written questionnaire in which they scored the severity of premenstrual syndrome (PMS) symptoms before and after two months of treatment with placebo or alpha-tocopherol (150, 300, or 600 IU/day). Controlling for age and pretreatment scores, alpha-tocopherol had a significantly greater effect than placebo, improving three of the four classes of PMS symptoms. These findings suggest that vitamin E supplementation may be of value in women with severe PMS symptoms.
London RS, Sundaram G, Manimekalai S, Murphy L, Reynolds M, Goldstein P. The effect of alpha-tocopherol on premenstrual symptomatology: a double-blind study. II. Endocrine correlates. J Am Coll Nutr 1984;3(4):351-356.
Abstract: In a randomized, double-blind, dose-response study, alpha-tocopherol significantly ameliorated symptoms in three of the four classes of the premenstrual syndrome (PMS). Alpha-tocopherol treatment had no significant effect on serum concentrations of testosterone, dehydroepiandrosterone sulfate (DHEA-S), estradiol, and progesterone. However, independent of treatment, a significant correlation emerged
between temporal changes in one PMS category and changes in DHEA-S concentrations. These results suggest that improvement in PMS severity is not mediated through direct effects of alpha-tocopherol on serum steroids. Androgens, however, may play a role in some PMS symptomatology.
Nicholas, A. Treatment of premenstrual syndrome with Magnesium. First Int. Sympos. on Magnesium Deficiency in Human Pathology.
Abstract: 192 patients received magnesium nitrate 4.5-6 gms daily for 1 week premenstrually and 2 days menstrually. Nervous tension was relieved in 159/179, mastalgia in 155/162, weight gain in 59/62 and headache in 16/37.
Rossignol, A. Caffeine containing beverages and PMS in young women. Am. J. Public Health 75(11):1335-37, 1985.
Abstract: 295 students with moderate to severe symptoms were studied. 61% of the women who drank 4.5 to 15 caffeine containing drinks daily experienced moderate to severe symptoms, while only 16% of the women who consumed no caffeine experienced moderate to severe symptoms.
Rossignol, A. Tea and PMS in China. Am J. Public Health 79:67-9, 1989.
Abstract: 188 nursing students were questioned about tea consumption and PMS. Women consuming more than 4.5 cups per day had a relative risk of 9.7. This adds to work done by Minton regarding coffee and FBD.
Thys-Jacobs, S. et al. Calcium supplementation in PMS: a randomized crossover trial. J. Gen. Intern. Med. 4:183-189, 1989.
Abstract: 78 PMS patients were given 1 gm of Ca carbonate for 3 months in a double blind intervention trial. 33 completed the trial. Pain, bloating and negative effect were significantly reduced in the calcium group. Overall symptoms were cut in half, and 73% preferred the calcium to the placebo.
Thys-Jacobs S, Alvir MJ. Calcium-regulating hormones across the menstrual cycle: evidence of a secondary hyperparathyroidism in women with PMS. J Clin Endocrinol Metab 1995 Jul;80(7):2227-2232.
Abstract: Calcium metabolism across one menstrual cycle was studied in 12 healthy, premenopausal women. Seven women had documented premenstrual syndrome (PMS), and five were asymptomatic controls. Fasting blood samples were drawn at six points throughout the ovulatory cycle. In both the asymptomatic and the PMS groups, total and ionized calcium declined significantly at midcycle with the increase of estradiol. In the PMS group only, peak midcycle intact PTH was significantly elevated by approximately 30% compared with early follicular levels (49 +/- 25 vs. 37 +/- 22 ng/L, t = 3.79, P = 0.009). In the asymptomatic group, iPTH did not vary during the menstrual cycle. Midcycle iPTH was significantly higher in the PMS group compared with that of the control group (49 +/- 25 vs. 26 +/- 7 ng/L, Wilcoxon Z = 2.28, P = 0.02). Multivariate analysis showed that total and ionized calcium both varied significantly across the menstrual cycle. Significant differences between groups were found for total calcium, 25OHD, and 1,25-(OH)2D. One woman with PMS was treated with oral elemental calcium and cholecalciferol daily for 3 months, with amelioration of her symptoms. Midcycle iPTH and 1,25-(OH)2D declined after repletion of 25OHD. In conclusion, we found that concentrations of total and ionized calcium significantly fluctuate during the menstrual cycle both in symptomatic and in asymptomatic women. We also found that concentrations of iPTH, 25OHD, and 1,25-(OH)2D differed between groups during specific phases of the menstrual cycle. Our data suggest that women with PMS have midcycle elevations of iPTH with a transient, secondary hyperparathyroidism.
Thys-Jacobs S, Starkey P, Bernstein D, Tian J. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Premenstrual Syndrome Study Group. Am J Obstet Gynecol 1998 Aug;179(2):444-452.
Abstract: OBJECTIVE: Previous reports have suggested that disturbances in calcium regulation may underlie the pathophysiologic characteristics of premenstrual syndrome and that calcium supplementation may be an effective therapeutic approach. To evaluate the effect of calcium carbonate on the luteal and menstrual phases of the menstrual cycle in premenstrual syndrome, a prospective, randomized, double-blind, placebo-controlled, parallel-group, multicenter clinical trial was conducted. STUDY DESIGN: Healthy, premenopausal women between the ages of 18 and 45 years were recruited nationally across the United States at 12 outpatient centers and screened for moderate-to-severe, cyclically recurring premenstrual symptoms. Symptoms were prospectively documented over 2 menstrual cycles with a daily rating scale that had 17 core symptoms and 4 symptom factors (negative affect, water retention, food cravings, and pain). Participants were randomly assigned to receive 1200 mg of elemental calcium per day in the form of calcium carbonate or placebo for 3 menstrual cycles. Routine chemistry, complete blood cell count, and urinalysis were obtained on all participants. Daily documentation of symptoms, adverse effects, and compliance with medications were monitored. The primary outcome measure was the 17-parameter symptom complex score. RESULTS: Seven hundred twenty women were screened for this trial; 497 women were enrolled; 466 were valid for the efficacy analysis. There was no difference in age, weight, height, use of oral contraceptives, or menstrual cycle length between treatment groups. There were no differences between groups in the mean screening symptom complex score of the luteal (P = .659), menstrual (P = .818), or intermenstrual phase (P = .726) of the menstrual cycle. During the luteal phase of the treatment cycle, a significantly lower mean symptom complex score was observed in the calcium-treated group for both the second (P = .007) and third (P < .001) treatment cycles. By the third treatment cycle calcium effectively resulted in an
overall 48% reduction in total symptom scores from baseline compared with a 30% reduction in placebo. All 4 symptom factors were significantly reduced by the third treatment cycle. CONCLUSIONS: Calcium supplementation is a simple and effective treatment in premenstrual syndrome, resulting in a major reduction in overall luteal phase symptoms.
Wilson SA. Calcium therapy for treating PMS. J Fam Pract 1998 Dec;47(6):410-411.