PMS-Can It Be Prevented By A Diet Change? 
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 PMS-Can It Be Prevented By A Diet Change?

This question came up in Sci. Med. Nutrition and I'm posting my answer
here.  Only 22 medical schools in the U.S. teach courses on human
nutrition.  We have already seen what a lack of nutrition education can do
when candida and kidney stones present themselves to the medical community.
I think that the best example of where U.S. medicine is really missing the
mark when it comes to a knowledge of nutrition is PMS.  So many women(and
their husbands) suffer from this disorder that it is really criminal that
most physicians in the U.S. are not taught that PMS is primarily caused by
diet and diet changes can prevent it from ever happpening.  Before shooting
your flames, read the entire article and then decide if flaming is

From A Poster In Sci. Medi. Nutrition:

>    In a psychological anthropology course I am taking, we got
> sidetracked onto a short conversation about PMS.  Some rumors shared
> by several of the students included ideas that vitamin levels, sugar
> intake, and caffeine intake might affect PMS symptoms.
>    Is there any data on this, or is it just so much hooey?

> Many thanks,

> Michael, I've wanted to reply to this post ever since I saw it but I got

side-tracked with candida.  PMS is a lot like Candida blooms, most
physicians don't recognize it as a specific "disease" entity.  Here is
everything that you would ever want to know about PMS.

Premenstrual syndrome has been divided into four specific subgroups:

        PMT-A(Anxiety)          PMT-D(depression)
        anxiety                 depression
        irritability            forgetfulness
        insomnia                confusion
        depression              lethargy

        PMT-C(Craving)          PMT-H(Hyperhydration)
        craving for sweets      weight gain
        increased appetite      {*filter*} congestion and tenderness
        sugar ingestion causes: abdominal bloating and tenderness
         1. headache            edema of the face and extremities
         2. palpitations
         3. fatigue or fainting

PMT-A is characterized by elevated {*filter*} estrogen levels and low
progesterone levels during the luteal phase of a women's cycle.

PMT-C is caused by the ingestion of large amounts of refined simple
carbohydrates.  During the luteal phase of a women's cycle, there is
increased glucose tolerance with a flat glucose curve after {*filter*}glucose
challenge.  The metabolic findings believed to be responsible for PMT-C are
a low magnesium and a low prostaglandin E1.  This condition of hypoglycemia
is not unique to PMS but there are a number of different causes of
hypoglycemia, magnesium and PGE1 seem to be specific to PMS hypoglycemia.
        A. Am. J. Psychiatry 147(4):477-80(1990).
Unrefined complex carbohydrate should be substituted for sugar, magnesium
supplementation and alpha linoleic acid supplementation(increased to 5-6% of
the total calories) using safflower oil or evening primrose oil as sources
of alpha linoleic acid.

PMT-D is characterized by elevated progesterone levels during the midluteal
phase of a women's cycle.  Another cause of PMT-D has been found to be lead
toxicity(in women without elevated progesterone levels during the midluteal
phase). "Effect of metal ions on the binding of estridol to human
endometrial cystol" Fertil. Steril. 28:312-18(1972).

PMT-H is associated with water and salt retention along with an elevated
serum aldosterone level.  Salt restriction, B6, magnesium and vitamin E
for {*filter*} tenderness have all been effective in treating PMT-H

This general discussion of the PMS syndromes came form:

        A. "Management of the premenstrual tension sundromes: Rational for
            a nutritional approach". 1986, A Year in Nutritional Medicine.
            J. Bland, Ed. Keats, Publishing, 1986.

        B. "Nutritional factors in the etiology of premenstrual tension
            syndromes", J. Reprod. Med.28(7):446-64(1983).

        C. "Premenstrual tension", Prob. Obstet. Gynecol. 3(12):1-39(1980)

Treatment has traditionally involved progesterone administration if you can
find a doctor who will treat you for PMS(just about as hard as finding one
that will treat you for candida blooms).  While progesterone will work,
supplementation with vitamins and minerals works even better.  There really
has been an awful lot of research done on PMS(much more than candida
blooms).  Many of these studies have been what are called experimental
controlled studies(the type of rigorous clinical studies that doctors like to
see done).

Here are a few of these studies:

        CARBOHYDRATE: Experimental Controlled Study, "Effect of a low-fat,
        high-carbohydrate diet on symptoms of cyclical mastopathy" Lancet
        2:128-32(1988).  21 pts with severe persistent cyclical mastopathy
        of at least 5 years duration were randomly selected to receive
        specific training to reduce dietary fat to 15% of total calories
        and increase complex carbohydrate ingestion or given general dietary
        advise with no training.  After 6 months, there was a significant
        reduction in the severity of the {*filter*} swelling and tenderness in
        the trained group as reported by self-reported symptoms as well as
        physical exams which quantitated the degree of {*filter*} swelling,
        tenderness and nodularity.

        VITAMIN A: Experimental Controlled Study, "The use of Vitamin A in
        premenstrual tension" Acta Obstet. Gynecol Scand. 39:586-92(1960).  
        218 pts with severe recurring PMS received 200,000 to 300,000IU
        vitamin A daily or a placebo.  Serum retinol levels were monitored
        and high dose supplementation was discontinued when evidence of
        toxicity occured(serum retinol above 450ug/ml).  The intent of the
        study was to load the liver up with vitamin A and get a normal pool
        size(500,000IU to 1,000,000IU) and then see if this
        normal vitamin A pool could prevent PMS.  48% getting the high dose
        vitamin A had complete remission of the symptoms of PMS.  Only 10%
        getting the placebo reported getting complete relief of PMS sysmptoms.
        10% of the vitamin A treated group reported no improvement in PMS

        Experimental Controlled Study, "Premenstrual tension treated with
        vitamin A" J. Clinical Endocrinology 10:1579-89(1950). 30 pts
        received 200,000IU of vitamin A daily starting on day 15 of their
        cycle with supplementation continuing until the onset of PMS symptoms.
        After 2-6 months, all 30 pts reported a significant improvement in
        PMS symptoms.  Vitamin A supplementation was stopped once evidence of
        toxicity was demonstrated and all 30 pts were followed for one year
        after high dose vitamin A supplementation was stopped.  PMS symptoms
        did not reoccur in any of these 30 pts for upto one year after the
        vitamin A supplementation was stopped.

Most Americans do not have a normal store of vitamin A in their liver.  
These studies and several others were designed to see if getting a normal
store of vitamin A into the liver could eliminate PMS.  Of all the vitamins
given for PMS(vitamin A, B6, and vitamin E), vitamin A has shown the best
single effect.  This is probably because vitamin A is involved in steroid
(estrogen/progesterone) metabolism in the liver.  Getting your liver full
of vitamin A seems to be one of the best things that you can do to prevent
the symptoms of PMS.  But vitamin A is toxic and you don't want to be trying
to do this without being seen by a physician who can monitor you for vitamin
A toxicity.

        VITAMIN B6: Experimental Double-blind Crossoverr Study, "Pyridoxine
        (vitamin B6) and the premenstrual syndrome: A randomized crossover
        trial"J.R. Coll. Gen. Pract. 39:364-68(1989).  32 women aged 18-49
        with moderate to severe PMS randomly received 50mg B6 daily or placebo.
        After 3 months the groups were switched and followed for another
        3 months.  B6 had a significant effect on the emotional aspects of
        PMS(depression, irritability and tiredness).  Other symptoms of PMS
        were not significanttly affected by B6 supplementation.

        Experimental Double-blind Study, "The efects of vitamin B6
        supplementation on premenstrual sysmptoms" Obstet. Gynecol
        70(2):145-49(1987).  55 pts with moderate to severe PMS received
        150mg B6 daily or placebo for 2 months.  Analysis of convergence
        showed that B6 significantly improved premenstrual symptoms related
        to the autonomic nervous system(dizziness and vomiting) as well as
        behavior changes(poor mental performance, decreased social interaction)
        Anxiety, depression and water retention were not improved by B6

Vitamin B6 is below the RDA for both American men and women.  Birth control
pills and over 40 different {*filter*} increase the B6 requirement in man.  
Women on birth control pills should be supplemented with 10-15 mg of B6 per
day.  The dose should be increased if symptoms of PMS appear.  Dr. David R.
Rubinow who heads the biological psychiatry branch of NIMH was quoted in
Clin. Psychiatry News, December, 1987 as stating that B6 should be
considered the "first-line" drug for PMS(over progesterone) and if the
patient does not respond, then other treatments should be tried.  Vitamin
B6 can be toxic(nerve damage) if consumed in doses of 500mg or more each

        VITAMIN E: Experimental Double-blind Study, "Efficacy of alpha-
        tocopherol in the treatment of premenstrual syndrome" J. Reprod.
        Med. 32(6):400-04(1987). 35 pts received 400IU vitamin E daily for 3
        cycles or a placebo.  Vitamin E treated pts had 33% who reported a
        significant reduction in physical symptoms(weight gain and {*filter*}
        tenderness) while the placebo group had 14% who reported a significant
        reduction in physical symptoms. The vitamin E group reported that 38%
        had a significant reduction in anxiety versus 12% for the placebo
        group.  For depression, the vitamin E group had 27% with a significant
        decrease in depression compared with 8% for the placebo group.

        Experimental Double-blind Study, "The effect of alpha-tocopherol on
        premenstrual symptomalogy: A double blind study" J. Am. Coll. Nutr.
        2(2):115-122(1983). 75pts with benign {*filter*} disease and PMT randomly
        received vitamin E at 75IU, 150IU, or 300IU daily or placebo.  After
        2 months of supplementation, 150IU of vitamin E or higher significantly
        improved PMT-A and PMT-C.  The 300IU dose was needed to significantly
        improve PMT-D.  No dose of vitamin E significantly improved PMT-H
        (other studies have shown that a higher vitamin E doses will relieve
        PMT-H symptoms).

        MAGNESIUM: Experimental Double-blind Study, "Magnesium prophylaxis
        of menstrual migraine: effects on itracellular magnesium" Headache
        31:298-304(1991). 20 pts with perimenstrual headache received 360 mg
        daily of magnesium as magnesium pyrrolidone carboxylic acid or a
        placebo.  Treatment was started on the 15th day of the cycle and
        continued until menstruation. After 2 months, the Pain Total Index
        was significantly lower in the magnesium group.  Magnesium treatment
        was also assocoiated with a significant reduction in the Menstrual
        Distress Questionnaire scores.  Pretreatment magnesium levels in  
        lymphocytes and polymorphonuclear leukocytes were significantly lower
        in this group of 20 pts compared to control women who did not suffer
        from PMS.  After treatment, magnesium levels in these cells was raised
        into the normal range.

        Experimental Double-blind Study, "{*filter*}Magnesium successfully
        relieves premenstrual mood changes" Obstet. Gynecol 78(2):177-81(1991).
        32pts aged 24-39 randomly received either magnesium carboxylic acid
        360mg of Mg per day or a placebo from the 15th day of the cycle to the
        onset of the menstrual flow.  After 2 cycles, both groups received
        magnesium.  The Menstrual Distress Questionnaire score of the cluster
        pain was significantly reduced during the second cycle(month) for the
        magnesium treatment group as well as the placebo group once they were
        switched to magnesium supplementation.  In addition, the total score on
        the Menstrual Distress Questionnaire was significantly decreased by
        magnesium supplementation.  The authors suggest that magnesium
        supplemenation should become a routine treatment for the mood changes
        that occur during PMS.

There are numerous observational studies that have been published in the
medical literature which also suggest that PMS is primarily a disorder
that arises out of a hormone imbalance that is dietary in nature.  But
since observational studies are considered by most physicians in Sci. Med.
to be anecdotal in nature, I have not bothered to cite them.  There are
also over a half dozen good experimental studies that have been done on
multivitamin and mineral supplementation to prevent PMS.  I've chosen the
best specific studies on individual vitamins and minerals to try to point out
that PMS is primarily a nutritional disorder.  But doctors don't recognize
nutritional disorders unless they can see clinical pathology(beri-beri,
pellagra, scruvy, etc.).  PMS is probably the best reason why every doctor
being trained in the U.S. should get a good course on human nutrition.  PMS
is really only the tip if the iceberg when it comes to nutritional
disorders.  It's time that medicine woke up and smelled the roses.

Here's some studies which show the importance in multivitamin/mineral
supplementation and/or diet change in preventing PMS.

        Experimental Study, "Effect of a nutritional programme on
        premenstrual syndrome: a retrospective analysis", Complement. Med.
        Res.5(1):8-11(1991).  200pts were given dietary instructions and
        supplemented with Optivite(R) plus additional vitamin C, vitamin E,
        magnesium, zinc and primrose oil.  The dietary instructions were to
        take the supplements and switch to a low fat, complex carbohydrate
        diet.  On a retrospective analysis, 96.5% of the 200pts reported an
        improvement in their PMS symptoms with 30% of the sample stating that
        they no longer suffered from PMS.

        Experimental Double-blind Study, "Role of Nutrition in managing
        premenstrual tension syndromes", J Reprod. Med. 32(6):405-22(1987).  
        A low fat, high complex carbohydrate diet along with Optivite
        supplementation significantly decreased PMS scores compared with diet
        change and placebo.  After 6 months on the experimental program, the
        vitamin/mineral supplementated group had significantly decreased
        estradiol and increased progesterone in serum during the midlutel
        phase of their cycle.

        Experimental Double-blind Study, "Clinical and biochemical effects
        of nutritional supplementation on the premenstrual syndrome", J.
        Reprod. Med. 32(6):435-41(1987). 119pts randomly given Optivite(12
        tablets per day) or a placebo.  The treated groups showed a
        significant decrease in PMS symptoms compared to the placebo.  Another
        group of 104pts got Optivite(4 tablets per day) or placebo.  For this
        second group of patients, no significant effect of supplementation on
        PMS symptoms was observed.

Martin Banschbach, Ph.D.
Professor of Biochemistry and Chairman
Department of Biochemistry and Microbiology
OSU College of Osteopathic Medicine
1111 W. 17th St.
Tulsa, Ok 74107

"Without discourse, there is no remembering, without remembering, there is
no learning, without learning, there is only ignorance"

Sat, 14 Oct 1995 05:16:54 GMT
 [ 1 post ] 

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