From the Nutrition Science News
by Joan Friedrich, Ph.D., C.C.N.
Current research shows that good nutrition and supplementation
can relieve many of the symptoms of PMS
Premenstrual syndrome (PMS) and related conditions have long been
known to have a significant impact on the quality of life for
many women. The symptoms resulting from hormonal alterations that
occur during this time are universally known and have been
discussed in medical writings since the time of Hippocrates.
Statistics today indicate that as many as 30 percent to 40
percent of menstruating women commonly experience some symptoms
of PMS during the premenstrual period. In recent years it has
been observed that PMS symptoms occur in definable clusters,
leading to four distinct medical classifications.  Most women
experience one or a combination of these symptom clusters:
PMS-A: Anxiety, irritability, nervous tension, insomnia,
PMS-H: Hyperhydration, water and salt retention, abdominal
bloating, breast congestion and tenderness, edema of face and
extremities, headaches, weight gain;
PMS-C: Cravings for sweets, food bingeing, increased
appetite, sugar ingestion followed by heart palpitation, fatigue,
fainting spells, headaches, shakiness;
PMS-D: Depression, withdrawal, insomnia, forgetfulness,
Fortunately, current research is making new strides in
determining the causes of these symptoms. Diet is being linked to
PMS, and good nutrition and supplementation have been found to
help relieve many of its symptoms.
The Working Body
In order to understand how diet can affect PMS, it is important
to look at how the female reproductive system works, especially
the functions of estrogen and progesterone -- two major hormones
involved in the menstrual cycle. In women, both of these
originate primarily from the ovaries.
During the first half of the menstrual cycle, estrogen levels
begin to increase. Acting as a central nervous system stimulant,
high estrogen levels can be linked to the irritability associated
with PMS. At ovulation, when estrogen levels start to decline,
the lowering of the estradiol (one form of estrogen) is believed
to contribute to the irritation and depression common before the
menses.  Changes in estrogen levels may also alter
aldosterone-renin functions involving regulation of sodium and
potassium in the blood, potentially leading to fluid retention,
another PMS symptom.
For its part, progesterone tends to have low concentrations
in the blood stream during the follicular (first) phase of the
menstrual cycle. However, during the second half of the
cycle -- from ovulation to menses -- levels increase dramatically.
During this later phase, progesterone acts as an antagonist to
estrogen, but when cycles are disturbed or imbalanced, or if
progesterone levels are insufficient, estrogen "dominates" and
PMS symptoms can be more pronounced. The natural decline of
progesterone near the end of the second phase prompts the menses
Following are some signs and symptoms of estrogen
- Edema (water retention)
- Breast swelling (fibrocystic breasts)
- PMS mood swings and depression
- Loss of libido
- Heavy or irregular menses
- Uterine fibroids (noncancerous tumors of the smooth muscle in
- Cravings for sweets
- Weight gain (especially hips and thighs). 
Progesterone offers many benefits to the PMS sufferer.
Progesterone helps by acting as a natural anti-depressant,
restoring libido, normalizing blood sugar, facilitating thyroid
hormone, serving as a natural diuretic, restoring proper cell
oxygen levels, protecting against fibrocystic breasts, helping
use fat as fuel and normalizing zinc and copper levels. 
While numerous theories exist regarding the causes of PMS, no
single explanation suffices. Many theories blame the syndrome on
various conditions: elevated estrogen or hyperestrogenism,
hormonal imbalances, alterations in brain amines (serotonin and
dopamine), elevated free luteinizing hormone levels (prompted at
ovulation), emotional and physical stress, and excess prolactin.
Two key theories, however, emphasize the roles of prostaglandin
balance and nutrition.
The Prostaglandins Theory: Prostaglandins are
modified forms of unsaturated fatty acids that are synthesized in
virtually all cells of the body and which act as chemical
messengers. PMS could result from a disturbance in the body's
production of prostaglandins and a consequent imbalance of the
various female hormones.
Prostaglandins are intimately linked to the composition and
balance of fatty acids in the body. Conversely, proper balance
and conversion of dietary and supplemental fatty acids, such as
omega-6 oil, promotes prostaglandin balance.
In particular, the prostaglandin E-series (PGE1, PGE2)
conversions are involved in maintaining normal composition and
balanced fatty acids in the body. Both PGE1 and PGE2 are
end-products of omega-6 fatty acids when they are converted into
prostaglandins. PGE2, however, is derived more directly from
arachidonic acid (AA) conversion, e.g. from the ingestion of beef
and most other animal fats. Since excessive amounts of PGE2 may
be produced from excessive intake of AA, meat intake may worsen
some PMS symptoms by promoting decreased pain threshold,
vasodilation and increased capillary permeability.
The theory linking prostaglandin and PMS suggests the importance
of promoting a healthier balance of prostaglandins leading to
more efficient PGE1 and PGE2 creation. Supplementation with plant
oils rich in omega-6 fatty acids appears to promote PGE1 and to
relieve PMS. A deficiency of PGE1 can produce fatigue, headache
and sweet cravings.  Therapeutic or dietary measures that promote
prostaglandin production from di-homo-gamma-linolenic acid
(DGLA), an unsaturated omega-6 fatty acid found in linseed and
other oils, achieve greater PGE1 levels relative to PGE2 and are
therefore promising means of PMS management. 
In order to receive sufficient PGE1, the delta-6-desaturase (D6D)
system must make proper conversions. Good health, proper
nourishment and a toxin-free lifestyle ensure the greater
likelihood of this conversion. Disturbances in the D6D conversion
process can occur, however, if any number of blocking factors
Potential D6D blocking factors include:
- Genetic tendency
- Excess sugar intake
- Decreased zinc levels
- Decreased magnesium levels
- Decreased pyridoxine (B6) levels
- Alcohol intake
- Elevated cholesterol
- Dietary trans-fats
- Caffeine intake
- Excess saturated fats
- Decreased vitamin C levels
- Decreased vitamin B3 levels
Nutritional Influence Theory: Several nutrients
also are believed to be involved in fatty acid balance and PMS
symptomatology. Magnesium, for example, plays a role in fatty
acid PGE1 conversion and magnesium deficiency is therefore
implicated in mood, fluid balance and cravings symptoms.
Research indicates that magnesium deficiency can cause a
depletion of dopamine levels in the brain, alter the adrenal
cortex, elevate aldosterone levels and increase extracellular
fluids.  Even minor magnesium deficiency can provoke symptoms
including anxiety, irritability, insomnia and depression.
Since chocolate is high in magnesium, it is often deduced that
the characteristic cravings for chocolate occurring during the
premenstrual period are a result of magnesium deficiency. Many
clinicians find that magnesium supplementation often helps reduce
cravings for sweets in PMS patients.
Zinc is also a cofactor required for prostaglandin conversions.
Additionally, zinc deficiency is associated with reduced
secretion of progesterone and "feel good" endorphins.  Therefore,
zinc appears to play an important role in PMS-related depression
and irritability. Since vegetarians are susceptible to having
insufficient zinc intake, special attention to zinc levels may be
needed when evaluating overall dietary nutrient levels in
Pyridoxine (B6) may assist in the normalization of magnesium
levels  and act as a coenzyme in the metabolism of several
mood-related neurotransmitters, including dopamine. Pyridoxine
can also play a role in fluid balance due to its diuretic action.
Other nutrients that are believed to assist in the alleviation of
PMS include vitamins C, B3, E and calcium.
PMS And Dietary Culprits: Several dietary factors
have been implicated in the symptomatology of PMS. Of particular
concern is sugar consumption.  Consuming large amounts of sugar
appears to have many harmful effects on the body including
increased insulin secretion and the suppression of ketoacid
formation (factors that reduce fluid retention). Both of these
effects promote weight gain. In addition, sugar has been shown to
increase magnesium urinary loss. 
Caffeine consumption has also been linked to PMS. This is
especially evident as dose levels increase.  Not only is
caffeine well known as a nervous-system stimulant, but excessive
caffeine can prompt increased urination, thereby promoting
nutrient losses that can further aggravate PMS symptoms.
Alcohol consumption can in particular be a contributor to PMS-C
symptoms, such as cravings for sweets, fatigue and headaches.
Alcohol inhibits gluconeogenesis (the formation of glucose from
fatty acids and proteins rather than from carbohydrates),
promoting reduction of blood sugar.  Furthermore, the increase
in stomach acid that follows alcohol ingestion can cause cellular
responsiveness that leads to glucose fluctuations and excessive
insulin release. 
As noted earlier, PMS-H symptoms have been linked to
hyperhydration or fluid retention. Salt therefore can aggravate
cravings, since it enhances glucose-induced insulin production
through greater glucose (sugar) absorption. 
The Importance Of A Healthy Diet
Various nutritional recommendations for the management of PMS are
commonly accepted. Besides avoiding the culprits outlined above,
strategic restructuring of the diet provides physiological
changes that eliminate or reduce many PMS symptoms.
Fiber-rich foods are particularly important in maintenance or
restoration of healthy estrogen levels. In one study comparing 10
vegetarian women (eating 25 to 33 g food/ day) and 10 omnivorous
women (eating 11 to 13 g food/day), blood estrogen levels were
significantly lower in the vegetarian women than in the
omnivorous women.  Hyperestrogenism may also be improved with
the addition of Lactobacillus acidophilus.  This
"friendly flora" appears to help metabolize estrogen properly in
The best sources of fiber are whole grains, legumes, root and
leafy vegetables, fresh fruits, nuts and seeds. Cruciferous
vegetables, in particular, contain an important substance called
indole-3-carbinol (I3C), a compound that can actually alter
estrogen metabolism in a positive manner.  Eating organically
produced foods can also ensure that pesticides, which can upset
estrogen balance, are excluded from that diet. And protein
sources that are hormone- and pesticide-free are sensible dietary
Research also indicates that soy is an excellent source of
phytoestrogens, plant-derived estrogens which have weaker effects
in the body but which can reduce the body's need to manufacture
its own human estrogens. 
Reducing animal protein in the diet also helps to shift dietary
fat composition. Animal fats may help increase populations of
bacteria in the intestine that can hydrolyze conjugated estrogens
into active free estrogens--thus, instead of being eliminated,
they can be reabsorbed.  A diet lower in animal fats and higher
in omega-3-rich fish and vegetarian proteins may also help reduce
the likelihood of an overabundance of AA and PGE2.
Dietary fats should include the essential fatty acids and can be
obtained from using a mixture of various natural oils and
oil-containing foods from the omega-6 (e.g., sesame, sunflower
and soy) and omega-3 (e.g., cold-water fish, pumpkin seed and
flaxseed) varieties. Many of these foods and oils also contain a
combination of the fatty acids.
Natural Remedies For PMS
Current research on PMS focuses on natural progesterone. The most
common form of natural progesterone is found in the wild yam.
This yam contains a sterol called diosgenin, which can be
converted into progesterone. Currently many nutritionally
oriented physicians are recommending natural progesterone creams
not only in the treatment of PMS, but within protocols for other
hormone-related conditions including menopause and osteoporosis.
A number of popular herbs are also helpful tonics. They include:
(Angelica sinensis): Contains
phytoestrogens, substances that have regulatory action on
estrogen activity. 
(Viburnum prunifolium) and Cramp
bark (V. opulis): In their beneficial actions, both
can act as antispasmodics, uterine sedatives and an emmenagogue
(helps promote menstrual flow).
(Rubus idaeus): A traditional
strengthening and tonifying herb, it can help relax uterine
(Cimicifuga racemosa): Another
estrogenic herb that promotes healthy menstruation; soothes
irritation and congestion of the uterus, cervix and vagina; and
acts as an anti-inflammatory agent.  NSN
Joan A. Friedrich, Ph.D., C.C.N., an independent health care
consultant, holds board certifications in clinical nutrition and
biofeedback therapy. She is a widely published author and serves
on the advisory board of Nutrition Science News.
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