Premenstrual Dysphoric Disorder (PMDD) is a severe form of Premenstrual Syndrome (PMS) that significantly impacts women's emotional and physical well-being. While the exact cause of PMDD remains unclear, research suggests that dietary and nutritional factors play a crucial role in managing its symptoms. This article explores the potential impact of diet, micronutrients, and lifestyle modifications on PMS and PMDD, offering recommendations for better management.
Understanding PMDD and PMS
Premenstrual syndrome (PMS) is a common disorder that affects women of reproductive age. Over 200 symptoms of varying severity have been identified. PMS can negatively impact a woman’s emotions and performance. The most severe form of PMS is premenstrual dysphoric disorder (PMDD), a medical condition that severely disrupts a woman’s quality of life. Up to 98% of women report at least one physical and mental symptom before the onset of their menstrual cycle. About 30-40% of women say PMS symptoms that involve drug treatment, and 3-8% of women suffer from PMDD that meets strict DSM-IV criteria.
PMS is a clinical condition that occurs during the luteal menstrual cycle, the last 14 days of the menstrual cycle (from ovulation to the onset of menstruation). Late luteal dysphoric disorder (LLDD), also known as premenstrual dysphoric disorder (PMDD), is the most severe form of PMS. It is considered a medical condition, severely disrupting women’s quality of life, often causing them to seek drug treatment. Due to the poor understanding of the mechanisms underlying PMS, the exact etiology of these premenstrual disorders remains unclear and effective treatments are limited. The most well-known hypotheses concerning PMS are associated with hormonal fluctuations, following ovulation, diets with nutritional deficiencies (especially in vitamin B6, magnesium, and calcium), family medical history, which includes depression or anxiety, etc. Symptoms may begin in the early, mid, or late luteal phase and are not associated with defined concentrations of any specific gonadal or non-gonadal hormone. Other arguments focus on abnormal serotonergic activity, progesterone, and gamma-aminobutyric acid (GABA) neurotransmitter aberrations and the presumed role of circulating gonadal steroids in the development of symptoms. Women with PMS experience affective or somatic symptoms that cause severe social or occupational dysfunction. The range of symptoms associated with PMS is extensive, varying in severity, differentiating from one individual to another, and extending across a range of medical specialties: from gynecological to psychiatric, affecting all aspects of life.
Better definitions and research based on strict inclusion-exclusion criteria have allowed the development of effective treatments adapted to the severity of lifestyle disruption and specific individual symptom totals.
The Role of Diet in Managing PMS and PMDD
Diet is an essential modulating factor in reducing and managing some of the symptoms of PMS. In a study that looked at the impact of three DPs: traditional DP, high in eggs, tomato sauce, fruit, and red meat; healthy DP, rich in dried fruits, spices, and nuts and Western DP, characterized by high consumption of fast food, carbonated drinks, and processed meat. Western DPs were positively associated with PMS, while healthy and traditional nutritional habits had an inverse correlation. It has been suggested that caloric intake, as well as preferential carbohydrate selection, during the premenstrual period is more significant in women with PMS, who are considered to be more sensitive to cyclical hormonal or neurotransmitter fluctuations. The improvement in mood after carbohydrate ingestion is explained by the increase in serotonin associated with tryptophan, ameliorating a potentially functional deficiency of serotonin in the brain and thus serving as self-medication. At the same time, a diet with excess sugars, especially simple fats, fried foods, coffee, and alcohol, correlates positively with the development of PMS.
Read also: The Hoxsey Diet
Macronutrients and PMS
Research has not identified correlations between the consumption of macronutrients and PMS: protein, fat, carbohydrates, and fiber. But it is suggested that maltose might be associated with PMS, and high intake of stearic acid may be associated with a lower risk of developing PMS.
Micronutrients and Supplements
Some studies have shown the effectiveness of micronutrients, especially calcium, magnesium, vitamin D, B vitamins, and herbal supplements, in reducing PMS.
Specific Dietary Recommendations
Calcium and Vitamin D
Several studies have shown that subjects with PMS have lower serum calcium levels, and calcium supplementation could significantly improve the incidence of PMS and its associated symptoms. Other research has justified the approach of a high intake of calcium associated with vitamin D in reducing PMS symptoms, including lowering the risk of osteoporosis and some cancers. Calcium and vitamin D supplementation is recommended as an inexpensive, low-risk, acceptable, and accessible approach to eliminate or reduce symptoms. Various studies show the importance of vitamin D in female reproduction, probably due to its effects on calcium homeostasis, cyclic sex steroid hormone fluctuations, or neurotransmitter function. It also helps reduce dysmenorrhea, inflammation, and antioxidant markers in women with PMS and vitamin D deficiency. In adolescents, vitamin D therapy is associated with improvements in PMS-related quality of life and mood disorders. According to the Mayo Clinic, 1,200 milligrams (mg) calcium daily can help ease physical and emotional symptoms.
Magnesium
Magnesium supplementation is considered effective in preventing dysmenorrhea, PMS, and menstrual migraine. According to the Mayo Clinic, 360 mg can help ease breast soreness and bloating.
B Vitamins
Thiamine (B1), riboflavin (B2), niacin (B3), pyridoxine (B6), folic acid (B9), and cobalamin (B12) are indispensable vitamins in the synthesis of neurotransmitters potentially involved in the pathophysiology of PMS. A comparative study, with reference to the effectiveness between vitamin B6 and broad-spectrum micronutrient formulas (which included minerals and vitamins) on PMS showed that both treatments provided similar benefits: the micronutrient formulas had a more significant effect on the quality of life, as well as a potential clinical use for PMDD. However, vitamin B6 therapy appears to be as effective as broad-spectrum formulas. According to the Mayo Clinic, 50 to 100 mg of Vitamin B-6 daily can help ease fatigue, irritability, and insomnia.
Read also: Walnut Keto Guide
Zinc
Zinc is known to have multiple beneficial effects, including anti-inflammatory, antioxidant, and antidepressant actions. Overall, zinc supplementation for 12 weeks among women with PMS had a beneficial impact on physical and psychological symptoms, total antioxidant capacity, and brain-derived neurotrophic factor.
Herbal Supplements
The effectiveness of dietary supplements is not sufficiently researched. Although some research claims that neither evening primrose oil nor St. John’s wort has any different effect than placebo, other research shows the positive impact of evening primrose oil on PMS. The potential beneficial effect of curcumin in alleviating the severity of PMS symptoms, possibly mediated by curcumin’s neurotransmitter modulation and anti-inflammatory effects, is also noted. According to an article published in American Family Physician, Evening Primrose Oil (EPO) is the most-studied herb for PMS. However, research is still inconclusive. There appears to be some benefit. In studies, participants took 500 to 1,000 mg of EPO daily. Chasteberry is thought to reduce prolactin production and reduce breast pain. St. John’s wort may help anxiety, depression, and irritability. It may also ease some physical symptoms of PMDD. Gingko reduces PMS symptoms better than a placebo, including bloating, fatigue, and insomnia. It’s thought gingko reduces prostaglandins in the body and increases the release of neurotransmitters in the brain.
Other Nutrients
According to the Mayo Clinic, 400 international units (IU) of Vitamin E daily can help reduce prostaglandins in the body. Prostaglandins are known to cause pain.
Lifestyle Modifications
Lifestyle modification and regular exercise may have a more pronounced positive effect in milder cases of PMS. At the same time, it is recommended to minimize the intake of salt, caffeine, and tobacco. A study of students in the United Arab Emirates reported that fruit consumption was associated with a reduced risk of behavioral symptoms, and smoking and consumption of caloric foods (high in fat, sugar, and salt) were identified as risk factors vital for PMS.
Aromatherapy
Aromatherapy involves inhaling essential oils to improve your physical and mental health. It’s used to reduce stress, improve sleep, and relieve pain. Some of the best essential oils for PMDD symptoms are: chamomile to promote relaxation and sleep, clary sage to relieve menstrual cramps and anxiety, lavender to experience a calming effect, neroli to ease anxiety and relieve PMS, and rose to reduce stress and relieve PMS.
Read also: Weight Loss with Low-FODMAP
Mindful Meditation
Research suggests that mindful meditation can reduce anxiety, depression, and pain - all common symptoms of PMDD. Meditation requires you to focus on the present moment and concentrate on your breathing. This can help you relax and detach from uncomfortable symptoms.
Warm Baths
Warm baths are good for almost anything that ails you. They can help soothe menstrual cramps, ease anxiety, and relax you for a better night’s rest.
Yoga
Yoga is an ancient practice that uses deep breathing, meditation, and specific poses to warm the body and help ease pain and promote relaxation. According to a 2016 study, yoga can improve menstrual pain and overall health. It also helped women become more aware of their physical and emotional distress, which may help them cope better.
Acupuncture
During an acupuncture session, thin needles are inserted into specific points on your skin to help relieve pain and reduce stress. According to a 2011 systematic review, acupuncture shows promise for treating PMS symptoms.
Quality Sleep
Chronic insomnia can lead to depression and anxiety. It also increases irritability and fatigue.
The Importance of Personalized Nutrition
Awareness of health and nutrition professionals to inform the public about the complexity of factors influencing PMS and the need for training/education regarding self-care practices for PMS management is current and necessary. At the same time, nutrition service providers should approach and adapt dietetic-nutritional therapy in a personalized way to reduce PMS.
tags: #pmdd #diet #recommendations