[SoFlaVeg] Nutritional Factors in PMS, Menstrual Pain

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Nutritional Factors in Menstrual Pain and Premenstrual Syndrome

Neal D. Barnard, M.D.

 

Disorders of menstrual function can be taxing and sometimes even

disabling. Up to 10 percent of women in their teens and early

twenties suffer from severe menstrual pain. In most cases, there is

no identifiable cause. However, for some women, the pain is a symptom

of endometriosis (a condition in which cells that normally line the

uterus have ended up in the abdominal cavity), adenomyosis (the

existence of islands of uterine lining cells deep within the uterine

muscle), fibroids (the presence of overgrown muscle cells in the wall

of the uterus), or other conditions.1 Nutritional factors appear to

play an important role in managing menstrual pain.

 

Premenstrual syndrome includes feelings of moodiness, tension, or

irritability, as well as physical symptoms, such as water retention.

Like menstrual pain, it appears to be influenced by nutrition.

 

One of the treatments we are testing is the use of a very-low-fat,

vegetarian diet. We are using this diet because, when it is properly

followed, it has the very helpful effect of reducing the amount of

estrogen in the blood, sometimes to a striking degree.2-12 For some

individuals at least, diets that avoid animal products and keep

vegetable oils to a bare minimum cause a marked reduction in

menstrual pain, presumably because of the diet's effect on hormones.

 

There are several reasons why this diet affects hormones. First of

all, reducing the amount of fat in the food you eat reduces the

amount of estrogen in your blood. This appears to be true for all

fats—animal fats and vegetable oils.

 

Second, plant products contain fiber (roughage), which tends to carry

estrogens out of the body. Here is how it works: The liver filters

estrogens out of the blood and sends them down a small tube, called

the bile duct, into the digestive tract. There, fiber from grains,

beans, vegetables, and fruits soaks up the estrogens like a sponge.

If plant foods are a major part of your diet, you'll have plenty of

fiber. But the amount of fiber in your diet is reduced when you have

yogurt, chicken breast, eggs, or other animal products, because fiber

comes only from plants. Without adequate fiber, the estrogens in your

digestive tract end up being reabsorbed back into the bloodstream.

 

Certain foods that are common in vegetarian diets have special

effects. Soy products, for example, contain phytoestrogens, which are

very weak plant estrogens that reduce your natural estrogens' ability

to attach to your cells. The result is less estrogen stimulation of

cells.

 

In addition to individual reports that low-fat, vegetarian diets can

cause dramatic reductions in menstrual pain, vegetarians also have

fewer ovulatory disturbances. Some researchers have found that excess

estrogen plays a role in PMS symptoms, too, and that shifting the

balance of the diet away from fatty foods and toward high-fiber plant

foods is helpful.13

 

A Dietary Approach

 

The diet that has been extremely helpful in individuals excludes

animal products completely and also keeps vegetable oils very low.

Our experience is that the diet must be followed closely in order for

it to work. This means no animal products at all—not even skim milk

or eggs. It also means keeping vegetable oils to a bare minimum in

the diet.

Even though olive oil or peanut butter are better than chicken fat or

beef fat when it comes to cholesterol levels, the effect on hormones

is what we are concerned about here, and all fats—animal fats and

vegetable oils—have to be avoided, because they all cause extra

estrogen to be made by your body.

 

So, in addition to keeping animal products out of the diet, it is

important to avoid oily salad dressings, french fries, potato chips,

butter, margarine, cooking oils, and the shortening that is in many

cookies and pastries. It also appears to be important to make this

change for the entire month, not just before your period.

 

This is a big change in the diet, of course. However, a very short

test will show whether it works for you. Its effects have been

noticeable in the very first month or two after women have made this

change.

It is also a great way to lose excess weight without counting

calories. Some people also note that other problems, such as

migraines, are less common with this kind of diet. To test whether a

change in diet will help you, we suggest that you follow a low-fat,

vegetarian diet very strictly for two months.

 

Let us look briefly at getting complete nutrition. It is a simple

matter, but please pay particular attention to the issue of vitamin

B12.

 

Protein is not a problem on vegetarian diets, because plant foods

have plenty of protein. Any normal variety of plant products contains

more than enough protein for the body's needs.

 

Calcium is found in abundance in green leafy vegetables and beans.

You'll also find a very rich source of calcium in fortified orange

juice. Also, plant-based diets actually reduce the amount of calcium

that is lost through the kidneys each day.

 

Iron balance tends to be better on pure vegetarian diets than on

other diets. Green leafy vegetables and legumes (beans, peas, and

lentils) are rich in a form of iron that is more absorbable if your

body needs more iron and less absorbable when your body already has

plenty of iron. Avoiding dairy products helps, because they contain

virtually no iron and can actually inhibit iron absorption.

 

Vitamin B12 is needed for healthy nerves and healthy blood.

Vegetarian sources, such as fortified soymilk or cereals, are not

very common, so we recommend supplementing with any typical daily

multivitamin or other reliable source of vitamin B12. While most

authorities believe that it is only necessary to take B12 supplements

if you have been on a pure vegetarian diet for more than three years

or in childhood, pregnancy, or lactation, we suggest that you begin

B12 supplementation within the first few months of beginning a

vegetarian diet, mainly to get in the habit of ensuring complete

nutrition.

 

For menus, recipes, and additional information, we suggest that you

look at Eat Right, Live Longer or Food for Life by Neal Barnard,

M.D.,

The Peaceful Palate by Jennifer Raymond, any of the nutrition books

by John McDougall, M.D., or cookbooks by Mary McDougall.

 

Other nutritional factors affect menstrual symptoms, too, and are

described below:

 

Essential Fatty Acids

 

As you know, different kinds of fats act differently in your body.

Animal fats contain a great deal of saturated fat, which is the kind

of fat that is solid at room temperature, while vegetable oils

contain more unsaturated fats, which are liquids. But there are

actually many more subtle differences between different kinds of fat.

 

Fats influence the production of prostaglandins in your body. These

natural chemicals are involved in inflammation, pain, muscle

contractions, blood vessel constriction, and blood clotting.

Prostaglandins are suspected of playing a role in menstrual pain,

migraines, and gastrointestinal pains, particularly since many of the

pain-killing medicines that are commonly used to treat menstrual pain

inhibit the effects of prostaglandins.14

 

People whose diets are balanced in favor of certain fats, called

omega-3 fatty acids, rather than other fats, tend to have milder

menstrual symptoms. Some people adjust their fat balance by adding

extra omega-3-rich oils, such as flax oil or fish oils, to the diet,

to try to counteract the " bad " fats in meats and dairy products.

Unfortunately, this strategy tends to increase the amount of fat in

the diet, which can be risky from several health standpoints.

 

A better strategy is to keep your diet rich in green, leafy

vegetables and legumes (beans, peas, and lentils) and to eliminate

meats and dairy products. The result is a new diet balance that

favors omega-3s.14

 

Vitamin B-6

 

Vitamin B-6 (pyridoxine) has been shown to reduce pain in some

research studies. It has been used to increase resistance to pain in

people who are withdrawing from overused headache remedies and has

helped people with carpal tunnel syndrome, nerve pains of diabetes,

and temporomandibular joint pain (TMJ).15

 

In a way, this is no big surprise, since the vitamin has long been

known to be used in the body to make neurotransmitters, the chemicals

that conduct our nerve messages, including those that affect the way

we feel pain.

 

Vitamin B-6 appears to affect the pain itself, not the underlying

condition. For example, when researchers check the nerve functions of

patients with carpal tunnel syndrome or diabetes, vitamin B-6 does

not seem to affect them, but it does appear to work against pain.

Vitamin B6 has also been shown to help in reducing depression,

irritability, and other symptoms in some research studies.16,17

 

B-vitamins appear to play a role in controlling estrogens, by

facilitating their removal in the liver. Presumably, if your diet is

low in B-vitamins, the amount of estrogen in the blood may rise.18

 

The healthiest B-6 sources are whole-grains, beans, bananas, and

nuts. Refined grains lose much of their B-6 along with their fiber.

People on typical European and North American diets are more likely

to be deficient in vitamin B-6, because their high protein intake

from meats, dairy products, and eggs, requires extra B-6.

 

HEALTHFUL SOURCES OF

VITAMIN B-6 (content in milligrams)

Source Amount

 

Walnuts 7.3

Soybean flour 7.2

Avocados 4.2

Cornmeal 2.5

Potatoes (raw) 2.5

Whole wheat bread 1.8

Peas (raw) 1.6

Spinach 1.5

 

Studies using B-6 supplements generally use doses in the range of 50

to150 milligrams per day. It should be used under the guidance of

your physician. Higher amounts must be avoided as they can actually

cause nerve problems. B-6 supplements typically take three months or

more to work.

 

Sugar

 

Simple sugars can contribute to irritability and depressed mood.

Researchers have found that sugar increases the amount of certain

brain neurotransmitters that control moods. In our experience,

individuals are affected by sugar very differently. For some women,

especially just before a period is due, a bar of chocolate or any

other sugary food—even orange juice—can cause a dramatic increase in

irritability, while other people have a much more mild reaction.16

 

While sugary foods, especially chocolate, are often craved during the

premenstrual period, it is well worth avoiding them as an experiment

to observe the differences in how you feel.

 

Foods that are rich in complex carbohydrates and fiber, such as whole

wheat bread, brown rice, oatmeal, vegetables, and beans, do not seem

to cause moodiness, and higher protein foods, such as beans or tofu,

tend to help block the effect of sugar on moods.

 

Calcium

 

Some evidence suggests that getting into better calcium balance can

help reduce both menstrual pain and PMS. The effect is probably not a

large one, however, and not all women notice an effect.

 

Most people think that improving calcium balance means ingesting more

calcium either through supplements or dairy products. And, indeed,

calcium carbonate supplements have been shown to reduce PMS

symptoms.19

 

But potentially much more important is to reduce the amount of

calcium your body is losing minute by minute. Researchers have

clearly established that animal proteins increase the loss of calcium

by increasing the amount of calcium your kidneys remove from the

blood and excrete in the urine. When people avoid animal proteins,

their calcium losses are cut to less than half of what they had

been.20

 

Calcium losses can be further reduced by avoiding excess sodium,

limiting caffeine intake to no more than two cups of coffee per day,

avoiding tobacco, having regular exercise, and assuring that you get

vitamin D, either from regular sun exposure or from a typical

multiple vitamin.

 

Manganese

Manganese is associated with reduced moodiness and menstrual pain.21

 

Caffeine

Caffeine aggravates PMS, and the more caffeine you consume—in coffee,

tea, colas, or chocolate—the worse your PMS is likely to get.22

Although individual brands vary, here is a guide to the approximate

amounts of caffeine in various products:

 

CAFFEINE CONTENT (in milligrams)

Source Amount

 

Percolated or drip coffee, 1 cup 115-180

Brewed coffee, 1 cup 80-135

Instant coffee, 1 cup 65-100

Black tea, 1 cup 30-50

Coca-Cola, 20 ounces 77

Pepsi, 20 ounces 63

Chocolate, 1 ounce 6-26

 

Please Share Your Experiences

 

In contrast to the number of women who are struggling with menstrual

pain and PMS, the amount of research on this subject is surprisingly

meager. You can help by sharing your individual experiences with

nutritional or other factors that have helped you. Such experiences

often lead researchers in useful directions. If you would like to do

so, please contact Neal D. Barnard, M.D., 5100 Wisconsin Avenue,

Suite 400, Washington, D.C. 20016. Thank you.

 

References

1. Mersky H, Bogduk N (eds). Classification of Chronic Pain, 2nd

edition. IASP Press, Seattle, 1994, pp. 164-6.

2. Goldin BR, Adlercreutz H, Dwyer JT, Swenson L, Warram JH, Gorbach

SL. Effect of diet on excretion of estrogens in pre- and

postmenopausal women. Cancer Res 1981;41:3771-3.

3. Goldin BR, Gorbach SL. Effect of diet on the plasma levels,

metabolism, and excretion of estrogens. Am J Clin Nutr

1988;48:787-90.

4. Shultz TD, Leklem JE. Nutrient intake and hormonal status of

premenopausal vegetarian Seventh-day Adventists and premenopausal

nonvegetarians. Nutr Cancer 1983;4:247-59.

5. Barbosa JC, Shultz TD, Filley SJ, Nieman DC. The relationship

among adiposity, diet, and hormone concentrations in vegetarian and

nonvegetarian postmenopausal women. Am J Clin Nutr 1990;51:798-803.

6. Adlercreutz H. Western diet and Western diseases: some hormonal

and biochemical mechanisms and associations. Scand J Clin Lab Invest

1990;50, Suppl 201:3-23.

7. Barr SI, Janelle KC, Prior JC. Vegetarian vs nonvegetarian diets,

dietary restraint, and subclinical ovulatory disturbances:

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Dietary fat reduction and plasma estradiol concentration in healthy

postmenopausal women. J Nat Cancer Inst 1990;82:129-34.

9. Ingram DM, Bennett FC, Willcox D, de Klerk N. Effect of low-fat

diet on female sex hormone levels. J Natl Cancer Inst 1987;79:1225-9.

10. Rose DP, Boyar AP, Cohen C, Strong LE. Effect of a low-fat diet

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in total fat in women with postmenopausal breast cancer: a pilot

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Morrill-LaBrode A. Low-fat, high-fiber diet and serum estrone sulfate

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premenopausal women. Am J Clin Nutr 1989;49:1179-83.

13. Abraham GE. Nutrition and the premenstrual tension syndromes. J

Appl Nutr 1984;36:103-24.

14. Deutch B. Menstrual pain in Danish women correlated with low n-3

polyunsaturated fatty acid intake. Eur J Clin Nutr 1995;49:508-16.

15. Bernstein AL. Vitamin B6 in clinical neurology. Ann NY Acad Sci

1990;585:250-60.

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premenstrual tension syndromes. J Reprod Med 1987;32:405-22.

17. Kleijnen J, Ter Riet G, Knipschild P. Vitamin B6 in the treatment

 

of premenstrual syndrome—a review. Br J Obstet Gynaecol

1990;97:847-52.

18. Biskin MS. Nutritional deficiency in the etiology of menorrhagia,

 

metrorrhagia, cystic mastitis and premenstrual tension: treatment

with vitamin B complex. J Clin Endocr Metab 1943;3:227.

19. Thys-Jacobs S, Ceccarelli S, Bierman A, Weisman H, Cohen M, Alvir

 

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1989;4:183-9.

20. Remer T, Manz F. Estimation of the renal net acid excretion by

adults consuming diets containing variable amounts of protein. Am J

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