By Stephanie Mercurio

What is PMS & PMDD?

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are a series of physical and psychological symptoms that affect up to 20% of women during the luteal phase of their menstrual cycle!¹

Symptoms include (but are not limited to) breast tenderness, abdominal bloating, headaches, water retention, depression, irritability, anxiety, confusion, social withdrawal, and anger. These symptoms can range can range from moderate to severe, and can negatively impact quality of life tremendously. Many women function in daily life while dealing with debilitating pain and discomfort in belief that this is just “how it is”.

How is this diagnosed?

PMS is diagnosed when at least one physical symptom and one psychological symptom presents during the 5 days leading up to the onset of your period, and disappears within 4 days during your period for at least 3 cycles. PMDD is diagnosed with increased severity of these symptoms.²

Women often underreport their related symptoms because it is thought that the pain and discomfort that they experience are considered to be “normal”! It is also not unheard of that reported symptoms are often downplayed and minimized by practitioners. I had one client tell me that their specialist told them that “it was all in their head”! 

Oral contraceptives, SSRI (selective serotonin reuptake inhibitor) drugs, and NSAIDs (like Advil) are often suggested as blanket treatment to manage these symptoms. Nevertheless, more and more women are rejecting these recommendations and are seeking alternative solutions!

This sounds like me. Tell me more.

Thankfully, there are women’s health experts who agree that a taking a functional approach to our reproductive cycle, observing dietary, lifestyle, and environmental factors, are superior in addressing some of these debilitating symptoms and experiences. Optimizing nutrition and lifestyle practices are increasing in popularity as more and more women become interested in taking more of a natural approach to their wellness. Nutrition and lifestyle modifications are also less invasive and may be more accessible to most women. It also helps that intuitively, investing in our wellness through nutrition is what feels right for us too! Never ignore that *gut* feeling!

The (TLDR) Nutritional Science. 

The good news is that we have a pretty good idea of what specific nutrients might be related. Vitamin B6, vitamin D, calcium, magnesium, iron, and potassium have all been studied in their relationship to PMS as well as their efficacy in reducing symptoms. In one study, women with PMS symptoms had insufficient dietary intakes of these nutrients, with their bloodwork showing low concentrations of calcium, magnesium, and potassium.¹

Additionally, Vitamin B6, iron, and magnesium are essential in the creation and conversion of neurotransmitters in the brain that help us feel mentally balanced and “with it”. Our body synthesizes Dopamine, a neurotransmitter responsible for helping us feel pleasure and motivation, is created by converting the amino acid Tyrosine, a process that requires B6, iron, and magnesium. 

Serotonin, helping us manage our attention and behavior, is synthesized from the amino acid Tryptophan, which also requires these nutrients as well. B6 and iron are required for the conversion of Glutamate to GABA, which helps us feel ease and calm after feeling anxiety or stress.^2,5

The Calcium & Vitamin D Relationship

One study found that women who supplemented with 1000mg of calcium resulted in significant reductions in both physical and psychological symptoms of PMS, and that women who have increased intakes of calcium and vitamin D are at a reduced risk for experiencing PMS.²  It is unclear if vitamin D alone helps improve PMS/PMDD symptoms, but, because calcium requires vitamin D in order to be absorbed in our gut, it is thought that vitamin D may be helpful by association, rather than direct cause.  Together, vitamin D and calcium support estrogen and progesterone, the two primary hormones involved in your reproductive cycle, and increasing your intake of both may reduce the severity of your symptoms.^5,7

Glutathione: Your Body’s Magic Antioxidant

Most people think that antioxidants are the things that we get from fruits and veggies are fight those little things we call “free radicals”. We know that antioxidants help reduce inflammation and help keep us healthy. But what many don’t realize is that our bodies also generate our own antioxidants too! Glutathione is your body’s most powerful antioxidant that is produced by the liver and is most commonly known for it’s role in immunity. However, it is hypothesized that glutathione status can also be impactful on how great you are feeling each month around your cycle!

It is thought that low availability of glutathione “precursors” (substances that combine to create another substance), are related to increased oxidative stress, impaired liver detox, and estrogen elimination. This could be related to why our boobs get unbearably sore and swollen, and we feel tired, irritable, and cranky leading up to our period. Your body creates glutathione at the end of a biochemical a process that is called trans-sulfuration. There’s a lot that is going on during the processes that lead us to glutathione synthesis, but what you need to know is that adequate protein, vitamin B6, magnesium, potassium, and zinc are all needed to help you create enough glutathione! These nutritional deficiencies are associated with low glutathione status and increased likelihood of suffering from PMS symptoms.^⁵,⁶

Sooo what do I do now?

Well, it just so happens that there are a world of different foods we can eat every day to help support our nutrient status! Remember that these specific nutrients aren’t the only ones that are important. Micronutrients are your body’s keycodes, and other outlying processes require their own set of nutrients to keep us feeling well! It’s important to consume a diversity of different foods every day to help support us. We can also use supplementation strategically to help support us where we might lack. Women who have adequate dietary intakes of B-complex vitamins, vitamin D, calcium, magnesium , iron, and potassium are found to be at a decreased risk for the onset of PMS and other related symptoms associated with the natural hormonal shifts we experience during the luteal phase of our menstrual cycle.^1,2,5 But before we go gung-ho on a bunch of different supplements, it would be best to be assessed by a women’s specialist who can observe your current dietary and lifestyle habits, micronutrient status, and hormonal balance and make specific recommendations that are right and true for you.

Most of us have a story about how we have had professionals *guess* about what is best for us, our hormones, our period, our fertility, our symptoms, and everything else in between. Birth control, antidepressants, and other pharmacological drugs have been prioritized as blanket treatment that often leave us feeling like they are merely a band-aid over the bullet hole. Although there is a time and a place for pharma, there is also so much we can do to positively influence our health simply by optimizing the quality and quantity of the foods we eat! 

I would love to hear from you! 

Do you have a story like this that you’d like to share? Leave me a comment below!
I can’t wait to hear from you!

Love,
Steph

 

 

References:

1. Yonkers KA, O’Brien PM, Eriksson E. Premenstrual syndrome. Lancet. 2008;371(9619):1200-1210. doi:10.1016/S0140-6736(08)60527-9
2. Kaewrudee S, Kietpeerakool C, Pattanittum P, Lumbiganon P. Vitamin or mineral supplements for premenstrual syndrome. Cochrane Database Syst Rev. 2018;2018(1):CD012933. doi:10.1002/14651858.CD012933
3. Jones DS, Quinn S. Reversing the chronic disease trend: Six steps to better wellness. https://p.widencdn.net/xazlwe/Intro_Functional_Medicine. Published 2017. Accessed August 6, 2020.
4. Bland J. Defining function in the functional medicine model. Integr Med (Encinitas). 2017;16(1):22-25.
5. Draper CF, Duisters K, Weger B, et al. Menstrual cycle rhythmicity: metabolic patterns in healthy women [published correction appears in Sci Rep. 2019 Apr 3;9(1):5797]. Sci Rep. 2018;8(1):14568. doi:10.1038/s41598-018-32647-0
6. Lord RS, Bralley JA. Laboratory evaluations for integrative and functional medicine. 2nd ed. Duluth Georgia; Genova Diagnostics:2012.