Nutrition IV - Common Ailments in Clinic - Premenstrual Syndrome

Question 1

Premenstrual Syndrome

Answer 1

Premenstrual Syndrome (PMS) refers to the presence of various symptoms during the late stages of the luteal phase (the second half) of the menstrual cycle that generally resolve within the first few days of menstruation
* Pathologically, PMS has been associated with sex hormone dysregulation that include:
o Oestrogen excess
o Low progesterone during the luteal phase (which subsequently lowers serotonin)
o Elevated prolactin (can be strongly influenced by stress)
o Inefficient processing of the hormones by the liver

Question 2

Causes and risk factors

Answer 2

• Nutritional deficits: Low magnesium and vitamin B6
• Stress: Stress stimulates cortisol release from the adrenals, which increases LH and FSH release from the pituitary gland. In turn, this disrupts oestrogen and progesterone
• Synthetic oestrogens (xenoestrogens): mimic oestrogen and bind to receptors to heighten oestrogen activity. Found in plastics (i.e. BPA). Pesticides, cleaning products, cosmetics etc

Question 3

General nutritional aims

Answer 3

• Ensure stable blood glucose as fluctuations can trigger symptoms
• Avoid refined carbohydrates. Include protein at each meal
• Avoid coffee, red meat and processed meat
• Good fibre intake (slows glucose release into bloodstream; thought to assist with the excretion of oestrogen)
• Include plenty of fresh fruit and vegetables, especially brassicas to support liver detoxification and processing of oestrogen
• If fluid retention is a symptom, decrease salt intake. Dandelion tea is a diuretic and assists with removing excess fluid

Question 4

Seed cycling

Answer 4

To regulate oestrogen levels in the first half of the cycle (follicular phase), consume 1 tbsp flaxseeds and 1 tbsp pumpkin seeds daily
In the second half of the menstrual cycle (luteal phase) comsume 1tbsp sesame and 1 tbsp sunflower seeds two boost progesterone levels

Follicular phase:
* Phytoestrogens in flaxseed modulate oestrogen
* Zinc in pumpkin seeds supports progesterone production in preparation for the luteal phase
Luteal phase:
* Lignans in sesame seeds block activity of excess oestrogen
* Vitamin E in sunflower seeds support synthesis of progesterone
Phytoestrogens = plant-derived compounds with structural similarity to oestradiol

Question 5

Vitamin B Complex

Answer 5

Vitamin B complex:
B1 & B2 (20 – 40 mg / day)
B3 & B6 (50 -100 mg / day)
B5 (150 – 300 mg / day)
B9 & B12 (500 – 1000 mcg / day)

• Food sources:
  o Whole grains; brown rice, barley, millet
  o Green veg
  o Lentils
  o Chickpeas
  o Avocado
  o Eggs
  o Salmon
• Functions:
  o The liver utilizes various B vitamins to detoxify oestrogen and excrete it in the bile
  o Several B vitamins are used to create neurotransmitters such as serotonin
  o Vitamin B6 is especially important because it:
   Is needed for progesterone production
   Assists with healthy oestrogen metabolism
  Is used for the production of GABA and serotonin – central roles in mood and pain regulation
   Alleviate fluid retention in PMS

Question 6

Zinc

Answer 6

Zinc (25 – 60 mg / day)

• Food sources:
  o Sesame seeds
  o Pumpkin seeds
  o Cashews
  o Lentils
  o Brown rice
  o Oysters
  o Salmon
• Functions:
  o Zinc levels are often lower in women with PMS and supplementation during the luteal phase has been shown to improve symptoms
  o Required for reproductive hormone synthesis
  o An essential co-factor in neurotransmitter production

Question 7

Evening Primrose oil

Answer 7

Evening Primrose oil (1500 mg daily for three months)

• Provides gamma linoleic acid (GLA)
• Functions:
  o GLA is a precursor to the beneficial ‘prostaglandin series 1’, which inhibits prolactin (increased in women with PMS)
  o Increased GLa has shown to improve PMS symptoms

Question 8

Magnesium

Answer 8

Magnesium (500 – 1000 mg / day, Epsom salt baths (500g – 1kg per bath))

• Food sources:
  o Dark leafy greens
  o Seeds
  o Nuts
  o Legumes etc.
• Function:
  o Shown to reduce anxiety– related PMS symptoms
  o Required for the synthesis of GABA (calming neurotransmitter) and serotonin (supports mood)
  o Magnesium is also needed for oestrogen metabolism

Question 9

Other considerations

Answer 9

Castor oil packs:
* Can ease muscle cramping when placed on the lower abdomen
* Soak a cloth in castor oil and place on the skin, layer a towel over the top and then a hot water bottle. Keep on for a minimum of 30 minutes