If you’re a woman with premenstrual syndrome (PMS), you know how bad it can be – uterine cramping (sometimes so bad that you have to stay in bed, and take painkillers), back pain, breast tenderness, carb cravings, moodiness, and even anxiety or depression. I feel for you. And if you’re a man living with or dating a woman who has PMS, I feel for you too, my brother.

                Fortunately, it doesn’t have to be this way. Hold on, I know what you’re thinking – “every woman has PMS. It’s normal.” But, that’s where you’re wrong. Not every woman has PMS. In fact, there are a lot of women without PMS. And this article will teach you how to become one of those women (yes, it is possible).

                But you have to suspend your disbelief, give it a fair shot for 3 menstrual cycles, and watch your PMS improve, or go away.

                In this article, we’ll discuss:

  • What is PMS, and its symptoms?
  • What causes PMS
  • The hormonal profile of PMS – the relationship between estrogen, thyroid, cortisol and PMS
  • Nutrition – what should you eat more of, and what should you eat (and drink) less of? In other words, what’s the best PMS diet?
  • Which supplements help improve PMS

If you’d like help that’s personal to your specific situation, we have a special online program called “PMS-Free 1-2-3.” If you’re interested, just apply to work with us by visiting FitnessSolutionsPlus.ca

PMS Diet
Original source: here.

What is PMS and Its Symptoms?

                PMS is premenstrual syndrome. If you break down that word, it tells you what it is – pre (before); menstrual (menstruation, or before the period/bleeding); syndrome (collection of symptoms).

                So it’s the group of symptoms that women feel in the 1-2 weeks before their period. What are those symptoms? Some of them were mentioned earlier, like:

  • Weight gain, because of bloating/water retention
  • Fatigue
  • Menstrual cramps
  • Carb cravings
  • Breast tenderness
  • Anxiety
  • Depression (depression during periods is called “premenstrual dysphoric disorder”, or PMDD)
  • Irritability
  • Acne

Unfortunately, because these symptoms are so common in the Western world, a lot of women give up trying to look for answers, and resign themselves to “this is just the way it is.” Better learn to live with it… for 40 years (from the time of the first period, around age 12, to menopause, around age 52). But again, it doesn’t have to be this way! If you implement the strategies in this article, you’ll either experience significant relief, or possibly even a complete disappearance of these symptoms, but again, it takes about 3 menstrual cycles, so give it a fair chance.

What Causes PMS?

                Unfortunately, the real cause(s) of PMS still elude scientists and doctors. But the best theories and research out there seem to link levels of hormone excess, and changes in brain chemicals (called “neurotransmitters”) with what’s going on. That’s why two of the most common treatments for PMS are the birth control pill and antidepressants (SSRIs, specifically).

                Since both high estrogen and high progesterone are associated with PMS, different birth control pills are used. If you want to read more about birth control, check out my article on that topic.

                And what is it that triggers fluctuations in a woman’s hormones during the menstrual cycle? Brain chemicals, like serotonin and dopamine.

                But we have to dig a bit deeper, and like a 4-year-old, ask “why?” Why would estrogen and/or progesterone be high in the first place? Why would there be imbalances in the neurotransmitters? Is it just genetics? Or is there a lifestyle component to it? Fortunately, if it was purely genetics, and there was nothing you could do about it, I wouldn’t be writing this article.

                So yes, there’s a very strong lifestyle component that affects estrogen, thyroid, cortisol, and serotonin levels.

PMS and Your Hormones

PMS and Estrogen

                Estrogen is the hormone that dominates the first half of the menstrual cycle. At day 0 (that’s the day you “get your period” or when you start bleeding), all hormones are low. Estrogen starts to rise gradually, and hits a high point around the mid-point – day 14. In the next 2 weeks, estrogen should fall, and progesterone should rise. That’s a healthy cycle.

                However, at least one study saw that in women with severe PMS, estrogen levels were higher in the second half of the cycle, compared to women who had mild PMS (508 pmol/l vs. 288 pmol/l). Severity was measured by both frequency of symptoms (number of times per day), and severity of symptoms (how bad is it – this is obviously subjective).

                But that begs the question – why would estrogen be high in the first place? There are a few different reasons (in no particular order):

  1. Diet high in low-fiber carbs. Whenever you eat a lot of carbohydrates, it raises blood sugar. The pancreas releases insulin to lower that blood sugar. The more low-fiber carbs you eat, the more insulin you release. Insulin stimulates an enzyme called “aromatase” to convert testosterone into estrogen to a greater extent than it would otherwise. By the way, I emphasize “low-fiber carbs”, because total carbs aren’t the problem. Excess low-fiber carbs are the problem. So things like beans, lentils, buckwheat and quinoa are better than pasta, white bread, and rice (contrary to popular belief, the difference between white rice and brown rice isn’t all that big).
  2. Environmental estrogens. Things like plastic bottles, personal care products (shampoos, body wash, cosmetics, deodorants, etc.), and others.
  3. Watching too many Julia Roberts, Meg Ryan, Matthew McConaughey and Ryan Gosling movies 😉

There are other causes of high estrogen (like ovarian and adrenal tumors), but they aren’t the first thing you’d suspect when a woman has high estrogen.

PMS and Thyroid

                The thyroid is a butterfly-shaped gland that sits in front of the windpipe, and it’s kind of like the “gas pedal” on your metabolism. The thyroid has a role to play in a lot of different functions, from your skin, to your hair, your brain, your body temperature, and others (by the way, if you’re an uber-geek, like me, and want to dive way deeper into thyroid physiology, Dr. Bryan Walsh does a great job of explaining it in this video).

                Could it be that a slow thyroid is at least partially responsible for PMS? This is where it gets interesting. Although some studies (like this one) show no relationship between thyroid and PMS, the majority of studies do.

                For example, one study concluded that “although it is clear that PMS is not simply masked hypothyroidism, abnormalities of stimulated thyroid function appear with greater than expected frequency in women with PMS and may define a subgroup of women with this disorder.” In this particular study, treatment with the thyroid hormone T4 didn’t not change much.

                Another study sheds a bit more light on this. In here, researchers measured the thyroid levels (and not just the standard TSH, but they went much deeper, testing T3, T4 and reverse T3) of women with PMS, and compared them to the thyroid levels of women without PMS. What they saw was that some (not all) women with PMS had abnormal thyroid function. They found that the biggest thyroid dysfunction was with reverse T3 (a test that is not often run, even though it’s covered by OHIP). This would explain a great deal when I hear clients saying “my blood work shows I’m normal… then why do I feel so crummy?” A good chunk of the time, it’s because inadequate testing is being done.

                With all this talk of “reverse T3”, we should probably define it. What is it? Reverse T3 is a molecule similar to T3 (the actual thyroid hormone), but it’s inactive. When it binds to thyroid hormone receptors, it essentially just blocks the receptor, so that actual thyroid can’t bind to it. It’s like putting a key inside the lock, and then breaking that key. No other key will get in. But if T3 only is measured on blood work, it doesn’t distinguish between T3 and reverse T3. However, if you run both T3 and reverse T3, you have a much clearer picture of what’s going on in the body.

                This makes sense from a practical perspective as well, because in one study, when a group of women with PMS was given T3 (Synthroid/levothyroxine) as a treatment (instead of T4, like in the other study), symptoms did improve within 3 months. In some participants of this study, symptoms went away entirely.

                What causes high levels of reverse T3? There are a number of causes, but the 2 most common ones are:

  1. Physical/mental/emotional stress.
  2. Low carbohydrate diets (keto, anyone?)

PMS and Cortisol

                Cortisol is what’s commonly known as “the stress hormone.” But we have it all the time – not just when we’re under stress. We just have more of it when we’re under stress.

                So could stress either be making PMS worse, or directly causing it? That’s what this study investigated. The researchers found that there was a significant relationship between stress and PMS. Women who reported lower stress levels had either less intense PMS, or no PMS.

                Though surprisingly, according to this study, it’s not high cortisol that causes PMS symptoms, but low cortisol. What’s going on here? The authors theorize the mechanism is “hypo-reactivity of the HPA axis.” Translation to English: when the brain hormones CRH (corticotropin-releasing hormone) and ACTH (adrenocorticotropic hormone) rise, in response to stress, cortisol should also rise. But in women with PMS, it doesn’t. Cortisol stays low, when it should actually be rising.

                For the purposes of this article, I break down stress into 2 categories:

  1. Mental/emotional
  2. Physical

For menta/emotional stress, the issue is largely of perception, rather than reality. Two people can experience the exact same event, but think about it completely differently. For instance, two people might be on an airplane. One person is sitting there quietly, anticipating the week-long vacation she’s about to be on. The other one is shaking, because she’s scared of flying. Objective event: identical. Flying on an airplane. Perception of the event: drastically different. This makes sense, because a number of studies have found cognitive behavioral therapy (CBT) to be an effective treatment for PMS.

I even wrote an article about 7 stress management strategies that may help you (no, alcohol is not one of them).

Physical stress would be either excessive exercise or insufficient exercise, but an even more important topic is sleep. Although there are no studies directly examining sleep hygiene as it relates to PMS, based on what we know about hormonal regulation, it would be a reasonable conclusion that sleep hygiene matters. When you sleep, you release melatonin, and it overall helps you “reset your hormones” (I elaborate on that in my article on what happens when you sleep). So proper sleep hygiene is key, and the most important part of sleep hygiene is bedtime regularity. That is, going to bed at the same time every day (including weekends), ideally between 10PM and 11PM. If you don’t have a regular bedtime, and you go to bed at different hours of the night, it’s very confusing to your body and brain. It’s like going to bed one day in Ontario time, the next day, in BC time, and the next day in Manitoba time. No es bueno.

The PMS Diet

                “OK, Igor. I understand the whole background on PMS, but what do I do about it?” I can hear you thinking. The solution is really simple: chocolate and red wine.

Just kidding.

I’m sorry, that was mean, I know.

                While there are a lot of foods purported to improve PMS (like celery, chickpeas, flaxseeds, etc.), I was not able to find any research to back it up. The research mostly looks at isolated nutrients (like calcium, magnesium, vitamin B6, etc.), and we can’t really generalize from isolated nutrients to nutrients at they’re found in food. But hey, PMS or no PMS, there’s certainly no harm in those foods, and potentially a benefit, so if you’re leaning that way, give it a shot (and I’ll provide a food list later in this article).

                What the research does focus on as far as the PMS diet is 2 things: caffeine and alcohol.

                One study looked at symptom severity and dose of caffeine, looking at women who drink as little as 1, to as many as 10 cups of a caffeine-containing beverage (coffee, tea, pop, etc.) per day, and it showed a dose-dependent increase in severity and frequency of PMS symptoms (ie the more they drank, the worse, and more frequent the symptoms). Another study found the same thing. It’s very rare to find such homogenous agreement on one topic in different studies (because sometimes studies show conflicting results), but when it comes to caffeine consumption, there is almost unanimous agreement: the more caffeine, the worse the PMS.

Sorry.

                Now that I’ve addressed one of people’s favourite beverages, let’s address the other one (because I have a death wish, you know…) – alcohol.

                Alcohol is another beverage that in multiple studies (like this one, this one, and others) has shown to make PMS worse. But to add confusion to the matter, in one study, women who drank more during the premenstrual period had greater symptoms of impaired social functioning (and we’re talking about casual drinking, not full-out alcoholism), and hostility/anger. Women who decreased their drinking during the premenstrual period had more pain and physical discomfort.

                The women who did the best were those whose drinking patterns hadn’t changed throughout their menstrual cycle.

                Unfortunately, unlike caffeine, alcohol hasn’t been studied to the same extent, so a few important questions aren’t answered, like:

  1. Are there differences between alcoholic beverages? How does wine compare to beer, vs. whiskey, etc.?
  2. Is it dose-dependent? With caffeine, we know that even a little caffeine can cause PMS symptoms, and the more caffeine a woman consumes, the worse the symptoms. Is it the same with alcohol? Or is it more of a threshold effect, where up to a certain amount is fine, and once you cross that threshold, PMS symptoms worsen?

The answer to both of these questions, at this time is “we don’t know.”

                Now that we have the “foods/drinks to avoid” out of the way, let’s address the obvious question: what do I eat? What’s the best PMS diet?

                To answer that, researchers look at the blood levels of different nutrients, to identify the biochemical differences between women with PMS and women without PMS. Here’s what they find:

  1. One study found that women whose magnesium levels were low had worse PMS compared to women who didn’t. Another study found the same thing as well.
  2. One study found that both dietary calcium and vitamin D correlated with PMS symptoms. Other studies have replicated these results.
  3. The other common nutrient that’s often used for the management of PMS is vitamin B6. With calcium and magnesium, we see deficiencies manifest as PMS. But one study looked at B6 status in women with PMS, and found no deficiency. Yet, a lot of studies show that supplementing with B6 improves PMS symptoms. What gives? Perhaps women with PMS have a higher requirement for vitamin B6, compared to women without PMS. Regardless of the theory, in practice, when vitamin B6 is given to women with PMS, their PMS improves.
  4. In one study, researchers divided women into 2 groups: tryptophan restriction (that’s an amino acid) and no tryptophan restriction. The group that restricted tryptophan had worse PMS symptoms (especially irritability) compared to women who didn’t restrict tryptophan. Makes sense, because tryptophan is what serotonin is made of.

Foods for the PMS Diet

                Now that we know which nutrients are low in PMS, it may make sense to add foods high in these nutrients to the PMS diet.

                If you’re using nutrition tracker apps, you can input what you currently eat, and they will tell you your nutrient breakdown. Below, I will tell you what to aim for.

Foods High in Magnesium           

  1. Pumpkin seeds. 50 grams of pumpkin seeds have about 265 mg of magnesium
  2. Squash seeds. Similar to pumpkin seeds
  3. Brazil nuts. 50 grams of Brazil nuts have about 170 mg of magnesium
  4. Cocoa powder has about 70 mg of magnesium per tablespoon
  5. Flax seeds. About 60 mg per tablespoon
  6. Sesame seeds. About 50 mg per tablespoon.
  7. Poppy seeds. About 50 mg per tablespoon.

For magnesium, aim for 300-600 mg per day

Foods High in Calcium

                Contrary to vegan propaganda popular myth, greens are not high in calcium at all. A person needs around 1200-1500 mg of calcium per day, but the typical greens listed (kale, broccoli and spinach) are quite low in calcium (90 mg, 42 mg, and 29 mg per cup, respectively).

                Here are the best sources of calcium:

  1. Sardines. 1 can has about 570 mg of calcium
  2. Romano cheese. 1 slice of cheese has about 330 mg
  3. Gruyere cheese. 1 slice has about 305 mg
  4. Yogurt. 1 cup has about 295 mg
  5. Mozzarella and Swiss cheese. 1 slice has about 290 mg
  6. Parmesan. 1 tablespoon has about 200 mg
  7. Milk. 1 glass has about 286 mg

Again, aim for 1200-1500 mg of calcium per day (that’s total calcium – food AND supplements).

Foods High in Tryptophan

  1. Dried cod. 100 grams of cod has about 700 mg of tryptophan
  2. Mozzarella. 100 grams have about 600 mg
  3. Lean beef. 100 grams has about 400 mg
  4. Lean pork. 100 grams has about 400 mg
  5. Chicken. 100 grams of chicken has about 370 mg
  6. Turkey. 100 grams of turkey has about 350 mg
  7. Pumpkin and squash seeds. 1 tablespoon has about 85 mg
  8. Parmesan. 1 tablespoon has about 85 mg

Aim to get 1500-3000 mg/day.

You’ll notice that vitamin B6 is missing from this list, and that’s because the dose given in research is 50-200 mg. You can’t even get close with food. The best food sources are in the 4 mg/serving range, and most foods are in the 0-1 mg range.

Foods for PMS

PMS Supplements

                We know some of the contributing hormonal and neurochemical factors contributing to PMS, and so supplements are used to improve those factors, whether it’s optimizing estrogen levels, improving cortisol status, or improving serotonin in the brain.

                Here are some of the most tried-tested-and-true supplements for PMS, along with their dosages:

  1. Magnesium (ideally magnesium glycinate): 200-600 mg/day. My favourite product is Genestra’s liquid mag glycinate.
  2. Calcium: 600-1200 mg/day. My favourite product is AOR’s bone basics or ortho bone (note: both of these products do have magnesium in them already).
  3. Vitamin B6: 50-200 mg/day.
  4. 5-HTP: 500-1000 mg/day.

My favourite product for both B6 and 5-HTP is 5-HTP Supreme, by Designs for Health. The reason I like it is because it’s a 2-in-1. It contains both B6 and 5-HTP in 1 capsule, so you don’t have to take multiple supplements.

PMS Supplements

And to this, although it’s not proven by research, I would add a basic multivitamin. My favourite one is Multigenics by Metagenics.

With all of these supplements, I’m not getting paid to mention them. I just mention them because they’re truly good products that I recommend to my clients who need them.

Now, you’ll notice that the range for dosages is fairly wide, so how do you figure out the right dose for you? I outline 4 criteria in this article.

In a nutshell, I’d start with figuring out the right dose. After that, I’d stick with it for at least 3 months. Then, I’d start experimenting with lowering the dose every month. If your symptoms stay at bay, great, you no longer need the same dose you needed in the first 3 months. If your symptoms, however, return at the lower dose, you know you need to bring it back up.

If you’d like help that’s personal to your specific situation, we have a special online program called “PMS-Free 1-2-3.” If you’re interested, just apply to work with us on our home page.