Who does it affect?
About 3-5% of women have symptoms so severe that it affects their work, education, relationships and/or daily activities. This is equivalent to 500,000 women in the UK alone. The average age of onset of PMS is 26 and it generally gets worse with age, with the most severe form affecting more women in their forties. As women get older they spend more time in the premenstrual phase as the cycle gets shorter and shorter towards menopause, giving rise to more frequent symptoms.
Premenstrual dysphoric disorder
Premenstrual dysphoric disorder (PMDD) is a diagnosis used by psychiatrists and other mental health workers to describe a specific set of particularly pronounced mood symptoms, appearing the week before, and going away a few days after, a period starts. Sometimes it is difficult to differentiate between a true depression and PMS. A telling difference is when your symptoms are only partially relieved when the period starts. In which case, it is worth exploring the possibility of an underlying psychiatric or physical health problem with your doctor or health care professional, as many conditions may give rise to similar symptoms. However, the good news is, once you have ruled out any other underlying condition, and you know that PMS is your problem, you can put an end to these unwanted symptoms after just a few months of following my optimum nutrition principles.
Elaine H is a case in point. She had suffered from PMS for as long as she could remember. Her moods were so bad in the week before her periods that her children would flee and her husband would cower. Here’s what she told me: “My PMS starts a week before a period. For the first two days I can handle it, my stomach starts churning, I get worse and worse, won’t listen to anyone, I go nuts, get breast tenderness, and have heavy painful periods.” Two months later here’s what she said: “I haven’t had any PMT – should be really bad right now. None of my outbursts. I’ve stuck to the diet completely. My energy has gone through the roof. I just feel like a completely different person. I can’t believe it’s happened so quickly. My husband can’t believe the change. No breast tenderness. My middle daughter said “what have you been doing to your skin. You look so much younger?” I’m really enjoying the diet. I’m trying new foods and the taste is great.”
What Causes PMS?
What is known is that PMS does not occur before the onset of the first period, during pregnancy or after natural or surgical menopause. Although the precise cause remains elusive, ovulation appears to be an important factor, with evidence suggesting that the symptoms are generally a result of changes in brain chemistry triggered by fluctuations in ovarian hormones. Both oestrogen and progesterone levels generally fall sharply before a period and this sudden change is thought to trigger PMS.
Two major brain chemicals (neurotransmitters) seem to be affected by this change – serotonin and gamma-aminobutyric acid (GABA). Serotonin - sometimes called the ‘happy hormone’ has been shown to help control appetite and carbohydrate cravings. Oestrogen helps to improve mood by keeping up the levels of serotonin. Antidepressants like Prozac and Seroxat are thought to work by helping to maintain levels of serotonin, although there are more natural ways to achieve the same thing (see below).
Similarly a derivative of progesterone enhances the production of GABA, which is a calming neurotransmitter that switches off adrenalin, helping to reduce anxiety and irritability. So falling levels of oestrogen and progesterone before a period could plausibly trigger PMS symptoms. Peri-menopausal and post-natal depression seem to bear this theory out, as in both cases there is a major decrease in both hormones.
Dopamine is another neurotransmitter involved, as you will see later. Having a well-balanced diet is the best way to provide the nutrients needed for all three of these neurotransmitters to work effectively. The protein that you eat is made up of amino acids, which are vital for many processes in your body, including making hormones, enzymes, and neurotransmitters. There are 22 altogether, eight of which are ‘essential’ which means they cannot be made in the body and therefore must come from the diet.
Tryptophan is one of these essential amino acids and is the raw material from which your body makes serotonin. However, it is the least abundant essential amino acid in food. Meat, beef, game, poultry, eggs and almonds are among the best sources. Dairy products, grains and chocolate also provide good amounts. Although chocolate is a stimulant and the sugar it provides makes it doubly attractive if you are having a blood sugar dip, it would be best not to rely on chocolate for your source of tryptophan.
Tryptophan is also carried into the brain by insulin so it is possible that carbohydrate cravings serve the purpose of increasing seorotonin production when needed. Therefore it is possible that low levels of serotonin explain sugar, carbohydrate and chocolate cravings before a period, so make sure your diet contains good sources. Many vitamins and minerals are needed to convert tryptophan to serotonin. Vitamin B6 in its active form - pyridoxal-5-phosphate (P5P) - is perhaps the most well known vitamin required for this conversion. However, the B vitamins niacin (B3), biotin and folate, plus vitamin C, as well as the minerals zinc and iron, are also needed. Interestingly, women taking the contraceptive pill are often deficient in B6. This vitamin plays a vital role in controlling mood and depression and was first prescribed in the 1970s to treat women on the pill suffering from depression. It is also ......
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