Nutritional Pearls: Could Diet Improve Premenstrual Syndrome Symptoms?

Jenny is a healthy 26-year-old woman. At her most recent check up, Jenny mentions that she has been experiencing symptoms of premenstrual syndrome, and is curious if there are any lifestyle modifications she can make to help improve her symptoms.

How would you advise your patient?
(Answer and discussion on next page)

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Up to 85% of menstruating women experience at least 1 of the clinically recognized symptoms of premenstrual syndrome (PMS), and as many as 10% of the population experience the syndrome fairly seriously. There are a number of theories regarding the cause of the syndrome as well as what might make the symptoms worse or better: studies have been performed that focus on higher sensitivity to the changing levels of progesterone and estrogen, while others have linked the hormonal and neurotransmitter imbalances to the effects of specific nutrients.

As you might expect, there has been some research into overall diet, including 1 study that appeared to show that a low-fat vegetarian diet might decrease the duration of symptoms. We do know that those women experiencing PMS tend to consume more sweets, fast foods, fried foods, coffee, and alcohol. Work stress has also been linked to more and more severe PMS symptoms.
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The Research

A team in Iran recruited female nurses from surrounding hospitals to participate in a case-control study. The nurses were screened using a standardized premenstrual symptom screening questionnaire to identify 160 nurses who experienced PMS and 160 nurses who did not.¹ None of the participants had other diagnosed diseases, including diabetes, polycystic ovary syndrome, or premature menopause, nor were they taking birth control pills, anti-depressants, or other psychoactive mediations, trying to lose weight, nor did they smoke. All participants had their body mass index and waist-to-hip ratio calculated by the researchers and responded to a demographic questionnaire that included such items as age, marital status, education level, and amount of physical exercise.

Finally, the subjects described their usual dietary intake for the previous year by estimating how frequently they consumed a specific portion size of 147 food items.

With the food questionnaire's responses the authors were able to identify 3 major dietary patterns that they described as "healthy," "Western," and "traditional."

A "healthy" diet was "high in vegetables, fruits, natural juice, olive, tea and coffee, fish, low-fat dairy products, legumes and nuts."
A "Western" diet was "high in red and visceral meats, fast foods, vegetable oil and mayonnaise, sweets and desserts, salty snacks, refined grains, sugar and soft drinks, high-fat dairy products, spices, and fried potato."
A "traditional" diet "was high in eggs, cooked potatoes, legumes and nuts, poultry, hydrogenated oil, cabbage, sweets and desserts."

The Results

The participants were first grouped into their overall dietary type and then split into 5 increasing levels of adherence to that diet. After taking into account body mass index, age, menstrual cycle status, physical activity level, and caloric intake, they saw that those with the highest adherence to a Western diet were more than twice as likely to experience Premenstrual syndrome than those in the lowest quintile of adherence. At the same time, those at the second-highest adherence to a healthy diet were 28% less likely to experience Premenstrual syndrome than those with the lowest adherence to a healthy diet as defined by the authors.

What’s the “Take-Home”?

Case-control studies like this one don't prove that 1 thing causes another—it may well be that those with severe PMS appear to have a less-healthy diet because their PMS leads them to crave less-healthy foods. Clearly more research is needed to see if diet can have an effect on PMS. That said, if you struggle with PMS, it would be worth your while to take a look at your usual diet and see if it can be tweaked to be a little less "Western."

Reference:

1. Farasati N, Siassi F, Koohdani F, et al. Western dietary pattern is related to premenstrual syndrome: a case–control study. Brit J Nutr. 2015;114:2016-2021