Dear Curious,

To help combat the multitude of symptoms during the menstrual cycle, eat healthfully throughout the month. Take in a variety of fruits, veggies, whole grains, lean proteins, low-fat dairy, and healthful oils (mono-unsaturated and Omega-3s), which provide a plethora of nutrients. For many women, eating more frequently helps lessen irritability and similar symptoms of low blood sugar. Other women who tend to retain fluids easily feel better with less sodium in their diet (<2000 mg/day). Some women find relief by reducing caffeine and alcohol intake. Studies have found that regular exercise all month long decreases the intensity of menstrual symptoms. Frequent exercise also helps alleviate stress and decrease excess fluid retention. Basically, improving overall nutrition is sound advice. Be easy with yourself — it takes time to incorporate these changes into a permanent, consistent eating style.

Many nutrition theories have been related to premenstrual syndrome (PMS), but most have gone unproven. Many of these are based on individual vitamin or mineral needs. The only one that may have some merit is calcium. First let's take a look at some of the popular suggestions and whether it pays to give them a try.

Vitamin B₆ has often been recommended to relieve PMS symptoms. In 1999, an overall analysis of many of the studies on this supplement was published (this type of review is termed a "meta-analysis"). Unfortunately, many of the studies had glitches — they weren't done very well, so firm conclusions can't really be drawn. The main problem is that lab studies on Vitamin B₆ used anywhere from 50 - 200 milligrams per day — and doses of 100 mg per day can cause non-permanent nerve damage. Given the potential risks (even though the damage is reversible), why experience negative side effects from a vitamin? Even if you don't take this upper limit in a supplement, be aware that many foods on the market today are fortified, and reaching toxic levels may be easier than you think. Vitamin B₆ is not recommended, then, for PMS relief, due to potential problems and little proof of effectiveness.

Magnesium has been recommended for PMS relief, but the evidence for this mineral is scanty as well. The Upper Tolerable Level is 350 mg. per day; studies on magnesium used 200 mg. If you want to try magnesium, since excess of this mineral acts as a laxative, be sure you aren't getting over 350 mg/day from all supplemental sources. (By the way, diarrhea usually doesn't occur from food sources of magnesium.)

Vitamin E has been studied as well — basically, some studies show a benefit, some don't. There is no proof of its effectiveness against PMS symptoms at this time.

Evening Primrose Oil is another suggested remedy for PMS symptoms. This supplement contains a gamma-linolenic acid, which is converted by our bodies into another substance (prostaglandins) that helps regulate pain and inflammation. Although Evening Primrose Oil is most likely safe, studies found it no more effective than a placebo. This supplement probably won't hurt you, but since it isn't a proven remedy, it's not recommended.

A variety of herbal supplements have been claimed to alleviate PMS symptoms, but be aware of possible undesirable side effects. For example, extract of chaste tree berry can interfere with the effectiveness of hormone-based medications, including birth control pills.

If you do want to try a supplement, calcium may be the only one that has shown promising results. It has been determined that estrogen regulates calcium metabolism. Calcium absorption fluctuates across the menstrual cycle. The similarity between low calcium levels and PMS is strong. Symptoms of both conditions include depression, anxiety, and irritability. A Columbia University College of Physicians and Surgeons study investigated the effect of calcium on body indicators and mood changes during the menstrual cycle. For three months, researchers tracked 17 different symptoms of PMS (cramps were included) in over 400 women. They were given either a placebo or 1,200 mg. of calcium carbonate. Twenty-nine percent of calcium takers found at least 75 percent improvement in symptoms, 55 percent found at least a 50 percent improvement, and 8 percent got worse. The results of this study were published in The American Journal of Obstetrics and Gynecology in 1998. Although this research was funded by GlaxoSmithKline, the maker of Tums, it was well done and hailed as impressive by many in the scientific and medical communities.

Calcium is an important mineral that many women fall short on. Adequate Intake levels are:

• 1300 mg/day for girls ages 9 - 18
• 1000 mg/day for women 19 - 50 years
• 1200 mg/day for people over 50 years old

The Upper Tolerable Level is 2500 milligrams per day. If you are not currently taking in sufficient calcium, adding more calcium-containing food choices to your eating plan is a good idea. Supplementation may be advisable if you cannot obtain the recommended levels through what you eat. For food sources of calcium, see Calcium — How much is enough? in Alice's Fitness and Nutrition archive.

There are no magic answers for symptoms related to one's menstrual period. For different women, some of the strategies listed above provide more relief than others. Leading a healthy lifestyle may provide you with the best results. If you decide to try any supplements, discuss them first with your health care provider, to prevent against any adverse interactions with other medications you may be taking (including oral contraceptives). In addition, be sure to visit your gynecologist for an examination to determine if the reason for your cramps is due to another medical condition.

Alice

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