How Can I Control PMS with Diet?

Are you struggling with fatigue, bloating, mood swings, and even cravings and wonder if there are any natural solutions to improve your symptoms? Although we used to think diet and lifestyle had limited impact on the symptoms of PMS, up and coming research is actually pointing to the fact that our nutrition, both during the luteal phase as well as throughout our cycle, can have a significant impact on our PMS related symptoms. So, what foods have been documented to be the most helpful and how should we use these foods? I am so glad you asked!

Let’s dive in.

Now, although PMS is common, this doesn’t mean it’s normal. If you are experiencing monthly symptoms leading up to your period that have become severe or even debilitating to your daily life, this is absolutely NOT normal and should be evaluated by your doctor. To learn more about how we diagnose and evaluate PMS, check out my other blog post: Understanding PMS and PMDD.

So, what is the current nutrition research telling us about PMS?

When it comes to PMS, we need to remember that PMS occurs due to an inappropriate response to your normal hormones. In other words, if we were to test the hormone levels of two separate women, one with PMS and one without, their hormone levels could look exactly the same, even though only one of the women is experiencing the symptoms of PMS. Researchers theorize that PMS arises from an inappropriate response by your endocrine (hormone) system but also your brain. It is also the reason we so often see mood and behavioral changes in women with PMS. So, those almost uncontrollable cravings aren’t just common in PMS but they likely impact your eating behaviors and nutritional choices. Researchers are still unsure which came first. It is the poor nutrition and poor eating behaviors that causes PMS, or does PMS cause the poor nutrition and eating behaviors that worsen PMS. It’s really a concept of “chicken vs. the egg”, and there is still so much we need to learn in order to truly understand the root cause. What we do know is that your eating behaviors, and the foods you eat, absolutely impact the severity and frequency of PMS symptoms. 

Now, although you might be wondering what specific diet should be recommended fo women with PMS, the reality is, as of now, most of the trials and current research available on PMS are based on observational studies rather than interventional studies. In other words, researchers are often observing the eating behaviors and nutritional choices women with PMS are making rather than telling them to eat particular foods and evaluating how the food impacts their symptoms. This is important to mention because when we review the current research they are often based on observational studies and additional research will hopefully be coming in the near future. 

Understanding Your Macronutrients 

Macronutrients are nutrients we need in order to provide our body with energy. These include fats, carbohydrates and proteins. According to researchers, women who experience PMS often have altered eating behaviors during their luteal phase. In fact, researchers have found that overweight women with PMS have an increase in not only total calories consumed during their luteal phase, but in each of their macronutrients comparative to overweight women without PMS. (Cross 2001). In other words, women with PMS aren’t only consuming more calories in their diet during the luteal phase but they are eating more fats, carbohydrates and proteins. This is particularly interesting because society often likes to blame PMS for “junk food eating” and although this is more likely due to changes in eating behaviors, even women who eat “well balanced diets”, are often consuming more during their luteal phase. This is where potentially tracking your macronutrients both during the luteal phase as well as throughout your cycle can be helpful. We want to know what is your brain telling you and how can we work on creating healthier habits to curb your craving while also reducing the risk of unnecessary caloric intake? If you are struggling with PMS and really looking for lasting solutions, part of your job needs to be allowing yourself to simply observe your eating patterns and behavior. Become your very own detective as this will ultimately help you create a plan that is most suitable for you. This is where personalized dietary recommendations are so helpful and something we help guide patients through at NMD Wellness of Scottsdale

Should I Avoid Alcohol? 

When it comes to the latest research, it is difficult to discern if alcohol consumption goes up during PMS because of PMS or if increased alcohol intake causes PMS. Again, although we want to assume that researchers have evaluated everything, there are still many unanswered questions we still need to evaluate for. We just aren’t quite sure which came first. 

Now, what we do know is that the research is very clear that alcohol isn’t ideal for patients with PMS. In fact, researchers in 2018 (Fernandez 2018), found that women who drank moderately (less than 7 drinks a week), had a 45% increased risk of having PMS and if they drank heavily (8 drinks or more per week), they increased their risk of PMS by 80%. They also estimated that 11% of all cases of PMS worldwide were actually caused by alcohol and about 21% in Europe. Researchers believe it is more prevalent in Europe, due to their higher daily alcohol consumption. 

So, should you avoid alcohol?  Ideally, yes. But, if you do decide to drink, opting for no more than 2-3 drinks outside of the luteal phase may be okay. Generally avoiding alcohol during the luteal phase is recommended by most researchers. Again, do we NEED alcohol?… No. So again, if you can avoid it and improve your PMS symptoms that is most likely most beneficial. 

Should I Avoid Caffeine if I Have PMS? 

Although caffeine has often been linked to breast tenderness and headaches, the reality is there is limited evidence or data as to whether or not caffeine has a profound impact on the severity of PMS symptoms. In other words, if you were deciding between avoiding alcohol and avoiding caffeine to improve your PMS symptoms, chances are, you will likely get more benefit by avoiding alcohol. That being said, caffeine does seem to be most associated with breast tenderness, so if a woman is experiencing severe breast tenderness during PMS, it may not be a bad idea to avoid caffeine, especially during the luteal phase.

Should I be Low Carb If I Have PMS? 

This is a particularly interesting topic because, as we know, the diet culture has often villainized carbohydrates and made women assume all carbs are bad. But the reality is, we are often seeing more severe cases of PMS in women who consume a low carb diet. But, why? Researchers theorize that carbohydrates help amino acids, like tryptophan, cross the blood brain barrier and make it more freely available to the brain for mood regulation. In other words, without appropriate levels of amino acids. like tryptophan, in your brain, you are more likely to experience mood swings and irritability, which as you know, is one of the most common symptoms reported by women with PMS. So again, carbohydrates, especially complex carbohydrates during the luteal phase are likely beneficial for women with PMS.

Does Avoiding Salt Help With PMS Bloating? 

During the luteal phase, women are more likely to retain sodium due to changes in their estrogen and progesterone levels. This causes their blood pressure to likely increase and can make their blood vessels more “leaky”. This increase in “leakiness” can cause molecules like albumin and fluid to leave the capillary blood vessels and move into the tissues giving women the symptoms of water retention, swelling of their hand and feet, and etc. In order to help reduce this reaction, reducing sodium intake appears to be helpful. In fact, researchers have found that women who decrease their sodium intake during the luteal phase experience improvements in their bloating and water retention. Limiting sodium intake to <1500-2000mg per day appears to be most beneficial for women with PMS. Now although avoiding sodium can be helpful, increasing potassium intake at the same time can also be extremely beneficial. This is important to mention because the majority of women who experience PMS can experience a reduction in their potassium intake, especially during their luteal phase, because the biggest source of potassium comes from fruits and vegetables, which is often not the first thing women with PMS are reaching for when they have cravings. Increasing vegetable intake, especially during the luteal phase, while also reducing sodium intake appears to be the most beneficial! 

Is Intermittent Fasting Helpful For PMS? 

Intermittent Fasting has grown in popularity in the health and wellness space, however, most, if not all, of the research currently available on the health benefits of intermittent fasting was done on overweight, diabetic men. They weren’t done on women, and especially not on women with PMS. That means that unless new research comes out, currently, there is no positive benefit associated with intermittent fasting and PMS. We do have research on caloric restrictions and have learned that women who are not eating enough are often more prone to PMS. Now again, as we discussed previously, overconsumption, otherwise known as “overfueling” can also worsen PMS. This means that it is extremely important that women with PMS evaluate their diet and ideally track their macronutrient consumption to make sure they are consuming just the right amount of calories and macronutrients based on their unique body and exercise routine. In general, aiming for a diet that consists of 40% carbohydrates, 30% protein and 30% fat appears to be most beneficial in our clinic. Again, if you have specific health conditions or exercise routines, this general rule may not apply to you and is the reason we always recommend consulting your doctor before making any dietary or lifestyle modifications. 

About the Author: Meet Dr. ZenAlissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...