There is much talk these days about developing a personalized diet based on DNA analysis, lifestyle, food sensitivities, and the use of apps alerting a dieter to situations that might derail a diet. However, in developing an overeating profile, is enough attention being given to a condition that causes some women to eat foods that are expressively forbidden on their diets? Does the eating profile include the information that this condition occurs every month, often for five days or longer? Does the eating control app have in its database knowledge that if the dieter does not get the food she craves during that time she may become very angry, may even delete the app from her phone, or that cognitive changes may make her misplace the cell phone? This monthly change is premenstrual syndrome (“PMS”), and unfortunately, it may be overlooked or marginalized when planning an individualized food plan. Indeed, if the wrong foods are on the food plan, the dieter may find her symptoms worsening and her ability to stay on a diet eroded.
PMS is associated with a change in hormones that occurs in the luteal, or second half, of the menstrual cycle. Estrogen levels begin to decrease and progesterone to increase soon after day 14 or so of the cycle. PMS typically appears a few days before menstruation and can suddenly alter mood, sleep, energy, concentration, and food cravings. Not all women experience PMS; the severity of the symptoms vary from barely noticeable to hampering daily life. Women who experience PMS may not experience it every month and with the same degree of severity. The most severe form is called premenstrual dysphoric disorder and is similar to clinical depression except, unlike a typical depression, it goes away by the beginning of the next menstrual cycle. PMDD, as it is called, is often treated with anti-depressants.
Craving chocolate is commonly associated with PMS and is not to be taken lightly as anecdotes describe women braving blizzards to get a chocolate bar. However, the cravings encompass both sweet and salty crunchy carbohydrates. A weight-loss client told me, “I did not know I was premenstrual until I returned home from my weekly grocery shopping with bags of cookies, ice cream, chips, hot fudge sauce, and packaged cupcakes. My husband asked me why I hadn’t bought any real food, and I told him this was what I wanted to eat. I got my period the next day.”
Several years ago, we were able to admit normal weight women with PMS to our MIT clinical research center to evaluate their mood and directly measure what they were eating when they were at the beginning of their menstrual cycle. We then would evaluate three weeks later when they had PMS. Food was provided in pre-measured servings at meals, and a computerized vending machine allowed the women to obtain protein-rich snacks such as cold cuts and cheese, as well as sweet and starchy snacks such as cookies and potato chips between meals and in the evening. When these normal-weight women were premenstrual, their calorie intake increased by more than 1100 calories a day, compared to the first half of their menstrual cycle — and the calories came from carbohydrate meals and snack foods.
Because all of these women were active and did not overeat when they were not premenstrual, their weight remained stable. However, if they had been trying to lose weight, the obvious response in developing a personalized weight-loss plan would be to insist on cutting out carbohydrates. Indeed, it seems obvious that if they had been on a low-carbohydrate diet, PMS would not have affected their food intake, because carbs would not have been allowed.
Perhaps. But eliminating carbohydrates would have affected their mood, and done so negatively.
Our research team discovered that the deterioration in mood, energy, focus and control over carbohydrate intake was due to alternation in serotonin activity, probably caused by the shift in hormones at the end of the menstrual cycle. Our research was involved in the first use of an antidepressant (Sarafem) that increased serotonin activity to relieve the symptoms of severe PMS.
Women with PMS apparently crave both sweet and starchy carbohydrates because their consumption will increase the level of serotonin. Eating carbohydrates is a natural solution to easing the deterioration of mood, energy, and concentration. A two-year study on the effects of a carbohydrate-rich drink on these symptoms of PMS showed this to be the case. The small amount of carbohydrate in the drink decreased cravings for carbohydrate snack foods significantly. When the women were given a drink containing protein, the PMS symptoms were intense including alterations in cognitive function.
The test carbohydrate beverage used in our study was fat and protein-free, and thus its calories came only from a combination of a simple sugar, glucose, and a mixture of starchy carbohydrates. Some breakfast cereals could easily be substitutes for our drink with their sprinkling of sugar on a high-fiber, starchy crunchy square or flake.
Eliminating carbohydrates, as is still the fashion in many weight-loss plans, overlooks a significant connection between this nutrient and brain function. The brain needs carbohydrates to be consumed to maintain serotonin levels and activities, especially when hormonal changes decrease such activity. In short, to remove carbohydrates in the interest of weight loss may be akin to tampering with nature.
Wurtman J, Brzezinski A, Wurtman R, and LaFerrerre B, , “Effect of nutrient intake on premenstrual depression,” Am J of Obstetrics and Gynecology l989; 161(5): 1228-1234
Brzezinski, A, Wurtman J, Wurtman R, Gleason R, Greenfield J, and Nader T D, “Fenfluramine suppresses the increased calorie and carbohydrate intakes and improves the mood of women with premenstrual depression,” Obstetrics and Gynecology l990; 76: (2) 296-391
Sayegh R, Schiff I, Wurtman J, Spiers P, McDermott J, and Wurtman R, “The effect of a carbohydrate-rich beverage on mood, appetite and cognitive function in women with premenstrual syndrome,” Obstetrics and Gynecology 1995; 86: 520-528.