PRE-MENSTRUAL SYNDROME NATURALLY
By Stephen Holt, MD, NY, NY
INTRODUCTION
Pre-menstrual syndrome (PMS) defies clear definition. In its classic form, it is a disorder of biorhythm that results in a series of unpleasant cyclical symptoms and signs, prior to menstruation. It is naïve to believe that PMS is a simple hormonal disorder requiring merely focused hormonal intervention. Complex socio-behavioral issues or adverse life events make PMS worse and PMS amplifies such events or exacerbates several diseases.
Among the most common symptoms of PMS are: emotional change, tiredness, irritability, anxiety, change of appetite, food craving and a litany of upsets in many body structures, resulting in: headaches, sinus problems, acne, joint pain and general clumsiness. PMS is often confused with many diseases or disorders and it can even masquerade as simple depression, chronic fibromyalgia, neurosis, organic disease of the female genital tract…to name a few misdiagnoses.
NATURAL MANAGEMENT STRATEGIES FOR PMS
Before any management strategies for PMS are proposed, an understanding of the causes of this clinical conundrum is advisable, but no simple or single cause of PMS can be defined. Suggested causes of PMS include: hormonal problems, water retention, body toxins, specific nutrient deficiencies, metabolic disturbances, imbalance of neurotransmitters in the central nervous system or, in isolated cases, frank neuroticism…and other matters.
The complex causes of PMS require multi-pronged interventions and the idea that there is a magic hormonal manipulation to treat PMS in a consistent manner is a “fairy tale”. Table 1 summarizes natural interventions that are linked to suggested causes of PMS.
SUGGESTED CAUSE COMMENT
Hormonal Problems-Various studies have identified changes in hormone balance in women with PMS, but there are no consistent changes that permit a clear diagnosis. High levels of estrogen and low levels of progesterone have been associated with PMS. Failure of function of the corpus luteum which forms in the ovary after ovulation may be involved. Progesterone supplementation is a popular intervention and it may be effective in some women with PMS. A preferred approach, in my opinion, is the use of herbs, botanicals and nutrients that are adaptogenic or modulators of hormonal profiles. These natural substances can be used in synergistic formulations with good effects. The use of single supplements for PMS management are obsolete and the same may apply to disturbances around the menopause. Dietary supplement ingredients with the greatest evidence base for the management of menstrual disturbance include: black cohosh, soy and red clover isoflavones, L-theanine, evening primrose oil, dong quai, chasteberry, ginkgo biloba…and others with anecdotal benefit.
Water Retention-Excessive salt and water retention is common in PMS, but it may be a result rather than a cause of PMS itself. Natural diuretics and herbal teas may be valuable (e.g. chamomile, dandelion root, green tea, etc.).
Body ToxinsThe concept of premenstrual intoxication was first reported 50 years ago, but scientific evidence that detoxification of the body with herbs or colon cleansing is universally effective has not been presented. Many women describe benefits of intermittent attempts to detoxify the body. One preferred route of detoxification is colon cleansing. Synergistic gentle colon cleansing formulae are most advisable with enhanced intake of fluids and dietary fiber.
Specific Nutrient DeficienciesDeficiency of vitamin B-complex has been linked to mood changes and depression in women with PMS or those taking progesterone hormone supplement. Excessive sugar intake and deficiency of omega-3 fatty acids have been variably implicated as a cause of PMS. For example, cramps may be caused by excess prostaglandin F2 alpha and alterations in prostaglandin
production occurs with deficiencies or imbalances in the dietary intake of essential fatty acids. I recommend enteric coated fish oil capsules for all women with PMS, but I stress the advantages of delayed release, targeted delivery of fish oil in special gel capsules to improve absorption of the active omega 3 fatty acids EPA and DHA.
Hypoglycemia/Syndrome X-Episodes of low blood sugar may occur in women with PMS and specific studies have shown that hypoglycemia may tend to occur more often in the premenstrual phase of the cycle. Alterations in the metabolism of glucose by the body due to insulin resistance and compensatory excess secretions of insulin are key factors in the metabolic Syndrome X, which is strongly associated with polycystic ovary syndrome (PCOS) and PMS. Lifestyle change and nutritional factors for Syndrome X are valuable.
Serotonin BalanceSerotonin is an important factor in central nervous system and other body functions. Deficiencies in serotonin have been described in women with PMS. This has led to dietary recommendations to boost serotonin levels in the body and the use of supplements that are precursors of serotonin, such as 5-HTP. Serotonin levels in the brain are increased by some antidepressant drugs, e.g., Prozac.
Sleep Deprivation-Restoration of the biorhythm of sleep is the most underestimated of all interventions in women with menstrual problems. Appropriate lifestyle changes and combination supplements can restore healthy sleep patterns. Without sleep PMS and menopause gallop in their progression.
NeuroticismPMS is real. While emotional disturbances are common in PMS, it is not acceptable to adopt the attitude that PMS is “all in a woman’s head.” Patients who visit physicians who have this opinion should vote with their feet.
Table 1. Potential causes of PMS with general comments about management options.
SYNDROME X AND PMS
The variable combination of hypertension, high blood cholesterol and an overweight status are fueled by insulin resistance. These problems form in the constellation of the metabolic Syndrome X. I emphasize that there is still widespread lack of knowledge about the importance of Syndrome X in women’s health, especially in relationship to menstrual function. The occurrence of cystic ovaries in young women has been quite clearly linked to Syndrome X. This condition is called polycystic ovary syndrome or Stein-Leventhal Syndrome. In popular medical literature, PCOS has been referred to as Syndrome X of the ovaries (or even Syndrome O). The typical female with PCOS is premenopausal, 18 to 28 years old, with variable degrees of obesity, excess body hair, irregular menstruation, period pains, acne and infertility. Lifestyle change and nutritional factors can be used to combat the Metabolic Syndrome X.
CONCLUSION
While topical progesterone cream has been proposed as a mainstay in the management of PMS, the application of this approach may require medical supervision and topical hormonal creams are not dietary supplements. Clearly, the general management approach to PMS involves its clear recognition together with good holistic management approaches, including but not limited to, psychosocial interventions, positive lifestyle changes and a first line approach with tailored nutritional medicine.
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SPECIAL AGES: SPECIAL CIRCUMSTANCES
by Stephen Holt MD
Some Alarming Facts About Children
Despite the importance of lifestyle in the maintenance of health in both childhood and later life, there are relatively few accounts of “effective” methods to correct adverse lifestyle in children or adolescents. Attempts to analyze some of the health problems in the young reveals some alarming statistics on the health and well-being of children in North America. Table 58 summarizes some of these worrying observations of diet, lifestyle and physical fitness among American youth. A perusal of some of the statements on Table 58 are alarming and probably very revealing for many readers. These statistics are getting worse not better.
Average duration of vigorous exercise, less than 15 minutes per day.
Greater than 40% of calories from simple sugars, often.
More than one-quarter may have high blood pressure.
One-third have elevated blood triglycerides.
One-half of all children may have high blood cholesterol.
Two-thirds eat too much salt.
Three-quarters eat excessive fat in their diet.
Sixty-seven percent of all children have three or more risk factors for cardiovascular disease.
All most 100% of all children have at least one major risk factor.
Sixty-four percent of all children may fail to meet minimum physical fitness criteria.
Table 58: Some facts on levels of fitness, lifestyle and general health issues among children in the United States based upon data presented by Dr. Charles Kuntzleman in his book entitled “Healthy Kids for Life” (1988).
Scary Statistics
We can recognize Syndrome X as a part of a huge health problem that affects Western society. It is increasing in its occurrence in young children who are developing maturity onset diabetes of the young (MODY). The child with MODY often becomes an adult with full blown cardiovascular risks which may result in early death and disability. It is clear that 70 million Americans have Syndrome X in one form or another and this is mirrored by the known presence of about 61 million Americans who have cardiovascular disease. Adding components of Syndrome X to these numbers on an individual basis produces some shocking statistics. The combined occurrence of high blood cholesterol and or obesity with cardiovascular disease is estimated by some to affect about 160 million North Americans!
It is easy to see why lowering blood cholesterol has become a national obsession. Cardiovascular disease causes at least one million deaths per year and every twelve months more than 7 million heart attacks occur, with reports of about 5 million strokes. Cardiovascular disease “swamps” all other causes of death in the US.
Surveys are Revealing
The support for strong statements on the poor health of our nations’ children comes, in part, from the National Health and Nutrition Examination Survey (HANES). The HANES has that implied that there is a direct relationship between the weight of a child and the amount of time that a child may spend watching television (or planked at a computer terminal or play station). It has been estimated that data from the HANES implies that the occurrence of childhood obesity increases by approximately by 2% for each additional one hour that a child watches television. Switching off TV (video games and computers) more often may be a very important, simple, public health intervention. The “couch-potato- phenomenon” appears to operate in adults to the same degree that it operates in children. The sad situation is that children tend to take their lead from adults. Sitting on a couch and sharing cigarette smoke, eating simple sugars, excessive salt and fat are obvious examples of Syndrome X-forming behavior.
X-Kids
Syndrome X is rearing its ugly head among US youngsters, but its level of occurrence has not been estimated with any precision. Researchers have stressed that cardiovascular disease due to atheroma germinates in childhood, whilst pediatricians have commented on the dangers of childhood hypercholesterolemia (high blood cholesterol) for more than forty years, in the presence of residual complacency. Dr. William Kannel of Boston University has coined the termed “atherogenic way of life” among young people and he has indicated that the average American child has a one chance in three of experiencing a cardiovascular catastrophe before reaching 60 years of age. Dr. Kannel has called for an expansion of the pediatrician’s responsibility for health beyond adolescence.
The best-selling author Robert E. Kowalski MD has defined the importance of high blood cholesterol and other factors (obesity and sedentary lifestyle) in childhood, as it pertains to the occurrence of heart disease later in life. In his book entitled “Cholesterol and Children”, (Harper and Row, NY, NY, 1988), Dr. Kowalski describes a combination of positive lifestyle change and nutritional interventions for dealing with cardiovascular risk factors. He stresses the problems of conventional treatments for childhood obesity, high blood cholesterol and diabetes, particularly in relationship to the use of pharmaceuticals. Dr. Kowalski makes a specific case for the use of soluble portions of oat bran for cardiovascular health in children – a matter discussed in detail in Section 7 of this book.
More than 50% of all children have at least one risk factor for heart disease and it is known from recent studies (Third National Health and Nutrition Examination Survey, Jan, 2002) that at least 6.7% of all young adults age 20 – 29 years have Syndrome X. It is known that up to one in five new patients attending pediatric treatment facilities may have Type 2 diabetes and in the late 1990’s local children’s’ clinics in Southern California reported a ten-fold increase in the number of cases of maturity onset diabetes of the young (MODY) over a five year period. My best guess is that about 2% of all children may have Syndrome X and an unknown proportion of these kids may be less than ten years of age.
Examining Aspects of Popular Childhood Diets and Lifestyle
Children are eating “piles of junk”. It is recognized that most of American children (almost 100% !) will eat sweet deserts on at least six occasions in a week and that they may on an average drink about 24 ounces of soda per day. It is commonplace for meals to be taken outside the home, usually at fast food restaurants, and the occurrence of diets with inadequate levels of fiber and essential nutrients is often the norm. Many children are relative strangers to vegetable protein and essential fatty acids of the omega 3 series.
Exercise has been shown to be a key initiative for promoting health in childhood. I recommend this approach strongly and I am astounded at reports that only about one-third of all American school children receive daily physical education classes, which are often lacking in more rigorous forms of exercise. The Government has appealed finally for more attention to be paid to promoting lifestyle change among children in the US.
Childhood Nutrition and Cardiovascular Risk
Contrary to popular belief, children and adolescents are not immune to heart disease. The acceptance of old notion that children are resilient to consequences of poorly planned diets and any food “that passes their lips is good for building their body” is one of the biggest mistakes ever made by the modern mother or father. Atheroma has its roots in childhood and evidence suggests that the children of modern times are accumulating an unprecedented burden of cardiovascular risk factors by engaging in lifestyle that will tend to result in Syndrome X. The media seems to avoid too much coverage of this mounting problem, perhaps for predictable reasons.
In terms of overall public health significance, education of children about healthy eating should be given priority. We are reminded often that coronary heart disease is the number one killer in Western Society and it starts in childhood. High blood cholesterol and hypertension is much more common in children than had been presupposed by many, including some members of the medical profession. America has the most obese youngsters in the world per capita and the increasing occurrence of diabetes (MODY) in childhood is frightening. It is not in anyway controversial to state that the dietary habits of the average child is often focused on fast-food items. Burgers and fries, or “fried anything”, are often loaded with cholesterol, saturated fats and damaged unsaturated fats (Trans fatty acids). When taken in continuity and excess, many types of fast or junk food are guaranteed to “break the heart”.
Interventions for Childhood Cardiovascular Risks and Syndrome X Prevention
How does one tackle this overlooked problem of childhood? The interventional principles to control cardiovascular risks in children are simple. Ideally, children should not be allowed to develop “bad habits. For a parent to let a child become permissively fat has been labeled by some to be a form of abuse. This type of rhetoric must be dismissed as counterproductive, but it helps define an increasing need for parental control. Childhood obesity in the US is tragically common, often impossible to reverse completely and it sets the stage for adult obesity. Whilst the causes of childhood obesity remain underexplored, several factors are known to contribute. Beyond some known genetic predispositions to obesity in children is the recognized contribution of emotional factors, family eating habits (or behavior) and misguided attitudes to food.
Children are receptive to positive attitudes about healthy food choices and their implications for weight control, athletic performance and “feeling good”. Parents can do much to reinforce these attitudes and help “counter” the fast-food culture that has “consumed” Western society. To deny a youngster a visit to the eating parlor of their choice, once in a while, is probably wrong. It is the saturated fat, refined sugar and salt content of fast food that leads to the need to limit its intake. I am respectful of the fast food industry’s (and general food industry) constant desire to examine and change the nutritional value of their meals to more beneficial compositions. After all, the fast food industry is fulfilling a consumer “need” which promotes the spread of “nutritional colonialism”. Whilst I do not wish to deny anyone unhealthy types of fast food, its intake should be limited. Fast food parlors tempt even the most self-disciplined individual. Moderation is desirable. Like the alcohol abuser who may seek controlled drinking behavior, the time to instill controlled-eating-behavior is in childhood.
My indulgence in continuing to remind parents (including myself) about the obvious may not be perceived as constructive by some. However, the unfortunate issue is that many of our children have “established” nutritional problems. These nutritional problems are true examples of “malnutrition” that occurs often as a consequence of dietary excesses. Hypercholesterolemia and abnormal blood lipid profiles should be taken more seriously in childhood, at least when children reach school age. Dietary interventions in children often fail and drug therapy with lipid lowering drugs has to be avoided in childhood for safety reasons. Indeed, many lipid lowering drugs are contraindicated in most circumstances in children. Furthermore, the safety of anti-diabetic drugs in children has not been defined, but it must be now, given the alarming rise in MODY. Problems with drug treatments make natural nutritional interventions very attractive for use in children.
Dietary Supplements Present Options in Childhood: Soluble Fiber and Soy Protein
One solution to the problem of established high blood cholesterol in children is the use of safe dietary supplements with blood-lipid-lowering properties. Clearly, beta glucan extracts of soluble oat fiber can be used to lower cholesterol and balance glucose in children. Soy protein and soluble fiber extracts are to be preferred over drugs for lowering cholesterol in children. The revered Italian physician, Dr. C. Sirtori, has emphasized the potential role of soy protein supplementation of the diet as an effective means of lowering blood lipids in children. In fact, Dr. Sirtori has gone as far as indicating soy protein inclusion in the diet may be among first line options for lowering blood lipids in childhood. I add beta glucans from oats to this suggestion.
Blood Pressure in the Young
Adolescents and teenagers with hypertension (or obesity or high blood cholesterol) are a difficult group to manage. Young people are less likely to take notice of the serious nature of high blood pressure as an important consideration in their day-to-day activity. The profile of children with high blood pressure is often recognizable, but not often spotted. Young people with high blood pressure often have a family history of hypertension, they may be obese and they may have a tendency to avoid physical activity. This risk profile moves our children towards the components of Syndrome X. Youngsters with these medical problems are not normal, but many US children or adolescents are beginning to match the X-profile.
The acceptance of the status of the “chubby child” who will grow out of their problem is a dangerous deception. Childhood obesity is a sad reflection of our “advanced” society. Substance abuse in teenagers must not be forgotten as an important underlying factor in the causation of elevated blood pressure. The healthcare giver or parent should be vigilant to spot drug abuse (e.g. “drug speed” or “herbal speed”, e.g. ephedra) and help the young person correct this type of adverse lifestyle.