“I hate winter. It’s not just the ice, the shoveling, too many snow days, and long traffic-congested commutes. What I really hate is that my PMS becomes unbearable. From November to April, I dread those days before my period comes because I turn into Attila the Hun!” So stated a weight-loss client of mine. She is not alone.
What Is Premenstrual Syndrome Or PMS?
Most women are not transformed into the 21st century version of a marauding barbarian when they have PMS—premenstrual syndrome—but they may feel that their lives are disrupted and moods out of control. PMS is linked to hormonal changes at the end of the menstrual cycle. The symptoms are numerous but most women do not, thankfully, experience more than a few. The most common are feeling depressed, angry, irritable, and longing for sweet or salty fatty foods like ice cream, chocolate or chips. Often a foggy mental state that makes speaking coherently or concentrating a difficult task occurs. PMS affects women of childbearing age, from teenagers to women about to enter menopause (whose symptoms are very similar but last for months rather than days).
PMS arrives, often without warning, during the fourth week of the menstrual cycle and may last hours or days, retreating only when menstruation begins. Changes in mood for no apparent reason, disturbed sleep and increased irritability are often the first signs that PMS is present, but also some women experience a dramatic increase in their carbohydrate craving. A friend of mine who does the family grocery shopping once weekly, told me of coming home with bags of pasta, bread, cookies, crackers, ice cream, doughnuts, boxes of instant mashed potatoes, and nothing else. When her husband helped her put away the food, he asked why she did not buy any milk, vegetables, chicken, and fruit. “Because I bought what l wanted to eat,” she told him. “I have PMS.”
Why PMS Symptoms Are Worse During Winter
Many of the PMS symptoms are similar to those of Seasonal Affective Disorder (SAD) or winter depression. People suffering from mood and appetite changes associated with diminished hours of daylight experience similar irritability, fatigue, depression, and carbohydrate cravings although they tend to sleep, if they can, many more hours. PMS, in contrast, often causes broken and unrestful sleep. Of course men also suffer from Seasonal Affective Disorder and there is no age limit as to who may experience it.
Winter can worsen PMS; symptoms can last longer and be more severe. One explanation might be that many of the stresses associated with winter add to the stress of PMS: prolonged commuting time; roofs sinking under the weight of snow; inability to exercise because sidewalks are too icy or weather too cold; and cabin fever that comes from not being able to escape the house over weekends.
The Connection Between PMS & Serotonin
However, there is probably a biological explanation as well as environmental discontent. Our research at MIT and that of a group from UCLA found insufficiently active serotonin underlying PMS symptoms. Decreased serotonin activity has also been linked to SAD. The diminished hours of winter sunlight further decreases serotonin activity, according to the research of Barbara Parry, thus exacerbating the moodiness, depression, anger, distractability, and poor sleep of premenstrual syndrome.
Ironically, Parry and others who have discovered this relationship live in southern California, where the fluctuation in hours of daylight is much smaller than in the northern tier of states where differences in sunrise and sunset between July and January are dramatic.
Phototherapy To Combat PMS Symptoms
Other than moving south, getting pregnant, or becoming menopausal, there are not many options to ease the monthly mood swings. Parry’s research suggests phototherapy, which involves sitting in front of a box that emits the light spectrum of sunlight without the damaging ultraviolet rays. It is still unclear how exposure to sunlight interacts with serotonin to increase its activity, but positive changes in premenstrual mood are evidence that it is having a positive effect.
Carbs Elevate Mood & Ease PMS Symptoms
The carbohydrate cravings experienced by women with PMS is a clue to another therapy. This one involves consuming a specific dose of carbohydrate once or twice a day to increase serotonin synthesis. The carbohydrate craving is real and measurable. Women with PMS eat about 1100 extra calories daily when they have PMS. The foods contributing these extra calories are sweet and starchy carbohydrates such as breads, pasta, cookies, chips, crackers, and candy. We have studied the changes in mood, concentration, and cravings before and after premenstrual women consume a beverage containing either carbohydrate or a placebo. Statistically significant improvements were found after the carbohydrate drink, but not after beverages containing nutrients like protein that do not increase serotonin synthesis.
The carbohydrates act like an edible mood elevator. Eating about 25 to 30 grams of any carbohydrate (except fructose) increases serotonin levels and activity, and subsequently takes the edge off of many PMS symptoms. Eating protein prevents this effect, as protein prevents serotonin from being made. It is best to eat a carbohydrate food like popcorn or oatmeal before eating protein, or two or three hours after a protein-containing meal.
If winter woes include a worsening of PMS, it may be necessary to eat a carbohydrate snack two or even three times a day. (Avoiding fat-containing snacks and limit the calories to about 120 per snack). Relief comes soon after the carbohydrate is digested. This is another reason why eating low or fat-free carbohydrates are best. They are digested faster if they contain no fat. From our research, we know that the symptoms ease for about three hours.
So far the combination of phototherapy and carbohydrate consumption has not been tested against each of these therapies alone. But presumably eating a bowl of oatmeal while sitting in front of a light box should make even a gloomy winter PMS or SAD day significantly brighter.