Is PMS Sabotaging Your Diet?

How to cope with food cravings and keep losing weight

By Charlene Laino
WebMD Weight Loss Clinic - Feature

Reviewed By Charlotte Grayson, MD

Do you find yourself successfully dieting for three weeks at a time, only to succumb to an uncontrollable urge to scarf down a few calorie-laden hot fudge sundaes as that time of the month rolls around? You're not alone.

As many as 85% of women experience at least one symptom of PMS, the disruptive physical and emotional changes that can strike anytime in the last 2 weeks of the menstrual cycle, according to the American College of Obstetricians and Gynecologists. And as many as 70% of these women suffer from PMS-related food cravings, bloating, fatigue, sleep disturbances, mood swings, and irritability -- any of which have the potential to sabotage your diet, says Judith Wurtman, PhD, director of the women's health program at Massachusetts Institute of Technology in Cambridge.

Fortunately, a better understanding of PMS in general and food cravings specifically can keep women from getting caught in a diet-destroying cycle.

Diet Double Whammy

PMS packs a double whammy against a diet, Wurtman says. "First, you have food cravings, usually for sweet, starchy foods with an underlay of fat, like chocolate ice cream. And then, your bad mood makes you say, 'To hell with it!' You lose your willpower to exercise any control over what you are eating."

The bloating that often goes with PMS also sabotages a diet, says Stephen Goldstein, MD, an obstetrician-gynecologist at New York University. "A woman steps on the scale and freaks out. And some people's response to being bloated and having to loosen their belt is to drown themselves in an ice cream sundae."

And what do we break down and eat when those cravings hit? Chocolate is No. 1 on the hit parade, followed generally by other sweets, Goldstein says. Salty foods, particularly chips, are a distant third.

"You never find anything nutritious on the A-list," agrees Wurtman, noting that women rarely come in complaining of cravings for fish, fruits, and vegetables. "If it's a dieting no-no, you can bet the PMS mind is saying, 'Yes, yes,'" she says.

Hormones to Blame

The hormonal ebbs and spikes that occur throughout a woman's cycle are the major culprits in PMS. As levels of estrogen go up and down, so do levels of the stress hormone cortisol, explains Pamela Peeke, MD, MPH, author of Fight Fat After 40 and assistant professor of medicine at the University of Maryland School of Medicine in Baltimore. "It's a very potent little partnership. The body wants to keep them aligned."

And when cortisol levels are high enough, the body turns on its fight-or-flight response, a woman becomes more metabolically charged, and her appetite is stimulated. This, in turn, causes a woman to seek out carbs and fat, "the actual fuels of the fight-and-flight response," Peeke says.

Whether a woman will crave sweets or croissants, though, depends on yet another player: the brain chemical serotonin, she says. Most women with PMS experience a drop in serotonin levels, which triggers cravings for carbs because the body uses carbs to make serotonin.

"If cortisol is high and serotonin is low, you'll seek carbs and fats, but really heavy duty on the simple carbs -- sugar-based sweets like chocolate bars," Peeke says. The reason: Simple sugars are metabolized more quickly than complex carbs, so they offer a quick serotonin fix.

If cortisol is way up but serotonin is relatively normal, a woman is more likely to crave a fat-carb combo without a huge sweet component, such as a bagel laden with cream cheese, Peeke says.

The Blood-Sugar Connection

Other research has linked PMS to a state of low blood sugar, or hypoglycemia, in the second half of the menstrual cycle, says Susan M. Lark, MD, a clinician in Los Altos, Calif., and author of Premenstrual Syndrome Self-Help Book: A Woman's Guide to Feeling Good All Month. "Women in these studies experienced a significant drop in blood sugar after eating, accompanied by edginess and irritability," Lark says. "Then within an hour or two, they are hungry again and craving more food."

Whether it's blood sugar, cortisol, or serotonin levels that are out of whack, experts say, eating huge servings of ice cream, chocolate, and chips are not the only way to bring levels backs into check -- in fact, they are the worst way. Proper nutrition and lifestyle habits will achieve the same thing, with long-lasting results.

How to Fight Food Cravings

So how can a woman combat PMS cravings and keep from gaining weight?

Eat complex carbs
Though it might seem counterintuitive to feed a diet, Wurtman suggests reaching for a snack high in complex carbs whenever you feel an attack of the grumpies coming on. Taking in a few extra calories in rice cakes now will prevent you from raiding the icebox later on. Meals also should be high in complex carbs, such as whole-grain breads, pasta, and cereals. "Eaten on an empty stomach, baked potatoes, even half a bagel or low-sugar cereals, will increase serotonin levels within an hour," Wurtman says.


"Reach for a snack high in complex carbs whenever you feel an attack of the grumpies coming on."

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