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.
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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.
Avoid processed sugar
Simple sugars increase insulin secretion, which lowers blood sugar, Lark explains. And if insulin levels shoot up enough, your appetite for carbs and fats increases.
Try foods high in essential fatty acids
Food high in essential fatty acids, such as salmon or safflower or canola oil mayonnaise, "slow absorption of carbs, stabilize the blood sugar, and stop cravings in their tracks," Lark says. Try tuna with a little low-fat canola-oil mayo on a rice cake, she says, or a couple of tablespoons of flax meal in a protein shake.
Drink plenty of water
Eight or so glasses of water a day help to flush the body out and reduce bloating, Peeke says.
Not only will a diet low in salt reduce bloating and fluid retention, but it also can help reduce your risk of high blood pressure, Wurtman says.
"Fat slows down digestion and absorption of carbohydrates. And you won't feel better until your body absorbs the carbs and turns them into serotonin," Wurtman explains.
Limit coffee and cola
Reduce caffeine intake to feel less tense and irritable and to ease breast soreness, advises the American Association of Family Physicians (AAFP).
Cut meals in half
Eating up to six small meals a day instead of three larger ones can help keep blood sugar more stable, which will cut back on carvings, Lark says. This strategy can help you lose weight even when you don't have PMS, adds Goldstein, noting that Americans tend to continue eating until their plates are clean, long after they are full.
"Figure out about when you'll be premenstrual and avoid scheduling any stressful obligations, such as a speech or dinner with the in-laws," Wurtman advises. Anything that exacerbates stress fuels yearnings for high-calorie comfort foods, such as mashed potatoes smothered in butter.
Abstain from alcohol
Drinking before your period can make you feel more depressed, according to the AAFP. Plus, alcohol can deplete the body of PMS-thwarting vitamin B and disrupt the metabolism of carbohydrates.
Get plenty of sleep
Noting that lack of sleep makes you more irritable and even less likely to exercise control over your diet, experts recommend eight hours a night. Plus, studies have shown that people who sleep through the night live longer.
Have a routine
Keeping to a regular schedule of meals, bedtime, and exercise will help alleviate systems of PMS, according to the AAFP.
Tackle Food Cravings With Exercise
Any physical activity, from swimming to running, that gets the heart going will raise serotonin and lower cortisol levels, Peeke says. Though most experts recommend working out for 30 minutes, four to six times a week, even a 10-minute walk will put a serious dent in your cravings, she says.
Plus, if you sweat a lot, you'll get rid of water and feel less bloated, Wurtman says. And once you get going, anger dissipates, "so you may not feel like murdering your colleagues."
Some studies suggest that mind-body activities such as yoga and tai chi can help calm a woman while lowering cortisol and increasing serotonin levels, Peeke says. And a massage by an experienced therapist evokes the same benefits. "That's also why a good massage makes you so sleepy."
Supplements Combat Food Cravings, Too
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While there's no proof that taking supplements can help curb food craving per se, studies have shown that certain vitamins and minerals can help improve your mood and make you more amenable to a healthy diet, Peeke notes. All Weight Loss Clinic members are encouraged to take a daily multivitamin/mineral in addition to eating their nutrient-dense diets.
Published July 11, 2003
SOURCES: American College of Ostetrics and Gynecology web site. Judith Wurtman, PhD, director of the women's health program, Massachusetts Institute of Technology, Cambridge. Stephen Goldstein, MD, obstetrician-gynecologist , New York University. Pamela Peeke, MD, MPH, assistant professor of medicine, University of Maryland School of Medicine, Baltimore. Susan M. Lark, MD, clinician, Los Altos, Calif. American Association of Family Practitioners web site. American Journal of Obstetrics and Gynecology, August 1998. Journal of Women's Health, November 1998. Darlene Parks, Ohio.
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