Calcium-rich diet may help with PMS
24 Jan 2007
Following hot on the heels of NAPS Chairman Nick Panay and trustee Nigel Denby’s appearance on the BBC Truth about Food programme recently, in which the importance of a calcium-rich diet was discussed, we have reproduced a recipe from Nigel’s latest book The GL Diet Made Easy to help you on your way to eating sensibly.
Click here to go to BBC Information Page.
A study conducted by Nick Panay, Consultant Gynaecologist at the Queen Charlotte and Westminster Hospitals, London, looked at 16 women, half placed on a three-month dairy rich diet and half on a placebo pill. “Women on the high Calcium and Vitamin D diet had a one-third improvement over the placebo group,” Nick commented. “Many scientists have observed a significant reduction of symptoms of PMS if sufferers are placed on high doses of Calcium and Vitamin D.”
The Science
Many women can identify with at least one of the many symptoms of premenstrual syndrome (PMS) – commonly swollen breasts, mood swings, tearfulness, lethargy, irritability or bloating. For some women, the symptoms are extremely severe, and can lead to relationship breakdowns, difficulties at work and severe depression. The causes of PMS are still not fully known.
Studies suggest that blood calcium and vitamin D levels are lower in women with PMS and that calcium supplementation may reduce symptom severity, but it is unknown whether this may prevent the initial development of PMS. A high intake of calcium and vitamin D may therefore reduce the risk of PMS but large-scale clinical trials addressing this issue are required. At present, the only interventional data are from small trials.
The main function of vitamin D in the body is to help absorb calcium, so it is no surprise that they should go hand-in-hand. The biggest source of vitamin D is ultraviolet radiation in sunlight, but some foods naturally contain vitamin D: oily fish, beef liver and, to a lesser extent, eggs, milk and cereals. Many foods are artificially fortified with vitamin D, including some margarines and breakfast cereals.
The mood-affecting neurotransmitter serotonin seems to play an important role in PMS. Sufferers have lower levels than non-sufferers, and some doctors prescribe anti-depressants that boost serotonin levels. Research suggests that to improve mood by boosting serotonin levels, low-GI carbohydrates are best – starchy, high-fibre foods such as brown rice, wholegrain bread, spaghetti and noodles.
The Study
A prospective randomised placebo-controlled trial into the treatment of PMS through dietary intervention. We set out to examine whether changes in diet can lead to alleviation of PMS symptoms as assessed through the analysis of validated Premenstrual Distress Questionnaires (PDQs) filled in prospectively by the trial subjects.We chose to look at the effects of two active intervention diets, both devised by Nigel Denby:
1. The Double D Diet (DD): designed to achieve very high levels of vitamin D and calcium, using an easy to follow selection of foods to add into your diet including yoghurt, cheese, flapjacks and fish.
2. The Glycemic Load Diet (GL): eating low-GI, high-fibre foods.
We recruited our contributors though adverts in the press and PMS help organisations. Respondents answered a brief questionnaire, and those whose responses indicated they were PMS sufferers attended a casting session in London. PMS Consultant Nick Panay and his colleagues talked to the women at the casting and studied their mood diaries from which they confirmed that some women suffered from classic PMS. It was these women that we put forward for our study.
We recruited 24 women in total and placed them in three intervention groups - two active groups (GL and DD) and one control group. Women in the control group were given a placebo supplement. Each woman was assigned randomly to one group and all were aware that there was a control group.
The intervention diets and control lasted for 3 months. Every month the women in the active groups either bought the food themselves or received deliveries to their homes. All women completed a premenstrual distress questionnaire daily for a month prior to starting their diet as a baseline and every day for the three-month study. This allowed us to chart eleven key PMS symptoms and their severity alongside their monthly period cycle. The PDQs were analysed by Nick Panay, who was blinded as to which woman was in which group.
According to Nigel Denby, senior dietician at Queen Charlotte & Westminster Hospital, “Women suffering from PMS, menopause and other hormone imbalances are often keen to try diet and lifestyle interventions for symptom relief. There is a huge range of unproven and unrealistic potions, remedies and diets which promise to be the "magic wand for women's health.” He stresses that a healthy diet and lifestyle is the most important foundation for general health with the concept of carbohydrate management linked to a range of health benefits.
“The GL diet combines the best aspects of carbohydrate management with a healthy diet and lifestyle. Many women have found the plan to be a practical way of improving their weight, food cravings, mood swings and other hormone imbalances. The GL diet is not a here today, gone tomorrow fad and is increasingly recognised by health professionals, health agencies and charities as the way forward for people who want to make simple, positive changes to improve their health and well-being,” he says.
Results
Rounded to the nearest integer, these figures compare symptoms after the study with those before.
| Depression | Mood swings | Swelling and bloating |
| DD diet group | 37% improved | 37% improved | 36% improved |
| GL diet group | 7% improved | 50% improved | 25% improved |
| Control group | 44% worse | 10% improved | 4% improved |
ANALYSIS
The results for DD are consistent, and look significantly better for both physical and psychological symptoms compared to the control group. The GL group results must be interpreted with caution as the numbers were small but there is a trend towards improvement.
REFERENCES
1. Bertone-Johnson ER et al. ‘Calcium and Vitamin D Intake and Risk of Incident Premenstrual Syndrome’ Arch Intern Med. 2005;165:1246-1252.
2. Alvir JM, Thys-Jacobs S. ‘Premenstrual and menstrual symptom clusters and response to calcium treatment’. Psychopharmacol Bull. 1991;27:145–148.
3. Thys-Jacobs S, Ceccarelli S, Bierman A, et al. ‘Calcium supplementation in premenstrual syndrome: a randomized crossover trial.’ J Gen Intern Med. 1989;4:183–189.
4. Thys-Jacobs S et al. ‘Calcium carbonate and PMS: effects on premenstrual and menstrual symptoms’. Premenstrual Syndrome Study Group. Am J Obstet Gynecol. 1998;179: 444–452.
Some sources of calcium
Good plant sources of calcium include tofu (if prepared using calcium sulphate contains more than four times the calcium of whole cow's milk), green leafy vegetables, seeds and nuts. The calcium in green vegetables which are not high in oxalate e.g. kale, is absorbed as well or better than the calcium from cow's milk.
Some soya milks e.g. Provamel, Plamil, Granovita are fortified with calcium. Drinking hard water can provide 200mg of calcium daily but soft water contains almost none. Other calcium rich foods include black molasses, edible seaweeds, watercress, parsley and dried figs.
Examples of amounts of foods providing 100mg calcium:
· Black molasses - 20g
· Dried figs - 40g
· Almonds - 42g
· Soya flour - 44g
· Parsley - 50g
· Kale - 67g
· Brazils Nuts - 59g
· Wholemeal bread - 185g
· Oatmeal - 192g
"Aim for two to three portions of calcium-rich foods every day which can include: a third of a pint/2000ml semi skimmed milk, a matchbox size piece of cheese, a small yoghurt or a milk based pudding like custard or rice pudding," suggests Nigel.
Try these two delicious recipes taken from Nigel Denby's The GL Diet Made Easy.
Easy Granola Yog Pot
You can make a large batch of the granola and keep it in the fridge, covered, to use as needed.
Instead of using the microwave, you can cook the granola in a pan on the hob for a couple of minutes until heated through.
Ready in 5 minutes
Serves 1
1 dessertspoon olive oil
1 heaped tbsp porridge oats
1 dessertspoon of any chopped or ground nuts
1 tsp agave syrup
1 tbsp Greek yoghurt
Handful of either fresh fruit (strawberries, raspberries, chopped apple or pear) or chopped dried fruit (apricot, apple, mango, strawberries, pear, pineapple or cranberries) or a fine and fruity combo of the above.
Cinnamon Banana Smoothie
Ready in 5 minutes
Serves 1
1 Small, green and yellow, stripy, straight banana (okay, a bent one will do!)
1tsp agave syrup
125 ml/1/2 cup natural, sugar-free yoghurt
Pinch of cinnamon to taste
1. Slice the banana roughly and place in a blender
2. Add the rest of the ingredients and blend until smooth
3. Pour into your favourite glass and serve sprinkled with a little more cinnamon
Enjoy!
