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Premenstrual Syndrome and Food: An Interview with Elisa D'Urso
by Carol Coven Grannick and Judith Matz
Most women notice a change in their food patterns prior to the beginning of their menstrual cycle. Women working with the Overcoming Overeating approach have learned to trust their bodies' signals and therefore should relax and give themselves the foods they crave. In this interview with Elisa D'Urso, a Chicago dietician who works with the Overcoming Overeating approach, we explore the reasons why women's bodies need certain foods premenstrually.
Judith: Elisa, can you tell us what physiological changes occur premenstrually that trigger certain food cravings?
Elisa: Sure. Cravings for sugar are very common. The hormones in your body that change premenstrually affect your blood-sugar levels. Therefore the kinds of foods you crave as well as the frequency of your physiological hunger may change. Some of the hormones affect your body's ability to maintain stable blood-sugar levels. Foods high in sugar raise blood-sugar levels quickly and trigger your body to release a lot of insulin. The insulin then causes your blood sugar level to drop rapidly, leaving you in a physiological state of craving sweets again. If you "check in" with your stomach hunger and find that something "substantial" (such as a protein like meat, milk or nuts) would feel right for you with the sweet, you may find that your blood-sugar level stays at a more even keel. This additional food may help avoid the rapid drops contributing to more cravings.
Carol: Many women have reported actually getting stomach hunger much more frequently premenstrually. What's the physiological reason for that?
ED: The hypothalamus in your brain is one of the parts of the body that registers hunger and satisfaction. This also is a body part affected by the hormones that change before menstruation begins, and it's fairly clear that hunger and satiety change at that time. Many women simply eat more premenstrually than they might at other times of the month. The hypothalamus may also affect moods.
CG: Elisa, women talk to us about feeling physiological cravings, but not in response to stomach hunger. It's as if the body needs something, but it does not seem to have to do with hunger. Although some women have this feeling at other times of the month, it occurs much more intensely during PMS.
ED: Yes, this absolutely happens! The body's ability to sense hunger and satiety are altered premenstrually, and that's why you might have trouble even identifying stomach hunger.
JM: We are often advised to restrict certain foods premenstrually. For women using Overcoming Overeating, this is disturbing. Yet it seems that craving salty foods and eating them leads to bloating and discomfort. As a dietician who uses the approach, how do you deal with this?
ED: There is usually no real reason to restrict foods premenstrually. For most people bloating is a redistribution of water in the body, not a major "retention." The concentration of sodium in your blood system may get "diluted," and this may trigger a craving for sodium. Also, excess carbohydrates (simple sugars, for example) cause water to pool in your body, and that can also result in feeling bloated. It's complicated. Hormonal changes probably redistribute the water in the body, and the sodium in your body (an electrolyte) will move around. The water will then follow the sodium and cause pooling as well. So adding protein or complex carbohydrates can help, if those choices fit in with your hunger needs. For some women, adding a high-potassium food such as bananas or orange juice also helps. The only reason to consider an alternate choice for sodium is if you have severe side effects—in other words, if your body is telling you that the food you ate just didn't feel good.
CG: I think it's sometimes confusing for women to discern a particular side effect from a particular food.
ED: Yes, it is… Women often feel that today's "side effects" have to do with yesterday's food, and that is not always the case. The effect on your body of salt and sugar, for example, is fairly quick—within hours for salt and possibly minutes for sugar.
JM: We hope the explanations about bloating and side effects will feel calming rather than alarming. We find it helpful to understand more about the physiology, as long as the knowledge is then not turned into rules.
ED: I think that's true. Someone may not even think, when she's having a craving for chocolate, "Gee, would some milk feel good with that?" If the answer is "no" fine, but maybe knowing about the physiology will broaden the options.
CG: Speaking of chocolate, that seems to be a big craving. Why do you think that is?
ED: Well, it's probably a combination of the physiological craving due to low blood sugar premenstrually, but also that the chocolate breaks down in such a way that it validates some of the emotional meaning chocolate has for many people. Chocolate breaks down into a substance in your body that has an endorphin-like effect, causing an elated, pleasurable, relaxed sensation. Many women tend to feel more depressed or irritated due to hormonal changes, and the chocolate may take care of some of that.
JM: We also hear a lot about caffeine and premenstrual syndrome. What are your thoughts about that?
ED: Caffeine, and alcohol, for that matter, operate just as simple sugars do. They cause a rapid rise, and then a rapid drop, in blood sugar levels. Sometimes a reduction in caffeine can help with premenstrual breast tenderness. The other thing we know about caffeine is that it operates as a drug, and if you're already feeling tense and anxious, it may not be your drug of choice.
JM: But, of course, we'd recommend again that each woman make that her own decision. If restricting coffee feels like deprivation, then the absence of it won't do much to calm that person.
ED: Of course.
JM: What happens after a hysterectomy? Do women still experience premenstrual syndrome?
ED: Whether a woman has had a total hysterectomy with the fallopian tubes and ovaries removed, or a partial hysterectomy, there's still a break in the hormonal pathway. Generally, the sense is that she will experience few or no "premenstrual" symptoms for 6 to 12 months after the surgery, and then premenstrual symptoms return. I would recommend that women in this situation think about charting their cycles (breast tenderness and mood swings are good indicators).
CG: So, in general, is there anything you recommend to women using the Overcoming Overeating approach?
ED: If you are premenstrual, continue to eat whatever your body craves and give yourself permission to accommodate whatever changes you experience in the frequency of hunger and the nature of the cravings. Remember that traditional books about PMS will recommend foods to avoid. Now that could be depressing! Your choices need to be internal, and I hope no one will use what I'm saying to begin yelling "shoulds" at themselves. Exercise consistently has been shown to help modify some premenstrual symptoms. In addition, some women find multivitamins ("Stresstabs" with extra B-complex) helpful for a couple of weeks before menstruation begins. Occasionally a physician may prescribe a mild diuretic to help with severe PMS discomfort, but if you have a history of diuretic overuse, you would want to be very cautious about looking into this option. Other than that, I would recommend that you use some of this information to understand what your body is going through at that time of the month, carry extra food supplies if you need them for the stress as well as for your more unpredictable hunger, and be as kind and loving to yourself as you are able.
JM: Elisa, what you've told us really validates listening to the messages our bodies so miraculously give us.