NUTRITIONAL REQUIREMENTS DURING PMS

Carbohydrate
Pre-menstrual craving for simple carbohydrates and sugars has been suggested as a compensatory response to the serotonin insufficiency. High carbohydrate intake results in the increased availability of tryptophan to the brain, which is a precursor of the neurotransmitter serotonin. But ingestion of large quantities of simple carbohydrates and sugar has deleterious effect on all PMS subgroups (D'Souza and Walker, 1998).

There is said to be a negative correlation between fiber intake and blood oestrogens whereas a positive correlation is found between fiber intake and faecal oestrogen levels. These findings suggest regular dietary fiber consumption at recommended levels i.e. 20-40 g per day. Approximately 60-65% calories must be derived from carbohydrates with 45-50% calories as complex carbohydrates and the remaining 10-15% calories from simple carbohydrates.

Moreover, excessive consumption of simple carbohydrates has been shown to increase the calorie consumption by 90-500 kcal per day during the luteal phase compared to the follicular phase. This may have a cumulative effect on the body weight of PMS women that further leads to obesity, which is a root cause of several diseases, such as diabetes mellitus, cardiovascular diseases, arthritis, etc.

Lipids
Altered food preferences among PMS women results in the consumption of various fatty acids in unbalanced ratio. Low intake of linoleic acid which is a precursor of arachidonic acid leads not only to arachidonic acid deficiency but also to the deficiency of gamma linoleic acid (GLA) which is an intermediate product and acts as a substrate for a series of enzyme reactions giving rise to series 1 eicosanoids (biologically active substances, including prostaglandins) which have a broad range of activities in the body.

However in some cases especially among non-vegetarians, high intake of arachidonate (present in preformed state in meat and meat products) might lead to the excessive production of series 2 eicosanoids that tend to be pro-inflammatory unless moderated by the presence of series 1 and 3 eicosanoids.

These eicosanoid imbalances lead to abnormalities in oestrogen and progesterone levels and activities. It has been observed that PMS patients derive 40% of their calories from dietary lipids consuming twice as much animal fat as vegetable oils. A reduction of fat calories to 30% or below, with a saturated: unsaturated ratio of 0:5, with mono-unsaturated and polyunsaturates equally distributed.

Since vegetable oils such as olive oil, safflower oil, sunflower oil and rice bran oil are good sources of unsaturated fatty acids, their consumption should be increased curtailing on animal fat. Consumption of a minimum amount of animal fat and more vegetable fat must be the most important dietary goal of PMS.

Proteins
High consumption of proteins especially animal proteins has been observed among PMS women. The major source of animal protein was found to be dairy products. Abraham and Rumby (1987) recommended 15% calories as protein, with a vegetable: animal protein ration > 2. Thus calorie consumption may increase either due to increased intake of carbohydrate, fat or protein.

These dietary micronutrient increments would result in an imbalance in the micronutrient consumption such as magnesium, vitamin D, potassium etc.