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In the last 6 years, there have been published trials raising concerns regarding511052570 calcium supplementation and excess risk for myocardial infarction and stroke, although the findings have not been consistent. An updated systematic review and meta-analysis of evidence on the effects of calcium intake from diet and from supplements, either alone or with vitamin D on the risk for cardiovascular disease in generally healthy adults, was conducted. There were four randomized trials and 27 observational studies that were analyzed. Calcium supplementation ranged from 400 mg/day to 1,600 mg/day.

The key points of the analysis were the following:

· Calcium intake with or without vitamin D, and either from food or supplements had no helpful or harmful risk for cardiovascular events in healthy adults.

· Calcium from either food or supplements, that does not exceed the “tolerable upper level of intake” is safe in relationship to cardiovascular health.

· These conclusions were primarily from observational studies. The two previously published meta-analyses that showed some excess risk in randomized trials were considered unreliable by the current authors and reviewers.

· Dietary sources of calcium may be preferred over supplements because it is easier to avoid an excess. Excess calcium may cause gastrointestinal side effects, increase the risk for kidney stones and interfere with absorption of medications.

Commentary: This issue has been confusing the last several years. But for those consumers and providers who have understood the guidelines from the Institute of Medicine, of 1,000 mg-1,200 mg/day of calcium, and understood this number is a total of dietary and supplemental calcium, there was never reason to be concerned. Most adults in the U.S. have a dietary calcium intake of 500mg-1,000 mg/day. These then requires supplementing on average, an additional approximate 500 mg/day in pill form. It was never intended that we eat 1,000 mg/day and then take another 1,000 mg-1,200 mg/day. Don’t forget to look at the amount of calcium in all your dietary supplements, per the serving size on the label, and then determine what it is based on the number of pills you are actually taking. Estimating your daily dietary calcium intake can be done by looking at charts on food sources of calcium. A general guideline has been to count 250 mg/day for the non-dairy and non-soy foods and then allow 300 mg per serving of dairy or tofu or soy milk.

References:

Chang M, et al. Calcium intake and cardiovascular disease risk: An updated systematic review and meta-analysis. Ann Intern Med 2016; Oct 25 (epub)

Kopecky SL, et al. Lack of evidence linking calcium with or without vitamin D supplementation to cardiovascular disease in generally healthy adults. A clinical guideline from the National Osteoporosis Foundation and American Society for Preventive Cardiology. Ann Intern Med 2016;Oct 25 (epub)

Margolis K and Manson J. Calcium supplements and cardiovascular disease risk: What do clinicians and patients need to know? Ann Intern Med 2016; Oct 25 (epub)

468985537During this darkest day of winter, the winter solstice, and the holiday seasons that we each celebrate uniquely… I enjoy reflecting on the year…..my personal life, those of my loved ones, and those near and far whom I do not know, but share a life with on this planet of ours.  I remind myself that we are of one planet, of one mother earth, of one human kind and all are children of the universe and of those who came before us. 

I hold special thoughts for the flora and fauna of our wild places, the tribal and native peoples of our world, children, and those refugees and peoples struggling to survive amidst fear and trauma and devastation of their homes and lives.

May we all strive for in our lives and in the lives of others: safety, decent food, clean water and air, home, wellbeing, a chance to thrive, and to know and share love and kindness.

Menstrual cramps, when due to functional problems and the release of635787428 prostaglandin F2alpha in the menstrual fluid, are a common monthly problem in menstruating women. The usual immediate treatments are anti-inflammatory drugs and prostaglandin inhibitors. One such nonsteroidal anti-inflammatory (NSAID) is mefenamic acid.

A prospective, randomized, crossover study was conducted for 2 months in 122 Iranian women aged 18-25 who had functional menstrual cramps, called primary dysmenorrhea. Group 1 received 3 peppermint oil capsules once daily for 3 days after the onset of the menses, followed by no treatment the next menstrual cycle. As best can be determined from the published study, one capsule contain 187 mg of peppermint oil. During the third menstrual cycle, these women were given 1 capsule of mefenamic acid every 8 hours for 3 days. Group 2 received these same treatments, but in reverse order: mefenamic acid cycle one, then no treatment, then peppermint oil for the third menstrual period.

Pain intensity, pain timing and bleeding amount were assessed. Both mefenamic acid and peppermint oil significantly reduced the severity of pain and there was no significant difference between the two. They also both reduced the duration of pain although mefenamic acid reduced duration more than the peppermint oil. Mefenamic acid significantly reduced bleeding, with a non-significant and slight increase with peppermint oil. Mefenamic acid did not improve nausea and vomiting, while peppermint oil significantly decreased both. Lastly, peppermint oil reduced diarrhea about four times greater than mefenamic acid.

Commentary: Peppermint contains the important active constituent, menthol, which exerts its effect on the myometrium (muscle wall of the uterus) contractions by inhibiting prostaglandin F2alpha and oxytocin. Peppermint also has analgesic and anti-inflammatory activity which explains its effect on improving vomiting and diarrhea. Drugs like mefenamic acid have potential complications such as gastrointestinal bleeding, gastrointestinal ulcers, flatulence, indigestion, stomach pain, and the worsening of colitis. While the average pain intensity and bleeding was significantly lower in the mefenamic acid group, the small difference was such that many women will gain sufficient relief with peppermint oil. I am especially familiar with using peppermint oil for the smooth muscle contractions of irritable bowel syndrome but am eager to recommend it for primary dysmenorrhea, although I will look closely at the dosages of peppermint oil products, and consider different regimens rather than the 3 capsules all at once of 187 mg per capsule, once per day during the first 3 days of the menses that was used in this study.

Reference: Masoumi S, Asi H, Poorolajal J, et al. Evaluation of mint efficacy regarding dysmenorrhea in comparison with mefenamic acid: A double blinded randomized crossover study. Iran J Nurse Midwifery Res 2016;21(4):363-367.

495119012This randomized, double-blind placebo-controlled clinical trial was conducted in women between the ages of 40 and 70 who reported menopausal symptoms. Women were evaluated using two conventionally recognized scales of menopause symptoms, the Kupperman Index (KI) and the Menopause Rating Scale (MRS). Women were randomized to receive either placebo or an extract of Schisandra chinensis… with each pill containing 196 mg of natural extract, and 2 pills twice per day. Women received the treatment for 6 weeks, and then were followed for 12 weeks.

Daily diaries, questionnaires and laboratory studies were performed at baseline, 6 weeks and 12 weeks.

The primary endpoint was the average interval change in KI score from baseline to week 12 with secondary outcomes including laboratory studies and the MRS for sexual and bladder problems. Thirty six women completed the study.

Results: In the Schisandra group, the KI score decreased by 21.6% at the 6 week visit and by 41.2% at the 12-week visit. In the placebo group, the KI score decreased by 12.6% at the 6 week visit and 27.2% at the last visit. The specific symptoms for which Schisandra helped were hot flushes, sweating and heart palpitations and the rates of reduction were about 50% from the beginning to the end. The MRS scores for sexual problems and urinary problems revealed no significant differences between the herbal group and the placebo group. Estradiol serum levels were slightly increased in the herbal group, but was not statistically significant compared to placebo.

Commentary: Schisandra chinensis is a berry whose name means “five flavors” in Chinese: salty, sour, bitter, spicy(pungent) and sweet. In traditional Chinese medicine, it has been used for thousands of years for the common cold, kidney diseases and memory improvement. Modern research has investigated it’s use in vascular diseases and Alzheimer’s disease. Schisandra chinensis should be added to the list of botanicals demonstrating some scientific efficacy for menopausal related hot flushes/ night sweats and heart palpitations.

References: Park J, Kim K. A randomized, double-blind, placebo-controlled trial of Schisandra chinensis for menopausal symptoms. Climacteric. 2016 Dec;19(6):574-580.

As most of us know, breast cancer is the most common cancer in women, although lung cancer is more deadly. Integrating some aspect of natural medicine has become common place for women with breast cancer… at the very least, nutritional and exercise changes. The inclusion of flax seeds in the diet of breast cancer patients has been one nutritional influence that has been looked at in the research. Flax seed contains high concentrations of α-linolenic acid, ω-3 fatty acid, and a variety of lignans. Flax seeds are a dense source of the lignan secoisolariciresinol.

Several databases, including Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Embase, Embase Classic, and Allied and Complementary Medicine were searched through December 2, 2011. The review included controlled and uncontrolled human studies of women at risk of developing breast cancer or already diagnosed with cancer. The flax seed products included flax seed, flax seed-derived compounds, and flax seed oil. Hot flash occurrence, risk of breast cancer, breast cancer recurrence, breast cancer mortality, tumor characteristics, surrogate markers of breast cancer risk, and changes in hormonally responsive tissues were included as outcomes.

A total of1892 articles were retrieved from the databases and ten studies met the inclusion criteria. Only two of these studies were randomized, controlled trials. In the first study, ground flax seed bars were not found to significantly affect the rate of hot flashes compared to placebo bars in 135 women with breast cancer or a history of breast cancer. The second study measured biopsied breast tissue in 32 women with breast cancer before and after treatment with flax seed cooked into flax seed muffins. In the women who consumed the flax seeds, beneficial findings included an apoptotic index that increased significantly and human epidermal growth factor receptor 2 (HER2)  expression and Ki-67 labeling index, a marker of cell proliferation, both decreased significantly (−71.0% and −34.2%), respectively.

There were two trials without controls. One in which hot flashes decreased significantly with the consumption of 40 g of crushed flax seed per day. The second in which women consumed 50 mg of a lignan found in flax seed, for 12 months. In those with a positive response, there was a significant decrease in Ki-67 and atypical cell morphology of breast tissue.

In a single, nonrandomized, open-label study, biomarkers of angiogenesis in breast tissue were measured. Nine healthy women consumed 25 g flax seed and were compared to 11 patients with breast cancer undergoing tamoxifen treatment (20 mg daily). Flax seed and tamoxifen increased endostatin by approximately 33% in breast tissue, whereas tamoxifen, but not flax seed, decreased the other markers of angiogenesis.

Five observational studies were found. In two of these, consumption of lignans or flax seed (one quarter cup per day of flax seeds) resulted in a 19% or 20% reduction in the risk of developing breast cancer, respectively. The effect of flax seed was significant only in postmenopausal women. In a third observational study, no decrease in breast cancer risk was found with the consumption of a combination of sesame and flax seeds, although the amount was quite low at 1.42 mg/day. In another sesame/flax combination study, no effect on breast cancer mortality was seen, however, women in the study that consumed 0.3 to 3.5 g/day of sesame/flax were found to have a 31% reduction in overall mortality; but no advantage of > 3.6 gm/day. In the last observational study, a significant relationship was found between flax seed oil consumption and better mental health scores, as reported by the women, in women with breast cancer.

Commentary: This data in total, is encouraging in that it suggests that flax seed may decrease the incidence of breast cancer and may alter the growth of tumors through altering angiogenesis… which means limiting the blood supply to tumors. There also appears to be some advantage for postmenopausal women in that they may benefit more from the consumption of flax seed than do premenopausal women. Flax seeds contain phytoestrogen compounds, which some individuals have been concerned about. However, these compounds appear to be protective, especially in a low estrogen environment such as post menopause. There is a large body of scientific evidence that plants containing these phytoestrogen compounds, including three very large studies on soy products in breast cancer patients…may decrease the progression of breast cancer and women who eat soy regularly if not daily…will have a better outcome with their breast cancer. In addition, animal studies have found that flax seed and flax seed extracts reduce cell proliferation, angiogenesis, metastasis, and tumor size, and promote apoptosis.

Reference: Flower G, Fritz H, Balneaves LG, et al. Flax and breast cancer: a systematic review. Integr Cancer Ther. May 2014;13(3):181-192.

Menstrual cramps, when due to primary dysmenorrhea, are caused by the action of endometrial prostaglandins and is a normal process of menstruation, to a degree, that then causes the contractions of the uterus. However, for some women, it is more than mild discomfort and can be mild, moderate or severe and depending on the pain level, needs to be treated during those painful days, as well as a strategy to try to reduce the pain for the next menstrual cycles. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most common acute treatment, but can cause peptic ulcers, liver or kidney disorders and allergic reactions. Hormonal contraceptives are also commonly used to manage the chronic nature of the problem. Herbal and nutritional therapies have been shown to reduce acute pain in several published studies and have included valerian, ginger, cinnamon and niacin. High dose Vitamin D before the menstrual cycle and regular select doses of fish oils have been shown to reduce the subsequent painful cycles.

Previous studies have shown that metabolism and absorption of vitamins and minerals may play a role in the etiology of and treatment of menstrual disorders. Lower serum calcium levels have been associated with muscle spasm and contraction. Vitamin D may help to regulate prostaglandins.

The current randomized placebo-controlled trial attempted to determine the effect of combined Calcium-Vitamin D and Calcium alone on the intensity of menstrual pain and menstrual blood loss in women with primary dysmenorrhea. Iranian women aged 18-32 with painful and regular menses in the previous 6 cycles were given either Calcium-Vitamin D tablets of 1,000 mg Calcium carbonate and 5,000 units of Vitamin D, or Calcium carbonate alone 1,000 mg or placebo. Each group took their tablet once daily from day 15 until the end of the menstrual flow, for one cycle.

Compared to placebo, the mean pain intensity was lower in both the Calcium-Vitamin D group (-0.7) and the calcium alone group (-1.6) but was only statistically significant in the calcium alone group. Menstrual blood loss was not significantly different in any of the 3 groups. The mean percent change of pain intensity from baseline was 20% in the Calcium-Vitamin D group, 32% in the calcium alone group and 6% in the placebo group.

Commentary: This study confirms the effectiveness of something as simple as508095722 Calcium 1,000 mg/day starting on day 15 and through the menstrual flow in reducing the severity of primary dysmenorrhea. In an earlier trial, the authors demonstrated that effectiveness of 600 mg/day from day 15 through menses in reducing menstrual pain intensity. Other research has shown that dysmenorrhea was significantly less common in young women who consumed 3 or 4 servings of dairy products every day compared to those who consumed no dairy. Another study showed that women with very severe dysmenorrhea reported lower intake of dairy products. On the other hand, there was a study that reported a positive relationship between consumption of dairy and severity of pain. Despite the one report showing a negative vantage point of dairy products and dysmenorrhea, I would assert that this simple notion of Calcium 1,000 mg/day starting on day 15 is an important option in trying to reduce the impending menstrual cramps.

Reference

Zarei S, Charandabi M, Mirghafourvand M, et al. Effects of calcium-vitamin D and calcium-alone on pain intensity and menstrual blood loss in women with primary dysmenorrhea: a randomized controlled trial. Pain Medicine 2016;0:1-11.

599254720Heartburn, often called acid indigestion is when there is a burning/acidic sensation in the chest. It is caused by a back up of acid from the stomach into the esophagus and throat. Classic symptoms are those burning sensation behind the sternum and/or in the throat, but can also be accompanied by nausea, belching, bloating. When we have one or more of these symptoms, it may not be a simply case of heartburn, which is a symptom, but rather gastroesophageal reflux disease (GERD), which is a disease that involves chronic acid regurgitation that can damage the lining of the esophagus. If one has at least two episodes of heartburn per week, that is when we need medical advice and perhaps an evaluation for GERD. GERD can also exist without any heartburn/acidic sensation at all…but perhaps a nagging cough, hoarseness, laryngitis, wheezing, postnasal drip, sinusitis, chest/ear or jaw pain, painful swallowing or a sensation in the throat.

There are natural medicine supplements, over the counter pharmaceuticals and prescription medications for heartburn and GERD. What I want to focus on here though, are the basic lifestyle changes that are fundamental to any pill, no matter the nature of the pill.

· WEIGHT-Weight management- excess weight, especially abdominal fat can contribute to heartburn or GER by putting pressure on the stomach which then pushes the contents up into the stomach. Even a gain of 10 # in women can increase the risk by 40%. Once a woman is in the category of overweight or obese, the risk of GERD symptoms doubles or triples. Losing weight can decrease symptoms.

· TIMING OF EATING-Avoid eating for 2-3 hours before bedtime. This allows time for the stomach to empty. Even before going to bed, avoid lying down after eating and avoid exercising right after eating.

· SMALLER MEALS; REDUCE FLUIDS WITH MEALS-Larger meals puts greater pressure on the lower sphincter of the stomach which then leads to a greater likelihood of back up into the esophagus.

· STOP SMOKING- Smokers have an increased risk for acid reflux due to possible relaxing effects of the smoking on the sphincter. Smoking also decreases salivary production and with less saliva, we miss out on some neutralization of acid in the stomach.

· AVOID SELECT FOODS and BEVERAGES- Spicy, fatty foods, fried foods, citrus fruits and beverages, alcohol, chocolate, milk, peppermint, coffee, tea, carbonated beverages and milk. Some relax the sphincter, some are acidic and some actually promote acid production.

· ELEVATE THE HEAD OF YOUR BED-for those who have symptoms at night or early in the morning, putting wooden blocks under the headboard to raise it 4-8 inches can help to prevent reflux. Another option is to use a foam bed wedge which elevates the upper part of the body.

· SLEEP ON LEFT SIDE- believe it or not… this could help… Our stomach bends to the left… so when you lie on the left side, a portion of the stomach is lower than the esophagus… which may help to reduce backup of food and acid into the esophagus. Every little bit can help.

· SUGARLESS GUM-chewing gum after meals can stimulate saliva production which then helps to neutralize stomach acid and soothe the lining of the esophagus. I would also mention here to choose gum wisely in terms of healthier choices for the gums and teeth. One example includes those made with xylitol.

· CHECK MEDICATIONS-some medications can actually cause or contribute to heartburn or acid reflux. Your doctor and pharmacist can be very helpful here. Possible suspects include bisphosphonates, aspirin, ibuprofen, benzodiazepines, opioid narcotics, calcium channel blockers, potassium, progestins, certain antihistamines and antispasmodics, and even peppermint based herbal products.

· AVOID TIGHT CLOTHES-tight pants at the waist, tight girdles and belts can put pressure on the stomach and can worsen reflux.

· BEND AT THE KNEES- there are many reasons to bend at the knees when lifting or picking up items from the floor due to low back care in particular… but for those individuals who may do this repetitively due to their job or activities of daily living… this may also put pressure on the stomach.

That’s it for now, in terms of lifestyle changes that serve as the basic foundation upon which to add select nutritional/botanical supplements that address both cause and provide symptom relief or over the counter or prescription medications if needed.

488559207Did you know that curcumin, a component of turmeric (Curcuma longa), has antidepressant activity? Natural medicine has much to offer individuals who suffer from mild to moderate depression, and increasingly, we have things to offer for those with major depression. One of the problems with conventional treatments, is that nearly 50% of patients with major depressive disorders discontinue their medication due to side effects. Finding treatments that do not cause side effects, then becomes much needed area of optimal management. Curcumin, a component of turmeric rhizome has been studied in several clinical trials, but the current paper is a meta-analysis the evaluated the safety and effectiveness of curcumin in treating major depressive disorder.

The meta-analysis of the literature that was searched included those that met the following criteria: (1) human study, (2) quantitative analysis, (3) intervention and control group, (4) curcumin was an independent intervention, (5) study addressed only major depressive disorder, (6) depression was measured with standardized scales, and (7) the study was in English. Studies were also rated according to quality and the data from all the studies were converted into Hamilton Depression Rating Scale scores.

A total of 1757 studies were identified, and six met all the inclusion criteria which totaled 342 patients (n=177 curcumin and n=165 control). There were four randomized controlled trials, one crossover study, and one open-label study. All patients received an antidepressant prescription medication in addition to either curcumin (1 g/day, n = 5 studies or 500 mg/day, n = 1 study) or placebo. Five of the studies rated strong in quality and one was moderate.

In this meta-analysis there was a significant reduction in major depressive symptoms with curcumin treatment compared with control. In addition, several subgroup analyses demonstrated that curcumin had a significant benefit in middle-aged patients but not older-aged patients, although age ranges were not defined; curcumin had a significant benefit in patients treated for > 6 weeks but not in patients treated for < 6 weeks; 500 mg / day of curcumin did not have an effect but 1,000 m g/day did have a significant benefit; and curcumin had a significantly greater benefit in those patients who only had major depressive disorder vs. those with major depressive disorder and other chronic health problems.

Commentary:

This appears to be the first meta-analysis of the effect of curcumin on major depressive disorder. Summary conclusions are that curcumin is effective in reducing symptoms of depression in patients with major depressive disorder and are already taking prescription antidepressants, and that curcumin is more effective in middle-aged patients. Effective doses were 1 g/day for > 6 weeks. A few cautionary notes with this meta-analysis are that there were only 6 studies; only two doses of curcumin were evaluated; the piperine used to enhance curcumin and/or the doses of curcumin may not have been optimal and that the study was quite short term for such a chronic condition. On the other hand, the methodology the authors used was rigorous and I am encouraged by the research on curcumin and depression.

Reference: Al-Karawi D, Al Mamoori DA, Tayyar Y. The role of curcumin administration in patients with major depressive disorder: Mini meta-analysis of clinical trials. Phytother Res. 2016;30(2):175-183.

Fenugreek seed has a long tradition of being used as an a466762923gent to increase the production of breast milk (“galactagogue”). There is general agreement among health care advisory organizations, including the World Health Organization, breast feeding is recommended for at least 6 months, due to its short and long term health benefits to the recipient. Not all women have sufficient milk production to succeed in a 6-month duration, and simple, safe methods are welcome options. The goal of this randomized, controlled, double-blind, clinical trial was to evaluate the effect of a fenugreek seed herbal tea on the signs of breast milk sufficiency in female infants from birth to the age of 4 months.

The study was conducted in Tehran, Iran and included 78 healthy female infants and their mothers. The infants weighed between 5.5 and 8.8 lbs., had normal sucking ability, were not consuming infant formula or other sources of nourishment. No other herbal or pharmaceutical agents were being used by the women to promote lactation.

The lactating women were randomly assigned to receive an herbal tea containing 7.5 g fenugreek seed powder in addition to 3 g black tea powder (n=39) or to the control group that was an herbal tea containing 3 g black tea powder (n=39). Teas were consumed 3 times per day, 2 hours after each meal for 4 weeks.

Growth measurements included infant weight, height, and head circumference and were done at baseline and each weekly visit. Mothers completed questionnaires about demographic factors and breastfeeding conditions and completed a 2-day account of the number of daily wet diapers, frequency of infant defecation, and the number of times they breast fed each day.

Upon entry into the study, women in both groups had similar body mass index, age, and similar infant weight, height, or head circumference.

After 4 weeks of teas: weight, head circumference, number of wet diapers, frequency of defecation, and number of breastfeeding times increased significantly in the fenugreek group compared with baseline. The growth in infant height was not different between the two groups. Growth in height difference between the 2 groups was not significant.

Commentary: While this was a small study, and the use of fenugreek teas was used in conjunction with black tea, it appears that fenugreek seed did improve signs of breast milk sufficiency. It would have been useful to know how much fenugreek seed was in the tea, how the tea was prepared as we do not know if it was an infusion or a decoction or even just mixing the powder into hot water and instantly drinking. It would also be useful to know how much liquid was consumed in each unknown amount of tea. I would also want to know if this approach could help a woman reach the goal of 6 months of lactation. All of that said, this study in my view, supports the tradition of fenugreek in promoting milk supply in lactating women, and supports the usefulness of it in women who want to assure the delivery of adequate milk to their infants.

Reference

Ghasemi V, Kheirkhah M, Vahedi M. The effect of herbal tea containing fenugreek seed on the signs of breast milk sufficiency in Iranian girl infants. Iran Red Crescent Med J. August 15, 2015;17(8):e21848. doi: 10.5812/ircmj.21848.

185081880Premenstrual syndrome (PMS) includes one or more of many symptoms in the areas of mood, the physical body and cognition. The most frequent symptoms are irritability, depression, fatigue, water retention, weight gain, breast tenderness, headaches, abdominal cramps and mood swings. About 80% of women may experience PMS and about 50% of women seek medical care for their symptoms.

The primary etiology of PMS has been thought to be the interplay of serotonin and hormones which is why conventional treatment of PMS most often includes SSRIs to increase serotonin levels and/or birth control pills to suppress ovarian hormone secretion.

High sensitivity C-reactive protein (hs-CRP) is an acute phase inflammatory marker that has been associated with risk for cardiovascular disease and menopausal hot flash symptoms. It has also been associated with some of the risk factors for PMS including depression, smoking, increased body mass index (BMI) and aging. Some studies have investigated the role of inflammation and PMS but only suggestive not significant connections have been observed. Select anti-inflammatory medications can also provide relief for some PMS symptoms.

The current study used data on PMS symptoms from a much larger study called the Study of Women’s Health Across the Nation (SWAN), a racially and ethnically diverse study of midlife women from five racial/ethnic groups and at seven clinical sites nationwide. The goal was to determine if hs-CRP was associated with PMS. The proportion of women who reported each PMS symptom, except breast pain or headaches, was significantly increased (26%-41%) for women who had hs-CRP values > 3 mg/L. A hs-CRP level > 3 mg/L in women with PMS was associated with mood symptoms, abdominal cramps, back pain, appetite cravings, weight gain, and bloating, but not with headaches, breast pain for women with three or more PMS symptoms.

Most symptoms, except for headaches and breast pain were reported by significantly more obese women, women who smoked or were exposed to passive smoke and by women with an elevation of depressive symptom scores.

Commentary: There has been very little literature that has focused on any relationship between inflammation and PMS. The current study that does observe a significant relationship with at least some PMS symptoms and in women who have less than 3 PMS symptoms suggests that inflammation may be involved in PMS. That said, I would not abandon the serotonin-hormone connection and would continue to recognize that PMS is likely a complex disorder with potentially different mechanisms for the etiologies of at least some of the symptoms. In addition to biology, there are numerous social, demographic and behavioral factors that are likely associated with PMS. The lifestyle and natural agents that have published research support that I rely on the most in clinical practice are aerobic exercise 4 or more times per week, St John’s wort, calcium, vitamin B6, chaste tree, magnesium, vitamin E and borage seed or evening primrose oil. For more difficult mood disorder PMS patients, usually called premenstrual dysphoric disorder (PMDD), I add one or more of the following: tryptophan, theanine, lavender, GABA, SAMe and more.

Reference

Ellen B. Gold, PhD, Craig Wells, BA, and Marianne O’Neill Rasor, MA. The Association of inflammation with premenstrual syndrome. J Women’s Health 2016; May on line ahead of print

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