In 2004 the University of Iowa published a report in Primary Psychiatry titled “The Epidemiology of Premenstrual Syndrome.”
It was an update regarding the nature and treatment of premenstrual syndrome (PMS). It stated that over the past two decades (1984 to 2004), significant progress had been made in the understanding of the epidemiology, diagnostic criteria, and treatment approaches for premenstrual symptoms.
In the abstract, the report cited the following:
- PMS and premenstrual dysphoric disorder affect approximately 20 to 30 percent of menstruating women, and the average age women with PMS seek treatment is in their early 30s.
- Women with PMS usually present with physical and mood complaints, with irritability as the hallmark symptom.
- The major impairment associated with PMS is an adverse effect on personal relationships.
- Whereas use of over-the-counter (OTC) remedies is common among women with any degree of symptoms, few women with severe symptoms use prescribed drugs.
Some studies have reported that PMS includes “more than 150 symptoms,” which suggests that it may not be possible to accurately determine a pharmaceutical pathway for treatment of non-pathological indications.
Nevertheless, analyses of the most common symptoms support the existence of a limited core of physical (visceral and structural) problems that account for the majority of symptoms women experience.
If the clinician can determine the exact cause of the symptoms based on stressed physiological processes, then nutritional and chiropractic intervention may very well be the answer. (And related emotional symptoms can be easily explained.)
Searching for a symptomology
PMS symptoms should be characterized by type, severity, and timing. Because the normal physiology of the luteal phase of menstruation is well-known, the cause of the patient’s symptoms should be fairly easy to find.
Once the cause is known (e.g., poor protein digestion), then needed nutritional support becomes obvious.
Pharmaceutical clinicians need to find a drug to relieve symptoms, but once we know the specific tissue that is stressed, not only does the required nutritional intervention become apparent, so too do the associated involuntary muscle contractions and subluxation patterns.
Is it possible that chiropractic clinicians are uniquely qualified to diagnose the cause and render specific nutrient and structural therapeutic procedures to help each woman suffering from PMS? (It should be emphasized that every woman has a unique heredity and lifestyle and should not be assigned to a generic “one-size-fits-all” treatment regimen.)
Your patients with non-pathological menstrual and reproductive problems may be receptive to nutritional intervention and chiropractic adjustments. Look for the cause of the symptoms they are presenting. In many cases, nutrition is the root cause of deviations from normal in women’s reproductive health.
The diagnostic methods that are useful in troubleshooting health conditions come directly from your chiropractic education.
Begin with a thorough case history that includes:
- A review of all 10 major organ systems including past surgeries and present medications, whether OTC or prescribed.
- A review of dietary habits with emphasis on what foods the patient craves and which she routinely avoids.
- Does she think she is a vegetarian, when in fact she may be a “pastatarian”? Is her diet balanced to meet her physiological needs?
- Emphasis must be placed on deter- mining the source of stress, or the source of energy deficiency. The body has a specific physiological response to stress regardless of whether it is from a structural, nutritional, or emotional source. It is imperative to find the source and focus on reducing it and properly nourishing the fatigued tissues.
- Therefore, a chiropractic evaluation is important to determine structural involvements, if any.
- Laboratory tests can be ordered as needed and should include a 24-hour urinalysis collection to rule out possible undiagnosed pathology.
Often, you’ll find that protein deficiency plays a major part in women’s health issues.
This is so common that most (but not all) female patients, following menarche, will present with symptoms indicating inadequate protein availability to meet their needs.
What are the signs and symptoms of protein deficiency and how do they relate to PMS?
The most common nutrition- related signs of inadequate protein to meet physical needs include the following:
- Menstrual cramps and muscle cramping at rest. These are related to the relationship of protein and calcium.
- Cold hands and feet.
- Water retention, and swelling of the hands and feet.
- Increased watery secretions from the eyes, nose, and mouth.
- Pink toothbrush.
- Low tolerance of exercise.
Protein metabolism is arguably the most important issue for women suffering from non-pathological premenstrual and postmenstrual symptoms. For example, loss of menstrual blood alone is often cited as a loss of protein, and hemoglobin itself is a protein molecule. And the process of producing a corpus luteum every month is much more demanding as protein is its primary component.
Many chiropractors include blood tests in their diagnostic procedures, but protein deficiency is not usually indicated on routine tests.
Low albumin and total protein levels in the blood are a late sign of protein deficiency related to advanced pathological processes.
The body is required to maintain homeostasis in the extracellular fluid (ECF), and when protein is needed in the ECF, or as a source of energy, the body pulls amino acids from the cells. The cells otherwise would use the amino acids for growth and repair. Hence, the deficiency is intracellular.
Because of the integral part that nutrition—and protein in particular—plays in women’s health issues, reeducate female patients.
The process involves reeducating the patient regarding her dietary needs and noting the true cause of her symptoms as opposed to finding a “magic bullet” that only relieves them. Once aware of the cause and understanding it is unnecessary to be burdened with symptoms, most women quite actively pursue getting well. But, of course, there is always a continual negotiation, especially concerning diet.
Another nutritional component in women’s health are lipids, but there is a huge void in public understanding of even the fundamentals of lipid metabolism.
There is usually no need for women to increase the amount of fat in their diet. But problems arise from not consuming good sources of lipids or from the inability to adequately digest and absorb the lipids already in the diet.
A fact about digestion is that bile is needed to emulsify fats. Bile (highly alkaline) is partially stimulated by the acid coming out of the stomach. Low or inadequate hydrochloric acid production equates to poor biliary function.
How many of your patients are taking antacids, H2 blockers, or proton pump inhibitors? There is a direct connection between good protein and lipid digestion, and there are simple tests to gauge stomach acid production.
The study cited at the beginning of this article stated that women with PMS usually present with both physical and mood problems, with irritability as the hallmark symptom.
The major impairment associated with PMS is an adverse effect on personal relationships.
Anxiety can be caused by many factors. The nutritional connection would be in calcium metabolism and its close relationships with protein, phosphorus, potassium, and magnesium. If we find the nutritional cause, reduce the stress, and nourish the body, then PMS- related anxiety can be greatly lessened.
Paramount among those relationships is the one between protein and lipid digestion, absorption, and assimilation. Supplementing calcium (even with vitamin D), in most cases will not be a comprehensive solution and won’t relieve the anxiety.
Another common complaint in PMS is cravings for carbs. What causes these cravings and how can they be prevented?
Carbohydrates are used exclusively for energy production. So obviously the body is seeking a source of quick energy. But you will find that women who do not adequately digest fats will eat excessive sugar-laden foods and store the energy as fat.
Menopause, considered the last phase of reproductive health, has its own set of symptoms and difficulties.
It is all about proper nourishment of the body. If this has been a lifelong pursuit there probably won’t be any problems. But women suffering from hot flashes and other symptoms of menopause are invariably protein-deficient in terms of meeting the body’s needs to prevent symptoms. Most likely they have been protein deficient most of their lives.
You will find the same problems responsible for PMS are at work in menopause and osteoporosis, too.
The Council on Nutrition of the American Medical Association defines nutrition as the “science of food; what is ingested, digested, absorbed, transported, utilized and eliminated.” So you would be well-advised to practice prevention and health maintenance and give up searching for magic bullets.
Howard F. Loomis Jr, DC, is a 1967 graduate of Logan College of Chiropractic. He ran an active general practice in Missouri for 25 years. He is a member of the postgraduate faculty at Logan and is the founder and president of Enzyme Formulations Inc. and the Loomis Institute of Enzyme Nutrition. He can be reached at 800- 662-2630 or through loomisenzymes.com.