As you probably know, premenstrual syndrome is a group of symptoms that express themselves in the latter half of one’s menstrual cycle. If you’re not aware that this can be an issue, you can probably skip the rest of this article. However, those who know this story will recognize the typical cluster of PMS symptoms which include : mood swings, food cravings, irritability, anger, crying spells, fluid retention and bloating, headaches, pelvic pain and cramping, depression and easy fatigability.
Research from multiple studies have shown a direct link between low calcium and Vitamin D and the expression of these symptoms. As a group, these studies show that increasing calcium and Vitamin D intake can reduce the expression of PMS symptoms by about 30%. The underlying mechanism for this improvement is not yet entirely clear. One study did show that both calcium and bio-active forms of Vitamin D can drop during latter half of the cycle (the luteal phase), so it would be reasonable that their support could stabilize symptom expression during this time frame.
As we know that optimal Vitamin D levels for multiple health benefits throughout the life cycle, and bone support starting in one’s 30’s are both important wellness factors, it would make sense that women with PMS should consider taking supplemental calcium and Vitamin D even in their 20’s and 30’s. Some considerations for those considering adding these nutrients include :
–The studies showed that in general it was more beneficial to take the additional calcium (in the range of 600 mg/day) in the form of whole foods vs a pill. While we all know that dairy products such as low fat versions of yogurt, milk and cheese are good calcium sources, it would be wise to mix in non-dairy sources like leafy dark greens (broccoli, bok choy, kale, green beans, spinach), tofu, quinoa, legumes, chia seeds, dried fruits and nuts, and fish with edible soft bones, such as sardines and canned salmon. Many of these sources also supply magnesium, which is essential for optimal calcium absorption.
-While dietary or sunshine sources of Vitamin D are important, many of us do not get adequate amounts from these sources. I routinely see patients where we are both shocked by their markedly deficient Vitamin D levels. You can’t know your level by intuition, you need to have it measured. Some of us have genetic variants for Vitamin D transport or receptors, and need a higher amount of Vitamin D3 intake than what the DV (Daily Value) recommendation would tell you to be therapeutic. While the ‘normal range’ for Vitamin D3 is 30-100; you should aim for the 50-70 level, especially if you have PMS symptoms.
– If you do take a calcium supplement, be aware that although calcium carbonate is the cheapest form, it can be constipating. In general I recommend the citrate form. One should also use ~250 mg of magnesium for every 500 mg of calcium.
-In general, one can’t effectively absorb more than 500-600 mg of calcium per dose. This is also the ballpark amount that the studies showed to be a benefit. But those who are directed to take a higher amount should divide it into two separate dosings.
-Although the benefit was seen most at the luteal phase, the studies indicated that additional calcium or Vitamin D3 should be taken daily throughout the month.
-There are a number of other factors that can affect the luteal phase of your cycle, such as estrogen/progesterone ratios, neurotransmitter levels, salt, caffeine, sugars or alcohol in the diet, and levels of exercise that may need to be addressed to reduce PMS symptoms.
Effects of calcium supplement therapy in women with premenstrual syndrome. Ghanbari, Z et.al.
Calcium and vitamin D intake and risk of incident premenstrual syndrome. Bertone-Johnson ER, et.al.
Calcium reduced PMS symptoms during the luteal phase of the menstrual cycle. Thys-Jacobs S, et.al.
