This question came up in Sci. Med. Nutrition and I'm posting my answer  here.  Only 22 medical schools in the U.S. teach courses on human  nutrition.  We have already seen what a lack of nutrition education can do  when candida and kidney stones present themselves to the medical community. I think that the best example of where U.S. medicine is really missing the  mark when it comes to a knowledge of nutrition is PMS.  So many women(and  their husbands) suffer from this disorder that it is really criminal that  most physicians in the U.S. are not taught that PMS is primarily caused by  diet and diet changes can prevent it from ever happpening.  Before shooting  your flames, read the entire article and then decide if flaming is  justified.  From A Poster In Sci. Medi. Nutrition: > 	In a psychological anthropology course I am taking, we got  > sidetracked onto a short conversation about PMS.  Some rumors shared > by several of the students included ideas that vitamin levels, sugar > intake, and caffeine intake might affect PMS symptoms. > 	Is there any data on this, or is it just so much hooey? >  > Many thanks, >  > Michael, I've wanted to reply to this post ever since I saw it but I got  side-tracked with candida.  PMS is a lot like Candida blooms, most  physicians don't recognize it as a specific "disease" entity.  Here is  everything that you would ever want to know about PMS.  Premenstrual syndrome has been divided into four specific subgroups:  	PMT-A(Anxiety)		PMT-D(depression) 	anxiety			depression 	irritability		forgetfulness 	insomnia		confusion 	depression		lethargy  	PMT-C(Craving)		PMT-H(Hyperhydration) 	craving for sweets	weight gain 	increased appetite	breast congestion and tenderness 	sugar ingestion causes: abdominal bloating and tenderness 	 1. headache		edema of the face and extremities 	 2. palpitations 	 3. fatigue or fainting   PMT-A is characterized by elevated blood estrogen levels and low  progesterone levels during the luteal phase of a women's cycle.  PMT-C is caused by the ingestion of large amounts of refined simple  carbohydrates.  During the luteal phase of a women's cycle, there is  increased glucose tolerance with a flat glucose curve after oral glucose  challenge.  The metabolic findings believed to be responsible for PMT-C are  a low magnesium and a low prostaglandin E1.  This condition of hypoglycemia  is not unique to PMS but there are a number of different causes of  hypoglycemia, magnesium and PGE1 seem to be specific to PMS hypoglycemia. 	A. Am. J. Psychiatry 147(4):477-80(1990). Unrefined complex carbohydrate should be substituted for sugar, magnesium  supplementation and alpha linoleic acid supplementation(increased to 5-6% of  the total calories) using safflower oil or evening primrose oil as sources  of alpha linoleic acid.  PMT-D is characterized by elevated progesterone levels during the midluteal  phase of a women's cycle.  Another cause of PMT-D has been found to be lead  toxicity(in women without elevated progesterone levels during the midluteal  phase). "Effect of metal ions on the binding of estridol to human  endometrial cystol" Fertil. Steril. 28:312-18(1972).  PMT-H is associated with water and salt retention along with an elevated  serum aldosterone level.  Salt restriction, B6, magnesium and vitamin E  for breast tenderness have all been effective in treating PMT-H  This general discussion of the PMS syndromes came form:  	A. "Management of the premenstrual tension sundromes: Rational for  	    a nutritional approach". 1986, A Year in Nutritional Medicine.  	    J. Bland, Ed. Keats, Publishing, 1986.  	B. "Nutritional factors in the etiology of premenstrual tension  	    syndromes", J. Reprod. Med.28(7):446-64(1983).  	C. "Premenstrual tension", Prob. Obstet. Gynecol. 3(12):1-39(1980)  Treatment has traditionally involved progesterone administration if you can  find a doctor who will treat you for PMS(just about as hard as finding one  that will treat you for candida blooms).  While progesterone will work,  supplementation with vitamins and minerals works even better.  There really  has been an awful lot of research done on PMS(much more than candida  blooms).  Many of these studies have been what are called experimental  controlled studies(the type of rigorous clinical studies that doctors like to  see done).  Here are a few of these studies:  	CARBOHYDRATE: Experimental Controlled Study, "Effect of a low-fat,  	high-carbohydrate diet on symptoms of cyclical mastopathy" Lancet  	2:128-32(1988).  21 pts with severe persistent cyclical mastopathy  	of at least 5 years duration were randomly selected to receive  	specific training to reduce dietary fat to 15% of total calories  	and increase complex carbohydrate ingestion or given general dietary  	advise with no training.  After 6 months, there was a significant  	reduction in the severity of the breast swelling and tenderness in  	the trained group as reported by self-reported symptoms as well as  	physical exams which quantitated the degree of breast swelling,  	tenderness and nodularity.  	VITAMIN A: Experimental Controlled Study, "The use of Vitamin A in  	premenstrual tension" Acta Obstet. Gynecol Scand. 39:586-92(1960).   	218 pts with severe recurring PMS received 200,000 to 300,000IU  	vitamin A daily or a placebo.  Serum retinol levels were monitored  	and high dose supplementation was discontinued when evidence of  	toxicity occured(serum retinol above 450ug/ml).  The intent of the  	study was to load the liver up with vitamin A and get a normal pool  	size(500,000IU to 1,000,000IU) and then see if this  	normal vitamin A pool could prevent PMS.  48% getting the high dose  	vitamin A had complete remission of the symptoms of PMS.  Only 10%  	getting the placebo reported getting complete relief of PMS sysmptoms.   	10% of the vitamin A treated group reported no improvement in PMS  	symptoms.  	Experimental Controlled Study, "Premenstrual tension treated with  	vitamin A" J. Clinical Endocrinology 10:1579-89(1950). 30 pts  	received 200,000IU of vitamin A daily starting on day 15 of their  	cycle with supplementation continuing until the onset of PMS symptoms.   	After 2-6 months, all 30 pts reported a significant improvement in  	PMS symptoms.  Vitamin A supplementation was stopped once evidence of  	toxicity was demonstrated and all 30 pts were followed for one year  	after high dose vitamin A supplementation was stopped.  PMS symptoms  	did not reoccur in any of these 30 pts for upto one year after the  	vitamin A supplementation was stopped.  Most Americans do not have a normal store of vitamin A in their liver.   These studies and several others were designed to see if getting a normal  store of vitamin A into the liver could eliminate PMS.  Of all the vitamins  given for PMS(vitamin A, B6, and vitamin E), vitamin A has shown the best  single effect.  This is probably because vitamin A is involved in steroid  (estrogen/progesterone) metabolism in the liver.  Getting your liver full  of vitamin A seems to be one of the best things that you can do to prevent  the symptoms of PMS.  But vitamin A is toxic and you don't want to be trying  to do this without being seen by a physician who can monitor you for vitamin  A toxicity.  	VITAMIN B6: Experimental Double-blind Crossoverr Study, "Pyridoxine 	(vitamin B6) and the premenstrual syndrome: A randomized crossover  	trial"J.R. Coll. Gen. Pract. 39:364-68(1989).  32 women aged 18-49  	with moderate to severe PMS randomly received 50mg B6 daily or placebo.   	After 3 months the groups were switched and followed for another  	3 months.  B6 had a significant effect on the emotional aspects of  	PMS(depression, irritability and tiredness).  Other symptoms of PMS  	were not significanttly affected by B6 supplementation.  	Experimental Double-blind Study, "The efects of vitamin B6  	supplementation on premenstrual sysmptoms" Obstet. Gynecol  	70(2):145-49(1987).  55 pts with moderate to severe PMS received  	150mg B6 daily or placebo for 2 months.  Analysis of convergence  	showed that B6 significantly improved premenstrual symptoms related  	to the autonomic nervous system(dizziness and vomiting) as well as  	behavior changes(poor mental performance, decreased social interaction)   	Anxiety, depression and water retention were not improved by B6  	supplementation.  Vitamin B6 is below the RDA for both American men and women.  Birth control  pills and over 40 different drugs increase the B6 requirement in man.   Women on birth control pills should be supplemented with 10-15 mg of B6 per  day.  The dose should be increased if symptoms of PMS appear.  Dr. David R.  Rubinow who heads the biological psychiatry branch of NIMH was quoted in  Clin. Psychiatry News, December, 1987 as stating that B6 should be  considered the "first-line" drug for PMS(over progesterone) and if the  patient does not respond, then other treatments should be tried.  Vitamin  B6 can be toxic(nerve damage) if consumed in doses of 500mg or more each  day.    	VITAMIN E: Experimental Double-blind Study, "Efficacy of alpha- 	tocopherol in the treatment of premenstrual syndrome" J. Reprod.  	Med. 32(6):400-04(1987). 35 pts received 400IU vitamin E daily for 3  	cycles or a placebo.  Vitamin E treated pts had 33% who reported a  	significant reduction in physical symptoms(weight gain and breast  	tenderness) while the placebo group had 14% who reported a significant  	reduction in physical symptoms. The vitamin E group reported that 38%  	had a significant reduction in anxiety versus 12% for the placebo  	group.  For depression, the vitamin E group had 27% with a significant 	decrease in depression compared with 8% for the placebo group.  	Experimental Double-blind Study, "The effect of alpha-tocopherol on  	premenstrual symptomalogy: A double blind study" J. Am. Coll. Nutr.  	2(2):115-122(1983). 75pts with benign breast disease and PMT randomly  	received vitamin E at 75IU, 150IU, or 300IU daily or placebo.  After  	2 months of supplementation, 150IU of vitamin E or higher significantly  	improved PMT-A and PMT-C.  The 300IU dose was needed to significantly  	improve PMT-D.  No dose of vitamin E significantly improved PMT-H 	(other studies have shown that a higher vitamin E doses will relieve  	PMT-H symptoms). 	 	MAGNESIUM: Experimental Double-blind Study, "Magnesium prophylaxis  	of menstrual migraine: effects on itracellular magnesium" Headache  	31:298-304(1991). 20 pts with perimenstrual headache received 360 mg  	daily of magnesium as magnesium pyrrolidone carboxylic acid or a  	placebo.  Treatment was started on the 15th day of the cycle and  	continued until menstruation. After 2 months, the Pain Total Index  	was significantly lower in the magnesium group.  Magnesium treatment  	was also assocoiated with a significant reduction in the Menstrual  	Distress Questionnaire scores.  Pretreatment magnesium levels in   	lymphocytes and polymorphonuclear leukocytes were significantly lower  	in this group of 20 pts compared to control women who did not suffer  	from PMS.  After treatment, magnesium levels in these cells was raised  	into the normal range.  	Experimental Double-blind Study, "Oral Magnesium successfully  	relieves premenstrual mood changes" Obstet. Gynecol 78(2):177-81(1991).  	32pts aged 24-39 randomly received either magnesium carboxylic acid  	360mg of Mg per day or a placebo from the 15th day of the cycle to the  	onset of the menstrual flow.  After 2 cycles, both groups received  	magnesium.  The Menstrual Distress Questionnaire score of the cluster  	pain was significantly reduced during the second cycle(month) for the  	magnesium treatment group as well as the placebo group once they were  	switched to magnesium supplementation.  In addition, the total score on  	the Menstrual Distress Questionnaire was significantly decreased by  	magnesium supplementation.  The authors suggest that magnesium  	supplemenation should become a routine treatment for the mood changes  	that occur during PMS.  There are numerous observational studies that have been published in the  medical literature which also suggest that PMS is primarily a disorder  that arises out of a hormone imbalance that is dietary in nature.  But  since observational studies are considered by most physicians in Sci. Med.  to be anecdotal in nature, I have not bothered to cite them.  There are  also over a half dozen good experimental studies that have been done on  multivitamin and mineral supplementation to prevent PMS.  I've chosen the  best specific studies on individual vitamins and minerals to try to point out  that PMS is primarily a nutritional disorder.  But doctors don't recognize  nutritional disorders unless they can see clinical pathology(beri-beri,  pellagra, scruvy, etc.).  PMS is probably the best reason why every doctor  being trained in the U.S. should get a good course on human nutrition.  PMS  is really only the tip if the iceberg when it comes to nutritional  disorders.  It's time that medicine woke up and smelled the roses.  Here's some studies which show the importance in multivitamin/mineral  supplementation and/or diet change in preventing PMS.  	Experimental Study, "Effect of a nutritional programme on  	premenstrual syndrome: a retrospective analysis", Complement. Med.  	Res.5(1):8-11(1991).  200pts were given dietary instructions and  	supplemented with Optivite(R) plus additional vitamin C, vitamin E,  	magnesium, zinc and primrose oil.  The dietary instructions were to  	take the supplements and switch to a low fat, complex carbohydrate  	diet.  On a retrospective analysis, 96.5% of the 200pts reported an  	improvement in their PMS symptoms with 30% of the sample stating that  	they no longer suffered from PMS.    	Experimental Double-blind Study, "Role of Nutrition in managing  	premenstrual tension syndromes", J Reprod. Med. 32(6):405-22(1987).   	A low fat, high complex carbohydrate diet along with Optivite  	supplementation significantly decreased PMS scores compared with diet  	change and placebo.  After 6 months on the experimental program, the  	vitamin/mineral supplementated group had significantly decreased  	estradiol and increased progesterone in serum during the midlutel  	phase of their cycle.  	Experimental Double-blind Study, "Clinical and biochemical effects  	of nutritional supplementation on the premenstrual syndrome", J.  	Reprod. Med. 32(6):435-41(1987). 119pts randomly given Optivite(12  	tablets per day) or a placebo.  The treated groups showed a  	significant decrease in PMS symptoms compared to the placebo.  Another  	group of 104pts got Optivite(4 tablets per day) or placebo.  For this  	second group of patients, no significant effect of supplementation on  	PMS symptoms was observed.  Martin Banschbach, Ph.D. Professor of Biochemistry and Chairman Department of Biochemistry and Microbiology OSU College of Osteopathic Medicine 1111 W. 17th St. Tulsa, Ok 74107