Title: The importance of calcium and magnesium nutrition in the treatment of premenstrual syndrome
Key words: premenstrual syndrome, PMS, magnesium, calcium, luteal phase, menstrual cycle, menstruating, women, menstrual cycle, dietary deficiency, refined sugar, high fat, low fibre, diet, oestrogen, zinc, corpus luteum, prolactin, neurotransmitter, hyperaldosteronism, hypothyroidism, organic, magnesium citrate, vitamin E, botanicals,
Date: Oct 2006
Author: Morgan, G
The importance of calcium and magnesium nutrition in the treatment of premenstrual syndrome
Premenstrual syndrome (PMS) is a multifactorial condition associated with nutritional, hormonal and metabolic disturbances. Both magnesium and calcium have been used successfully in its treatment and, both on theoretical and practical grounds, have led some authors to claim them as the most effective treatment available (Walker 2004). This review will consider the evidence for their use.
The widespread prevalence of both calcium and magnesium deficiency has
been well documented. A large
Though not documenting a more pronounced dietary deficiency of calcium
and magnesium in the PMS subgroup, a
Calcium, magnesium and zinc are key enzyme cofactors involved in numerous metabolic pathways, especially the neurotransmitter and hormonal pathways afr affected in PMS. Magnesium deficiency is closely associated with impaired corpus luteum function, elevated oestrogen to progesterone ratios and PMS symptomatology (Piesse 1984, Murray 1999). Zinc deficiency is associated with increased prolactin production and disturbed neurotransmitter activity (Judd 1984). Disturbed function of the hypothalamic-pituitary-adrenal-thyroid axis is evidenced by raised FSH and functional hyperaldosteronism and hypothyroidism (Nader 1991, Schmidt 1993, Halbreich 2003) all reflecting disturbances in key neurotransmitter-modulated pathways closely associated with calcium, magnesium and zinc metabolism.
Several studies have now been carried out showing marked reductions in
PMS symptoms with magnesium supplementation (Abraham 1983, Facchinetti
1991, Walker 1998). Doses of up to 12 mgs/Kg per day
have been recommended (
These trials have shown that pharmacological doses of B6, up to 100 mgs/day potentiate the action of magnesium leading to reductions of up to 70% in PMS symptoms. The effect of vitamin B6 on its own has not been shown to be as effective as magnesium or calcium. A recent meta-analysis of the results (Wyatt 1999), whilst showing a positive benefit, also showed these trials to be poorly designed and underpowered. It is not therefore possible to say from the evidence whether B6 on its own is effective in relieving PMS. Larger more controlled trials are indicated. The two trials of calcium both used doses of calcium of 1000 mgs/day or over (Penland 1993, Thys-Jacobs 2002). The Thys-Jacobs study led to a 48% reduction in overall symptoms and the Penland study to significant improvements in mood and water retention. These were both double- blinded controlled studies. Again, organic forms of calcium appear to be better absorbed and utilised (Sakhaee 1999).
Theoretically, large doses of calcium might lead to an
imbalanced calcium to magnesium ratio and increased blood
coagulation-related problems (Seelig 1993). No
research has addressed this problem in PMS. In any event, it would seem wise in
a condition such as PMS, involving a complex web of nutritional and hormonal
factors to provide as balanced a nutritional and lifestyle programme as
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