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

Category:

Nutrimed Module:

Type: Article

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 UK nutritional survey (Gregory 1990) showed levels of calcium and magnesium intake falling below the RNI in 47% and 72% of menstruating women respectively. These figures match others (Piesse 1984, Rosenstein 1994, Shamberger 2003) which show reduced levels of these minerals in red blood cells in PMS patients with a further drop in plasma and ionised magnesium during the luteal phase of the menstrual cycle (Posaci 1994, Muneyvirci-Delale 1998).

Though not documenting a more pronounced dietary deficiency of calcium and magnesium in the PMS subgroup, a US survey (Abraham 1983) nevertheless showed significant aberrations from the already poor standard American diet in this group, including an increased intake of refined sugar, dairy products and salt of 275%, 278% and 78% respectively, and a decreased zinc intake of 52%. This high fat, refined sugar and salt, and low fibre diet, is known to be associated with profound hormonal and metabolic disturbances. A high fibre and low animal fat vegetarian diet, for example, has been shown to lead to up to a threefold increase in the excretion of oestrogen in the faeces and a 50% reduction in free oestrogen in the blood (Gorbach 1987, Woods 1989). Increased carbohydrate intake is associated with elevated oestrogen levels (Yudkin 1988) leading to shifts of magnesium from the intracellular compartment (Seelig 1993). Increased dairy consumption also leads to reduced magnesium absorption (Abraham 1983).

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 (Murray 1999). The organic forms, such as magnesium citrate, have been shown to be much better absorbed than the magnesium salts (Walker 2003). The Abraham trial (Abraham 1983) showed reductions of nervousness of 89%, breast tenderness in 96%, and weight gain in 95%. The Facchinetti trial led to marked reductions in mood changes. These double-blinded results are highly significant. The synergistic effect of vitamin B6 in facilitating magnesium transport and metabolism has led to several trials of combined magnesium/vitamin B6 supplementation in PMS (Stewart 1987, London 1991, De Souza 2000). B6 is known to also be important in liver, oestrogen and neurotransmitter metabolism.

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 possible (Murray 1999). Though magnesium and calcium have been shown, individually, to be most efficacious, the trials are limited and combining these minerals with B vitamins, zinc, manganese, fatty acids, and beneficial agents such as vitamin E and the botanicals may well yield even more encouraging results.

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