Saturday, March 29, 2014
PMDD, Prostaglandins, Pain, and YOU
How do our bodies experience pain?
Through chemical messenger hormones called prostaglandins that exist throughout
the body (but do not physically move around in the body—despite being called
messenger hormones). Prostaglandins pass
messages of pain to the brain. Basically,
they take care of their own little backyards, and do their work, good or bad, without
straying too far from the cells that created them.
So...If you could find a way to cut these "chemical messengers of pain" off
at the pass, your brain would not register your pain.
Sounds simple, right? It is.
Even better, if you can keep your prostaglandin production in positive
balance, there won't be any menstrual pain messages for your body to send.
First, some important background:
Just like with cholesterol, there are two main types of prostaglandins
in our bodies. (Actually, there are
three, but let's keep it simple.) And
just like with cholesterol, there are good and bad prostaglandins. Sort of like Dr. Jekyll and Mr. Hyde, a
reference every woman with PMDD understands.
The short version is: Series 1 (and
3) are the Good Guys, Series 2 are the Bad Guys.
The Bad Guys are also called antagonistic prostaglandins. Think of it this way: They antagonize your
body, making it, and you, feel uncomfortable.
Antagonistic prostaglandins are made from a fatty acid that comes from
ANIMAL products. We're talking meat and
dairy here. These bad-for-you prostaglandins
can also be found in corn oil, soybean oil, and other light vegetable oils. (At least one of which is in most, if not
all, processed baked goods. I point this out, because PMDD women tend to flock to baked goods (aka carbs) when having an episode.)
So what are these prostaglandins
anyway, and why do we need them?
Have you ever touched a hot pan?
It's prostaglandins that let you feel that pain. Have you ever burnt or cut yourself and then
stared at your hand for a split second, knowing you did something painful,
but it hasn't kicked in yet? And then it
does...like wildfire??
That's your prostaglandins rushing to the rescue, while telling your
brain to make sure you move away from the danger, and starting clotting procedures
to save the burnt/cut/bruised part of your body.
This is a good thing. Something
we all need for survival.
Prostaglandins are a subset of a larger family of substances called
eicosanoids. Eicosanoids are hormones
that help with regulating different body processes. As a side note, eicosanoids are found in
chocolate. Could this be why we reach
for chocolate to dim our pain? Is it
possible that in craving chocolate, we subconsciously seek a way to
create some good prostaglandins?
Prostaglandins help with many things, such as:
Blood vessel dilation
Muscle contractions
Inhibition and promotion of blood clotting
Regulation of secretions, including digestive hormones
Cell division and growth
Body temperature regulation
Lowering (or raising) blood pressure
Immune system responses
PMDD women are mostly concerned with the first few on the list
above. In addition to those, we need prostaglandins
for several more reasons, including ovulation, ending our monthly menstrual
cycle, sperm motility and fertility issues, immune system interactions, and
uterus contractions in childbirth and when we menstruate.
For instance, there's a normal surge of prostaglandins at the end of your
menstrual cycle, which causes your period to come. And those painful contractions and cramps you
get during your period? The ones that
radiate down your legs into your thighs, knees, calves, and even into your feet? The kind that make you want to vomit, they're
so intense? That's your prostaglandins
in action, as well.
So why do our uterine muscles even have to contract? To help us shed our
uterine lining during menstruation. The
problem is, some women release more Series 2 prostaglandins than other
women. These higher levels of Bad Guy prostaglandins
create more cramps and PAIN. And yes, unruly
prostaglandins can even cause constipation, diarrhea, and/or a fever at that
time of the month. The first two because prostaglandins can affect the muscular
movements of your intestines and the third because of prostaglandins'
connection to fighting infections and regulating your body temperature.
Tell me something good about
prostaglandins, then.
Well, prostaglandins metabolize quickly. So your body can not store prostaglandins,
but instead creates them as needed.
The good news is you DO have a say in what kind are created, Series 1 or Series 2, by your food and nutrition
choices.
Since we want the good guys to win, we'll start with the bad.
Series 2 Prostaglandins (the Bad Guys)
These are produced by trans
fatty acids, or trans fats, found in hydrogenated oils, meats, fried foods,
junk foods, and dairy products.
There is a special enzyme in our bodies that helps to create Series 1
prostaglandins. High stress, too much sugar and flour (baked goods) slow this special enzyme
down, so that the Series 1 prostaglandins aren't made fast enough, which allows
the Bad Guy Series 2 prostaglandins to get the upper hand.
Trans fats are also bad for the structure of your nerve and brain cells,
areas in which PMDD women need to be particularly protective. Trans fats also hamper our ability to create Good
Guy Series 1 prostaglandins.
There is much hope though: Series 2 prostaglandins are formed at a
slower rate than Series 1 prostaglandins.
So if you eat the right foods and avoid the wrong ones, you can easily tip
the scales in your favor and avoid much of your monthly influx of pain and
inflammation.
Series 1 Prostaglandins (Our
Heroes)
Series 1 prostaglandins are made from a fatty acid primarily found in
fish and fish oils, known as EPA. (The most critical of the Omega-3 essential fatty
acids). This EPA is the ONLY material
that our body uses to make the Series 1 prostaglandins that reduce pain and inflammation.
Our bodies need three types of Omega-3 fatty acids to stay healthy:
ALA - which comes from green plants, and provides the building blocks for EPA
EPA - which comes from marine plants and fish, and provides the building blocks
for DHA
and
DHA - which comes from marine algae plankton, fish and mammals, and are
especially helpful for maintaining healthy eye and brain tissue (something I am especially delighted to hear).
And here's more good news: The
essential fatty acids found in olive oil and nut oils, while they don't make/create
Series 1 prostaglandins, they do block the paths of your Series 2 Bad Guy prostaglandins.
Here are some more items you can stock up on to help combat your Bad
Guy prostaglandins:
(and I'm not talking about any heat-processed stuff you get off the shelf...be sure to read
your labels!)
evening primrose oil
naturally fermented fish oil
flaxseed oil
borage oil
starflower oil
a high quality Vitamin B-complex vitamin (B vitamins are essential for
creating Series 1 prostaglandins)
with an extra dose of Vitamin B-6 on the side for your PMDD
Most of these you have heard of before as being beneficial during an
episode of PMDD. Now you know why they
have been suggested. And get this:
painful menstrual cramps are not considered to be a symptom of PMDD, but rather
PMS. You can indeed have both PMS and
PMDD at the same time. You can also
reduce your symptoms of PMDD until all you have left is PMS. But cramps?
That's pure PMS.
Other ways to combat Bad
Guy Prostaglandins:
Aspirin and other NSAIDs do block prostaglandins produced in inflamed
or injured parts of our bodies. These
NSAIDs also act on prostaglandin sites in the central nervous system involved
in transmitting messages of pain. This
is why ibuprofen is usually the drug of choice when the cramps begin.
However: The enzyme bromelain
from the stem of the pineapple has been proven to inhibit the Series 2 prostaglandins
and reduce pain at a much higher rate
than that provided by painkillers.
This is great news, especially because of how toxic NSAIDs are to your gastrointestinal
tract. At a minimum, NSAIDs can cause
erosion of the stomach lining and ulcers, and at a maximum, death by
gastrointestinal bleeding without warning.
PMDD women bleed enough. God
knows we don't need to bleed any more. NSAIDs
can also raise your blood pressure and push you along the path to heart disease,
the number one killer of women. More on NSAIDs
in another post.
Why this Prostaglandin and
NSAIDs information is important to you, outside of your PMDD
If your body is not in balance, and you have too many Series 2 prostaglandins,
you can be susceptible to diseases linked to excessive inflammation (such as
heart disease, cancer, diabetes, and Alzheimer's) and/or developing blood clots,
which can also lead to strokes and death.
The latter connection is especially dangerous for women taking birth
control pills for your PMDD, or HRT for perimenopause.
So, to recap:
Your prostaglandins will do the
job they were meant to do. What type of prostaglandins your body
creates is entirely up to you. The fuel
(or fatty acids) your body uses to create prostaglandins (as needed) builds up
in your body over time...so you want to make sure you have the right fuel on hand when the time comes.
Series 1 prostaglandins have the
opposite effect of Series 2 prostaglandins.
Series 1 prostaglandins reduce inflammation, dilate blood vessels, and
inhibit blood clotting. They help us to
recover from injuries by reducing pain, swelling, and redness. They are part of our natural defenses against
infection.
Series 2 prostaglandins are
created in response to trauma or stress, including trauma or stress on the
body created by our food and drink choices. Series 2 prostaglandins supply blood to the
traumatized area, which in turn causes inflammation and pain. On one level this is a necessary protective
measure for injury to the body, but on the other, such as when the Series 2 prostaglandins
supply more blood to your uterus, swelling it up and aggravating your cramps, this process works
against you. However, if you have more
Series 1 prostaglandins in your system than Series 2, your period can be pain
free.
Basically, your cramps are letting you know your prostaglandins are out
of balance.
What, specifically can you do to
put things back in balance?
Well this is the part nobody wants to hear, so if you want to keep on
having cramps, stop reading now.
Otherwise, to cut down on the amount of Series 2 pain-producing
prostaglandins only you can create in
your body through your food and drink choices...
Avoid these top ten culprits.
1. Sugar
2. Wheat
3. Caffeine
4. Soy
5. Alcohol (which also depletes
your vitamin B levels)
6. Dairy products, especially
milk and cheese.
7. Red meat (plus that steak you
so love may well contain growth hormones that include estrogen, another big problem
area for women)
8. Saturated fats and oils -
palm oil, butter, margarine, lard, and fried foods (especially when eating out,
where you have no idea what kind of
oil they used.)
9. Refined carbs - white bread,
pasta, flour, pastry, and cakes. Stick with whole grain breads and pastas, etc.
10. Food additives and
preservatives - Virtually anything processed, frozen, and or
pre-packaged for your convenience.
You don't have to give these up, but if you don't, the cramps will
continue to come. It's that simple.
At least now you will understand what causes cramps, and understand
that the key to making your period a lot less painful depends entirely on YOU.
Sunday, March 9, 2014
Scientific Awareness of PMDD is not the Problem
Almost daily I hear someone mention how we need to raise
awareness of PMDD, so that more studies of this debilitating disorder will be
done, and someone can finally unlock the secret of what causes PMDD and how to successfully
treat it.
So one day last August, a week before my most recent brain surgery, I was apparently looking for some challenging reading material when I
got out of the hospital, (thinking positive, I imagine) so I spent an hour and
a half clicking on links and printing out various scientific abstracts and studies
I could find on PMDD.
In just that small segment of time, I found nearly 50 studies
on PMDD, which broke down as follows:
2013 - 19
2009-2012 - 18
2006 - 2008 - I
already have most of these in my files, so did not print them out again
2001-2005 - 10
I am sure there have been countless more studies done in the
past 14 years, but this was a random sampling of those I might not already have
read, and I also chose not to print out many that were over 7 years old, as so
much information about PMDD has changed since 2007.
Of the 2001-2005 studies, I printed only those that might be
of use in my research. A list of titles
appears below. And yes, I do intend to
read each study listed, and share with you in plain language anything that
seems relevant. But first I want to point
out that in the scientific community, the problem is not awareness. Scientists are well aware of PMDD and for
what looks like mixed reasons. An analysis of what those reasons might be will
be the subject of a future post.
For now I just want to repeat that awareness on a scientific level is not the problem. Awareness in the medical community—short of misleading
advertisements by drug companies—and awareness in our friends and families is. Hopefully blogs like mine will help to
rectify that situation for you and your loved ones.
In the meantime, here is a list of the studies on PMDD I
uncovered in less than two hours of searching.
If you think the list is dry reading, imagine reading the studies
themselves :). But like I said, it keeps
my brain sharp. Not to mention I'm a total research geek and love it.
If you wish to read any of these studies yourself, you can
Google the name provided. I typed the
titles exactly. Just retype it yourself, or cut and paste the
title into your browser. These can all
be found on the PubMed.gov site, which is part of the U.S. National Library of Medicine, and the
National Institutes of Health. Many of
them are abstracts, but you *can* find the full studies if you look hard
enough. Update: the first comment below tells you exactly how you can get copies of the full studies.
Enjoy!
2013
Comorbid bipolar disorder and PMDD: real patients,
unanswered questions
Elevated gray matter volume of the emotional cerebellum in
women with PMDD
Allopregnanolone serum concentrations and diurnal cortisol
secretion in women with PMDD
Examination of premenstrual symptoms as a risk factor for
depression in postpartum women
Luteal serum BDNF and HSP70 levels in women with PMDD
PMS and PMDD among Jordanian women
Circulating insulin and leptin in women with and without
PMDD in the menstrual cycle
Abnormalities of dorsolateral prefrontal function in women
with PMDD; a multimodal neuroimaging study
Lamotrigine augmentation in PMDD : a case report
Depressive mood and frontal alpha asymmetry during the
luteal phase in PMDD
PMDD and severe premenstrual syndrome in adolescents
Selective serotonin reuptake inhibitors for PMS
Premenstrual disorders and rumination
Anger in women with PMDD: Its relations with PMDD and
sociodemographic and clinical variables
Non contraceptive benefits of oral hormonal contraceptives
Premenstrual symptoms and posttraumatic stress disorder in
Japanese high school students 9 months
after the great East-Japan earthquake
Personal history of major depression may put women at risk
for premenstrual dysphoric symptomatology
A review of treatment and management modalities for PMDD
Biopsychosocial aspects of premenstrual syndrome and
premenstrual dysphoric disorder
2012
Pilot investigation of the circadian plasma melatonin rhythm
across the menstrual cycle in a small group of women with PMDD
Bipolar disorder and PMS or PMDD comorbidity: a systemic
review
Survey of premenstrual symptom severity and impairment in
Korean adolescents; PMDD subthreshold PMDD and PMS
Intercountry assessment of the impact of severe PMDD on work
and daily activities
2011
Work stress, PMS and PMDD are there any associations?
Lifetime discrimination associated with greater likelihood
of PMDD
Posttraumatic stress disorder and trauma characteristics of
PMDD
Reduced Phase-Advance of Plasma Melatonin after bright
morning lithe in the luteal, but not follicular menstrual cycle phase in PMDD:
An extended study
Exposure to American culture is associated with PMDD among
ethnic minority women
Health advantage for black women: patterns in PMDD
2010
Histories of major depression and PMDD: evidence for
phenotypic differences
Neuroticism related personality traits are related to
symptom severity in patients with PMDD and to the serotonin transporter
gene-linked polymorphism 5HTTPLPR
Predicting response to leuprolide of women with PMDD by
daily mood rating dynamics
Estrogen receptor alpha (ESR-1) association with
psychological traits in women with PMDD and controls
Increased sensitivity to light-induced melatonin suppression
in PMDD
Prefrontal brain asymmetry and PMDD symptomatology
Explorative evaluation of the impact of severe PMDD on work absenteeism
and productivity
2009
Safety, efficacy, actions and patient acceptability of (Yaz)
contraceptive pills in the treatment of PMDD
2005
Lack of beneficial effects of clonidine in the treatment of
PMDD: results of a double blind, randomized study
Histories of sexual abuse are associated with differential effects of clonidine on autonomic function in women wit PMDD
Histories of sexual abuse are associated with differential effects of clonidine on autonomic function in women wit PMDD
2004
Historic sexual abuse and current thyroid axis profiles in
women with PMDD
2003
The prevalence, impairment, impact and burden of PMDD
Biological correlates of abuse in women with PMDD and
healthy controls
2002
Prevalence, incidence and stability of PMDD in the community
Prevalence and predictors of PMDD in older premenopausal
women. The Harvard Study of Moods and Cycles
2001
Characteristics of women with PMDD who did or did not report
a history of depression: a preliminary report from the Harvard Study of Moods
and Cycles
Allopregnanolone levels and reactivity to mental stress in
PMDD
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