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~Seek first to understand, then be understood~
If you're looking for information on a particular topic, type that word in the search box below. If I have written about that subject, a list of posts will appear. If no posts come up, I haven't written about it...yet. Emails, and questions in the comments section for possible posts, are welcome.
I have a "friend" who shows up once a month. She turns my world upside down, over and over again.
I am a good person, caring and sweet, but when she comes to visit, I could rip off your head.
She takes no prisoners, foul words she does spout, I try to keep the words in, she lets them come out.
People don't understand me, or what this is about, to have this creature inside my head.
I despise who I am, half of the time, I feel sorry for my daughter, family and friends.
There's no way to describe it, for those who don't know, it's a living nightmare, she really needs to go.
~Neysia Manor, Rest in Peace

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
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.
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
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
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
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
Safety, efficacy, actions and patient acceptability of (Yaz) contraceptive pills in the treatment of PMDD
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
Historic sexual abuse and current thyroid axis profiles in women with PMDD
The prevalence, impairment, impact and burden of PMDD
Biological correlates of abuse in women with PMDD and healthy controls
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
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