A PMDD Valentine: Not All Chocolates Are Equal

For Valentine's Day, a post about chocolate (and a few other things), first written in 2009, but updated and still relevant today.

Having come freshly off a week of spending up close and personal time with my evil twin, who kicked my butt so badly the last day she was here I had to take a three-hour nap in the middle of the day, on top of getting a full night's sleep, today I feel uber-qualified to write about how it feels to experience PMDD. The thing is, now that the episode (aka her latest visit) is over, it's the last thing I want to think about.

I look around and see all that didn't get done over the week, the laundry piling up, the floors that need to be cleaned, the clutter of all I didn't feel up to coping with and simply set aside, and would much rather regain some semblance of control over my life—if only its external appearance—than write about the dark place I inhabited for eight full days and change this time around.

Why such a long visit this time? I think I know. I think it had something to do with my recent road trip: the stress of travel, the staying up later than usual, sleeping in strange environments, the change in diet, the miniscule amount of alcohol consumed, although in comparison to my usual alcohol intake, it was a big jump. Add that to the copious amounts of caffeine I consumed while on the road, the pasta-heavy fare at the conference, and I think I'm getting the picture. At home, I'm usually alcohol and caffeine free-or close to it. An occasional cup of coffee, usually one cup of caffeinated tea in the morning, if I feel the need, and chocolate only when "the cravings" come.  I hadn't had pasta or bread in weeks before the conference.

Why? All of these are bad for women with PMDD. Caffeine, alcohol, sugar, flour, hence the bread and pasta. But why am I so sensitive to their effects? I know women who practically live on caffeine and sugar, others who drink freely, others who love their bread and pasta. Is it possible they feel as miserable as I do, or more so, but deny their misery and continue to self-medicate with food and drink?

Because attempts to self-medicate is what these addictions (for lack of a better word) are. My research is showing there are very few true physical addictions in life. Most compulsions are emotionally or psychologically based. Only in rare cases is an addiction physiological.

That's not to say we can't get cravings. But cravings are cravings, temporary urges for some kind of substance to relieve our mental, emotional, or physical discomfort. Cravings are not addictions, although when you are in the throes of one, it can feel like an addiction. But as someone writing a book on dealing with addiction recently pointed out to me, "You're not going to stick a gun in someone's face for a piece of cake."

Cravings are the body's signals that some physiological need is not being met. You're low on some vital nutrient, to be exact. Your body is saying, for instance, "I'm low on magnesium," and you feel a sudden urge to eat a banana, or some almonds, maybe some oatmeal, or, yes, some chocolate.

Chocolate is one of the best known substances we crave. What confuses the issue with chocolate is not only its physical healing properties (of which there are many), but its emotional associations. We associate chocolate with feeling good. But not all chocolate is equal. Some are better for us than others. Much better. Others are almost useless, physiologically speaking. In the example above, a banana would provide as much magnesium as a 1.5 ounce chocolate candy bar, but a handful of almonds or cashews would provide almost three times as much magnesium as either the banana or candy bar.

So why do we reach for chocolate? It's as much for the emotional fix as the nutrients needed. More confusion arises when we don't know the difference between types of chocolate, due to the marketing and advertising claims of their manufacturers. Manufacturers is the key word here. Quality chocolates from true chocolatiers abound with the beneficial properties of chocolate. True dark chocolate is a rich source of flavanoids and antioxidants, with the cacao bean containing more than twice as many antioxidants the so-called superfoods like blueberries, kale, spinach, or broccoli.

It's the cheap, mass-marketed brands that—while they may contain tiny amounts of chocolate's beneficial properties—have processed most of the antioxidants and flavanoids right out of the chocolate. To derive any benefit from eating these lower quality chocolates, you need to eat way more than is healthy for you. When this happens, the negatives outweigh the positives—and you could end up outweighing all your friends.

If that's not enough, did you know that adding milk to your chocolate, or even drinking milk with your chocolate can negate its good effects?

Meanwhile you're bewildered, thinking, "Chocolate is supposed to be good for me, right? Milk is supposed to be healthy for me. Isn't that what the ads say? By eating chocolate and drinking milk, I'm doing something good for my body, right? So why do I feel so miserable?"

Because all the chocolate in the world isn't going to solve your problems, honey, and while I may crave it like mad at times, neither is it going to make my PMDD go away. For all its mood-enhancing abilities, even the finest Belgian chocolate won't "cure" dysphoria.

Dysphoric is the opposite of euphoric. Euphoric means happy, dysphoric means depressed. As in depression. But only pre-menstrually, which I suppose can be considered a blessing.

In some atypical cases, however, the dysphoria can come AFTER a woman begins her period. Lucky me, I'm atypical. Mine usually starts on Day 3, if it's going to come. It doesn't always come. Which is what drives me batty, trying to keep on top of what I need to do—or to avoid—to keep it from returning.

I lead too full and rich a life to keep being knocked flat by this unwelcome change in my body. It makes me feel like I'm constantly behind—on everything.

As women, we all know "it will never get done," but to have something come along and steal a full week or more out of your month, something that no matter what you do or don't do seems to be totally beyond your control...it's more than frustrating. It's crazymaking.

I'm here to tell you you're not crazy. I'm here to tell you there are scientifically proven physiological reasons for why you crave the things you do—like carbs—and what happens to your body as a result of that. I'm here to tell you there's help, and hope, but it's far from easy, living in a body that seems to have a will of its own at times, and a manufacturing and marketing culture that promotes unhealthy foods as healthy because of their base ingredients, while completely ignoring the toxic effects of their processing processes.

That said, the first step is to forgive yourself for falling short of your own expectations, and to understand that what is happening to you is as involuntary a response as an allergic reaction. You cannot control it. You can try to soften it, to be sure, by living a universally healthy lifestyle (once you understand what that truly is) but you cannot control it.

Nor can you deny it and simply plow through it, as most women do. We have commitments, responsibilities, schedules, and deadlines. We have people counting on us to be there for them.

But first, we have to learn how to be there for ourselves. My book PMDD and Relationships, addresses this topic in detail. I can hit on a subject here and there in a blog post, but the book...the book covers it all, from start to finish. And if you are a partner here looking for information about PMDD and how to live with the woman you love: PMDD: A Handbook for Partners is for you. Click on the book covers in the sidebar for more information.

So be good to yourself today, and every day, and when it comes to chocolate—insist on the good stuff. 

Because you are most definitely worth it.

Happy Valentine's Day, all!

Remember: When it comes to chocolate, the darker, the better.  You might have to work your way up to it (I'm now at 70% cacao), as it can taste bitter at first.  But the darker it is, the better it is for you (and your blood pressure!).  And don't drink milk with it because that interferes with your body's ability to absorb the antioxidants in the chocolate and therefore dims its beneficial/healing effects.

Liana Laverentz is the award-winning author of two books on PMDD, PMDD and Relationships, and PMDD: A Handbook for Partners.  Both books are based on the most asked questions by her readers, and therefore the most popular posts on this blog. Both books are also an excellent resource for understanding your PMDD and for starting a meaningful conversation with loved ones who want to know more about this debilitating disorder we live with daily.   More information on PMDD can also be found on Liana's Facebook page, Living with PMDD.

The Voices of PMDD, A Partner's Perspective on Seeking Treatment

I have to start with thanking everyone for reading my last post. It was great to know that my post hit a chord with so many.

Liana asked me an interesting question – does my partner know she suffers from PMDD?

The simple answer is yes, but I think she subconsciously would prefer to forget that PMDD-driven events happen. One of my greatest struggles has been the lack of empathy received during and after PMDD episodes – just part of the PMDD zone, I guess.

How black have I been?

I wrote the following during one of our PMDD episodes:

Do I care anymore?

I don’t like being hurt, but it is also pointless being in a relationship where I don’t get what I need. This can only lead to frustration. I am being made to feel worthless every month. As I’ve been warned, that comes with a substantial mental health cost. There is only so much you can put up with, and I think I am there now.

So, plan from here? I’m an exhausted man. I’ll just avoid her, and give myself space to think about if I can handle things any more. There is no point trying to directly reconcile, as she will just want to fight.

One of the pieces of feedback I received from my prior post was asking what we had done to try and treat the PMDD. I couldn’t fit everything into my prior post, so I thought I’d cover it here.

My partner has found it challenging to seek clinical help – to do so requires her to speak to outsiders regarding the details of her moods etc., that she knows are challenging (you are making me shove pills down my throat/they are making me fat/you are making me tell strangers about how crazy I am).
I completely understand...and yet, I definitely end up with a sense of hopelessness - if she had diabetes, there would be no doubt she'd be accepting of medical help. 
However, with my support and encouragement, we have certainly explored this space.

We first went down the SSRI route. I’ve no doubt this helped, but the side effects became frustrating for both of us.

We sought specialist assistance after that and some hormone type medications were prescribed, one of which was Cyproterone, but it was really a disaster. We only lasted a couple of months – the side effects were horrific. The most accurate description would be that she was in the PMDD zone for two solid months. It is almost impossible to describe how awful you end up feeling as a partner when she is constantly angry and you can't do anything right.  You end up suffering from sleep deprivation from wondering just what has gone so horribly wrong in your relationship. What makes it even worse is she has no ability to understand the impact her behavior is having on you - there is absolutely no empathy. 

I ended up as a burnt out mess.

Where are we today? We are retrying vitamin type supplements, as well as making diet changes. Caffeine seems to be a bit of a problem – one of the many tips we’ve picked up from the Rushing Woman’s Syndrome eBook, which describes the “biochemical and emotional effects of constantly being in a rush, and the health consequences that urgency elicits.ˮ

So things are quite calm at the moment – and my own blackness has gone. Until the next time.

PMDD and Why Me?

Okay, we’ve heard enough stories for a while of what it’s like to have PMDD.We all know what it is by now.  And we know there is not much we can do about it once an episode hits.  The best we can hope for is to ride out the storm.  So a question I’m sure all of us have asked at one point or another is Why Me?

 Well, today I’m going to look into the possibilities I’ve uncovered so far.   First, however, a little background.  When does PMDD happen?  And How does PMDD progress? 

You don’t get it before your first period.  Girls, on average, in part due to the tremendous amount of environmental toxins being dumped into our lives, are now getting their first period at age 12.  Your probability of developing PMDD increases with each hormonal event in your life thereafter: pregnancy, miscarriage, abortion, or birth.  (You do not experience PMDD when you are pregnant, because you are not menstruating.) With each new pregnancy, your chances of developing PMDD increase.  And unless your PMDD is addressed, it will continue to worsen with each hormonal event, and as you age, becoming increasingly difficult through perimenopause, until it stops when you reach menopause.

But don’t start cheering yet…if your PMDD is not addressed before menopause, you run the serious risk of developing Major Depressive Disorder after menopause. 

The average age of menopause is 51. 

So, that means, on average, women have approximately 40 years during which we can develop PMDD.

What causes PMDD?

Nobody knows for sure just yet, but scientists do know it is a biological event that manifests as emotional symptoms.  What does that mean?  It means PMDD is caused by something that happens in your body and shows itself in your moods.  The closest science has come to defining what happens is that whatever happens, happens in concert with your menstrual cycle, and involves your hormones.  The hormones they are looking at the most these days are estrogen and progesterone.  It’s not that you have too much or too little, or maybe not even the balance between them, as this is still being studied, but that something goes awry in your brain when processing these hormonal fluctuations in your body.

That’s right.  Something goes wrong in your brain.  No news to us, right?  We’ve known all along something wasn’t right with our brains, with our thinking processes, during an episode of PMDD.  Why else would we say and do the things we say and do during an episode and not the rest of the month?

But I won’t go into all of that right now.  For now it’s good enough to know there is a biological “something” that happens where our brain does not properly process the fluctuating levels of our reproductive hormones during the second half of our menstrual cycle.  This leads to a disconnect in the brain, like when an extension cord comes apart from a plug, or when your cell phone coverage drops.  The result of this disconnect is a depletion of serotonin in the brain, the neurotransmitter that in part governs our moods, and our ability to be happy. 

This is why we crave carbs.  Carbs increase the level of serotonin in our bodies, and therefore improve our moods.  Problem is, most of us reach for the WRONG kind of carbs.  You know who you are and what you eat.  Not just any carbs will do.  But that’s the subject of another post. 

This is why doctors prescribe anti-depressants.  Certain antidepressants, called SSRI’s, help to increase the level of serotonin in our brains.  Problem is, we’re not low on serotonin all the time, and antidepressants come with a bunch of side effects that can make your symptoms worse.  Plus they don’t work at all for at least 40% of the women who take them.  (So if you’re one of the 40% or more, don’t blame yourself!)

This is why doctors prescribe birth control pills.  Birth control pills keep you from ovulating, which is the main cause of this shift in your hormones that your brain does not process correctly.  But again, this is treating only the symptoms and not the underlying cause, and birth control pills have their own array of side effects -- including death. 

Never mind that some women would rather be dead than suffer from another episode of PMDD.  I, for one, am not interested in taking something that could kill me when there are so many less drastic options to try.

Which brings me to the question of what contributes to PMDD?  Weight, lifestyle habits, including smoking, drinking, drug use, caffeine and sugar consumption, stress, trauma, abuse, and yes, genetics.  We’ll get more into genetics in another post.  For now it’s enough to know that in some cases, you really “can’t” help what happens to you when you’re experiencing an episode of PMDD.  It could be in your genes.

And if it’s in your genes, you’re not going to be able to cure it with a magic pill, be it synthetic or natural.  The best you can hope to do is manage the condition.

So what can you do about your PMDD?

You can address the things that apply to you. I’m not going to touch weight, because there are sooo many factors that go into a woman being overweight that it’s the most difficult of all for us to address.  (That’s a whole other blog post in itself as well, maybe even two or three.)  But yes, you can quit smoking, yes, you can cut down on your drinking, maybe even eliminate it altogether.  Same goes for caffeine -  you can cut out caffeine and not die – not like other options mentioned above.   You can cut back and even eliminate eating sugar.  And please do not make the mistake of thinking sugar substitutes are the answer to the situation.  If you’re determined to go that route, you’d be better off to keep eating sugar.  Raw sugar if you must, but no sugar is the best route of all.  Sugar feeds PMDD, and it also feeds cancer.  So think about it, and do what you can.

If you’re a sedentary soul, you can get more exercise.  Two to three half hour walks a week will do wonders for your PMDD.  45 minutes is even better.  Work your way up to whatever time you can spare.  Really, how can you not spare the time, when your life is at stake? 

Over-exercising is just as bad as not getting enough exercise.  More on why some other time.

Stress – starting to sound like a broken recording here, I know.  The stresses in our lives are as numerous and varied as our PMDD symptoms.  You know yours.  Get rid of them.   Don’t you deserve a better life? 

Rest – get as much as you can, especially during an episode.  Learn how to “Just Say No.”  Start small and work your way up.  And do it gently.  Don’t put it off until it becomes a snarl.

Nutrition – there’s a reason fresh, whole foods are good for you.  They’re packed with the nutrients your body, including your brain, needs to function properly.  You can’t get good nutrition from a box any more.  It just doesn’t happen.  And taking high quality, pharmaceutical grade vitamin supplements (not the cheap ones!) does help, but it doesn’t by a long shot make up for what you can do to make yourself feel better by simply eating foods as close to their natural state as possible.  Vitamins are meant to boost your nutritional balance, not replace what you lost from not eating right and depleting your body’s nutrients when you drink, smoke, and/or take drugs -- even common over the counter drugs. 

So there are a lot of things you can do to make your PMDD better.  Most, however, require time and effort.  It takes time to make good, healthy meals.  It takes time to listen to your body and become aware of what makes you feel better and what makes you feel worse.  It takes time to find the right treatment for your particular symptoms.  It takes time to make time for you, take time out for rest and relaxation, or deal with those messy stresses eating up your life.  It takes time to become comfortable with your emotions.  It takes time to work on your relationships.  It takes time to quit using the crutches you’ve been using to get through your however many years of PMDD.

But think of how many more years you have to go, and how it will only get worse if you don’t do something about it.  Do you want to spend your golden years depressed?

I know I don’t.  And I don’t want you to have to do it, either. 

You didn’t ask for the hand of cards you were dealt.  The best you can do is learn how to play them.  The information is out there. The willpower is inside you.  Are you going to sit around asking Why Me?

Or are you going to come to the table and say, Not Me. Not Today.

One day at a time.  That’s all you need to work with.  One hour at a time, if that’s all you have.  Pick one positive thing mentioned in this post, and do it for yourself, do it today.  Do the same thing tomorrow.  Keep doing it, one day at a time, until you have it down.  Then pick something else, and start the process all over again.  Baby steps are still steps in the right direction.

You can do it.  Because PMDD women are strong.  Super strong.  We have to be, with all that we have to deal with.

Liana is the author of PMDD and Relationships, a book written to help a woman with PMDD gain personal awareness, and insight into why she says and does the things she does.  PMDD: A Handbook for Partners, was written to help explain the unexplainable to partners of women with PMDD.  Either one of them can be used as a resource on tips for how to handle PMDD, or as a conversation starter for someone who wants to explain their PMDD to a loved one to someone they care about.  Both are available in ebook from Amazon and Smashwords (Kobo, ibooks, Nook, and Overdrive), and in print from Amazon, and the International Association for Premenstrual Disorders, or IAPMD.  For more information, please check out Liana's Facebook Page, Living with PMDD.

More Things That Make Your PMDD Worse

Hi, I can’t believe another week has gone by. A few weeks ago my original intention was to write a post about things to do help manage your PMDD, but there are still a lot of things out there we need to avoid to keep it from getting worse. It won’t do us any good to drink, eat and do the right things as long as we are still eating, drinking and doing the things that make it worse. At best, we’ll only be self-defeating our good intentions. True balance can’t be achieved by coming at this disorder hit or miss.

I’ve been scanning the PMDD loops and forums, and there are so many women out there crying out for help. As I read the posts, I can pinpoint some things they are doing to make their PMDD worse, without even realizing it. Nobody intentionally wants to make themselves feel badly, especially a PMDD woman. We know—even if at times it seems only like a distant memory—what it feels like to feel good, and we want to feel that way all the time.

As I said last week, the information is out there. The problem is it’s scattered all over the place, and some of it isn’t quite true. Some of it is slanted toward getting us to purchase products in which the author of that information has a financial interest. In the interests of my research I’ve bought several books and tapes and products designed to make me feel better, even “cure” my PMDD. Most have failed, because the information they are based upon is faulty to start with.

For instance, there is one doctor who insists over and over again in his literature that PMDD is caused by using birth control pills and hormone replacement therapy. If that is the case, I shouldn’t have it, because I’ve never used either. But a vast majority of women have used one or the other, and so by claiming that they cause PMDD, he is guaranteed to have a wide range of women wondering if that is the cause of their PMDD and flocking to buy his products. Instant consumer base.

Based on the scientific information I have read, in particular the information produced in the past five years—information which is not referred to at all in this doctor’s literature--it’s clear that birth control pills and hormone replacement therapies worsen your PMDD, but do not cause it. The studies I have read indicate that overall there is some relief in the initial months when using these methods to treat your symptoms of PMDD—and that is all you can do with these methods—treat the symptoms—because neither of these treatment methods address the underlying cause of PMDD.

But after a certain period of time—usually several months—both clinical studies and anecdotal stories show that birth control pills and hormone replacement therapies make your PMDD worse. And if that’s not enough misery for you, when you stop taking these drugs for your PMDD, your PMDD worsens even more. Because your body has to do all that additional work to recover from the damage that was done to your hormonal balance through using these methods of treatment. The bottom line is you end up feeling worse than you did before you started these treatments.

Realize now that the failure was not yours. The failure was in the treatment, which is at best a one-size fits all treatment for what is a highly individualized disorder.

I have not used bio-identical hormone replacement treatment, so can not address that subject here. At this point I’m still on the fence about that. I have been able to manage my PMDD symptoms through rest, diet, nutritional supplements, and exercise. I still have episodes, but they are mild compared to what they once were, and more than manageable. I would like to make them go away completely, and in the interests of doing so (and research!) hope to try bio-identical hormone replacement therapy in time, but have yet to find a doctor in my local area who will prescribe them. So for now I muddle along, but again, my symptoms are mild and more than manageable.

Two other things that make your PMDD worse are:

Any prescribed drug, including anti-depressants (more on this in a future post).
Any over the counter drug, including NSAIDs, or non-steroidal anti-inflammatory drugs—that’s right—ibuprofen. That wonderful substance that does wonders for our cramps and sore joints only adds to our PMDD burden.

I’m not saying to never take drugs again. There are genuine disorders, diseases, and conditions that can not be managed any other way. I’m saying you need to be aware that these things make your PMDD worse, and that it’s not just you and you’re not crazy.

For instance when you reach for that bottle of ibuprofen, you need to reach for it knowing you’re making a trade off…relief from your cramps now, or relief from your PMDD later.

Just knowing this makes me pause, and decide whether my cramps and aches are really bad enough for me to need that ibuprofen. Or do I really just need some rest and relaxation to give my body the time it needs to deal with the inflammation on its own?

Dealing with PMDD is more about awareness than anything else. It’s making ourselves aware of what our body is trying to tell us. For example, we need magnesium—chocolate craving—we need carbs—to boost the level of serotonin in our brain—we need sleep—to allow our brains can naturally re-regulate themselves.

Our bodies are designed to heal themselves naturally, given the right nutrients and rest. In our busy society, more often than not, we don’t have the time to stop and listen to what our bodies are telling us. We’ve been conditioned to carry on, no matter what, and consume whatever pill, food, or drink is handy to get us through. Recently I heard an ad on the radio for some kind of product you can puff into your mouth that brings you up to five more hours of energy. It has some nutrients in it to make it sound healthy, but it also has a heavy dose of caffeine—which cancels out any questionable benefits of the nutrients added. Never mind that a PMDD woman needs to avoid caffeine like the plague.

This company promotes their product as something you can take in the afternoon to get you through the rest of the day. So you can be even more productive than you already are. It’s touted as a good thing. Something to make you virtually indefatigable. In our case, a superwoman.

But if you’re tired, your body is telling you that you need rest, not that you need something to override your body’s natural warning system that you’re heading for a breakdown.

So sure, if you use this product--or any of the countless ones just like it you can find next to cash registers at any number of stores--you get the added boost for that particular afternoon. But what about the damage you are doing to your body, which is already screaming for relief? What about the price you will pay with a whopper of a PMDD episode down the line?

Is it really worth it? Or don’t you deserve any better?