Let’s start at the beginning. Your first period and the onset of puberty is where nutritional differences between males and females become apparent.
Over the course of the menstrual cycle, women have different calorie and nutrient requirements due to fluctuations in sex hormones, namely progesterone and oestrogen. These hormones not only influence our monthly cycle but also our body temperature, metabolism, hunger and food cravings.
The fact that we have a monthly bleed also puts us at higher risk for iron deficiency and iron deficiency anaemia. Between 15 and 18 per cent of women of childbearing age worldwide are iron deficient and during pregnancy, one in four women in the UK will become anaemic, increasing to one in two women in low-income countries.
What we eat and how much we eat can also impact our menstrual cycle, and eating too few calories can lead to very light, irregular or absent periods. Here's what you need to know…
Why we crave chocolate before our period
During the luteal phase, when progesterone and oestrogen are high, there is an increase in resting metabolic rate. This means that, at rest, we burn more calories in the second half of our cycle after ovulation – up to 300 more calories. The extent of this increase varies from day to day and woman to woman, along with other factors such as age, body composition, genetics, illness, physical activity levels, pregnancy and breastfeeding.
The human body is very clever at adjusting for changes in metabolic rate and so during this time we also often see a natural increase in food intake, in addition to increased hunger. In particular, cravings for foods high in carbohydrates and fat are very common.
Interestingly (as a bit of a side note), when it comes to food cravings, in general, women appear to crave chocolate more than men, and it also appears to be the most frequently craved food among women. I can personally absolutely vouch for that, but I’m pretty consistent across my cycle when it comes to my chocolate cravings and daily consumption!
Progesterone is thought to increase appetite, whereas oestrogen may suppress it, which is why we might observe these changes during the luteal phase. Insulin sensitivity may also be lower in the luteal phase, meaning the body cells are less responsive to insulin, and therefore, we may require higher amounts of it to bring down blood sugar levels. This may contribute to symptoms of PMS and increase food cravings during this time.
Did you know that the lifetime risk of insomnia is 40% higher for women than men?
Beware ‘miracle cure’ diets for period problems
A few years back, after months of irregular periods, I visited my GP to investigate what was happening. I had originally put it down to stress, and after my blood tests came back normal, my GP put it down to that too. He advised me to ‘stress less’ – easier said than done, was my response.
I incorporated meditation into my day, added yoga to my weekly routine, cut back on very intense exercise sessions and waited . . . but still nothing. So after a further three months, I went back to the GP and we agreed to arrange an ultrasound scan to have a look at my ovaries and womb. This scan was followed up by an appointment with a gynaecologist who decided to re-scan me before confirming that I had polycystic ovary syndrome or PCOS.
The diagnosis offered me some relief, but, despite my medical knowledge of the condition, I still had a lot of questions. My first (without much thought – or filter) was, ‘Oh sh*t, can I have babies?’ to which the gynaecologist replied yes, although having PCOS can make getting pregnant a bit more difficult.
My next question was, ‘Do I need treatment?’ He explained that as I had a mild form of PCOS, no medication was necessary for now and to come back when I was planning for a baby. He didn’t seem to want to discuss anything further and so I picked up my bag to leave. However, just as I was about to walk out the door, he did offer some ‘lifestyle advice’. He suggested that as I was within a ‘healthy BMI’ range, I did not need to lose weight, but I should ‘just make sure to cut out the carbs'.
Oh, red flag!
First of all, not once did he ask me about my diet (I could have been on a low-carb diet already for all he knew) and; secondly, the role of diet in the management of PCOS is much more nuanced than simply avoiding carbohydrates. Luckily, I didn’t take his advice on board, but it did leave me feeling a bit peeved – I mean, how many other women left that clinic fearing that bread was driving their condition?
One study estimates that women with PCOS are roughly eight times more at risk of suicide.
Can food ease PMS symptoms?
If you have a menstrual cycle, you’ve likely experienced premenstrual symptoms at some point. The severity of symptoms occurs on a spectrum, and for some women, they can be bad enough that they interfere with their daily lives, which then becomes premenstrual syndrome (PMS).
Unfortunately, you can’t cure PMS, but there are some steps you can take to ease your symptoms, including nutrition and supplementation, gentle exercise, limiting alcohol and stopping smoking.
Carbohydrates: Women are often advised to steer clear of carbohydrates, particularly sugars, to help improve PMS symptoms. However, there is no clear link between total or type of carbohydrate intake and the risk of PMS. That said, opting for complex carbohydrates (whole grains, legumes, fruit and vegetables) more often than foods high in sugar (cakes, sweets, chocolate, ice cream) is certainly not a bad idea and may help control carbohydrate cravings and support mood and energy levels by stabilising your blood glucose levels.
Caffeine: As this is a stimulant, it can impact our sleep, mood and gut function. So if you struggle with insomnia, anxiety or bloating before your period, it may be worth looking at your caffeine intake, and making sure to limit, if not avoid, caffeine later in the day.
Magnesium: Magnesium supplementation has been shown to reduce PMS symptoms, mainly fluid retention (#periodbloat). One study found that it works best in combination with vitamin B6 rather than taking it alone. While these studies used supplements, magnesium can also be obtained through the diet in foods like pumpkin seeds, nuts, spinach and whole grains. So, if your symptoms are mild, including these foods in your diet may be a good place to start.
Iron: One study found that women who consumed a high intake of non-haem iron had a 36 per cent reduced risk of PMS. Non-haem iron is mainly found in plant-based foods such as fortified cereals, beans, pulses, soya products, nuts and seeds.
Answers about vitamins A to Z(inc).
Salt: If fluid retention is a PMS symptom issue for you, it may be wise to limit salt intake, as the sodium including salty foods like soya sauce, crisps, salted nuts, bacon and salami. This is because the body is constantly trying to maintain a balance of electrolytes so when you consume sodium, from salt, your body retains more water to maintain equilibrium.
Calcium and vitamin D: Research shows that women with higher intakes of vitamin D and calcium in their diet had a lower risk of developing PMS compared to those with a low intake. Studies where women received calcium supplementation, versus those who were given a dummy pill, also report fewer symptoms.
B vitamins: B vitamins are a family of vitamins involved in most processes in the body – from converting carbohydrates to energy to supporting the brain and nervous system. Higher intakes of vitamin B1 (thiamine) and B2 (riboflavin) from food sources have been linked to lower rates of PMS from observational studies. Pyridoxine (or vitamin B6) supplements are often still recommended, despite limited evidence. They’re not something I recommend; however, some women find them useful in helping their PMS symptoms and I can’t argue with that.
[Note: toxicity (including nerve damage) can occur with doses of vitamin B6 as low as 200mg/day so recommended doses are 25–100mg/day.]
Chasteberry (vitex agnus-castus): The vitex agnus-castus fruit, also known as chasteberry, is produced by the chaste tree, and can be taken as a supplement in tablet or capsule form. It’s often promoted as a dietary supplement for symptoms of PMS – particularly breast pain associated with PMS – infertility and other conditions.
Surprisingly, a number of studies have shown a benefit when compared to a placebo. While it may work (and it is generally considered safe), there are varying doses and formulations used in the different studies, so a standard recommendation is not available. The herb is believed to work through hormone modulation, and therefore it is not advised during pregnancy or while breastfeeding. It may also reduce the effectiveness of hormonal contraception.
Soya isoflavones: A few small studies have found that consuming soya isoflavones from a supplement or in the diet (from soya-based foods such as tofu, tempeh and soya milk) may help to improve PMS symptoms, possibly due to the impact of high doses of soya on oestrogen.
Omega-3 fatty acids: Omega-3 supplementation has shown some promise in reducing mental and physical symptoms of PMS. However - we need more good-quality research to confirm this. In the meantime, adding omega-3-rich foods such as oily fish, walnuts, and flaxseed is a good idea around this time.
The Female Factor: Making women’s health count and what it means for you by Dr Hazel Wallace is available now (Yellow Kite, £22).
