Women’s Health: Rhythm Is Gonna Get You – Gloria Estefan

From an early age, feeding follows a pattern based on critical nutrients and how well our body responds to assimilating them. Developing diversity in breaking foods down comes with age and a maturing system as well as a need for increased amounts of specific nutrients such as iron, protein and calcium. Over our lifetime, we tend to accept that nutrient needs change as you age, and in recent years the emphasis on the importance of specific nutrients are well ingrained in our knowledge.

Research supports that higher levels of certain nutrients, at certain ages, keeps pace with the demands of growth, up until late teenage years. From early teens, what sets women apart from men is that our menstrual cycle dominates our physiology and therein comes the difference in nutrient needs between males and females. Rhythms we take for granted are heartbeat and daily sleep-wake cycle. Less obvious are the physiological processes inside the body such as the rhythmicity of the sex hormones that drive the menstrual cycle and others that regulate growth and metabolism.

The menstrual cycle is an essential life rhythm for all females driven by a well-choreographed dance between levels of estradiol, progesterone, follicular stimulating, and luteinizing hormones. A closer look at the levels of clinical chemistries over this cycle includes the need for much more than a supplement.

A varied diet with an emphasis on specific nutrients is enlightening and may well highlight some shortfalls in women’s food choices, frequency and amounts.

Women experience a ‘jumble’ of common symptoms over the cyclic month, and for some, the challenge of managing weight, despite exercising and eating the same diet; mood swings, hot flashes, diminished libido, hair thinning, changes in skin, poor immunity, loss of muscle mass, joint and bone issues, irritable bowel and a greater sensitivity to certain foods.

Studies observing reduced metabolite levels over the monthly cycle may show a time of vulnerability to hormone related health issues such as pre menstrual syndrome (PMS) and post menstrual dysphoric disorder (PMDD), in the setting of a healthy, rhythmic state. PMDD is a more severe form of PMS and includes lifestyle and dietary changes sometimes along with medications. Even in the absence of chronic symptoms, a normal cycle appears to require fluctuating levels of nutrients in order to keep balance.

The first half of the menstrual cycle during which time estrogen levels are low (menstrual phase) and rise (follicular phase) and moves onto the second phase (periovulatory) in which follicular stimulating hormone (FSH) and luteinizing hormones (LH) peak. This second half of the cycle is called the luteal phase (estrogen levels rise with a progesterone peak) and the pre-menstrual phases during which time estrogen and progesterone levels fall.

As women age and sex hormones dip and dive, this is the time that many women experience an increase in chronic diseases such as diabetes and inflammatory bowel disease, bloating, poor sleep quality, and premenstrual syndrome (PMS) or PMDD.

The research on metabolic differences over the cycle identify nutrient level fluctuations that may well signal vulnerability to sex hormone related disorders, something the diet could help to off-set.

These biochemical changes suggest nutrient use is affected by changing sex hormone levels between phases. During the luteal phase (pre menstruation when estrogen and progesterone levels fall), blood serum levels of amino acids from protein falls along with an increased need for energy which the body may try to balance by increased appetite, food cravings and excess calorie intake. The suggestion here is that greater requirement is needed to prepare the uterus for pregnancy. Insufficient protein intake may resort also to breaking down muscle mass. Serotonin (made from amino acid tryptophan) levels are often affected at this time to influence mood and sleep. It maybe considered that the luteal phase puts more stress on body chemistry and raise responses to environment and dietary intake.

Of particular interest to scientists is the extra demand on subsystems:

  • reduced glutathione (the mother antioxidant in the liver) and essential for detoxification
  • fluctuations in a number of specific amino acids, some available only from a diet that includes a wide range of protein foods (meat, fish, poultry, dairy, eggs, pulses and grains)
  • the energy cycle (citric acid cycle)
  • omega 3 fatty acids and the synthesis of bile acids to break down fats for excretion.  

The anabolic (muscle breakdown) effect of the luteal phase is not limited to amino acids, but also requires a higher need for fat and particularly phospholipids (egg yolk, soy lecithin) which play a part in cell wall linings and brain health. Antioxidant levels are in greater demand in fat metabolism making a diet rich in vegetables, fruits, wholegrains, nuts and seeds important.

Endocannabinoids are known to interact with sex hormones and cytokines to regulate fertility, cognitive function, pregnancy, appetite, pain, mood and memory. Omega 3 fats as well as other plant based fats such as gamma linoleic acid (GLA) found in evening primrose oil, borage, mushroom oil, are a good source of phospholipids to support the dynamics of biochemical systems and their rhythmic demands.

Cholesterol is a key component of sex hormones and is utilized during the luteal phase for progesterone and estrogen synthesis. Cholesterol from the diet is from animal fats and while we often try to keep these foods under control, they are still essential to health and especially as a backbone to hormones during critical phases.

An interesting vitamin, B8 or now known as inositol, plays a key role in insulin signaling and hormonal function. Research reveals a significant reduction in luteal phase myo-inositol can cause a drop in blood glucose and increase cravings. Neurotransmitter pathways are heavily reliant on select amino acids from proteins, and B vitamins to infuence mood, anxiety and depression implicated in PMS and PMDD. Women are more affected than men by depressive disorders during the time between menstruation and menopause suggesting this increase in depression risk is sex hormone related.

Neurotransmitter serotonin, dopamine and GABA have a direct influence on mood, emotions and brain clarity. Vitamin B6 is a cofactor in sex hormone gene expression and neurotransmitter metabolism to convert tryptophan to serotonin and to synthesise calming GABA.

Glutathione is associated with oxidative stress and liver detoxification, important for maintaining biochemical balance and flushing out waste products of metabolism. Sex hormones are correlated with redox balance during the menstrual cycle in the endometrium relying on glutathione metabolism. Individuals with PMS have been shown to have an imbalance in oxidant/antioxidant status and may be more susceptible in a state of low glutathione metabolic activity in the luteal phase of their cycle. N-acetyl cysteine (NAC) forms glutathione where oral glutathione is poorly absorbed. Foods rich in cysteine are high in protein – turkey, chicken, eggs, pulses, cheese, yoghurt, seeds.

Vitamin D supplementation, when combined with calcium, has shown to be a female essential for insulin management, menstrual regularity, fertility in women with PCOS and serotonin synthesis to affect mood. It interacts with progesterone to regulate the immune system through T cell induction of the vitamin D receptor has a sensitive relationship with changes in estrogen levels.  

Phospholipids are phosphate molecules with a water soluble and fat soluble tail for moving fats around within watery fluids. They makeup cellular membranes, regulate cellular processes and create stability to reduce inflammation.  Studies show common PMS symptoms related to infammation include mood, abdominal cramps, back pain, breast tenderness, appetite cravings, weight gain and bloating. Inflammation is indicated by elevated levels of CRP seen alongside PMS.  

The relationship between menstrual rhythms and diet, stress and environment may have more of an impact on sex hormone related health challenges suggesting dietary change may be the first phase of your wellness journey and well worth focusing on.

Higher protein load, phosphatidylcholine from egg yolks/soy lecithin, omega 3 and omega 6 fatty acid intakes are essential to the luteal phase along with sufficient vitamin D intake/sun exposure, B6, sulfur containing vegetables to promote glutathione metabolism, and antioxidant food sources intake throughout the cycle.

What hasn’t been discussed here is the effect of exercise, alcohol, caffeine and increased sensitivity of some foods and food chemicals.

References:

Draper CF et al (2018) Menstrual cycle rhythmicity: metabolic patterns in healthy women. Scientific Reports; 8:14568

Vigod, S. N et al (2014) Systematic review of gamma-aminobutyric-acid inhibitory defcits across the reproductive life cycle. Arch Womens Ment Health; 17: 87–95.

Kashanian, M., Mazinani, R. & Jalalmanesh, S (2007) Pyridoxine (vitamin B6) therapy for premenstrual syndrome. Int J Gynaecol Obstet; 96: 43–44.

Serviddio, G. et al (2002) Modulation of endometrial redox balance during the menstrual cycle: relation with sex hormones. J. Clinical Endocrinology and metabolism; 87: 2843–2848.

Pal, L. et al  (2012)Therapeutic implications of vitamin D and calcium in overweight women with polycystic ovary syndrome. Gynecol Endocrinol; 28: 965–968,