How diet affects menstrual pain
Diet and lifestyle have a major impact on your hormones and levels of inflammation all of which can in turn affect your period and menstrual pain. Most people blame their hormones directly for their period problems, but in reality, following an anti-inflammatory diet can be just as effective as taking ibuprofen (Motrin) or paracetamol (Advil). In fact, several studies have shown that an anti-inflammatory diet can be very effective at reducing menstrual and endometriosis pain.
How diet affects inflammation and menstrual pain
Menstrual pain is caused by the hormone-like substance prostaglandins that the uterus produces in order to help trigger cramps and the shedding of the uterine lining. They play an important role in the inflammatory response. The more inflammation you have the more prostaglandins you will produce during your period. Additionally, high levels of estrogen in women are associated with period pain and endometriosis.
So what’s a girl to do?
Luckily you don’t have to pop a bunch of pills to survive your period. Your diet can influence both your estrogen and inflammation levels. For example, eating a fiber rich diet can help your body eliminate excess estrogen while eating estrogenic foods such as soy, dairy and conventional meat from animals treated with hormones can raise your estrogen levels.
What is an anti-inflammatory diet?
The anti-inflammatory diet consists of consuming unprocessed foods that reduce or prevent inflammation. Basically, we want to try to eat whole unprocessed foods as much as possible. My rule of thumb is if you can't pronounce the ingredient or don't know what it is, avoid it.
Foods to include:
Colorful fruits and vegetables
Nuts
Legumes
Fish and seafood (ideally wild caught)
Unprocessed meat (ideally free range and/ or organic)
Pasture raised or organic eggs
Herbs and spices
Tea
Filtered water
More and more studies are coming out showing that super-processed foods cause various health problems, not just hormones. Whenever we can, it is better to consume organic meat and wild fish. It is also important to recognize that diet and servings per food group changes depending on health, level of exercise and stage of life. For example, a pregnant woman will eat differently than a woman in menopause, so we can say that the diet changes throughout our lives, but we can still follow an anti-inflammatory diet. It is also very important not to skip meals or snack throughout the day to maintain a balanced level of blood glucose avoiding large and low blood glucose spikes that cause a lot of stress for the body and stress can cause more inflammation and therefore more period pains.
Supplements that may help reduce inflammation and period pain
*Always consult your nutritionist or medical professional before taking taking any herbs or supplements as they may be contraindicated depending on your personal health status and medication. It’s also important to purchase herbs and supplements from a reputable source as many are not regulated for safety or quality.
Black cohosh
Cramp bark
Turmeric
Vitex (chasteberry)
Pycnogenol
Ginger
Dill
Fennel
Cinnamon
Infusions: red raspberry leaf, chamomile
Specific nutrients that are anti-inflammatory
It’s important to keep in mind that nutrients work synergystically and not in isolation. So although I list these nutrients that have been shown to have anti-inflammatory properties, it doesn’t mean that you shouldn’t have a varied diet that’s colorful and full of local and seasonal ingredients.
Omega 3 fatty acids
Fatty fish like wild caught salmon, sardines, anchovies, herring
Pasture raised eggs
Free range beef
Nuts and seeds like chia, flax and hemp seeds and walnuts
They’re called essential fatty acids because our body cannot produce them and therefore we have to consume them. Omega 3s are found mainly in fatty fish and some nuts. Fatty fish like salmon, sardines and herring contain the types of omega three called DHA and EPA which are the most widely used forms. In contrast, plant sources of omega three provide the ALA type, which is the precursor to EPA and DHA. The conversion rate from ALA to EPA or DHA is around 1%. That is why it is better to boost the consumption of fatty fish or take fish or cod liver oil supplements instead of eating a lot of chia or flax seeds to consume omega 3, although eating nuts and seeds provides many nutritional benefits.
Magnesium
Nuts and seeds
Chocolate
Avocado
Dark chocolate
Banana
Whole grains
Black beans
Supplements: magnesium citrate is best for constipation as it has a laxative effect but isn’t readily absorbed; magnesium glycinate is a readily absorbed form that can cross into the blood-brain barrier creating a calming effect; magnesium malate is good for energy production.
Magnesium is a mineral involved in more than 300 enzymatic processes. It helps to relax muscles and also maintains the proper functioning of the nervous system. It also helps to produce our body's main antioxidant glutathione. Along with vitamin B6 it can alleviate PMS symptoms. Most people are deficient in this vital mineral because our soil has become depleted and many simply don’t consume enough magnesium-rich foods. Adequate magnesium intake (which is between 300-400 milligrams a day) has been associated with a lower risk of endomestriosis.
Calcium
Dairy (yogurt, milk, cheese)
Sardines and anchovies with the bones
Broccoli
Almonds
Sesame seeds
Fortified plant based milk
We need calcium not only for the bones, but also for the proper functioning of the heart, muscles and nervous system. Adequate calcium intake is about 1,000 milligrams a day which can reduce menstrual pain. Because many people have an intolerance to lactose or cow's milk protein, especially more than goat's or sheep's milk, it is important to consume other sources of calcium apart from dairy. Also, dairy can be inflammatory for many people and the calcium that comes from vegetables is more absorbible than the calcium in milk.
Vitamin B1 (thiamine)
Beans
Brown rice
Salmon
Flax seeds
Peas
Asparagus
Mussels
Speaking of how nutrients work together, a study showed that women who took 100mg of vitamin B1 with 500mg of fish oil suffered much less menstrual pain. Vitamin B1 is an essential nutrient for the growth, development and proper functioning of the body. Consuming about 100mg a day for at least three months can be effective in reducing moderate or severe menstrual pain in women suffering from amenorrhea. Vitamin B1 is also found in fortified cereals, pork, salmon, and trout.
Vitamin B6
Salmon
Chicken breast
Pork loin
Bananas
Pistachios
Avocado
Sunflower seeds
Sweet potato
Vitamin B6 is a very important nutrient for women because it performs many functions including facilitating the production of the female hormone progesterone. Adequate levels of progesterone can reduce the symptoms of PMS. Furthermore, this vitamin metabolizes estrogens in less potent forms. An excess of estrogen is related to menstrual pain, endometriosis, and PMS. Other studies have also shown that B6 can reduce various PMS symptoms such as water retention, headaches, cramps, anxiety, back pain, and cravings.
Vitamin C
Citrus fruits
Watermelon
Pineapple
Strawberries
Acerola cherries
Broccoli
Peppers
Vitamin C is a powerful antioxidant that has anti-inflammatory properties.
Vitamin D3
Sun exposure (15-20 minutes per day for most people)
Fortified milk
Eggs
Liver
Cremini mushrooms
I think vitamin D is one of the most powerful and under recognized nutrients. I’m kind of obsessed with it (I wrote my master’s thesis which I published about vitamin D) because it plays such an important role in almost all aspects of our health, yet billions of people worldwide are deficient in this nutrient. It plays a very important role in immune, digestive and bone health. It can also reduce the levels of prostaglandins that cause menstrual pain. A low level of vitamin D in the blood is related to desmenorrhea. Vitamin D deficiency is a global problem thanks to our modern lifestyle, excessive use of sunscreen, and fear of skin cancer. In reality the majority of the population needs to sunbathe for 15-20 minutes a day to avoid a deficiency, or take supplements. Although I mention foods rich in vitamin D, most fortified foods carry the form D2 (ergocalciferol) that the body does not use as much as D3 (cholecalciferol) that comes from exposure to the sun, eggs or liver for example.
Vitamin E
Extra virgin olive oil
Wheat germ
Almonds
Sunflower seeds
Peanuts
Avocado
Pasture raised eggs
Liver
Like vitamin C, vitamin E is another powerful antioxidant that can reduce inflammation.
Iron
Liver
Red meat
Oysters
Non-heme iron: legumes, fortified cereal, spinach, quinoa, pumpkin seeds
Many women who experience menstrual pain or endometriosis also have periods with heavy blood loss and therefore may suffer from iron deficiency, which is a type of anemia. There are two types of iron— heme that comes from animal products like liver, red meat, and shellfish, and non-heme that comes from vegetables like lentils and spinach. Absorption of non-heme iron is between 5-12%. In addition, many nuts and plants carry substances that inhibit iron absorption. So if you are deficient in iron, it is better to boost your consumption of organic animal sources than vegetable sources. If you are vegan or vegetarian, it would be best to consider taking an iron supplement ideally iron bisglycinate which is the most absorbable form and has fewer side effects such as constipation compared to other types.
Your gut and period pain
Fiber (at least 25-30g/ day
Fruits, vegetables, legumes, whole grains, seeds
Prebiotics; a type of fiber that beneficial bacteria consume and therefore facilitate the survival of these bacteria in our intestines instead of non-beneficial bacteria
Asparagus, green banana, jicama, apple, leek, onion
Probiotics: bacteria and other beneficial microorganisms that inhabit the intestinal flora
Fermented foods (yogurt, kefir, miso, sauerkraut) and supplements
I wrote a previous post titled What’s the deal with period poop that talks more in detail about how the gut microbiome affects estrogen levels. There is a special group of bacteria that reside in the intestines called the estrobolome that regulates estrogen metabolism in a major way. Non-beneficial bacteria contain an enzyme called beta glucaronidase that converts estrogens to their active form. In fact, our poop carries estrogens that we don't need, so if you don't poop every day or have digestive problems, you may have an imbalance of the intestinal flora.
Foods to avoid
Refined sugar and carbohydrates (little to no nutritional value and very high glycemic index)
White bread, pasta and rice; pastries, cakes, cookies, ice cream, crackers, cereal, chips, pretzels, etc.
Processed fats
Omega 6 like sunflower and safflower oils, trans fatty acids, fried foods, etc)
Processed meat
Hotdogs, chicken nuggets, conventional meat, etc
Processed soy (most vegetarian alternatives and processed foods contain some form of processed soy)
Food additives and artificial food coloring
Caffeine, tobacco, alcohol
Any food that you are intolerant or allergic too. The biggest culprits tend to be: gluten, dairy, soy, corn, peanuts, tree nuts, and shellfish although it can be any food or food additive
High histamine foods if you are intolerant as high histamine production has been associated with menstrual pain and endometriosis.
First of all, I want to say that there is no perfect diet and I’m NOT a fan of super restrictive diets long-term or depriving yourself in the name of “health”. Nor am I against cravings or indulgences from time to time. You have to live and enjoy life and not suffer as a punishment to yourself because that’s what you think you need in order to say healthy and prove to yourself that you have lots of willpower like modern diet culture has indoctrinated in so many. However, it is important to avoid regular consumption of super processed foods, sugars, alcohol, and lots of caffeine that cause inflammation and can cause menstrual pain.
It is important to note that the most inflammatory or intolerant foods are usually dairy and gluten (big downer I know because these foods are delicious). Gluten has been associated with endometriosis and dysmenorrhea. I'm also not saying that gluten-free products are a better option because they are typically heavily processed with a high glycemic index that causes a spike in blood glucose. It is a good idea to avoid the consumption of dairy and gluten completely 100% for at least a month to assess if you have an intolerance and ideally work with a nutritionist or healthcare practitioner.
General advice
No food can work miracles for health, but it is about having a balanced diet.
It is better to consume fresh and simple food.
Try to eat a variety of colors at each meal.
Read labels and watch ingredients in processed foods
Diet is only one part of a healthy lifestyle → you need to sleep well, reduce stress, have healthy relationships, and exercise regularly.
Implement changes little by little to avoid the stress of making many changes at once.
A good way to balance blood glucose is not to skip meals or snack throughout the day and you must incorporate fiber, protein and healthy fat in every meal.
