Menstrual cramps, otherwise known as dysmenorrhea is thought to affect about 50% of the women. Doctors tend to deal with it by either dismissing the pain as a psychological problem or prescribing painkillers. Today researchers have come a long way toward a better understanding of menstrual cramps.
There are 2 types of dysmenorrhea:
- Primary dysmenorrhea: Dysmenorrhea not caused by any physical abnormality of reproductive organs. Characterised by sharp, spasmodic pains in your lower abdomen OR dull ache in your lower back at the beginning of your period, or a day or two earlier, and it lasts two to three days.
- Secondary dysmenorrhea: Dysmenorrhea marked by pelvic and lower-back pain in which the pain is a symptom of another disease or condition that may require treatment such as endometriosis, pelvic inflammatory disease, uterine fibroids, and adenomyosis.
Main cause of dysmenorrhea:
- Dysmenorrhea happens when your uterus contracts to push out the menstrual blood. Imbalances between the hormones progesterone and estrogen worsen menstrual cramping. Hormone-like substances (prostaglandins) involved in pain and inflammation trigger the uterine muscle contractions and higher levels of prostaglandins are associated with more-severe menstrual cramps (1).
- Warm bath or lying down with a heating pad or hot-water bottle on your lower abdomen
- Exercise, take a walk around the block or a few sit-ups will stimulate your muscles to release feel-good endorphins
- Birth control or estrogen pills to decrease your body's production of prostaglandin.
- Calcium 1000mg daily has been found to reduce both premenstrual and menstrual symptom scores (2). In fact high intake of calcium and Vitamin D may reduce risk of premenstrual syndrome (PMS) (3).
- According to Christiane Northrup, M.D in her book 'Women's Bodies, Women's Wisdom (Revised Edition): Creating Physical and Emotional Health and Healing', she suggested getting plenty of essential fatty acids (salmon, flaxseed oil etc); take extra magnesium and a multivitamin-and-mineral supplement; take extra vitamin E during your menstrual cycles; eliminate trans-fatty acids from your diet; cut down on stress and consider yoga or massage.
1. Mayo Clinic http://www.mayoclinic.org/diseases-conditions/menstrual-cramps/basics/causes/con-20025447
2. Thys-Jacobs S, Ceccarelli S, Bierman A, Weisman H, Cohen MA, Alvir J. Calcium supplementation in premenstrual syndrome: a randomized crossover trial. J Gen Intern Med. 1989 May-Jun;4(3):183-9. PubMed PMID: 2656936.
3. Bertone-Johnson ER, Hankinson SE, Bendich A, Johnson SR, Willett WC, Manson JE. Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med. 2005 Jun 13;165(11):1246-52. PubMed PMID: 15956003.
Maintaining adequate levels of essential vitamins and minerals is extremely crucial for good health. This has also been highlighted by Havard School of Public Health in their Food Pyramid. It is common in the general population, especially the elderly to have suboptimal intake of some vitamins which is a risk factor for chronic diseases. On top of it, micronutrient adequacy has the potential to extend lifespan – recent research has found that multivitamin use is associated with longer telomere length in women (an indicator of a slower rate of aging) and this has also been highlighted in my previous article.
Of course, in addition to vitamins and minerals, a diet full of colorful natural plant foods is still needed because multivitamins cannot and will not replace your daily intake of healthy natural food. But the truth is that there are some nutrients that are lacking even in an ideal diet and deficiencies in certain nutrients can undermine your health causing various chronic diseases. On top of that, we cannot be sure that we are getting the precise optimal amounts of vitamins and minerals from our diet everyday – especially since absorption efficiency and utilisation of nutrients varies from person to person. For example, someone who has gastrointestinal issues like inflammatory bowel disease (IBD) will have decrease absorption of nutrients, so just having a healthy diet will not be sufficient. A high quality multivitamin can fill these gaps, ensuring that we get adequate amounts of essential micronutrients.
Some vitamins and minerals are often lacking even in a healthy diet:
Vitamin D is definitely at the top of the list. It was once thought to be important only for bone health, now scientists have found that Vitamin D has important actions in almost every cell in the human body, regulating the expression of over 200 different genes, including the ones related to apoptosis and immune modulation (1). Insufficient vitamin D levels are associated with several cancers, diabetes, cardiovascular disease, depression, and autoimmune diseases. Today, a lot of people suffer from insufficient Vitamin D levels with nearly 1/3 of Australian adults suffering Vitamin D deficiency according to a recent study by Deakin University. Since many of us live in cool climates and work indoors, and because of the potential risks of skin damage and skin cancer with sun exposure, supplementing is the best choice for achieving adequate vitamin D levels. In my experience, 2000 IU has been an appropriate dose to bring most people into the favorable blood 25(OH)D range of 50-75nmol/L. For extra assurance, I’ve also utilized Vitamin D3 because of its high biological value, the most effective form for raising 25(OH)D levels (2).
Vitamin B12 is required for important biological functions like red blood cell production, nervous system function, and DNA synthesis. Insufficient B12 levels are also associated with increased risk of Alzheimer’s disease (3). Deficiency in B12 can cause a variety of health problems including elevated homocysteine (a cardiovascular risk factor), anemia, depression, confusion, fatigue, digestive issues, and nerve damage (4).
Vitamin B12 is unique in that it is made only by microorganisms. Today, we live in a sterile polluted environment where our food is scrubbed (generally with chemicals) ‘clean’ of any soil and B12 possibility and due to the fact that our produce is washed and often transported far before we eat it (soil contains B12-producing microorganisms), most of us are unable to get sufficient B12 from plant foods alone. B12 deficiency is common, especially in vegans who don’t supplement and in the elderly (ability to absorb B12 decreases with age) and about 20% of adults over the age of 60 are either insufficient or deficient in vitamin B12 (5). Supplementation with vitamin B12 is important for most people, and absolutely required for most vegans to achieve sufficient B12 levels.
Iodine is required by the body to make thyroid hormones. A recent study of vegans estimated that only about 40% of the daily requirement for iodine was commonly met on a vegetarian or vegan diet (6). Another study concluded that 80% of vegans, 25% of vegetarians, and 9% of conventional eaters are iodine-deficient (7). Most plant foods are low in iodine due to soil depletion. The chief source of iodine in the typical diet is iodised salt. Since salt should be avoided for general good health, it is important to supplement with iodine to maintain adequacy.
Zinc is essential for immune function, growth, and reproduction, and supports hundreds of chemical reactions. Zinc is abundant in whole plant foods but is not readily absorbed. Beans, whole grains, nuts, and seeds contain zinc, but also contain substances that inhibit zinc absorption (8). A recent study of vegetarians found a high prevalence of zinc deficiency, and zinc requirements for those on a completely plant-based diet are estimated to be about 50% higher than the US RDI (9).
1: Hyppönen E. Vitamin D and increasing incidence of type 1 diabetes-evidence for an association? Diabetes Obes Metab. 2010 Sep;12(9):737-43. doi: 10.1111/j.1463-1326.2010.01211.x.
2: Tripkovic L, Lambert H, Hart K, Smith CP, Bucca G, Penson S, Chope G, Hyppönen E, Berry J, Vieth R, Lanham-New S. Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis. Am J Clin Nutr. 2012 Jun;95(6):1357-64. doi:10.3945/ajcn.111.031070. Epub 2012 May 2.
3. Hooshmand B, Solomon A, Kåreholt I, Leiviskä J, Rusanen M, Ahtiluoto S, Winblad B, Laatikainen T, Soininen H, Kivipelto M. Homocysteine and holotranscobalamin and the risk of Alzheimer disease: a longitudinal study. Neurology. 2010 Oct 19;75(16):1408-14. doi: 10.1212/WNL.0b013e3181f88162.
4. Office of Dietary Supplements, National Institutes of Health. Dietary Supplement Fact Sheet: Vitamin B12
5. Allen LH. How common is vitamin B-12 deficiency? Am J Clin Nutr. 2009 Feb;89(2):693S-6S. doi: 10.3945/ajcn.2008.26947A. Epub 2008 Dec 30.
6.:Waldmann A, Koschizke JW, Leitzmann C, Hahn A. Dietary intakes and lifestyle factors of a vegan population in Germany: results from the German Vegan Study. Eur J Clin Nutr. 2003 Aug;57(8):947-55.
7. Krajcovicová-Kudlácková M, Bucková K, Klimes I, Seboková E. Iodine deficiency in vegetarians and vegans. Ann Nutr Metab. 2003;47(5):183-5.
8. Hunt JR. Bioavailability of iron, zinc, and other trace minerals from vegetarian diets. Am J Clin Nutr 2003;78(suppl):633S–9S.
9. de Bortoli MC, Cozzolino SM. Zinc and selenium nutritional status in vegetarians. Biol Trace Elem Res. 2009 Mar;127(3):228-33. doi:
10.1007/s12011-008-8245-1. Epub 2008 Oct 25.
Attended a very interesting health meeting today and it was brought to my attention that Havard School of Public Health (HSPH) updated the Food Pyramid in 2008 based on the best available scientific evidence about the links between diet and health. According to HSPB this new Food Pyramid fixes the fundamental flaws in the original US Department of Agriculture (USDA) Pyramid and offers sound information to help people make better choices about what to eat.
HSPB has also kindly listed the top 5 tips to be healthy:
1. Start with exercise : A healthy diet is built on a base of regular exercise
2. Focus on food, not grams: Don't worry about specific servings or grams of food. It is important to note that everybody is different with different sizes, pre-existing conditions, family history etc. so there shouldn't be a set amount of serving.
3. Go with plants: Eating a plant base diet is the healthiest. Aim for lots of greens and healthy fats like olive oil and canola oil
4. Cut way back on American staples: Cut down on red meat, sugary drinks, potatoes and salty snacks.
5. Take a multivitamin: Taking a multivitamin can be a good nutrition insurance policy as it can fill in nutrient holes that may affect even the most careful eaters. Choose one multivitamin and top it up with Vitamin D. There is growing evidence Vitamin D lowers the risk of Colon and Breast Cancer.
For more info you can check out HSPB's handout here
I think this Food Pyramid is more in line with current average person's activity and nutritional requirements. Back in the days, my parents had lots of daily exercises working in the farm hence there was no need to put this in the pyramid. What do you think about current living trends?
In a very interesting study of 586 participants done in 2009, multivitamin use was related to longer telomere length in women aged 35–74 years (1). Compared with nonusers, the relative telomere length of leukocyte DNA was on average 5.1% longer among daily multivitamin users (P for trend = 0.002). As you probably already know, telomere length is related to biological aging and excessive telomere shortening may play an important role in development of some chronic diseases eg. Type 2 Diabetes.
It is understandable that regular multivitamin users tend to follow a healthy lifestyle and have a higher intake of micronutrients. The same study found that higher intakes of vitamins C and E from foods were each associated with longer telomeres too, even after adjustment for multivitamin use.
Researchers believe that the findings are related to the antioxidant power of many of the vitamins and minerals in the multivitamins which help prevent damage to all parts of DNA, including telomeres.
1: Xu Q, Parks CG, DeRoo LA, Cawthon RM, Sandler DP, Chen H. Multivitamin use and telomere length in women. Am J Clin Nutr. 2009 Jun;89(6):1857-63. doi: 10.3945/ajcn.2008.26986. Epub 2009 Mar 11. PubMed PMID: 19279081; PubMed Central PMCID: PMC2714373.
Dr Nicole Ng (MBBS) is a medical doctor with a passion in women's health and medical research