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Chocolate may help prevent PMS



a variety of light, dark, and white chocolate candies

Premenstrual syndrome (PMS) is no joke. Back in 2015 I shared with you a study that estimated that up to 10% of women are seriously affected by the symptoms associated with premenstrual syndrome, and more recent estimates are that up to 20% of women meet the clinical diagnostic criteria for the disorder. That study from two years ago looked at the quality of sufferers' diet overall, concluding that those following a healthier diet higher in vegetables and fruits, legumes, and nuts were 28% less likely to experience PMS than those following a more Western diet higher in fast foods, refined grains, sugar, and soft drinks.

That study was a case-control study of a total of 320 women in the United Kingdom and looked at overall diet. A recent article in the British Journal of Nutrition (2017;118:849-857) describes a much larger study, which makes use of data gathered for the Nurses' Health Study 2, which originally enrolled over 100,000 women and began collecting detailed dietary information every four years starting in 1991.

Like the study in the UK, this study matched women diagnosed with moderate to severe PMS symptoms with women of the same age and without other health conditions that might mimic PMS symptoms. The authors chose to include only those women with at least one each of physical and emotional symptoms of PMS and required that the symptoms started at least two weeks before menses, ended at least 4 days after the start of menses, and were absent during the week after menses.

Instead of looking at overall diet, the authors analyzed the amount and types of fats the women consumed, breaking them down not only into saturated and unsaturated fats, but also analyzing the specific source (land or fish animal protein? dairy? vegetables? supplements?) and subtype of fat. The authors then compared the amount and types of fats consumed by those women with PMS and compared them to their case controls without PMS.

After taking into account the usual variables of age, height and weight, physical activity, and whether they were smokers, the authors also considered number of pregnancies, age at menarche, previous childhood trauma, history of antidepressant use, use of hormonal birth control, and other characteristics that can affect the risk of PMS.

Contrary to another study that found that following a low-fat vegetarian diet seemed to help prevent PMS, the authors of this study were somewhat surprised to see that overall fat intake was not significantly associated with PMS either way - it had no significant effect on risk. Saturated fats, regardless of source, seemed to be inversely associated with PMS - more saturated fats meant a lower risk of PMS. A specific medium-chain fatty acid, stearic acid, seemed to be the most strongly associated with a lower risk of PMS, with those consuming the most stearic acid being 25% less likely to experience PMS than those who consumed the least stearic acid.

What this means for you

What is one of the most common sources of stearic acid? Cocoa butter. Unfortunately, case-control studies can only show association, not causation: we can't know for sure that eating a lot of chocolate was the reason these women were less likely to experience Premenstrual syndrome. It does, however, go along with other studies we've seen on the health benefits of some medium-chain fatty acids: a low-fat diet is unlikely to help prevent PMS.

First posted: December 27, 2017