These days, many women embark on conception and pregnancy apprehensive about the potential for postpartum depression, anxiety or panic attacks to descend upon them in those early, exhausting, new baby months.
Since the characterization and treatment of postpartum anxiety, depression, and psychosis remain largely incomplete, prevention is where it’s at.
A recent retrospective study found that having a history of moderate to severe PMS (PMDD) increased the risk of postpartum depression approximately two-fold. Irritability, weepiness, bloating, breast tenderness, sleep, and energy changes, and even hopelessness plague up to 10% of women of reproductive age. This is approximately the incidence of women who go on to develop postpartum depression. With that news, what is a woman with PMS to do?
Here are some considerations:
Make Peace With Your Blood Sugar
In the setting of diets high in refined carbs (flour) and sugar, and/or low cortisol from stressed adrenals, control of blood sugar and cellular energy-burning may be disturbed. Cortisol is responsible for mobilizing stored sugar to the bloodstream and maintaining fat storage of sugar when it is unused in the bloodstream. Thus, when it is low, one experiences everything that comes with hypoglycemia including:
- Poor morning appetite
- Irritability or jitteriness (headache, nausea) after fasting >3 hrs
- Night waking
- Energized by eating
- Forgetfulness
- Need for caffeine, cravings for sugar
When cortisol runs high as it tends to in acute stress or the early stages of adrenal burnout, it promotes high blood sugar and symptoms of insulin resistance including:
- Morning sugar cravings
- Persistent hunger
- Abdominal weight
- Frequent urination
- Fatigue after meals
- Insomnia
- Irregular periods
- Acne
- Body hair growth/head hair thinning
- Frequent illness
Imbalances of blood sugar can feed forward into a hormonal loop because insulin promotes the production of male hormones, raises cortisol which promotes insulin resistance and interferes with thyroid function and progesterone levels. It’s all a big spider’s web that all moves when you pull a tiny area.
Stopping the runaway train requires eliminating added sugars and refined flours (bread, pasta, cookies, pretzels, etc), and often requires elimination of grains entirely with a focus on “safe starches” or whole food tubers like sweet potatoes and yams best consumed with a healthy fat such as coconut oil, olive oil, or ghee (quality sources). Fats and proteins such as those from pastured animal meats and wild fish are the best antidotes to the ups and downs of a high carb diet.
If further support is needed, magnesium and chromium are minerals that improve insulin sensitivity, and L-carnitine is an amino acid that shuttles fatty acids to be burned in the cell. It can help with the “hybrid performance” of a system whose glucose metabolism is somewhat derailed.
Protect Progesterone
In functional medicine, estrogen dominance is referred to as a cumulative load of estrogen effects that outpace progesterone. This state is thought to underlie symptoms of PMS, perimenopause, and some cases of postpartum psychiatric disorders. Estrogen can come from our environment in the form of xenoestrogens found in plastics, pesticides, and cosmetics. Its excretion can be impaired by abnormal gut flora and by poor methylation status/use of B vitamins. Stress, as referenced above, can lead to shunting of progesterone to make cortisol, called a pregnenolone steal. If the body determines that it is in a state of alarm, those stress hormones are more important than conception hormones!
In my practice, I start with Maca, a mineral and phytonutrient-rich Peruvian vegetable that has adaptogenic properties in supporting the signaling around hormone production, called the Hypothalamic Pituitary Axis. This root helps to support the body’s ability to produce and balance hormones, buffering the effects of the stress hormone cortisol.
Vitex/ChasteTree is an herb that has historically been used as a female reproductive tonic and approved in Germany as a treatment for PMS. It is thought to have effects on prolactin release and to promote progesterone production and receptor sensitivity. A number of studies have examined its efficacy and associated safety.ii
At least three randomized, placebo-controlled trials of evening primrose oil (0.5-2mg) in premenstrual syndrome suggest that this GLA-rich anti-inflammatory fatty acid is an effective intervention potentially related to its effects on prolactin signaling.iii
Topical bioidentical progesterone is an option that I reserve for when other interventions are not successful as supplying the hormone directly does not account for the activity of other hormones, nor does is resolve an issue of receptor insensitivity or resistance.
Temperament-regulating Thyroid
While there is not a clear relationship between low thyroid function and PMS/PMDD, some studies have demonstrated thyroid “volatility” and increased hormonal responsiveness of the gland. Intervention studies have focused on T4/levothyroxine, but it is T3, active thyroid hormone that is active at the cellular level enhancing the functioning of every tissue and promoting adequate energy production. There is scientific speculation that low progesterone relative to estrogen may inhibit thyroid hormone uptake at the cell. When the above interventions are of limited yield, and there are other symptoms like cold intolerance, fatigue, cloudiness, weight fluctuations, constipation, and depression, the thyroid is an important place to focus.
There are a number of single nutrients like B6, Calcium, Magnesium, Vitamin C, and vitamin D that have been studied for the treatment of PMS, all of which contribute to global nutritional support, immune and nervous system support, but I tend to doubt there is one magic supplement used in this type of one-pill-for-one-problem way. Treating these symptoms means bringing the body into better balance, and doing that before pregnancy is a gift to the baby, and to your postpartum self.
Sources
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In suffering from post partum depression I can see that there are diet changes I need to make. Perhaps this will help me with other issues I am dealing with as well. This article i found really helpful- it explains a lot about your adrenals and the hormones, like progesterone… very informative (drlam.com/blog/serious-progesterone-side-effects-and-brittle-adrenals/29049/)
Has anyone ever, made the connection that some postpartum depression can be a withdrawal symptom. The pain medication Demerol and other meds like morphine that I got are narcodics and opids. Even in small doses, you still have to come down, or withdrawal. Depression, anxiety, are symptoms of withdrawal. Even epidurals have narcodics in them, unless you state that you do not want narcodics. Combine that with raging hormones, well I ‘ll leave that alone for now.
It’s now been a year since I started taking iodine in liquid form (lugols I get from Australia) and the horrific PMS I have had since 12 years old (I’m 40 now) is completely gone. My PCOS symptoms have greatly improved and I have almost no cramps during my menstrual cycle. I’ve had to take 20+ Ibuprofen A DAY since I was 12 years old because my cramps were so bad I would be on the floor in a heap otherwise, making it impossible for me to keep a job. Now I only occasionally take at most 4 only 1 day of my period every so often and I must admit that’s because I sometimes get scared the pain will come. The Iodine combined with l-tyrosine has really stabilized my moods. I also used to get so angry inside it would physically hurt or if I got angry I would shake uncontrollably. All gone now. Now I’m working on my diet (going gluten, sugar free), liver repair from the years of Ibuprofen use, etc.
GI
Hi Kelli,
I have a history of bad (intense) PMS, was on 5 different birth control pills throughout high school to try to decrease my crazy periods, went OFF of birth control two years ago, switched to naturopathic remedies for one year, then finally became regular on my period when I added Progessence Plus from Young Living.
So, haha, after than nutshell of information: I am having all of the symptoms of the high cortisol levels almost consistently these days. I crave sugar EVERY SINGLE MORNING and I also crave the foods I haven’t been able to eat for years now, gluten and dairy.
Do you think that there may be something I should do first to help my body get off this bad cycle? Like eat all Paleo, or do a candida cleanse? I want to heal and especially with the increase in my cravings for sugar. I just don’t want to do something too drastic or miss something important.
Thanks for your articles, they are so informative and helpful!! Bless you!
Sarah
RV
Thank you for this post! I have really enjoyed reading them!
Have you ever posted an article about alcoholism and nutritional ways to support someone who has binged and now suffers from anxiety and depression? My husband is trying to stay sober and it is really difficult. Any suggestions? He is not really on board with my organic health kick.
Hi Kim…would recommend The Mood Cure or The Diet Cure…both by Julia Ross. She is a wonderful speaker at the Weston Price Conferences and specializes in working with those addicted to alcohol…which is sugar in it’s extreme form. She uses nutritional support and amino acid therapy.
I second that! The supplements she recommended really cut down on my cravings for alcohol. Now, I can have one and more often than not, I just skip the wine. Good luck, not an easy road but well worth it.
My husband and I have 5 children plus 1 up in heaven. I had no difficulty whatsoever after my first 3 children. However after #4 I had a severe panic attack on day 10 postpartum..initially I didn’t even know what it was. After baby #6 I struggled b/t anxiety and depression. I went to a naturopath who prescribed me a homeopathic remedy and some diet and supplement changes. I would say it took care of about 80% of my symptoms. I greatly admire (ok am jealous of) women that can handle extremely large families. Unfortunately, I can’t. I am so glad to read of Dr. Brogan’s work. Thank you for posting this Sarah.