These medicines should be taken in the 6th or 30th potency. Generally, if there is minor pain or discomfort, you should take the medicine three times a day, stopping once health has been restored. If there is more severe the pain, you can consider taking the medicine every one to three hours, decreasing the doses as symptoms are reduced. If you do not observe some improvement after 24 hours in an acute condition, the medicine is probably not the correct one. If symptoms persist, consider another medicine or seek professional homeopathic care.

It is generally recommended that people treat themselves for non-threatening acute conditions only and obtain professional care for chronic or potential dangerous health conditions. Dr. Stephen Cummings and Dana Ullman’s Everybody’s Guide to Homeopathic Medicines (Tarcher/Perigee, 1991) provides detailed protocols for helping to determine when symptoms are beyond self-care.



Allium cepa (onion): Because it is known to cause tearing of the eyes and dripping of the nose, it is a frequent remedy for the common cold and hay fever, especially when there is a thin, watery, and burning nasal discharge that irritates the nostrils. Typically, the person’s symptoms are worse in a warm room and are relieved in a cool room or in the open air.



Arnica (mountain daisy): This is the #1 remedy in sports medicine and first aid. It is used for shock and trauma from injury. It also helps to reduce pain from injury and to speed the healing process. Whether you’re into competitive sports or exercise regularly or if you simply don’t like to feel the pain of an injury, Arnica is the place to start.



Chamomilla (chamomille): Many parents owe their sleep to homeopathy, not because it helps them directly, but because it is so good for their infant. Chamomilla is THE remedy for the irritable infant, especially from teething or colic. The infant cries incessantly, and nothing seems to provide any relief, except carrying them, and even then, the crying begins recurs as soon as the parent puts the child down.



Hypericum (St. John’s wort): This remedy is the first medicine to consider for injuries to the nerves or to parts of the body rich with them, including the fingers, toes, and back. Any injury with shooting pains should be given this remedy.



Ignatia (St. Ignatius bean): One day this remedy will be used by the majority of psychiatrists. It is one of the leading homeopathic medicines for acute grief, anxiety, and depression, especially after a death or separation from a loved one. The person sighs frequently, has a lump in the throat, and may tremble.



Magnesia phosphorica (phosphate of magnesia): This is the most effective remedy for cramps, including menstrual cramps. It has helped prevent many women turn from Dr. Jekkyl into Ms. Hyde as a result of menstrual cramps. It is particularly indicated when a woman’s cramps cause her to bend over and when they experience some relief from warm applications.



Nux vomica (poison nut): This is the premier medicine for ailments exacerbated by conventional or recreational drugs. It is also a common remedy for treating symptoms of overeating or from drinking too much alcohol. Considering how many people have these vices, this is an all too frequent medicine today.



Pulsatilla (windflower): Perhaps the most commommon remedy given to both children and women, this medicine is not indicated for a specific disease but for a specific pattern of physical symptoms and psychological characteristics. Physically, these people are warm-blooded: they wear less clothes than others, prefer open air, and don’t feel as well in the heat. Psychologically, they are a gentle, mind, and yielding person, with a quickly changing emotional state and a strong tendency to want to please others.



Rhus tox (poison ivy): This medicine is the most common remedy for sprains and strains. It is especially indicated when a person experiences a “rusty gate” syndrome, that is, pain on initial motion which is reduced the more the person continues to move. It is also often given to people with the flu or arthritis who experience this similar rusty gate syndrome.

How do I Learn More About Homeopathy?

The best source of homeopathic books, tapes, home medicine kits, and software is:

Homeopathic Educational Services

2124B Kittredge St.

Berkeley, CA 94704

(510) 649-0294

(510) 649-1955 (fax)

Usually, they have many treatment alternatives but they have no information about their choices. One example of effective alternatives is the reduction in blood pressure that meditation produces. Others are the dietary changes and exercise programs that lead to lowered cholesterol. Since the medical treatments for these two conditions are often more dangerous than the problems, it is worth seeking safer alternatives.

Dr. Dean Ornish has shown that patients with heart disease can often avoid surgery and reverse their heart disease with a combination of a low-fat diet, meditation, and exercise. Norman Cousins healed his ankylosing spondylitis (a form of arthritis of the spine) with laughter and high doses of vitamin C. He wrote about his experience in the New England Journal of Medicine, and followed this article with a book, The Anatomy of an Illness. Many patients have cured their digestive disturbances simply by avoiding certain foods.

Over and over, we are seeing the results of lifestyle changes in health care. A recent scientific medical conference put on by the American College for Advancement in Medicine was entitled: Lifestyle Medicine—Medicine for the Nineties. Researchers and physicians both attended and taught at this scientific meeting. Much of it related to the role of dietary supplements in medical therapy.

Dietary supplements are amongg the safest and most effective choices in health care. They are almost free of side effects, they are easy to take, they are relatively inexpensive, and they usually enhance many life functions besides the specific condition for which they are being given. Following is an example of how nutritionally oriented physicians might use supplements as part of the treatment for a specific health problem. This is a suggestion that is supported in the medical literature and in the experience of many physicians.

Remember this is an example, not a prescription for you, and the supplement list is in addition to many other health practices. Other supplements may be helpful, and you may not need all of these to get results. For more information on any one supplement, look for its description in Dietary Supplements. No one program is appropriate for everybody, but these suggestions are good starting points from which individual programs can be modified.

Premenstrual symptoms range from mild to severe, and they include bloating, cramps, headaches, fluid retention, depression, low back pain, abdominal pressure, sugar cravings, anxiety, irritability, breast tenderness, acne, and mood swings. Some of these symptoms may also occur during the menstrual period, especially cramps, and they are often controlled by the same supplements.

For both premenstrual and menstrual symptoms, in addition to the dietary supplement program, you may need supplements of natural progesterone. This is the hormone, produced primarily by the ovaries, but also by the adrenal glands, that supports pregnancy and also helps to maintain and increase bone density. It also counteracts excessive estrogen stimulation.

Natural progesterone (as opposed to synthetic “progestins” such as Provera®) has no side effects and it regulates many different functions. It is particularly important to menopausal women for increasing bone density and managing some menopausal symptoms. (Synthetic progestins are different, and do little for bone density.) Progesterone is commonly deficient, is free of side effects, and can be taken as a supplement either orally or as a skin creeam. It is wise to have a gynecologic examination before proceeding with progesterone treatment.

The following table of supplements includes those most commonly helpful with both premenstrual syndrome and menstrual symptoms:

	AM	PM
Basic Multiple Formula	3	3
Vitamin C 1000 mg	2	2
Pyridoxine (B6) 250 mg	1
Magnesium aspartate 200 mg	1	1
GLA 240 mg (from borage oil)	1
Vitamin E 400 IU natural mixed	1	1
Flaxseed oil, 1–2 tbsp daily, or
EPA 1000 mg	2	2

There are two types of dysmenorrhea – primary and secondary. The primary form usually occurs in females who have just begun to menstruate. It may disappear or become less severe after a women reaches her mid-twenties or gives birth. (Childbirth stretches the uterus).

The cause of menstrual cramps is thought to be related to hormone-like substances called prostaglandins. These are chemicals that occur naturally in the body. Certain prostaglandins cause muscles in the uterus to go into spasms.

Dysmenorrhea occurs much less often in women who do not ovulate. For this reason, oral contraceptives reduce painful periods in 70-80% of women who take them. When the pill is stopped, women usually get the same level of pain they had before they took it.
Secondary dysmenorrhea refers to menstrual cramps that are due to other disorders of the reproductive system such as fibroids, endometriosis, ovarian cysts and rarely, cancer. Having an intrauterine device (IUD), especially if you’ve never been pregnant, can also cause menstrual cramps, except with the Progestasert IUD. It releases a small amount of progesterone into the uterus which helps with cramps and lightens menstrual flow.

Have your menstrual periods been especially painful since having an intrauterine contraceptive device (IUD) inserted?
Do you have any signs of infection such as fever and foul smelling vaginal discharge or do you have black stools or blood in the stools?
Do you have a heavier than usual blood flow? For women who are still capable of bearing children, is your period late by one or more weeks?
Is the pain extreme or have you had pain-free periods for years, but are now having severe cramps?
Does cramping continue even after your period is over?

• Take over-the counter ibuprofen or naproxen sodium around the clock as directed to relieve pain and inhibit the release of prostaglandins. Acetaminophen will help with pain, but not with prostaglandins. Most over-the-counter menstrual discomfort products contain acetaminophen. Read labels.
  

  [Note: Do not give aspirin or any medication containing salicylates to anyone 19 years of age or younger, unless directed by a physician, due to its association with Reye’s Syndrome, a potentially fatal condition].
  

• Drink a hot cup of regular tea, chamomile or mint tea.
  
• Hold a heating pad or hot-water bottle on your abdomen or lower back.
  
• Take a warm bath.
  
• Gently massage your abdomen.
  
• Do mild exercises like stretching, yoga, walking or biking. Exercise may improve blood flow and reduce pelvic pain.
  
• Whenever possible, lie on your back, supporting your knees with a pillow.
  
• Unless you have reasons to avoid alcohol, have a glass of wine or other alcoholic beverage. Alcohol slows down uterine contractions.
  
• Get plenty of rest and avoid stressful situations as your period approaches.
  
• Consider using the birth control pill because it blocks the production of prostaglandins or the Progestasert IUD because its use lessens menstrual cramps.
  
• If you still feel pain after using self-care procedures, call your doctor.

Symptoms of Acute PID:

• Pain in the abdomen or back (can be severe).
  
• Bad smelling vaginal discharge.
  
• Pain during intercourse.
  
• Abdominal tenderness and/or bloating.
  
• Difficult menstrual cramps.
  
• High fever.
  
• Symptoms of Chronic PID:
  
• Pain (less severe) – often occurs halfway through the menstrual cycle or during a pelvic exam.
  
• Skin on abdomen is sensitive.
  
• Vaginal discharge.
  
• Change in menstrual flow.
  
• Nausea.
  
• Low grade fever.

The Causes of PID:

• A sexually transmitted disease (STD) such as gonorrhea and chlamydia. The organisms that cause these STDs travel into the internal reproductive organs.
  
• Bacteria normally found in the intestines that get into the pelvic cavity. This most likely happens:
  
  • After sexual intercourse, especially having vaginal intercourse right after having anal intercourse.
    
  • After getting an intrauterine device (IUD) put in or repositioned (low risk).
    
  • Because of high risk sexual practices that increase the risk of infection, such as having multiple sex partners or having sex with a person who has many partners.
    
  • Having had PID in the past or a recent bout with vaginitis.

The symptoms of PID are a lot like those of other conditions such as endometriosis (see page 21) and urinary tract infections (see page 54). This can make it hard to diagnose from symptoms alone. To know whether or not you have PID, your doctor may need to do a laparoscopy (a scope is inserted into the abdomen through a small incision(s) so the surgeon can see inside to find the cause). An ultrasound may also be done.

Treatment for PID is antibiotics (often more than one kind over a period of three to four weeks) and bed rest. If the infection is severe, intravenous (IV) antibiotics may need to be given in a hospital. Preventing further infections is important. This may include treatment for an infected sex partner so as not to get re-infected.
When PID is not treated, it can lead to blood poisoning, blood clots that break off and travel to the lungs and bands of scar tissue in the pelvis. All of these can be life threatening.

Permanent damage to a woman’s reproductive organs and/or infertility can occur as well. Also, a woman who has had PID is at increased risk for:

• Ectopic or tubal pregnancy.
  
• Premature labor and birth.

Do you have two or more of the following? Pain in the abdomen or back (this may be severe). Bad smelling vaginal discharge. Pain during intercourse. Abdominal tenderness and/or bloating. Difficult menstrual cramps. High fever.
Do you have two or more of these? Pain in the abdomen or back halfway through your menstrual cycle. Skin on your abdomen feels sensitive. Vaginal discharge when you’re not having a menstrual period. Change in menstrual flow. Low grade fever.
Have you had an IUD inserted, especially within the last 20 days, and are you feeling discomfort from it?
Have you had unprotected sex with someone who has PID or do you think might have a sexually transmitted disease? (Unprotected sex means without the use of a male or female condom with spermicide).

• Wipe from front to back after a bowel movement to keep bacteria from the feces from entering the vagina.
  
• Change tampons and/or pads frequently when you menstruate.
  
• Don’t have vaginal intercourse right after anal intercourse.
  
• Don’t have sex with anyone who has not been treated for a current case of PID or STD or anyone who has partners that haven’t been treated.
  
• Use barrier birth control methods with spermicides to reduce the risk of getting PID from an infected partner. These include the male or female condom, cervical cap or diaphragm. Use these even if you use other contraceptives like the pill.
  
• If you use an IUD, have your doctor remove it if you become pregnant and then miscarry. If it is left in, your risk for PID goes up.
  
• Don’t smoke. If you smoke 10 or more cigarettes a day, you have a higher risk for PID.
  
• Don’t douche. This may spread the organisms that cause infection and in so doing, increase the risk for PID.
  
• Do not have sexual intercourse for six weeks after childbirth or for one week after a D & C, abortion or miscarriage. Use a condom for 2 weeks after having an IUD inserted.
  
• Get tested for chlamydia and gonorrhea every 6 months if you are at risk for PID. (See causes of PID on page 50).

There are two types of dysmenorrhea – primary and secondary. The primary form usually occurs in females who have just begun to menstruate. It may disappear or become less severe after a woman reaches her mid-twenties or gives birth. (Childbirth stretches the uterus.) The cause of menstrual cramps is thought to be related to hormone-like substances called prostaglandins. These are chemicals that occur naturally in the body. Certain prostaglandins cause muscles in the uterus to go into spasms.

Dysmenorrhea occurs much less often in women who do not ovulate. For this reason, oral contraceptives reduce painful periods in 70-80% of women who take them. When the pill is stopped, women usually get the same level of pain they had before they took it.

Seconcary dysmenorrhea refers to menstrual cramps that are due to other disorders of the reproductive system such as fibroids, endometriosis, ovarian cysts and rarely, cancer. Having an intrauterine device (IUD), especially if you’ve never been pregnant, can also cause menstrual cramps, except with the Progestasert IUD. It releases a small amount of progesterone into the uterus which helps with cramps and lightens menstrual flow.

Self-Care Tips

To relieve menstrual cramps:

• Take over-the-counter ibuprofen or naproxen sodium around the clock as directed to relieve pain and inhibit the release of prostaglandins. Acetaminophen will help with pain, but not with prostaglandins. Most over-the-counter menstrual discomfort products contain acetaminophen. Read labels. [Note: Do not give aspirin or any medication containing salcylates to anyone 19 years of age or younger, unless directed by a physician, due to its association with Reye’s Syndrome, a potentially fatal condition.]
  
• Drink a hot cup of regular tea, chamomile or mint tea.
  
• Hold a heating pad or hot-water bottle on your abdomen or lower back.
  
• Take a warm bath.
  
• Gently massage your abdomen.
  
• Do mild exercises like stretching, yoga, walking or biking. Exercise may improve blood flow and reduce pelvic pain.
  
• Whenever possible, lie on your back, supporting your knees with a pillow.
  
• Unless you have reasons to avoid alcohol, have a glass of wine or other alcoholic beverage. Alcohol slows down uterine contractions.
  
• Get plenty of rest and avoid stressful situations as your period approaches.
  
• For birth control, consider using the pill because it blocks the production of prostaglandins or the Progestasert IUD because its use lessens menstrual cramps.
  

Questions to Ask

Have your menstrual periods been especially painful since having an intrauterine contraceptive device (IUD) inserted?
Do you have any signs of infection such as fever and foul smelling vaginal discharge or do you have black stools or blood in the stools?
For women who are still capable of bearing children: Do you have a heavier than usual blood flow or is your period late by one or more weeks?
Is the pain extreme or have you had pain-free periods for years, but are now having severe cramps?
Does cramping continue even after your period is over?

The current medical theories about PMS or, as it is sometimes termed, premenstrual tension (PMT), relate it to an estrogen-progesterone imbalance, particularly reactions to the increased estradiol levels. During the second half of the cycle, after ovulation, progesterone levels normally rise, while estrogen levels also rise slightly. These changes can influence water retention, causing some fullness of the uterus and other body tissues; this seems to be exaggerated premenstrually with the relatively deficient level of progesterone. Many of the symptoms, such as bloating, breast swelling and tenderness, fatigue, headaches, emotional irritability, depression, back pain, and pelvic pain, are probably a result of the water retention and subsequent emotional tension. Other hormonal and physiological factors, or effects on the immune system, may contribute to the problem as well. Less common symptoms include dizziness, fainting, cystitis, hives, acne, sore throat, joint pains and swelling, and constipation.

Low progesterone levels seem to be the main factor in PMS symptoms. Why progesterone levels may be low has not yet been determined, but many women seem to respond to treatment with progesterone in the second half of their cycle, from just after ovulation to the usual time of menstruation. A common treatment is to use vaginal or rectal suppositories containing progesterone (or even topical progesterone) once or twice daily. The newer treatment is oral, micronized progesterone that is not destroyed by the gastrointestinal tract or broken down by the liver. Usually, however, progesterone therapy is not needed, because most women will respond to a nutritional and herbal approach to treating PMS. Many nutrients are needed, but probably the two most important ones are vitamin B6 (pyridoxine) and magnesium. B6 helps to clear water through a diuretic effect on the kidneys. Usually 50–100 mg. once or twice daily will be effective. A complete B vitamin supplement is also necessary to prevent these higher amounts of B6 from causing imbalances of other B vitamins. It has been theorized and shown in some studies that magnesium deficiency within the cells is also correlated with some of the PMS symptoms. Supplementing magnesium at amounts equal to up to one and a half times the calcium level, that is, about 800–1,200 mg., is helpful in reducing some PMS symptoms. Zinc is also an important mineral here.

Other possible menstrual irregularities, as discussed by Susan Lark, M.D., in the PMS Self Help Book (Celestial Arts, Berkeley, CA, 1984), have symptoms that may be related to low estrogen levels. Women with this problem often experience more of their symptoms after their period than before it. This low-estrogen state is far less common than the progesterone deficiency. Occasionally, tests to measure hormonal levels can be done at specific times of the month. However, these are expensive and not always easy to interpret (the range of normal is wide) unless done repeatedly. Generally though, as long as there are relatively regular menstrual periods, these ovarian and pituitary hormone levels will be within normal values. Other tests that may be abnormal include thyroid hormone levels, thyroid antibodies, or antiovarian antibodies, which may represent some autoimmune problems.

Another common symptom, not only of PMS but of most women’s premenstrual time, is a craving for sweets. This desire is often enhanced in those with PMS, which brings up another important point. Women with PMS often have other correlating conditions that may contribute to symptoms. These include hypoglycemia (low blood sugar), candidiasis (an overgrowth of and hypersensitivity to the common yeast Candida albicans), food and/or environmental allergies, moderate to severe stress, and vitamin and mineral deficiencies. Whether these problems contribute to or are a result of the premenstrual and hormonal problems is not clear, but it is important to evaluate women for these conditions when they either have significant PMS symptoms or do not respond well to treatment. PMS is definitely aggravated by low blood sugar generated by stress and an intake of refined flour and sugar products.

From a dietary point of view, it is important to avoid the food stressors, irritants, and stimulants that, if they do not contribute to the PMS problem in the first place, definitely make it worse. These include sugars and refined foods, caffeine, alcohol, and chemicals. A diet that helps in reducing symptoms is a balanced, wholesome, and high-nutrient one, with lots of whole grains, leafy greens and other vegetables, good protein foods, and some fruits, but a minimum of fruit juice. A hypoglycemic diet of regular meals and protein-oriented snacks is often helpful. If there are yeast or allergy problems, a diet to help with those conditions (see previous programs) would be beneficial. If these problems are not present, extra brewer’s yeast, with its high levels of B vitamins and minerals, can be a supportive food. Eating a variety of foods and a modified rotation diet (as is discussed in the Allergy program in this chapter) are also helpful in getting the wide range of important nutrients and maximizing food sensitivities. Some women also experience a reduction of symptoms through colon detoxification and a cleansing-type diet high in juices, soups, and salads. Intake of fiber as psyllium or bran started a week before symptoms usually begin will improve colon elimination, and an enema or colonic irrigation at the time symptoms begin might be helpful.

Premenstrual syndrome is more common in women in their 30s and 40s than in those in their 20s and teenage years. Dr. Lark points out a number of other factors associated with an increased likelihood of PMS problems—these include women who are or have been married, do not exercise, have had children, experience side effects from birth control pills, have had a pregnancy complicated by toxemia, have a significant amount of emotional stress in their lives, or those whose nutritional habits lead to certain deficiencies or excesses. Dietary factors that worsen PMS include foods high in refined sugars and fats, processed or chemical foods, caffeine drinks (coffee, tea, colas), alcohol (especially wine and beer with the higher carbohydrate level), chocolate products, eggs, cheese, red meats, and high-salt foods. A natural food diet, of course, will help alleviate the symptoms of PMS.

British physician Katherine Dalton, M.D., was one of the first to describe PMS and offer some therapeutic help. Guy Abraham, an obstetrician-gynecologist, has further classified PMS problems, a system that Dr. Lark also discusses in her book. The four main types are:

1. Type A (“anxiety”)—a mixture of emotional symptoms: anxiety, irritability, and mood swings.
   
2. Type C (“carbohydrates” and “cravings”)—sugar cravings, fatigue, and headaches.
   
3. Type H (“hyperhydration”), also known as Type W (“water retention”)—bloating, weight gain, and breast swelling and tenderness.
   
4. Type D(“depression”)—depression, confusion, and memory loss.
   

Other groups of symptoms include acne—oily skin and hair and acne—and dysmenorrhea (painful periods)—cramps, low back pain, nausea, and vomiting; recently classified as Type P for pain.

Dr. Susan Lark’s PMS Self Help Book provides specific treatment plans for the different types of symptoms. The recommendations for the different types, including diet and suggestions, are all very similar. In her programs, all include some form of stress reduction, exercise, supplementation, herbal therapy, acupressure massage, and yoga postures.

For acne problems with PMS, extra vitamin A (20,000–40,000 IUs, mainly as beta-carotene) and zinc (20–40 mg.) are usually helpful. Choline and inositol, nutrients found in lecithin, may help nourish the skin; 500 mg. of each daily are recommended.

Dysmenorrhea and other pain problems respond well to higher amounts of magnesium, about 500 mg. more than calcium, as this has a nerve tranquilizing and muscle relaxing effect. Vitamin E (400–800 IUs) and vitamin B6 (100–300 mg. daily) may also be helpful in reducing pain. Extra B vitamins and a general vitamin and mineral program are usually also necessary.

Anxiety symptoms, such as mood swings and irritability, often respond to extra B vitamins, particularly thiamine (B1), 150–250 mg. per day, and pyridoxine (B6), 200–300 mg. per day, with about 50 mg. each of the rest of the B vitamins. Using inositol and extra magnesium, such as magnesium citrate (which causes fewer bowel symptoms, especially diarrhea, than other magnesium salts), about 400–600 mg. daily, will help. Progesterone therapy may be most helpful for Type A, or anxiety, problems. A doctor must be consulted for this therapy. Also, phenylethanolamine (PEA), a substance found in certain foods, such as bananas, chocolate, and hard cheeses, may increase symptoms of anxiety. These foods should be avoided in this type of PMS.

For depression, added tryptophan (if available), 1,000 mg. before bed, may be helpful. If this does not help, or if it causes side effects, such as headache, Stuart Berger, in his Immune Power Diet, recommends trying another amino-acid, L-phenylalanine, in the same dosage. Zinc, vitamin B6, and calcium/magnesium may also be beneficial in reducing premenstrual depression.

For women with the Type C, or sugar cravings, pattern, often associated with stress, fatigue, and headaches, confusion, or dizziness, a program that should help reduce these symptoms supplements the basic vitamin and mineral plan with additional B vitamins, particularly B6, 200–300 mg. per day, and B1, 150–250 mg. per day; chromium, 200–400 mcg.; vitamin E, 800 IUs; and vitamin C, around 6–8 grams per day. Eating frequent, small meals and avoiding sugar will also be helpful in reducing cravings.

For Type H with water or bloating problems, which can be the most troublesome, causing weight gain, breast tenderness, and general emotional upset, the basic B vitamins, including high amounts of B6 and supplemental B1, magnesium, potassium, vitamin E, and evening primrose oil (with GLA, gamma-linolenic acid, as the active ingredient), 1–2 capsules taken three times daily, may be very helpful. (I have seen evening primrose oil be helpful for many women with various PMS symptoms.) Also, with water retention problems, food allergy, particularly to wheat, may be a contributing factor. A trial of a couple of months of avoiding wheat products can aid in providing relief of symptoms. Sometimes the response can be dramatic. Regular exercise is also important in reducing this type of PMS.

Many herbs are helpful in treating PMS. Angelica, or dong quai, is a commonly used herb that acts as an energizer and female tonic when it is taken regularly as capsules (2 capsules twice a day) or as a tea. Ginger root acts as a circulation aid and mild stimulant and is helpful in getting some of that retained water moving. Other diuretic herbs include parsley and juniper berry. Licorice root is a good balancer and seems to provide an “up” feeling when drunk with some ginger as a tea. Their flavors tend to combine well. Valerian root or catnip tea will provide some relaxation when there is general anxiety or irritability. Sarsaparilla is a tonifying (strengthening) herb that supports the hormonal functions and may actually contain some hormones itself. There are also many herbal formulas for treating PMS and for strengthening the female functions. One that I have found helpful to my patients is FE-G (Female General Tonic), made by Professional Botanicals. It contains black haw, licorice, false unicorn root (estrogen-containing plant), ginseng root, ginger, and life root. I recommend 2 capsules two or three times daily, usually for three to six months if it appears helpful. In the first month or two herbs tend to work more slowly and must be taken over a longer period of time than stronger pharmaceuticals. There are many similar formulas available now for PMS and other female problems.

Some doctors also use glandular supplements in treating PMS. In Super Fitness Beyond Vitamins (New American Library, New York, 1987), Michael Rosenbaum, M.D., describes his success with the use of pituitary, particularly anterior pituitary, extract in treating stubborn PMS symptoms. Brain and pancreas glandular supplements may also be helpful, Dr. Rosenbaum points out.

There are also many nutritional supplement formulas available for premenstrual syndrome. The table below presents an all-encompassing nutrient program (most of these nutrients are best taken in two or three portions over the course of the day). This may be tailored for specific symptoms by application of the suggestions given earlier. Of course, many of the nutrients listed are consumed in the diet. Supplementation of sodium, potassium, chloride, fluoride, iodine, and phosphorus is usually not necessary, though additional potassium, about 1 to 2 grams, may be helpful in some cases. Even extra vitamins D and K may not be needed. The precursor of B6 (pyridoxine), pyridoxal-5-phosphate, may actually be more effective than B6 itself, because some people may not be able to easily convert the pyridoxine to its usable form. Both forms of vitamin B3 are used; niacin offers some circulatory stimulation and flushing while niacinamide supports the general neuromuscular relaxation of B3.

I have seen a high rate of success in the improvement and elimination of symptoms in women who change their diets and implement a regular supplement program. I have also heard other gynecologists, family doctors, and nurse practitioners claim that they see nearly an 80 percent success rate with a good program. Of course, learning to deal better with life stresses, relationships, and sexual issues will further increase the likelihood of success.

When specific acupressure points are pressed, they create changes on two levels. On the physical level, acupressure affects muscular tension, blood circulation, and other physiological parameters. On a more subtle level, traditional Oriental healing believes that acupressure also helps to build the body’s life energy to promote healing. In fact, acupressure is based on the belief that there exists within the body a life energy called chi. It is different from yet similar to electromagnetic energy. Health is thought to be a state in which the chi is equally distributed throughout the body and is present in sufficient amounts. It is thought to energize all the cells and tissues of the body.

The life energy is thought to run through the body in channels called meridians. When working in a healthy manner, these channels distribute the energy evenly throughout the body, sometimes on the surface of the skin and at times deep inside the body in the organs. Disease occurs when the energy flow in a meridian is blocked or stopped. As a result, the internal organs that correspond to the meridians can show symptoms of disease. The meridian flow can be corrected by stimulating the points on the skin surface. These points can be treated easily by hand massage. When the normal flow of energy through the body is resumed, the body is believed to heal itself spontaneously.

Stimulation of the acupressure points through finger pressure can be done by you or by a friend following simple instructions. It is safe, painless, and does not require the use of needles. It can be used without the years of specialized training needed for insertion of needles.

How to Perform Acupressure

Acupressure is done either by yourself or with a friend when you are relaxed. Your room should be warm and quiet. Make sure your hands are clean and nails trimmed (to avoid bruising yourself). If your hands are cold, put them under warm water.

Work on the side of the body that has the most discomfort. If both sides are equally uncomfortable, choose whichever one you want. Working on one side seems to relieve the symptoms on both sides. Energy or information seems to transfer from one side to the other.

Hold each point indicated in the exercise with a steady pressure for one to three minutes. Apply pressure slowly with the tips or balls of the fingers. It is best to place several fingers over the area of the point. If you feel resistance or tension in the area on which you are applying pressure, you may want to push a little harder. However, if your hand starts to feel tense or tired, lighten the pressure a bit. Make sure your hand is comfortable. The acupressure point may feel somewhat tender. This means the energy pathway or meridian is blocked.

During the treatment, the tenderness in the point should slowly go away. You may also have a subjective feeling of energy radiating from this point into the body. Many patients describe this sensation as very pleasant. Don’t worry if you don’t feel it, not everyone does. The main goal is relief from your symptoms.

Breathe gently while doing each exercise. The point that you are to hold is shown in the photograph accompanying the exercise. All of these points correspond to specific points on the acupressure meridians. You may massage the points once a day or more during the time that you have symptoms.

Acupressure Exercises



Exercise 1: Balances the Entire Reproductive System

This exercise balances the energy of the female reproductive tract and alleviates all menstrual complaints. It also helps relieve low back pain and abdominal discomfort.
Equipment: This exercise uses a knotted hand towel to put pressure on hard-to -reach areas of the back. Place the knotted towel on these points while your two hands are on other points. This increases your ability to unblock the energy pathways of your body.

• Lie on the floor with your knees up. As you lie down, place the towel between the shoulder blades on your spine. Hold each step 1 to 3 minutes.

  
  

  

  
  

• Cross your arms on your chest. Press your thumbs against the right and left inside upper arms.

  
  

  

  
  

• Left hand holds point at the base of the sternum (breastbone).

  
  Right hand holds point at the base of the head (at the junction of the spine and the skull).

  
  

  

  
  

• Interlace your fingers. Place them below your breasts. Fingertips should press directly against the body.

  
  

  

  
  

• Move the knotted towel along the spine to the waistline.

  
  

  

  
  

• Left hand should be placed at the top of the pubic bone, pressing down.
  
  Right hand holds point on tailbone.

  
  

  

  
  

• Sit up and prop your back against a chair, or lie down and put your lower legs on a chair. Hold each step 1 to 3 minutes.

  
  

  

  
  

• Left hand is placed in the crease of the groin where you bend your leg, one-third to one-half way between the hip bone and the outside edge of the pubic bone. Right hand holds a spot 2 to 3 inches above the knee.

  
  

  

  
  

• Left hand remains in the crease of the groin.
  
  Right hand holds point below inner part of knee. To find the point, follow the curve of the bone just below the knee. Hold the underside of the curve with your fingers.

  
  

  

  
  

• Left hand remains in the crease of the groin.
  
  Right hand holds the inside of the shin. To find this point, go four fingerwidths above the ankle bone. The point is just above the top finger.

  
  

  
  
  
  
  

  
  

• Left hand remains in the crease of the groin.
  
  Right hand holds the edge of the instep. To find the point, follow the big toe bone up until you hit a knobby, prominent small bone.

  
  

  

  
  

• Left hand remains in the crease of the groin.
  
  Right hand holds the big toe over the nail, front and back of the toe.

  
  

  

  
  

• Lie on the floor or sit up. Hold the points 1 to 3 minutes.
  

  
  

• Left index finger is placed in navel and pointed slightly toward the head.
  
  Right hand holds point at the base of the head.

  
  

  

  
  

• Sit up and prop your back against a chair. Hold each step 1 to 3 minutes.
  

  
  

• Left hand holds point at the base of the ball of the left foot. This point is located between the two pads of the foot.

  
  

  

  
  

• Right hand holds the point midway between the inside of the right ankle-bone and the Achilles tendon. The Achilles tendon is located at the back of the ankle.

  
  

  

  
  

• Left hand holds point below right knee. This point is located four fingerwidths below the kneecap toward the outside of the shinbone. It is sensitive to the touch in many people.

  
  

  

  
  

• Sit on the floor and prop your back against a wall or a heavy piece of furniture. Hold each step 1 to 3 minutes.

  
  

  

  
  

• Alternative Method: Lie on the floor and put your lower legs over the seat of a chair. Follow the exercise from that position.
  
  

  
  

• Place right hand 1 inch above the waist on the muscle to the right side of the spine (muscle will feel firm and ropelike).
  
  Place left hand behind crease of the right knee.

  
  

  

  
  

• Right hand stays in the same position.
  
  Left hand is placed on the center of the back of the right calf. This is just below the fullest part of the calf.

  
  

  

  
  

• Right hand remains 1 inch above the waist on the muscle to the side of the spine.
  
  Left hand is placed just below the ankle bone on the outside of the right heel.

  
  

  

  
  

• Right hand remains 1 inch above the waist on the muscle to the side of the spine.
  
  Left hand holds the front and back of the right little toe at the nail.

  
  

  

  
  

The Academy of Traditional Chinese Medicine. An Outline of Chinese Acupuncture. New York: Pergamon Press, 1975.

Bauer, C. Acupressure for Women. Freedom, CA: The Crossing Press, 1987.

Chang, S. T. The Complete Book of Acupuncture. Berkeley, CA: Celestial Arts, 1976.

Gach, M. R., and C. Marco. Acu-Yoga. Tokyo: Japan Publications, 1981

Houston, F. M. The Healing Benefits of Acupressure. New Canaan, CT: Keats Publishing, 1974.

Kenyon, J. Acupressure Techniques. Rochester, VT: Healing Arts Press, 1980.

Nickel, D. J. Acupressure for Athletes. New York: Henry Holt, 1984.

Pendleton, B., and B. Mehling. Relax With Self-Therap/Ease. Englewood Cliffs, NJ: Prentice-Hall, 1984.

Teeguarden, I. Acupressure Way of Health: Jin Shin Do. Tokyo: Japan Publi-cations, 1978.

In fact, at least 10 percent of younger women have symptoms so severe that they are unable to handle their normal range of activities. Many women have to miss days of work and important social functions because any movement or activity is too painful. For the first day or two of menstruation, only bed rest or curling up on the floor in the fetal position is tolerable until the symptoms finally pass. This often happened to me during my teens and twenties.

Besides the lower abdominal pain, cramp sufferers can also experience backache, pinching and pain sensations in their inner thighs, bloating, nausea, vomiting, diarrhea, constipation, faintness, dizziness, fatigue, and headaches. For those women who must curtail their activities because of cramps, these problems translate into billions of dollars of lost wages and productivity on the job, as well as a significant decrease in the quality of life for several days each month.

In fact, the gynecology textbook that I used during my medical training estimated that menstrual cramps caused the loss of 140 million work hours annually. It is no wonder that women with moderate to severe cramps regard their monthly period with apprehension and even dread.

Despite the many symptoms and the millions of sufferers, menstrual cramps have been traditionally considered by the medical community to be a “minor” female ailment. Doctors treated women as if the problem were “all in their heads.” The problem was either ignored or else treated with powerful painkilling drugs and tranquilizers. Often these drugs had significant side effects and did nothing to alleviate or help prevent the problem on a long term basis. Luckily, the medical community’s interest in menstrual cramps has increased during the past two decades. Researchers understand much more about what causes menstrual cramps on a physiological basis. This has led to newer, much more effective drug treatments, as well as nutritional and other lifestyle related therapies.

The Normal Menstrual Cycle

It is important to look at the normal menstrual cycle and see how it functions. This background will make it easier for you to understand why painful menstruation occurs.

First, understand why we menstruate. Menstruation refers to the shedding of the uterine lining, or endometrium. Each month the uterus prepares a thick, blood-rich cushion to nourish and house a fertilized egg. If pregnancy doesn’t occur and the egg doesn’t implant in the uterus, then the body doesn’t need this extra buildup of the uterine lining. The uterus cleanses itself by releasing the extra blood and tissue so that a fresh buildup can occur all over again the following month, in preparation for a possible pregnancy.

The mechanism that regulates the buildup and shedding of the uterine lining is controlled by fluctuations in your hormonal levels. It begins each month when follicle stimulating hormones (FSH) and luteinizing hormones (LH) are released from the pituitary, a gland located at the base of the brain. Once FSH and LH are released into the bloodstream, their destination is the ovaries. The ovaries hold all the eggs a woman will ever have, in an inactive form called follicles. During each cycle, the FSH and LH from the pituitary gland cause one follicle to ripen, and normally one egg is released for possible fertilization. As part of this pro-cess, the follicles begin to produce the hormones estrogen and progesterone. Estrogen reaches its peak during the first half of the cycle as the newly released egg is maturing. Progesterone output occurs after midcycle when ovulation has occurred. Ovulation refers to the production of a mature egg cell.

Besides preparing the egg for fertilization, estrogen and progesterone stimulate the lining of the uterus. During the first two weeks following menstruation, estrogen causes the uterine lining to gradually rebuild itself. The inner mucous layer of glands of the endometrium begin to grow long, and the lining thickens through an increase in the number of blood vessels as well as the production of a mesh of fibers that interconnect throughout the lining. By midcycle, the lining of the uterus has increased three times in thickness and has a greatly increased blood supply.

After midcycle, usually around day 14, ovulation occurs; the egg is picked up by the fallopian tube and continues on to the uterus. The follicle that has produced the egg for that month (graafian follicle) is further stimulated after midcycle by LH and changes into a yellow body, or corpus luteum. It is the corpus luteum that secretes progesterone. Progesterone has further effects on the uterine lining. It causes a coiling of the blood vessels of the lining, which becomes swollen and tortuous and secretes a thick mucous.

If the egg is fertilized, it will implant on the uterine wall and the corpus luteum will continue to secrete progesterone. If no fertilization occurs, the corpus luteum begins to deteriorate and the progesterone levels decrease. The lining of the uterus starts to break down and menstruation begins.

Types and Causes of Menstrual Cramps

There are two types of menstrual cramps: primary dysmenorrhea, in which the pain itself is the main problem; and secondary dysmenorrhea, in which the pain is a consequence of another underlying health problem.

By far the most women suffer from the primary type of dysmenorrhea. This classification breaks down into two subtypes: primary spasmodic or congestive. Primary spasmodic dysmenorrhea is the type most commonly found in young women in their early teens to late twenties. It is more common in women who have never borne children. In fact, childbearing seems to mark the end of the primary spasmodic type of cramps in many women. It is characterized by sharp, viselike pains that are caused by a constriction and tightening of the uterine muscle. Some women also feel these sharp pains in the inner thighs and low abdominal muscles, and some additionally experience feelings of hot and cold, faintness to the point of passing out, nausea, vomiting, and bowel changes varying from constipation to diarrhea. The immediate cause of the cramping is that the uterine muscle and the blood vessels that supply the uterus are tight and contracted. Blood circulation and oxygenation to this area are diminished, so the metabolism of the uterus and pelvic muscles is decreased. Waste products of metabolism, such as carbon dioxide and lactic acid, build up, intensifying the pain and discomfort.

Primary Spasmodic Dysmenorrhea

Primary spasmodic dysmenorrhea has been linked to imbalances in the intricate hormonal system that operates throughout the menstrual cycle. First, medical researchers observed that women who don’t ovulate, and consequently undergo only the estrogenic effects on the lining of the uterus, do not experience cramps. Therefore, progesterone needs to be present for menstrual cramps to occur. When cramps occur, the changes seen in the lining of the uterus are typical of those occurring during an ovulatory cycle when progesterone is present. Pain-free menses without ovulation are typically seen in women at both the beginning and end of their reproductive years, that is, in young teenagers who have just started to menstruate and in women who are transitioning into menopause. There is no evidence, however, that women with cramps actually have low levels of estrogen, or conversely, high levels of progesterone. It may be the interplay between the two hormones that influences the tension and constriction in the uter-ine muscle and blood vessels.

In addition to the hormones estrogen and progesterone, hormonelike chemicals called prostaglandins also affect menstrual cramps. These chemicals are found in many tissues in the body, including the uterus, gastrointestinal tract, and blood vessels. There are many different types of prostaglandins, all of which affect muscle tension. However, not all prostaglandins affect muscles in the same way. Some, such as the series two prostaglandins (specifically the E2 and F2 Alpha), trigger powerful smooth muscle contractions. Because of this physiological effect, an overabundance of series two prostaglandins is strongly linked to menstrual cramps and pain. These prostaglandins have also been linked to high blood pressure because they act to narrow the diameter of blood vessels. They can also trigger irritable bowel syndrome since they cause cramping of the intestinal muscles. Not all prostaglandins, however, cause muscle contraction. Others, such as the series-one and series three, actually promote muscle relaxation and can help relieve menstrual cramps.

Prostaglandins are derived from fatty acids in the diet. The series two prostaglandins that trigger muscle contractions are derived from animal fat meat, dairy products, and eggs. The beneficial muscle relaxant series one and series three prostaglandins are derived from vegetable and fish sources of fatty acids. These fatty acids, called linoleic acid and linolenic acid, are found predominately in raw seeds and nuts, such as flax seed or pumpkin seed, and in certain fish, such as trout, mackerel, and salmon. Thus, how we eat can actually determine which hormonal pathway we travel, leading to either muscle tension or muscle relaxation. This is a very good example of how our food selection can determine our state of health. Like progesterone, excessive prostaglandin production is seen only during ovulatory menstrual cycles. Prostaglandin production increases during the second half of the cycle, peaking toward the end of the cycle with the onset of menstruation.

Primary Congestive Dysmenorrhea

The pain that characterizes primary congestive dysmenorrhea is different from that of spasmodic cramping. Congestive symptoms produce a dull aching in the low back and pelvic region, often accompanied by bloating, weight gain, breast tenderness, head-aches, and irritability. Unlike spasmodic cramping, these symptoms don’t improve with age and, in some women, can worsen with age. Some of the worst symptoms are seen in women in their thirties and forties.

Women with congestive symptoms tend to retain excessive amounts of fluid and salt. Bloat accumulates in the pelvic region as well as breasts; it can cause an uncomfortable, dull aching sensation that makes these parts of the body tender to the touch. Excessive amounts of estrogen can worsen these symptoms, since estrogen increases fluid and salt retention in the body.

An excess secretion of the pituitary hormone ACTH can also worsen congestive symptoms. ACTH stimulates the production of adrenal hormones, which are then sent to the kidneys and cause the kidneys to retain fluid. As a result, women urinate less frequently in the time leading up to menstruation. Once the menstrual period starts, this excess fluid is released. Nutritional factors also influence bloating. High salt foods should be avoided, since they increase fluid retention.

Food allergies can also contribute to congestive symptoms. Women who are sensitive to both wheat and dairy products (two of the most allergenic foods) can have a premature increase in their congestive symptoms. I have observed this in many of my patients. Other high stress foods include alcohol, which is toxic to the liver. The liver is responsible for the breakdown of estrogen so that it can be excreted from the body. Excessive alcohol intake can increase the levels of estrogen in the body, increasing pelvic congestion. Sugar causes constriction of blood vessels, which can worsen cramps; both sugar and alcohol should be avoided in a cramp relief program. When I put women on a salt-free, dairy-free, and wheat-free diet, the tendency to accumulate bloat decreases, as does the dull, aching abdominal discomfort and low back pain. Other risk factors can also contribute to both spasmodic and congestive menstrual cramps. These include the following variables:

• Use of tampons may contribute to menstrual cramping in some women. Women who find that tampon use worsens their cramps should switch to sanitary napkins.
  

  
  

• Use of an IUD may significantly worsen the spasmodic type of cramping, and the device may need to be removed if symptoms are too severe.
  

  
  

• Bladder infections can cause symptoms of dull, aching pain in the lower abdominal region. Frequent bladder infections near or during menstrual periods can be a problem for some women.
  

  
  

• Vaginal yeast infections can occur during menstrual periods because of changes in the vaginal pH.
  

  
  

• Childlessness is a risk factor for spasmodic cramping; congestive symptoms may actually be worse in women who have had several pregnancies.
  

  
  

• Lack of exercise and poor posture increases the tendencies toward both types of cramps, since blood circulation and oxygenation is decreased.
  

  
  

• Stress can worsen cramps by causing women to tense their pelvic and low back muscles unconsciously.
  

The result of underlying health problems that can cause uterine and low back pain, secondary dysmenorrhea occurs most frequently in older women, typically in their forties and early fifties. Often, periods will suddenly become painful after years of pain-free menstruation. Secondary dysmenorrhea is much less common than the primary types. Some common causes of secondary dysmenorrhea include the following conditions.

Fibroid Tumors of the Uterus. Fibroid tumors occur when the muscular tissue of the uterus grows excessively. Fibroids can grow very large in some women, enlarging the uterus to sizes seen in pregnancy. If they grow large enough to impinge on the bowel and bladder, or if their growth outstrips their blood supply, they can worsen menstrual cramps. These growths occur most often in women during their reproductive years.

Fibroid tumors are stimulated by estrogen. They may expand in size with the use of estrogen dominated birth control pills, during pregnancy, or in women who secrete high levels of estrogen naturally. Besides causing menstrual cramps, large fibroids can put pressure on the bladder or bowels, causing urinary frequency or bowel changes. Fibroids can also cause excessive menstrual bleeding and pelvic discomfort to the point of necessitating a hysterectomy. In fact, fibroids are one of the most common reasons for the 650,000 hysterectomies performed each year in the United States. Usually such tumors shrink after menopause because of the decrease in estrogen.

Pelvic Inflammatory Disease (PID). This refers to an infection of a woman’s uterus, fallopian tubes, or ovaries. This serious infec-tion must be diagnosed and treated immediately in order to pre-vent scarring of the reproductive organs and infertility. Symptoms of PID include fever, chills, back pain, a puslike vaginal discharge, pain during or after sexual intercourse, and spotting. When chronic, a low-grade smoldering infection can also cause lower abdominal cramps during menstruation. If untreated, the chronic menstrual pain can necessitate a hysterectomy.

Endometriosis. In this condition, pieces of the uterine lining, or endometrium, implant and grow outside the uterus in other parts of the pelvic cavity. Implants can be found on any pelvic structure, including the fallopian tubes, ovaries, and outer wall of the uterus. They can even become embedded in the intestinal and bladder walls. These tissues, like the normal lining of the uterus, are responsive to hormonal changes and can bleed with the onset of the menstrual period. Although the bleeding from the uterine lining can leave the body vaginally through menstruation, bleeding from endometrial implants in the pelvis is retained by the body and can cause scarring and inflammation over time. Pain is the most common symptom that arises from this structural damage. Women with endometriosis suffer from pain during menstruation as well as during sexual intercourse.

Treatments for endometriosis vary depending on the woman’s age, severity of symptoms, and her childbearing status. Supportive therapy often includes antiprostaglandin medication such as Motrin and Ponstel. Stronger painkilling medication may be used if symptoms are severe. Pregnancy is actually a treatment for endometriosis, since it relieves monthly menstruation. In fact, doctors have traditionally recommended that women with endometriosis consider pregnancy to alleviate the problem. Unfortunately, women with endometriosis suffer from a higher level of infertility than the general population because of the scarring and other structural damage that endometriosis creates in the reproductive tract. In some cases, physicians recommend treatments including the use of birth control pills and other hormonal therapies that inhibit normal menstruation and reverse the stimulation of the endometrial implants. These therapies can be quite effective in reversing the process, but their use requires care because of the many possible side effects that can occur. In advanced cases, endometriosis may culminate in a hysterectomy.

In summary, this chapter has given you information on the dif-ferent types, causes, and symptoms of menstrual cramps. As you can see, menstrual cramps can arise from a variety of conditions. To identify your specific type of menstrual cramp pattern, go on to the next chapter. Chapter 2 contains a self evaluation workbook that will help you pinpoint the risk factors and lifestyle habits that contribute to your symptoms.

Types of Menstrual Cramps

Primary Spasmodic Dysmenorrhea

Severe viselike pain, backache, tightening and pain sensations in the inner thighs, nausea, vomiting, diarrhea, constipation, faintness,
dizziness, fatigue, headaches

Primary Congestive Dysmenorrhea

Dull aching in low back and pelvis, bloating, weight gain, breast tender-
ness, headaches, irritability

Secondary Dysmenorrhea

Pelvic and back pain, spotting, pain during or after sexual intercourse,
fever, chills, puslike vaginal discharge, urinary frequency, bowel changes

Risk Factors for Menstrual Cramps

• Use of tampons
  

  
  

• Use of IUD
  

  
  

• Bladder infections
  

  
  

• Yeast infections
  

  
  

• Childlessness (primary spasmodic dysmenorrhea)
  

  
  

• Multiple pregnancies (primary congestive dysmenorrhea)
  

  
  

• Lack of exercise
  

  
  

• Poor posture
  

  
  

• Emotional stress
  

Like most other B vitamins, thiamine is needed in regular supply, though after its absorption from the upper and lower small intestine, some B1 is stored in the liver, heart, and kidneys. Most excess thiamine is eliminated in the urine; some seems to be excreted in the sweat as well.

Sources: Since thiamine is lost in cooking and is depleted by use of sugar, coffee, tannin from black teas, nicotine, and alcohol, it is necessary to insure that intake of thiamine is optimal. There are a number of food sources for thiamine; however, they may not be the everyday fare for many people. Good sources of vitamin B1 include the germ and bran of wheat, rice husks (outer covering), and the outer portion of other grains. With the milling of grains and use of refined flours and white or “polished” rice, many of us are no longer getting the nourishment of thiamine that is available when we eat wholesome, unprocessed foods.

Other good sources of thiamine besides wheat germ and bran, whole wheat or enriched wheat flour, and brown rice are brewer’s yeast and blackstrap molasses. Oats and millet have modest amounts, as do many vegetables, such as spinach and cauliflower, most nuts, sunflower seeds, and legumes, such as peanuts, peas, and beans. Of the fruits, avocado is the highest in vitamin B1. Pork has a high amount of this B vitamin. Many dried fruits contain some thiamine, though the sulfur dioxide often added as a preservative seems to destroy this vitamin.

Functions: Thiamine helps a great many bodily functions, acting as the coenzyme thiamine
pyrophosphate (TPP). It has a key metabolic role in the cellular production of energy, mainly in glucose metabolism. Thiamine is also needed to metabolize ethanol, converting it to carbon dioxide and water. B1 helps in the initial steps of fatty acid and sterol production. In this way, thiamine also helps convert carbohydrate to fat for storage of potential energy.

Thiamine is important to the health of the nerves and nervous system, possibly because of its role in the synthesis of acetylcholine (via the production of acetyl CoA), an important neurotransmitter. With a lack of vitamin B1, the nerves are more sensitive to inflammation. Thiamine is linked to individual learning capacity and to growth in children. It is also important to the muscle tone of the stomach, intestines, and heart because of the function of acetylcholine at nerve synaptic junction. It is conceivable that adequate thiamine levels may help prevent the accumulation of fatty deposits in the arteries and thereby reduce the progression of atherosclerosis.

Uses: Vitamin B1 is, of course, used to treat any of the symptoms of its deficiency or its
deficiency disease beriberi (discussed below). It is used in the treatment of fatigue, irritability, low morale, and depression and to prevent air- or seasickness. It seems to help the nerves, heart, and muscular system function well. By aiding hydrochloric acid
production, thiamine may help digestion or reduce nausea, and it can remedy constipation by increasing intestinal muscle tone. Thiamine is used commonly to improve healing after dental (or, often, any) surgery.

Increased thiamine intake may be suggested for numerous mental illnesses and problems that affect the nerves. These include alcoholism and its nerve problems, multiple sclerosis, Bell’s palsy (a facial nerve paralysis), and neuritis. Treatment with thiamine, for example, has been helpful in decreasing the sensory neuropathy that accompanies diabetes and in lessening the pain of trigeminal neuralgia. Thiamine also has a mild diuretic effect and is supportive of heart function, so it is suggested in the treatment program for many cardiovascular problems.

Since thiamine is eliminated through the skin somewhat, doses of over 50-100 mg. per day may help repel insects such as flies and mosquitos from those with “sweet blood.” Other uses for increased thiamine include treatment of stress and muscle tensions, diarrhea, fever and infections, cramps, and headaches.

Deficiency and toxicity: There is no known toxicity in humans from thiamine taken orally.
People have taken hundreds of milligrams daily without any harmful effect, although some may become more stimulated than others. Thiamine injections, however, have occasionally been associated with trauma or edema.

Prolonged restriction of thiamine intake may produce a wide variety of symptoms, particularly affecting the general disposition, nervous system, gastrointestinal tract, and heart. With thiamine deficiency, as with deficiency of most any essential nutrient,
symptoms range from mild to moderate depletion disorders to the serious disease state that RDA amounts usually prevent.

Beriberi is the name given to the disease caused by thiamine deficiency. There are three basic expressions of beriberi, namely childhood, wet, and dry beriberi. Childhood beriberi stunts the growth process, and in infants high-pitched scream and rapid heartbeat are associated with the disease. Wet beriberi is the classic form with edema (swelling) in the feet and legs, spreading to the body, and associated decreased function of the heart. Dry beriberi is not accompanied by swelling but seems to be manifested by weight loss, muscle wasting, and nerve degeneration. Another thiamine deficiency disease involves degeneration of the brain and affects the general orientation, attitude, and ability to walk. This has been termed the Wernicke-Korsakoff syndrome and is usually seen in people who have been addicted to alcohol for many years.

These severe problems can and do lead to death when they are not corrected with dietary change or supplemental thiamine. Before vitamin B1 was discovered, this affected many people who ate a diet consisting mainly of polished rice. Today, deficiency of this vitamin is still quite common. Although it does not usually lead to beriberi, a number of symptoms can result from a depletion of thiamine body levels. A low-B1 diet consisting of polished rice or unenriched white flour is not often the culprit in our culture. The diet that contributes to deficiency today, especially among teenagers, is high in colas, sweets, fast foods, and many other empty-calorie foods. This diet can also lead to skin problems and symptoms of neurosis, almost like a Jekyll-and-Hyde disposition.

With a deficiency of thiamine, carbohydrate digestion and the metabolism of glucose are diminished. There is a build-up of pyruvic acid in the blood, which can lead to decreased oxygen utilization and therefore mental deficiency and even difficulty in breathing. While B1 is needed for alcohol metabolism, alcohol abuse is often associated with a poor diet and poor B1 absorption. The poor perceptions, mental states, and nerve problems that come with alcoholism may be associated with thiamine deficiency.

The first symptoms of thiamine deficiency may be fatigue, instability. These may be followed by confusion, loss of memory, depression, clumsiness, insomnia, gastrointestinal disturbances, abdominal pain, constipation, slow heart rate, and burning
chest pains. As the condition progresses, there may be problems of irregular heart rhythm, prickling sensation in the legs, loss of vibratory sensation, and the muscles may become tender and atrophy. The optic nerve may become inflamed and the vision will be affected.

Generally, with low B1 the central nervous system–the brain and nerves–does not function optimally. The gastrointestinal and cardiovascular systems are also influenced greatly. Vitamin B1 levels have been shown to be low in many elderly people, especially those that experience senility, neuroses, and schizophrenia. We might question how much of the degeneration and disease of old age may be a result of withering digestion and assimilation, leading to deficiencies of various vitamins and other necessary nutrients.

Requirements: The RDA for vitamin B1 is about 1.2 mg. per day, or 1.4 mg. during
pregnancy or lactation. Infants need more per body weight though less in total, about 0.5 mg. per day. Thiamine needs are based on many factors; given good health, we need about 0.5 mg. per 1,000 calories consumed, since B1 is required for energy metabolism. So our needs are based on body weight, calorie consumption, and the amount of vitamin B1 synthesized by intestinal bacteria, which can vary greatly from person to person.

Thiamine needs are also increased with higher stress levels, with fever or diarrhea, and during and after surgery. Those who smoke, drink alcohol, consume caffeine or tannin from coffee or tea, or who are pregnant, lactating, or taking birth control pills all need more thiamine, possibly much more than the RDA, for optimum health.

Thiamine is needed in the diet or in supplements daily. There are some stores in the heart, liver, and kidneys; however, these do not last very long. The minimum B1 intake for those who are very healthy is at least 2 mg. per day. A good insurance level of thiamine is probably 10 mg. a day, though even higher levels may be useful in some situations. When we do not eat optimally, have any abusive substance habits (especially alcohol abuse), or are under stress, increased levels of thiamine are recommended. An example is the B complex 50 products–that is, 50 mg. of B1 along with that amount of most of the other B
vitamins–suggested as a daily regimen. The upper intake levels of thiamine should not be much more than 200-300 mg. daily. Often B1, B2 (riboflavin), and B6 (pyridoxine) are formulated together in equal amounts within a B-complex supplement. When people take higher amounts of the B vitamins, many feel a difference in energy and vitality. (Note: Riboflavin taken for any length of time is best limited to 50 mg. daily.)

Pyridoxine is absorbed readily from the small intestine and used throughout the body in a multitude of functions. Fasting and reducing diets usually deplete the vitamin B6 supply unless it is supplemented. Usually within eight hours, much of the excess is excreted through the urine; some B6 is stored in muscle. It is also produced by the intestinal bacteria.

Sources: Vitamin B6 in its several forms is widely available in nature, though not many
foods have very high amounts. Since it is lost in cooking and in the refining or processing of foods, it is not the easiest B vitamin to obtain in sufficient amounts from the diet, especially if we eat much processed food, as it is not one of the vitamins replaced in
“enriched” flour products such as cereals and pastries.

The best sources of vitamin B6 are meats, particularly organ meats, such as liver, and the whole grains, especially wheat. Wheat germ is one of the richest sources. Besides meat, good protein sources of B6 include fish, poultry, egg yolk, soybeans and other dried beans, peanuts, and walnuts. Vegetable and fruit sources include bananas, prunes, potatoes, cauliflower, cabbage, and avocados. As examples of how easily vitamin B6 is lost in the processing of food, raw sugar cane has a good amount, while refined sugar has none; whole wheat flour contains nearly 0.5 mg. of pyridoxine (wheat germ and wheat flakes have much more), while refined wheat flour has almost none, and even whole wheat bread has lost nearly all of its vitamin B6.

Functions: Pyridoxine and its coenzyme form, pyridoxal-5-phosphate, have a wide
variety of metabolic functions in the body, especially in amino acid metabolism and in the central nervous system, where it supports production of gamma-aminobutyric acid (GABA). Many reactions, including the conversion of tryptophan to niacin and arachidonic acid to prostaglandin E2 require vitamin B6. The pyridoxal group is important in the utilization of all food sources for energy and in facilitating the release of glycogen (stored energy) from the liver and muscles. It helps as well in antibody and red blood cell production (hemoglobin synthesis) and in the synthesis and functioning of both DNA and RNA. By helping maintain the balance of sodium and potassium in the body, vitamin B6 aids fluid balance regulation and the electrical functioning of the nerves, heart, and musculoskeletal system; B6 is needed to help maintain a normal intracellular magnesium level, which is also important for these functions. The neurotransmitters norepinephrine and acetylcholine and the allergy regulator histamine are all very important body chemicals that depend on pyridoxal-5-phosphate in their metabolism. Also, the brain needs it to convert tryptophan to serotonin, another important antidepressant neurotransmitter.

Pyridoxine is especially important in regard to protein metabolism. Many amino acid reactions depend on vitamin B6 to help in the transport of amino acids across the intestinal mucosa into the blood and from the blood into cells. By itself and with other enzymes,
pyridoxal-5-phosphate helps build amino acids, break them down, and change one to another and is especially related to the production and metabolism of choline, methionine, serine, cysteine, tryptophan, and niacin.

The body has a high requirement for vitamin B6 during pregnancy. It is important for maintaining hormonal and fluid balance of the mother and for the developing nervous system of the baby. Pyridoxine may somehow be related to the development and health of
the myelin covering of the nerves, which allows them to conduct impulses properly.

Uses: With its many functions, there is also a wide range of clinical uses of vitamin B6,
clearly being most helpful when symptoms and diseases are related to a pyridoxine/pyridoxal-5-phosphate depletion or deficiency. Recently there has been widespread use of higher doses of B6, usually from 50-200 mg. per day (though some studies use 500 mg. per day of pyridoxine in time-release form) for premenstrual symptoms, especially water retention, which can lead to breast soreness and emotional tension. Pyridoxine has been very helpful in this role, probably because of its diuretic effect through its influence on sodium-potassium balance and its mysterious influence on the hormonal system. Vitamin B6 also helps with the acne that often develops premenstrually, as well as with dysmenorrhea, or menstrual pain; magnesium is usually used as well in all of these menstrual-related problems. In pregnancy, B6 has been helpful in many women for controlling the nausea and vomiting of morning sickness, which some authorities feel is highly related to vitamin B6 deficiency.

It seems that whenever there are increased levels of estrogen in the body, more B6 is required. This occurs not only in pregnancy but also for women who take birth control pills and those postmenopausal women on estrogen treatment as well. It is likely that some of the emotional symptoms experienced by many women on the pill, such as fatigue, mood swings, depression, and loss of sex drive, may be related to a deficiency of B6 and thereby helped by supplementation.

Vitamin B6 is used for people with stress conditions, fatigue, headaches, nervous disorders, anemia, and low blood sugar or diabetes, and in men for prostatitis, low sex drive, or hair loss. Pyridoxal-5-phosphate (P5P) is occasionally used in formulas or as an individual supplement for certain conditions. As the active coenzyme of pyridoxine, P5P can go more directly into the metabolic cycles and does not have to be converted; thus, it may be more helpful than pyridoxine alone in such problems as fatigue, allergies, viral disease, chemical sensitivities, mental illness, and cancer. Pyridoxine supplementation is also used for a variety of skin problems–dandruff, eczema, dermatitis, and psoriasis. In regard to the nervous system, vitamin B6 has been supportive in cases of epilepsy, Parkinson’s disease, multiple sclerosis, and neuritis. Vitamin B6 therapy, from 100-300 mg. daily for 8-12 weeks, appears to reduce carpal tunnel syndrome and increase the ability to use the hands in most patients.

Pyridoxine is a natural diuretic and is often helpful not only for the previously mentioned premenstrual problems but also in overweight and fluid-retaining people and as an adjunct to blood pressure control. Vitamin B6 (along with magnesium) has received some note in regard to preventing the formation of kidney stones or the recurrence of stones in those who have had them. In his book Nutrition and Vitamin Therapy (Grove Press, 1980), Michael Lesser, M.D., states that in a study reported in 1974 by the Journal of Urology, 10 mg. of vitamin B6 and 300 mg. of magnesium oxide prevented recurrence in about 80 percent of patients with a long history of kidney and urinary tract stone formation. Dr. Lesser also noted that the B6-magnesium combination helps in some hyperactive kids and those with fits or problems of autism. He states that pyridoxine in fairly large doses will stimulate dream activity as well as reduce the potential toxicity of barbiturate drugs, carbon monoxide and some other chemical exposures, and irradiation. Vitamin B6 works best when taken with magnesium, zinc, riboflavin, and brewer’s yeast or the other B vitamins.

Pyridoxine, probably more than the other B vitamins except folic acid, is supportive of healthy immune function. B6 deficiency can produce immune weakness, and B6 treatment may be helpful against infections and cancer. Recent studies have shown that pyridoxine can inhibit the growth of some cancer cells, specifically mice and human melanoma cells. Further research with B6 will likely find an even wider range of uses.

Deficiency and toxicity: There is basically no toxicity with pyridoxine at reasonable daily
dosages, though there has been some recent concern about this. Regular oral intake of 200 mg. and intravenous doses of 200 mg. have shown no side effects. Usually, the toxic doses are much higher, between 2Ð5 grams. Some recent reports in the medical literature show that regular usage of over 2,000 mg. per day, which some women especially have been taking, are correlated with episodes of peripheral neuritis. Although the experience of weakness or tingling of arms or legs has been transient and mostly correctable by decreasing the B6 dosage, this does warrant some concern about excessive use of B6, especially long-term use. Since part of the neuropathy problem comes from the liver’s inability to convert all of the pyridoxine to active P5P, this concern can be lessened by supplementing some of the B6 as pyridoxal-5-phosphate (as I have done in many of my programs), especially when the dose of vitamin B6 exceeds 200 mg. per day. In addition, using increased amounts of magnesium with the higher levels of vitamin B6 will reduce the occurrence of the peripheral neuritis.

Deficiency, as usual, is a bigger concern with vitamin B6, as it is with all the B vitamins. So many functions are performed by pyridoxine that its deficiency affects the whole body. Most of these deficiency symptoms are fairly vague. Muscle weakness, nervousness, irritability, and depression are not uncommon. Many of the symptoms are similar to those of both niacin and riboflavin deficiencies; depression is common in all of them.

Metabolically, pyridoxine deficiency has a dramatic effect on amino acid metabolism, with a decreased synthesis of niacin from
tryptophan, a decrease in neurotransmitter chemicals, and a decrease in hemoglobin production. Fatigue, nervous system symptoms, and anemia are all influenced by deficiency. Further nerve-related problems include paraesthesia, incoordination, confusion, insomnia, hyperactivity, and, more severely, neuritis, electroencephalogram (EEG) changes, and convulsions. Other problems include dermatitis or cracks and sores at the corners of the mouth and eyes and visual disturbances.

There is special concern about deficiency during pregnancy, when vitamin B6 needs are higher, as it may cause water retention and the nausea and vomiting of morning sickness and has been correlated with a higher incidence of common problems of later pregnancy, such as toxemia (preeclampsia, high blood pressure, edema, and hyper-reflexes) and eclampsia (those same symptoms plus seizures). B6 deficiency in later pregnancy can be associated with birthing difficulties. There is also an increased likelihood of diabetic and blood sugar problems in pregnancy when vitamin B6 is deficient.

Overall, vitamin B6 deficiency can cause a variety of nervous symptoms, skin problems, and amino acid/protein metabolic abnormalities. These can lead to the more common expressions–headache, dizziness, inability to concentrate, irritability and epileptic-type activity, labile depression, and weakness. Water retention is common. Nausea, vomiting, and dry skin, especially extensive dandruff and a cracked sore mouth and tongue are also more likely with vitamin B6 deficiency.

Requirements: Vitamin B6 intake, though based on many factors, is determined primarily
by protein intake, because it is so important to protein metabolism. The RDA for adults is a minimum of 2 mg. of B6 per 100 grams of protein consumed. In children, it ranges from 0.6-1.2 mg. per 100 grams of protein.

However, the need for vitamin B6 increases in a variety of situations. During pregnancy and lactation and with birth control pill or estrogen use, higher levels are required. For those who eat a high-sugar or processed-food diet or a high-protein diet, requirements for B6 are greater and deficiencies or depletion are more common. When there is impairment of the digestive system, cardiac failure, or radiation use, or even just the aging process, needs for vitamin B6 are increased.

Drugs that influence needs for B6 are oral contraceptives, isoniazid (for tuberculosis), hydralazine (for high blood pressure), amphetamines, reserpine (for high blood pressure), and some antibiotics. More B6 is utilized with an increased intake of the amino acid methionine. Adequate magnesium in the body is important to the functions of vitamin B6.

A safe, basic intake for vitamin B6 is probably 10-15 mg. per day, though much higher daily amounts are easily tolerated. B6 should also be taken along with other B vitamins to prevent metabolic imbalance. For therapeutic purposes, amounts between 50-100 mg. (this is the quantity pyridoxal-5-phosphate usually comes in) are most common, and up to 200-500 mg. per day in time-release forms is used for some conditions, such as premenstrual problems and depression. With the current questions about neurologic side effects associated with megadoses of vitamin B6, particularly as pyridoxine hydrochloride, I suggest limiting regular daily intake to 500 mg. daily or 1,000 mg. for a short course of treatment, such as one to two weeks; also, take some additional magnesium, 200-300 mg, which may help reduce any neurologic concerns.