2.

pounds red or green Swiss chard, thinly sliced Salt Ground black pepper

In a large nonstick skillet over high heat, warm the oil. Add the garlic and cook, stirring constantly 1 to 2 minutes. Add the Swiss chard and sprinkle with salt and pepper. Cook 4 to 5 minutes, until the Swiss chard is soft and reduced by half in volume. Serve immediately.

PER SERVING.

106 calories, 4 g protein, 9 g carbohydrate, 7 g fat (1 g saturated), 0 mg cholesterol, 483 mg sodium, 4 g fiber; plus 185 mg magnesium (46% DV), 0.21 mg riboflavin (19% DV) HOT SPICED TEA.

Delicious and low-calorie, this hot beverage treat delivers a shot of riboflavin, thanks to the fat-free milk!

Makes 2 servings

2.

cups water

1.

1 piece of fresh ginger, sliced

1.

small cinnamon stick

4.

green cardamom pods, crushed

1.

cup fat-free milk

2.

decaffeinated Earl Grey or English Breakfast tea bags

1.

tablespoon brown sugar

In a small saucepan, combine the water, ginger, cinnamon, and cardamom pods. Bring to a boil. Add the milk, reduce the heat, and simmer 5 minutes. Remove from the heat and add the tea bags. Steep for 3 to 4 minutes. Strain through a sieve or coffee filter. Add the brown sugar. Serve immediately, or chill and serve over ice.

PER SERVING.

62 calories, 4 g protein, 11 g carbohydrate, 0 g fat, 0 mg cholesterol, 60 mg sodium, 0 g fiber; plus .257 mg riboflavin (23% DV)

CHAPTER 15.

PREMENSTRUAL SYNDROME.

Many years ago, I had a client come to see me specifically to address her little problem with premenstrual syndrome (PMS). For about one week of the month, just before she got her period, Mich.e.l.le would descend into a nightmare when she turned into what she called her "serial-killer self." During that time, she was p.r.o.ne to wildly changing and unpredictable moods, mostly rage with occasional bouts of weeping. She would cry at the soft look a father and his son exchanged on a fast food commercial...scream at the cabbie who dared to stop at a yellow light when she was in a hurry...fume or cry at the office over things that normally rolled off her back...and, just once, she took her car, stomped on the accelerator and rammed into the back of a car belonging to an ex-boyfriend's current lover. She hadn't dated the guy in over a year. It ended up costing her a small fortune in car repair bills, not to mention the increase in her premiums.

For Mich.e.l.le, every month followed a predictable pattern: one week of being totally out of control, followed by two weeks spent begging forgiveness and writing letters of apology to all the people she hurt or offended the previous week. By the time she came to see me, she was desperate.

FAQSThere are lots of herbal "cures" for PMS...do they help?

There's no doubt about it: herbal remedies come in and out of fashion just like hemlines. You may have heard that black cohosh, wild yam root, dong quai, and evening primrose oil can help relieve your symptoms. The only problem is there's no scientific evidence that shows any of them relieve PMS symptoms. Not only are they ineffective, some of them can be downright dangerous for some women so I cannot recommend any of them. St. John's wort and SAMe (S-adenosylmethionine) may be beneficial, but they are too potent to take without a doctor's guidance. If you want to try them, talk with your physician. (More information about St. John's wort and SAMe can be found on Chapter 13.)

PMS is estimated to affect about 40 percent of American women of childbearing age. Between 3 and 9 percent of women have a more extreme form of PMS called premenstrual dysphoric disorder premenstrual dysphoric disorder (PMDD). PMS and PMDD cause physical and emotional symptoms-including irritability, sadness, mood swings, low self-esteem, difficulty concentrating, bloating, water retention, lack of energy, and breast tenderness-for some portion of each month, triggered by the normal hormonal changes a.s.sociated with the menstrual cycle. PMDD, the form of the disorder Mich.e.l.le probably had (although she hadn't had a formal diagnosis when I knew her) is casually defined as PMS that is so severe that it negatively affects a woman's life. PMS feels uncomfortable and unpleasant, but PMDD can turn social lives, work lives, families, and marriages upside-down. In fact, I can remember a married couple-close friends-having a drag-out fight after the woman's husband asked a pharmacist working at a local drugstore for "Motrin with extra b.i.t.c.h control." (PMDD). PMS and PMDD cause physical and emotional symptoms-including irritability, sadness, mood swings, low self-esteem, difficulty concentrating, bloating, water retention, lack of energy, and breast tenderness-for some portion of each month, triggered by the normal hormonal changes a.s.sociated with the menstrual cycle. PMDD, the form of the disorder Mich.e.l.le probably had (although she hadn't had a formal diagnosis when I knew her) is casually defined as PMS that is so severe that it negatively affects a woman's life. PMS feels uncomfortable and unpleasant, but PMDD can turn social lives, work lives, families, and marriages upside-down. In fact, I can remember a married couple-close friends-having a drag-out fight after the woman's husband asked a pharmacist working at a local drugstore for "Motrin with extra b.i.t.c.h control."

Regardless of whether you experience a little extra moodiness near your period, or car-crashing emotional breakdowns, nutrition can help alleviate many premenstrual symptoms. I worked with Mich.e.l.le to level out her moods, and we had great results. Once she felt that she was able to make it through a month without potentially litigious behavior, we decided that she might benefit from talking with a therapist. I haven't heard from Mich.e.l.le in a long while, but the last time I saw her, she was calm, happy, and-in a testament to her self-control-still in possession of her driver's license. My fighting friends...well, they are a whole other story.

WHAT AFFECTS PMS?.

No one knows exactly why some women experience symptoms while others do not. The main theory is that some women have a greater sensitivity to the effects of the female hormones estrogen and progesterone, and to the effects of these hormones on serotonin. Research and clinical results seem to confirm that serotonin plays an important role-when women with the most severe premenstrual symptoms are treated with a serotonin-enhancing antidepressant (similar to Prozac), about 70 percent get substantial relief.

What we do know is that for many women, PMS is an uncomfortable fact of life. The exact severity and cl.u.s.ter of symptoms will differ from woman to woman. Some will have fatigue, bloating, and depression...others will have breast tenderness and irritability, or any combination of any of the symptoms. Most typically, symptoms begin the week before a woman is due to get her period, peak the day before the start of her period, and then disappear within a day after her period starts. The vast majority of women with PMS have symptoms for five to seven days each month. But some women can have symptoms that last two, or even three, weeks each month.

If you are a woman of childbearing age experiencing mood issues, I recommend keeping a PMS diary. On a regular calendar, write down your primary moods, emotions, and unusual physical symptoms each day. On the same calendar, keep track of your menstrual cycle. If your troubling moods or other symptoms occur primarily within the two weeks prior to the start of your period, you may have PMS (in addition to all the regular aggravations of life). However, if the days you experience irritability or depression are evenly s.p.a.ced throughout the month, you may not have PMS, but a simple mood problem.

It is important to note all your physical symptoms in your PMS diary. For reasons that aren't exactly clear, many the symptoms of many diseases or disorders get worse premenstrually, a phenomenon known as premenstrual exacerbation premenstrual exacerbation. Depression and anxiety are p.r.o.ne to this exacerbation, as are migraines, epilepsy, asthma, allergies, diabetes, irritable bowel syndrome, and many autoimmune disorders. Just because your symptoms aren't generally included in a list of the symptoms of PMS doesn't mean that they aren't related to your menstrual cycle. If your worst symptoms seem to occur the week before your period, talk with your doctor about whether there are things you can do to better control your particular disorder.

HOW FOOD AFFECTS PMS.

Many women with PMS define their monthly nutrition needs in terms of their cravings for anything salty or chocolate. Although indulging in chocolate-dipped pretzels might seem like a fantasy-come-true, they won't improve your mood or reduce the bloat. There are many better options: CALCIUM.

Calcium deficiency and PMS share many symptoms, which led researchers to test to see if they might be related. The results suggest that they very well might be. Compared with women who don't have premenstrual symptoms, women with PMS have lower blood levels of calcium around their time of ovulation. And when PMS sufferers take 1,000 to 1,200 milligrams of calcium supplements daily, their mood and bloating improve after just a few months. I consider calcium-rich foods an absolute must for women with PMS.

BEST FOODS FOR CALCIUM: Yogurt (fat-free, low-fat), milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, calcium-fortified fruit juice, cheese (fat-free, low-fat), tofu with calcium, canned sardines (with bones), wild salmon (with bones, fresh), soybeans, frozen yogurt (fat-free, low-fat), low-fat ice cream, calcium-fortified whole grain waffles, bok choy, kale, white beans, broccoli, almonds Yogurt (fat-free, low-fat), milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, calcium-fortified fruit juice, cheese (fat-free, low-fat), tofu with calcium, canned sardines (with bones), wild salmon (with bones, fresh), soybeans, frozen yogurt (fat-free, low-fat), low-fat ice cream, calcium-fortified whole grain waffles, bok choy, kale, white beans, broccoli, almonds VITAMIN D.

Our bodies can't absorb or use calcium without vitamin D. That's why the two are so often mentioned together, and why some high-calcium foods (such as milk) are often fortified with vitamin D. In addition, research suggests that vitamin D may act on its own to prevent PMS. In a study that followed more than 3,000 women for more than 10 years, women who ate a diet high in vitamin D reduced their risk of PMS by about 40 percent.

BEST FOODS FOR VITAMIN D: Wild salmon (with bones), mackerel (not king), sardines (with bones), herring, fortified milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, egg yolks, mushrooms (especially shiitake), vitamin D-fortified soft tub trans fat-free margarine spread, fortified whole grain breakfast cereal Wild salmon (with bones), mackerel (not king), sardines (with bones), herring, fortified milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, egg yolks, mushrooms (especially shiitake), vitamin D-fortified soft tub trans fat-free margarine spread, fortified whole grain breakfast cereal MAGNESIUM.

Just as was found with calcium, women with PMS seem to have lower blood levels of magnesium compared with women who did not have PMS symptoms. Women with PMS who took magnesium supplements had better mood and less water retention than women who did not get enough magnesium. (And really, doesn't less water retention sound good for everybody?) It is thought that magnesium might help regulate the activity of serotonin, the so-called feel-good neurotransmitter. Magnesium-rich foods are second only to calcium foods for improving your chances for symptom reduction.

BEST FOODS FOR MAGNESIUM: Pumpkin seeds, spinach, Swiss chard, amaranth, sunflower seeds, cashews, almonds, quinoa, tempeh, sweet potatoes, white potatoes, soybeans, millet, beans (black, white, navy, lima, pinto, kidney), artichoke hearts, peanuts, peanut b.u.t.ter, chickpeas (garbanzo beans), brown rice, whole grain bread, sesame seeds, wheat germ, flaxseed Pumpkin seeds, spinach, Swiss chard, amaranth, sunflower seeds, cashews, almonds, quinoa, tempeh, sweet potatoes, white potatoes, soybeans, millet, beans (black, white, navy, lima, pinto, kidney), artichoke hearts, peanuts, peanut b.u.t.ter, chickpeas (garbanzo beans), brown rice, whole grain bread, sesame seeds, wheat germ, flaxseed VITAMIN B6.

Your body can't make dopamine-one of the mood neurotransmitters-without vitamin B6. Research studies into the effects of vitamin B6 on PMS have been mixed-some show that taking supplements reduces irritability, depression, and breast tenderness, while others don't find any effect at all. Still, I highly recommend eating vitamin B on PMS have been mixed-some show that taking supplements reduces irritability, depression, and breast tenderness, while others don't find any effect at all. Still, I highly recommend eating vitamin B6-rich foods because they seem to have helped many of my clients with PMS.

BEST FOODS FOR VITAMIN B6: Fortified whole grain breakfast cereal, chickpeas (garbanzo beans), wild salmon (fresh, canned), lean beef, pork tenderloin, chicken breast, white potatoes (with skin), oatmeal, banana, pistachio nuts, lentils, tomato paste, barley, rice (brown, wild), peppers, sweet potatoes, squash (winter, acorn), broccoli, broccoli raab, carrots, Brussels sprouts, peanut b.u.t.ter, eggs, shrimp, tofu, apricots, watermelon, avocado, strawberries, whole grain bread Fortified whole grain breakfast cereal, chickpeas (garbanzo beans), wild salmon (fresh, canned), lean beef, pork tenderloin, chicken breast, white potatoes (with skin), oatmeal, banana, pistachio nuts, lentils, tomato paste, barley, rice (brown, wild), peppers, sweet potatoes, squash (winter, acorn), broccoli, broccoli raab, carrots, Brussels sprouts, peanut b.u.t.ter, eggs, shrimp, tofu, apricots, watermelon, avocado, strawberries, whole grain bread MANGANESE.

Manganese is found in minute quant.i.ties in foods, but that's OK because we don't need a lot to stay healthy. If you eat a relatively balanced diet, you're probably getting enough manganese. But blood levels of manganese vary throughout the menstrual cycle, so it is not surprising that this mineral might be involved in PMS. A handful of studies have suggested that manganese, in combination with calcium, may reduce the irritability, depression, and tension a.s.sociated with PMS. One study found that women who did not get enough manganese in their diets had more pain and worse moods premenstrually. Therefore, I encourage you to go out of your way to incorporate manganese-rich foods, specifically around the time of PMS.

BEST FOODS FOR MANGANESE: Pineapple, wheat germ, spinach, collard greens, pecans, amaranth, lima beans, pumpkin seeds, walnuts, oats, tempeh, quinoa, brown rice, flaxseed, raspberries, chickpeas (garbanzo beans), sunflower seeds, peanuts, tofu, soybeans, soy nuts, lentils Pineapple, wheat germ, spinach, collard greens, pecans, amaranth, lima beans, pumpkin seeds, walnuts, oats, tempeh, quinoa, brown rice, flaxseed, raspberries, chickpeas (garbanzo beans), sunflower seeds, peanuts, tofu, soybeans, soy nuts, lentils OTHER FOOD FIXES.

- Avoid salt and salty foods. PMS causes bloating and water retention. Salt can cause bloating and water retention. Ergo, salt can make those problems of PMS worse. PMS causes bloating and water retention. Salt can cause bloating and water retention. Ergo, salt can make those problems of PMS worse.

- Avoid alcohol. Premenstrually, alcohol can cause increased breast tenderness. Also, alcohol can lower blood sugar, which may make typical PMS mood symptoms worse. If you cannot totally avoid alcohol premenstrually, at least try not to drink to excess. Premenstrually, alcohol can cause increased breast tenderness. Also, alcohol can lower blood sugar, which may make typical PMS mood symptoms worse. If you cannot totally avoid alcohol premenstrually, at least try not to drink to excess.

- Avoid caffeine. Some research suggests that the effects of caffeine are magnified premenstrually, leading to greater breast tenderness, more nervousness, and potentially more irritability. Instead of coffee, tea, or caffeinated soft drinks, try herbal teas and other decaffeinated beverages. Some research suggests that the effects of caffeine are magnified premenstrually, leading to greater breast tenderness, more nervousness, and potentially more irritability. Instead of coffee, tea, or caffeinated soft drinks, try herbal teas and other decaffeinated beverages.

MAGNESIUM-RICH AMARANTHAlthough amaranth (p.r.o.nounced AM-uh-ranth AM-uh-ranth) is touted as a "super grain," it is actually not a grain at all. It is a plant related to the common garden weed called pigweed. Its leaves cook and taste much like spinach, but amaranth is mostly prized for its abundance of tiny, high-protein seeds, or grains grains. The whole seeds, when simmered, produce a thick, oatmeal-like porridge that has a gelatinous texture (translation: it's not for everyone!). To make amaranth more appetizing, mix it with a grain such as brown rice or buckwheat (amaranth should make up no more than 15 percent of the total mixture), then follow the cooking instructions for the predominant grain. Amaranth can be found in many natural food stores and some supermarkets alongside rice, barley, and other grains. Sticker shock alert! Because harvesting amaranth is labor intensive, it is relatively expensive.Cooking amaranth: Simmer 1 cups liquid (such as broth, apple juice, or water) and cup amaranth seeds for about 30 minutes, or until the seeds are tender. Add fresh herbs or gingerroot to the cooking liquid to make it tastier, or mix with beans for a main dish. For a breakfast cereal, increase the amount of cooking liquid and sweeten with a bit of honey or brown rice syrup, and add 1 to 2 tablespoons raisins, dried cranberries, allspice, and/or nuts. Simmer 1 cups liquid (such as broth, apple juice, or water) and cup amaranth seeds for about 30 minutes, or until the seeds are tender. Add fresh herbs or gingerroot to the cooking liquid to make it tastier, or mix with beans for a main dish. For a breakfast cereal, increase the amount of cooking liquid and sweeten with a bit of honey or brown rice syrup, and add 1 to 2 tablespoons raisins, dried cranberries, allspice, and/or nuts.

- Drink chamomile tea. Premenstrually, chamomile tea may be particularly helpful because it contains properties that relieve muscle spasms, and may therefore help reduce the severity of menstrual cramps. In addition, chamomile seems to reduce tension that may lead to anxiety and irritability. Premenstrually, chamomile tea may be particularly helpful because it contains properties that relieve muscle spasms, and may therefore help reduce the severity of menstrual cramps. In addition, chamomile seems to reduce tension that may lead to anxiety and irritability.

BONUS POINTS.

- Read the chapter about mood. All the good-mood advice about getting appropriate amount of exercise, eating regularly throughout the day, getting the right mix of proteins and high-quality carbohydrates, and decreasing stress apply to PMS as well. All the good-mood advice about getting appropriate amount of exercise, eating regularly throughout the day, getting the right mix of proteins and high-quality carbohydrates, and decreasing stress apply to PMS as well.

- Get enough sleep. Hormonal shifts can make some women lose sleep, which in turn may make them irritable. It is generally important to get enough sleep to level out moods. Premenstrually, sleep becomes crucial. Many women even feel the need to nap during the premenstrual week-if you can manage a quick few minutes of sleep in the middle of the day, indulge. It may make the difference between a good day, and a day of snapping and tears. Hormonal shifts can make some women lose sleep, which in turn may make them irritable. It is generally important to get enough sleep to level out moods. Premenstrually, sleep becomes crucial. Many women even feel the need to nap during the premenstrual week-if you can manage a quick few minutes of sleep in the middle of the day, indulge. It may make the difference between a good day, and a day of snapping and tears.

SUPPLEMENTS.

If you experience PMS and want to consider supplements in addition to in addition to the food fixes, I recommend: the food fixes, I recommend: 1. Multivitamin. In order to a.s.sure that you get all the nutrients important for mood and physical symptoms of PMS, look for a multivitamin that contains 100% DV of vitamin D (400 IU), 100% DV manganese (2 milligrams), at least 20% DV of magnesium (80 milligrams or more), and 100% DV of B In order to a.s.sure that you get all the nutrients important for mood and physical symptoms of PMS, look for a multivitamin that contains 100% DV of vitamin D (400 IU), 100% DV manganese (2 milligrams), at least 20% DV of magnesium (80 milligrams or more), and 100% DV of B6, all of which may help improve mood and reduce bloating. (The vitamin D is necessary to help the body absorb calcium.) 2. Calcium plus vitamin D3 and magnesium. and magnesium. Most women need calcium supplements, regardless of whether or not they have PMS. That's why I recommend taking calcium supplements-500 to 600 milligrams two times a day (with food if it's in the form of calcium carbonate), for a total of 1,000 to 1,200 milligrams. The calcium supplements should also provide vitamin D Most women need calcium supplements, regardless of whether or not they have PMS. That's why I recommend taking calcium supplements-500 to 600 milligrams two times a day (with food if it's in the form of calcium carbonate), for a total of 1,000 to 1,200 milligrams. The calcium supplements should also provide vitamin D3 (cholecalciferol, the most potent form of vitamin D) and magnesium. This should be taken (cholecalciferol, the most potent form of vitamin D) and magnesium. This should be taken in addition to in addition to a multivitamin that includes vitamin D and magnesium. a multivitamin that includes vitamin D and magnesium.

3. Vitamin B6. The studies of this vitamin have been mixed, with about half showing no benefit at all. Although I can't give it my unadulterated endors.e.m.e.nt, women with The studies of this vitamin have been mixed, with about half showing no benefit at all. Although I can't give it my unadulterated endors.e.m.e.nt, women with severe severe PMS symptoms may want to consider taking a separate supplement of 50 to 100 milligrams of vitamin B PMS symptoms may want to consider taking a separate supplement of 50 to 100 milligrams of vitamin B6 daily. daily. Important note: Important note: Taking amounts in excess of 100 milligrams per day may cause permanent nerve damage in hands, arms, feet, and legs. Take no more than 100 milligrams daily. Taking amounts in excess of 100 milligrams per day may cause permanent nerve damage in hands, arms, feet, and legs. Take no more than 100 milligrams daily.

4. Chasteberry extract. If the food and nutritional supplements aren't enough to calm your premenstrual symptoms, scientists have found that chasteberry extract may also help. Typical dosage is a 20 milligram tablet, one to two times a day. This extract has been shown to relieve mood swings, irritability, anger, headache, and breast tenderness in about half the women who took it for three months. Scientists believe that the actions of chasteberry are due to flavonoids and other phytochemicals that seem to relieve anxiety and reduce inflammation. If the food and nutritional supplements aren't enough to calm your premenstrual symptoms, scientists have found that chasteberry extract may also help. Typical dosage is a 20 milligram tablet, one to two times a day. This extract has been shown to relieve mood swings, irritability, anger, headache, and breast tenderness in about half the women who took it for three months. Scientists believe that the actions of chasteberry are due to flavonoids and other phytochemicals that seem to relieve anxiety and reduce inflammation. Important note: Important note: If you experience headache, gastrointestinal distress, or rash while taking chasteberry extract, discontinue using it. Chasteberry lowers prolactin levels, so it should not be used by women who are pregnant or nursing. Because of possible interactions, do not use chasteberry if you are also taking drugs or hormones that affect the pituitary, such as bromocriptine. If you experience headache, gastrointestinal distress, or rash while taking chasteberry extract, discontinue using it. Chasteberry lowers prolactin levels, so it should not be used by women who are pregnant or nursing. Because of possible interactions, do not use chasteberry if you are also taking drugs or hormones that affect the pituitary, such as bromocriptine.