Calcium & PMS

Note: The following abstracts are written in extremely technical language and include technical research and case studies. References are provided. For 'user-friendly' informative reading, check out the health topics presented by Dr. Martin and Dr. Davenport. Feel free to contact us for more information or if you have any questions.

Calcium channel blockers for anxiety disorders?

The role of calcium in the etiology of anxiety has been proposed for several decades. Calcium channel blockers profoundly influence calcium metabolism and the transport of calcium. Even though the evidence for the role of calcium remains weak, drugs affecting calcium might be useful in the treatment of anxiety disorders. One of these compounds, verapamil, has been used to treat mood disorders. Calcium channel blockers have also been tried in other indications such as premenstrual syndrome, irritable bowel syndrome, schizophrenia, tardive dyskinesia, and Tourette's syndrome. However, the number of articles on the use of calcium channel blockers in the treatment of anxiety disorders is low. Three reports (two open, one double-blind) described some success in the treatment of panic disorder with verapamil, diltiazem, or nimodipine and one open-label study described unsuccessful treatment of anxiety and phobia with nifedipine in patients with various anxiety disorders. Further double-blind placebo-controlled studies of calcium channel blockers in the treatment of anxiety disorders are warranted to determine a possible role of these compounds in the armamentarium of antianxiety drugs.

Balon-R; Ramesh-C
Ann-Clin-Psychiatry. 1996 Dec; 8(4): 215-20

Calcium-regulating hormones across the menstrual cycle: evidence of a secondary hyperparathyroidism in women with PMS

Calcium metabolism across one menstrual cycle was studied in 12 healthy, premenopausal women. Seven women had documented premenstrual syndrome (PMS), and five were asymptomatic controls. Fasting blood samples were drawn at six points throughout the ovulatory cycle. In both the asymptomatic and the PMS groups, total and ionized calcium declined significantly at midcycle with the increase of estradiol. In the PMS group only, peak midcycle intact PTH was significantly elevated by approximately 30% compared with early follicular levels (49 +/- 25 vs. 37 +/- 22 ng/L, t = 3.79, P = 0.009). In the asymptomatic group, iPTH did not vary during the menstrual cycle. Midcycle iPTH was significantly higher in the PMS group compared with that of the control group (49 +/- 25 vs. 26 +/- 7 ng/L, Wilcoxon Z = 2.28, P = 0.02). Multivariate analysis showed that total and ionized calcium both varied significantly across the menstrual cycle. Significant differences between groups were found for total calcium, 25OHD, and 1,25-(OH)2D. One woman with PMS was treated with oral elemental calcium and cholecalciferol daily for 3 months, with amelioration of her symptoms. Midcycle iPTH and 1,25-(OH)2D declined after repletion of 25OHD. In conclusion, we found that concentrations of total and ionized calcium significantly fluctuate during the menstrual cycle both in symptomatic and in asymptomatic women. We also found that concentrations of iPTH, 25OHD, and 1,25-(OH)2D differed between groups during specific phases of the menstrual cycle. Our data suggest that women with PMS have midcycle elevations of iPTH with a transient, secondary hyperparathyroidism.

Thys-Jacobs-S; Alvir-MJ
J-Clin-Endocrinol-Metab. 1995 Jul; 80(7): 2227-32

Vitamin D and calcium in menstrual migraine

Two premenopausal women with a history of menstrually-related migraines and premenstrual syndrome were treated with a combination of vitamin D and elemental calcium for late luteal phase symptoms. Both cited a major reduction in their headache attacks as well as premenstrual symptomatology within 2 months of therapy. These observations suggest that vitamin D and calcium therapy should be considered in the treatment of migraine headaches.

Headache. 1994 Oct; 34(9): 544-6

Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine and premenstrual syndrome

The anticonvulsive and antihypertensive values of magnesium (Mg) in eclampsia, and its antiarrhythmic applications in a variety of cardiac diseases, have caused Mg to be considered only for parenteral administration by many physicians. In contrast, nutritionists have long recognized Mg as an essential nutrient, because severe deficiencies elicit neuromuscular manifestations similar to those justifying its use in eclampsia. More recently, this element has been used to favorably influence latent tetany with and without thrombotic complications, to delay preterm birth, to influence premenstrual syndrome, and to ameliorate migraine headaches. Most of these disorders exclusively or largely afflict women. The lesions of arteries and heart caused by experimental Mg deficiency have been well documented and may contribute to human cardiovascular disease. Estrogen's enhancement of Mg utilization and uptake by soft tissues and bone may explain resistance of young women to heart disease and osteoporosis, as well as increased prevalence of these diseases when estrogen secretion ceases. However, estrogen-induced shifts of Mg can be deleterious when estrogen levels are high and Mg intake is suboptimal. The resultant lowering of blood Mg can increase the Ca/Mg ratio, thus favoring coagulation. With Ca supplementation in the face of commonly low Mg intake, risk of thrombosis increases.

J-Am-Coll-Nutr. 1993 Aug; 12(4): 442-58

Hormonal and biochemical profiles of premenstrual syndrome. Treatment with essential fatty acids

Women diagnosed as suffering from premenstrual syndrome and symptom free controls were compared on hormonal parameters, glucose tolerance, mineralocorticoids, cholesterols, triglycerides, apolipoprotein (a), magnesium and calcium in the follicular and luteal phases of the menstrual cycle. The effect of treatment with essential fatty acids on the biochemical variables was also evaluated in a randomized, double-blind crossover design. The results showed that the hormonal and biochemical profiles of women with PMS and symptom free controls were markedly similar, except for aldosterone which was lower in the follicular and luteal phases and cholesterol which was higher in the follicular phase in women with PMS. No effects of treatment with essential fatty acids were found for any of the biochemical variables studied.

Cerin-A; Collins-A; Landgren-BM; Eneroth-P
Acta-Obstet-Gynecol-Scand. 1993 Jul; 72(5): 337-43

Dietary calcium and manganese effects on menstrual cycle symptoms

OBJECTIVE: This exploratory study was designed to determine whether dietary calcium and manganese affect menstrual symptoms in healthy women. STUDY DESIGN: Ten women with normal menstrual cycles completed the Menstrual Distress Questionnaire each cycle during a 169-day, live-in metabolic study of calcium and manganese nutrition. Women were assigned in a double-blind, Latin-square manner to each of four 39-day dietary periods: 587 or 1336 mg calcium per day with 1.0 or 5.6 mg manganese per day. Responses were analyzed by repeated-measures analysis of variance. RESULTS: Increasing calcium intake reduced mood, concentration, and behavior symptoms generally (p < or = 0.05), reduced pain during the menstrual phase of the cycle (p = 0.034), and reduced water retention during the premenstrual phase (p = 0.041). In spite of increasing calcium intake, lower dietary manganese increased mood and pain symptoms during the premenstrual phase (p < or = 0.05). CONCLUSION: Dietary calcium and manganese may have a functional role in the manifestation of symptomatology typically associated with menstrual distress.

Penland-JG; Johnson-PE
Am-J-Obstet-Gynecol. 1993 May; 168(5): 1417-23

Premenstrual and menstrual symptom clusters and response to calcium treatment

Fourteen perimenstrual symptoms were rated daily by 33 women in a randomized, double-blind, crossover trial of calcium supplementation. Factor analysis was performed on these symptoms using 2,413 daily ratings during the luteal and menstrual phases with at least one symptom present. Four factors (negative affect, water retention, food, and pain) accounting for 67 percent of the total variance were extracted. Internal consistency was high for scales based on these factors. Correlations between the scores ranged from .35 to .69. Scores were low during the intermenstrual phase and much higher during both luteal and menstrual phases. Paired t-tests comparing the intermenstrual phase with both luteal and menstrual phases all resulted in significant differences at p less than .01. There was more pain reported during the menstrual compared with the luteal phase (p less than .01). Calcium supplementation reduced negative affect (p = .045), water retention (p = .003), and pain (p = .036) during the luteal phase and pain (p = .02) during the menstrual phase.

Alvir-JM; Thys-Jacobs-S
Psychopharmacol-Bull. 1991; 27(2): 145-8

Calcium supplementation in premenstrual syndrome: a randomized crossover trial

OBJECTIVE: To determine the efficacy of calcium supplementation in women with premenstrual syndrome (PMS). DESIGN: Randomized, double-blind crossover trial. SETTING: Outpatient medical clinic of a large city hospital. PARTICIPANTS: Seventy-eight women were initially screened. Trial selection was based on a history of recurrent PMS symptoms and on the results of a prospective assessment of daily symptom scores. Only women with symptom scores during the late luteal phase that were at least 50% greater than those during the intermenstrual phase were selected. Thirty-three women completed the trial. INTERVENTION: A preliminary evaluation included physical examination, routine laboratory tests, dietary assessment, and psychiatric evaluation. Each participant received six months of treatment involving three months of daily calcium supplementation (1,000 mg of calcium carbonate) and three months of placebo. MEASUREMENTS: Efficacy was assessed prospectively by changes in daily symptom scores over a six-month period and retrospectively by an overall global assessment. Multivariate repeated measures analysis of variance on symptom ratings derived from daily PMS symptom scores demonstrated a reduction in symptoms on calcium treatment during both the luteal (p = 0.011) and the menstrual phases (p = 0.032) of the reproductive cycle. Calcium supplementation had no effect during the intermenstrual phase. Retrospective assessment of overall symptoms confirmed this reduction: 73% of the women reported fewer symptoms during the treatment phase on calcium, 15% preferred placebo, and 12% had no clear preference. Three premenstrual factors (negative affect [p = 0.045]; water retention [p = 0.003]; pain [p = 0.036]) and one menstrual factor (pain [p = 0.02]) were significantly alleviated by calcium. CONCLUSION: Calcium supplementation is a simple and effective treatment for premenstrual syndrome, but further studies will be needed to determine its precise role in PMS.

Thys-Jacobs-S; Ceccarelli-S; Bierman-A; Weisman-H; Cohen-MA; Alvir-J
J-Gen-Intern-Med. 1989 May-Jun; 4(3): 183-9

Normocalcemic tetany and candidiasis

We have observed a high frequency of chronic Candida albicans infection and of allergic sensitization to candida among patients with normocalcemic latent tetany (LT). Among 50 LT patients, 34% suffered from recurrent or chronic candida infection by history, 24% showed evidence of active infection and 48% demonstrated type I hypersensitivity to C. albicans extract on intradermal testing. Treatment with oral antifungal drugs and allergy desensitization to Candida produced complete relief of symptoms in 44% of the patients, with remission occurring for symptoms of depression, irritable bowel syndrome, fatigue, premenstrual tension, headache, anxiety and back pain. The complex relationship between candidiasis and Mg deficit is discussed. Patients with LT, refractory symptoms and a history of prolonged antibiotic exposure or recurrent candida infection should be considered for oral antifungal therapy and candida desensitization.

Magnesium. 1985; 4(5-6): 339-44

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