Sep. 20. 2019
McKel Hill Kooienga, MS, RDN, LDN

McKel Hill Kooienga, MS, RDN, LDN

Founder of Nutrition Stripped and the Mindful Nutrition Method™

We’ve all heard of PMS, but what about PMDD? The weeks leading up to your period can be particularly challenging.

Changes in mood, energy and food preferences can make day-to-day activities feel much harder than usual. But how do we know what’s considered “normal” and when to seek support from a health practitioner?

Today we’re shedding a light on PMDD — what it is, when to ask for help and how your diet can impact your symptoms. If you or someone you know is experiencing particularly difficult period symptoms or has been diagnosed with PMDD, keep reading to find out exactly what is going on and what you should do.


When we really strip it down, PMDD is essentially characterized by an exceptionally uncomfortable, frustrating week leading up to your period. The symptoms may also last a few days into your period as well. After hearing this, you may think to yourself — oh, that’s me! I get intense cramps, mood swings and some pretty crazy cravings the weeks prior to my period, that must mean I have PMDD? Not exactly.

PMDD is much more severe than PMS, plus it isn’t nearly as common. About 20-40% of women experience typical PMS symptoms ranging from mild to severe. On the other hand, only 3-8% of women experience symptoms so severe that they prevent them from functioning regularly in their day-to-day lives – this is PMDD (1).

What is PMDD?

PMDD stands for Premenstrual Dysphoric Disorder. This disorder causes severe, debilitating symptoms in women of childbearing age similar to those that we commonly associate with PMS.

In addition to the mere severity of the symptoms, in contrast to PMS, PMDD symptoms frequently require medical intervention and are usually mood altering as well (2).

PMDD Symptoms

Common PMDD symptoms include:

  • Depressed mood
  • Feeling hopelessness
  • Self-deprecating thoughts
  • Anxiety
  • Tension
  • Feeling on edge
  • Difficulty concentrating
  • Feeling overwhelmed or out of control.
  • Loss of interest in usual activities
  • Lack of energy
  • Changes in appetite or food cravings
  • Changes in sleep
  • Breast tenderness and swelling
  • Bloating (3)

How Do I Know If I Have PMDD?

So if you think your premenstrual symptoms are pretty severe, how do you know if it’s actually PMDD?

First and foremost, schedule an appointment with your doctor. Talk to them about your symptoms and walk them through what you are experiencing. More often than not they will require you to maintain some sort of journal of your symptoms moving forward.

At least 5 symptoms must generally be present in order to warrant a PMDD diagnosis. Additionally, at least one of those symptoms must be mood-related. The mood symptoms are essentially what differentiates PMDD from PMS (4).

How Did I Get PMDD?

Currently, there is no definitive answer to this question, additional research is presently being conducted.

At this point in time, the PMDD diagnosis has been associated with genetic factors, central nervous system sensitivity to reproductive hormones and stress. The abnormal reactions to regular hormonal changes pertain specifically to estrogen and progesterone. In turn, these abnormal reactions can lead to decreased serotonin levels (5).

Serotonin is a neurotransmitter that’s responsible for a multitude of different functions in the body. One of those functions is to contribute to mood. Because of this, low levels of serotonin are associated with depressive symptoms.

PMDD And Diet

The food you eat is what your body uses to build, repair, fuel and energize your body. When a particular disease state is present, we can optimize certain food groups and incorporate specific items that have been clinically associated with minimizing symptoms to promote a healthy lifestyle.

Serotonin And Diet

SSRIs (selective serotonin reuptake inhibitors) are currently referred to as the “gold standard” treatment for PMDD. SSRIs are a type of medication that essentially increase the amount of serotonin in the brain by preventing its reabsorption elsewhere (6).

While medication is more often than not the primary treatment for PMDD, diet changes can also impact your serotonin levels to improve your quality of life after a PMDD diagnosis.


Just as we discussed above, when it comes to PMDD symptoms, serotonin levels are particularly important. Protein is made up of amino acids, 20 amino acids to be exact. While all of these amino acids are important for health, there is one in particular that is required for adequate serotonin production – tryptophan.

Some amino acids are nonessential, meaning the body is able to make them all on its own. Unfortunately, tryptophan is not in this group. In order for the body to get tryptophan and subsequently synthesize serotonin, it must be obtained through the diet (7). This is where protein comes in!

By consuming protein sources that are high in tryptophan (salmon, nuts, seeds, poultry, eggs, and soy), you can ensure your body is supplied with ample amounts of tryptophan.


In order for tryptophan to be utilized in this scenario, it needs to reach the brain. This is where carbohydrates come in.

Ok, let’s use a visual here. Picture two pieces of land separated by a river. The tryptophan is on one piece of land, and the brain is the other piece of land on the opposite side of the river.

Next to tryptophan are some of the other amino acids, and they greatly outnumber tryptophan. The problem is that there is only one boat that the amino acids can use to pass through the river to get to the brain. Unfortunately, the other amino acids are selfish, so they nearly fill up the boat that crosses the river and only let one measly little tryptophan get in the boat (not nearly enough to build the serotonin we need).

In comes to the carbohydrates. The carbohydrates arrive with a bigger boat (how about a ferry?) that offers to take all of the other amino acids down the river to even “better” pieces of land (the liver, heart and other major organs).

The other amino acids take the offer and tryptophan stays behind. Now tryptophan can fill the entire boat to the other side of the river, allowing for ample tryptophan to reach the brain. Still with me?

Essentially, carbohydrates play a key role in serotonin production. In order for the tryptophan we’ve consumed to actually reach the brain and help with the production of serotonin, we need carbohydrates as well (8).


Turmeric is widely known for its anti-inflammatory properties. The primary active ingredients within turmeric are called curcuminoids, with curcumin predominantly stealing the show.

Curcumin essentially has the ability to modulate the release of serotonin and has been shown to increase brain levels of serotonin when combined with various antidepressant agents (9). With SSRIs being the primary intervention method for PMDD, this is particularly positive news.

One of my favorite ways to incorporate turmeric is through turmeric milk! It’s easy to make and a great way to wind down at the end of a long day. You can also add turmeric to dishes as a spice, we have a great recipe for turmeric mashed potatoes that goes great with almost anything.


While not as widely known as turmeric, saffron too has been tied to higher serotonin levels in the brain. Research has shown that saffron (otherwise known as Crocus sativus L.) may amplify the effects of SSRIs, which therefore results in a longer presence of serotonin in the brain. This increased presence of serotonin can enhance its effects and combat depressive symptoms (10).

Saffron is a great spice to add to salads and sauces whenever you can. Our Apricot Quinoa Salad, Herb Falafel And Vegan Tzatziki and Cherry Cardamom Bircher Muesili are some awesome recipes to try if you’re looking to use more saffron!

Physical Symptoms And Diet

Just like PMS, PMDD also has some physical symptoms that can be quite frustrating. By decreasing the frequency of certain food items in your diet, you may be able to lessen your symptoms and increase your quality of life during the weeks leading up to your period.

Processed Carbohydrates

Processed carbohydrates can cause irregularities in blood sugar such as extreme spikes or drops. These fluctuations may exacerbate symptoms such as fatigue, mood swings, and cravings. Opt for complex carbohydrates instead, such as whole grains, fruits, vegetables, and legumes. Also, be sure to pair your carbohydrates with a lean protein or healthy fat, this will help to slow down digestion and prevent blood sugar fluctuations even more.

High Sodium

Fluid retention and bloating are associated with excessive sodium intake. During the weeks leading up to your period, decreasing sodium intake can help reduce bloating and even breast tenderness.

An easy way to reduce sodium levels in your diet is to reduce the number of packaged goods you consume. Most packaged products have added sodium to retain freshness and extend the shelf life of the product. The more you stick to whole food items, the less concerned you have to be with excessive sodium intake.


I would love to hear from you – Do you have PMDD? Have you made changes to your diet that have helped? Whatever your opinion, let us know! Chances are you aren’t the only one reading this with some personal experience, I’m sure there are other women out there who would love to hear what you have to say.

As always, you can also connect with us on Instagram via #nutritionstripped, #nswellnesscoaching, @nutritionstripped@nutritionstrippederica.